EN

(...PICT...)|EUROPEAN COMMISSION|

Brussels, 21.4.2010

SEC(2010) 418 final

COMMISSION STAFF WORKING DOCUMENT

Progress made on the Millennium Development Goals and key challenges for the road ahead accompanying the COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS A twelve-point EU action plan in support of the Millennium Development Goals

{COM(2010) 159} {SEC(2010) 419} {SEC(2010) 420} {SEC(2010) 421} {SEC(2010) 422}

TABLE OF CONTENTS

CHAPTER ONE: The Millennnium Development Goals (MDGs): what progress has been made? 4

1.1 What the MDGs are… and what they are not …? 4

1.2 What progress has been made on the MDGs? 5

a) Some significant progress, but insufficient and highly uneven 5

b) A focus on fragile countries 7

1.3 The impact of the financial/economic crisis on developing countries 8

a) Impact on economic development 8

b) A fragile recovery 9

c) Impact on social development 10

CHAPTER TWO: Lessons to be learnt from EU support for the MDGs 12

2.1 MDGs: some general lessons 12

a) Economic growth is essential for progress on the MDGs, so the global economic context is critical. 12

b) But economic growth is not sufficient to ensure sustainable progress on the MDGs 13

c) Ownership and sound domestic policies are crucial to success 13

d) Improving the quality of donor development policies is also important 13

e) Good governance and democracy are important to MDG progress 13

f) Increased emphasis on equity and social justice is linked to MDG progress 14

h) ODA is crucial to foster MDG progress 14

2.2 The EU’s role in promoting the MDGs 14

a) The MDGs at the centre of EU development policy 14

b) EU stories of good practice in support of the MDGs 15

CHAPTER THREE: Key challenges to ensuring MDG progress by 2015 28

3.1 Challenge No 1: Tackling the continued effects of the economic and financial crisis 29

3.2 Challenge No 2: Fostering MDG ownership in developing partners 29

3.3 Challenge No 3: Unleashing the potential of the private sector for human development 30

3.4 Challenge No 4: Focusing on the most off-track goals and countries 31

3.5 Challenge No 5: Addressing fragility 31

3.6 Challenge No 6: Increasing emphasis on equity and social justice 33

3.7 Challenge No 7: Climate change and environmental stress 33

3.8 Challenge No 8: Demographic growth 34

3.9 Challenge No 9: Improved access to energy 34

ANNEX A 36

ANNEX B 49

CHAPTER ONE: The Millennium Development Goals (MDGs): what progress has been made?

1.1 What the MDGs are… and what they are not …?

The Millennium Development Goals (MDGs) constitute the first ever set of shared development goals at international level, on which there is an unprecedented level of consensus. This unique, relatively simple, and wide-ranging framework of goals, targets and indicators has become a rallying point to combat world poverty in its different dimensions.

The MDGs constitute a set of eight goals, 18 quantifiable and time-bound targets and 48 indicators to be achieved (mostly) by 2015. Goals 1 to 7 address different dimensions of poverty, such as hunger, disease, lack of education and inadequate access to clean water and sanitation. Goal 8 sets out the global responsibility of the international community to support the achievement of the other goals, particularly in the areas of aid, debt, trade and access to information and communication technologies and essential drugs In 2007, the MDG monitoring framework was revised to include four new targets for employment and decent work, reproductive health, access to HIV/AIDS treatment and loss of biodiversity, agreed by member states at the 2005 World Summit and recommended, in 2006, by the UN Secretary-General in his report on the work of the organisation. The current framework therefore comprises eight goals, 21 targets and 60 indicators (see Annex). .[1]

In 2007, the MDG monitoring framework was revised to include four new targets for employment and decent work, reproductive health, access to HIV/AIDS treatment and loss of biodiversity, agreed by member states at the 2005 World Summit and recommended, in 2006, by the UN Secretary-General in his report on the work of the organisation. The current framework therefore comprises eight goals, 21 targets and 60 indicators (see Annex).

The MDGs should not be perceived as a disparate set of sectoral targets and indicators, however. They are interdependent and are mutually reinforcing. Inequalities in child mortality (MDG 4), for example, reflect the depth of poverty children experience as well as unequal access to nutrition (MDG 1). The MDGs should be integrated within comprehensive and coherent development strategies, as both economic and social development is needed to foster sustainable MDG progress. There is no dichotomy in this regard. Investment in infrastructure such as roads and energy facilities and a sound business environment are crucial to sustainable development and effective health and education systems.

Assessing the impact of the MDG framework in changing behaviours, policies and resource allocation and in improving development outcomes is very complex, not only because of lack of research and evaluation but also because of the multiplicity of factors and interactions influencing development processes over time. However, there is a largely shared consensus that the MDGs have played an essential political role in galvanising international effort and mobilising support for development, particularly after the dramatic decline in aid and slow rates of development experienced in many countries during the 1990s Francois Bourguignon et al. (2008) in the EU research paper ‘Millennium Development Goals at Midpoint: Where do we stand and where do we need to go?’ http://ec.europa.eu/development/icenter/repository/2008.11.06%20MDG_long_paper_en.pdf .[2]

Francois Bourguignon et al. (2008) in the EU research paper ‘Millennium Development Goals at Midpoint: Where do we stand and where do we need to go?’ http://ec.europa.eu/development/icenter/repository/2008.11.06%20MDG_long_paper_en.pdf

At country level, the MDGs have provided a general framework allowing developing countries to plan their social, economic and environmental development and monitor/track progress over time, sometimes on the basis of targets and indicators specifically adapted to reflect their local reality. They have also had a positive influence on data collection and helped donors to focus on results. The MDGs have proven to be an effective advocacy and communication tool for political decision makers and civil society actors to raise the profile and generate commitments and pledges for development. Richard Manning, ‘Using indicators to encourage development: lessons from the Millennium Development Goals’, DIIS Report 2009:01. http://www.diis.dk/graphics/Publications/Reports2009/DIIS_Report_20091_Using_indicators_to_encouragedevelopment.pdf[3]

Richard Manning, ‘Using indicators to encourage development: lessons from the Millennium Development Goals’, DIIS Report 2009:01. http://www.diis.dk/graphics/Publications/Reports2009/DIIS_Report_20091_Using_indicators_to_encouragedevelopment.pdf

At the same time, the ‘limits’ of the MDG framework should be considered. The MDGs do not provide recipes or prescriptions for how to foster development progress. Nor do they capture and reflect exhaustively all the different, and sometimes very context-specific, dimensions of development and poverty. The MDGs constitute a benchmark of global goals that have to be adapted at regional and country level.

1.2 What progress has been made on the MDGs A more detailed table highlighting progression each goal and target is annexed. ?[4]

A more detailed table highlighting progression each goal and target is annexed.

a) Some significant progress, but insufficient and highly uneven

Over the last two decades, the world has made strong and sustained progress in reducing extreme poverty as well as on other goals such as universal primary education, gender equality in primary education, and access to water.

Some encouraging progress…

- The overarching MDG goal of halving extreme poverty by 2015 is still within reach on the basis of current projections. Worldwide, extreme poverty decreased, in terms of people affected, from 1.8 billion to 1.4 billion between 1990 and 2005, though there are strong regional disparities.

- Enrolment in primary education reached 88 per cent in 2007, up from 83 per cent in 2000. Major breakthroughs have been achieved in sub-Saharan Africa, where enrolment increased by 15 percentage points from 2000 to 2007, and Southern Asia, which gained 11 percentage points over the same period.

- Deaths among children under five have declined steadily worldwide, to 8.8million in 2008, down from 12.6 million in 1990, despite population growth. In 2008, the global under-five mortality rate was 65 deaths per 1 000 live births, down from 93 in 1990.

- Coverage rates for insecticide-treated bed nets to counter malaria have tripled since 2000. Globally, deaths from measles fell by over 60 % between 2000 and 2005, with striking gains in Africa, where measles deaths decreased by nearly 75 % over the same period — from an estimated 506 000 to 126 000.

- 87 % of the global population now have improved sources of drinking water , compared to 77 % in 1990 World Health Organisation and United Nations Children’s Fund (2008) Joint Monitoring Programme: Progress on Drinking Water and Sanitation: Special Focus on Sanitation. WHO: Geneva. http://www.who.int/water_sanitation_health/monitoring/jmp2008/en/index.html . C urrent trends suggest that more than 90 % of the global population will be using improved drinking water sources by 2015.[5]

World Health Organisation and United Nations Children’s Fund (2008) Joint Monitoring Programme: Progress on Drinking Water and Sanitation: Special Focus on Sanitation. WHO: Geneva. http://www.who.int/water_sanitation_health/monitoring/jmp2008/en/index.html

However, recent analyses and reports from the UN and the World Bank UN MDG Report 2009, http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf ; World Bank Global Monitoring Report 2009, www.worldbank.org/gmr 2009 . , together with the EU’s own analysis, show that progress has been highly uneven among regions, countries and population groups, and that we are still off-track at global level on several targets such as maternal mortality, child mortality and access to sanitation. Sub-Saharan Africa in particular is off-track on all MDG targets.[6]

UN MDG Report 2009, http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf ; World Bank Global Monitoring Report 2009, www.worldbank.org/gmr 2009 .

…But progress is insufficient and uneven so far

- In 2009, the number of chronically hungry persons topped the 1 billion mark, while at least another 2 billion are undernourished. South Asia has the highest rates of malnutrition. One third of the world’s 150 million malnourished children live in India.

- Large gaps still remain in access to education and completion rates , with significant inequalities based on gender , ethnicity, income, language or disabilities. 72 million children of primary school age were not in school in 2007. Seven out of ten such children out of school live in sub-Saharan Africa or South and West Asia.

- There has been little improvement in maternal mortality since 1990, with still 450 deaths per 100 000 live births in developing regions in 2005. Together, sub-Saharan Africa and Southern Asia account for 85 % of all maternal deaths.

