New Gates Foundation Report Shows Wins on Global Issues but Tough Challenges Ahead

The stories "behind the data" are about local communities uniting, governments devising new policies, and civil society becoming increasingly involved. Looking at the global picture indicates that the race to 2030 is well under way, some countries have made headway and others have a long way to go. "Goalkeepers " is a sobering reminder that on every issue ranging from access to healthcare to infant mortality and HIV, the world is not on track to meet the 2030 targets.

The data outlined in the report indicates the world has not regressed in economic development, poverty alleviation and access to healthcare.

In 1990, 35 percent of the world's population lived below the international poverty line, today the figure stands at nine percent amid demographic pressure in underdeveloped countries. Regarding the rate of infant mortality, deaths under the age of five per live birth fell from 85 per 1,000 in 1990 to 38 today. But the evidence points to glaring disparities between progress made in certain areas versus that made in others.

While the number of people using unsafe sanitation worldwide fell by 24 percent between 1990 and 2016, the proportion of women with access to family planning methods only increased by 10 percent. If nothing changes, new cases of Malaria per 1,000 people will fall from 29 in 2016 to 28 in 2030. These dismal gains would be way off the mark, as the target figure is seven.

On a brighter note, the global immunization rate against major diseases would reach 93 percent by 2030 in large part due to the prevalence of vaccines.

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But beneath the veneer of international statistics lurks a harsh reality: For each indicator, only certain countries are doing the heavy lifting.

For example, the report notes that while child mortality in Malawi was reduced by a factor of four over a 15-year period, children remain at greater risk in countries with similar levels of development such as Nigeria or the Democratic Republic of Congo. The same goes for poverty: The report clearly shows that the steady decline in the last decades can be mostly attributed to China and India.

Despite a seemingly growing defiance toward institutions, governments and elected officials, the report highlights the critical role of public services and policy-making .

At the turn of the century, Ethiopian officials embarked on an unprecedented campaign to curb child and maternal mortality. Faced with a flawed system that concentrated most health practitioners in cities, the Ethiopian Health Ministry launched large-scale training programs to provide care and spread awareness across the country. Child mortality was cut in half, but officials still observed a prevalence of maternal mortality because mothers were still giving birth at home.

"Maternal mortality, though, was a different story. It went down, but not nearly as much as child mortality. To save mothers' lives, you need skilled obstetric care, and that happens in health facilities." wrote Kesete Admasu, Ethiopia's former minister of health, in the report.

Ethiopian officials then launched the Women's Development Army – a plan to train and allocate one health extension worker per six families. (Previously, one health worker was covering a community of 500 families.) The results have been incredible. Between 2011 and 2016, women giving birth in facilities increased from 20 to 73 percent.

In 2011, the government of Senegal introduced sweeping family planning reforms by increasing access to reproductive and health services: "Senegal took the lead to develop the first national actionable plan for family planning in the region. The government set the tone, with ambitious policies to change the status quo as well as the funding to back them up," wrote Fatimata Sy, Director of the coordination unit for the Ouagadougou Partnership, in the report.

Senegalese authorities launched a public awareness campaign to change deeply rooted mentalities concerning sexual practices in Senegalese society, before deciding to decentralize its contraceptive supply chains to make contraceptive products available nationwide.

In India, the government recently broke from a longstanding tradition of distributing wages and social benefits to the head of the household (typically a man), instead opting to split them evenly. Connecting women to the financial system and allowing them to increase their savings and manage their incomes was a leading factor in their empowerment: "After the intervention, when we asked women to tell us their occupation, they were more likely to say 'worker' instead of 'housewife," said Rohini Pande – Professor of Public Policy at Harvard – in an interview featured in the report.

More often than not, these policies are shaped by activists and NGOs that inspire new leadership.

In 2005, Peru's malnutrition rates were fueling a growing stunting problem. The Peruvian government tried to tackle the issue with conventional policy tools but in vain: "The government had been trying to address the problem with traditional feeding programs, but interventions that didn't address health and nutrition more broadly were never going to work," noted Milo Stanojevich, National Director of Care Peru, in the report.

Care Peru obtained funding from the United States Agency for International Development (USAID) to develop a different approach to stunting focused on nutrition, food security, water and sanitation, and health. Chronic malnutrition dropped by 10 percent in the 1,200 communities that subsequently received investments. Both the UN and Care Peru – along with other NGOs involved – petitioned the government to adopt similar guiding principles across the country. The stunting rate decreased by 15 percent since.

The long-term impact of aid spending is fiercely debated, and the idea that free markets and for-profit investments are more effective in cutting poverty is gaining traction. But the report shows that when it comes to sustainable development, the quantity of aid matters as much as the quality.

In the early 2000s, the international community made massive investments in AIDS prevention and treatment via the Global Fund to Fight AIDS. "In the history of global health, there had never been an increase of that magnitude in getting products and services to people who need them. That's why the curve of AIDS deaths bent so sharply around 2005," writes Bill Gates. "Governments in both donor and developing countries that responded so aggressively to the crisis 15 years ago are now focusing on other things. Funding for HIV control has been flat, and now there are talks of cuts."

A 10 percent budget cut for HIV treatment could lead to 5.6 million additional annual deaths.

But it's not always about the money. The report digs deeper into how to spread and reap the benefits of simple "best practices."

Using child mortality as an example, it highlights how a majority of the 5 million children that die every year could be saved by a few simple interventions such as resuscitation, cheap antiseptics and breastfeeding.The same goes for vaccination.

Immunization could curb 1.5 million premature deaths annually: "There are still nearly 20 million children in the world who aren't immunized at all. This explains why measles, preventable with a vaccine that costs less than 20 cents, still kills almost 150,000 children per year," the report says. It also emphasizes the critical role that technology and innovation play in adopting these best practices: "Consider how difficult it is to deliver a vaccine that needs to be kept cold. New coolers using insulation can keep vaccines cold for a month and help us reach millions of children."

In the report's conclusion, Bill and Melinda Gates remind us that the SDGs identified global problems that need solving, providing a roadmap that can unite governments, industry, NGOs, activists and others.

But the report demonstrates that to turn the SDGs into a step forward for humanity, the road ahead is long.

The world needs more innovation to eliminate malaria, more health professionals to curb maternal mortality, more funding for AIDS research, more government spending on universal health coverage, and so on. At present, nothing signals that this is the path the world has taken. The Bill and Melinda Gates Foundation has committed to publishing a similar report each year to update the indicators used to measure progress and to continue to inspire new leadership by telling the stories that lie behind the data.

No one candidly expects the world as a whole to meet every SDG target. Meeting these objectives is not about plotting curves that look nice; rather, it concerns the millions of lives that are at stake. Development deserves everyone's attention.

To support the work relevant to the SDGs, the Gates Foundation will host Goalkeepers, an event in New York City on September 19 and 20 that convenes activists, world leaders, and the public to share their successes and challenges in advancing the SDG agenda. Key speakers include Barack Obama and Malala Yousafzai.

To learn more about the SDGs, head to the Goalkeepers site.