I am, I think, starting to sound like a broken record. I just posted this comment on a blog written by Rica Garde, an Economic Policy Officer with the Development Policy Team at Save the Children UK about their recent report "Addressing the Inequalities in Child Survival". The text of the blog is at the end of this post and may be found at URL:
http://www.savethechildren.org.uk/blogs/2010/08/addressing-the-inequalities-in-child-survival/. This is my comment:
Dear ColleaguesThe number of reports published by Save the Children and other relief and development organization is impressive. The URL to download the report referred to in this blog is: http://www.savethechildren.org.uk/en/54_12286.htm
I am always surprised at the rather "obvious" conclusions drawn in well publicized papers from well known organizations like, for example, this paper on child survival from Save the Children (UK). There is something wrong with the whole of the global relief and development industry ... and I am not really sure what it is!
When I first did work in this field in the 1970s I was immediately struck by the poor management processes in use compared to the corporate sector where I had been involved in Management Information System development and had been a Chief Financial Officer of a complex international company. In my corporate career I had been actively engaged in helping to improve performance and profitability ... but the same level of attention to progress and performance in the relief and development sector was totally absent. The situation has not improved very much of the subsequent 30 plus years.
Spend a couple of days in any country in the world and it is pretty clear that national averages are totally useless in managing anything ... yet they are almost the only data points being widely discussed. The national average reflects neither the good that should be replicated or the bad that should be eliminated ... and I would argue using advanced common sense that what one does to replicate good is rather different from what one does to eliminate bad.
The availability of "reports" is pretty impressive ... but they overwhelm as much as they inform. Somehow the management process is not working because while there are good things to write about, the scale of bad things remains ridiculously large. I argue that it leadership was doing its job and the systems were working there would not be multiple billions of people poor, hungry and in ill-health.
I can go on ... but will not, except to observe that until we get the metrics and measurements right, there will be little or no progress in relief and development and in the socio-economic status of most people on the planet. The incentives to do nothing by make profit for corporate organizations and to make a profitable career for "me" are just too powerful at the moment, and they ignore absolutely everything associated with value that contributes to quality of life and a stable planet!
and and lot more reports about development progress are located at:
The problem is that all of these reports do not add up to a system of accounting and accountability for progress ... they are good if you have the time to study them, but most decision makers are busy and these reports are overtaken by all sorts of other matters, many of which should not be in play. More on that subject later!
This is the text of the blog.
Addressing the inequalities in child survivalWhile I am a strong critic of the metrics used for corporate performance with a total focus on profit performance without much reference to anything else ... but at least there are widely followed metrics about the profit performance of each independent organization.
Tuesday 17 August 2010
Every year figures on child deaths are released to track how countries are progressing towards Millennium Development Goal 4 — to reduce the under-five mortality rate by two-thirds between 1990 and 2015.
Reductions in under-five mortality are usually reported as national averages however, masking the unequal progress across different groups within a country.
A new Save the Children paper entitled “Inequalities in child survival: looking at wealth and other socio-economic disparities in developing countries” outlines a number of important issues surrounding children’s unequal survival prospects.
Across the developing world, countries with lower levels of under-five mortality tend to have more inequality in child mortality between the richest and poorest households.
Child deaths are more concentrated in poor households in developing countries that have reduced under-five mortality the fastest. This suggests that these countries made progress at the expense of poor households.
A few, like Egypt, however have managed to improve child survival and narrow disparities in under-five mortality between the rich and poor at the same time. Cases like these prove that inequalities in child survival can be avoided.
Unequal survival chances between rich and poor children are driven by a host of factors. Poor households often lack clean water and sanitation, cannot afford to buy nutritious food and have no access to medical care making their children more vulnerable to diseases.
These deprivations are both driven by and contribute to poverty, joblessness, low female education, weak health systems and poor governance. Wealth is an important but not the only determinant of inequalities in child survival. Unequal survival outcomes are present across gender, ethnicity, caste and tribe.
India perfectly mirrors the child survival story in the developing world. While under-five mortality has fallen in India, high and sustained growth rates in recent years have not been enough to put the country on-track for the MDG 4 target.
Child survival varies in different parts of the country. Southern states like Kerala and Tamil Nadu have brought down under-five mortality way below the national average, while northern states are lagging behind.
For example, the under-five mortality rate in Rajasthan is more than twice that of Tamil Nadu. The poorest children in India are three times more likely to die than those from the richest households.
Girls are less likely to survive to their fifth birthday than boys, and so are children from scheduled castes compared to the average under-five population.
There is some good news however. A of number of poor countries have shown that it is possible to make a dent on child deaths with limited resources. Bangladesh, which is on-track to meet MDG 4, has significantly improved child survival with only modest economic growth.
It has done so by rolling-out effective but inexpensive interventions widely, ensuring that the poor is not left behind. For example, coverage for immunisation against measles—one of the most common causes of child deaths—went up from 62% in 1996-97 to 80% in 2007 among the poorest households.
Coverage gaps in measles vaccination between boys and girls have effectively disappeared in the past decade according to the Countdown to 2015 Decade Report. Other socioeconomic disparities in under-five mortality still need to be addressed in Bangladesh however, such as unequal survival chances in urban and rural areas.
World leaders will meet in a UN Summit in September to accelerate progress towards the MDGs. With only five more years to go before the deadline, it is just right to put pressure on national governments and donors to agree on an action agenda.
We should not forget to press them for a more equitable achievement of the goals. In the case of child survival, meeting MDG 4 at the national average but leaving poor children behind makes it a shallow achievement.
To better understand these issues, read our paper and engage in the debates in the run up the Summit.
In the relief and development sector, there are not even the metrics to compare the performance of different entities in the sector. Of course money profit is not a meaningful metric in relief and development ... but after so long I would have expected some metric to have been development that would be both useful and universal. My solution to this is a "value" based standard for impact which can be related to a money cost for the organization as well as a "value" based consumption of resources that would, for example, handle the value of volunteer efforts.
When there is a humanitarian disaster there is a media focus on the plight of the affected people and organizations raise money to address the disaster ... but it is also arguable that the poor half of the world's population live a permanent disaster. This being so, then the question is what should be done to have metrics that focus clearly on the reasons for the poverty and those who have the possibility to do something about it ... those that are responsible.
This may be complex and it is difficult to use national average data as a way to identify responsible parties, if not impossible ... but similar data at a community level is way more easy to understand. The private sector and the public sector are possible culprits ... the for profits and the non-profits ... the available resources, organization and the systems of governance. But the culprits are also the solutions ... and, in our view, it is meaningful metrics that are going to change the that get made and the behavior of people and organizations so that the outcomes reflect positive socio-economic progress and efficient and effective performance.
More on all of this another time.