- Despite the overall decrease in the number of new infections, the total number of people living with HIV worldwide continues to grow (which is partly due to increased survival because of increased coverage with anti-retroviral treatment) . The number of people living with HIV globally now stands at 33.4 million. Sub-Saharan Africa remains the worst affected region, accounting for 71 % of all new HIV infections in 2008. In sub-Saharan Africa, women outnumber men 3 to 1 among 15-24 year olds with HIV.

- Between 1990 and 2006, the proportion of people without improved sanitation decreased by only 8 % World Health Organisation and United Nations Children’s Fund (2008) Joint Monitoring Programme: Progress on Drinking Water and Sanitation: Special Focus on Sanitation. WHO: Geneva. . More than 2.5 billion people remain without improved sanitation, and at the current rate of progress the MDG sanitation target will be missed for over 700 million people. The lowest sanitation coverage is found in sub-Saharan Africa, where only 31 % of the population has improved sanitation, up just 5 % since 1990. [7]

World Health Organisation and United Nations Children’s Fund (2008) Joint Monitoring Programme: Progress on Drinking Water and Sanitation: Special Focus on Sanitation. WHO: Geneva.

Some progress has been made over the last years towards fulfilling the global commitments embodied in MDG 8 which sets the Global Partnership for Development . On debt relief for instance, 35 of the 40 countries that were deemed potentially eligible for debt relief under the Highly Indebted Poor Countries (HIPC) Initiative had qualified (decision point) by the end of March 2009. They are expected to receive debt relief of US $57.3 billion as well as US $23.6 billion in additional relief under the Multilateral Debt Relief Initiative (MDRI), both measured in terms of end-2008 values. Overall, for the average developing country, the burden of servicing external debt fell from almost 13 % of export earnings in 2000 to 4 % in 2007 (prior to the financial crisis). Good progress has also been made in the years prior to the crisis regarding the access of the world’s population to information and communication technologies (ICT), especially cellular telephones. During 2007, Africa added over 65 million new mobile subscriptions and mobile penetration had risen to close to one third of the population, from just 1 in 50 people in 2000.

However, the last MDG Gap Task Force Report (2009) shows that the Global Partnership for Development has suffered important setbacks recently, most of which have arisen from the global financial and economic crisis. On the basis of 2008 ODA figures, a n additional US $35 billion would be needed this year to meet the Gleneagles G8 ODA target by 2010, of which an extra US$ 20 billion for Africa alone. Regarding access to medicines, people in developing countries currently pay in average three to six times more than international reference prices for the cheapest generic medicines. On trade, only 80 % of least developed country (LDC) exports have acquired so far duty-free status in industrialized country markets, while the 2005 World Trade Organization (WTO) Hong Kong Ministerial Declaration foresees to allow 97% duty-free access to imports from the poorest countries (except arms and oil).

In the countdown to 2015, urgent responses will therefore be needed to bridge the existing implementation gaps MDG Gap Task Force Report 2009, http://www.un.org/esa/policy/mdggap/ . .[8]

MDG Gap Task Force Report 2009, http://www.un.org/esa/policy/mdggap/ .

b) A focus on fragile countries

Fostering sustainable progress towards the MDGs is particularly challenging in ‘situations of fragility’, where ‘the social contract between the population and state structures has been broken due to the state’s incapacity and/or unwillingness to deal with its basic functions and responsibilities’ See Doc. 15118/07 of 20 November 2007. See also the Commission Communication Towards an EU response to situations of fragility - COM(2007) 643, 25.10.2007. . Many of the world’s poorest countries can be described as ‘fragile’, the majority of them located in sub-Saharan Africa. One third of the world’s poor are living in so-called ‘fragile states’ European Report on Development 2009, ‘Overcoming fragility in Africa — Forging a new European approach’, http://erd.eui.eu/erd-2009 . . Fragile countries also account for one third of maternal deaths worldwide. [9][10]

See Doc. 15118/07 of 20 November 2007. See also the Commission Communication Towards an EU response to situations of fragility - COM(2007) 643, 25.10.2007.

European Report on Development 2009, ‘Overcoming fragility in Africa — Forging a new European approach’, http://erd.eui.eu/erd-2009 .

Overall, fragile countries display poor human development records. Recent analyses show that fragile countries have significantly lower yardsticks for the broad set of MDG targets and indicators in relation to other developing countries. The first European Report on Development (ERD 2009) indicates a strong negative correlation between fragility and MDG performance For a detailed analysis of this issue, see: Harttgen and Klasen, ‘Fragility and MDG Progress: how useful is the fragility concept?’, research paper produced for the ERD 2009, http://erd.eui.eu/publications/erd-2009/background-papers/fragility-and-mdg-progress/ . . Using the CPIA (Country Policy and Institutional Assessment) classification, the last World Bank Global Monitoring Report (2009) also shows clearly that MDG performance has so far been much lower in fragile and conflict-affected countries (see figure below) World Bank Global Monitoring Report 2009. www.worldbank.org/gmr 2009 .[11][12]

For a detailed analysis of this issue, see: Harttgen and Klasen, ‘Fragility and MDG Progress: how useful is the fragility concept?’, research paper produced for the ERD 2009, http://erd.eui.eu/publications/erd-2009/background-papers/fragility-and-mdg-progress/ .

World Bank Global Monitoring Report 2009. www.worldbank.org/gmr 2009

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1.3 The impact of the financial/economic crisis on developing countries

While the immediate impact of the financial crisis is now behind us, its consequences for the real economy of developing countries will be long-lasting, threatening not only the achievement of the MDGs by 2015, but also undermining past progress .

a) Impact on economic development

Virtually all developing countries have been struck by the global financial and economic crisis much harder than expected initially. Although they have been relatively spared from the direct effects of the financial crisis, they have been severely affected as the crisis has spread throughout the highly globalised and inter-connected world economy, mainly through trade and financial market channels .

The specific impact of the crisis, combined with the effects of the previous food and fuel shocks, varies greatly among countries, depending on a combination of factors such as the regional-national context, the economic situation pre-crisis, the degree of vulnerability and resilience to external economic shocks, as well as the action taken in response.

Countries heavily dependent on external finance and with limited economic diversification are those that have been the hardest hit by the crisis. Fragile countries have also been strongly affected, especially because of their lack of resilience, meaning the capacity to cope with and recover from shocks through the design and implementation of appropriate policy responses European Report on Development 2009 p. 6., Overcoming fragility in Africa — Forging a new European approach . http://erd.eui.eu/erd-2009 http://ec.europa.eu/development/icenter/repository/2008.11.06%20MDG_long_paper_en.pdf . [13]

European Report on Development 2009 p. 6., Overcoming fragility in Africa — Forging a new European approach . http://erd.eui.eu/erd-2009 http://ec.europa.eu/development/icenter/repository/2008.11.06%20MDG_long_paper_en.pdf

Since the outbreak of the crisis, Gross Domestic Product (GDP) in developing countries has decelerated sharply, with an average growth rate of only 1.2 % in 2009 (down from 5.6 % in 2008 and 8.1 % in 2007) World Bank, ‘Global Economic Prospects 2010 - Crisis, Finance and Growth’, January 2010. http://siteresources.worldbank.org/INTGEP2010/Resources/GEP2010-Full-Report.pdf . In sub-Saharan Africa in particular, growth fell to 1.1 % in 2009. This is a major setback in comparison with the impressive average growth rates above 5 % experienced since 2000 (e.g. 5.1 % in 2008 and 6.5 % in 2007).[14]

World Bank, ‘Global Economic Prospects 2010 - Crisis, Finance and Growth’, January 2010. http://siteresources.worldbank.org/INTGEP2010/Resources/GEP2010-Full-Report.pdf

Virtually all emerging and developing countries have been deeply affected by reduced trade volumes as well as falling and volatile commodity prices. In Eastern Africa for instance, the World Bank notes a sharp reduction in agricultural earnings due to reduced exports of cotton from Tanzania and a drop of nearly 25 % in the price of coffee in Rwanda World Bank, ‘Protecting Progress: The Challenge Facing Low-Income Countries in the Global recession’, September 2009. .[15]

World Bank, ‘Protecting Progress: The Challenge Facing Low-Income Countries in the Global recession’, September 2009.

Recently, commodity prices have staged a comeback and world trade is beginning to pick up, so some developing countries are well placed to recover in 2010. However, the near-term outlook for commodity prices depends on the timing and strength of the global recovery.

In addition, many developing countries have also been severely affected by decreasing remittances, albeit with notable regional differences . According to the World Bank, remittance flows to developing countries plummeted by 6.1 % in 2009, falling to $ 317 billion from $ 338 billion in 2008. Latest projections foresee a modest recovery in remittance flows in 2010 and 2011, but they are still unlikely to reach the levels of 2008.

Other private capital flows, including Foreign Direct Investment (FDI), have also dropped significantly due to a tightening of liquidity in global financial markets. For Low Income Countries (LICs), private capital flows represent a significant relative share of their national income and investment, and the cutbacks are expected to curtail their growth prospects as well as their ability to meet their huge financing needs The World Bank assesses the total financing needs of all developing countries at around $ 1.2 trillion in 2010. Sub-Saharan Africa’s financing needs represent close to 12 % of GDP (World Bank, GEP 2010). .[16]

The World Bank assesses the total financing needs of all developing countries at around $ 1.2 trillion in 2010. Sub-Saharan Africa’s financing needs represent close to 12 % of GDP (World Bank, GEP 2010).

b) A fragile recovery

Recently, there have been some first signs of mild recovery at global level, due notably to the strong performance of Asian economies and stabilisation or modest recovery elsewhere (including in the US and Western Europe). G lobal growth is expected to expand by 3.9 % in 2010 and 4.3 % in 2011 IMF, ‘World Economic Outlook — Update’, 26 January 2010. . While growth in advanced countries is expected to average 2.1 % in 2010 and 2.4 % in 2011, growth in emerging and developing economies is expected to rise to about 6 % in 2010. According to the latest World Bank estimates, growth in sub-Saharan Africa is projected to rise to 4.3 % in 2010.[17]

IMF, ‘World Economic Outlook — Update’, 26 January 2010.

