Development Co-operation Report 2018

Chapter 4. Delivering the Sustainable Development Goals for all: Policy priorities for leaving no one behind

Jessica Espey

Guillaume Lafortune

Guido Schmidt-Traub

Abstract

Drawing on successful examples, this chapter explores how to meet three challenges to meeting the Sustainable Development Goals (SDGs): investment, policy and data. Sections discuss financing for leaving no one behind, how to co-ordinate planning and budgetary processes to make more efficient use of resources, how to encourage long-term, cross-sectoral planning and build the necessary data systems to enable targeted and efficient interventions. The chapter then uses a good practice example from the Millennium Development Goal (MDG) period (2000-15) focused on the health sector, where access to treatments for malaria, AIDS and tuberculosis improved significantly, including for the most vulnerable population groups in low-income countries, to illustrate how investment, policy and data challenges can be met in the context of the SDGs. In particular, it discusses the role that development co-operation can play in generating and scaling up innovations to improve health, education and other societal outcomes.

 

Seventeen interdependent goals…

The 2030 Agenda provides an opportunity to transform public policy making and strengthen international co-operation to achieve more equitable outcomes. Integrated and coherent approaches are needed to achieve the Sustainable Development Goals (SDGs) as a whole by 2030 and are essential to tackle the multiple dimensions of inequalities, which are intersecting in nature and stem from exclusion from economic opportunities, social services and natural resources (Chapter 3). A first science-based assessment of interactions between the 17 SDGs found that there are 316 target-level interactions overall, of which 238 are positive or reinforcing interactions, 66 are negative or hindering, and 12 are neutral (ICS, 2017_[1]) (Nilsson, Griggs and Visbeck, 2016_[2]). The nature of these interlinkages varies depending on country context, geography and governance arrangements.

In particular, SDG 2 (no hunger) and SDG 3 (good health and well-being) are both key enablers and critical outcomes of sustainable development (Figure 4.1). The relationship is bidirectional: poor health can reduce the ability of individuals and households to farm and produce food, resulting in malnutrition (including undernourishment and poor eating habits), which can have a long-lasting impact on mental and physical health. At the same time, monocultural crop production, genetically modified organisms, forest clearing and irrigation have the potential to increase production and reduce undernourishment in deprived areas, but they may also have a detrimental impact on the environment and adversely affect future food security. The recently released report by the World in 2050 Initiative provides additional insights on such interactions (IIASA, 2018_[3]), and clearly demonstrates the importance of co-ordinated cross-sectoral government planning to achieve outcomes that benefit multiple SDGs.

Figure 4.1. Positive and negative interactions of SDG 2 (no hunger) and SDG 3 (health and well-being) with other Sustainable Development Goals

Source: (ICS, 2017_[1]), “A guide to SDG interactions: From science to implementation”, http://council.science/cms/2017/05/SDGs-Guide-to-Interactions.pdf.

…three strategic challenges: Investment, policies and data

National governments and the global community need to address three strategic challenges to ensure that policies and plans positively reinforce each other to meet all SDGs in a way that leaves no one behind (Figure 4.2) (SDGC/A and SDSN, 2018_[4]). First, there is an investment challenge, especially in low-income countries, where increasing access to basic infrastructures and services will require mobilising additional national and international financial resources. Second, there is a policy challenge, since implementing the agenda in the context of the SDGs requires deep transformations of economic, social and environmental systems to ensure fair and redistributive policies (IIASA, 2018_[3]). Integrated approaches to policy making and concrete measures to enhance policy coherence will be essential to maximise synergies and minimise trade-offs between economic, social and environmental policy objectives. Third, there is a data challenge, since more disaggregated and timely data are needed to inform policies and reforms and evaluate their impact on various population groups.

Figure 4.2. Key challenges for implementing the Sustainable Development Goals: Responses from government officials in 11 African countries, 2018

Source: (SDGC/A and SDSN, 2018_[4]), “Africa SDG index and dashboards report 2018”, http://unsdsn.org/wp-content/uploads/2018/07/AFRICA-SDGS-2018-Report-FINAL.pdf.

