An analysis of the MDGs so far -- what's going right and wrong

As part of their work, the authors of The Lancet-LIDC Commission produced an analysis of each MDG. These analyses form a Web Appendix to the Commission.

By providing indicators for progress and developing improved data systems and sets for target 1A, MDG1 has made an important contribution to improving the availability of information and knowledge about poverty and to raising the international and national political profile of poverty in developing countries. It has also focused donors' and governments' attention on poverty reduction and human development.

But the authors add: "However, MDG1 has in some ways proven weak as a target because, in contrast to other MDGs, it has no indicators concerned with service access or with policy interventions with significant direct outcomes. While it has outcome targets, its indicators (incidence of extreme poverty, poverty gap ratio, consumption share of the poorest quintile) do not implicitly or explicitly identify an action or policy change that would generate the outcome, nor do they indicate who should deliver what resources for what changes in services. This precluded the use of results-based management approaches dominant in many other MDGs."

In developing countries the net enrolment ratio (NER) increased from 83% in 2000 to 88% in 2007. This increase can also be seen by region, by urban/rural residence, and by gender. For example, the NER in sub-Saharan Africa increased from 58% in 2000 to 74% in 2007; and in Southern Asia from 79% to 90% over the same period.

However, the authors caution that NERs can be affected by overage children enrolling and dropping out soon after. And the generally positive global trend in NER masks considerable variation between and within countries. In the sub-Saharan Africa region, Eritrea, Liberia, and Niger report NERs of less than 50% in 2007, while Madagascar, Mauritius, Uganda, and Tanzania report NERs of 95% or more.

Furthermore, the authors add that MDG2's target failed to place appropriate focus on learning, concluding: "If future education goals are to serve the interests of the poor, they must be formulated in relation to changing economic rewards of different levels of education and to the learning levels expected of those different levels. Primary education is a human right and meaningful post-primary education depends on completion of high quality primary education. But policies for education designed to reduce poverty must include and go beyond the primary level."

Among other factors related to MDG3, the authors note that fulfillment of the target on gender parity in primary and secondary education was set for 2005, earlier than that set for all the other MDGs, because it was believed that this would indicate increasing access of women to education and that this was a lynchpin and precondition for the achievement of all the other MDGs. This proved to be a poisoned chalice. The date was far too early for the MDG message to have been internalised by governments and civil society, and took little account of the resources that would be required and the poor understanding of the range of local issues that kept children out of school.

The authors say: "The very substantial resources estimated to be required for achieving MDG3 did not materialise. This has led to suggestions that more focused initiatives in gender mainstreaming or gender budgeting may be more feasible."

While noting that, on the positive side, aid organisations have used MDG3 to give prominence to gender in their programmes, the authors conclude: "Overall, the limited implementation of MDG3 would seem to be associated with a lack of leadership, particularly in the women's rights area, where relevant civil society organisations were not involved in its development, and in limited ownership by governments, in contrast to aid organisations."

Statistics from developing countries indicate that, globally, the mortality rate per 100,000 live births for children under five has declined from 103 in 1990 to 65 in 2008 . This progress is much slower than what is needed for the world to achieve MDG4 by 2015. The Countdown to 2015 initiative has been charged with monitoring progress in 68 high priority countries. Of those 68 countries, only 16 have been judged to be 'on track' to achieve MDG4, while a further 26 were judged to be making some progress but insufficient to achieve MDG4. Only one sub-Saharan African country, Eritrea, is said to be on track, yet a close examination of that country raises serious concerns about the degree of mortality under-reporting, especially of neonatal mortality, as the lowest socioeconomic quintile reports lower mortality rates than two wealthier quintiles. Indeed, close examination of other countries said to be on track raises concerns about data quality. China reports unlikely dramatic declines in child mortality, including a 48% decline in mortality in just 5 years between 2002 and 2007. Murray and colleagues conducted a detailed analysis of the period before and after the MDGs were launched and concluded that the impact on child mortality has been minimal

The authors add: "There are a number of major problems with the structure, implementation, and evaluation of MDG4. Data on child mortality in the poorest countries is notoriously poor, especially for neonatal mortality, which appears to be systematically underestimated in many areas. There is a natural tendency for repeated application of different child survival interventions to increase inequity. The lack of reference to inequity, and weak monitoring of trends in inequity, are major problems with MDG4. Finally the growing proximity of the deadline for MDG4 is likely to see the application of increasingly short-term strategies, many of which may not be sustainable."