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The IMF warns however that the global recovery remains very fragile since prospects are very uncertain. In particular, concerns remain about the strength of the financial system and the sustainability of the recovery once fiscal and monetary stimuli are phased out.

The monitoring of trade restrictive measures carried out so far by international bodies such as the World Trade Organization (WTO) or the Organization for Economic Cooperation and Development (OECD) shows that the recourse to trade distorting measures as a response to the economic crisis has been relatively limited. In order to maintain this trend, extreme vigilance will be needed to ensure that protectionist tendencies do not undermine the economic recovery process.

c) Impact on social development

As both internal and external sources of development finance dry up and fiscal situations deteriorate, it is more difficult for developing countries to fund infrastructure and social services. Past experience shows that economic downturns tend to have severe and lagging impacts on poverty, health, education and employment, with sometimes long-term consequences for human capital.

The global economic crisis threatens the past gains already made on the MDGs but the precise magnitude of the impact is still difficult to estimate and will vary from country to country. However, it is reasonable to expect that the social effects of the crisis will be particularly felt in Low Income Countries because of their limited resources to maintain levels of public spending and to respond to needs emerging from the crisis, as well as the absence or weakness of mechanisms to cushion the effects of shocks on ordinary people (such as unemployment benefits or social security arrangements).

Because of the succession of food and financial/economic crises, the pace of poverty reduction has already significantly slowed. The World Bank estimates that the financial and economic crisis could have pushed around 55 million more people into extreme poverty in 2009, and some 64 million people by the end of 2010. This is in addition to the 130-155 million people who were already pushed into poverty in 2008 as a result of the food crisis. The number of poor people is expected to rise in more than half of all developing countries, two-thirds of low-income countries, and three-quarters of sub-Saharan African countries (see figure below) World Bank, Global Monitoring Report 2009. www.worldbank.org/gmr 2009 .[18]

World Bank, Global Monitoring Report 2009. www.worldbank.org/gmr 2009

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The decrease in government revenues may also force many poor countries to cut public resources allocated to social spending, notably on nutrition, health and education. Prospects are particularly grave for child mortality. UNICEF estimates that child malnutrition and infant mortality might increase with between 200 000 and 400 000 additional deaths in 2009. Women, children, the poor, and minority groups are expected to suffer disproportionately from the health impacts of the crisis African Centre for Gender and Social Development (AGCS), ‘African perspectives of the Global Economic and Financial Crisis, including the impact on health’, 2009. . The World Bank’s preliminary findings indicate that social spending has been largely protected so far World Bank Global Monitoring Report 2010, preliminary publicity, March 2010. , and in some countries social safety nets have even been extended (for example in Yemen, Ethiopia, and the Philippines).[19][20]

African Centre for Gender and Social Development (AGCS), ‘African perspectives of the Global Economic and Financial Crisis, including the impact on health’, 2009.

World Bank Global Monitoring Report 2010, preliminary publicity, March 2010.

With regard to unemployment, the number of jobless worldwide reached nearly 212 million in 2009 following an unprecedented increase of 34 million compared to 2007 International Labour Organisation, ‘Global Employment Trends 2010’, January 2010. http://www.ilo.org/wcmsp5/groups/public/---ed_emp/---emp_elm/trends/documents/publication/wcms_120471.pdf . The global unemployment rate for 2009 is estimated at 6.6 %. The global youth unemployment rate reached 13.4% the same year. [21]

International Labour Organisation, ‘Global Employment Trends 2010’, January 2010. http://www.ilo.org/wcmsp5/groups/public/---ed_emp/---emp_elm/trends/documents/publication/wcms_120471.pdf

The ILO also stresses that the number of women and men in vulnerable employment Vulnerable employment is often characterised by inadequate earnings, low productivity and difficult conditions of work that undermine workers’ fundamental rights. is estimated to have increased by as much as 110 million in 2009 compared to 2008. The share of workers in vulnerable employment worldwide is now estimated at over 1.5 billion, equivalent to over half of the world’s labour force. Even more alarmingly, the ILO warns that 633 million workers and their families were living in absolute poverty in 2008, with as many as 215 million additional workers living on the margin and at risk of falling into poverty in 2009.[22]

Vulnerable employment is often characterised by inadequate earnings, low productivity and difficult conditions of work that undermine workers’ fundamental rights.

CHAPTER TWO: Lessons to be learnt from EU support for the MDGs

2.1 MDGs: some general lessons

In order to make progress on the MDGs, it is important to identify and analyse success stories, which policies work and how best those policies can be implemented, using both country-level evidence and specific examples. This helps to identify why certain countries and regions are progressing well on the MDGs while others are stagnating or lagging behind, and what lessons might be drawn in order to design strategies to accelerate progress on the MDGs.

Each situation is context-specific, and there is great variability between countries, regions within countries and between sectors in terms of what works and what does not in making progress towards the MDGs. Extreme caution is therefore needed when trying to identify good practice and successful approaches and in considering scaling up or replicating successful approaches in other contexts.

It must be borne in mind that treating poverty as a multi-dimensional issue emphasises the interrelatedness and mutually reinforcing nature of the individual MDG goals.

Interesting general lessons can be drawn, however, and there are ample illustrations of interventions that have supported country-led progress towards the MDGs.

General lessons with respect to progress towards the MDGs

a) Economic growth is essential for progress on the MDGs, so the global economic context is critical.

The impact that sustained economic growth has on poverty reduction will depend on the level of inequality in a country. For example, India, which has consistently experienced high growth rates, only saw a reduction in poverty from 51 % to 42 % between 1990 and 2005 (and an increase in the absolute numbers living in poverty). Studies have shown that growth can make a major contribution to poverty reduction Dollar and Kraay, 2001, ‘Growth is Good for the Poor’, Policy and Research Working Paper, The World Bank. Kraay, A. (2006), ‘When is Growth Pro-Poor? Evidence from a Panel of Countries’, Journal of Economics 80, 198-227. http://www.sciencedirect.com/science , but changes in income distribution are important too Paul Collier, 2007. ‘The Bottom Billion: Why the Poorest Countries are Failing and what can be done about it’, Oxford University Press. http://www.oup.com/us/catalog/general/subject/Economics/Developmental/?view=usa&ci=9780195311457 . [23][24]

Dollar and Kraay, 2001, ‘Growth is Good for the Poor’, Policy and Research Working Paper, The World Bank. Kraay, A. (2006), ‘When is Growth Pro-Poor? Evidence from a Panel of Countries’, Journal of Economics 80, 198-227. http://www.sciencedirect.com/science

Paul Collier, 2007. ‘The Bottom Billion: Why the Poorest Countries are Failing and what can be done about it’, Oxford University Press. http://www.oup.com/us/catalog/general/subject/Economics/Developmental/?view=usa&ci=9780195311457

The instability of the global economic context, as illustrated by the recent food and fuel crises and the current economic crisis, has been a serious obstacle to progress towards the MDGs. This has highlighted the need to tackle the challenges of reducing vulnerability and enhancing resilience at the level of both countries and individual people.

b) But economic growth is not sufficient to ensure sustainable progress on the MDGs

To achieve the MDGs, countries will need to improve the structure and quality of economic growth as well as make appropriate changes to national development strategies. Countries need to ensure that poor people gain from economic progress and are protected in difficult times. Concrete measures such as social protection help tackle chronic poverty and cushion populations against economic shocks.

c) Ownership and sound domestic policies are crucial to success

It is important to encourage ownership of the MDGs in partner countries. Key domestic factors influencing MDG progress include domestic budget allocation to MDG sectors, the relevance of domestic policies in MDG-related areas, and ‘good governance’ in public financial management and efforts to tackle corruption and promote democracy. It is also important to assist developing countries with the tools they need to mobilise domestic resources effectively, including through promoting the principles of good tax governance. Ensuring leadership by developing countries themselves is important – including by ensuring that the MDGs are incorporated into national development strategies - including specific goals in policy documents such as Poverty Reduction Strategy Papers.

For example, the Comprehensive African Agriculture Development Programme (CAADP) is the African Union’s own programme for addressing MDG 1 on food security. African governments have committed to raising agricultural productivity by 6 % per year by increasing investment in agriculture to 10 %of national budgets. So far, Chad Ethiopia, Madagascar, Mali, Namibia and Niger have met or surpassed the 10 % goal. Kenya, Malawi, Rwanda and Zambia, have already boosted their agriculture budgets significantly in pursuit of the 10 % target. A high level of ownership is seen as critical in CAADP’s relative success.

d) Improving the quality of donor development policies is also important

Development-related policies pursued by all relevant actors are important. This includes both MDG-related sectoral policies and other policies that address issues that inhibit sustainable pro-poor development. Trade, migration, agricultural, environmental, financial and many other EU policies can have an impact on the capacity of developing countries to attain the MDGs. ‘Policy Coherence for Development’ is an important EU approach in this regard See PCD Work Programme 2010-2013 - SEC(2010) 421, 20.4.2010. http://ec.europa.eu/atwork/programmes/docs/execution_report_2009.pdf . [25]

See PCD Work Programme 2010-2013 - SEC(2010) 421, 20.4.2010. http://ec.europa.eu/atwork/programmes/docs/execution_report_2009.pdf

e) Good governance and democracy are important to MDG progress

Poor and disempowered people struggle to meet their basic needs and are the most vulnerable. Increasing the voice of the people through democratic structures holds government to account. Citizen monitoring of MDG progress may engender political commitment and prevent the reversal of MDG gains already achieved.

f) Increased emphasis on equity and social justice is linked to MDG progress

Inequalities in life chances based on income, gender, age, social exclusion and geographic location underpin the distribution of extreme poverty among and between populations. Persistent inequalities also undermine progress on the MDGs — acting as a brake on progress. F. Bourguignon et al. (2008) in the EU research paper ‘Millennium Development Goals at Midpoint: Where do we stand and where do we need to go?’ http://ec.europa.eu/development/icenter/repository/2008.11.06%20MDG_long_paper_en.pdf Addressing gender equality and women's empowerment and marginalised groups by adopting a human rights-based approach to the MDGs also addresses the social and structural barriers to progress on the MDGs. National capacities should be built for disaggregated data collection. Equity-based targets and reporting systems, for example, could strengthen the MDGs on nutrition and child mortality. Civil society actors can play an important role in providing basic services to the most marginalised groups of population and/or in remote areas where governments are either reluctant or unable to operate.[26]

