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The progress on MDGs, SDGs

Haddis Desta Tadesse is the director for Ethiopia and the African Union (AU) at the Bill and Melinda Gates Foundation where he leads the team which oversees partnerships across the region and investments in Ethiopia’s agricultural development, health, financial services, water and sanitation, nutrition and emergency relief by managing programs and building diplomatic relations with key partners and stakeholders, including governments, AU and UN officials, donors, private sector decision-makers, NGOs and members of the press. Haddis has been with the Bill and Melinda Gates Foundation since 2007 where he managed government relations work in Africa from Seattle before moving to Ethiopia to establish the office of the foundation in 2012.  Prior to joining the Gates Foundation, Haddis was a senior policy advisor to Seattle Mayor Greg Nickels on citywide policies for human services, public health, housing and civil rights.  He also led outreach to immigrants and refugees and implemented several new initiatives to support these communities. A US citizen of Ethiopian origin, Haddis lived and worked in the United States for nearly 25 years. He earned a Master’s in public administration (MPA) from the University of Washington. He serves on a number of boards and has held several fellowships, including at the German Marshall Fund of the United States and the European Union. Following the launch of a new report entitled “Goalkeepers” Wednesday, Birhanu Fikade of The Reporter sat down with Haddis at his office situated within the premises of the International Livestock Research Institute (ILRI) to talk about the progress and challenges of the Millennium Development Goals (MDGs), hopes and worries the Sustainable Development Goals (SDGs) might bring, with a special focus on Ethiopia. Excerpts:

The Reporter: The Bill and Melinda Gates Foundation has launched a global report featuring the progress and challenges of achieving targets set for health, education and agriculture in line with the MDGs and the SDGs. Could you brief us what else is in the report?

Haddis Tadesse: Sure. We’re launching an annual report tracking 18 indicators from the goals, highlighting what’s working and not, to inspire bold leadership, spread best practices and hold leaders accountable.  The report uses first-person accounts from leaders driving progress against the goals, highlighting the innovations and best practices that have made the difference in the most successful countries.  It also includes breakthrough data projections to forecast good and bad future scenarios – with millions of lives hanging in the balance.

The key messages of the report are about progress, leadership and the potential danger of falling back.  The world has been on an incredible path of progress – in our lifetimes we have witnessed the biggest decrease in poverty, disease and child mortality.  Extreme poverty, child mortality and malaria cases have all been cut in half, and HIV and maternal deaths nearly by half.  But progress is not inevitable. The current global political upheaval threatens development budgets and puts at risk the phenomenal progress achieved to date.  To achieve the global goals, it will take commitment and perseverance, continued investment and innovation; but most importantly, it will take leadership at every level.  193 governments signed up to the goals -- a clear plan that countries can implement against, and a commitment that citizens should hold their governments accountable to. 

The MDGs have fallen short of expectations. Many countries could have achieved targets that were set for 2000. One of the challenges in achieving MDGs targets was financial gaps as indicated during the Finance for Development Conference held in Ethiopia three years ago. Trillions of dollars are required and many developed countries seem pulling out their supports. Could you tell me what worries you in that regard?

We are extremely worried about that. In fact, it’s one of the reasons why we are launching such a report at this critical time. A good example that’s highlighted in the report is the case of HIV/AIDS. In the course of our life-time, about 35 million people died of AIDS. That makes it one of the worst humanitarian disasters we have witnessed. It’s a big deal. You still have 36 million people living with HIV/AIDS. Our analysis shows that if you cut 10 percent of the funds for HIV, we think we will lose 5.6 million people between now and 2030. You can see that a small reduction in HIV funding can have a significant adverse impact. When you extrapolate that into maternal health, child health, nutrition, and diseases such as TB and malaria, you can imagine how many people could be affected. That’s why we launched this report to highlight the opportunity and the challenges we have. But now is not the right time to cut funds. We think now is the time to accelerate the gains to make difference in peoples’ lives. For us, it’s a matter of life and death.

In addition to HIV/AIDS, hunger is a critical problem that we stil grapple with. What does the report say as regards this particular issue?

