policy - diss 13

REVIEW ARTICLE

The Millennium Development Goals: experiences, achievements and what’s next

Marta Lomazzi1,2*, Bettina Borisch1,2 and Ulrich Laaser1,3

1World Federation of Public Health Associations, c/o IGH/CMU, University of Geneva, Geneva, Switzerland; 2Institute of Global Health, University of Geneva, Geneva, Switzerland; 3Faculty of Health Sciences, University of Bielefeld, Bielefeld, Germany

The Millennium Development Goals (MDGs) are eight international development goals to be achieved

by 2015 addressing poverty, hunger, maternal and child mortality, communicable disease, education, gender

inequality, environmental damage and the global partnership. Most activities worldwide have focused on

maternal and child health and communicable diseases, while less attention has been paid to environmental

sustainability and the development of a global partnership. Up to now, several targets have been at least

partially achieved: hunger reduction is on track, poverty has been reduced by half, living conditions of 200

million deprived people enhanced, maternal and child mortality as well as communicable diseases diminished

and education improved. Nevertheless, some goals will not be met, particularly in the poorest regions, due

to different challenges (e.g. the lack of synergies among the goals, the economic crisis, etc.). The post-2015

agenda is now under discussion. The new targets, whatever they will be called, should reflect today’s political

situation, health and environmental challenges, and an all-inclusive, intersectoral and accountable approach

should be adopted.

Keywords: Millennium Development Goals; sustainable development; equity; education; accountability; governments;

post-2015 agenda

*Correspondence to: Marta Lomazzi, World Federation of Public Health Associations & Institute of Global

Health, University of Geneva, rue Michel Servet 1, CH-1211 Geneva, Switzerland, Email: marta.lomazzi@

unige.ch

This paper is part of the Special Issue Facets of Global Health: Globalisation, Equity, Impact, and Action.

More papers from this issue can be found at http://www.globalhealthaction.net.

Received: 5 September 2013; Revised: 28 November 2013; Accepted: 18 December 2013; Published: 13 February 2014

T he Millennium Development Goals (MDGs) are

the most widely supported and comprehensive

development goals the world has ever established.

These eight goals and 18 targets provide a concrete

framework for tackling poverty, hunger, maternal and

child mortality, communicable disease, education, gender

inequality, environmental damage and the global partner-

ship for development (1) (Table 1).

These targets are both global and local, adapted to each

country to meet specific needs. They provide a framework

for the whole international community to work together

towards a common goal. If these goals are achieved, world

poverty will be reduced by half, millions of lives will be

saved, and billions of people will benefit from the global

economy in a more sustainable environment (2). Further-

more, the MDGs are inter-dependent and largely influence

each other. For example, promoting gender equality and

empowering women enables not only better conditions for

women but also improved household management leading

to better health and education for children and to higher

income for the family.

The MDGs find their origins in development ideas and

campaigns of the 1980s and 1990s; they were officially

established following the Millennium Summit of the

United Nations in 2000, as an output of the United

Nations Millennium Declaration (3). All 189 United

Nations member states agreed to achieve these goals on a

voluntary basis by the year 2015. New global health

initiatives (such as the Global Fund, the World Bank, the

GAVI Alliance, etc.) and increased financial resources

have advanced the opportunity to deliver MDG-related

health programmes worldwide (4).

From 2000 on, important high-level meetings and

summits have been organized to follow up with the

Global Health Action �

Global Health Action 2014. # 2014 Marta Lomazzi et al. This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

1

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695 (page number not for citation purpose)

progress in the MDGs and to define action plans for their

achievement. In 2008, governments, foundations, busi-

nesses groups and civil society announced new commit-

ments to meet the MDGs, during the high-level event at

the UN Headquarters (5). Two years after, the 2010

MDG Summit concluded with the adoption of a global

action plan � Keeping the Promise: United to Achieve the Millennium Development Goals � and announced a number of initiatives against poverty, hunger and disease,

with a special focus on women’s and children’s health (6).

In 2013, participants in the Global MDG Conference

underlined the importance of maintaining the momen-

tum for accelerating progress to 2015, while taking lessons

learned from the MDGs to be used in the development of

the agenda of the next round of goals beyond 2015 (7).

MDGs achievements and failures To assure an appropriate monitoring and evaluation

within and among countries and to conceive suitable

policies and interventions, reliable, timely and interna-

tionally comparable data on the MDG indicators are of

primary importance. They are also essential in encoura-

ging funding and allocating aid effectively (8). Several

methodologies and indicators (Table 2) have been devel-

oped to measure progress towards the MDGs, such as

the MDG indicators website, the UN Data � and the UNICEF Portal (9�11). Moreover, progress towards MDG achievement can be tracked through the MDG

Monitor, both globally and at the country level (12).

