Driving Development: An Evidence Ecosystem? James Smith ACMS Lecture 2
Pre-MDGs • Tendency to re-hash the same commitments endlessly. Easterly’s ‘historical amnesia’ (2002, 49) • For example, it took the UK 45 years to honour its 0.7% GNP for ODA pledge • The MDGs marked a sea change but also identified development to reducible, technical problems articulated through 18 targets and 48 technical indicators • A new global development infrastructure developed as a result of new MDG commitments and in order to deliver them
In order to determine the success of eight narrowly-defined goals, the architecture of development was restructured to collect the evidence needed to chart progress. In this process, routine terms like ‘success’ and ‘failure’ were assigned numerical values, and ‘impact’ became narrowly conceptionalised as a change between two data points.
End-of-the-Millennium Development • The MDGs emerged as the efficiency and effectiveness of the state had been critiqued (Thatcher, Reagan etc) • ‘Aid effectiveness’ entered the lexicon, and various agreements tried to ensure greater coordination
• The Paris Principles – Ownership – Developing countries set their own development strategies – Alignment – Donor countries and organisations bring their support in line with these strategies and use local systems to deliver that support – Harmonisation – Donor countries and organisations coordinate their actions, simplify procedures and share information to avoid duplication – Managing for Results – Developing countries and donors focus on producing and measuring results – Mutual Accountability – Donors and developing countries are accountable for development results
The Business of Development • A turn towards the private sector as a deliverer of aid (post-state, philanthrocapitalism) Fragmentation • 2007 financial crash exacerbated this – PDPs, PPPs, DIBs and many new acronyms emerge • Efficiency, value, accountability and impact enter the lexicon – these are quite problematic terms in the context of complex development, however….
Four Propostions for you‌. 1) More data is needed for better decision-making 2) Gold standards of evidence collection are needed to ensure high-quality data 3) Global targets and working at scale, supported by data, help us work more effectively 4) Data tells us what we need to know, not what we want to know
1) More data is needed for better decision-making • Technology means we can create more and more data • But, more data doesn’t necessarily count • Data saturation, but no ability to analyse • Indicators: signal, but no insight • No one says I don’t know. Flawed models are defended We don’t acknowledge the limits of our knowledge
2) Gold standards of evidence collection are needed to ensure highquality data
• Gold standards (derived from medicine) such as RCTs or SRs do not translate to the messy, contextcontingent world of development • Unit of analysis too lofty – countries or districts – not enough detail • We model data but we don’t collect it – cost • Data lags behind reality • Burden of disease – includes all data, too complex, cannot be critiqued
3) Global targets and working at scale, supported by data, help us work more effectively • Development, where context matters, is being guided by global targets and goals – disconnect • ’Success’/’Failure’ problematic in current climate • Aggregating data means it loses meaning. We miss complexity, therefore miss causality • Gaming and simplifying leads to “immodest knowledge claims”. EG Payment by Results. Reality is in complex systems attribution can rarely be tied to any one intervention
4) Data tells us what we need to know, not what we want to know
• Data is designed to map against our goals/targets no matter how unrealistic • Data therefore does not help us decide what is best to do, or whether it can be done better • Aggregation means simplification means optimism • There is little mileage in highlighting failures, failures are reframed as success. Therefore no learning How do we make data truly work for development?
Worm Wars: Diatribe and/or Dialogue Allen, T. and Parker, M. (2011) The ‘other diseases’ of the millennium development goals: rhetoric and reality of free drug distribution to cure the poor’s parasites, Third World Quarterly, 32(1), 91-117.
Tim Allen & Melissa Parker
David Molyneux et al
“Evaluation must now become the top priority in global health”
“factual errors which call into question the credibility of the authors… unethical and grossly negligent” [TB] “worst it is damaging to poor people who benefit.” “[C]ould lead to donors withdrawing much-needed funding for a massive programme”
“A commitment to combating neglected tropical disease is a hugely positive development… but that is all the more reason to avoid treating fund-raising rhetoric as fact.”
Cross purposes? Or disciplines failing to understand evidence?
“The most important thing is that NTDs are written in the document that emerges from the [SDG] process. Without that, we don’t have any platform at all” (Prof David Molyneux 2015)
Sustainable Development Goal 3 Targets 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination 3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate 3.b Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all 3.c Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks
SDG tenets • Leave no-one behind “in the future neither income, nor gender, nor ethnicity, nor disability, nor geography will determine whether people live or die, whether a mother can give birth safely, or whether her child has a fair chance in life.”
• Data revolution “refers to the transformative actions needed to respond to the demands of a complex development agenda, improvements in how data is produced and used; closing data gaps to prevent discrimination…”
Approach #1: Making the case that the NTDs are cross cutting and underpinning (Targets)
SDG TARGETS WITH DIRECT AND INDIRECT ASSOCIATIONS TO THE NTDS Target 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases Target 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all Target 6.1 By 2030, achieve universal and equitable access to safe and affordable drinking water for all Target 6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations Target 13.3 Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning
NTDs as indicators of equity Margaret Chan (2015) depicts Universal Healthcare “as one of the most powerful social equalizers among all policy options” WHO (2015) suggests the burden of NTDs could be a “proxy for inequitable access to the systems – especially health systems - through which people improve their health and wealth”
Approach #2: Lobbying for indicators The indicator for target 3.3 seeks to measure the “number of people requiring interventions against neglected tropical diseases.� Indicator adopted. Proposal to adopt the NTDs as tracers of equity for SDG targets 3.8 (universal healthcare), 6.1 (access to safe water) and 6.2 (adequate and equitable sanitation and hygiene). Still being debated.
Conclusions – NTDs/Evidence •
The NTDs achieved a lot despite their MDG snub, demonstrating the power of effective networking and lobbying. But meaningful inclusion in the SDGs was always the overarching goal for the NTD lobby.
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The NTDs were effectively invisible during the MDG era; that invisibility is now being used as a selling point by the NTD lobby to reconceptualise the diseases as both a target (SDG 3.3) and a tool to measure equitable access to health provision (NTDs as a tracer indicator for UHC).
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The fact that a target can simultaneously be a proxy indicator, and that the weakness of invisibility can transform into the possibility of capturing reality underlines the contingency of ‘evidence’ on politics, perspective and priority.
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The tensions between data and development help create the space in which evidence is politicised – we rarely ask ourselves what does this mean?