Costing, co-ordinated budgeting and coherent government action to leave no one behind

Delivering on the SDGs as an integrated and indivisible package and ensuring no one is left behind is costly in terms of financing but also because it requires complex, co-ordinated and long-term planning across governments. This is especially true for countries where basic social systems and infrastructures are not yet in place. Given the tight fiscal environment in many developed and developing countries, governments need to find more effective and efficient ways to raise, leverage and direct their investments (Box 4.1 and Chapter 10). Governments worldwide are starting to put in place institutional mechanisms to help facilitate co-ordination between budget departments, sectoral policy makers, and agencies responsible for their implementation and evaluation, as highlighted by the 2016 and 2017 voluntary national reviews on progress presented to the United Nations (UNDESA, 2017_[5]).

Box 4.1. The estimated cost of implementing the Sustainable Development Goals is in the trillions

Altogether, the United Nations Conference on Trade and Development (UNCTAD, 2014_[6]) estimates that achieving the SDGs will take between USD 5 trillion and USD 7 trillion, with an investment gap in developing countries of about USD 2.5 trillion. Estimates of the annual cost of eradicating extreme poverty in all countries (measured as increasing the incomes of all people to at least USD 1.90 per day) are about USD 66 billion annually (UNDP, 2018_[7]). The World Health Organization (WHO, 2017_[8]) estimates, under an “ambitious” scenario, that achieving the SDG health targets (including universal health coverage) in 67 low- and middle-income countries that account for 75% of the world’s population would require new investments increasing over time from an initial USD 134 billion annually to USD 371 billion, or USD 58 per person, by 2030.

Costing and whole of government planning and budgeting

To estimate accurate costs and design the right mix of policies to meet the SDGs as a whole, government departments need to work together when considering trade-offs, to identify and reinforce synergies between goals and, ultimately, integrate actions. Using modelling techniques and scenarios, the World in 2050 Initiative findings (IIASA, 2018_[3]) suggest, for instance, that lessening resource impact and waste (SDG 12) allows not only the reduction of environmental burdens and the furthering of the goals of related SDGs on water (SDG 6), climate (SDG 13), oceans (SDG 14) and biodiversity (SDG 15), but also stands to free the resources for ending poverty and aiming at a more equitable distribution of material well-being.

Institutional structures and mechanisms can facilitate more integrated policy making and budgeting (Box 4.2). While institutional structures specifically dedicated to the SDGs are nascent, the simple process of bringing diverse experts from across government together, collectively reviewing policies and investments across sectors has already had a powerful impact. In Afghanistan, for example, the Council of Ministers and Ministry of Finance have decided that national SDG targets and indicators will be incorporated into the budget planning process at the national and subnational levels; to this end, the relevant line ministries have been requested to submit an account for the SDGs in their budget proposals, thereby helping to highlight how resources are being allocated to meet the SDGs and which investments will have the most profound impact upon national development.

Box 4.2. Policy coherence to deliver the Sustainable Development Goals: OECD building blocks to support coherence

According to most voluntary national reviews presented to the United Nations, policy coherence needs to be enhanced to deliver the SDGs but progress is slow and challenging. The OECD has been working to unpack the complex topic of policy coherence and translate it into concrete action. It sees policy coherence as an approach to understand the barriers to, and the drivers for, sustainable development; and as a policy tool to integrate the economic, social and environmental dimensions of sustainable development at all stages of policy making. Experience in promoting policy coherence for development over the past two decades has led the OECD to identify eight building blocks: institutional mechanisms which can help enhance policy coherence in governments from different political and administrative traditions (see below). There are encouraging country examples applying these eight building blocks that have made progress in improving the institutional architecture to support coherence in SDG implementation (OECD, 2018_[10]).

Political commitment and leadership – to guide whole-of-government action and translate commitment on the SDGs and policy coherence into concrete measures at the local, national and international levels.

Policy integration – to consider systematically interlinkages between economic, social and environmental policy areas as well as ensure consistency with international engagement before taking decisions.

Intergenerational timeframe – to make informed choices about sustainable development considering the long-term impact of policy decisions on the well-being of future generations.

Analyses and assessments of potential policy effects – to provide evidence on the potential negative or positive impact on the well-being of people at the domestic level and in other countries, and inform decision making.

Policy and institutional co-ordination – to resolve conflicts of interest or inconsistencies between priorities and policies.

Local and regional involvement – to enact the economic, social and environmental transformation needed for achieving the SDGs and ensure that no one is left behind.

