Performance anxiety about the MDGs – are all poor countries lagging?


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An old man, in Livingston, Zambia, stooped to scoop muddy water from a puddle into his pail. “What I want most is clean water,” he said, to me. I was conducting a World Bank field survey back in 2000 in Livingston. Even as the man expressed his desire for such a basic need, I could hear the roar of the mighty Victoria Falls just a few kilometers away. That was the sound of billions of gallons of fresh water, but not immediately drinkable. I never forgot the sound of it.

The extent to which people across the world have access to clean water, education, food, healthcare and other basic needs is measured by the Millennium Development Goals (MDGs), a set of internationally agreed targets adopted in 2000. Last week, world leaders and the developmental community gathered in New York for the MDG summit to urge the international community to speed up progress toward the MDGs.

At first glance, the global numbers tell a very dismal story about development performance as measured by the Millennium Development Goals (MDGs).  And it is easy to single out low-income countries, particularly fragile states and those in sub-Saharan Africa, as bad performers lagging on all the MDGs or not likely to reach any single target by 2015. 

Fragile states and low-income countries made the least progress towards the MDGs

That gloomy conclusion is misleading, however. There is quite a bit of positive news. First, recent achievements are obscured by poor performance in the past and by disproportionate challenge posed by the MDGs in many African and poor countries. The greater the distance to the 2015 targets, the steeper the path to achieve the targets. In Africa, poverty was stable during the 1990s, but fell steeply since 2000.

Second, data gaps may fail to convey the further progress already made. For example, the global and regional indicators of poverty do not go beyond 2005 level because it takes time to complete household surveys of incomes and expenditures in large countries. In the meantime, recent information of small countries may indicate further progress. The higher weights of large countries in global aggregates will also understate the great diversity of performance across countries.

If one goes beyond the aggregates, a pervasive heterogeneity indeed characterizes MDG performance. A dive below the global statistics shows that it is not just the middle-income countries that are doing well, but many low-income countries (LICs), too. A recent paper by Leo and Barmeier (2010) at the Center for Global Development also concluded that progress in individual African and poor countries was surprisingly strong.

We should take heart and celebrate the remarkable achievements that are already being made by several low-income countries, many in Sub-Saharan Africa (see table).

Selected MDGS LICs that have achieved goals LICs that are on-track
Poverty Kenya, Mauritania, and Senegal Central African Republic, Ethiopia, and Ghana
Universal Primary Educations Myanmar, Uzbekistan, and Vietnam  
Gender Parity in Primary Education Bangladesh, The Gambia, Ghana, Kenya, Kyrgyz Republic, Malawi, Mauritania, Myanmar, Rwanda, Senegal, Tanzania, Uganda, Uzbekistan, Zambia, Zimbabwe Benin, Burkina Faso, Burundi, Cambodia, Comoros, Ethiopia, Guinea, Madagascar, Nepal, Sierra Leone, Togo
Gender Parity in Secondary Education Bangladesh, Kyrgyz Republic, Myanmar, Uzbekistan Cambodia, The Gambia, Ghana, Malawi, Mauritania, Nepal, Rwanda, Uganda, Zimbabwe
Under 5 Mortality Rate Vietnam Bangladesh, Eritrea, Lao PDR, Malawi, Nepal
Improved Water Source Afghanistan, Burkina Faso, Comoros, The Gambia, Ghana, Dem. Rep, of Korea, Kyrgyz Republic, Malawi, Nepal, and Vietnam Benin, Cambodia, Guinea, and Uganda
Improved Sanitation Facilities Myanmar, Tajikistan, Uzbekistan, and Vietnam Rwanda

In a related stock - taking, the UN singled out the progress of 8 least-developed countries through the MDG Awards on Sept 19, 2010 – namely, Bangladesh, Burkina Faso, Cambodia, Liberia, Malawi, Nepal, Sierra Leone, and Tanzania. The work is far from done, however. There are many more countries that are still off-track despite significant gains. They will need a favorable global economic environment and strong multilateral institutional and donor support to continue their policy reforms and progress. There is still much to do. 




