This morning, on my way to an advocacy event on “Delivering for Girls, Women, and Babies” at the Waldorf Astoria hotel in New York, I was thinking about a pregnant Tanzanian woman in a film preview I saw recently. The preview of No Woman, No Cry had captured with terrifying clarity the helplessness of a sick pregnant woman in a remote village in Tanzania. I couldn’t help thinking the Manhattan streets around me were far removed from such painful realities.
But, as Graca Machel pointed out during the event, this wasn’t always the case. A women’s hospital had once occupied the site of the historic Waldorf Astoria—it was in fact the last hospital in the United States for women with obstetric fistulas. “We should make every fistula hospital in the world just as unnecessary as this one was found to be,” Machel said.
It’s been 10 years since the World Bank signed on to the Millennium Development Goals. At the time, I managed the Bank's HIPC initiative, providing debt relief for the most heavily indebted countries, and I remember the hope we all felt. I am now responsible for IDA—the World Bank’s fund for 79 of the poorest countries, for whom the MDGs are critical, and I can say that our commitment to these goals remains as strong today, if not stronger.
We have made considerable progress on many of the goals. Growth over the past decade has contributed to reductions in extreme poverty. In 1990, over 40 percent of the population in developing countries lived on less than $1.25 per day. By 2005, that share fell to roughly 25 percent and is expected to fall to 15 percent by 2015, more than meeting the goal to halve extreme poverty.
As the global summit gets off and running in New York to look at progress toward the Millennium Development Goals, we have a great deal to celebrate. At the same time, we have some big challenges ahead in order to realize the promise of the goals: a world that overcomes poverty and hunger, where all citizens have access to opportunity and hope.
On the celebration side: 30 years ago, 52 percent of people in developing countries lived in extreme poverty; by 2005, that share had been cut by more than half. In Africa before the triple blow of the food, fuel and financial crises in 2008, primary school enrollment rates were rising faster than in any other continent, and child mortality rates had fallen by 25 percent in about 13 countries in just 4 years.
Earlier today, the bank hosted a film preview and panel discussion on maternal health and progress toward Millennium Development Goal 5, which focuses on reducing maternal deaths.
The film clip shown—part of a moving documentary titled “No Woman, No Cry”, directed by Christy Turlington Burns—tells the story of a pregnant Tanzanian woman facing a difficult delivery in a remote village. The local clinic is understaffed and ill-equipped for complicated cases, and finding transport to the nearest hospital is difficult and expensive.
At an event a few days ago at the Spring Meetings on Africa and the Millennium Development Goals—or MDGs for short—the speaker who left me with the strongest impression of hope for 2015 and beyond was Ted Sitima-Wina, Malawi’s Principal Secretary, Planning. Malawi, a small landlocked country with a per capita income of $280, is on track to meet five out of the eight goals, no small achievement in a region where most countries appear off-track on most goals, and many started from a very low base in 1990.
So what worked in Malawi? According to Sitima-Wina, it was aligning the Malawi National Development Strategy closely to the MDGs. “Papers signed in 2000 showed us goals and targets,” he said, “but what we did in Malawi was to contextualize them in our own poverty reduction strategy.”
Perhaps one of the most famous steps that Malawi took to cut poverty and hunger was a targeted subsidy which allowed poor farmers to afford fertilizer and hybrid seeds. With this, the country has moved from being a net importer to a net exporter of food. A recent survey showed that over the past few years, people in rural areas have reported that food is available, despite the crisis.
Ray Chambers, the UN Secretary General’s Special Envoy for Malaria, was here today to thank President Zoellick for $200 million to fund bed nets that will help prevent malaria in Africa. Chambers, who wants to bring a swift end to what he calls “the genocide of apathy,” conveyed a sense of great urgency as he described the UN’s sweeping campaign with 50 celebrities on Twitter—from Ashton Kutcher to Bill Gates. Through them, and through millions of tweets and re-tweets, money is being raised to ensure that all vulnerable people have bed nets by the end of the year. Yes, that’s this year.
As African governments look for ways to help the poorest people in the wake of the food, fuel, and financial crises, I think this was a very good moment for President Zoellick and Africa Vice President Oby Ezekwesili to note that anti-malaria efforts are relatively straightforward, with high returns on investment. The Bank’s effort to help close the gap—by funding 25 million of the 50 million remaining nets needed—is a timely one. It will cover seven countries—the Democratic Republic of Congo (DRC), Ethiopia, Ghana, Kenya, Mozambique, Sierra Leone and Zambia—among the 31 hardest hit by malaria.
“This was a highlight of my trip to Washington this spring,” said Uhuru Kenyatta, Kenya’s Finance Minister, “It is a key step to restore dignity to so many African men, women, and children.” Kenyatta called for a concerted effort by African governments to make sure that funds are used as intended and to scale up their own malaria funding. Finance Minister Mapon of the DRC spoke of great successes against malaria in his country, but noted that the “need remains sizeable.” And Zambia’s Minister Musokotwane echoed this conclusion, calling malaria “an obstacle to development.”
Even during the busy Spring Meetings here in Washington, my thoughts keep going back to two places I visited this month that lie on either side of the Congo River. I crossed the great river by boat from Brazzaville to Kinshasa, a special journey for many reasons. In Brazzaville, capital of the tiny Republic of Congo, I’d been impressed by the quality of leadership in managing additional financing for one of our projects which addresses HIV/AIDS, and on the other side of the river, I was returning to the Democratic Republic of Congo after a long gap, to find that a health systems rehabilitation project I’d worked on many years ago was in fact thriving and delivering good results.
Today being World Malaria Day, I must register that I saw some extremely useful work going on in Kikimi, a very poor neighborhood near Kinshasa. Our partnership with local NGOs to provide better health services across DRC looks like it’s working well here. Instead of just being shown reports on inputs and equipment, which I’ve found frustrating in the past, this time I met a large number of women who told me about insecticide-treated bed nets they’d received during routine visits to their health center and how useful these nets were to prevent malaria. I saw pharmacy shelves well-stocked with malaria drugs, oral rehydration therapy for diarrhea, and basic antibiotics. The project wasn’t perfect but it was delivering results that I could see with my own eyes.
At a candid discussion yesterday with African ministers of education and a range of education experts from the public and private sectors, one thing was very clear – that higher education was recognized by everyone in the room as being critical for Africa’s development in the 21st century. All participants—from the Gambia’s education minister, who pointed out that his country went without a university for 30 years after independence and was facing a severe resource gap, to his counterpart in Senegal who wanted to catch up with Tunisia on the number of students enrolled in universities—agreed that higher education was key to diversifying Africa’s growing economies and reducing their dependence on natural resource extraction.
There’s another reason higher education is so important in Africa—the region has burgeoning numbers of young people, some 7 to 10 million of whom knock on the doors of the labor market every year. These young people constitute a huge opportunity for Africa. Yet of today’s unemployed in the region, a full 60 percent are youth. Good quality, relevant education that goes well beyond the primary stage will turn out the types of employable graduates and professionals that Africa so urgently needs. Doctors, nurses, lawyers, engineers, and entrepreneurs—but also agriculturists and environmentalists. This morning’s news about intensifying drought in West Africa’s Sahel region, with 10 million people thought to be short of food, only underscores the great urgency to build human resource bases in each country that can help tackle the environmental and health issues that confront Africa.