Spanning more than two decades, dedicated international efforts to eradicate extreme poverty and achieve the United Nations Millennium Development Goals (MDGs) yielded extraordinary successes. Buoyed by the dramatic reductions in food insecurity, child and maternal mortality, deaths from HIV/AIDS and malaria, and the numbers of out-of-school children worldwide, a more inclusive “international community” encompassing rich and poor nations alike has now come together to make further ambitious commitments to a new set of global goals: the Sustainable Development Goals (SDGs).

With more than 800 million people still living in extreme poverty and 2.4 billion—a full one-third of the planet—still using unimproved sanitation, it is clear that the stakes are high for success of the SDGs, with much left to be accomplished. With an unprecedented 62 million people who have lost or left their homes and are on the move, fleeing armed conflict, drought, floods, failed harvests, or other effects of climate change, it is also clear that the playbook for development needs to change, along with the name of the new development goals.

The scale and the impacts of this dynamic uprooting, this crisis-driven mobility, and the widespread dispossession, dislocation, and destruction cannot, amid such fluidity, be calculated—except to accept that they mock most prior estimates and planning. As just one example, despite having reduced by nine percent the proportion of those inhabiting slums between 2000 and 2014, over that same period—due to the rapid in-migration resulting from conflict and climate change—the number of slum dwellers actually increased by 10 percent, according to the United Nation’s 2015 Millennium Development Goal Report.

And so our best scientists, policymakers, and peacemakers are frantically playing catch-up with a rapidly changing world. One vastly underutilized resource is the expertise of the poor themselves, who are by far the best equipped to teach us precisely what they need, how best to go about getting those things, and what may be the main obstacles to doing so.

In this article, I will review some of the hopes, successes, and shortcomings of the MDG agenda, as well as some of the lessons learned while working to help impoverished sub-Saharan municipalities attain the MDGs. Finally, I will suggest an approach to sustainable development that we are now attempting with our new non-governmental organization, WomenStrong International, which advocates for all plans and programming to begin by listening to those who know best what their communities need and who have the most investment in these needs being met: the women of all ages, particularly those living in the world’s poorest communities, whose lives have thus far been largely untouched by the remarkable Goal-related achievements. Once tangible results from our efforts have substantially improved both the lives of these women and the outcomes for their daughters, we will know that the Sustainable Development Goals have been achieved.

The World's First Best Anti-Poverty Effort: A Recap

Before 2015, the world’s most focused and internationally concerted global development effort was the UN’s eight Millennium Development Goals: halving extreme poverty; achieving universal primary education; promoting gender equality; reducing child mortality by two-thirds; reducing maternal mortality by three-fourths; reversing the spread of HIV, malaria, and tuberculosis; improving environmental sustainability; and lastly, creating a global partnership for development. These ambitious Goals were forged in the course of a series of major international sector-specific conferences that took place during the 1990s. Since 1990, according to the 2015 Millennium Development Goals Report, efforts to attain them have succeeded in reducing extreme poverty and under-five mortality by more than half, the proportion of undernourished and out-of-school children by nearly half, and maternal mortality by 45 percent worldwide. HIV infection rates have decreased by 40 percent, mortality from malaria by 58 percent, and the prevalence of tuberculosis by 41 percent. In the last 25 years, many more women have gained employment for non-farm work, including nearly double the number in national parliaments. Nearly two billion people now have access to piped drinking water and 2.1 billion to improved sanitation, and there have of course been world-altering increases in mobile-cellular and Internet coverage and usage.

Yet huge and increasing equity gaps remain—between rich and poor, men and women, those in and out of school, those with and without access to lifesaving drugs, or to safe shelter, water, sanitation, transport, and working conditions. When 16,000 children under five are still dying every day from preventable causes, our mandate is far from being met.

And even as efforts to eradicate these inequities have been ratcheted up to high gear, climate change and environmental degradation accelerate, undermining hard-won progress. These environmental stresses—catastrophic drought, sea rise, floods, disease outbreaks—compound the burdens already crushing the world’s poorest communities, exacerbating conflicts among those for whom, in the face of chronic shortages, meeting their most fundamental needs—water, shelter, food, work—is a zero-sum game.

