TCS Daily

Millennium Development Holes

By John Luik - September 26, 2005 12:00 AM

Editor's note: This article is the second of two parts. Part one may be read here.

Pick up just about any management text today and there is a chapter or two about the importance of strategic thinking and planning, organizational goal-setting, agility, critical success factors, benchmarks, metrics and something called institutional alignment. While the management consulting profession -- which I admit to having been, on occasion, a part of -- would like to make these skills and activities appear complicated and difficult, they are for the most part the routine competencies that should be found in every well-developed manager and every well-run organization. Well, with perhaps one rather startling exception and that is the United Nations and its associated agencies like the World Health Organization (WHO). For judging by the UN's approach to the Millennium Development Goals (MDG), neither the organization nor its bureaucrats appear to have read even the Dummies Guide to Strategic Planning.

Established in 2000 by the world's leaders meeting at the UN, the MDG aim to substantially reduce poverty, hunger and ill-health for the world's poorest citizens by 2015. In and of themselves there is nothing objectionable about such goals What is objectionable, however, is the fact that the agency given lead responsibility for moving the MDG from platitude to reality is the incompetent, corrupt and strategically challenged UN.

As the most basic of planning manuals notes, goals without carefully crafted and detailed plans are useless since they offer up a destination but neglect the roadmap necessary for finding it. In fact they are worse than useless since they give the appearance that something, as opposed to nothing is happening. But the UN's MDG, like some disappointing children's toy, come not only without batteries but without any guidebook for assembly. They are a vision ungrounded in any sense of the strategic steps necessary to bring the vision to fruition.

All Talk, No Action

For example, according to WHO, about a billion people lack access to safe drinking water, while 80% of all illness in the world's poorest regions is linked to water-bred diseases. Poor water and sanitation annually kills about five million people, according to the UN's own statistics, and 50% of people in the developing world suffer from a disease associated with poor water quality and inadequate sanitation. Given these facts, you would think that there would be some carefully crafted plan, as part of the MDG strategy, for addressing these problems. Yet there is none.

What there is instead is a wealth of empty talk about action. Kofi Annan, for instance, speaks about the "sustained action across the entire decade between now and the deadline. It takes time to train the teachers, nurses and engineers; to build the roads, schools, and hospitals; to grow the small and large businesses able to create the jobs and income needed." But this talk is disconnected from a credible strategic plan as to how such difficult goals can be met.

Compare this utter strategic disarray with the carefully thought out Grand Challenges in Global Health Project, for which the Bill and Melinda Gates Foundation is providing 450 million dollars, and which brings realizable plans to bear on 14 obstacles to a healthier world, and which actually offers the prospect, unlike the MDG, of improving the health of the world's poorest people.

None of this should be surprising, for if there is one thing that the UN and its agencies like WHO are quite good at it is endless, meaningless, unintelligible talk. The UN is a master of transnational capacity strengthening, of inter-sectoral collaboration, of consultations designed to build institutional infrastructure, of fostering health-inducing environments, but an abject failure at reducing the incidence of malaria or infant mortality. This inability, whether from ineptness, indifference or corruption, to link the MDG with action plans means that the goals will not be met. And as Richard Tren observed in this space (9/16/05) "It is morally reprehensible for political leaders to sign onto goals they know they have no means of attaining."

The Problem of Non-Measurability

Second, even if there were an action plan, the MDG suffer from another, basic planning failure: they are non-measurable. In the language of strategic planning, they are not connected to critical success factors, those key yardsticks that tell an organization where it is in terms of meeting its goals. But goals towards which progress is non-measurable are meaningless goals that have no prospect of fulfillment. This lack of yardsticks is not accidental. Writing in the New York Times (9/13/05), Amir Attaran of the University of Ottawa noted that the UN's deputy Secretary General, Canadian Louise Frechette, "instructed the organization's scientists that she didn't want the summit meeting being 'distracted by arguments over the measurement of the Millennium Development Goals' and ordered that they refrain from proposing any refinements to the goals."

The reasons for this reluctance to confront the measurement problem stem both from the fact that with many of the goals - such as reducing maternal and infant mortality and the incidence of mortality for instance -- it is difficult to know with any degree of precision what mortality and incidence rates currently are and thus to talk in any meaningful way about progress to some goal is impossible. This means, as Attaran noted, that perhaps the most useful thing that world leaders could do with respect to the MDG is to abandon them and "endorse new goals against which they could truly measure progress." This, of course, will not happen because the lack of measurable goals is precisely what the UN wants. What the MDG should really be called is the Political-Cover Millennium Development Goals, for their purpose, both to the leaders that conceived them and the UN which oversees them, is to provide political cover for an organization that is systematically and institutionally incapable, due to its incompetence and corruption, of reducing ill-health and poverty.

