The 2030 agenda for attainment of the Sustainable Development Goals (SDGs) adopted by all United Nations member-states in 2015, provides a blueprint for peace and prosperity for all.
The central theme is that the 17 SDGs are an urgent call for action by all countries, developed and developing in a global partnership. They recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality and spur economic growth, while tackling climate change and working to preserve our oceans and forests.
In June, 1992, at the Earth summit in Rio de-Janeiro, Brazil, more than 178 countries adopted “Agenda 21”, a comprehensive plan of action to build a global partnership for sustainable development to improve human lives and protect the environment. Member-states unanimously adopted the millennium declaration at the millennium summit in September 2000 at the UN headquarters in New York. The summit led to the elaboration of eight millennium development goals (MDGs) to reduce extreme poverty by 2015.
The Johannesburg declaration on sustainable development and the plan of implementation adopted at the world summit on sustainable development in South Africa in 2002 reaffirmed the global community’s commitment to poverty eradication and the environment, and built on Agenda 21 and the millennium declaration by including more emphasis on multilateral partnerships.
According to Pan African Medical Journal 2016, the MDGs have been the world’s only time-bound and quantifiable targets for addressing extreme poverty in its many dimensions. Nigeria, like most other nations of the world signed the eight goals initiatives which was planned to eradicate extreme poverty and hunger, while aiming to achieve universal primary education, promote gender equality, reduce child mortality, improve maternal health, combat HIV/AIDs, malaria and other diseases and promised to work towards the realisation of these goals. Central government fund was released, offices were created and individuals appointed to key positions to work towards achieving these goals.
According to the United Nations, the number of people living in extreme poverty declined worldwide by more than half, falling from one billion in 1990 to 836 million in 2015. Primary school enrollment rate has increased and the number of out-of-school children of primary school age worldwide has fallen by almost half. There has been significant improvement in gender equality with empowerment of women as more girls are in school, more women are in paid employment and many more women are no in government around the world. Global under-five-years mortality rate has declined by more than half, dropping from 90 to 43 deaths per 1000 lives. In addition, maternal mortality ratio has declined by 45 per cent worldwide since 1990 with an improvement in contraceptives prevalence and decline in malaria and HIV/AIDS cases.
The question is where was Nigeria at the end of MDGs in 2015?
There is a number of unsupported claims which Nigeria has put forth, including the reduction of HIV/AIDS and maternal mortality. However, according to a UN report, nearly 60 per cent of the world’s one billion extremely poor people lived in just five countries in 2011, including Nigeria, and the Democratic Republic of Congo.
Nigeria contributed significantly to more than 42,000 people who were forced to abandon their homes and seek protection and greener pastures in other countries. Nigeria has one of the lowest number of children sleeping under mosquito nets, in a comparison of surveys among nations of the world.
According to recent estimates, Nigeria has an infant mortality rate of 72.7 deaths per 1000 live births.
It is questionable as to whether deaths have reduced in Nigeria and if there has been a significant change in malaria-induced mortality and morbidity. It seems that maternal death rates have not changed significantly.
With the regular healthcare workers’ strikes, attempt to reduce national mortality rate have been severely hampered. The question now is why did Nigeria fail to meet the millennium development goals target? This is critical as it is fundamental to the success or failure of the recently launched SDGs.
Dr Festus Ajayi of the University of Port Harcourt Teaching Hospital (UPTH) in an interview with The Tide identified lack of human capacity for implementation, poor access to primary health care delivery systems, high cost of health care, inadequate and unreliable data systems, inadequate funding and indiscipline coupled with endemic corruption as facing MDGs in Nigeria.
Dr Johnson Obinna, a medical practitioner in Rivers State stated that lack of continuity is one of the major problems in Nigeria policies.
“I have said it time without number that this country lacks continuity.
“From where one administration stops the incoming administration should, as a matter of urgency, carry on and complete any projects knowing that government and governance is all about continuity.
“What was wrong with the seven-point agenda of late President Umaru Musa Yar’ dua? What was wrong with the school-to-land programme of Fidelis Oyakilome in the state and many other projects?” Obinna queried.
Mr Anthony Oforidi of the Federal Ministry of Health emphasized poor equipment of the health sector in the rural areas, unemployment, and deep-rooted culture as some factors that may have hindered MDGs in Nigeria.
Dr (Mrs) Ngozi Amadi, another medical practitioner in Rivers State, has a different view on why the MDGs failed in Nigeria.
“I know why the so-called millennium development goals failed. Poverty, Nepotism and neglect, coupled with our deep rooted culture is the case in Nigeria.”
Whether these reasons were correct or wrong, there are other reasons which are not limited to:
Wrong assumption: the assumptions on which the MDGs were predicated were fundamentally wrong. It was believed that the poor health indices in Nigeria were as a result of poverty and lack of resources, because of this, central fund was released and injected into the healthcare system to overcome these inequalities.
It was also assumed that systems were in place to support the activities towards the achievement of the MDGs.
Absence of true and validated baseline data: Since independence Nigeria has survived on public health “guesstimates” rather than informed estimates. There is no single dependable, reliable, validated and easily verifiable public health dataset in Nigeria, even the organization that ought to have this dataset, like the National Health Insurance Scheme (NHIS), does not have validated, verifiable dataset of those enrolled into the insurance system.
All attempt to have national ID cards, proper census and nationwide survey have failed to deliver verifiable results.
Incessant health care workers industrial action has often paralysed the health care industry, resulting in high rate of mortality.
The bombings and killings by Boko Haram in the north as well as kidnappings in the south have caused social discord, and reversed the gains of so many years of investments in healthcare in Nigeria, especially in affected communities. Today, there are several hundreds of thousands of displaced persons, who are current victims of communicable diseases, malnutrition and several other social problems.
The way forward is that there should be real healthcare leaders, not managers, as drivers of the SDGs. Medical qualification and years of experience in the health industry may not be enough in the choice of leaders of the SDGs. People and individuals who have the right leadership orientation, skills and competence should be tasked with the assignment of ensuring effective take-off, implementation, evaluation and reporting of the SDGs.
There is need for full integration rather than virtualization of healthcare services. This will allow for leveraging of resources, development of sustainable processes and healthcare systems.
Individuals should be trained and retrained to ensure proper reorientation with a new integrated care mentality. Training should also be aimed at building transparency into the system, developing skilled data managers and excellent evaluators who will conduct both the process and summative evaluation.
The time to work differently in Nigeria is now. Positive change is a choice not a chance. Nigeria must make positive changes to achieve the SDGs come 2030.