Making the case for increasing the national budget allocation to the health sector is critical if more domestic resources are to be garnered for financing universal health coverage. Yet, there are competing priorities for more allocation for other sectors. While political will remains pivotal to decisions on national priorities, against limited resources, fiscal managers- such as ministries of finance or treasury- have a challenging job translating national priorities into budget allocations for sectors.
When the door closed behind her, Maria’s world seemed to collapse. The mother of a girl and two boys had just learned that her eldest son, the teenager who became the pillar of the family after their father died, was not only in a deep depression and increasingly using alcohol but he was gay. She had noticed him becoming moodier and even heard he received a warning at his job for not showing up, something totally unlike him at all. She felt helpless but knew his depression had to stay hidden from the rest of the family and the neighbors as mental health problems brought with them social stigma. But she was most afraid someone would find out he was gay, causing the family to be ostracized and endangering the future of the other children.
What is there not to like about the Sustainable Development Goals? The 17 goals and 169 targets are nothing if not a smorgasbord of worthy ambition. But the sheer breadth and scope of the SDGs, allied to the 2030 target date, can make it difficult for governments to prioritise. It can also make it difficult for citizens to hold their governments to account. Cynics might suggest that’s why so many governments signed up for an SDG pledge that few of them have any intention of delivering.
For those of us who are more interested in achieving change than indulging in cynicism, the challenge is to identify pathways for translating rhetorical commitments into practical outcomes. If I had to select just one morsel of accountability from the SDG feast it would be this sentence tucked away in the preamble: “We wish to see the Goals and targets met…. for all segments of society. And we will endeavour to reach the furthest behind first.”
It’s tough to think of a more elevated test of fairness. The SDGs establish bold targets for eliminating extreme deprivation. But they also signal an intent to combine national progress towards those targets with ‘social convergence’, or a decline in the disparities separating the most marginalised from the rest of society. This is a marked departure from Millennium Development Goals (MDGs), which focused attention on national average progress. As the findings from an excellent 2015 paper by Adam Wagstaff and Caryn Bredenkamp noted national progress in child survival and nutrition masked widening inequalities in a majority of countries, notably in sub-Saharan Africa.
While it might be hasty to suggest we have collectively moved beyond the legacy of panic and neglect behavior, I am hopeful that the multiple global and country level efforts to strengthen pandemic readiness emerging since the deadly West Africa Ebola outbreak of 2014 might be starting to bear fruit.