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Sustainable Development Goals: Giving teeth to a vision
Sustainable Development Goals: Giving teeth to a vision
A woman squats on the cement floor, biting her lip hard. She has travelled for two days, by foot to get here, after being turned away from another health center that had no beds left. There are empty beds here, but members of this woman’s ethnic group are forced to deliver on the floor. There is agony on her face, but she knows that the medical staff will abuse her if she moans. The birth is complicated. She bleeds heavily. When the baby is delivered, she is left to nurse it on the filthy, bloodied floor. Two nurses yell at her for making a mess. This woman’s country has recently instituted universal healthcare. Yet she is told that she must pay for the services she has received – the services that were supposed to be free.
Situations like these, in which women, especially poor, indigenous, and ethnic minority women are maltreated and discriminated against, are the reality for millions of women and girls worldwide. It is a reality that the ambitious global vision recently outlined in the “Zero Draft” of the Sustainable Development Goals seeks to transform by 2030. These goals will set out a plan to guide global efforts to fight poverty and address issues like gender inequality and climate change. The SDGs will heavily influence the way that an estimated $2.5 trillion in global aid will be spent between 2015 and 2030.
The countries of the world have declared that there must be ‘no-one left behind’ when these goals are implemented, and that empowering women and girls is critical. It is an inspiring and welcome call to global action, the result of an inclusive and comprehensive process to which thousands of civil society organizations have contributed.
But the vision laid out in the Zero Draft will not be realized unless civil society – and poor and marginalized people in particular – can monitor how public finances are actually spent. Public and private actors need to be fully accountable for the quality and accessibility of services, and for protecting human rights and the environment. At present, the text on this critically important issue of accountability is worryingly vague. What we have is a vision, but the discussion about how to realize it has been postponed. Last week, governments headed into one of the last few rounds of negotiations. In July, they will meet in Addis Ababa to discuss how the development agenda will be financed. And in December, they will meet in Paris to determine how the world will tackle climate change.
The importance of these three meetings cannot be emphasized enough. And in all three cases, the success of the agreements reached will depend on the existence of robust and enforceable accountability mechanisms. So what might genuine citizen monitoring and accountability look like? What kind of concrete mechanisms must now urgently be discussed?
CARE has been working with communities all over the world to address this question. In 2008 in Peru, we partnered with a local organization, Forosalud, and the regional Ombudsman to promote community monitoring of maternal health services in poor, rural areas. The initiative was spearheaded by indigenous, Quechua women leaders. The women monitors (“vigilantes”) undertake citizen surveillance in their local areas. Monitors are accredited on completion of a series of trainings. They then visit health facilities 2-3 times week, staying 6 hours, making observations and speaking privately with female patients. Each month, the reports made by the citizen monitors are discussed with local decision-makers and reviewed by the ombudsman. Since this initiative began, the demand for maternal health services has steadily risen, the number of women dying in childbirth has decreased, and women have begun to report vastly improved treatment.
After the Peruvian Health Minister met with the monitors in 2008, he supported policy changes at the national level. Ministerial resolutions and national policy guidelines have since been passed to promote citizen health monitoring, recognizing this as crucial to achieving quality, non-discriminatory healthcare – to ensure that no-one is left behind.
Other CARE country offices have established mechanisms such as voluntary advisory boards, in which citizens review decisions made by CARE’s leadership team and give their input. In Nepal, for example, CARE uses ‘Public Hearings’ to discuss with communities how much funding they had for the program, how it was spent, the results they achieved and what rights people have to monitor their work. The communities themselves have now adopted this practice in order to hold their leaders to account.
These are the kind of concrete mechanisms that CARE calls on member states to have in their minds as they determine the methods by which the Zero Draft will be enacted. These reporting mechanisms current only exist at national levels. To leave no-one behind, it is critical that we go beyond that. All levels of reporting must then feed into each other. Citizens on the ground, monitoring their local services, must be heard regionally, nationally and globally. To make this possible, governments must commit to a universal accountability framework – one that is financed and enforceable.
The Sustainable Development Goals offer a powerful vision for a better future, and the next months will determine whether member states are prepared to give that vision teeth. We have a chance to truly begin dismantling the structures that drive profound human suffering in our world.