Delegates gathering in New York this week to discuss progress on Millennium Development Goals (MDGs) that were agreed in 2000 will hear calls for redoubling efforts to meet the 2015 targets, given evidence that many countries, including Uganda, are not ‘on track.’
Uganda has made significant progress in raising its citizens above the dollar-a-day poverty line. In 1992, more than half of Ugandans lived below that line. Now the proportion is less than a third (of a much larger population) and this is expected to fall to a quarter by 2015, aided by a ‘stability dividend’ in the North. There is a good chance that Uganda will meet the MDG target of halving income poverty by 2015 (from a 1990 baseline).
Other goals require the provision of affordable and accessible services, and here the picture is less rosy. Despite the introduction of Universal Primary Education, and the fact that the great majority of Ugandan children are now enrolling, only slightly over half stay the course and complete. There are signs, too, of slippage in Aids prevention, where Uganda was once considered a beacon of good practice.
Much attention in New York will, rightly, focus on maternal and child mortality, where many countries, are off track. The latest available figures (2006) suggest that in Uganda as a whole 137 children per 1,000 die before their fifth birthday and, for every 100,000 births, 435 women die from complications in pregnancy or childbirth. These are aggregate figures; in poor, rural areas actual death rates are higher, and there seems to be little prospect of Uganda cutting the rates to 56 and 131 respectively by 2015, in line with the MDGs.
This is despite the fact that, many practitioners argue, the ‘technology’ of improving mother and child health is well known—bringing appropriate “care closer to women and women closer to care,” as Dr Naamala Hanifa Sengendo of Save the Children puts it—and that Uganda has piloted an apparently successful regional programme in Soroti to do precisely this. Showing what can and needs to be done has not yet sufficed to turn around Uganda’s ailing public health system. Why not?
Corruption and casual looting of donor funds are certainly part of the answer, but only a part.
Formulation of the MDGs marked a significant departure from the neoliberal structural adjustment era, when ‘the market’ was vaunted as the real champion of development, and GDP growth assumed to be a tide that would lift all boats. The MDGs were a ‘results oriented’ return to basics: or, rather, a way of underlining that ‘development’ should not just be about wealth creation for the few, but about tangible benefits for the whole population.
Yet these lofty ideals are not easy to harmonise with actual, and invariably messy, development processes. Growth drivers, such as regional economic integration, trade and investment, are stimulating primary wealth accumulation and the growth of a ‘middle class’ (which is not really in the middle at all, but very near the top). Growth also brings deep contests for control of national assets—pre-eminently, in Uganda, land—with much of the political class engaged in a fight around the trough. This is not mere ‘corruption,’ it is something deeper, closer to a ‘robber baron’ stage of development, in which the rural poor have to take a rain check on decent public services until the tax base is solid enough, and the political class willing, to support modest redistribution.
This is no reason to abandon the MDGs. On the contrary, with Uganda likely to see oil revenues coming onstream by around 2015 (and with international aid perhaps declining proportionately) it is even more important to find ways of balancing private wealth accumulation with social services and safety nets. This is to some extent a ‘technical’ issue; but more fundamentally it is one of social justice, and it must be addressed to ensure future stability.
Mr Young is a British writer on development issues, currently based in Kampala