As the new Sustainable Development Goals (SDG) era has kicked off, on January 1st, the focus is now increasingly on national implementation, even if SDG indicators and monitoring and evaluation mechanisms are still being fine-tuned. Globally, India has been engaged in the SDG indicator setting exercise as a representative (along with China) of countries from Central, Eastern, Southern, and South-Eastern Asia, in the United Nations Statistical Commission Inter-agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs). Together with other countries, the Indian delegation assists in designing the core SDG indicator framework. The zero draft of the framework was released in mid-2015, and has been followed by numerous meetings, conferences and brainstorming sessions. Two open consultations have been organised, first on indicators with general agreement (the ‘green’ indicators) and then on those for which further detailed discussions were needed (the ‘grey’ indicators). India pushed hard for the inclusion of certain issues in the framework, including 1) economic growth, employment, infrastructure and industrialisation; and 2) “common but differentiated responsibilities” in sustainable development and climate change. The Indian Prime Minister stated at the September 2015 UN Summit for the adoption of the Post-2015 development Agenda that poverty, climate change and sustainable development are key challenges for the country. He has also stated that his government would prioritize 11 of the 17 SDGs. Others, including Bill Gates and Jim Kim, have indicated that the success of the SDG goals depends to a large extent upon their success in India. Nationally, however, there is a lot of scepticism on how India will monitor and finance the progress on SDGs, once they are defined.
The 17 SGD goals encompass (as of now) 229 indicators, many of which have “unresolved issues” or require further deliberations. While criticism of the indicators is widespread, from there being too many in number to prioritize (see the redefined acronym “Senseless, Dreamy, Garbled”), to the ambiguous logic behind set targets and levels (the infamous poverty line, for example), the Indian establishment has already expressed its reservations on its ability to monitor the indicators. The CEO of the Niti Aayog, the replacement for the erstwhile Planning Commission of the Government of India (GoI), has gone on record to state that they have been struggling to monitor 25 core indicators for India’s five year planning cycles, and that “How then would India manage to meet all the 169 targets that are now being set?”
This cautious trepidation can be understood by examining India’s capacities to monitor the proposed, non-fuzzy, ‘green’ indicators, for example in the thematic area of health. With the demographic transition, non-communicable diseases (NCDs) are the leading cause of burden of disease in India. Under the proposed target 3.4, under SDG Goal 3, the indicators are as follows: “By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”, “Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance abuse disorders.” and “Harmful use of alcohol defined according to national context as alcohol per capita (15+ years old) consumption within a calendar year in litres of pure alcohol”. While these may seem relatively straightforward, India lacks the resources to comprehensively implement and monitor such metrics and interventions. Current burden of disease estimates are based on modelling exercises and various assumptions, in the absence of information systems to monitor morbidity and mortality from all sources and service providers. The national Health Management Information System covers only government facilities, leaving out the majority of ambulatory and inpatient services that are availed in private facilities, and use of collected data is fragmented and feedback mechanisms rudimentary. The National Programme for Prevention and Control of Cancer, Diabetes, Cardio-vascular Diseases and Stroke has been designed by the Ministry of Health and Family Welfare (MoHFW) to monitor NCD prevalence and provide preventive and curative services. However, nearly 8 years after inception its activities remain confined to two pilot districts each in nine states, leaving nearly 670 out of 688 districts with no coverage. Some states, such as Kerala and Tamil Nadu have undertaken state-level programs and initiatives to cover all districts in the state with a basic package of NCD services. Information on the nature of services and coverage of substance use disorders is non-existent, as is information on per capita alcohol consumption in the country. Consumer expenditure surveys that currently measure household alcohol consumption approximate consumption volumes that are a miniscule proportion of sales data from states. India also does not have a clear roadmap for operationalizing universal health coverage and interventions required to meet SDG goals, and much of the developments are at the sub-national, driven by interventions in richer, more progressive states like Kerala, Karnataka and Tamil Nadu.
Notwithstanding the ability of proposed indicators to measure intended outcomes, the lack of routine data to monitor progress will be a big challenge in the country. Since the proposed SDG framework calls for information disaggregated by income, sex, age, race, ethnicity, migratory status, disability etc, the data systems needed will be immense. Even more challenging will be collecting information on inter-sectoral indicators, such as the linkages of health to air and water quality, and climate change. Increasing capacities, both human and financial, to develop and implement robust monitoring mechanisms will also be a huge task in the future. Perhaps some sort of knowledge translation will also be required, especially considering the multiplicity of actors involved, such as the industry, civil society, and state and local governments, to implement these monitoring systems. Stewardship of the entire exercise also has to be decided.
It took many years for the Millennium Developmental Goals to catch on in national and sub-national policy circles; there is an urgent need to hit the ground running, both in terms of interventions and monitoring, in order to achieve SDG goals within the stipulated time frame.
The author benefited from discussions with Bhargav Krishna on this topic.