Agriculture is no different. We need to invest heavily in the sector now again more so than before. But not only have we had the typical challenges in the agriculture sector, that challenge is compounded by the fact that climate is becoming unpredictable and erratic than before.  Hence, in this environment you need to invest more to make sure farmers weather the effects of climate change, create better seeds, and you need to make sure that farmers have access to fertilizers and markets. In line with that, we are increasing our investment in agriculture, livestock, and we encourage others to do the same.

We are in the second year of SDGs implementation. What  progress has so far been registered on the ground? Do you think countries get adequate financing and support to achieve the SDGs?

You have to preface that question by saying it depends on where, which country and others. Hence, there is no one answer that fits everybody. Some countries are much focused. I would put Ethiopia in that group. The national plan (Growth and Transformation Plan - GTP II) takes into account the SGDs goals fully. The level of investment that goes into various sectors is impressive. But there are countries which are not making as much investment and efforts as we have seen in Ethiopia. You have also donors. Some donors are really committed to helping countries achieve SDGs and you have other donors who say they are cutting resources that go to developing countries for SDGs. The other fact here is that there are circumstances that make it difficult for some countries to deal with such situations because they have much bigger problems. If you are in a middle of a war or a major national disaster, it takes away the focus and the resources that could be channeled to the development goals.

Does the report say how much is required to invest in SDGS?

This report doesn’t, but according to most available studies, we need an extra investment of USD 2.5 trillion per year - equivalent to the nominal GDP of France - for the next 15 years in order to achieve the global goals and leave no one behind.  The challenge is not knowing how much is needed.  Now what we are talking about is the commitment to make sure those finances are made available to African countries to accelerate development.

Countries which provide financial assistance in the form of official development assistance (ODA) or in other forms currently seem shifting focus, insisting that domestic resources be considered as alternate sources of financing. Does the report discuss such issues?

The report does discuss this.  We believe domestic resources and ODA are not mutually exclusive.  Rather, they complement each other.  We are encouraging both to accelerate their financing at this critical time.  

 The Bill and Melinda Gates Foundation has been keen to supporting vulnerable communities across the world. But what has been achieved in its operations in Ethiopia?

We are focused on building and strengthening partnerships and that’s one of our strong areas of strategic engagement in the countries where we have investments. In Ethiopia, the strong role that the government plays in charting the course of the economic model in consultation with its various stakeholders has been its strength. We have also made significant strides in health – particularly in partnering with the Ministry of Health and other donors on the Health Extension Workers Program at the community level that has improved health outcomes in the country and helped Ethiopia achieve the MDG goals.

We also invest in the agriculture sector.  The sector is the most promising economic resource for Ethiopia. Our work in agriculture has also been strategic, again, through our partnership with the Ministry of Agriculture, supporting production and productivity of small holders in particular. One of the pillars of our support is the establishment of the Agricultural Transformation Agency that is helping to drive the government’s agriculture transformation agenda.

What has been the most formidable challenge for the foundation here?

A challenge that we have seen is not unique to Ethiopia – it has to do with the usual disconnect between the greatest needs on the ground against the available resources to address those needs. We understand there are a lot more development challenges and they don’t all fall within the agriculture and health sectors.  We can’t do everything and it takes multiple resources from key actors to tackle some of the problems.  What we strive to do is work closely with other donors and the government on inclusive programs that aim to reduce poverty and help improve the livelihoods of Ethiopians.

We know the foundation focuses on agriculture and health. But there are also some areas that grab the attention and funds of the foundation. Could you briefly tell me what the other areas are?

Besides agriculture and health, the foundation is dedicated to ending extreme poverty worldwide and these efforts will help better the lives of people in the poorest countries by participating in an inclusive global financial system.  In brief, basic financial services help the poor use what money they have to improve their lives, and the foundation works on connecting people who live completely outside the formal financial system to localized financial services.  Now we recognize that connecting rural populations to a digital financial system will not solve all of the barriers to reaching people with financial, utility and other services, but it is a step forward to ensuring people lift themselves out of poverty.  Today, with mobile phones, it is easier and cheaper to reach people with financial services, and we are starting to see the impact – the number of people with bank accounts is going up quickly.  These financial services can especially be revolutionary for women who traditionally have been excluded from making economic decisions.