Of the 62 million estimated to be currently fleeing violence or lands stripped of opportunities, half are children. Each day, an additional 42,000 people join them, swelling the ranks of the displaced poor for whom our world has no good solutions.

Yet huge and increasing equity gaps remain—between rich and poor, men and women, those in and out of school, those with and without access to lifesaving drugs, or to safe shelter, water, sanitation, transport, and working conditions.

The current epidemic of conflict- and climate-related adversity is beyond the scope of this paper. The commitments made and missed, however, by the international community to help the world’s poorest attain the MDGs are relevant to the record of Goals achieved and those still unmet.

In 2005, at their summit in Gleneagles, Scotland, the world’s then-most powerful nations, known as the Group of Eight (G8), committed to contributing 0.7 percent of their respective gross national incomes (GNI) to their official development assistance portfolios, as well as US$25 billion more per year to sub-Saharan Africa, the region deemed the furthest off-track from MDG attainment. But with the notable exceptions of Norway, Sweden, Luxembourg, Denmark, and the United Kingdom, neither the G8 nor other donor nations have followed through, and the promised net transfers of wealth between rich and poor countries have, for the most part, not taken place. This failure was apparent well before the global financial crisis that turned self-described “rich” countries into self-professed “poor” ones; before and after the Great Recession, the United States, the largest G8 economy, mustered only 0.19 percent of its own GNI for development assistance.

Nevertheless, back in 2005, the promises were fresh and grand, and hopes were high.

One Small Part of this Global Effort, and Lessons Learned

I played a small role in this hopeful global effort as co-founder and director of the Millennium Cities Initiative (MCI), a modest part of a larger proof-of-concept project undertaken by Columbia University’s Earth Institute to demonstrate in selected sub-Saharan sites that the MDGs could, in fact, be attained by 2015. As a sister effort to the better known Millennium Villages Project, an integrated rural development project operating in ten sub-Saharan countries and led by then-Earth Institute Director and UN Special Advisor to the Secretary-General Jeffrey D. Sachs, MCI was designed to help strengthen the regional sub-Saharan capitals in close proximity to the Millennium Villages (those sites having been determined largely for agro-ecological reasons) by preparing these severely under-resourced cities—deemed “Millennium Cities”—to receive the anticipated influx of development assistance and to be accountable as to where the funds went, with regard to advancing the MDG agenda.

In seven “Millennium Cities,” MCI undertook multiple needs assessments, applying for the first time at the municipal level those instruments developed explicitly by the UN Millennium Project Task Forces to assess national-level needs in specific sectors. Our needs assessments in the areas of public health, education, gender, water, and sanitation revealed gaping holes in service provision in those areas and provided estimates of the costs of alleviating those gaps.

These top-down assessments were necessarily focused on equipping those institutions responsible for service delivery, and consequently reflected “the supply side” of the problem. To understand the needs of those on the ground, MCI developed a comprehensive, poverty-related household survey that we applied in selected slums in two Millennium Cities. This multi-sectoral, MDG-based instrument, generally conducted with female heads of household, revealed some different priorities than those indicated by our needs assessments (e.g., better street lighting and bus service, to improve personal safety, mobility, and convenience).

Unwilling to wait for development assistance to trickle down to the municipal level before addressing a city’s most shocking public service deficits, MCI also brought in experienced partners and designed some of its own programs to help address specific pressing needs. In Kumasi, Ghana, for instance, where newborn deaths were skyrocketing and the neonatal intensive care unit at the tertiary care center was crowding five premature infants into each incubator, MCI arranged for MASHAV, Israel’s Agency of International Development Cooperation within its Ministry of Foreign Affairs, to second Ben Gurion University neonatologists to train local nurses, midwives, and other medical practitioners in neonatal survival. These doctors then designed a low-cost, low-tech neonatal clinic to treat newborns not requiring intensive care; MASHAV built two of these modest “Mother-Baby Units,” which alone reduced the crowding in the neonatal ICU by more than 30 percent and are now being scaled nationwide.

