Helping the World's Poor

September 13, 2005
Wall Street Journal
http://online.wsj.com/article/0,,SB112656556206738622,00.html
The so-called Millennium Development Goals for helping the planet's poorest will be among the topics of discussion at the U.N. summit that begins tomorrow in New York. In recent weeks, the Bush Administration has come under media fire for suggesting some sensible revisions, such as requiring more accountability from countries on the receiving end of international assistance (imagine that).
But according to an article by Amir Attaran in the October issue of PLoS Medicine, a public health journal, the MDG program has much more fundamental problems that the U.S. might take into account before succumbing to mounting pressure to increase aid.
The MDGs -- which target poverty, hunger, infectious disease and other problems in the developing world -- were drafted in 2000 to great fanfare. Yet five years on, writes Mr. Attaran, a professor at the University of Ottawa who specializes in population health and global development policy, many of the most important MDGs, including those to reduce malaria, maternal mortality, or tuberculosis (TB), suffer from a worrying lack of scientifically valid data.
The article goes on to say that while progress on each of these goals is portrayed in measurable terms, often the subject matter is so immeasurable, or the measurements are so inadequate, that one cannot know the baseline condition before the MDGs, or know if the desired trend of improvement is actually occurring.
Perhaps even more disturbing, however, is Mr. Attaran's revelation that U.N. scientists know about these troubles and that the necessary corrective steps are being held up by political interference, including the organization's senior leadership, who have ordered delays to amendments that could repair the MDGs. Anticipating this week's summit, a September 2004 memo from U.N. Deputy Secretary General Louise Frechette actually instructed U.N. scientists in charge of MDG statistics to downplay the measurement problems until after the summit because any changes at this stage would only distract from the result that we would like to achieve. That result, of course, is more money from wealthy nations with no questions asked.
Other U.N. health outfits have demonstrated a similar inability to measure progress, or the lack thereof. The World Health Organization launched its Roll Back Malaria program in 1998 with the goal of halving the number of malaria deaths by 2010. Seven years into the effort, WHO is claiming it's too early to tell if they're on track to meet the goal.
Defenders of the U.N., such as Columbia University's Jeffrey Sachs, accuse the organization's critics of being stingy and irresponsible. But the U.S. government's real responsibility is to make sure tax dollars are put to wise use. U.S. development aid has increased 90% since President Bush took office, and as the world's largest donor it has every right to demand that the U.N. be held accountable for making promises that aren't objectively verifiable.
Health goals that can't be measured, said Mr. Attaran in a recent interview, should be abandoned in favor of alternative approaches. Because serial guessing isn't helping poor people. If we set quantitative goals, then we ought to be concerned enough to actually quantitate.
If the U.N. and its supporters are serious about the Millennium Development Goals, and U.S. support in pursuing them, they should stop equating criticism of U.N. methods with criticism of its motives. U.N. reform is a better use of their energies this week. And the establishment of an auditor general or some other independent body responsible for commissioning and publishing performance reviews is a good place to start.