F. Bourguignon et al. (2008) in the EU research paper ‘Millennium Development Goals at Midpoint: Where do we stand and where do we need to go?’ http://ec.europa.eu/development/icenter/repository/2008.11.06%20MDG_long_paper_en.pdf

g) Environmental sustainability needs to be given adequate attention

The depletion of natural capital resulting from unsustainable management of natural resources is in many ways undermining development efforts. Environmental sustainability, including maintenance of ecosystems services which are important for the poor, is crucial for MDG progress. Maintaining healthy ecosystems, resistant to stress, and avoiding non-reversible damage, is necessary for securing economic growth and reaching the MDGs in the face of resource depletion and global environmental challenges.

h) ODA is crucial to foster MDG progress

Aid remains a powerful tool through which the international community can bring about progress on the MDGs by easing budget constraints, building capacities and fostering domestic policy reforms, and by having a ‘leverage’ effect on economic growth. Indeed, development aid is more important than ever, since the financial crisis has reduced other sources such as private capital flows, remittances and export revenues to developing countries. We need not only to increase the volume of aid, but also to increase the quality of aid. EU Member States are committed to delivering 0.7 % of gross national income in Official Development Aid (ODA) by 2015 in support of the MDGs. Global progress also needs to be made in implementing the Paris Declaration and the Accra Agenda for Action (2008) commitments. New binding commitments on aid effectiveness will be discussed at the 4th High Level Forum on Aid Effectiveness in Seoul in 2011.

2.2 The EU’s role in promoting the MDGs

a) The MDGs at the centre of EU development policy

As stated in the European Consensus on Development (2005) The European Consensus on Development, (December 2005), http://ec.europa.eu/development/icenter/repository/eu_consensus_en . , the primary and overarching objective of EU development cooperation is to eradicate poverty in the context of sustainable development, including pursuit of the UN Millennium Development Goals. The EU — as the provider of 60 % of global aid flows — has always shown strong and proactive leadership on sustainable development and the MDGs in international fora. To foster sustainable progress on the MDGs, the EU supports comprehensive development strategies beyond MDG-focused policies, which include democratic governance, human rights protection and the rule of law, pro-poor economic growth, private sector development, trade development, human and social development, and environmental sustainability.[27]

The European Consensus on Development, (December 2005), http://ec.europa.eu/development/icenter/repository/eu_consensus_en .

Recognising the need for more concrete and better coordinated actions to speed up progress towards the MDGs, an EU Agenda for Action on MDGs EU Agenda for Action on the MDGs (June 2008), http://register.consilium.europa.eu/pdf/en/08/st11/st11096.en08.pdf . identified in June 2008 a number of intermediate milestones to be reached by 2010 to meet the MDG targets by 2015, as well as examples of EU actions to reach these targets and the expected outcomes in terms of increased EU aid in the sectors concerned. It builds on and is consistent with the work of the UN Secretary General's MDG Africa Steering Group The MDG Africa Steering Group was convened in September 2007 and brings together the leaders of multilateral development organisations (including the European Commission) to identify the practical steps needed to achieve the Millennium Development Goals and other internationally agreed development goals in Africa. More information: http://www.mdgafrica.org/ . , in which the Commission participates. Since 2009, EU Member States have recorded concerted action in support of the MDGs in the annual Monterrey reporting process.[28][29]

EU Agenda for Action on the MDGs (June 2008), http://register.consilium.europa.eu/pdf/en/08/st11/st11096.en08.pdf .

The MDG Africa Steering Group was convened in September 2007 and brings together the leaders of multilateral development organisations (including the European Commission) to identify the practical steps needed to achieve the Millennium Development Goals and other internationally agreed development goals in Africa. More information: http://www.mdgafrica.org/ .

b) EU stories of good practice in support of the MDGs

What has been the impact of EU development support on MDG progress in developing partner countries? The question is complex, as it is extremely challenging to isolate the effects of external support from other factors, whether domestic or international, which influence development progress.

Sector-specific budget support can help deliver predictable, performance-based results in areas such as health and education. Key criteria to be met by recipient governments for general and sector budget support are commitment to poverty reduction, accountability and positive performance on macroeconomic and financial governance as well as sound sector policy for sector budget support.

The European Commission has adopted an innovative approach to provide budget support with a clear link to MDG outcomes through ‘MDG Contracts’. These ‘Contracts’ provide longer-term (6-year), more predictable commitments of budget support that enable governments to plan their strategies and budgets to achieve the MDGs. In 2009, the Commission launched MDG Contracts in 8 countries (Burkina Faso, Ghana, Mali, Mozambique, Rwanda, Tanzania, Uganda, and Zambia), with total commitments amounting to € 1.8 bn, or 50 % of all general budget support programmed during EDF10.

MDG 1 — Poverty and Hunger

Millions of people are trapped in poverty, most of them in Sub-Saharan Africa and South Asia. Limited education and ill health deprive people of productive livelihoods. Depleted environmental resources, conflict situations and poor governance also deepen poverty. Political will to tackle global hunger and malnutrition is now high In 2009, donors pledged $22 billion over the next three years for agriculture and food security. . Overall, the achievements under this goal are promising though less so on hunger with over 50 countries having made insufficient progress to reach the target by 2015 .[30]

In 2009, donors pledged $22 billion over the next three years for agriculture and food security.

To address poverty and hunger we need increasingly to focus on areas that are harder to reach and on chronic poverty. We know that while sustained per capita income growth will, for example, alleviate malnutrition in Sub-Saharan African, achieving the MDG 1 targets will require not just increasing agricultural production but also complementary measures such as targeted income and food transfers, and targeted measures to protect vulnerable households from floods and drought. Social Protection measures including cash transfer programmes to sustain the poorest and most marginalised families can change the structure of opportunities and help reduce the intergenerational transmission of poverty and inequality. For example, it is estimated that direct cash transfers in Brazil, including social pensions and the Bolsa Familia, accounted for half of the fall in inequality between 1995 and 2007.

The EU and its Member States have largely contributed to the international response to the food crisis. For instance, the launching of the ‘ Food Facility ’ has demonstrated the EU’s ability to react rapidly and substantially to food security problems in developing countries caused by the food price volatility of 2007/08. Thus far, the € 1 billion Food Facility is the most significant additional global contribution to stimulating agricultural development and fighting hunger since the G8 leaders pledged their support to this end in Toyako in July 2008 and l’Aquila in 2009. The Food Facility was approved in December 2008 and began to be implemented in 2009. In the course of the year, the EU committed more than € 830 million and spent more than € 450 million. The Facility operates in 50 target countries and supports projects and programmes implemented by international organisations, NGOs, Member State agencies and national governments. It focuses on three types of actions: (i) measures to improve access to agricultural inputs and services; (ii) safety net measures; and (iii) small-scale measures aiming to increase agricultural production. Research plays an essential role for the attainment of the MDGs. In that regard, the Food, Agriculture, Fisheries and Biotechnology Theme of the 7 th Framework Programme for Research and Development (FP7) has already allocated at least €200 million on MDG related research and plans in 2010 to spend an additional €190 million on 52 topics jointly identified with our Partners in developing countries and emerging economies in the area of food security and of the impact of climate change on agriculture.

Example of EU programme support for food security and livelihood recovery in the Eastern Harrarghe zone of Oromia state in Ethiopia

In the Eastern Harrarghe zone of Oromia state in Ethiopia, the International Committee for the Development of Peoples has been implementing a series of relief, rehabilitation and development programmes through funds secured mainly from the EU . The European Commission ( EC) contribution is € 4 336 243. The EC has also provided 19 113 tonnes of food. The programme is contributing to long-term self-reliance and is reducing both structural and transitory food insecurity among the target communities.

The specific programmes financed by the EC in the zone include: rehabilitation and extension of water points in Gursum; community-based water supply to improve health status in Gursum and Babile; promotion of food security and economic development in Babile; employment generation schemes and construction of relief food outlets; and integrated food security programmes.

The project has raised the household incomes of beneficiaries, increased vegetable production and productivity, and improved the capacity of target beneficiaries, local communities and government partners to manage project interventions effectively and sustainably. Beneficiaries no longer need to sell assets to buy food and are consuming more food or better quality food than before the advent of the programme.

Access to modern and affordable energy services is a prerequisite for achieving the MDGs, in particular for poverty eradication. In that regard, the EU Energy Initiative for Poverty Eradication and Sustainable Development (EUEI) was launched in 2002 as a joint commitment by the EU Member States and the Commission to give priority to the important role of energy in poverty alleviation, and is a catalyst for action. This Initiative is meant to raise political awareness among decision makers, to encourage the coherence and synergy of energy-related activities and to attract new resources from the private sector, financial institutions, civil society and end-users. In addition, the ACP-EU Energy Facility has been established in 2005 in order to support projects on increasing access to sustainable and affordable energy services for the poor living in rural and peri-urban areas in ACP countries . Almost seven million people have already benefited from the 74 projects co-financed by the first Energy Facility. After the successful implementation of this first Energy Facility , a second Energy Facility call has been launched in 2009 with a total budget of more than 200 million €. In order to support developing countries in creating a sustainable energy supply, the Facility focuses on renewable energies.

MDG 2 — Universal Primary Education

Education gives people the opportunity to overcome poverty, lead healthy and productive lives and contribute to global stability and prosperity. Countries with more educated populations enjoy higher rates of economic growth. One additional year of schooling is associated with a 0.37 % increase in GDP. A child who completes ten years of education will earn, on average, ten times more over a lifetime than a child who dropped out of school in the first grade.

