By Ann-Lis Svensson (Sweden)
The infant mortality rate in the 1980s was high: one out of 10 children died before their fifth birthday. A young girl from a low income country was asked what she wanted to be when grown up.
She answered, “alive.”
As many children as possible should be saved; therefore it was agreed in the Summit for Children in 1990 that 80-90% of the world’s children should be immunized by the year 2000. To achieve this goal, health systems, structures and policies in low income countries had to be developed from the ground up and needed to reach all newborn in the most remote areas.
With the Sustainable Development Goals we are in another phase. There has been a fast, but uneven progress within and between countries. Indicators, including immunization have stalled in many countries and inequalities are increasing .
In order to fulfill the commitment of the Sustainable Development Goals, to “leave no one behind” by 2030, we must set “the furthest behind first;” make those who are most excluded our target and highest priority, and ensure that our systems, structures, policies and practices are inclusive and working for everybody. First then will we “leave no one behind”.
 those with the lowest social and economic indicators; at a subsistence level; people with poor or no access to health and education service
That might seem like a radical statement. Let’s explore the reasons behind it.
1. The “Furthest behind First” is a people-centered approach to development.
We cannot expect that doing more of the same will change the trend of increasing disparities and inequalities; some people are stuck in poverty and exclusion, unable to benefit from progress.
Over the years, there have been discussions and doubts about the incremental approach.
Should we aim to increase the coverage of the total population or to decrease inequalities, focusing on the population that is left out?
When the coverage of vaccinated children was 20% and the target was 80%, the incremental approach seemed logical. Structures, policies, planning and monitoring systems and practices around the world were developed based on increase in coverage in relation to total population.
To “leave no one behind”, we have to work another way. The ‘trickle-down effect’ to those left behind, is not happening. Policies and practices must be redefined to be inclusive and to work for everyone. It is not enough, as sometimes claimed, to have “particular focus” on the furthest behind. It is a systemic issue.
2. Focusing on the furthest behind is an opportunity to ‘leave no one behind’.
2.1 We need a clear target population.
With the SDGs we have committed to aim for inclusive development: “leave no one behind.” This is a visions but ‘no one’ is not a target that can be addressed for implementation. The ‘furthest behind’ is; we can identify who they are, set targets and monitor progress.
2.2 Learning from the excluded people, what is wrong and what has to be done.
We know practically nothing about the furthest behind. Who are they, why and how are they excluded and what do they need to benefit from development. Responses to those questions gives us new insight into what is wrong in our society and in our systems and what must be done to move to people centered, inclusive social development.
Participatory planning is typically not an option for “hard core excluded” people. They do not have the time to do anything but survive and they do not have the resources, capacities, abilities, possibilities and trust to participate and communicate their requirements and needs.
We have to go deeper, to study case by case, to understand what is actually happening. What are the hindrances, barriers of exclusion and what has to be done to overcome them? This helps us introduce an inclusive, people-centered approach to social development. Services and institutions have to adapt to the reality and requirements of people. (See Peru case)
‘Leave no one behind’ is a vision that we can realize by addressing “the furthest behind” and learning from those who are excluded.
3. The furthest behind must come FIRST; be the priority.
The furthest behind are ‘invisible,” ‘do not exist,’ are often depressed, not respected and not treated as part of society. Discrimination is closely related to exclusion, and it can be extensive within societies, communities, institutions, organizations, governments, service providers, and the family. (See Indian case)
Setting the furthest behind first makes them visible and gives them priority within services and institutions. Defined as such, targets and implementation must be set accordingly. This impedes discrimination in institutions and it could become a norm that spreads in society.
3.2 We have agreed to “leave no one behind” by 2030.
This is a unique opportunity. The furthest behind must receive high priority now, from the start of the SDG period.
As agreed in Agenda 2030 the countries of the world will transition towards a social development model that is inclusive and sustainable. Disparities are increasing and with that, social unrest, migration and wars.
For people, for countries and for the world, our vision is to “leave no one behind.” We can, and we must do that by setting “The Furthest behind First.”
Monitoring report on the most excluded.
Inclusion, “leave no one behind”, is a core issue in social development.
The HLPF could suggest countries to prepare Country Plans on how to address ‘the furthest behind first’ by 2030, and to prepare a special Report on how the transformation of their systems and the inclusion of the ‘furthest behind’ are progressing.
This could be an excellent opportunity for countries and civil society to exchange experiences and learn from each other.
|Example from Peru, setting people in the center; maternal mortality.
Health indicators improved fast in Peru in the 1990ies, early 2000, all but maternal mortality.
It remained constant and high despite blood banks, campaigns etc. At that point some committed medical doctors, with the support from UNICEF and NGOs, decided to risk their medical credentials and challenge established health policies and rules on safe deliveries. Together with trained traditional birth attendants they identified 24 for women critical issues that were contrary to established delivery routines. Just to mention a few; everybody in the health center were wearing white clothes and the mothers to be were also dressed in white. White for these women meant death!
They had to lie down in beds, with their legs in the air. They were afraid to fall, since they slept on the floor, and not even their husband had seen them undressed. Also, their husband did not want them to leave their house and they could not leave the animals they had to take care of.
These experimenting health centers changed the colours of the clothes, let women deliver with their traditional birth attendant and husband present, hooking and respecting most traditional rituals. The neighbours help with the animals while women were away. The traditional birth attendants spread the word and women came in increasing numbers to deliver in the health centers. You could see in the statistics that something was happening. Eventually it spread also within the health sector and policies were changed.
|Example from India, “nobody”
In Uttar Pradesh, India parents and teachers went from house to house, persuading and helping parents in their community so that all children would go to school. I visited one of the schools. Children learned; dancing and singing. You could hear them from far away; joyful teaching, learning. Then 4 curly, dirty boys peeked in through the window behind me. When I asked if those children should not be invited I was told, no, they are nobody. Parents and teachers had achieved a lot, getting all children of all casts to school, but there were still children who were..nobody.
Ann-Lis Svensson (Sweden) is a Founding Director of ‘it is about us’ and Rio Monte, organizations dedicated to sustainable development. As member of top management in the UN, in large corporations, and as director within international NGOs and the Swedish international development cooperation, SIDA, Ann-Lis played a direct and active role in social development in various countries over the last 30 years.