The big reckoning: how many people did the millennium goals save?
The 45-year-old beautician-cum-caterer is sitting outside her modest house on the far outskirts of Accra and trying to sum up life in Ghana in 2015. Close by, children play and fight on the sandy earth, vendors sell drinks and dried fish, and traffic rattles along the main road to the capital.
“There are economic problems all over,” says Qansah. “I thought things were going to get better because business was booming, but it’s been going down for the past three years.”
Two years after it became the first country in sub-Saharan Africa to achieve the UN millennium development goal (MDG) of halving hunger and extreme poverty - the mood in the west African nation is a little despondent.
Qansah and her husband, James, have six children. In an exceptionally good week, his work as a carpenter and her cosmetic and culinary labours will bring in 900 cedis (£150). Almost half of that, says Mercy, goes on food alone.
“It’s just by the grace of God that we are surviving and pulling through,” she adds. “Generally speaking, things are not good for us. Life is difficult.”
Fifteen years ago, hope was more abundant. In 2000, the UN adopted the Millennium Declaration, vowing to “spare no effort to free our fellow men, women and children from the abject and dehumanising conditions of extreme poverty, to which more than a billion of them are currently subjected”.
It went on to agree the eight millennium development goals aimed at narrowing the gulf between the developed and developing world over the course of 15 years. Although the goals were only fixed in the aftermath of the declaration and designed to expire in 2015, many of them used 1990 statistics for their baseline targets, meaning they, in effect, measured progress over a 25-year period.
Ban ki-moon, the UN secretary general, called the initiative “the most successful anti-poverty movement in history”.
But was it?
Ghana was, in many senses, a bellwether country for the MDGs: the turn of the century found the west African nation basking in its newfound stability after four decades of coups, violence and authoritarian rule. The future glowed more brightly still in 2007, when oil was discovered off the coast and there was excited talk of Ghana becoming “the African tiger”.
But as the UN prepares for a final reckoning this weekend at a New York summit to draw a line under the MDGs, the picture in Ghana – as elsewhere – is at best mixed.
The cost of living is rising, gold prices are down and there are problems with the cocoa crops. Five months ago, the International Monetary Fund approved a $918m (£600m) loan to help Ghana keep its social reform and job creation programmes afloat.
This frustrating picture is replicated across sub-Saharan Africa – the key battleground in global efforts to accelerate development. Conflicts, large populations and food insecurity have stymied progress across the region and resulted in a failure to hit MDG1 – the drive to halve the number of people living on less than $1.25 a day. In sub-Saharan Africa, extreme poverty is down just 28%, a fall that arguably might have happened anyway, without bureaucratic acronyms. In southern Asia and in the Latin America-Caribbean area it has fallen 66% and in south-east Asia it is down 84%.
Even in Ghana, which is more peaceful, stable and well off than some of its neighbours, MDG progress has been varied from goal to goal. While debt relief, increased government development spending, a high GDP growth rate and rising foreign investment have helped reduced poverty in many areas, they have not always yielded similar dividends elsewhere.
The government’s drive to achieve universal primary education – as enshrined in MDG2 – is paying off: almost 90% of children are in school and the primary completion rate is above 80%. Sub-Saharan Africa has shown the greatest improvement in primary education of any region since the MDGs were introduced, with enrolment rising from 52% to 90% between 1990 and this year.
Between 1990 and 2012, the number of children enrolled in primary school in the region more than doubled, from 62 million to 149 million. In Latin America and the Caribbean, the proportion in primary education has risen from 87% to 94%; in south Asia from 75% to 95%, in south-east Asia from 93% to 94% and in northern Africa from 80% to 99%. Across developing regions as a whole, the primary school net enrolment rate is 91% – up from 83% in 2000.
Ghana has also more than halved the proportion of people without access to safe drinking water, with 89% of people getting clean water. Globally, the target on improved drinking water – enshrined in MDG7 – was reached five years ago. By 2015, 91% of people were using an improved drinking water source, compared with 76% in 1990.
Unlike eastern Asia, Latin America and the Caribbean, south and south-east Asia and western Asia, sub-Saharan Africa failed to halve the proportion of those without access to improved drinking water – but managed a 20 percentage point rise in the use of improved sources of drinking water (from 48% to 68%). That said, nearly half of all people using unimproved sources live in sub-Saharan Africa.
The targets on reducing both under-five mortality and maternal mortality by two-thirds have proved more elusive and will not be met in Ghana. In 1990, the under-five mortality rate per 1,000 live births was 128; 10 years later it was 101; and, by 2013, it was 78.