Furthermore, there have been numerous consultations

on the MDGs by various organizations. Some of the

consultations and surveys have had an official character

and others should be considered ‘private’ initiatives, by

organizations such as non-governmental organizations

(NGOs) and private foundations (13�18). More than a few official reports have tracked the global assessment

of progress, based on those data (14, 19�21). Although considerable progress has been made, reliable data and

statistics analyses remain poor, especially in many devel-

oping countries (8).

In the last 13 years, the MDGs have managed to focus

world attention and global political consensus on the

needs of the poorest and to achieve a significant change

in the Official Development Assistance (ODA) commit-

ments (22). They have provided a framework allowing

countries to plan their social and economic development

and donors to provide effective support at national and

international level (8). Most activities worldwide have

targeted MDGs 4, 5 and 6, focusing on maternal and

child health (MCH) and communicable diseases, espe-

cially in the developing countries, while fewer initiatives

have focused on MDGs 1, 2, 3 and 7, which are more

difficult to influence (14). Some studies have underlined

regional differences in the importance that is attributed

to specific MDGs. For example, MDGs 4 and 5 have

been considered most important in the African region,

while MDGs 7 and 8 in the Western Pacific Region. Low-

income countries have attached high relevance to MDG1

when compared to high-income countries (14, 23). Arab

countries have not considered MDGs among the top

priority for the policy makers, academia and social actors

in general mainly due to ethnic, religious, political and

social limitations (18).

The most recent UN report on progress towards the

MDGs has highlighted several achievements in all health

and education areas (21): the hunger reduction goal is

on track; the target of decreasing extreme poverty by

half has been met, as well as the goal of halving the

proportion of people who lack steady access to drinking

water; conditions for more than 200 million people living

in favelas have been improved; significant achievements

have been made in the fight against communicable diseases

such as malaria and tuberculosis and child and maternal

mortality have been reduced. Moreover, primary school

admission of girls has equalled that of boys and develop-

ing countries experienced a reduced debt burden and an

improved climate for trade (20, 21, 24, 25).

However, progress has been highly unequal. The

reduction in global income poverty is mainly due to the

rapid growth of a few countries in Asia, such as China,

India, Indonesia and Vietnam. In many other countries,

poverty reduction has been quite slow, or poverty has

even increased (8). Sub-Saharan Africa remains the

most underdeveloped region (8). Projections indicate

that in 2015 more than 600 million people worldwide

will still be using unsafe water sources, almost 1 billion

will be living in very poor conditions, mothers will

continue to die giving birth, and children will die from

preventable diseases. Also, environmental sustainability

remains a global challenge due to a fast decline of bio-

diversity and an increase in gas emissions. The goals of

primary education and gender equality also remain un-

fulfilled, with broad negative consequences, given that

achieving the MDGs deeply relies on education and

women’s empowerment. Moreover, there are severe inequal-

ities that exist among populations, especially between

rural and urban areas, or that affect marginalized people

(20, 21). MDG8 remains one of the most challenging

Table 1. The eight Millennium Development Goals (MDGs)

MDG1 Eradicating extreme poverty and hunger

MDG2 Achieving universal primary education

MDG3 Promoting gender equality and empowering women

MDG4 Reducing child mortality rates

MDG5 Improving maternal health

MDG6 Combating HIV/AIDS, malaria and other diseases

MDG7 Ensuring environmental sustainability

MDG8 Developing a global partnership for development

Marta Lomazzi et al.

2 (page number not for citation purpose)

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695

Table 2. Millennium Development Goals (MDGs) targets and indicators. Adapted from: http://www.unmillenniumproject.org/

goals/gti.htm

MDGs Targets Indicators

MDG1 Target 1. Halve, between 1990 and 2015, the

proportion of people whose income is less than

$1 a day

1. Proportion of population below $1 (1993 PPP) per day

(World Bank)

2. Poverty gap ratio [incidence �depth of poverty] (World Bank)

3. Share of poorest quintile in national consumption

(World Bank)

Target 2. Halve, between 1990 and 2015, the

proportion of people who suffer from hunger

4. Prevalence of underweight children under five years of age

(UNICEF�WHO)

5. Proportion of population below minimum level of dietary

energy consumption (FAO)

MDG2 Target 3. Ensure that, by 2015, children everywhere,

boys and girls alike, will be able to complete a full

course of primary schooling

6. Net enrolment ratio in primary education (UNESCO)

7. Proportion of pupils starting grade 1 who reach grade 5

(UNESCO)

8. Literacy rate of 15�24 year-olds (UNESCO) MDG3 Target 4. Eliminate gender disparity in primary and

secondary education, preferably by 2005, and in all

levels of education no later than 2015

9. Ratio of girls to boys in primary, secondary and tertiary

education (UNESCO)

10. Ratio of literate women to men, 15�24 years old (UNESCO)

11. Share of women in wage employment in the

non-agricultural sector (ILO)

12. Proportion of seats held by women in national parliament

(IPU)