How are the activities of the foundation viewed by the government and what is officials’ opinion of engagements of the foundation with civil societies, if any?

One of our key partners is the government in Ethiopia. Our work in the health and agriculture sectors is implemented in close collaboration with both the Ministries of Health and Agriculture.  Our strategies to improve both health outcomes and agriculture productivity are designed to be in alignment with the national development plan.  We continuously engage the government to ensure we understand their priorities, so we can identify where we can provide support.  We also work with universities, NGOs, the private sector, the media and other players.  The more collaborations we create, the better the solutions and the impact will be. 

From the report launched today, we witness progress in reducing both child and maternal mortalities. But it remains difficult to impact maternal mortality compared to child mortality in Ethiopia? Why do you think that is the case?

Despite the incredible progress we’ve made, maternal mortality continues to devastate families and communities.  Globally, the number of mothers who die in pregnancy or childbirth has been cut in half in the past generation, especially in countries investing in frontline health systems and encouraging more women to give birth in health facilities rather than at home, like in Ethiopia.  Most causes of maternal death are preventable. However, while we know how to save mothers’ lives, these interventions are not reaching the women who need them, and that is one of the factors that can contribute to the high rate of deaths.  Another factor is failing to improve the quality of care that moms and babies receive at health facilities, particularly following the big shift from home to facility births. In Ethiopia in particular, the introduction of the Health Extension Platform, established more than a decade ago, has served as the vehicle to implement top-down and bottom-up efforts that ultimately translated into effectively reducing maternal and child mortality rates.  Huge gains have been made in the shift from home delivery to health-care facility births in Ethiopia, but the success of increasing facility deliveries is challenged by the fact that not all facilities are equipped to deliver the quality obstetric services needed to ensure that women do not die in childbirth or in the critical 48-hour window immediately after delivery.  At the foundation, we believe that a community that is aware and empowered has the ability to hold itself accountable and can, in turn, hold the system accountable for delivering timely, responsive, equitable and high quality services. This fuels our belief in the need to continue investing in strengthening the healthcare system.

What can be said about the nutritional needs and the stunting of under-fives in Ethiopia?

Good nutrition is essential to reduce maternal and child mortality as well as to advance educational attainment and economic productivity. We know that under-nutrition contributes to 45 percent of under-five child deaths. An under-nourished child will have an impaired immune system, which in turn increases the incidence, severity and duration of disease. A stunted child has an almost five-fold increased risk of mortality compared to a child with no stunting.  While progress has been made in Ethiopia, we still have a stunting rate of 38%, and over half of children are anemic, while only 7% of children receive what is considered a minimally acceptable diet.

The economic consequences of undernutrition are also significant: a 2011 Cost of Hunger study found that Ethiopia lost 16.5% of GDP due to undernutrition (USD 4.7 billion).  The foundation is investing in Ethiopia and working with the government in support of the National Nutrition Program. Our investments in nutrition aim to yield human capital and productivity gains, thus contributing to the government’s GTP-II vision of achieving middle-income status by 2025.

The prevalence of HIV/AIDS in many countries, including Ethiopia, has seen a remarkable decline until it resurfaced recently. What went wrong?

Incredible progress has been made in our fight against AIDS over the past 15 years; however, this success is at risk as governments shift their focus elsewhere. Quite simply, budget cuts are a challenge to AIDS response efforts, and it will only mean that more people will die. There is a vital need to accelerate the global AIDS response. At a minimum, this means maintaining current funding levels for prevention and treatment as well as R&D, and identifying major efficiencies in dealing with the pandemic. Without this, we won’t have the new discoveries that will make it easier to prevent transmission of HIV. Also, if we don’t spend more to deliver the tools we have now, we will have more cases, which mean that we will, in turn, need to spend more on treatment, or people will die.  It is now essential to continue lobbying governments and partners to ensure these commitments are fulfilled and funding from bilateral agencies, national governments and other donors is maintained.