Stakeholder engagement – to make sure that SDGs are owned by people, diverse actions are aligned, and resources and knowledge for sustainable development mobilised.

Monitoring and reporting – to inform policy making and ensure that sectoral policies can be adjusted in light of progress, new information and changing circumstances.

Source: (OECD, 2018_[10]), Policy Coherence for Sustainable Development 2018: Towards Sustainable and Resilient Societies, https://doi.org/10.1787/9789264301061-en.

Further to developing long-term plans and pathways, governments need to work across sectors and departments to streamline leave no one behind considerations (such as measurements of income inequalities, poverty distribution, gender equity and so on) into public sector processes (such as budget, regulatory management, procurement and audits) to ensure that synergies and trade-offs between various policy objectives and sectors are carefully considered. Early evidence collected by the SDSN in the G20 and some African countries shows that there is wide variation in government efforts to institutionalise the SDGs (Sachs et al., 2018_[9]). For example, although many African countries have put in place some form of co-ordination or planning mechanism for SDG implementation, not one of the countries covered by the survey has made a quantitative assessment of incremental financing needs for the SDGs (Box 4.2).

Back-casting from the goals to the right policies and investments

In addition to establishing co-ordinated institutional arrangements on financing, countries need to determine how to achieve long-term development objectives as part of overall development planning. This requires working backwards from the goals (“back-casting”) to identify the investments and policies required to build infrastructure, strengthen human resources, deliver services and undertake other interventions to achieve the SDGs. Such long-term planning can help lay out potential operational pathways that demonstrate the feasibility of achieving complex, ambitious goals, and can help to mobilise stakeholders around shared strategies and innovation. This is particularly relevant for countries missing basic social infrastructure, where single policy measures and incentives (fiscal policies, in-kind benefits, employment policies, etc.) are largely insufficient.

The Deep Decarbonization Pathways Project provides a useful example of back-casting (Box 4.3). The project support national pathways for deep decarbonisation of energy systems, consistent with the 2°C limit and national development objectives. Following deep technical analyses, extensive consultations with stakeholders, and problem solving with other country teams, these national pathways show how decarbonisation can be reconciled with economic and social development. On the basis of these pathways, several governments undertook much deeper commitments and more integrated policies to achieve complex development objectives. These lessons can be applied in areas where people are leave no one behind, including income inequalities, gender parity and access to key services for vulnerable groups.

Figure 4.3. Institutional mechanisms in place for implementing the Sustainable Development Goals in 11 African countries, 2018

Source: (SDGC/A and SDSN, 2018_[4]), “Africa SDG index and dashboards report 2018”, http://unsdsn.org/wp-content/uploads/2018/07/AFRICA-SDGS-2018-Report-FINAL.pdf.

Box 4.3. Deep decarbonisation pathways and social benefits

Deep decarbonisation pathways accommodate the expansion of energy services needed to meet countries’ economic growth targets and social priorities. The set of pathways created by the Deep Decarbonization Pathways Project aims to decarbonise 16 national energy systems in a context of economic growth and development. They were designed to ensure that crucial domestic socio-economic objectives are met in each country and, notably, that energy services through 2050 would meet national objectives; allow citizens of developing countries expanded access to energy; and enable economies to continue transporting passengers, shipping freight, providing similar or better housing and public amenities, and supporting high levels of industrial and commercial activity.

The pathways show that deep decarbonisation supports sustainable development provides multiple economic and environmental benefits and opportunities for raising living standards. These include improved air quality (as in the Chinese and Indian pathways); enhanced energy security (as in the Japanese pathway); less energy poverty (as in the United Kingdom pathway); improved employment, reduction in basic poverty and improved income distribution (as in the Indian and South African pathways). For all countries to fully realise these benefits, low-carbon technologies must be made affordable and energy planning must integrate social priorities.

Source: (DDPP, 2015_[11]), “Pathways to deep decarbonization 2015 report”, http://deepdecarbonization.org/wp-content/uploads/2016/03/DDPP_2015_REPORT.pdf.