MDG4 Target 5. Reduce by two-thirds, between 1990 and

2015, the under-five mortality rate

13. Under-five mortality rate (UNICEF�WHO)

14. Infant mortality rate (UNICEF�WHO)

15. Proportion of 1 year-old children immunized against

measles (UNICEF�WHO)

MDG5 Target 6. Reduce by three-quarters, between 1990

and 2015, the maternal mortality ratio

16. Maternal mortality ratio (UNICEF�WHO)

17. Proportion of births attended by skilled health personnel

(UNICEF�WHO)

MDG6 Target 7. Have halted by 2015 and begun to reverse

the spread of HIV/AIDS

18. HIV prevalence among pregnant women aged 15�24 years

(UNAIDS�WHO�UNICEF)

19. Condom use rate of the contraceptive prevalence rate

(UN Population Division)

19a. Condom use at last high-risk sex (UNICEF�WHO)

19b. Percentage of population aged 15�24 years with

comprehensive correct knowledge of HIV/AIDS

(UNICEF�WHO)

19c. Contraceptive prevalence rate (UN Population Division)

20. Ratio of school attendance of orphans to school attendance

of non-orphans aged 10�14 years (UNICEF�UNAIDS�WHO)

Target 8. Have halted by 2015 and begun to reverse

the incidence of malaria and other major diseases

21. Prevalence and death rates associated with malaria (WHO)

22. Proportion of population in malaria-risk areas using effective

malaria prevention and treatment measures (UNICEF�WHO)

23. Prevalence and death rates associated with tuberculosis

(WHO)

24. Proportion of tuberculosis cases detected and cured under

DOTS (internationally recommended TB control strategy)

(WHO)

MDG7 Target 9. Integrate the principles of sustainable

development into country policies and programs and

reverse the loss of environmental resources

25. Proportion of land area covered by forest (FAO)

26. Ratio of area protected to maintain biological diversity to

surface area (UNEP�WCMC)

27. Energy use (kg oil equivalent) per $1 GDP (PPP) (TEA, World

Bank)

MDGs: what’s next

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695 3 (page number not for citation purpose)

Table 2 (Continued )

MDGs Targets Indicators

28. Carbon dioxide emissions per capita (UNFCCC, UNSD)

and consumption of ozone-depleting CFCs (ODP tons)

(UNEP-Ozone Secretariat)

29. Proportion of population using solid fuels (WHO)

Target 10. Halve, by 2015, the proportion of people

without sustainable access to safe drinking water and

basic sanitation

30. Proportion of population with sustainable access

to an improved water source, urban and rural (UNICEF�WHO)

31. Proportion of population with access to improved

sanitation, urban and rural (UNICEF�WHO)

Target 11. Have achieved by 2020 a significant

improvement in the lives of at least 100 million slum

dwellers

32. Proportion of households with access to secure tenure

(UN�HABITAT)

MDG8 Target 12. Develop further an open, rule-based,

predictable, non-discriminatory trading and financial

system (includes a commitment to good governance,

development and poverty reduction both nationally

and internationally)

Target 13. Address the special needs of the least

developed countries [includes tariff- and quota-free

access for least developed countries’ exports,

enhanced program of debt relief for heavily indebted

poor countries (HIPCs) and cancellation of official

bilateral debt, and more generous official development

assistance for countries committed to poverty reduction]

Target 14. Address the special needs of landlocked

developing countries and small island developing states

(through the Program of Action for the Sustainable

Development of Small Island Developing States and

22nd General Assembly provisions)

Target 15. Deal comprehensively with the debt

problems of developing countries through national

and international measures in order to make debt

sustainable in the long term

Official development assistance (ODA)

33. Net ODA, total and to LDCs, as percentage of OECD/

Development Assistance Committee (DAC) donors’ gross

national income (GNI)(OECD)

34. Proportion of total bilateral, sector-allocable ODA

of OECD/DAC donors to basic social services (basic education,

primary health care, nutrition, safe water and sanitation)

(OECD)

35. Proportion of bilateral ODA of OECD/DAC donors that is

untied (OECD)

36. ODA received in landlocked developing countries as a

proportion of their GNIs (OECD)

37. ODA received in small island developing States as

proportion of their GNIs (OECD)

Market access

38. Proportion of total developed country imports

(by value and excluding arms) from developing

countries and from LDCs, admitted free of duty (UNCTAD,

WTO, WB)

39. Average tariffs imposed by developed countries on

agricultural products and textiles and clothing from developing

countries (UNCTAD, WTO, WB)

40. Agricultural support estimate for OECD countries as

percentage of their GDP (OECD)

41. Proportion of ODA provided to help build trade capacity

(OECD, WTO)

Debt sustainability

42. Total number of countries that have reached their

Heavily Indebted Poor Countries Initiative (HIPC) decision

points and number that have reached their HIPC completion

points (cumulative) (IMF � World Bank)

43. Debt relief committed under HIPC initiative

(IMF-World Bank)

44. Debt service as a percentage of exports of goods and

services (IMF-World Bank)

Some of the indicators listed below are monitored separately for the least developed countries, Africa, landlocked developing countries

and small island developing states

Target 16. In cooperation with developing countries,

develop and implement strategies for decent and

productive work for youth

45. Unemployment rate of young people aged 15�24 years,

each sex and total (ILO)

Marta Lomazzi et al.