According to the UNESCO Education for All Global Monitoring Report 2010, many countries are close to achieving universal primary enrolment. Currently, 89 % of school age children are enrolled in school . Fewer children were out of school in 2007 (72 million) than in 2000. Since 1999, the number of children not attending school has fallen by 33 million and more children are completing a full cycle of primary education. Ethiopia and Tanzania, for example, have each reduced their numbers of out-of-school children by 3 million since the Education for All conference in Dakar in 1999. The enrolment of girls at primary level is close to parity: the gender gap has closed with 96 girls of primary school age in school for every 100 boys. Nepal and Bangladesh have increased enrolment of girls and the disadvantaged, for example.

Education must be relevant and meaningful to have an impact on welfare-promoting outcomes such as health, gender equality and economic growth. However, many children in developing countries leave school lacking basic literacy and numeracy skills EFA Global Monitoring Report 2010, UNESCO, http://www.unesco.org/en/efareport . Achieving MDG 2 requires an enabling environment both in and out of school, including nutritional and health aspects, a relevant curriculum, trained teachers in sufficient quantity, school leadership, and community involvement and accountability ‘More and Better Education in Developing Countries’, Commission Staff Working Document SEC(2010) 121. . Improving learning outcomes requires the recruitment of 10.3 million more teachers by 2015. Public sector reform is important too to improve teachers’ pay, management and conditions, and it is important to ensure that the decentralisation of education management is adequately resourced.[31][32]

EFA Global Monitoring Report 2010, UNESCO, http://www.unesco.org/en/efareport

‘More and Better Education in Developing Countries’, Commission Staff Working Document SEC(2010) 121.

More needs to be done to remove the barriers to access and to make education more inclusive. Within countries, children from the richest households are up to 5 times more likely to be enrolled that those from the poorest. EFA Global Monitoring Report, 2010. UNESCO. www. efa report.unesco.org Measures to increase access by abolishing primary school fees have rapidly increased the numbers of children in school. Malawi (1994), Uganda (1997), Tanzania (2001) and Kenya (2003) have taken this step, enabling more than one million extra children in each country to enrol in primary school UN MDG Report 2009. www.unoorg/millenniumgoals . However, governments have found they cannot sustain such high levels of enrolment and at the same time provide education of sufficient quality. Enrolment levels have thus subsequently fallen (Uganda 84 % 1997 – 76 % 2000; Malawi 98 % 1999 – 91 % 2006).[33][34]

EFA Global Monitoring Report, 2010. UNESCO. www. efa report.unesco.org

UN MDG Report 2009. www.unoorg/millenniumgoals

Evaluations of programmes have shown that the European Commission has contributed to increasing access to primary education significantly in a range of countries (Lao PDR, Angola, Vietnam) through infrastructure provision. In countries such as India, where the approach has been wider but the focus still on enrolment, recent evaluation reports suggest that there is nearly full access in terms of children attending school and there being schools in every locality. Access for children of all groups and localities has been expanded primarily by building new schools, expanding existing schools by adding classrooms, and spreading the net of Education Guarantee Schemes (EGS) and alternative school centres. The number of out-of-school children aged 6-14 years has been reduced from 25 to 14 million and the existing gender and social gaps have been narrowed so that the enrolment of girls is now equal to that of boys. 78 % of girls were enrolled between 2001 and 2006. Over € 3 billion has been invested in the District Primary Education Programme and the Sarva Shiksha Abhiyan (SSA) education programme, to which the EC has contributed around € 350 million.

EU support for the Education Fast Track Initiative (FTI)

In 2002, the FTI was launched as a compact between donors and partner countries to ‘ensure that all countries with a serious commitment to achieving Universal Primary Education can receive support to realise their aims’. The FTI is an example of a platform for aid effectiveness in education, a framework to align support with national education sector plans, and to help mobilise funding for these plans. The EU (Member States and the Commission), the driving force behind the Initiative both politically and financially since its inception, has a critical role to play in the strategic development of the Initiative to ensure it fulfils its potential for greater impact. This entails not only assisting well-performing countries with a credible sector plan but also addressing the education needs in fragile countries. 40 countries are endorsed to date. The FTI Catalytic Fund is supported by eighteen donors, thirteen of them EU Member States. Total pledges to the Catalytic Fund (2003-2013) as of 5 October 2009 amount to US$ 1.6 billion, 90 % of this from the EU (Member States and the Commission). According to the recent evaluation of the FTI the number of children enrolled in schools in African FTI countries increased by 64 % between 2000 and 2007, which is double the increase in non-FTI countries. The FTI has successfully maintained a focus on country ownership, promoted aid effectiveness principles, and built on country processes and structures. It has financed critical gaps in some countries which would otherwise be unaddressed.

MDG 3 — Gender Equality

Gender equality underpins progress on all the MDGs. Gender inequality limits women’s rights and opportunities, their personal security, their access to public services and economic resources, and political power. MDG 3 tracks progress in three important areas: girls’ enrolment in primary, secondary and tertiary education; women’s share in wage employment in the non-agriculture sector; and the proportion of seats held by women in national parliaments.

The gender target recognises that education for girls is one of the most effective ways of reducing poverty. Children of educated mothers are healthier, better nourished and more likely to survive. The gender gap is slowly closing in school enrolment in the developing world. The net enrolment ratio (NER) for girls in primary school (as a proportion of boys’ NER) improved from a global average of 88 % in 1991 to 97 % in 2006. However, completion rates are lower. In sub-Saharan Africa, school completion rates were as low as 55 % for girls and 65 % for boys in 2006. This is reflected in female literacy. Women make up around 64 % of the estimated 774 million illiterate adults in the world. Globally, only 77 % of adult women are literate compared to 87 % of men.

More than half the children out of school are girls. Removing the social and economic obstacles that stop parents from sending their daughters to school is a priority. For many poor families the economic value of girls’ work and care responsibilities at home exceeds the perceived returns to schooling. Girls’ education may also be affected by social norms that encourage early marriage and condone gender-based violence. In Nigeria, which has 23 % of the total of out-of-school children in sub-Saharan Africa, 48 % of girls from the poorest quintile in the poorest state have never attended school. EFA Global Monitoring Report (GMR) 2009. UNESCO. Pakistan only enrols 80 girls per every 100 boys in primary education, and the figures are even lower in Mali, Niger, and Chad. In some countries, boys are disadvantaged, especially in Latin America and the Caribbean.[35]

EFA Global Monitoring Report (GMR) 2009. UNESCO.

Progress is being made, however, with 59 out of 176 countries having achieved gender parity in both primary and secondary education. EFA Global Monitoring Report (GMR) 2009. UNESCO.[36]

EFA Global Monitoring Report (GMR) 2009. UNESCO.

Achieving MDG 3 also requires progress in: political participation; access to and control over productive assets and employment opportunities; access to health and other services; and protection from violence. Unequal treatment of women and girls puts them at a disadvantage throughout their lives and affects the wellbeing of society at large. Illiterate and poorly educated mothers are less able to care for their children. Low education levels and responsibilities for household work prevent women from finding productive employment or participating in public decision-making. Worldwide, as of September 2008, women occupied just over 18 % of the seats in single and lower houses of national parliaments, a negligible increase over the previous year. Indian girls are 61 % more likely than boys to die between the ages of 1 and 5, due to neglect. Gender is also a significant factor in the HIV epidemic. In sub-Saharan Africa, women outnumber men 3 to 1 among 15-24 year olds with HIV.

In Swaziland , EC support has been given to the implementation of the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW), which the Government of Swaziland ratified in March 2004 . The implementation of CEDAW is also identified as a priority area in the Country Strategy Paper and National Indicative Programme for the period 2001-2007 under the 9th European Development Fund (EDF). The Gender Programme is a response to the pervasive gender inequality and violation of rights experienced by women in Swaziland. It is implemented by the Government of Swaziland and United Nations Development Programme (UNDP). The programme has: supported the ratification and implementation of CEDAW; strengthened the capacity of the national gender coordinating unit in the Deputy Prime Minster’s office; undertaken an audit of legislation and its alignment with CEDAW and the Constitution; enhanced civil society advocacy on CEDAW and Human Rights; increased the capacity of women parliamentarians; and supported CEDAW-related training, information and advocacy tools.

EU Support for promoting the participation of girls in universal elementary education in India

The Sarva Shiksha Abhiyan (SSA) programme, India’s flagship initiative to universalise elementary education in the country, puts a crucial focus on girls’ education and gender equity . EU support for Sarva Shiksha Abhiyan was € 200 million in 2002-02 and will be € 70 million from 2008-13, including sector budget support from the EC.

While the programme addresses all children in the 6-14 age group, it continues to have a special focus on ensuring gender and social equity, with targeted initiatives for the participation of girls and disadvantaged communities. Two specialised schemes for girls, concentrating on educationally disadvantaged 'blocks', have helped to accelerate girls’ enrolment and participation. As a result, t he gender parity index rose from 0.90 in 2003-04 to 0.94 in 2008-09 at primary level and from 0.82 and 0.91 at upper primary level over the same period. The percentage of girls out of school has declined from 7.9 % (2005) to 4.6 % (2009). Particularly noteworthy is the progress made by some of the more challenging states. Rajasthan, for example, reduced the gender gap from 17 % in 2001 to 10 % in 2008-09. The policy of moving towards a 50 % share of female teachers has now ensured that 74 % of all schools have at least one female teacher. Over 53 % of all schools now have separate toilets for girls.

Health MDGs

The EU is promoting an integrated approach to MDGs 4, 5 and 6 to strengthen the capacity of health systems to provide essential services, to develop managerial skills in the sector, to support reforms, and to train health workers. The EU supports in particular the approach of the International Health Partnership (IHP) in applying the Paris Declaration principles in the health sector, ensuring external resources serve to strengthen the national health system through alignment behind a robust country strategy and plan.

Reducing financial barriers to access for health systems also increases the rate of progress on the MDGs. In September 2009, 6 countries pledged to abolish user fees to support health systems that deliver quality services free at the point of use United Nations General Assembly high-level event on health, 23 September 2009. Nepal, Malawi, Ghana, Liberia, Burundi and Sierra Leone announced that they would expand access to health services, giving ten million more people access to free health care. . [37]

United Nations General Assembly high-level event on health, 23 September 2009. Nepal, Malawi, Ghana, Liberia, Burundi and Sierra Leone announced that they would expand access to health services, giving ten million more people access to free health care.

