South Africa: Millennium Development Goals: The What, The Who And The How

Last Updated: 25 April 2012
Article by Neil Kirby

The Millennium Development Goals or MDGs were identified by the World Health Organisation in terms of the Millennium Declaration signed by 189 countries in 2000. In its publication concerning the status of MDGs in 2005, the World Health Organisation ("the WHO") stated that the MDGs "refl ect an unprecedented commitment by the world's leaders to tackle the most basic forms of injustice and inequality in our world: poverty, illiteracy and ill-health" (see Health and the Millennium Development Goals, Report by the World Health Organisation, 2005). The target date to achieve the MDGs is 2015.

The MDGs therefore are a set of goals that need to be reached by governments who have signed the Millennium Declaration and are required as a result to address issues concerning ill-health and poverty within their various countries. The health-related MDGs are described by the WHO as not necessarily covering "all the health issues that matter to poor people and poor countries. But they do serve as markers of the most basic challenges ahead: to stop women dying during pregnancy and child birth; to protect young children from ill-health and death; and to tackle the major communicable diseases, in particular HIV/AIDS. Unless we can deal with these fundamental issues, what hope is there for us to succeed in other, equally important areas of health?" (The WHO report at page 3.)

The MDGs therefore, from the point of view of the health related MDGs, must fi nd resonance in domestic legislation in order for governments to implement the MDGs and achieve the goals agreed to in the Millennium Declaration. The MDGs are based on challenges posed to governments to implement the MDGs and to achieve the goals that are contemplated by the MDGs and the Millennium Declaration.

The challenges are derivatives of the goals that are to be established or have been established. The MDGs are as follows:

  • Goal 1: Eradicate extreme poverty and hunger
  • Goal 2: Achieve universal primary education
  • Goal 3: Promote gender equality and empower women
  • Goal 4: Reduce child mortality
  • Goal 5: Improve maternal health
  • Goal 6: Combat HIV/Aids, malaria and other diseases
  • Goal 7: Ensure environmental sustainability
  • Goal 8: Develop a global partnership for development

Of the abovementioned goals, Goals 4, 5 and 6 address healthcare related issues directly whilst goals 1, 7 and 8 address issues concerning healthcare indirectly: in relation to the eradication of poverty and hunger, environmental sustainability and better development for poorer nations. Unfortunately, the implementation of the MDGs, at a domestic level, is not achieving the resounding successes hoped for in Africa although health planning across the globe is AFRICA LEGAL BRIEF SERIES | MARCH 2012 cited as a weakness when implementing the MDGs:

Whilst stronger health systems are recognised as a prerequisite for achieving the MDGs, neither health donors nor national health planners have paid sufficient attention to systems strengthening. The drive to produce results for the MDGs has led many stakeholders to focus first on their own disease priority, within an implicit assumption that through the implementation of specific interventions the broader system will benefit". (The WHO report at page 41.)

What the MDGs do bring into sharp focus are:

  • the status of domestic healthcare systems;and
  • the ability of those systems to produce effective results for the populations that they service.

The obligations upon a State to provide its citizens with effective healthcare is one that rests both in international law - in various human rights treaties - and domestic law in relation to the provision of healthcare services, whether by constitutional directive or otherwise. The particular focus that the MDGs present to the provision by States of healthcare systems is whether or not the healthcare systems in question are providing effective healthcare to citizens of a population in accordance with the rights the citizens enjoy at international law, more particularly, the MDGs. The nature of the service delivery structures within a domestic healthcare setting is increasingly going to be criticised and scrutinised by international bodies such as the WHO or the African Union in order to determine whether or not the healthcare needs of a particular population are being adequately addressed and human rights respected.

Therefore, the MDGs place pressure on various governments to ensure that healthcare delivery systems comply with international obligations imposed upon those governments and are consistent with the human rights entitlements enjoyed by citizens of various States. The MDGs are therefore a useful criteria against which to measure a particular government's compliance with providing adequate healthcare in particular and human rights in general - the delivery of an effective healthcare system to a population becomes paramount:

From a policy perspective, the MDG targets and indicators have played an important role in drawing attention to critical health and development needs, and in monitoring responses at the global and country levels. However, there are inherent tensions in the monitoring process that need to be managed. One of these tensions is the balance between global and country reporting ....Ideally, the identification and generation of global indicators should respond to country needs and emanate from country health information systems." (The WHO report at page 76.)

The application of the MDGs, to a domestic setting, in relation to the health outcomes that are required of the MDGs may very well create tension between the application of the MDGs and the priorities and the legal constraints in a domestic setting. This may be especially prevalent in poorer countries and those facing high disease burdens such as the government of South Africa. Unfortunately, Africa receives adverse attention in the 2005 WHO report in relation to the issue of health outcomes:

Particularly in Africa, it is essential to take action to prevent deaths of health personnel from HIV/AIDS. Where migration is stripping health system of vital personnel, efforts are required – both within and among countries – to manage mobility without infringing upon individual rights. The key point is that the crisis demands political as well technical solutions because it is deeply associated with national priority setting (for example, why should health workers get special treatment, compared to other public sector workers?) and because it often involves overcoming conflicting interests at the core of national and international political processes...". (The WHO report page 34)

Part of achieving the MDGs related to health is defining the rules of engagement, and the stewardship and role of the State. As a starting point, it is unclear whether or not many African jurisdictions have followed a particular course, consistent with domestic priorities and laws, to achieve the MDGs. An evaluation is therefore required of the level of stewardship adopted by a particular State to the application of the MDGs, more particularly, within the context of the healthcare systems used in Africa and the outcomes produced by those healthcare systems in relation to domestic disease priorities. This principle of stewardship should be examined on a State by State basis and compared with the actions or omissions taken by a particular State in relation to the application of the MDGs vis á vis the health sector. The outcome of the comparison, if adverse to the achievements of the MDGs in a particular jurisdiction should then be evaluated with reference to remedies that may present in both domestic and international law to ensure that states comply both with their internal obligations and domestic legal obligations: "Stewardship refers to the oversight role of the state in shaping, regulating, and managing health systems. Governments are expected to provide public and private health system actors with overall policy direction; to create conditions that allow them to do their jobs; to ensure oversight across the whole system with particular attention to equity concerns; and to reconcile competing demands for resources. The growing share of external funding channelled through disease–specific initiatives poses a particular challenge to the government oversight function...". (The WHO report at page 40)

The evaluation of the implementation of the MDGs occurs every five years by the WHO with the next review occurring in 2015. Based on the enormous difficulties faced in numerous African jurisdictions from a healthcare point of view, much must be done in order to achieve the implementation of the MDGs with reference to the state of healthcare sectors in Africa and the particular burden of disease in Africa in relation to HIV/AIDS, malaria and tuberculosis. The questions that need asking are:

  • what will Africa and its governments have done by 2015 to realise the MDGs based on the rights of their populations, respectively, to health and dignity as stated in a number of domestic constitutions but also international treaties
  • how will the governments of Africa assess their achievements, or lack of it, of the MDGs?

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on

Click to Login as an existing user or Register so you can print this article.

Some comments from our readers…
“The articles are extremely timely and highly applicable”
“I often find critical information not available elsewhere”
“As in-house counsel, Mondaq’s service is of great value”

Mondaq Advice Centre (MACs)
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at and we will use commercially reasonable efforts to determine and correct the problem promptly.