Join the Conversation

Doctor Michel ODIKA
January 27, 2011

In many regards, malaria is a development issue of the highest priority. Otherwise said, success, or progress, in controlling this poverty-related disease suggests much more attention being paid to reaching most of the Millenium Development Goals (MDGs). To date, for example, malaria is still the leading cause of under-five mortality in several African countries. Today, therefore, a problem of this magnitude requires multisectoral responses, multidimensional approaches, coordinated efforts and accountability for progress against the disease. To meet thee requirements, however, the hardest-hit countries have no alternative but to establish innovative partnerships and state-non-state multi-stakeholder networks, such as… “Malaria Observatories”. Why?

For the most part, the response to malaria has always been inadequate and naïve. Inadequate, insofar as current strategies shine a powerful spotlight on anachronistic disconnections (1) between where money is most needed (hygiene, prevention and sanitation) and where money is most spent – e.g. misdirected care (2), counterfeit drugs included (3,4). Naïve, insofar as a system’s failure requires a system’s solution – not temporary remedies, as is often the case in many malaria-affected countries, most of them in sub-Saharan Africa…

Today, my native country (Congo-Brazzaville) is off-track on most of the MDGs. In response to this fact, I work on establishing a Malaria Observatory (5,6,7). Shortly, the project aims to promote:
- Innovative partnerships and networks;
- Collaborative and participative models;
- Multisectoral strategies;
- Multidimensional approaches.

In matter of controlling malaria, many, if not most, sub-Saharan African countries need, not only a sweeping shift from the reactive to the active and strategic, but equally a robust foundation on which to build an adequate response. In this regard, the project to establish a Malaria Observatory in Congo-Brazzaville (5,6,7) goes well beyond the health sector and, therefore, cuts across the health-related MDGs (IV,V,VI). Otherwise said, I campaign for a human development initiative commensurate with the challenge of:
- mitigating the impact of poverty (MDG I);
- reducing child mortality (MDG IV);
- protecting maternal and child health (MDG V);
- fighting… malaria (MDG VI);
- improving environmental safety and sustainability (MDG VII);
- promoting partnerships for development on a global scale (MDG VIII).

As malaria-affected countries seek to strengthen their capacity-building and building-capacity, they are increasingly looking to innovative, effective, evidence-based and cost-efficient approaches to provide a clear and comprehensive direction. However, establishing a Malaria Observatory is a long-term process, if only because of the long time lag to restructure the workforce in terms of resources, be they human, financial or technical – and possibly also in terms of Country Response Information Systems (8,9).

What else? If we do not urgently strengthen the response to malaria, neither progress on key fronts nor the MDG of rolling back malaria by 2015 will be achieved. Failure to meet this Goal will also seriously endanger progress towards the MDG to reduce childhood mortality and poverty, as each of these is inextricably tied to our response – or lack of response – to malaria.

In the 21st century, we are all living with malaria, and must all be part of the response…

Doctor Michel ODIKA (Congo-Brazzaville)

1. Malaria funding requirements (
2. In most cases, resource allocation clusters around curative services at great cost, neglecting the potential of malaria prevention, health promotion and appropriate sanitation. At the same time, the health sector in malaria-affected countries often lacks the expertise to mitigate the adverse effects on health from other sectors and make the most of what these other sectors can contribute to health.
3. Médicaments de la rue à Brazzaville (…).
4. Faux médicaments: faux problème en mal de vraies solutions (
5. Malaria observatories: opportunity for development (
6. Observatoire du Paludisme: tableaux de bord (…).
7. Observatoire du Paludisme: architecture et infrastructure du futur (…).
8. Information systems: key to improving health systems (
9. Health information systems: facilitators of policymaking (