MDG 4 — Child Mortality

The number of deaths among children under 5 years old decreased from 12.5 million in 1990 to less than 9 million in 2008. The under-five mortality rate fell from 90 deaths per 1 000 live births to 65 deaths per 1 000 live births over the same period, but progress is insufficient. Most deaths of children under five years old are attributable to acute respiratory infections (mostly pneumonia), malaria, measles, diarrhoea, HIV/AIDS and neonatal conditions — which can all be prevented by existing interventions. Promoting the use of insecticide-treated bed nets to help prevent malaria, for example, has been shown to reduce under-five mortality rates by up to 20 %, which would prevent almost half a million child deaths each year in sub-Saharan Africa.

While improved public health plays a vital role in reducing child mortality, action is also required to improve nutrition, gender equality, education, and household incomes. Malnutrition increases the risk of dying of disease, and over half of all child deaths occur in children who are underweight.

There is a clear relationship between child mortality and poverty. Poor families are often unable to obtain even the most basic healthcare for their children; they usually suffer most from food scarcity and lack of access to a safe water source or adequate sanitation. Children in the wealthiest 20 % of households are twice as likely to survive as those in the poorest 20 %.

Improved immunisation coverage has averted child deaths

Countries that have adopted well-known and effective anti-measles strategies including: Botswana, Malawi, South Africa and Namibia, have reduced measles deaths to near zero since 2000. Globally, deaths from measles fell by over 60 % between 2000 (873 000 deaths) and 2005 (345 000 deaths). The most striking gains were in Africa, where measles deaths decreased by nearly 75 % over the same period - from an estimated 506 000 to 126 000. Improved immunisation coverage in Bangladesh has averted over two million child deaths in the last two decades, in a cost-effective manner. . In less than 10 years since its founding, the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation) - a global partnership that funds expanded immunisation for children in poor countries - has helped prevent an estimated 3.4 million deaths, according to the World Health Organisation (WHO). European Union donors have contributed 1/3 of GAVI’s public funding over the last 10 years Gates Foundation: Progress Towards Immunisation: Winning the Fight Against Deadly Diseases, Living Proof Project, September 2009. http://www.gatesfoundation.org/livingproofproject/Documents/progress-towards-maternal-newborn-child-health.pdf .[38]

Gates Foundation: Progress Towards Immunisation: Winning the Fight Against Deadly Diseases, Living Proof Project, September 2009. http://www.gatesfoundation.org/livingproofproject/Documents/progress-towards-maternal-newborn-child-health.pdf

MDG 5 — Maternal Health

Maternal health is the MDG that is most off track, and where the widest discrepancies exist between the richer and the poorer countries. At global level, maternal mortality decreased by less than 1 % per year between 1990 and 2005, far below the 5.5 per cent annual improvement needed to reach the MDG target. Unsafe abortion is one of the leading causes of maternal mortality and morbidity, resulting each year is 68.000 maternal deaths and millions of women suffering from complications. 4 out of 5 maternal death are the direct results of obstetric complications, most of which could be averted through delivery with skilled birth attendance (SBA) and access to emergency obstetric care.

Health systems need to be strengthened to provide the required maternal health services. Maternal mortality can be reduced in low-income settings by increasing access to skilled attendants, emergency obstetric care and family planning services, as shown in Bangladesh and Sri Lanka. Since 1990, every region has made progress in antenatal care — a core component of maternal health services. Even in sub-Saharan Africa, more than two thirds of women receive antenatal care at least once during pregnancy.

The Maputo Plan of Action on Sexual and Reproductive Health

The vast majority of maternal deaths can be prevented. Improving access to comprehensive family planning could reduce the number of maternal deaths by about a third, and safe terminations could avoid an estimated 68 . 000 deaths. The Maputo Plan of Action on Sexual and Reproductive Health and Rights, supported by the EU, promotes universal access to comprehensive sexual and reproductive health services in Africa and was unanimously agreed by African Union Health Ministers in September 2006. The Plan of Action includes support for better family planning, improved contraceptive commodity security, and action to reduce unsafe abortion. There are ongoing challenges to implementation, but major milestones were attained within the first two years of the Plan of Action. Twenty-seven countries have developed Maternal and Newborn Health Road Maps, and several countries report progress in scaling up linkages between Sexual and Reproductive Health and HIV/AIDS, implementing and expanding family planning, passing laws to protect women against violence, and criminalising harmful practices against women.

EU support for improving health outcomes through a comprehensive approach to strengthening health systems — the case of Zambia

The health sector in Zambia has benefited from an enabling environment with acceptable levels of democracy, stability, and political will, with Zambia meeting the Abuja targets for health expenditure (15 % national budget allocation to health) . Funding to the health sector is internationally aligned, and predictable support (mainly basket funding and budget support, with the exception of The US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund) has increased overall public on-budget funding above € 20 per capita. A sector-wide approach has been set up with the participation of civil society organisations, there have been reforms in human resources in the health sector, and health user fees have been abolished in rural areas for basic services. Zambia has also seen an increase in the uptake and completion of basic education, with progress in gender equity, sustained economic growth (pre-crisis) and improved household economy over the last decade. Recent demographic health surveys show progress on the MDGs and reduced infant and maternal mortality. Universal access targets for anti-retroviral therapy for HIV/AIDS are also being met in Zambia. There are problems, however, such as a disrupted TB control programme, public financial management weaknesses and some equity challenges. The EU has contributed predictable general and sector budget support, funded complementary actions on health system priorities, health human resource policies and health information systems, supported civil society actions and participation, and fostered a dedicated and experienced health sector dialogue. Zambia can now report that 80 000 children do not die every year thanks to advances in health conditions and access to health services. This result is due to a comprehensive national health strategy and to substantial political and domestic finance commitments to health.

MDG 6 — Combating HIV / AIDS, malaria and other diseases

There is a growing political commitment and momentum to fighting HIV and AIDS through a mixture of prevention and treatment strategies. There have been many successes in the AIDS response, including increases in HIV treatment coverage and prevention of mother-to-child transmission services, and there are indications that HIV incidence is declining in some regions. Globally, the coverage of services to prevent mother-to-child HIV transmission rose from 10 % in 2004 to 45 % in 2008 World Health Organisation, United Nations Children’s Fund, UNAIDS, 2009. http://www.unaids.org/en/default.asp , and the drop in new HIV infections among children in 2008 suggests that these efforts are saving lives.[39]

World Health Organisation, United Nations Children’s Fund, UNAIDS, 2009. http://www.unaids.org/en/default.asp

The number of HIV-related deaths has declined by over 10 % over the past five years, as more people have gained access to life-saving treatment. UNAIDS and WHO estimate that since the availability of effective treatment in 1996, some 2.9 million lives have been saved. In Botswana, where treatment coverage is 80 %, AIDS-related deaths have fallen by over 50 % over the past five years, and the number of newly orphaned children is also coming down as parents are living longer.

Young women are particularly affected. In South Africa, young women (aged 15 to 24) are four times as likely to be HIV-infected than young men. However, prevention efforts are not keeping pace with the changing face of the epidemic. Data show that few HIV prevention programmes exist for people over 25, married couples or people in stable relationships, widowers and divorcees. Funding for HIV prevention has become the smallest percentage of HIV budgets in many countries. In Ghana for example, the prevention budget was cut in 2007 by 43 % from the 2005 level 2009 AIDS Epidemic Update, UNAIDS and WHO, 2009. http://www.unaids.org/en/default.asp . Stigma and discrimination also stop people from taking up preventive services and testing, disclosing their status, and seeking treatment and care. Globally, five people are becoming infected with HIV for every two people accessing treatment UNAIDS Outlook 2010: Fresh perspective on the AIDS epidemic and response, Nov 2009. . [40][41]

2009 AIDS Epidemic Update, UNAIDS and WHO, 2009. http://www.unaids.org/en/default.asp

UNAIDS Outlook 2010: Fresh perspective on the AIDS epidemic and response, Nov 2009.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)

The Global Fund has increased access to anti-retroviral therapy. At the end of 2008, four million people were estimated to be receiving treatment in low- and middle-income countries — half of these treatments were financed by the Global Fund. However it is necessary to further align with national strategies and priorities, in order not to create distortions.

EU support for the Global Fund and the Global Fund’s impact on the three diseases :

The European Commission is a founding member of the Global Fund. It has been providing strong political and financial support since 2002. From 2002 to 2009, the EU contributed a total of EUR 872.5 million, making it the sixth largest donor to the fund (after the USA, France, Italy, Japan, and UK). Over the same period, European Union donors pledged more than US$ 11.5 billion (+/- 55 %).

In the end of 2009, the Global Fund supported programmes in 140 countries in the world, with 2.5 million people receiving anti-retroviral (ARV) treatment, 4.5 million orphans receiving medical services, education and community care, 6 million new cases of infectious tuberculosis detected and treated, and more than 100 million bed nets and malaria drug treatments delivered.

In addition to funding collaborative research projects, the Health Research programme of the EU also funds the European and Developing Countries Clinical Trials Partnership (EDCTP), which is a partnership between 14 EU countries, Switzerland and Norway, and 47 sub-Saharan African countries, which aims to reduce poverty by developing new clinical interventions to fight HIV/AIDS, malaria and tuberculosis in sub-Saharan Africa. It has an overall budget of around €400 million over seven years (2003-2010): €200 million from the Member States and €200 million from the Commission's FP budget.

MDG 7 — Environmental Sustainability

MDG7 on ensuring environmental sustainability covers a number of different issues. The EU has been active on several fronts in order to promote better environmental sustainability, thereby contributing to the preservation of progress made under the other MDGs.

The first target under MDG7 relates to the integration of environmental concerns in the development strategies. The European Commission has put in place several tools to foster the integration of the environment in its development cooperation activities. This is reflected in the environment integration strategy European Council conclusions, 25th June 2009. .[42]

European Council conclusions, 25th June 2009.