4 (page number not for citation purpose)

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695

even if of primary importance for the achievement of all

MDGs (8).

Discussion on the effectiveness of the MDGs As reported above, a major part of the MDGs has been at

least partially accomplished and many countries are on

the way to achieving the MDGs and trying to adopt a

sustainable path (21). However, in spite of the general

positive outputs, global targets will not be met in some

regions, particularly sub-Saharan Africa and south Asia.

Indeed, MDGs have encountered a range of common

challenges (26).

First, they were not the product of a comprehensive

analysis and prioritization of development needs and

consequently were sometimes too narrowly focused. The

inconsistent progress partly indicates a trend over time to

focus on a subset of specific targets that were easier to

achieve, implement and monitor (26). The untied nature

of many goals has often affected the creation of the

synergies that could arise across these targets and in

particular between education, health, poverty and gender.

Even if acceleration in one goal is likely to improve

progress in others, these synergies are not always evident,

and often vary across countries (26, 27).

Second, this framework has not afforded enough

consideration to the potential impacts on environmental,

social and economic dimensions. Environmental aspects

are addressed under goal 7 but only some topics are

covered, neglecting key issues for sustainable develop-

ment. Most goals focus on the social dimension of

development, e.g. MDGs 1, 2 and 6, addressing social

problems such as hunger, education, equality, MCH and

communicable diseases. However, these goals are also

interconnected with environmental and economic factors.

While some links are recognized (e.g. the importance

of clean drinking water to health), others such as the

maintenance of environmental resources or the quality of

air are not. MDG8 addresses the implementation of

sustainable development but does not consider new forms

of financing, technology and capacity building (28).

Third, the issue of equity has represented one of the

main challenges to face. A gender focus is clear only in

MDGs 3 and 5, while it is missing throughout the other

goals. MDG3 measures gender equality in education,

employment and the proportion of women in national

legislatures. MDG5 focuses on maternal mortality and

access to reproductive health. This limited explicit inclu-

sion in two MDGs is too narrow and clearly indicates

that the gender issue and its dynamics have not yet been

fully understood nor integrated in policy dialogues

(26, 29). Improving equalities will require health system

strengthening, associated with a political and social

engagement to address all forms of discrimination (30).

Fourth, a lack of clear ownership and leadership

internationally and nationally might have partially af-

fected the achievement of the MDGs. Even if different

countries scale up health services and make progress

towards the MDGs at very different rates, we have mainly

observed a trend to a global uniform approach. Rather

than spreading specific technical interventions tested in

one country on large scale, a more specific approach

as well as the adoption of alternative models such as

‘learning by doing’ engaging key stakeholders and taking

advantages from evidence-based data from pilot projects,

might be adopted (26, 31). Furthermore, not only

stakeholders but also public health professionals should

be considered as key actors in the process. Indeed, it has

been shown that understanding of MDGs among public

health professionals was limited (14, 32). This general

lack of information and awareness represents an im-

portant challenge. There is an absolute need for more

elaborate publicity and awareness about the MDGs

among key players if attaining the MDGs is to be a

reality (33).

Fifth, achievement of the MDGs depends much on

the fulfilment of MDG8 on global partnership. In

his preface to the report, UN Secretary General Ban

Ki-moon said, ‘At the just-concluded Rio�20 Confer- ence, commitments were made on an ambitious sustain-

able development agenda. But to keep those pledges

credible, we must deliver on previous commitments. As a

world community, we must make rhetoric a reality and

keep our promises to achieve the MDGs’ (8, 34). As

reported above, almost 200 countries engaged themselves

and provided substantial contributions to the cause.

However, these commitments have not been always fully

Table 2 (Continued )

MDGs Targets Indicators

Target 17. In cooperation with pharmaceutical

companies, provide access to affordable essential

drugs in developing countries

46. Proportion of population with access to affordable essential

drugs on a sustainable basis (WHO)

Target 18. In cooperation with the private sector,

make available the benefits of new technologies,

especially information and communications technologies

47. Telephone lines and cellular subscribers per 100 population

(ITU)

48. Personal computers in use per 100 population and Internet

users per 100 population (ITU)

MDGs: what’s next

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695 5 (page number not for citation purpose)

fulfilled. Engagement by governments (and donors in

general) has been deeply affected by the global econo-

mic and financial crisis that has seriously undermined

progress towards poverty reduction and MDGs achieve-

ment in general, from 2007 on. Furthermore, not only

governments but also the private sector plays an essential

role in the development of the global partnership. Up to

now, more than half of the services used for MDGs have

been provided by private sources and the role of the

private sector is intended to be boosted in the next

period. Thus, it is of primary importance that govern-

ments and the private sector work together to mobilize

more resources to achieve the MDGs and counter the

negative effect that the global financial crisis may have on

the targets attained and future achievements (35, 36).

