In 1982, on my first day as a newly appointed Reports Officer at the WHO Regional Office in New Delhi, I learned that there would be an extraordinary meeting of all staff that afternoon to hear a speech by WHO’s Director General, Dr Halfdan Mahler. Mahler was a Danish TB specialist. The son of a famous preacher, he had evidently inherited the gift of eloquence. He would need it: he was visiting India to promote WHO’S new objective, “Health for All by the year 2000”. How that could be achieved in a scant 18 years needed some explanation. To me, it seemed an impossible task.
I was told that my job at that day’s staff meeting would be to write up the visit for our staff paper. Duly armed with pencil and pad, I got into the elevator for the ride to the top floor. There was someone already in the lift. As the doors closed, I found – to my horror – the tall figure of Dr Mahler beaming down at me.
“Hello,” he said, nodding affably. A deep, musical voice.
“Hello, sir.” Mine came out as a squeak. We both laughed. In an attempt to salvage some dignity, I blurted out the first thing that came to mind: “Do you really think we will have health for all by the year 2000?”
“No,” he said with a smile. “But we will have fun trying.”
What Halfdan Mahler offered that afternoon in WHO’s New Delhi conference room was a perspective of health development leading up to the framework abbreviated as HFA/2000. He spoke about a history of changing development attitudes that can be traced from “the happy glory of the missionary days in the 1950s”, when a supranational spirit obscured the need to leave something behind and promote self-reliance. You could hear the preacher’s son in that. Colonial empires were crumbling rapidly and a whole tier of colonial administrators moved out of national service and into the offices of the United Nations system. Multilateralism was born.
In what he called the “integration sixties”, people were not so motivated. The emphasis shifted to technical virtues. “Experts” engaged in “pilot projects”, building up basic services and integrating all efforts into them. The problem with these experts was that they were experts at home, but not necessarily so when they got to what was called “the field” – the countries that allowed them to operate within their boundaries. Confronted by snags and difficulties unknown at home, the pilot projects they left in the field often collapsed when funding stopped, sometimes after many years of being propped up from abroad and numerous visits by further baffled experts. The fact that these men (rarely women) did most of their head-scratching in five-star hotels did not go unnoticed either.
The 70s continued the trend. Nevertheless, there was a palpable shift from the previous decade towards recognition that local knowledge could not be ignored in development. To an extent, this reflected changes in the wider social environment in the industrialised countries, where a wave of long hair and liberal thinking was busily dissolving many of the rigid concepts of the past. It became essential to integrate local knowledge into all development projects. In some cases, however, this laudable shift went too far. Development staff from the multilateral organizations so deeply submerged their own external knowledge and experience, and let local knowledge and opinion rule, that they made no impact at all. Being humble was not enough: while it was good to sit at the feet of the villagers to learn, there wasn’t much point in foreigners turning up if they brought no new ideas to the table. Towards the end of the 1970s, development actors began searching for a unifying concept for their entire effort.
The 1980s, which Mahler termed “the implementation 80s”, became a time of policy implementation, as “Health for All by the Year 2000” began its journey. It became the first decade with a clear overarching policy framework for health development, and it was the first such holistic effort across a any sector.
Until then, WHO staff responsible for health programmes had followed paths laid down by donors, politicians and blind luck. Malaria had one such financial and political environment, diabetes another, Buruli Ulcer a third – and so on, for hundreds of conditions, each programme canyon completely unrelated to the others.
Mahler made WHO turn the HFA idea into a full-scale programme framework. All of WHO’s institutional components became locked into the framework, as set out in a “rainbow series” of policy documents (the cover of each policy booklet in a different colour). All activities undertaken by the Organization, however small, had to be coherent with the overall strategy. For staff, having to justify the purchase of a computer by explaining how the purchase would help to achieve health for all people by the year 2000 was a strange and sometimes unwelcome experience. The client countries had to get used to this new way of thinking too, in their regular negotiations over how to deploy WHO funds and activities.
Of course, WHO’s organizational canyons have not disappeared. They are still there, as each programme confronts its separate administrative, technical and financial world. What has changed, however, is that – starting from HFA/2000 – they have become united as clear and explicit parts of an overall development strategy. It is the framework that was the success. This was the historic innovation Mahler gave the development world. WHO set up goals and targets, created timetables for national and regional action, all signed and agreed by every country. And it is a durable achievement.
When we didn’t achieve health for all by the year 2000, UN Secretary General Kofi Annan picked up the baton and proposed the Millennium Development Goals (MDGs) in his Millennium Declaration speech. Following the same kind of framework as WHO used for the health goals, the UN proposed to solve all the world’s development problems by the year 2015. The eight MDGs, their subsidiary targets and indicators, became the overriding obsession of the development world in every multilateral agency and national ministry between 2000 and 2015.
As with HFA/2000, the MDGs were not fully achieved, and so everyone agreed to a new set of 17 Sustainable Development Goals (SDGs), aimed at finishing the job by 2030. The growth in the numbers of goals and targets implied a boom in the indicators used to measure progress. However, whereas the UN set most of the goals and targets for the MDGs, national, non-UN system actors developed most of the targets and indicators for the SDGs.
Will the SDGs be attained by 2030? To use a hated expression, “Whatever”. It is not the repeated failure to reach the promised land that is worthy of comment, but rather the success in encapsulating the entire development ambition in a growing, but still slender list of goals and targets. It would not be surprising if a new formulation of the goals appeared well before the end of the present decade. However often we push the goalposts back, we can be grateful for a robust, interrelated set of targets to guide us. The road may be long, but at least it is there, with signposts and speed limits, and we are on the way.
In conclusion, let’s return to Halfdan Mahler speaking to a rapt audience of WHO staff in the WHO Conference room in New Delhi in 1982. For the previous 30 minutes he had amused, entertained, and carried us along with his eloquence and passion, and now he concluded his speech by describing what he took to be the right approach to development work:
Aggressive humility is needed. Rather than missionary sympathy, what we need is empathy – the ability to see through national eyes. Motivation is essential; technical competence is not enough – the competence must be socially attuned. There has never been progress through pure technocratic solutions – there must be a huge swell of emotional energy behind these technocratic solutions if they are going to be translated into something beneficial for people and peoples.
This statement of values should be nailed to the walls of everybody working in this area.
As I write this, 40 years later, I wonder what I was thinking in that elevator. How could I, a lowly regional reports officer, have had the nerve to fire such a conversational torpedo at the Director-General’s main strategic ambition within five seconds of meeting him? If Mahler hadn’t been such a confident leader, he would have fired me on the spot. His answer to my fumbled question about the virtues of development is another worthy statement of values: “We will have fun trying”.