The Commission is actively supporting the Poverty-Environment Initiative, jointly implemented by UNEP and UNDP, which aims to integrate the environmental sustainability dimension into country systems at all levels.

Access to safe drinking water and basic sanitation are essential for the achievement of the other MDGs . Diarrhoea causes nearly 1.5 million deaths each year, mostly among young children, and is the third largest cause of death from infectious disease. About 90 per cent of those deaths could be prevented through safer water, sanitation and hygienic practices, according to the World Health Organisation World Health Organisation (2008) UN Water Global Annual Assessment of Sanitation and Drinking-Water: 2008 pilot report — testing a new reporting approach. WHO: Geneva. .[43]

World Health Organisation (2008) UN Water Global Annual Assessment of Sanitation and Drinking-Water: 2008 pilot report — testing a new reporting approach. WHO: Geneva.

At any one time, half the people in the developing world suffer from diseases associated with inadequate water supply and sanitation services, along with water-related diseases. Improving access to water can be difficult, because responsibility for water resource management is usually spread across many different parts of the government in developing countries.

In 2002, the Commission launched the EU Water Initiative (EUWI) to provide a policy framework for policy dialogue with partner countries, using a multi-stakeholder approach to increase and streamline EU Member State and EC support for the sector. EUWI was launched at the 2002 Johannesburg World Summit for Sustainable Development as a joint commitment to give priority to the important role of water and sanitation in poverty reduction and achievement of the MDGs.

The initiative has improved the quality of cooperation and coordination between Commission and EU Member States and has developed strong partnerships with key partners, such as the African Ministerial Council on Water (AMCOW) and stakeholders in the water and sanitation sector. It has led to several national policy dialogues to develop strategies for integrated water resources management as well as for sector financing. EUWI has also helped put in place the ACP-EU Water Facility, amounting to € 500 million, which is financing 175 projects aiming to provide access to water and sanitation and to improve governance, with expected results including 14 million people benefiting from access to safe water, some 3 million benefiting from improved sanitation, and about 11 million people involved in hygiene awareness activities. The second phase of the ACP-EU Water Facility, with € 200 million, was launched in February 2010.

EU support for the Whitfield Town Sanitation & Water Upgrading Project, Jamaica

One of the largest community development initiatives undertaken by the European Union and the Jamaica Social Investment Fund is the Whitfield Town Sanitation & Water Project. Its two sub-projects involve upgrading of the sanitation system serving the entire community, with over 1 500 citizens expected to benefit. The project is being financed by a € 500 000 allocation under the EU’s Poverty Reduction Programme.

Whitfield Town is one of the poorest and least developed communities in the Kingston Metropolitan Region of Jamaica. 56 % of the population are under 24 years of age and only 9 % are over 55 years. Deterioration in Whitfield Town crept in with the political violence of the seventies, the migration of many house owners and the ongoing economic decline since the late seventies. Over 80 % of households are without access to adequate sanitation facilities and 60 % of households do not have piped water.

This initiative is the most significant upgrading intervention ever seen in the 90-year history of Whitfield Town — a massive effort aimed at reversing the trend of physical deterioration over the last 30 years, with the accompanying social problems. It involves the community at the decision-making level and at every level of the project, from the project manager down.

Reducing biodiversity loss is another important target under the MDG 7. Biodiversity is crucial for proper nutrition contributing to the eradication of poverty and hunger. Marine biodiversity enhances sustainability of fish stocks and improves livelihoods in coastal areas. The EU has been actively involved in promoting better attention to biodiversity in its development cooperation.

MDG 8 – Global Partnership for Development

Debt relief provides long term, additional resources for countries to spend on health, education and infrastructure as set out in national Poverty Reduction Strategies. Poverty-reducing expenditures in countries that receive HIPC assistance have risen from $5,952 billion in 1999 to $26,697 billion in 2008. In countries receiving debt relief, debt service has been cut by two-thirds, and annual spending on anti-poverty programmes increased from US$6 billion to US$21 billion since 1999.

For example, in Uganda, HIPC debt relief of nearly $2 billion since 2000 has helped make possible the removal of user fees for healthcare. As a result, the number of new out-patient consultations has increased from 9.3 million in 1999/2000 to 24.5 million, indicating a doubling in the use of health services over 5 years. Immunization coverage increased from 41% in 1999/2000 to 89% in 2004/05. Uganda will use its MDRI savings ($57.9 million in 2006) for energy infrastructure to try to ease acute electricity shortages, as well as towards poverty reduction priorities set out in the 2006/07 budget such as improving the quality of primary education, malaria control, medicines and health supplies for primary health and immunization, reproductive healthcare and water infrastructure (specifically targeting the poor and under-served villages).

Trade policy can offer a strong hand to the poorest countries through supporting them to integrate into the global economy and raising their living standards in a way that delivers both greater political stability and social progress. In that regard, the EU offers from October 2009 100% Duty-Free and Quota-Free (DFQF) market access to all Least Developed Countries (LDCs) and all products (excluding arms and ammunitions) in the framework of its Generalised System of Preferences (GSP) and in particular the Everything But Arms (EBA) initiative. This is in line with the commitment made in the 2005 WTO Hong Kong Ministerial Declaration and has been unmatched so far by any other nation. Total imports under the EBA scheme have gradually increased to reach € 5.8 billion in 2008. The rough value of the preferences provided can be estimated at € 657 million in terms of duties foregone. Top beneficiary countries of the EBA scheme are Bangladesh and Cambodia.

Information and Communication Technologies (ICTs) offer tremendous opportunities for developing countries, not only in the field of telephony but also in terms of increased productivity, sustained economic growth and improved service delivery in all socio-economic areas. Good progress has been made over the last years in bridging the so-called "digital divide". 67% of the world's population, representing around 4,6 billion people are today mobile subscribers, up from only 1 billion in 2002 and the fastest penetration rates have occurred in developing countries. In Africa alone the number of mobile subscribers has increased from less than 10 million in 2000 to around 400 million today. The EU has made great strides in promoting an inclusive Information Society through a comprehensive approach tackling research/innovation, regulatory and capacity-building as well as infrastructure development. Regarding Africa in particular, the Africa-EU Partnership on Infrastructures in the context of the joint Africa-EU Strategy supports the deployment of physical infrastructures in the areas of transport, energy, water and ICT to promote interconnectivity at continental level. This is complemented by the Africa-EU Partnership on Science, Information Society and Space which includes key capacity-building initiatives in support of the African Regional Action Plan for the Knowledge Economy (ARAPKE). The ubiquity of mobile technology opens ways to very innovative applications highlighting the unique ICT potential to leapfrog development and fast-track socio-economic transformation in the developing world. This is notably illustrated at national level by new services such as the M-Pesa mobile banking system implemented in Kenya in 2007 to address the unmet demand for reliable services for the poor, reaching today a volume of person-to-person transactions over $ 300 million per month and around 8 million registered users in Kenya alone.

CHAPTER THREE: Key challenges to ensuring MDG progress by 2015

With five years remaining before 2015, there is an urgent need for a step change in global efforts, together with our developing partners, to accelerate progress towards the MDGs. As UN Secretary-General, Ban Ki-moon, said at the UN High Level Event on the MDGs in 2008: ‘Today we have strengthened the global partnership for development. Your resolve to act is evident. Yes, you have stepped up to confront growing challenges. Now, I urge you to move with more speed and focus’ (25 September 2008).

The past ten years provide useful lessons in terms of good practices and factors that impact on MDG progress. They show that achieving decisive results is possible when adequate policies, resources and political will are mobilised. These lessons must inform our future priorities, strategies and actions.

At the same time, it must be emphasised that the development cooperation landscape has seen profound changes between 2000 and today. Global challenges such as climate change and environmental degradation, the scarcity of, and growing competition over, natural resources, demographic growth, financial stability or international security have become increasingly significant in global development policy and are likely to have increasing weight in determining the progress of sustainable development in the future.

Most of these factors already have strong implications today for the development policy agenda. However, as they will have an impact well beyond the 2015 time horizon, they should feed into the forward-looking reflection needed on a new multilateral development agenda beyond the agreed deadline for the MDGs The MDGs have placed poverty reduction at the heart of the development agenda. The MDGs are viewed as a set of indicators for guiding poverty reduction and for holding international agencies and governments accountable to citizens. However, there is a need to ensure the predictability and continuity of development policy and to launch a reflection on the possible international development agenda beyond 2015. Even if the MDGs are achieved globally by 2015, the challenges to poverty reduction will remain formidable . Indeed, g lobal poverty will only have been reduced by half, and the remaining half will pose new challenges to the international development agenda. For low-growth poor countries and those countries in situations of fragility, 2015 may herald little in the way of development progress. The reflection should thus cover the so-called ‘missing dimensions’ of the MDG framework, its impact and added value as well as ways of (better) integrating the new global challenges/global public goods such as climate change, access to energy and peace/security within the development agenda. Work needs to start soon on developing a consensus on the purpose, method, areas and responsibilities for carrying out this reflection process, so that sufficient time is left for an evidence-based discussion by policy communities on what might be appropriate targets and/or indicators in their areas of competence. The process will need to engage a very wide group of actors, including governments, civil society and the private sector. .[44]

The MDGs have placed poverty reduction at the heart of the development agenda. The MDGs are viewed as a set of indicators for guiding poverty reduction and for holding international agencies and governments accountable to citizens. However, there is a need to ensure the predictability and continuity of development policy and to launch a reflection on the possible international development agenda beyond 2015. Even if the MDGs are achieved globally by 2015, the challenges to poverty reduction will remain formidable . Indeed, g lobal poverty will only have been reduced by half, and the remaining half will pose new challenges to the international development agenda. For low-growth poor countries and those countries in situations of fragility, 2015 may herald little in the way of development progress. The reflection should thus cover the so-called ‘missing dimensions’ of the MDG framework, its impact and added value as well as ways of (better) integrating the new global challenges/global public goods such as climate change, access to energy and peace/security within the development agenda. Work needs to start soon on developing a consensus on the purpose, method, areas and responsibilities for carrying out this reflection process, so that sufficient time is left for an evidence-based discussion by policy communities on what might be appropriate targets and/or indicators in their areas of competence. The process will need to engage a very wide group of actors, including governments, civil society and the private sector.