After conducting our research and introducing some effective tools to fill critical gaps in service provision, MCI convened a wide array of stakeholders to share our findings and to help citizens determine their own top priorities for urban and social development, in light of their own knowledge, coupled with the projected costs of various interventions. These determinations then became the basis of new MDG-based City Development Strategies on which Millennium City officials could base their annual budget proposals. These would then be submitted to regional or national government for review, approval, and for the actual allocations that would dictate what could and could not be accomplished at the municipal level.

Sadly, very little was allocated to the cities in direct MDG-related financing, and precious little could be accomplished. There are multiple reasons for this. First, as noted, the donor nations failed to come through with the funds. A second set of reasons relate to the UN Millennium Project’s urging that MDG-related financing be fast-tracked through existing ministries, where pipelines presumably functioned and funds flowed. In the sub-Saharan region, each country’s MDG agenda was largely managed by the Ministry of Economic Planning or Finance, where the priorities for MDG attainment were not necessarily aligned with the priorities of, and the need for, crisis management by each severely underfinanced line ministry (Sanitation, Transport, etc.). Nor were the new MDG-related priorities likely to be in sync with what the Ministry of Local Government had allocated for its various jurisdictions, following its own budget procedures, complete with standardized line items and multiyear infrastructure projects, most planned without the MDG agenda in mind. Moreover, given existing reporting chains, a local official hired by and accountable only to the Ministry of Local Government could not be compelled by a Planning or Finance official to alter his work plan to more directly address MDG-related targets.

Thus do broken rich world promises, chronic poor world budget shortfalls, and universal bureaucratic dysfunction perpetuate the status quo.

Another structural reason explaining why some components of the MDG agenda have not come close to achievement is that two areas critical to a functioning, sustainable planet—gender equality and urban sustainability—are downplayed in the MDG agenda, at least with regard to the concrete investments needed to make the world’s women, girls, and cities safe and able to realize their full potential.

One might argue that “Gender Equity” was, after all, the third Millennium Development Goal, seemingly prioritized even before child health; but the understanding has always been that gender is a cross-cutting sector covered under every MDG, whether it is achieving universal primary education for girls, reducing maternal mortality and infectious disease rates, or improving water, sanitation, roads, energy, and other physical infrastructure that directly affect the quality of women’s lives.

As a result, the robust set of priority areas for gender explicitly enumerated by the UN Millennium Project Task Force on Education and Gender, once translated into a set of costed interventions to be carried out under countries’ Ministries of Women’s Affairs, became little more than low-cost budgetary add-ons to the major investments that were anticipated to be covered by other ministries. Line ministries were expected to follow through on this agenda by investing substantially in those areas that would most benefit women and girls. But again, when a minister of public works, charged with managing decades-old, severely deteriorated infrastructure, finds himself careening from water line break to cholera outbreak to transit strike, the mission to ensure a water tap near each household, so as to spare women and girls hours of backbreaking, time-consuming work that regularly exposes them to sexual violence, is not likely to be a top priority.

This disconnect can also be seen in the arena of urban affairs. The seventh MDG, “Ensuring Environmental Sustainability,” includes targets mandating the reduction of emissions and the use of solid fuels and improvements in the provision of safe drinking water, in basic sanitation, and in the lives of slum dwellers. But again, with scarce municipal financing and daily crises triggered by failing infrastructure, it should not be surprising that those targets remain unrealized.

Finally, government turnover, corruption, and politics also interfered with MDG implementation, as when a new local mayor did not see his own interest in continuing with a program identified with his predecessor, regardless of its intrinsic merit or its alignment with national or internationally agreed long-term Goals.

Losing Ground, Losing Hope

Therefore, the weakness of public institutions, local capacity, and donor commitments have inhibited the reach of the successes achieved. Naturally, in poor urban communities, those failures to deliver read as a distinct lack of caring, even callousness, on the part of local officials. Serial broken promises cannot help but demoralize impoverished urban dwellers, diminishing their trust in further partnership with government or the international community.