Those investments should be sustainable over a long

period and predictable, and innovative financing mechan-

isms might be taken in account (30).

Accountability must be an essential part of the frame-

work. A few studies have underlined the problem of

corruption in relation to the use of MDGs resources by

governments and other organizations (14, 18, 37, 38).

A health care system in a corrupt environment is weak

and unstable, and it will be important for the post-2015

period to find solutions to address both the health and

the governance aspects of the development agenda at the

same time. Emerging governance models can allow larger

citizen participation, ownership and influence, as well

as intersectoral action. The participation of civil society

and its accountability is essential for a strong new policy

development and implementation process (30, 39, 40).

Last but not least, goal measurement is often too

narrow, or might not identify a clear means of delivery

(26). A lack of scientifically valid data on some MDGs,

such as MDGs 5 and 6, did not allow the improvement

achieved to be measured adequately or to be compared

with a baseline (41). Government reports have sometimes

been criticized as false and government-driven, leading

to a lack of confidence into the official reporting systems

(14, 18, 37, 38). More and better data are definitely

needed, especially relating to the poorest and most

vulnerable people. However, even the limited data sys-

tems available in some developing countries have allowed

the making of assessable investments in education,

health, essential infrastructure and environment (42).

The post-2015 agenda Despite the positive achievements attained, many see the

health MDGs as ‘unfinished business’. Indeed, MDGs

have not fully addressed the large concept of development

included in the Millennium Declaration, which comprises

human rights, equity, democracy and governance (30).

A post-2015 slowdown must be avoided. The Millennium

Declaration is still valid and the work should be finalized.

To fully address this, the new targets, whatever they will be

called, should follow the new political situation and

include the emerging countries. The framework adopted

for the MDGs should be adapted to today’s needs: new

power, new countries, new groups of the poor and new

partnerships. The notion of good health is progressing,

shifting towards a people-centred approach to create and

preserve good health and well-being rather than prevent-

ing and treating diseases. Health is now a societal issue of

the global community and should be considered as a global

good (43). Health systems should be able to adapt to more

complex expectations and new health and environmental

challenges. New ways are emerging to improve health: new

technologies allow unique access to information and

enable civil society worldwide to be connected and take

part in the decision-making process. In this way, margin-

alized people can also be integrated in the debate (30). A

strong emphasis might be placed on the importance of

learning and sharing knowledge and experiences of best

practices (30).

The post-2015 health agenda should also include

specific sustainable health-related targets as well as take

an all-inclusive approach to preserving people’s health

for the entire lifespan. As a first step, the current MDGs

targets should be achieved and new targets should

be adopted for addressing, e.g. the burden of non-

communicable diseases (NCDs � such as cardiovascular diseases, cancers, chronic respiratory diseases and dia-

betes), sexual education, aging, mental illness and other

emerging health challenges such as human mobility and

refugees (13, 30). Equity and education should be con-

sidered as the base of health and incorporated in all targets.

The links between health and sustainable development

goals (SDGs), as underlined in the Rio � 20 report, need to be strengthened with a rigorous framework and the new

agenda should adopt a social determinant of health

approach (13, 44). Indeed, improving people’s health and

quality of life cannot be achieved by focusing only on the

health sector, but requires action to address the wider

socioeconomic issues that influence how people live and

get sick, including risk factors, services availability and

accessibility, etc. These conditions depend on the distribu-

tion of resources and power at local and global levels.

An integrated ‘health-in-all-policies’ approach involving

different sectors linked to governance, environment, edu-

cation, employment, social security, food, housing, water,

transport and energy are necessary in order to address the

complexity of health inequities (30, 45�47). Global health diplomacy is nowadays focusing on the development of

such a framework, thus incorporating health as a part of all

policies or, on the other hand, starting from health to drive

policies to protect national security, free trade and

economic advancement. Health should be perceived as

an investment and not only as a cost (44, 48).

Accountability remains of primary importance. On

one hand, better data will be required to allow transpar-

Marta Lomazzi et al.

6 (page number not for citation purpose)

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695

ency, proper evaluation and improvements. On the other

hand, governments’ engagement and partnership dyna-

mics between all actors should be improved and adapted

to the new socio-political context.

The north�south division is no longer applicable; NCDs such as obesity are affecting all, independently

of their country income, with a negative impact not only

on human well-being but also on national productivity.

Any future health goal must be universally relevant;

however, targets and indicators must be adaptable to a

country’s health priorities and needs and regional differ-

ences should be considered (14, 30).