Supreme audit institutions can incentivise government co-ordination for the Sustainable Development Goals

Supreme audit institutions (SAIs) play an institutional role in promoting effective policy implementation and accountability. Traditionally SAIs have focused on financial and compliance audits, but they are increasingly incorporating other aspects, such as performance and value-for-money audits (OECD, 2017_[12]). The International Organization of Supreme Audit Institutions (INTOSAI, n.d._[13]) and recent reports produced by SAIs in Canada, Ecuador, Peru, Sudan, United Republic of Tanzania and West Bank and Gaza Strip, demonstrate the positive role that performance auditing can play in promoting a whole-of-government approach to implementing the SDGs and in highlighting shortfalls, including in issues related to access to and quality of public services across population groups and regions. The reports also find that the machinery of government is not sufficiently prepared to implement the SDGs, whether in relation to strategy setting, co-ordinating agencies and levels of government, stakeholder engagement, and data monitoring systems. Several barriers still prevent SAIs from playing a greater role for the SDGs, including lack of capacities as well as independence in some countries. Furthermore, in a number of countries, their mandates do not cover audits of policy effectiveness and efficiency, including cross-sectoral policy effectiveness (UNDESA, 2017_[5]) (G. Vries, 2016_[14]). As the role of SAIs evolves, countries might need to revise the legislative provisions and mandates for SAI audits.

Data for monitoring, data for management

To support costing, co-ordination and coherence and to guide evidence-based policy to leave no one behind, governments need to invest in and use timely, disaggregated data. The SDGs emphasise the importance of data for leaving no one behind, requiring that monitoring and tracking of the SDGs be disaggregated “where relevant, by income, sex, age, race, ethnicity, migratory status, disability and geographic location, or other characteristics, in accordance with the Fundamental Principles of Official Statistics” (UN, 2015_[15]).

Data are central for monitoring, tracking and understanding progress as well as policy making and management. Data for management requires functional administrative data systems and performance metrics, which enable governments to register their populations, track vital events, report on service performance, identify who is accessing the services, and so on. These data are lacking in the majority of low- and middle-income countries where statistical capacities remain low and funding for statistics is in short supply (Chapter 5). In fact, the 2010 World Population and Housing Census found that 7% of the world population – approximately 48 million people from 26 countries in Africa and Asia – were not counted at all (UN, 2015_[16]). As many as 83% of Africans live in a country without a complete and well-functioning birth registration system (UNECA, 2016_[17]). But this problem is not confined to low-income countries. Even in the United States, there are almost no comparable city-level records on the state of maternal and neo-natal mortality – a fundamental indicator of health and social well-being (Espey, Dahmm and Manderino, 2018_[18]).

Innovative sources of data, coupled with a supportive policy and regulatory environment, can also be used to fill SDG data gaps rapidly. For example, population estimates that not only rely on household counts but also satellite imagery and telecom data may be able to fill gaps in current census records. The POPGRID Data Collaborative1 has catalogued a huge array of high-resolution population estimation techniques drawing on satellite imagery, mobile telecommunications data, and other data sources. With a supportive infrastructure to match supply-side data innovations with data demands, population estimates can be improved worldwide while governments and policy makers will have access to more timely and granular data on to improve social and economic challenges and to target services and interventions more effectively.

International action to target the most vulnerable: Lessons from global health

As countries develop their strategies and approaches to leaving no one behind, it is useful to consider lessons from the MDGs. While many MDGs, including in health, were not fully met, progress towards health goals was fastest in some of the poorest countries, notably in sub-Saharan Africa (McArthur and Rasmussen, 2017_[19]). The global partnership for health which set operational targets underpinned by global back-castings; conducted evidence-based advocacy; invested substantially in strengthening evidence and data and closing technology gaps; and developed funding mechanisms that promoted innovation and learning, played a key role in this success.

This partnership transformed access to care and treatment with lessons that can inform new partnerships for the SDGs and leave no one behind. Critically, faster progress in controlling and treating infectious diseases (malaria, AIDS, tuberculosis) and combating other causes of child and maternal mortality required reaching vulnerable and often marginalised groups, such as the poor; ethnic minorities; lesbian, gay, bisexual, and transgender (LGBTI) individuals; sex workers; injecting drug users and others (Jamison et al., 2013_[20]). We will briefly consider the four key features of the partnership and explore lessons for non-health SDGs.