Bureaucracy Is Destiny

Third, strategic success requires organizational agility, a key component of which is a suitably lean structure. Unfortunately, this is an organization in which the term Byzantine is a compliment. It is also an organization controlled by an extraordinarily top-heavy cadre of bureaucrats whose agenda, when it is even clear enough to discern, is more likely to benefit their own interests rather than anything as unimportant as the MDG.

Take, for example, WHO, which has a major responsibility for three of the most crucial MDG. Of WHO's biennium budget, roughly two-thirds go towards "base salaries and other costs" of WHO's richly remunerated bureaucrats. Economists Robert Tollison and Richard Wagner have calculated that with the inclusion of overhead costs, for every two dollars WHO spends on programs it spends another eight dollars on salaries and overheads.

To understand just how this affects the MDG consider how one of those goals -- reducing infant mortality -- is affected by WHO's distorted bureaucratic priorities. Diarrhoeal diseases, which are a major source of infant mortality, received less money ten years ago than WHO spent on its own office supplies. And during the same period, WHO spent more money for so-called "health promotion campaigns" than on combating the malaria (MDG goal 6) which kills about a million children a year, mostly in Africa.

Nor are these bureaucratic spending distortions an anomaly. In WHO's most recent budget for 2006-7, support for WHO's 140 country offices and their bureaucrats consumes $188 million scarce dollars. Of the almost $153 million allocated for arguably WHO's primary mission -- communicable disease prevention and control (MDG goals 4,5,6) -- only 42% is to be spent at the country level while 58% is spent on the WHO bureaucracy in Geneva. "Human resources management" will take up a staggering $ 51million, while infrastructure and logistics will eat up $130 million for a total of about 6% of the WHO's entire budget.

Ideology and Science

Fourth, success at anything as strategically ambitious as the MDG requires what planners call strategic alignment, that is an organization whose policies, people and structures work together toward a common purpose. The UN, however, is a case study in almost purposeful misalignment, particularly where its leftist ideology and good science intersect. And it is this misalignment that dooms the MDG. Consider some examples.

WHO's action -- along with its sister UN agency, the Food and Agriculture Organization -- in requiring a host of regulations on food products made with gene-splicing techniques, a move based not on science but on WHO's desire to embrace anti-GM activists, impedes the development of more plentiful and cheaper food and thus actively works against MDG 1, which is to eradicate extreme poverty and hunger.

The UN and WHO's unthinking commitment to the precautionary principle as a basis of risk analysis and health protection threatens MDG 1,4,5,6, and 8 by blocking promising new technologies, foods and medicines that greatly reduce poverty, hunger and ill- health.

The opposition of the UN and WHO to effective malaria control makes MDG 6 virtually unattainable. Despite the failure of its Roll Back Malaria Campaign, WHO refuses to consider the use of DDT for malaria control. Despite the fact that DDT was originally banned because of its threat to birds and despite the consistent scientific evidence that the current application of DDT inside houses, as opposed to its previous massive agricultural use, does not pose a significant threat to the environment and saves the lives integral to realizing MDG 6, despite all of this, the UN and WHO's politicized malaria "science" continues to based on the science of the UN's Persistent Organic Pollutants Convention.

Finally, whereas the MDG first goal is to eradicate hunger, the UN and WHO, appear to believe that the real problem is not too little but too much food since they have decided to devote increasing attention and resources to the so-called "obesity epidemic". Instead of devoting its resources to global hunger and despite the dramatic lack of evidence that obesity reduces lifespan, WHO proposes to focus on pushing for a global food treaty modeled on the recent WHO tobacco treaty that would restrict food marketing, raise taxes on so-called unhealthy foods and require a series of warning labels to distinguish 'good' from 'bad' foods. This in a world where the essential micro-nutrients like iron, zinc, iodine and vitamin A -- all integral to MDG goals 1, 4, and 6 -- are missing from about half the world's diet.

The great tragedy of the MDG is that they are wedded to the UN. They offer the world's poorest, sickest and often most disheartened citizens the prospect of a world that is better in almost every respect. But as long as the MDG are linked to an institution that carries not simply a crippling burden of corruption but whose capacities for organizing, thinking, planning, and acting are so acutely impaired, they will remain nothing more than a prospect.

John Luik is writing a book on health care policy.


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