Despite all the challenges, a few countries like Ethiopia have been considered achievers of MDGs. Has the foundation reviewed what has been achieved and what was not?

The MDGs have helped catalyze global successes in many areas. In the 1990s, nearly 12 million children under the age of five were dying every year of entirely preventable causes. That was one in five babies that did not make it to their fifth birthday. This plunged down to five million in 2016. Strong global and national campaigns on basic vaccines have been key factors to this success.  Extreme poverty fell by half globally between 1990 and 2010 (this target was reached five years ahead of schedule). AIDS is no longer the unsolvable global catastrophe that it was a mere 10 years ago. Today, more than 10 million people are receiving anti-retroviral therapy for AIDS, which also costs 99 percent less than it did then. The rate of new HIV infections has fallen by one-third.  Deaths from TB have also fallen by nearly 50 percent.  A decade ago, the world had no good plans for fighting these diseases. Now, we have the plans, the partnerships and the means to win the battle. Even where exact targets have not been met, a global focus has helped make huge progress.  Much of this progress has happened in Africa. Eleven of the 20 developing countries that have made the most absolute progress against MDGs are in Africa.

Albeit at its infancy, what has the progress and lessons been so far on SDGs?

We can learn a lot about the SDGs, and the report really highlights this fact. First and foremost, we should learn that our goals are achievable and this has been proven by the unprecedented progress the world has seen over the MDGs.  The pathway to achieving certain goals is clearer than others, and this is highlighted in the report as well. Our role is to learn that we need continued commitment and ownership by governments, investment and innovation to achieve this. Today, there are shifting priorities. War and terror, political unrest, economic fragility and budget cuts can put progress at risk but this should not stop us from finding innovative ways to solve global problems we are facing. An important thing to take from the launch of the report is the need for continued leadership and innovation by African governments to be able to meet the SDGs. The most important thing to learn from the SDGs and the report is the stories of leaders who were able to solve development challenges in their country in an innovative or creative way. Continued commitment by leaders – in donor and developing countries – to maintain this progress is required if the world is to achieve the goals.

 Let's talk about how incorporating the poor in the financial system can help alleviate poverty in an economy like Ethiopia. What could be said with regard to Ethiopia's stride in providing an inclusive financial service for the poor?

Overall, a majority of Ethiopian formal financial institutions [including banks and MFIs (micro financial institutions)] seem to have a mandate and are focused on increasing saving mobilization through various saving schemes. Digital financial services, as shown through experience, can be a vehicle for not only increasing access to financial services but as a gateway to reaching the savings mobilization goals of the country. From a macroeconomic point of view, what is currently most important to Ethiopia is increasing savings mobilization and not just velocity or consumption, transfers or payments. In many respects, digitization is seen as a vehicle for achieving increased household savings and national savings mobilization. The increased penetration of mobile-phone subscription presents a unique opportunity.  Subscription rate is likely over 50 percent, with close to 1.5 million new subscribers being added monthly. Five years ago, the mobile subscription rate was only 6 percent.  So the opportunity to increase financial access to the rural populations is there. 

There was a move the Bill and Melinda Gates Foundation announced to invest in mobile banking in Ethiopia focusing on rural communities. How is that coming? What progresses have been made since July 2016?

Yes, in alignment with the GTP II objective to accelerate the progress of Ethiopia’s financial sector, the foundation is in discussions with the government to promote financial inclusion, particularly for rural populations.  We think there are opportunities to help implement the financial inclusion strategy, which is an important roadmap to full financial access and inclusion.  There is also a commitment to digitize government payments.  The government of Ethiopia has recently made a Better than Cash Alliance (BTCA) commitment.  The BTCA member engagement team will be working with the government on an assessment of the current capacity to digitize government payments and what is needed to close the gap. We believe it is important to create a regulatory roadmap for the National Bank of Ethiopia that will enable them to achieve their financial inclusion goals, including specific roadmaps for financial inclusion and digitization.  We are in discussions with them to support with the necessary components of the payment platform needed for success.