First, international organisations and civil society organisations proposed aggressive, time-bound targets for improving health and developed global back-castings to achieve them.2 These global back-castings focused attention on the practical challenges of scaling up successful interventions and empowered countries to put forward ambitious national strategies. In particular, the global targets and back-castings helped shift the international consensus towards new and more expensive treatments for malaria, AIDS and tuberculosis, even though poor countries lacked the domestic resources to finance their scaling up.

Second, a large number of evidence-based advocacy organisations sprang up or expanded their advocacy for goal-based strategies and vastly increased funding volumes (Behrman, 2008_[21]).

Third, the back-castings were supported by a rapidly growing evidence base which helped to identify key technology gaps, which became the focus of targeted research3 and development programmes through investments from businesses, science funders and foundations. In a short period of time, long-lasting insecticide-treated bed-nets, rapid diagnostic tests for malaria, artemisinin combination therapy, new antiretroviral therapy and other technologies were developed and deployed at large scale.

Fourth, and greatly facilitated by evidence-based advocacy organisations, several new major funding mechanisms for health were launched, including Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the US President’s Emergency Plan for AIDS Relief; and the US President’s Malaria Initiative. These mechanisms help to scale up funding and to generate high-quality national disease programmes and knowledge sharing between countries (Box 4.4).

Box 4.4. Enabling country ownership and co-ordination: The case of the Global Fund to Fight AIDS, Tuberculosis and Malaria

Experience from the Global Fund to Fight AIDS, Tuberculosis and Malaria shows that country co-ordination mechanisms and independent country-led project approval processes contributed to increasing the quality of national diseases control programmes and in spreading innovation quickly between countries.

All eligible countries were required to establish country co-ordinating mechanisms (CCM) involving governments, civil society, business, international organisations and persons living with the diseases. In many countries this was the first time that governments and civil society discussed how the needs of the some of the most vulnerable populations could be met. Following an initial period where CCMs were often seen as disruptors (McKinsey, 2005_[22]), they became a central mechanism for fighting the diseases (Sachs and Schmidt-Traub, 2017_[23]).

Funding proposals to the Global Fund were country-led. While countries were free to request as much funding as they felt necessary, they also need to make rigorous proposals. Each proposal underwent a rigorous technical review by an independent panel which informed funding decisions and served to safeguard decisions from country-specific political considerations (Schmidt-Traub, 2018_[24]). The standards were tough, and during the first years, more than half of all proposals were rejected by the Global Fund. In the end, this process created incentives to refine their proposals and design more successful programmes (Sachs and Schmidt-Traub, 2017_[23]).

In summary, the global partnership for health enabled rapid and profound improvements in country programmes and promoted innovation, particularly to meet the needs of marginalised populations. It is perhaps the most impressive illustration of how a combination of global goals, strong advocacy, rigorous analysis, co-ordinated implementation and mass mobilisation can make progress in leaving no one behind. Other challenges under the SDGs, such as education, smallholder farming and gender equality, face similar challenges: back-casting from complex, long-term development challenges; reaching vulnerable and marginalised populations; innovating programme design and implementation; advocating for resources; and focusing on the marginalised. As a result, lessons from health are highly relevant to each leave no one behind priority area.

Conclusion

Making significant progress in leaving no one behind as part of the 2030 Agenda will require raising additional resources, but also focusing on innovation and learning, so countries know how to target their resources most effectively. Strong institutions and a capable and co-ordinated public sector are crucial in this endeavour. Similarly, understanding successes in international development co-operation such as the global partnership for health is vital. Lessons from the global partnership for health during the MDG period can be applied to other investment challenges under the SDGs, such as access to schools and equity in learning outcomes, access to basic infrastructure, or support for smallholder farming.

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Notes

← 1. More information available here: https://sites.google.com/ciesin.columbia.edu/popgrid

← 2. Examples are the plans to stop tuberculosis (Stop TB Partnership, 2000_[25]), the goal to put 3 million people on anti-retroviral treatment by 2005 (WHO, 2003_[26]), or the initiative to roll back malaria (Roll Back Malaria Partnership, 2008_[28]). The Commission on Macroeconomics and Health chaired by Prof. Jeffrey D. Sachs played a critical role in shifting the consensus towards greater action (WHO, 2001_[27]).

← 3. The Lancet and other leading medical journals devoted substantial publishing space to cross-disciplinary implementation research, particularly through the Lancet commissions, which helped achieve better country programmes.