The post-2015 framework: A melting pot of targets and indicators, where to begin?

A community health worker speaks to a woman with her baby about reproductive and child health. Ensuring effective monitoring and accountability is at the core of sexual and reproductive health and rights promotion and protection. Photo by: International Rescue Committee / European Union

The long and arduous process surrounding the sustainable development goals will soon come to a close, yet we still face many challenges.

I am concerned that with more indicators on the table, and with countries being able to pick and choose from a list, this could lead to many of the neglected but important aspects of health and development being left out.

Everyone is trying to fight their corner and push their priorities, yet the agreement on the final list of indicators will be made by member states, who are concerned that the sheer number of indicators in the sustainable development framework will place an additional burden on countries.

Indicators are only useful if they can really monitor progress on the SDG targets, and when you start limiting them; this is when it proves difficult.

Sexual and reproductive health and rights targets have multiple components — contraception, maternal health, sexually transmitted infections, adolescents, abortion, etc. Vital SRHR targets, like maternal health, will be incorporated into target 3.1 but more work is needed on identifying how best to monitor its progress. Crucially, indicators on contraception and adolescents should also remain in the framework.

We will need to analyze the overall health goals and see how aspects like abortion can be incorporated. For example, unsafe abortion can be reflected as part of the causes of maternal death. We must ensure that the SRHR indicators are sound, measurable and accurate. This is a long process with multiple mechanisms, and defining the most relevant and rigorous indicators for the related targets will be fundamental to the success of the SDGs.

The Millennium Development Goals were a success because of the clear, simple monitoring framework, common for all countries worldwide. We need to have a similar monitoring framework for the SDGs. Although this would mean fewer indicators to be measured at a global level, countries can have national-level priorities in focus areas that represent wider issues around the key topics. In this context, we have to support countries in prioritizing SRHR within their national monitoring frameworks and to strengthen their capacity to measure and monitor established SRHR indicators.

Inequalities remain unacceptably high across all main dimensions of human life. In terms of human development outcomes and related MDG targets, there is a more mixed picture. Despite areas of improvement, such as the gender ratio in primary school enrolment, wide and often mutually reinforcing disparities persist across groups of countries and regions — the most glaring examples can be seen within low-income countries, parts of Africa, and countries affected by or emerging from conflicts.

The U.N. General Assembly in its Dec. 21, 2012, resolution expressed concerns over inequality as a challenge for the achievement of the MDGs, and that efforts to achieve these goals often take inadequate account of the impact of inequality on development. Recent discussions on the nature of inequalities have seen a high level of consensus around findings that are key to understanding and tackling the challenge of inequalities for sustainable and inclusive development.

With growing socio-economic inequality and the concentration of deprivation in geographic subareas and among identifiable population groups, it is essential that the post-2015 agenda fully address disparities and promote equity-focused policies that tackle both the manifestations of inequalities and their structural drivers, while focusing both on the people and countries that are furthest from achieving internationally agreed development goals. Such measures should be underpinned by human rights standards and principles, including of equality and nondiscrimination.

Ensuring effective monitoring and accountability is at the core of SRHR promotion and protection. The Commission on Information and Accountability for Women’s and Children’s Health emphasized multiple dimensions of accountability, by adopting a framework built on three pillars: monitoring, review and action (including redress).

Accountability is intrinsic to ensuring that individuals’ agency and choice are respected, protected and fulfilled. Agency and choice are fundamental to enabling individuals to have a voice, and holding governments to account. Governments must ensure accountability by monitoring, reviewing and remedying SRHR and violations. It is important to strengthen existing systems, and enhance the capacity of civil society, parliamentarians and other nongovernmental mechanisms in demanding accountability and monitoring.

Substantial progress has been made over the past couple of years, especially on information, resource tracking, and women’s and children’s’ health. High-level political leadership, key public-private partnerships, increased resources and intensive civil society participation have all contributed to increased accountability and accelerated progress. However, challenges remain, including weak national accountability mechanisms, lack of data transparency and health systems under great pressure to deliver ambitious political goals with limited worker and management capacity.

It is important that the current rhetoric on accountability is translated into mechanisms for robust and independent monitoring, transparent and participatory review, and effective and responsive action.

Let’s not reinvent the wheel, but work at improving current mechanisms through strong targets and effective monitoring systems.

This piece is part of a series of articles to be published in “Health Matters,” a news bulletin commissioned by Action for Global Health for European Health Month, as part of the European Year of Development 2015. The paper brings together key stakeholders working on health to confront the challenges of the post-2015 framework, provide recommendations on the means of implementation, and raise awareness on the importance of health for all.

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About the author

  • Marleen Temmerman

    Marleen Temmerman is the director of WHO's reproductive health and research department. She was an elected senator in Belgium and a professor of gynecology and obstetrics with years of research and project implementation experience worldwide.