Editor’s Note: The following is the last in a series of articles reviewing the progress and challenges in reaching the United Nations Development Goals. You can find all the articles in this series here. Thank you to all our authors.
Develop a global partnership for development. This can mean so many things, but I understand Millennium Development Goal #8 to suggest that developing countries ought not to be left alone to alleviate poverty in their countries. Partnerships for development can offer the scale to make an idea, project, or action compelling. Partnerships can provide capacity-building support and lend credibility to an initiative. Partnerships can offer hope and help for countries working to alleviate poverty.
I spent much of 2008 living in Liberia as a volunteer with the Clinton Health Access Initiative (CHAI). CHAI’s approach to global health and development is partnership-based, in that it establishes a presence in a country upon receiving an invitation from the host government. CHAI serves at the pleasure of the head of state, and works closely with its Ministry of Health to achieve that country’s health access goals.
CHAI’s early success stemmed from its efforts related to MDG #8, Target 8.F: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries. Prior to 2003, pharmaceutical companies’ production and sales of antiretroviral medicines (ARVs) followed a model of low volume, high price. The relative few who could afford the HIV medicine paid a lot for it. As a result, most people living with HIV in the developing world were unable to access treatment. CHAI convinced pharmaceutical companies that there was a significant market opportunity in the developing world, and that the firms would benefit were they to convert to a model of high volume, low price. In October of 2003, President Clinton announced a 50% price reduction in first line drug regimens, after CHAI negotiated this deal with generic drug companies. Also in 2003, the U.S. Government committed $15 billion to HIV treatment, prevention, and care programs globally. In 2008, another $48 billion was authorized for the second five year cycle of the program. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest commitment by any one nation to combat a specific disease, and, among other goals, it aims to work in partnership with donors and recipient countries to reduce the cost of ARVs. By the end of 2010, 6.6 million people in the developing world were receiving antiretroviral treatment, as compared to just 200,000 seven years earlier, although 7.6 million people remain in need of treatment today.
While price is an important first step, Target 8.F’s access to affordable, essential drugs does not encompass price alone. Individuals must be able to receive treatment, and in countries with poor infrastructure, challenged health systems, and few health professionals, this is not an easy feat. Partnerships for development must be structured to address these factors and more. In 2007, the Liberian Ministry of Health and Social Welfare issued its National Health Policy and Plan, which outlined the country’s health priorities and goals for achieving them. The Plan defined and standardized the health services that the Ministry committed to providing every Liberian citizen and empowered its counties to manage health care delivery locally. One example of this is the rebuilding of County Health Teams, professionals who provide local health services and access to care and treatment.
2003 marked the end of Liberia’s prolonged civil war, throughout which the country’s leaders emptied the national coffers and sunk the country into extreme debt. Target 8.D reminds us that poverty alleviation is a particular challenge for those countries with financial burdens: Deal comprehensively with developing countries’ debt. In recent years, Liberia’s debt burden was forgiven by virtue of a multilateral partnership for development. The IMF and World Bank established the Heavily Indebted Poor Countries (HIPC) initiative in 1996 to ease the significant debt some countries shoulder. If a country meets specified criteria, commits to poverty reduction policies, and demonstrates a track record of reform, it is eligible for HIPC assistance. Liberia is one of 32 countries, among 40 eligible nations, to have received debt relief under HIPC; it even received additional (“beyond-HIPC”) debt forgiveness.
Liberia has focused not only on easing its national debt, but managing incoming donor funds well. Target 8.B indicates partnerships for development should address the special needs of least developed countries. By the time I arrived, the country had attracted the attention of major international donors who committed funds for the country’s re-development. President Ellen Johnson Sirleaf, Africa’s first female head of state, was elected in 2006 and quickly became a darling of the international community. Several of Liberia’s government Ministries, including Health and Social Welfare, established policies and systems that signaled the government was serious about rebuilding the country’s infrastructure.
As the Ministry of Health and Social Welfare developed its National Health Policy and Plan, and committed to providing all citizens with a Basic Package of Health Services, donor funds were earmarked to implement these health targets. However, implementation takes time, particularly when paired with infrastructure improvement and capacity-building. To aid in Liberia’s post-conflict transition from relief to development, and to coordinate donor funds provided to the country’s health sector, the Ministry established a Health Sector Pool Fund, through support from partners and donors including UNICEF, UNHCR, DFID and Irish Aid. The Pool Fund assures donors that funds are well-managed and will be spent against the priorities outlined in the Policy and Plan.
MDG #8 is unique among the Millennium Development Goals in that it is cross-cutting and can be applied to all of the other Goals. Poverty alleviation cannot happen in isolation. It requires political will, international commitments, significant funding, and strong communities. It involves heads of state, multilateral institutions, technical advisors, and local citizens. It is both complex and simple, in that it requires sustained effort by diverse partners, yet there are opportunities for all of us to play a role.
 Alexis Hyder is a Manager of Urban Business Initiatives at ICIC: the Initiative for a Competitive Inner City. In 2008, Alexis volunteered with the Clinton Health Access Initiative (CHAI) in Monrovia, Liberia, and worked closely with the Deputy Minister for Social Welfare at the Ministry of Health and Social Welfare.