[Ip-health] ​How the MDGs gave up on measuring access to medicines

Melissa Barber melissajoybarber at gmail.com
Tue Apr 19 00:46:30 PDT 2016

​Dear all,

The following comment published today in Lancet Global Health may be of
with regards to monitoring of access
​ to medicines​
within the sustainable development goal context.


Melissa Barber

Copied under CC-BY license. <
m D, Onarheim KH, Barber MJ
. How the MDGs gave up on measuring access to medicines. Lancet. 2016;
4(5):e296-e297. Available from:

*How the MDGs gave up on measuring access to medicines*


Dzintars Gotham, Kristine H Onarheim, Melissa J Barber

In March, 2016, the United Nations Statistics Commission agreed upon the
metrics used to measure progress towards, or away from, the new Sustainable
Development Goals (SDGs).1 These so-called indicators define the
real-world, measurable counterparts to the targets within the visionary
goals of the sustainable development agenda. In the context of health in
the SDGs, we wish to highlight the little-known story of the Millennium
Development Goals' (MDG) target on access to medicines. Of the 21 targets
in the eight MDGs that permeated the development debate over the past 15
years, it was the only target that was dropped from the MDG report. The
lessons learnt from this exclusion have important implications for the
design of workable indicators for the SDGs, and even more importantly, for
their implementation.

MDG 8 was to “develop a global partnership for development”. But the
targets of MDG 8 were unique in having no time limit, focusing on “actions
to be taken [primarily] by rich countries”, and being “purposefully vague”
due to “grossly unequal power relations […] during the negotiations”.2

Access to affordable medicines was included in MDG 8 at a time when the
crisis in access to HIV/AIDS medicines laid bare a globally dysfunctional
system of pharmaceutical pricing.3 This was target 8E: “In cooperation with
pharmaceutical companies, provide access to affordable essential drugs in
developing countries.”

While target 8E was reported on in the separate MDG Gap Task Force
reports,4 the
target was omitted from the last six MDG progress reports, which go
straight from 8D to 8F (2009–14). The MDG reports do not acknowledge or
explain the reason for this exclusion.5 Target 8E was relegated to a grey
zone, reported in some places, and not others: some UN sites list “zero”
data available for the target.6Although other indicators were neglected in
this way (eg, within Goal 7), 8E was the only target with this fate. After
we began making inquiries into 8E's absence, it resurfaced after 6 years of
absence in the 2015 MDG report, as a single paragraph acknowledging the
paucity of data.7

Data for access to affordable medicines is notably lacking in comparison to
other MDG targets. For affordability and availability of medicines, the MDG
Gap Task Force reports averages from a sample of only 26 country surveys
over 7 years (2015). By contrast, data for Goal 6 indicators are generally
available for more than 100 countries.8 These observations suggest to us
that data collection and reporting for the indicator received less priority
than other targets.

The decision to deprioritise 8E is not easy to trace. A 2005 Report of the
Friends of the Chair recommended that target 8E be amended, deleted, or
have “special effort […] put into setting up data collections to provide
the information”.9 The report recommended that “established” indicators
that are “closely related to existing data collection programmes” should be
favoured. Although we could not find an explicit record of a decision to
abandon target 8E, a senior employee in the UN Statistics Division
explained by email that “[t]he decision not to report on the indicator for
target 8E was made by the WHO representatives in the IAEG [Inter-Agency and
Expert Group] group […] A few years ago they decided to focus on HIV/AIDS
treatment and stopped reporting on the rest.” It is concerning to find that
a decision like this can be made in obscurity without consultation of
relevant stakeholders.

A substantial part of the value of setting goals, targets, and indicators
lies in the imperative to collect information for measurement and
accountability —“what gets measured gets done”.10 The decision to exclude
an indicator because it is less established is diametrically opposed to the
potential gains of establishing new data collection systems. Indicators
analogous to the MDGs' indicator on access to affordable medicines have
been proposed as SDG indicators.11

Global goals have substantial influence on the agendas of govern
ments and NGOs.2 The deprioritisation of reporting on access to affordable
medicines without consultation and without broader acknowledgment is
unacceptable, and undermines global recognition of inequalities in access.
Without true accountability and transparency, the development process is
superficial and

​ ​
will fail to engage decision makers. To be taken seriously, the SDG targets
and indicators on access to affordable medicines, vaccines, and medical
technologies demand sufficient political will and investment for robust

The views expressed in this Comment are the authors' own, and not official
views of Universities Allied for Essential Medicines. We declare no
competing interests.

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