Across sub-Saharan Africa, under-five mortality has decreased substantially – from 179 deaths per 1,000 live births in 1990 to 86 in 2015 (a 52% drop) – but the region still has the highest rates in the world. Globally, the under-five mortality rate has declined by more than half, dropping from 90 to 43 deaths per 1,000 live births between 1990 and 2015. In starker terms, almost 6 million children under five will die this year, compared with 12.7 million a quarter of a century ago.
As for MDG 6 – the battle against HIV/Aids – the UN has reported progress globally, with new infections falling by 40% and life expectancy substantially prolonged for people with the virus.
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Those are the numbers. But precisely what the goals and their accompanying targets and indicators mean to ordinary Ghanaians is harder to gauge. Yes, the Qansahs have a toilet of their own and a well from which they can draw salty water for washing and cooking – but not for drinking – yet they struggle to identify similarly tangible benefits.
Mercy shrugs when the MDGs are mentioned: she has neither heard of them nor felt any concrete benefits from them. But they do ring a distant bell with her husband. “The roads have got better over the last 15 years, but there hasn’t been any great progress with job creation,” says James.
His wife agrees: “People finish school now but there’s no work for them to do.”
Others are more optimistic. Nicholas Nortui, who has been chief of nearby Kutunse since 1981, reels off the social and educational changes he has noticed.
“Women in the area used to be illiterate; they used to say that women were for the kitchen and that stuck in their minds for years,” he says.
“But things are changing and women are starting to challenge the men and now men and women are working hand-in-hand. Things have improved a lot economically and women are working more. Because women are working more, they can help pay for the school fees.”
Nortui, who runs a hardware shop whose shelves are neatly stacked with boxes of nails and tins of paint, believes some of the progress can be ascribed to the MDGs. “More children are going to school than 15 years ago,” he says. “Medically, things are better than they were. Before, not all pregnant women went to the doctor – they used to use traditional medicine – but now they go to antenatal classes.”
Saani Mohammed Yakubu, ActionAid’s deputy country director for Ghana and its head of policy and social programmes, is measured in his assessment of the MDGs. “Ghana has done quite well in the area of halving poverty. We have done well in the area of education in terms of achieving gender parity,” he says. “Areas where we’ve struggled are maternal and child health; areas around the environment; and not much was done in the area of regional integration.”
But, Yakubu adds, even the headline success of MDG1 is not quite as it appears. “There’s been a lot of investment – especially in halving poverty – but the disparities are still there and they are widening,” he says.
“As much as we recognise that there has been an increase in the country’s wealth because of the oil find and other things, poverty levels are actually increasing because of the focus of our development: it’s more about mechanisation and competing externally and not taking into consideration the very poor, who also need to be pulled along.”
He agrees with Nortui that women in Ghana are playing a more prominent role in society, but hesitates to attribute the shift in attitudes to the MDGs. Some of the momentum, he adds, has come from the ministry of gender, children and social protection, which was established in 2001.
“It’s interesting that in every community you go to you will find female leaders and champions who will challenge violence against women,” says Yakubu. That said, there needs to be more leadership “at the national level – where it has to start from”.
In the meantime, ActionAid is continuing its campaign to empower women in Ghana, which is why, in a local church in Treba, Greater Accra, two women are holding aloft condoms, contraceptive pills and an intrauterine device as they lecture a 100-strong and predominantly female audience on sexual health and sexual rights.
The session, which takes in everything from hygiene to temptation, ends with a chant: “Your choices! Your actions! Your life! Own it!”
Ghana’s ministry of finance, which has overseen the country’s MDG programmes, did not respond to repeated requests for comment or an interview.
Yakubu, however, was prepared to offer his own opinion of the progress of the past 15 years. What mark out of 10 would he give Ghana on the MDGs?
“Six. Some efforts have been made and some foundations have been laid. We may not get it right, but at least we have started from somewhere. There have been recognisable achievements that shouldn’t be downplayed.”
It remains to be seen what the next 15 years will hold for Ghana and to what extent the MDGs’ soon-to-be-agreed successors – the sustainable development goals – will build on their successes and learn from their failures.
Mercy and James Qansah’s eldest daughter, Helen, is due to give birth to her first child in December. The 25-year-old is slightly more optimistic than her parents when she thinks about what lies ahead. “There’s hope, but sometimes when you listen to what’s happening, you feel there is none,” she says.
Asked how she feels as she ponders her baby’s future, Helen repeats the familiar, ineluctable creed of parents the world over: “We’ll manage.”