The role of governments internationally and at the

local level, including in areas such as health workforce

recruitment and supply and production of products for

health (e.g. vaccines), should be improved. On one side,

low and lower-middle income countries (23) should be

able to mobilize local resources and improve in-country

productivity as well as bring innovations and solutions

that are more suitable for emerging countries. On the

other side, rich countries should contribute more to the

UN system. MDGs were agreed on a voluntary base by

governments; the new goals should be norms for global

governance and to reinforce the concept of the ‘right to

health’. These targets should be global social contracts

between governances and societies, and the concept of

social responsibility, lacking for the MDGs, should be

included.

A more efficient partnership among the different

agencies could be envisaged, reducing to a few effective

organizations the numbers of agencies involved. The

dynamic between the actors should change: public�private partnerships are assuming more and more importance.

The private for-profit (commercial companies) and not-

for-profit [e.g. Bill and Melinda Gates Foundation (49)]

sector is the only one that can afford the huge cost

associated with this framework: no country, even the

very rich, can replace this role. Moreover, the private

sector should not be considered only as a donor but be

embedded in the path, taking advantages of the capabilities

offered by the sector.

The new goals: picking and choosing Everyone who has a cause wants a goal: however, to

be successful the new goals should be limited to a few.

Moreover, we are experiencing a sort of ‘goals anxiety’

due to a spasmodic search for fast-defined, effective and

universal goals able to include all major issues. A careful

consideration of all aspects in the due time would most

probably lead to better definition of the goals.

Most of the discussions are focusing on two types of

comprehensive goals for health: universal health coverage

(UHC) and healthy life expectancy (HALE).

UHC and access could represent a successful model

to achieve health goals and improve people’s health at

large (30). Margaret Chan, Director General of the WHO,

has stated that ‘Universal Health Coverage is the single

most powerful concept that public health has to offer’ and

the Rio � 20 conference recognized that UHC has the potential to reduce inequalities, improve economic growth

and strengthen social organization (50). To achieve UHC,

health services and infrastructures as well as coverage

with financial risk protection should be guaranteed to

everyone (51).

Maximizing HALE could be the other health goal. To

achieve this aim, we should be able to ensure that people

not only survive but enjoy good health throughout their

lifespan (46, 51).

Both goals are linked and interconnected: an increase

in HALE can be measured as an indicator and out-

come of progress towards UHC and the UHC can be

considered as the mechanism to improve HALE (51).

Both UHC and HALE are interesting targets but their

measurement will be challenging.

Debates about post-MDG targets and linkages with

SDGs are now on going with in-country and thematic

consultations, including, e.g. a UN Task Team, a post-

2015 high-level panel established by the UN Secretary

General, society consultations through social media,

an Open Working Group provided by the UNSG in

consultation with governments, etc. (44, 52�54). Regardless of which overarching targets will be

selected, the goals must be translated into measurable

indicators; accountability and regular reviews of progress

should be easy to perform, to share and to be understood

by governments and the general public (13). A multi-

sectoral approach will be essential, integrating the social

determinants of health and with a main focus on equity,

education and poverty reduction.

Summary and conclusions The MDGs have focused world attention on the needs of

the poorest and driven countries and donors commit-

ments to the achievement of common goals.

Even if a major part of the MDGs has been at

least partially accomplished, many see the MDGs as

‘unfinished business’. A post-2015 slowdown must be

prevented. A new round of goals is now under definition,

aiming at fully addressing the large concept of sustainable

development included in the Millennium Declaration.

A new framework, an intersectoral approach and strong

commitments by governments and donors would be of

primary importance to define effective goals and translate

them into reality.

Conflict of interest and funding

The authors have not received any funding or benefits from

industry or elsewhere to conduct this study.

MDGs: what’s next

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695 7 (page number not for citation purpose)

References

1. United Nations (2000). Official list of MDG indicators.

Available from: www.mdgs.un.org/unsd/mdg/Host.aspx?Content� Indicators/OfficialList.htm [cited 14 April 2013].

2. United Nations Development Programme (UNDP) (2013).

MDG strategies. Available from: http://www.undp.org/content/

undp/en/home/ourwork/povertyreduction/focus_areas/focus_mdg_

strategies/ [cited 10 April 2013].

3. United Nations (2000). Resolution adopted by the General

Assembly. 55/2. United Nations Millennium Declaration.

New York: United Nations.

4. Ravishankar N, Gubbins P, Cooley RJ, Leach-Kemon K,

Michaud CM, Jamison DT, et al. Financing of global health:

tracking development assistance for health from 1990 to 2007.

Lancet 2009; 373: 2113�24. 5. United Nations (2008). Commitments for achieving the Millen-

nium Development Goals. High-level event. Available from:

http://www.un.org/millenniumgoals/2008highlevel/commitments.

shtml [cited 10 April 2013].

6. United Nations (2010). Keeping the promise: united to

achieve the Millennium Development Goals. New York: United

Nations.