The key challenges to accelerating progress by 2015 are identified as follows:

3.1 Challenge No 1: Tackling the continued effects of the economic and financial crisis

For many poor countries, the global financial and economic crisis, combined with the previous food and fuel shocks, may entail long-term setbacks in MDG progress.

In the short run, sound domestic policies and programmes backed by adequate support are needed to restore macroeconomic stability and fiscal sustainability and to stimulate economic growth and job creation, while protecting the most affected/vulnerable groups (notably through social transfers). In the longer run, it will be crucial to reduce the vulnerability and improve the resilience of developing countries to external economic shocks, notably through economic diversification and wide-coverage social protection systems and insurance mechanisms, and to support them in moving to low-emission pathways. At global level, reforms of the global economic governance architecture and regulatory and supervisory measures maybe needed to make the global economy less volatile and more predictable. Efforts shall also be pursued to help developing countries to better integrate their markets into the global economy, including through the conclusion of an ambitious, comprehensive and development-friendly multilateral trade agreement in the context of the WTO Doha Round.

Rapid and coordinated initiatives have already been taken by the international community to tackle the effects of the crisis and help the most vulnerable countries. But much more could be done in terms of implementation and scaling up. More efforts are needed in particular to tackle the ‘implementation gap’ between existing donor policy frameworks and concrete actions on the ground, and to improve the coherence of non-aid policies. Moreover, sufficient financial resources should be leveraged in a predictable way in order to narrow the ‘financing gaps’ For instance, the International Food Policy Research Institute (IFPRI) has estimated the additional amount necessary to meet the MDG of halving poverty and hunger by 2015 to be US$ 14 billion annually. On health, the World Bank estimates that about US$ 48 billion is required to accelerate progress towards the neglected MDGs (child and maternal mortality) over 2009-2015 in sub-Saharan Africa. On education, the UNESCO EFA Global Monitoring Report 2010 estimates the financing gap to be around US$ 16 billion annually. A recent World Bank study also estimated that US$ 93 billion is needed annually over the next decade to meet infrastructure needs in sub-Saharan Africa. in efforts to reach the MDGs. This is a shared responsibility and implies corresponding accountability mechanisms.[45]

For instance, the International Food Policy Research Institute (IFPRI) has estimated the additional amount necessary to meet the MDG of halving poverty and hunger by 2015 to be US$ 14 billion annually. On health, the World Bank estimates that about US$ 48 billion is required to accelerate progress towards the neglected MDGs (child and maternal mortality) over 2009-2015 in sub-Saharan Africa. On education, the UNESCO EFA Global Monitoring Report 2010 estimates the financing gap to be around US$ 16 billion annually. A recent World Bank study also estimated that US$ 93 billion is needed annually over the next decade to meet infrastructure needs in sub-Saharan Africa.

3.2 Challenge No 2: Fostering MDG ownership in developing partners

Strong government leadership and a sense of ownership among developing partners in designing domestic policies, implementing costed programmes and mobilising the needed resources is key to fostering sustainable MDG progress. Successful examples of MDG progress all point to the importance of strong local political engagement and ownership.

To foster ownership, efforts are needed to translate the MDGs into country-specific objectives and indicators showing the reality on the ground, and to integrate them into nationally owned development strategies and programmes. Cambodia has for example adapted the targets and developed ‘Cambodia MDGs’, whereas others have addressed the MDGs in combination with other strategic frameworks such as ‘Vision 2020’ in Rwanda Vandemoortele, J. (2008), ‘The MDG Conundrum: Meeting the Targets Without Missing the Point’. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1416364 . However, the MDGs are often not fully incorporated within national planning and budgeting, either because resources could not be mobilised or because of concerns about the reliability of the estimates and their potential macroeconomic impact on public expenditure ceilings and aid dependence United Nations Development Group (UNDG) (2005), Making the MDGs Matter: The Country Response . New York: UNDP. http://www.undg.org/docs/10795/Addendum-to-MDGR-Guidelines-Approved-UNDG_English.pdf .[46][47]

Vandemoortele, J. (2008), ‘The MDG Conundrum: Meeting the Targets Without Missing the Point’. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1416364

United Nations Development Group (UNDG) (2005), Making the MDGs Matter: The Country Response . New York: UNDP. http://www.undg.org/docs/10795/Addendum-to-MDGR-Guidelines-Approved-UNDG_English.pdf

Public monitoring of MDG progress by civil society and citizens in general is an essential element of ownership. However, several constraints such as weak statistical capacity at national level, lack of regular, reliable and disaggregated data available to guide national policies and track country progress, and the weak organisational capacity of civil society actors often stand in the way of such a ‘watchdog’ function in poor countries. More efforts are needed in this regard. In particular, the establishment of National Strategies for the Development of Statistics (NSDS) are important to afford the availability of timely, reliable and accurate data.

3.3 Challenge No 3: Unleashing the potential of the private sector for human development

The scale of the challenge for attaining the MDGs requires mobilising the participation of all actors and all sources in complementary ways. While governments have primary responsibility for delivering MDG progress, private actors (both profit and non-profit) can complement public interventions in designing, delivering and financing specific actions (examples of mechanisms include contracting out services from governments, Output Based Approaches such as voucher schemes and social franchising). They represent a huge potential in terms of innovative approaches, technological resources and organisational and management expertise. But they also bring new risks and challenges in terms of quality control and accountability.

Recent analyses show that private service providers are increasingly present in the developing world in MDG-related sectors, such as health and education but also ICTs which has a key potential to fast-track development in different socio-economic domains. An important proportion of the MDG-related maternal, reproductive and child health services in South Asia and sub-Saharan Africa are privately provided. In some developing countries where data are available, such as Jamaica, Peru, and Zambia for example, the private sector contributes more than 40 % of total expenditure on education See in particular: World Bank Global Monitoring report 2009, pp. 85-112; Report of the UN Secretary General, ‘Keeping the Promise — A forward-looking review to promote an agreed action agenda to achieve the MDGs by 2015’, February 2010, pp. 53-55. www.worldbank.org/gmr 2009 .[48]

See in particular: World Bank Global Monitoring report 2009, pp. 85-112; Report of the UN Secretary General, ‘Keeping the Promise — A forward-looking review to promote an agreed action agenda to achieve the MDGs by 2015’, February 2010, pp. 53-55. www.worldbank.org/gmr 2009

More should be done to develop or scale up pro-poor business models, services and products (building on existing successes such as in the mobile telephony sector fo instance), to improve legal and regulatory frameworks to foster private investments, to reinforce coordinated management of infrastructures development and to support government capacities in developing partner countries to design and manage creative public-private partnerships, with the aim of enhancing the contribution of private actors to the MDGs.

3.4 Challenge No 4: Focusing on the most off-track goals and countries

The world is particularly off-track on certain MDG targets and indicators, in particular on nutrition, child and maternal mortality, and access to sanitation. Similarly, available data show that some countries, especially those in ‘situations of fragility’ as well as many countries in sub-Saharan Africa, are lagging far behind on a wide set of targets and indicators.

A revitalised effort to foster MDG progress could be accompanied by more financing and action to accelerate improvements in the most off-track countries and goals. Here, however, it is important to be mindful of the interdependency and mutually reinforcing nature of the MDGs as well as the need to frame them within integrated development strategies.

There are good examples of targeted initiatives, sometimes based on complementary public and private investment, which have proven successful and could be shared, replicated and/or scaled up. In food and nutrition, for example, micronutrient supplementation, including vitamin A, iron, zinc and folic acid, have helped to reduce micronutrient deficiencies and hence child morbidity and mortality and contributed to child growth and cognitive development. Other interventions, such as measles immunisation, increase in the number of trained midwives, low-cost access to water and sanitation and provision of bed nets have also yielded significant results for MDGs 4, 5 and 6 ‘Stocktaking on the Millennium Development Goals’, background paper prepared jointly by UNDP, UNFPA, UNICEF and WFP, January 2010, pp. 8-14; Report of the UN Secretary General, ‘Keeping the Promise — A forward-looking review to promote an agreed action agenda to achieve the MDGs by 2015’, February 2010, p. 37. http://www.fultonpreschurch.org/January%202010%20Lamplighter%20Online.pdf . Such action needs to be aligned with country owned sector policy dialogue and sector monitoring mechanisms.[49]

‘Stocktaking on the Millennium Development Goals’, background paper prepared jointly by UNDP, UNFPA, UNICEF and WFP, January 2010, pp. 8-14; Report of the UN Secretary General, ‘Keeping the Promise — A forward-looking review to promote an agreed action agenda to achieve the MDGs by 2015’, February 2010, p. 37. http://www.fultonpreschurch.org/January%202010%20Lamplighter%20Online.pdf

3.5 Challenge No 5: Addressing fragility

Security and fragility concerns must be tackled if sustainable progress on the MDGs is to be achieved by the set deadline. Violent conflict is an important factor contributing to poverty. The last Global Monitoring Report from the World Bank clearly states in that regard that ‘looking ahead, the challenge to achieve the MDGs will increasingly be concentrated in low-income countries, especially fragile states’ World Bank Global Monitoring Report 2009, p. 16. www.worldbank.org/gmr 2009 .[50]

World Bank Global Monitoring Report 2009, p. 16. www.worldbank.org/gmr 2009

Addressing situations of conflict and fragility requires sustained engagement and innovative combinations of political/diplomatic, financial, technical and sometimes military resources or ‘whole-of-government’ approaches. Such situations call for long-term commitments as well as predictable and flexible approaches. Coordination and complementarities among the various actors operating on the ground and improved coherence among the various - and sometimes conflicting - objectives, priorities and policies are also of the utmost importance. This includes the need to articulate in a coherent, complementary and coordinated way humanitarian, security and long-term development related strategies and operations. Each fragile situation is specific and calls for tailor-made strategies rooted in an in-depth knowledge of the local context European Report on Development 2009, pp. 155-192, Overcoming fragility in A