Country processes

Every country's MDG-based poverty reduction strategy needs to outline the specific and practical steps required to reach the Goals. Fortunately, these steps are known. For example, we know how to prevent mothers from dying in pregnancy and childbirth. We know how to encourage girls to enroll in and complete a full cycle of basic education. We know how to triple African maize yields. We know how to provide rural clinics and hospitals with uninterrupted electricity. And we know how to increase tree coverage in deforested areas. The same is true for the other Goals as well. The task forces of the UN Millennium Project describe these proven investments and policies in considerable detail in their reports, essential accompaniments to this report.

At first glance the list of what is needed may seem long. Fighting hunger, for example, requires training farmers, providing fertilizer, improving roads and transport services, managing water resources more effectively, providing good nutrition, and many other things. There are comparable lists for health, education, water, sanitation, environmental management, and other areas of concern. Implementing the full set of interventions and policies will take time and work across many sectors. Fortunately, we have 10 years to reach the Goals. This is enough time for most countries, if not all. But we need to get started in 2005.

It is possible for developing countries to start implementing some elements of this package immediately and to see breathtaking results within three or fewer years. Although far from comprehensive, some Quick Wins could bring vital gains in well-being to millions of people and start countries on the path to the Goals. With adequate resources, the Quick Wins include:

• Eliminating school and uniform fees to ensure that all children, especially girls, are not out of school because of their families' poverty. Lost revenues should be replaced with more equitable and efficient sources of finance, including donor assistance.
• Providing impoverished farmers in Sub-Saharan Africa with affordable replenishments of soil nitrogen and other soil nutrients.
• Providing free school meals for all children using locally produced foods with take-home rations.
• Designing community nutrition programs that support breastfeeding, provide access to locally produced complementary foods and, where needed, provide micronutrient (especially zinc and vitamin A) supplementation for pregnant and lactating women and children under five.
• Providing regular annual deworming to all schoolchildren in affected areas to improve health and educational outcomes.
• Training large numbers of village workers in health, farming, and infrastructure (in one-year programs) to ensure basic expertise and services in rural communities.
• Distributing free, long-lasting, insecticide-treated bed-nets to all children in malaria-endemic zones to cut decisively the burden of malaria.
• Eliminating user fees for basic health services in all developing countries, financed by increased domestic and donor resources for health.
• Expanding access to sexual and reproductive health information and services, including family planning and contraceptive information and services, and closing existing funding gaps for supplies and logistics.
• Expanding the use of proven effective drug combinations for AIDS, tuberculosis, and malaria. For AIDS, this includes successfully completing the 3 by 5 initiative to bring antiretrovirals to 3 million people by 2005.
• Setting up funding to finance community-based slum upgrading and earmark idle public land for low-cost housing.
• Providing access to electricity, water, sanitation, and the Internet for all hospitals, schools, and other social service institutions using off-grid diesel generators, solar panels, or other appropriate technologies.
• Reforming and enforcing legislation guaranteeing women and girls property and inheritance rights.
• Launching national campaigns to reduce violence against women.
• Establishing, in each country, an office of science advisor to the president or prime minister to consolidate the role of science in national policymaking.
• Empowering women to play a central role in formulating and monitoring MDG-based poverty reduction strategies and other critical policy reform processes, particularly at the level of local governments.
• Providing community-level support to plant trees to provide soil nutrients, fuelwood, shade, fodder, watershed protection, windbreak, and timber.

These Quick Wins are not the only interventions needed to reach the Goals—just the ones with very high potential short-term impact that can be immediately implemented. Other interventions are more complicated and will take a decade of effort or have delayed benefits. The world cannot afford to let another year go by without investing in these simple and proven strategies.

The Quick Wins need to be embedded in the longer term investment policy framework of the MDG-based poverty reduction strategy. The UN Millennium Project has identified “best practices” in seven investment-and-policy clusters that are key to achieving the Goals. The UN Millennium Project has also produced a companion Handbook of Best Practices to Meet the Millennium Development Goals Here are the seven main investment-and-policy clusters.

Smallholder farmers and their families constitute perhaps half of the world's people living with chronic hunger, and an even larger share in Sub-Saharan Africa. These farmers often do not have access to soil nutrient replenishment, such as chemical fertilizers ( map 5 ) and agroforestry techniques. Their yields are therefore dramatically reduced. We recommend raising their productivity through a “Twenty-first Century African Green Revolution” to supply them with soil nutrients and related technologies. Investments are also needed to increase rural access to transport, information and communications, safe drinking water, sanitation, modern energy, and reliable water for agriculture and agriculture-related small and medium-size enterprises. All this can—and should—be done in an environmentally sustainable manner.