7. United Nations Development Programme. 2013 Global

MDG Conference. Making the MDGs work; 2013. Available

from: http://www.undp.org/content/undp/en/home/presscenter/

events/2013/february/27-28-february--making-the-mdgs-work.html

[cited 10 April 2013].

8. Bourguignon F, Bénassy-Quéré A, Dercon S, Estache A,

Gunning JW, Ravikanbur R. Millennium Development Goals

at midpoint: where do we stand and where do we need to go?

Brussels: European Commission; 2008.

9. United Nations. MDG indicators. The official site for the MDG

indicators. Available from: http://unstats.un.org/unsd/mdg/

[cited 12 April 2013].

10. United Nations (2013). UNdata. A World of information.

Available from: http://data.un.org [cited 12 April 2013].

11. UNICEF (2012). UNICEF statistics and monitoring.

Millennium Development Goals (MDG) monitoring. Available

from: http://www.unicef.org/statistics/index_24304.html [cited

13 April 2013].

12. United Nations (2007). MDG monitor. Track, learn, support.

Available from: http://www.mdgmonitor.org/aboutMDG.cfm

[cited 15 April 2013].

13. World Health Organization (2013). Health in the post-2015 UN

development agenda. Available from: http://www.who.int/topics/

millennium_development_goals/post2015/en/index.html [cited 21

March 2013].

14. Lomazzi M, Theisling M, Tapia L, Borisch B, Laaser U.

MDGs � a public health professional’s perspective from 71 countries. J Public Health Policy 2013; 34: e1�e22.

15. PROCOSI (2013). Civil society consultation on health in

the post-2015 development agenda � final report. Available from: http://www.worldwewant2015.org/node/313416 [cited 16

December 2013].

16. World Health Organization (2012). Informal member state

consultation on health in the post 2015 development agenda � summary report. Available from: http://www.who.int/topics/

millennium_development_goals/post2015/summary_informal_

consultation_memberstates_20121214.pdf [cited 22 March 2013].

17. MyWorld 2015. My world � the United Nations Survey for a better world. Available from: http://www.myworld2015.org/

[cited 16 December 2013].

18. Mahjoub A, Halim MMA, al Khouri R. Assessing the

Millennium Development Goals process in the Arab region �

a survey of key issues; 2010. Available from: http://www.annd.org/

english/data/publications/pdf/21.pdf [cited 16 December 2013].

19. United Nations (2009). The Millennium Development

Goals report 2009. New York: United Nations.

20. United Nations (2012). The Millennium Development Goals

report 2012. New York: United Nations.

21. United Nations (2013). The Millennium Development Goals

report 2013. New York: United Nations.

22. United Nations (2012). Official development assistance.

Available from: http://iif.un.org/millennium-development-goals/

official-development-assistance-oda [cited 25 April 2013].

23. World Bank. Gross National Income according to the

World Bank indicators, 2013. Available from: http://wdronline.

worldbank.org/worldbank/a/incomelevel [cited 8 May 2013].

24. Lozano R, Wang HD, Foreman KJ, Rajaratnam JK, Naghavi

M, Marcus JR, et al. Progress towards Millennium Develop-

ment Goals 4 and 5 on maternal and child mortality: an

updated systematic analysis. Lancet 2011; 378: 1139�65. 25. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang MR,

Makela SM, et al. Maternal mortality for 181 countries,

1980�2008: a systematic analysis of progress towards Millen- nium Development Goal 5. Lancet 2010; 375: 1609�23.

26. Waage J, Banerji R, Campbell O, Chirwa E, Collender G,

Dieltiens V, et al. The Millennium Development Goals: a cross-

sectoral analysis and principles for goal setting after 2015

Lancet and London International Development Centre Com-

mission. Lancet 2010; 376: 991�1023. 27. LoBue MC, Kaluse S. Identifying synergies and complementa-

rities between MDGs: results from cluster analysis. Soc Indicat

Res 2013; 113(2): 647�70. DOI: 10.1007/s11205-013-0294-y. 28. UN System Task Team. Building on the MDGs to bring

sustainable development to the post-2015 development agenda.

Thematic Think Piece; 2012. Available from: http://www.un.org/

millenniumgoals/pdf/Think Pieces/17_sustainable_development.

pdf [cited 4 August 2013].

29. Jones N, Holmes R, Espey J. Gender and the MDGs: a gender

lens is vital for pro-poor results. ODI Briefing Paper 42.

London: ODI; 2008.

30. TheWorldWeWant. Health in the post-2015 agenda. Report of

the Global Thematic Consultation on Health, 2013. Available

from: http://www.worldwewant2015.org/file/337378/download/

366802 [cited 16 December 2013].

31. Subramanian S, Naimoli J, Matsubayashi T, Peters DH. Do we

have the right models for scaling up health services to achieve

the Millennium Development Goals? BMC Health Serv Res

2011; 11: 336.

