Postcards from New York: MDG Q&A with Malawi’s Martha Kwataine

Are the MDGs the right way to fight global poverty?

The MDGs are a useful framework but a one-size fits all approach is not the best way to go about tackling the problems of individual countries.  Often aid is given on the basis of

Martha enjoys a lighter moment

whether an MDG-driven approach is being taken, ignoring local policies which are doing some excellent work that doesn’t match MDG criteria. e.g. the Global Fund is ringfenced for HIV, malaria and TB. National priorities naturally  switch to where the money is, so governments and civil society move their priorities and other needy areas are neglected. Diseases such as hepatitis and cancer are on the rise in the developing world but no one is doing anything about it. Bi-lateral donors – such as the UK’s DfID – will acknowledge these diseases are problems but say they aren’t priorities because they don’t fall under the MDG remit.

What are the biggest mistakes that have been made?

The approach has been too reactive -  the international community has been jumping from one issue to another depending on what’s popular. There has also been far too much fire fighting, particularly on HIV, malaria and TB. A more programmatic approach to global health would be integrated.

At present, the existing approach to MDG 5 (maternal mortality). pre-supposes women already have access to enough doctors, no user fees for seeing them, assumes facilities for everyone within walking distance, assumes women and mothers are able to demand quality healthcare systems. And yet, these basics are not in place. At the start of the MDGs training programmes should have been in place to ensure there were enough healthworkers to meet the disease burden.

In Malawi the number of women giving birth in the presence of qualified health workers is 54%. So any strategy that Ban-Ki moon outlines on Weds will be incomplete unless it addresses these basics.

What’s needed from the Summit this week if the goals  are to be met by 2015?

If the MDGs are to be met by 2015, they need to be strategic in addressing the challenges. We have 5 years to go and need to get realistic about what we can achieve. No one can pretend they don’t know what’s needed. The WHO has developed a code of practice to stop the migration of healthworkers to rich countries. The worst culprits for poaching are still the U.S., the UK, Australia and Canada. However, in a global village you can’t stop people leaving their country to look for a better life. But we can put up policies that are conducive to helping them stay – and that means, better pay, better working conditions, proper drugs etc.

Martha Kwataine is the Executive Director of the Malawi Health Equity Network