With its emphasis on the Maternal Mortality Ration (MMR) rather than the rate or number of deaths, MDG5's initial formulation limited the visible contribution that family planning could make by reducing unwanted pregnancy and unsafe abortion.

The authors say: "MDG5 is widely held up as the most unsuccessful MDG to date. Between 1990 and 2005, when the latest UN figures were estimated, global MMR decreased from 430 deaths per 100 000 live births in 1990 to 400 in 2005. This is a total reduction of 7% (roughly 0•4% per year, well short of the 5•5% annual reduction required to achieve the global target)."

The authors cite the conflict with MDG4 across the continuum of care between maternal, neonatal, and child health, as a factor undermining MDG5. They say: "Efforts to break down institutional silos and territoriality between agencies that own these different issues have not always been successful and, as a result, synergies are not realised and competition for resources arises. Investment in community workers to increase child survival may, for instance, compete with investment in expanding skilled birth attendance. The Countdown to 2015 initiative which tracks progress towards MDGs 4 and 5 is a notable exception."

The authors note that the incidence of HIV probably peaked before 2000, malaria morbidity and mortality (although harder to measure) are currently on the decline, and TB incidence has also reached its peak. They say: "Whatever the challenges of implementation, the contribution to reducing mortality and morbidity has been very impressive. It is not possible to determine the precise contribution of MDG6 to this progress through increasing funding and focusing effort."

The authors add: "A principal issue facing MDG6 is its sustainability. The diseases targeted are all capable of overcoming control measures if not applied consistently and constantly improved. Only in this way can development of resistance to medicines or vector control measures be addressed."

The authors note that it is likely that the global target on access to drinking water will be met or exceeded. If current trends continue, by 2015 86% of the population in developing regions will have gained access to improved sources of drinking water. Most progress has been made in rural areas, where substantial problems with access, particularly in sub-Saharan Africa, remain. Sanitation has historically received comparatively less attention from governments than water, and this target is unlikely to be met globally.

For targets 7A and 7B, the news is not so good. UN MDG progress reports tend to present general data on environmental trends, assessed by different studies over varying timescales. All trends show a decline in recent years in forests, fisheries, biodiversity, and water—all natural resources where MDG7 has targeted reduction or reversal in loss. The target to reduce the rate of biodiversity loss by 2010 has not been met and, if anything, biodiversity loss is accelerating. Over the same period, greenhouse gas emissions have continued to rise. MDG7 reports can, however, celebrate the successful reduction by 97% of the consumption of substances that deplete the Earth's ozone layer, towards which 175 country signatories of the Montreal Protocol contributed in a process that predates the MDGs.

MDG8 is exceptional among the MDGs as it primarily concerns actions to be taken by rich countries. Assessing its implementation is problematic because MDG8 operates at the global rather than the national level, includes loosely defined and diverse targets, and involves multiple actors, including rich countries, International Financial Institutions (IFIs), and the private sector.

The authors say: "MDG8 was designed to create an enabling environment to benefit the advance of the other more specific MDGs. However, it has been largely ineffectual at achieving this and its own targets since its beginnings. Already in 2003 its progress was deemed to be "extremely slow". Its prospects are now worsening because of the impact of the economic crisis. Today total aid remains far below the UN's target of 0•7 % of gross national income, with only five countries reaching this benchmark. The collapse of the Doha trade round has also undermined the likelihood of significantly better market access for developing countries."

For more information and to request an interview with Professor Jeff Waage – the lead author of the Commission – contact Guy Collender T) +44 (0) 20 7958 8260 / +44 (0) 7813 708 283 E) guy.collender@lidc.bloomsbury.ac.uk

For full Web Appendix see: http://press.thelancet.com/mdgwa.pdf