Such feelings were notable at the UN Summit last fall, convened to launch and embrace the new set of Sustainable Development Goals. A day or so after the SDGs were unanimously endorsed by the UN member states, a veteran South African slum leader from a Pretoria township, in a rare appearance on any panel by someone representing the Goals’ ultimate target population, simply shook her head when a UN-Habitat official enthusiastically reiterated the many bold targets for the new, hard-won SDG11: “Make cities inclusive, safe, resilient, and sustainable.”

“Umm, ummmh,” she exclaimed quietly, to a room crowded with suited bureaucrats and diplomats. “I’m just wondering, 20 years from now, if we’re going to be here, learning about another new set of Goals, and still nothing’s changed on the ground.”

Clearly, to this bold community activist, these new Goals, like the old Goals, were wholly abstract. The pressures on social service delivery and decaying infrastructure, exacerbated by the unprecedented in-migration and overcrowding, have only heightened the risks to the public health, social sustainability, and community cohesion that are the sine qua non of urban development.

The internalized personal, family, and community trauma wrought by years, decades, even generations of displacement, distress, prolonged periods of suffering under degraded conditions, and official neglect can be crippling, the loss of faith and momentum difficult to overcome. Yet after years of pontificating about what will help the poor, this is where those of us who care about successful and sustainable social development must begin: by listening to those who know best what they need and how best to get where they hope to go.

This shift in perspective may prove difficult for practitioners and political leaders alike: technical experts, bureaucrats, and even local politicians are not used to listening to those operating at the grassroots. Experts believe they know what needs to be done, bureaucrats push through the requisite paperwork to get it done, and across the sub-Saharan region, at least, most local leaders are appointed, not elected, and consequently are often too busy obliging their superiors to hear out their actual constituents. Yet until we heed the despair articulated by that South African activist, who had no more time for noble rhetoric and empty promises, and unless we consider as our bottom-line SDG target the provision to women like her of essential services and economic opportunity, we can expect to fail.

From the Summit to the Ground: Women Leading With What They Know

As the MDG agenda sunsetted in late 2015, the Millennium Cities Initiative also came to a close. In chronicling our work over more than a decade, we observed that women and girls on the ground had led our most effective programs in the Millennium Cities. Whether through the vehicles of savings groups, community cleanup crews, or Girls’ Clubs, the girls and women clearly valued the chance to succeed, to lead, to form common bonds, and to broaden their range of future opportunities. To continue this work, and as a further proof-of-concept, we resolved to create an organization explicitly for the purpose of enabling women-driven development, to see how far severely under-resourced neighborhoods might get with women devising the agenda and leading the way. That organization, WomenStrong International, is in its second year as a consortium of determined non-profits working with impoverished girls and women in five cities in five countries, two of which—Kisumu, Kenya, and Kumasi, Ghana — have been able to build upon the work accomplished under MCI. Together with WomenStrong’s three new venues—in Madurai, India; Borgne, Haiti; and Washington, DC—the projects share useful tools, resources, programming ideas, and lessons learned and brainstorm solutions to the many common challenges they face.

WomenStrong team members, all local, began by listening hard and by establishing an essential trust and confidence with the women and girls in each setting, as the outcomes clearly depend on their will to succeed, both for their own benefit and that of their families and communities. Our collaboration and constancy, together with the extended networks and evidence-based findings we bring to bear, are reassuring, for along with their seemingly indomitable energy, industry, and entrepreneurial spirit, the women are clear that they cannot do this themselves. They know precisely what they need; now, they need the technical and financial resources that can make those things happen. We hope to be able to demonstrate that with access to such resources, and to a reservoir of evidence-based solutions gleaned from work accomplished worldwide, women and girls anywhere can make use of proven tools and strategies that can take root, are sustainable, and can help them lead their families and communities out of extreme urban poverty. After all, the mothers care more than anyone and are keenly aware that their daughters—vulnerable, yes, but bright-eyed, robust, and full of dreams and potential—are their future.

When those daughters have experienced reliably safe water, sanitation, transport, clean energy, and decent clinics, schools, connectivity, and job opportunities, then we will know that the Sustainable Development Goals have been achieved. And that the pained cynicism evidenced by that longtime South African activist, and the millions like her, can finally be laid to rest.