Map 5: Fertilizer consumption, 2001

The package of interventions should include improving the security of tenure for slum dwellers, supporting poor people's own efforts to build decent new housing, strengthening urban planning with strong community and especially women's participation, expanding core urban infrastructure services, reducing the pollution of air and water, and promoting special investment zones to attract private companies and promote indigenous enterprises. A central focus should be to strengthen the operational capacity of local governments, nongovernmental organizations (NGOs), women's organizations, and other civil society groups, and to include them in the formulation of relevant national policies.

Map 6: Physicians per 1,000 people

Health interventions are best provided through an integrated district health system centered on primary care and first-level referral hospitals with special measures to ensure that the health system reaches all groups in the population, including the poor and marginalized. The number of doctors and the coverage of antiretroviral treatment for HIV/AIDS are exceedingly low in the places most affected by endemic diseases ( maps 6 and 7 ). Practical investments and policies for a functioning health system include training and retaining competent, motivated health workers, strengthening management systems, providing adequate supplies of essential drugs, and building clinics and laboratory facilities. Eliminating user fees for essential health services, -improving -community health education, promoting behavior change, and involving communities in decisionmaking and service delivery are also critical measures. There is increasing international consensus, for example, that community workers should be trained to recognize and treat diarrhea, pneumonia, and malaria in children. Effective planning and management of district-level health systems requires an integrated monitoring, surveillance, and evaluation system.

Map 7: Antiretroviral drug coverage

Governments should ensure that every child, boy or girl, completes basic schooling of good quality, that a substantial proportion also completes postprimary education, and that a significant number are enrolled in tertiary education by 2015. In many countries, this will require political transformation to support an inclusive and egalitarian society and changes in the institutional and political incentives that now undermine the performance of school systems. As a start, governments should create and reinforce rules and rights that enable parents and communities to hold their local schools -accountable; improve the content, quality, mode of delivery, and relevance of curricula while eliminating gender biases; build schools and train teachers where necessary; eliminate primary school fees; and institute special incentives to reach vulnerable out-of-school children. Governments should also recognize civil society organizations as legitimate partners in debates about the education system.

Specific interventions to address gender inequality should be an intrinsic part of all MDG-based investment packages. They should also address systemic challenges such as protection of sexual and reproductive health and rights (including access to information and family planning services), equal access to economic assets such as land and housing, increased primary school completion and expanded access to postprimary education for girls, equal labor market opportunities, freedom from violence, and increased representation at all levels of governance. One essential step to addressing these systemic challenges is the collection of gender-disaggregated data for monitoring progress.

Countries should integrate environmental strategies into all sector policies, promote direct investments in environmental management, promote regulatory and market reforms to reduce environmental degradation, and improve environmental monitoring. In each of these intervention areas, countries will need to consider their growing need to adapt to climate change. Examples of direct investments in environmental management are replanting forests, treating wastewater, curbing chemical pollution, and conserving critical ecosystems. Well designed sector strategies, including agriculture and infrastructure services, can use strategic impact assessments to minimize negative environmental tradeoffs. The removal of environmentally damaging subsidies can further improve environmental management.

Sustainable MDG-based strategies require the buildup of indigenous institutions and skills to advance science, technology, and innovation. Practical measures to increase a country's scientific capacity include creating science advisory bodies to the national government, expanding science and engineering faculties in universities and polytechnics, strengthening development and entrepreneurial focus in science and technology curricula, promoting business opportunities in science and technology, and promoting infrastructure development as a technology learning process.

Each investment cluster depends on the others. To achieve any particular Goal, it is not enough to invest merely in the corresponding sector 3 . -Conversely, most interventions have effects on several Goals. For example, reducing gender inequality is essential for reducing hunger, containing HIV/AIDS, promoting environmental sustainability, upgrading slums, and reducing child and infant mortality. Ready access to clean water, electricity, and modern cooking and heating fuels are essential for ensuring that clinics and hospitals function, for reducing women's and girls' time burdens so that they can engage in productive economic activity and attend school, and so forth. Reaching the Millennium Development Goals thus depends on ambitious action across many sectors. This point must be kept in mind when evaluating MDG priorities in any country or region (box 5).