The MDGs picked low hanging fruit. To achieve them, the incentive has been to go for those who were closest to thresholds or easiest to help, for instance people close to the poverty line, those who are most accessible and so on. But this precisely leaves out the last, those who are poorest, least able, most marginalised, women most vulnerable to maternal mortality and babies most likely to die. What this has meant can be shown by UNICEF’s diagram of sanitation in India. The Total Sanitation Programme of subsidised toilets was meant for those below the poverty line, roughly the bottom two quintiles. But they hardly gained at all. The biggest gains were by those already better off, the third and fourth quintiles.
Let me propose, and add my voice to others who are proposing, that post-MDG the great need and opportunity is to think and act from the other end, with those who are poorest, weakest, and most excluded and marginalised, those who are disadvantaged and lving with physical, mental and/or social disability. It means aiming to level up from the bottom with equity as the goal and a radical rethink of policies and priorities.
It also means reviewing and focusing systems of monitoring and learning. Policy-makers need to be closely in touch with what is happening on the ground to those who are worst off, the conditions they experience and their changing realities. It means finding ways in which there can be flows of honest, accurate, insightful and credible information to those in positions of power. This matters more than ever given the rates of change for all people living in poverty, not least with the rapid transformations of global interconnectedness, the mobile phone revolution, and accelerating changes in social conditions and relationships. Being out of touch and out of date has always been a problem, and has repeatedly led to misfits between policy and field realities. More than ever before, those in capital cities are finding it challenging to keep up with developments and changes at the grass roots,. This can be expected to be even more pronounced after 2015.
Fortunately, we have a new means for being in touch and up-to-date. An approach has been pioneered which all countries can and should adopt. This is the Sida-supported Reality Checks pioneered in Bangladesh. This is a brilliant and extraordinarily successful innovation. Many have still not heard of it, but it is beginning to be recognised and spread.
The Reality Checks are conducted annually at the same time of year by the same teams. Outsiders spend several days and nights staying in the homes of people living in poverty. Each year they stay with the same families in the same nine representative areas. The brief for those who take part in Bangladesh is to listen, observe and understand the perspectives of their host families and others in their communities. The focus has been primary education and primary health care, two sectors which Sida supports, but a great deal else has come to light. The approach lends itself very well to learning about the realities of those who are poorer, weaker and most marginalised.
The insights repeatedly surprise, not least people’s changing experiences, behaviours and priorities. Unrecognised policy issues are raised. Much more is learnt than just about education and health. The teams have been struck, even astonished, by how much has changed and how fast it has changed since the first Reality Check was conducted in 2007. The people who live in poverty in all countries deserve that their governments keep themselves in touch in this sort of way.
A bottom up focus on equity and on those who are ‘last’, and the approach of Reality Checks, combine and support each other well. Emulating Bangladesh, they could and in my view should be adopted and adapted by all governments. David Cameron could set an excellent and early example by starting Reality Checks in the UK. Though his stay was brief, the Secretary of State, Andrew Mitchell, can testify to the value of staying overnight in a community from his own experience with a poor family in Ethiopia.
We do not need to wait for 2015. We could start now. Experience could then be gained across a range of countries and conditions, ready to inspire and inform extensive adoption post 2015 and to make it more feasible for equity and the wellbeing of those who are ‘last’ to come first.
Robert Chambers is a Research Associate in the Participation, Power and Social Change research team at IDS.