Global Development Institute Blog

By Fortunate Machingura, a Global Challenges Research Fund Postdoctoral Fellow at the Global Development Institute, University of Manchester. Fortunate holds a PhD in Development Policy and Management from the University of Manchester

The aphorism that the populations furthest behind should be reached and no one should be left behind continues to consume the development world. The 17 Sustainable Development Goals (SDGs) have galvanised thinking about how to leave no-one behind, based on optimism around the world’s ability to cooperate and govern for sustainability towards ending poverty, deprivation, and inequality for all. Questions of who these populations are, where they live and what kinds of inequalities they experience are critical.

Some countries in Sub-Saharan Africa have taken the leave no-one behind mantra to heart; policymakers, NGOs, the private sector, donors and other decision-making stakeholders, are making frantic efforts to avoid real or imagined abandonment of populations and social groups that are “behind”. For example:

At the project and program level, improved methods and more rigorous approaches to evaluation of development outcomes have led to a massive effort to ensure that resources are mobilised and effort is deployed to the best effect for poorer quintiles of the population who need these resources the most.

What is missing and what counts for populations left behind?

In most of Sub-Saharan Africa, what is missing from this promising early progress narrative is adequate consideration of how social groups ‘left behind’ define advances in development outcomes or assess changes to their lives. Ensuring that everyone, particularly the poor, actively participate and benefit from economic opportunities and growth, should lead to employment complemented by an efficient social policy that equitably distributes income and opportunities while protecting the environment, investing in cities, rural development and agriculture.

Effective participation for groups that are ‘left behind’ would mean that their voices are heard from the onset. This would help to ensure they are not viewed as just a problem to be dealt with, but are also part of the solution, increasing ownership and prospects for success and real value.

Leaving no one behind also means a move towards a culture of inclusion and human security to strengthen solidarity. It should comprise of meaningful democratic deliberation and decision-making, including democratic control of the parameters within which private enterprise operates, rather than enhancing corporate power over governments. There should be systematic ways of addressing the skewed balance of political power; equity with respect to voices of populations left behind around access to material resources.

However, the past has demonstrated that there often are disconnects between priorities of those involved in development policy making and those at the receiving end of interventions (mostly those left behind). Closing these gaps has the potential to improve the legitimacy and effectiveness of development interventions.  It may improve the quality of decisions over the allocation of scarce development resources, strengthen alliances leading to better transparency and accountability in any development effort.

Making decisions more inclusive and transparent will illuminate the trade-offs between policy objectives and groups which must be resolved in most development interventions.

Fiscal scarcity, competing priorities, and complexity of implementing SDGs

Solving the overlapping and complex factors around the achievement of SDGs is not just a matter of levelling-up those at the bottom with those racing ahead. Despite appearances, the task is not as simple as surface level observation renders, especially when we start thinking of the complex calculations that are necessary to navigate the mass of independent and competing priorities.

Even some of the most advanced economies, the United States, for example, are still hounded by conversations of grave inequalities between classes (the top 1% versus the other 99%). While part of the complexity of implementing development programs is not new, and is rather intrinsic to the development process, relatively new trends have emerged that make the SDG landscape even more complex.  Private capital/firms have increasingly joined bilateral and multilateral aid donors and NGOs in an increasingly intricate web of partnerships.

Development objectives have become more ambitious (eg to reconcile economic growth with environmental sustainability while creating shared prosperity and enhancing the quality of people’s lives). Solving these complexities will require a whole government approach and ways of doing so will depend on country contexts speaking to country specific needs.

Gaining and sustaining momentum to accelerate progress in SDG implementation

The promising start alluded to above in terms of racing towards agenda 2030 goals by some Sub-Saharan African countries can accelerate progress in SDG implementation if managed properly. This optimistic and positive outlook informs my work as part of the ESRC Global Challenges Research Fund, which I believe presents two significant opportunities.

Firstly, my work as part of the Global Challenges program sets out to engage political, academic, media and policy audiences on some of the findings from my doctoral research in Zimbabwe. Specifically, the work will engage with the Ministry of Health and Child Care, National AIDS Council and the University of Zimbabwe; the University of Kwazulu Natal – South Africa; University of Namibia; the Southern Africa Development Community; the East, Central and Southern Africa- Health Community, Tanzania and civil society working with marginalised social groups in Zimbabwe, and especially people living with HIV/AIDS, women in sex work, sexual minorities and poorer sections of society. It will also involve the Overseas Development Institute and The University of Manchester’s Global Development Institute in the United Kingdom.

This international network should assist to leverage and build impact opportunities and to debate the practical and contextually relevant mechanisms to bring back political and policy attention on health inequality and preventable mortality, as part of advancing the SDG agenda to leave no-one behind.

For many households in low resource contexts, health is the difference between whether you live above or below the poverty line, whether your children can attend primary and or secondary education, or whether you have access to potable water and decent sanitation. This is especially poignant given that failure of governments to provide basic services — in health or otherwise — which can erode trust and promote instability.

Unless health inequality (and of course, other broader social determinants of health) is tackled, social groups vulnerable to poverty, disease and deprivation will continue to constitute an ever-growing marginalised group of those left behind. Such inequalities will undermine progress on ending hunger/malnutrition, AIDS eradication and poverty reduction, creating the kind of social tensions and political dynamics that can derail the SDG agenda, and drive countries away from positive engagement in international processes.

Secondly, the project is translating my doctoral findings into useful and useable tools that might have a lasting impact on the advancement of the well-being of poor people and especially those living with HIV/AIDS. The work aims to pin down the priorities of the marginalised groups and especially poor people living with HIV/AIDS by digitising and weighting their priorities through community level data traces. These will be linked with big data through well-being weighting economic techniques and transformed into an HIV outcome measure (CHOM) to strengthen understanding on what matters for the most vulnerable and how data uptake by those most vulnerable could improve patient choice. This approach is significant especially when local level data traces are the condition to access free health care and a pathway to addressing inequality at the community level where the need is greatest.

This work, combines high-quality research with communications work, high-level political and academic networking, strategic convening and policy advice, dissemination and public engagement on what it means to confront allowable deaths and to ‘leave-no-one-behind.’

The project will most certainly assist in maintaining the momentum for action needed to continue the dialogue on HIV-related preventable mortality and also demonstrate relevance in the implementation of SDGs and tracking progress for marginalised social groups. It focuses on some of the crosscutting issues that are critical to building responsive health systems, but which are not well understood – for instance: how to tackle health inequality that limits the opportunities and blights the lives of many of the poorest people. The work aims to put the lives of the poorest at the centre and to show how their views and values can be better incorporated into policy making, ensuring that those ‘left behind’ are brought on board development initiatives from the outset, enhancing chances of meeting SDG and other targets through increased ownership and involvement of development policy beneficiaries.


Note: This article gives the views of the author/academic featured and does not represent the views of the Global Development Institute as a whole.
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