"All human beings are born free and equal in dignity and rights"
First published 7th May 2011
The Millennium Development Goals (MDGs) have shaped the international response to health inequalities across the globe for the last ten years, and are unprecedented in terms of their international ratification and the effect they have had in directing the work of global health in terms of both projects and funding. Having reached the ten-year milestone since the adoption of the MDGs attention has now begun to focus on what should replace them in 2015. This has stemmed from the recent United Nations Summit reporting on a decade of the MDGs (United Nations, 2010). Other discussions have been concerned with their successes and failures as well as looking to their replacements post-2015. There is much controversy about their content, and the conversation is beginning to turn towards to how the global community will decide what should replace them. What should they contain? And is the UN the appropriate body to make this kind of decision?
This is a brief report from the facilitators of a workshop at the recent Medsin-UK Global Health Conference concerning the future of the MDGs. The purpose of the workshop was to establish the opinion of young professionals, who plan to be working in global health or related fields when the current MDGs expire, as to what should replace the MDGs in 2015. The workshop involved 20 participants, including medical students, students of other disciplines and qualified healthcare professionals. The group was facilitated by Jonnie Currie (immediate past-President of Medsin) and Tim Crocker-Buque (Medsin Trustee and junior doctor). A presentation was delivered regarding the history of the MDGs, from inception to the recent UN Summit. Three questions were posed to the participants and the conclusions of the group are outlined below.
1. Should there be new targets, and if so what form should they take?
There was consensus amongst the group that the current MDGs have been important aspirational targets and that some form of target system should remain. The group noted that the nature of current targets might have skewed work and funding towards specific diseases, and any replacements should take a broader approach. Targets should be used as a baseline and that these should be built on by local communities and organisations focused towards specific population needs. Any new targets should bring a stronger focus on broader issues, such as non-communicable diseases, water and sanitation, health systems, economics and trade for example. New targets should include incentives to both actively tackle diseases, but also take a preventative approach to disease. The group agreed that a core framework, including central principles should be created on a global level, but that it would be more appropriate to develop specific targets on a more regional scale. There was a suggestion that stronger accountability structures should be put into place, although there was recognition that this may be challenging. It was agreed that the United Nations was an appropriate authority to build international consensus, however in developing new targets a ‘bottom-up’ approach would be valuable to better address the needs of populations who receive development assistance and international aid funding. There was also discussion around the fact that the funding streams for MDG work are deeply complex and wasteful. These problems should be addressed through strong global health governance. The group strongly agreed that ultimate outcomes should be measured in relation to population health, even if any targets set are not specific health interventions.
2. Whose responsibility should is it to monitor progress towards any new targets?
The group agreed that the United Nations provides the most appropriate forum to build international consensus and monitor progress towards any new targets, due to both its unique position and its successes with the current set of MDGs. It was noted however that there was limited scope to monitor progression towards the targets on a regional or national level, and there may be significant value in improving local accountability systems. In any future system there should be a shared responsibility towards reaching any MDG replacements, from local community and NGO to governmental and international levels. A bottom-up approach to setting and meeting targets accompanied by a top-down system for developing a core framework, as well as monitoring progress and accountability, would be most effective. Any global governance structure must ensure that progress towards any future goals is not skewed by national political interests, and should purely serve the goal of improving population health.
3. How can civil society in the global North and South engage to drive progress in meeting these goals?
There was consensus that in any new framework there must be stronger arrangements for setting up true partnerships between civil society organisations, governments, communities and universities in order to share experience and expertise. These partnerships must be equal, with exchange of ideas and resources in both directions. Partnerships should involve exchange of information as well as human and financial resources. The power of public pressure to ensure progress towards targets was discussed, and a new framework should have the empowerment of communities and civil society at its heart. The group noted that the current MDGs have some public awareness, but not enough to ensure that the public holds governments to account in countries where this is most needed. There is a risk however that this kind of approach may leave the door open to vocal special interest groups to hijack target setting or MDG work. The group agreed that this must be avoided by having a core framework to guide local target setting, as well as solid accountability structures to ensure that local target setting is in the best interest of the population as a whole.
In light of this we would like to welcome the recent paper by Waage et al (2010) published in the Lancet discussing the principles for goal setting post 2015, the conclusions of which broadly match those of the group. Of the options presented in Sumner’s 2009 paper on the future of development policy post-2015 the group supported the third option: that a core set of principles should be decided on an international level combined with locally defined targets is the most appropriate structure for any MDG replacements, and that the principles described in Waage et al’s paper are an excellent starting point.
These are very preliminary ideas as discussed by a small but dedicated group of individuals, and more work is required in this area. However the workshop group agreed it would be of great value to involve future global health professionals in the dialogue and debate regarding MDG replacements, in order to provide invaluable experience as well as create a sense of ownership for the next generation of advocates. In light of these conclusions we would like to announce the founding of the MDG15 Young Professionals Forum to produce and evidence-based consensus on the future of the MDGs. The Forum will take a collaborative multidisciplinary approach, involving students and young professionals from the sciences, medicine and humanities, with the key principle of engaging individuals and groups from both the global north and global south. Current students and junior professionals are likely to be the ones who see the work of any MDG replacement through to their conclusion, and inclusion in the process would provide invaluable experience as well as creating a sense of ownership for the next generation of advocates. We would like to highlight this to the IFMSA and encourage other NMOs to get in touch if they feel they would like to be part of the MDG15-YPF project.