Truly Sustainable Development Calls for Systemic Responses

Emerging Voices features contributions from scholars and practitioners highlighting new research, thinking, and approaches to development challenges. This article is by Alicia Ely Yamin, lecturer on global health and policy director of the FXB Center for Health and Human Rights at Harvard University.

At the UN General Assembly last month, world leaders moved toward a new development agenda, the Sustainable Development Goals (SDGs), which build upon the soon-to-expire Millennium Development Goals (MDGs). As these discussions continue, policymakers must prioritize creating equitable and effective health and social protection systems, rather than only focusing on stand-alone, single-issue initiatives.

As a recent John and Katie Hansen Family Foundation study conducted through Harvard University demonstrates, the challenges of development are complex, often cutting across multiple aspects of wellbeing, including health, nutrition, education, and socioeconomic status.  Over generations, these interrelated problems are too often compounded, and they can persist in the face of narrow interventions that tackle only a single issue and ignore the big picture challenges of developing communities.

Consider the broad-reaching impact of maternal mortality: though the actions needed to stop women from dying in pregnancy and childbirth have long been known, approximately every ninety seconds, a preventable maternal death occurs. The Hansen Foundation study investigates the intergenerational impacts of maternal deaths on children in Malawi, South Africa, Ethiopia, and Tanzania and finds that losing a mother can ruin an impoverished child’s chances for future prosperity. Indeed, consequences range from elevated mortality levels in infants and young children to early school dropout and early pregnancy.

Isolated programs, such as those focused on nutritional supplementation or ensuring appropriate vaccinations for children, are beneficial, but this piecemeal approach leaves many gaps in the system through which orphans might slip. The study reviews the few programs that exist for maternal orphans in Tanzania, Malawi, and Ethiopia and finds that all three countries lack sufficient coordination both horizontally—among the health, educational, and other sectors—and vertically—between national and local government structures. Even in South Africa—a country with a higher GDP per capita than the others studied and a history of social protection grants—the process of applying to social welfare programs can be fraught with delays. These delays are due, at least in part, to weak linkages within the system, such as the communication between a health facility and social development office. The result is fragmented orphan care; for example, if an orphan was born to an HIV-positive mother receiving prevention of mother-to-child transition (PMTCT) care, that orphan often does not receive follow up care, either medical care for AIDS or other social support. These disconnects and delays place a burden on families in need of more immediate assistance and, in some cases, prevent individuals from accessing government services.

Rather than single initiatives, these countries need systemic linkages and multisectoral programs that support both women’s reproductive health and the health, educational, and other needs of orphans and their communities. Social protection programming needs to take a holistic approach to the analysis, planning, and budgeting processes from the beginning of the policy cycle, incorporating orphans’ needs for income, educational support, food security, and health care throughout. These integrated, multisectoral plans of action then need to come to fruition in full and include measures to ensure orphans receive care across the different sectors of social protection, such as referral services. This streamlined approach could remove vulnerable populations’ barriers to accessing services, prevent individuals from falling through the system’s gaps, and empower affected families and communities to make holistic decisions about their needs.

Social protection systems are within reach for all countries, even impoverished ones,  and investments in universal social protection systems have high returns. In economic terms, these systems typically generate internal rates of return from 8 percent to 17 percent. Yet their more important effect is on social inclusion and equity. By accelerating progress for the most vulnerable and often excluded populations, social protection systems help to level the playing field across societies, thus promoting more democratic inclusiveness.

All of these outcomes—increasing healthy years of life, productivity, and economic growth and improved social equity—have been identified as SDG aims. As the debate continues over the SDG agenda, the full intergenerational costs of failing to prioritize reproductive and maternal health within functioning health systems should be considered, but so too should the broader role that social protection systems can play in improving cross-cutting social and economic rights, substantive equality, and meaningfully “sustainable” development.