In the complex and brave new world of the SDGs, we still have unfinished business on the basics of mother and child health

In the complex and brave new world of the SDGs, we still have unfinished business on the basics of mother and child health
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On December 31st, the curtain will close on the Millennium Development Goals (MDGs) which have defined the development and global health agenda for the past 15 years. The new set of Sustainable Development Goals (SDGs) formally adopted during the United Nations General Assembly in September will go into effect. These 17 broad and ambitious goals and 169 related targets will form the strategic blueprint for global development for the next decade and a half to 2030, replacing the more streamlined MDG set of 8 goals and 21 targets set in 2000, which focused on a few key objectives, including improvements in maternal and child health and control of infectious disease epidemics.

Even though these health MDGs are set to expire at the end of December, the work is far from over. We would argue that it is vital for low- and middle-income countries and their donor partners to maintain, and even intensify, the current emphasis on lowering mother and child deaths and ending AIDS, TB, and malaria, especially in the more complex world of the SDGs where it would be easy to lose focus.

During the 15-year lifespan of the MDGs, health outcomes have dramatically improved overall, but progress has been highly uneven among the world's poorest countries. Some, like Bangladesh, Malawi, Nepal, Niger, and Rwanda, have done remarkably well, while others with more resources, like Nigeria and Zambia, have made little progress, and a third set of countries, like Somalia, Sudan, and DR Congo, have gone in reverse, putting the lives of millions of children in jeopardy.

What has driven the success of the exceptional countries that have met the health MDG targets for reduced child and maternal mortality and reversal of their AIDS, TB, and malaria epidemics? Can these lessons of success be applied to the lagging countries over the coming years?

In our retrospective analysis conducted last year, we found that "fast-track" countries that met their health-related goals took different paths, suggesting that there is no one formula of actions to ensure success. However, the successful countries generally focused on delivering a narrow set of high-impact interventions using a small handful of delivery platforms that reduced financial and physical barriers to access. These platforms included mass campaigns for immunization and micronutrient supplementation, emergency obstetric care and maternity waiting homes, and community-based delivery of child health and nutrition services using trained and closely supervised front-line workers. We also found evidence that well-designed results-based incentives for providers and innovative financing mechanisms like the Affordable Medicine Facility for malaria treatments helped to accelerate progress.

A very poor country like Niger, for example, used mass campaigns to immunize against measles and promote the use of insecticide-treated bednets, brought wasted children under care in a network of nutrition rehabilitation centers, and deployed community health workers to treat malaria, pneumonia, and diarrhea at upgraded rural health posts and centers, while strengthening their supply chains for medicines and essential commodities. As a result, child mortality in Niger fell by more than 5% a year over a decade, while in neighboring countries the decline was only 1.5% annually.

Our findings point to an agenda for continued targeted action by committed governments and development partners over the next five years - especially in countries which have lagged behind and could leapfrog ahead between now and 2020. This is something that will require continued support from donors, including those contributing to the new Global Financing Facility.

The contrast between the scope and ambition of the new SDGs and the original MDGs reflects the profound differences between the state of the world in 2000 when the MDGs were launched, and where we are today in 2015. Fifteen years ago there was a strong, almost laser-like focus on health in developing countries. The HIV epidemic was nearing its peak, and malaria and TB deaths were on the rise, increasing awareness among governments and donors about the huge human toll that these diseases were imposing. Nearly 10 million children were dying each year, many from causes like measles and pneumonia that could be easily and cheaply prevented with vaccines and antibiotics. And there was a growing realization, reinforced by the World Bank's 1993 flagship report "Investing in Health" and its profound influence on Bill Gates to establish his foundation, that millions of lives could be rescued for just a few dollars per "life-year gained" through simple, proven interventions.

In contrast, the sprawling set of SDGs approved in New York in September operates on the belief that the world is much more complex, and that achieving sustainable development and ensuring better health outcomes correspondingly requires addressing factors in the enabling environment and in wider underlying systems. Towards that end, only one of the SDGs focuses on health, while the remaining 16 highlight the importance of cities and communities, gender and equality, climate action and renewable energy, and innovation and partnerships in addition to the more traditional development areas of poverty reduction, hunger elimination, and education.

As the world embarks upon this broader SDG agenda, we would urge developing country governments and donors to sustain the highly effective efforts to lower infections, illness and deaths among the world's poor from the same causes that collectively we have been working so diligently to tackle over the past decade and a half. The battle for mothers, children, and those susceptible to major killer diseases is far from won. While the SDG framework provides space to shape policies and programs to improve maternal and child health, the same simple approaches that led to progress since 2000 still need to be pursued relentlessly and with focus, especially in the large numbers of countries, in Africa and in other regions, which missed out on the gains of the past 15 years.

Robert Hecht is a Results for Development Institute (R4D) Managing Director, Shan Soe-Lin is an R4D Program Director, Elijah Goldberg is a 2015 graduate of Yale University, and David de Ferranti is R4D President.

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