No Goals at Half-time

MDG 2, the achievement of universal primary education, has a target of ensuring that by 2015 children everywhere will be able to complete a full course of primary schooling. Net enrolment ratios have increased, with notable regional increases in sub-Saharan Africa and South and West Asia. However, regional ratios disguise wide variations between countries. National ratios disguise variations in enrolment patterns across the grades of primary education and in the enrolment by grade patterns by income group, gender and location. Many educational challenges remain, not least the provision of 18 million additional teachers if the 2015 goals are to be reached. This presentation underlines the inter-relations between the MDGs. It concludes by asking whether global partnerships are adequate to the task of providing integrated, horizontally coordinated and simultaneous action across sectors at the points where it is most needed - children, households and communities.

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The intensity of international efforts to reduce child mortality has varied since global child mortality data became available. During the 1980s UNICEF spearheaded a “Child Survival Revolution” focused on simple, mainly vertical, interventions, yet in the 1990s interest waned as UNICEF focused on other issues and child survival seemed to disappear from WHO’s agenda. The MDGs have given renewed energy to the child survival movement, especially MDG4’s target to reduce under-five mortality by two-thirds. This is meant to be a global and regional goal, not a country-level goal. It may be particularly unfair for Africa, which starts from a much higher baseline. There is an irresistible trend with donors towards country-level vertical strategies and the inevitable result is growing inequity in child survival. Like all quantitative goals, the MDGs are likely to lead to distortions in reported data, particularly in the neonatal mortality field, where existing data are notoriously unreliable.

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Progress is being made to achieve the targets for MDG 6 but there is more work to be done. Global trends for HIV show that the epidemic is beginning to plateau but the need for treatment and prevention continues to outpace current interventions. Malaria interventions with bed-nets and appropriate anti-malarial treatment for children under five are making inroads into reducing deaths. The global incidence of tuberculosis (TB) is levelling off but TB control strategies (DOTS) will need to be accelerated in sub-Saharan Africa and the Commonwealth of Independent States (CIS) if the global targets are to be achieved by 2015. Important themes of poverty, health systems and inter-sectoral collaboration are emerging as foci for future approaches to communicable disease control strategies. These interlinking themes will help to relate each of the MDGs to the overall goal of improving health worldwide.