UN predicts that millennium development goals will be missed by a wide margin in Africa

The recent UN prediction that its Millennium Development Goals will be missed by a wide margin may serve a useful purpose. If nothing else, it may compel the UN and its specialized agencies to re-assess their tendencies to adopt promethean goals in the absence of any operational capacities to carry them through to completion.

The World Health Organization (WHO) is a good case in point. When Dr. J. W. Lee, Director General of the WHO, initiated the organization’s plan to treat 3 million AIDS patients by 2005, he also published a companion article in the Lancet. Sensing that the sheer immensity of his plan was an Everest too steep for WHO to climb, he proposed in the Lancet what unfortunately became a self-fulfilling prophecy: “If we cannot reach 3 by 5, there is no reason to believe we can achieve the Millennium Development Goal.”

Dr. Lee’s plan had built-in flaws which incapacitated WHO’s efforts from the start:

•It was dependent on voluntary contributions of $350 million to cover WHO’s costs first, which was 44 percent of its Regular Budget for the Biennium.

•Its total costs for the plan were projected at $5.15 billion, to be raised from Members that were already heavily involved in AIDS progamming (UNAIDS; the UN/Accelerated Access Initiative (of which WHO is a founding member); the Global Fund for HIV/AIDS, TB and Malaria; PEPFAR (President Bush’s $15 billion emergency initiative for AIDS); numerous multilateral (World Bank), and bilateral programs (U. S. AID, etc.), and several on- going national efforts, e.g., Brazil, South Africa, Uganda, Botswana, etc.

•Its treatment guidelines were at variance with institutions mentioned in item (3) above, such as waivers on CD4 cell count testing because it was deemed by WHO as too expensive in resource limited settings.

•It subordinated existing drug regulatory standards in favor of its own lesser standards. Of the ARV drugs it had pre-qualified, WHO issued a disclaimer on their safety and efficacy if used in the treatment of HIV/AIDS. Subsequently, WHO had to disqualify most of them due to a lack of proof of their bioequivalency with patented products.

•It abandoned a provision in the UN Universal Declaration of Human Rights: informed consent for items (4 & 5) above.

WHO is already well on its way to missing the projected goal, even though it has taken credit for other ARV treatment programs. In February 2005, WHO reported that some 700,000 AIDS patients were receiving antiretroviral (ARV) treatment. Of this number, approximately 90 percent had either been under treatment prior to the January 2004 launch of the WHO plan, or were being treated by other than WHO-supported efforts.

WHO attempted to implement its plan in competition with several global players in AIDS treatment—even itself via the UN/AAI Program and UNAIDS. It should have been no surprise that income to WHO’s voluntary funds budget dropped by 45 percent in 2004 while it was in the midst of fund raising. Perhaps donors were tapped out. Or perhaps it was WHO’s hubris. However late it had come to the AIDS treatment table, WHO was determined to lead rather than to follow the on-going national plans put in place by its own Members.

A precursor to the difficulties UN agencies have in the conduct of international healthcare services was unveiled in an assessment by the World Bank’s Operation Evaluation Division (OED) in 1999. After reviewing its program experience on 107 health projects, largely funded with the assistance of WHO, OED concluded:

•the Bank does not adequately access borrower capacity to implement planned project activities;

•the Bank’s analysis lacks an adequate assessment of demand for health services;

•the Bank knows little about what it has “bought” with its investments.

On May 20, the Financial Times ran a front page story on a most recent assessment by the OED. This was a re-affirmation of its earlier findings in 1999. The OED’s review of 2005 was based on an analysis of bank projects over the past 15 years. It concluded that the Bank “should focus on promoting economic growth rather than social policies as the route to reducing poverty. It criticized the emphasis placed on health spending. The OED review went further and questioned the bank’s effort, since 2001, to pursue the United Nations’ Millennium Development Goals.”

Following this story, the International Policy Institute (IPN) in London released a study on June 10 2005. It found that “aid has generally failed to achieve its stated goals. Meanwhile, it has undermined democracy and delayed policy reforms that would have benefited the poor … India and China, home to many of the world’s poorest people, have achieved rapid and sustained economic growth despite receiving trivial amounts of aid.”

The G8 meeting in Scotland next month offers a venue to re-examine outmoded development principles. In March, Prime Minister Tony Blair chaired a Report on the Commission for Africa, the center piece for this meeting. It recommends a doubling of aid to Africa, reaching $75 billion annually in new money by 2015, in addition to existing levels of Official Development Assistance (ODA), total debt forgiveness, and a tax of $5 on airline passenger ticket sales. Of the $75 billion, 44 percent is directed towards health-related Millennium Development Goals. Public budgets would be the prime benefactors. And almost all health funds would be consigned under WHO auspices.

Given the World Bank’s OED findings, WHO’s illusionary 3 by 5 plan, the IPN study,and now the UN’s statement that the MDGs will be missed by a wide margin … these should be the markers that point to where the rainbow ends on traditional development aid. In the period 1990 to mid-2005, ODA had allocated more than $1 trillion to developing countries. At least an equal amount has been contributed by foundations, religious organizations, corporations, and private giving. Oil exports from Africa now account for 11 percent of the world’s supply, led by Nigeria with $340 billion in revenues over the past few decades, and Africa’s foreign direct investment has risen sharply to 10.1 percent of GDP in 2004, up from 9 percent in 2003. Yet, despite this allocation of free money, locally generated revenues, and inflows of private capital, Prime Minister Blair found that “African poverty and stagnation is the greatest tragedy of our time.”

The donor community does not lack for money to assist developing countries. It has, though, held its development concepts in amber to the point where, according to the IPN study, “increased aid would not eliminate global poverty … more likely it will do the opposite”. There are some promising signs of a different tack. The African Growth and Opportunity Act, sponsored by the U. S. Congress, has reduced barriers to trade, increased exports, created jobs, and expanded opportunities for Africans and Americans alike. And it also is encouraging African governments to reform their economies. Last year, U. S. exports to sub- Saharan Africa increased by 25 percent, and America’s imports from Africa rose 88 percent.

This is what the Marshall Plan did for Europe: it enabled destitute and devastated nations, whose populations were living in rags, to become competitors in the international marketplace by first creating jobs, economic opportunities and institutions of free societies. South Korea, an international basket case in the 1960s, followed much the same road and it entered the ranks of donor nations in 2000.

The World Bank’s findings are timely, as are those from IPN. The UN’s prediction is a prescient reminder that good can come from international organizations. Development aid should focus on economic growth rather than on social engineering programs--which are of greater benefit to the donors than to the recipients. Aid should be used to create things that are not now in developing countries, rather than to consume things through high transaction costs in developed countries.

Let’s get jobs, economic opportunities and institutions of free societies for people in Africa by collaborating with its nations to develop the enabling environment that will make this possible--and bid a farewell to alms.

Competing interests: None declared