32. Pogge TW. World poverty and human rights. London: Wiley,

John & Sons; 2002, p. 284.

33. Adegboye OA, Adeboye MA, Yahaya-Kongoila, Erinle SA,

Nwachukwu ND, Salawu FK, et al. Millennium Development

Goals*Knowledge and attainability as perceived by doctors: a case study. Niger J Clin Pract 2011; 14: 318�21.

34. Gaffikin L, Ashley J, Blumenthal PD. Poverty reduction and

Millennium Development Goals: recognizing population,

health, and environment linkages in rural Madagascar. Med

Gen Med 2007; 9: 17.

35. WorldBank (2009). Global monitoring report 2009 � a devel- opment emergency. Washington, DC: WorldBank.

36. United Nations Development Programme (2010). Active macro-

economic policy for accelerating achievement for the MDG

targets. New York: United Nations Development Programme.

37. Anti-Corruption Research Network. Corruption and the

MDGs; 2013. Available from: http://corruptionresearchnetwork.

org/resources/frontpage-articles/corruption-as-an-obstacle-to-

achieving-the-millennium-development-goals [cited 29 April

2013].

Marta Lomazzi et al.

8 (page number not for citation purpose)

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695

38. Pieth M. Collective action: innovative strategies to prevent corrup-

tion, in Dike Verlag AG, 2012. Available from: http://www.

baselgovernance.org/big/news-single-view/archive/2012/october/

article/mark-pieth-ed-collective-action-innovative-strategies-to-

prevent-corruption/?tx_ttnews[backPid]�323&cHash�6cb8592462 [cited 16 December 2013].

39. Chopra M, Lawn JE, Sanders D, Barron P, Abdool Karim SS,

Bradshaw D, et al. Achieving the health Millennium Develop-

ment Goals for South Africa: challenges and priorities. Lancet

2009; 374: 1023�31. 40. People’s Health Movement (2012). Health in the post-2015 devel-

opment agenda. Available from: http://www.phmovement.org/sites/

www.phmovement.org/files/PHM statement submitted to the

WHO.pdf [cited 22 March 2013].

41. Attaran A. An immeasurable crisis? A criticism of the Millen-

nium Development Goals and why they cannot be measured.

PLoS Med. 2005; 2: e318.

42. McArthur JW, Sachs JD, Schmidt-Traub G. Response to Amir

Attaran. PLoS Med 2005; 2: 379.

43. Smith R, Beaglehole R, Woodward D, Drager N, editors.

Global Public Goods for Health: health economics and public

health perspectives. Oxford: Oxford University Press; 2003.

44. United Nations (2013). Health in the post-2015 development

agenda: need for a social determinants of health approach � joint statement of the UN Platform on Social Determinants

of Health. Available from: http://www.who.int/entity/social_

determinants/advocacy/UN_Platform_FINAL.pdf [cited 4

August 2013].

45. Shaikh BT. Marching toward the Millennium Development

Goals: what about health systems, health-seeking behaviours

and health service utilization in Pakistan? World Health Popul

2008; 10: 16�24. 46. Boerma T, Chopra M, Creo C, El-Halabi S, Lindgren-Garcia J,

Moeti T, et al. What do people want for health in the post-

agenda? Lancet 2013; 381: 1441�3. 47. Pronyk PM, Muniz M, Nemser B, Somers MA, McClellan

L, Palm CA, et al. The effect of an integrated multisector

model for achieving the Millennium Development Goals and

improving child survival in rural sub-Saharan Africa: a non-

randomised controlled assessment. Lancet 2012; 379: 2179�88. 48. Kickbusch I, Novotny TE, Drager N, Silberschmidt G, Alcazar

S. Global health diplomacy: training across disciplines; 2013.

Available from: http://www.who.int/bulletin/volumes/85/12/07-

045856/en/ [cited 7 May 2013].

49. Bill and Melinda Gates Foundation. 2013. Available from:

http://www.gatesfoundation.org/ [cited 7 May 2013].

50. Evans DB, Marten R, Etienne C. Universal health coverage is a

development issue. Lancet 2012; 380: 864�5. 51. World Health Organization (2012). Positioning health in

the post-2015 development agenda � WHO discussion paper. Available from: http://www.who.int/topics/millennium_

development_goals/post2015/WHOdiscussionpaper_October

2012.pdf [cited 4 August 2013].

52. WorldWeWant (2013). The World we want. Available from:

http://www.worldwewant2015.org/ [cited 26 April 2013].

53. Post2015.org (2013). What comes after the MDGs? Available

from: http://post2015.org/ [cited 26 April 2013].

54. United Nations (2013). Beyond 2015. Available from: http://

www.un.org/millenniumgoals/beyond2015-overview.shtml [cited

26 April 2013].

MDGs: what’s next

Citation: Glob Health Action 2014, 7: 23695 - http://dx.doi.org/10.3402/gha.v7.23695 9 (page number not for citation purpose)