The 2000 Millennium Development Goals (MDGs) established a lofty global development agenda, requiring both national and transnational efforts to ‘move the needle’ in meeting basic needs and encouraging socio-economic development in low (and middle) income countries.

On balance, the MDG campaign was a success. The combination of government commitment, private sector investment, non-governmental interventions and innovative know-how saw many countries reach and surpass the MDGs within an ambitious 15-year timeframe. The success of the MDGs prompted a subsequent round of goal-setting and a renewed commitment by the global development community to sustain and deepen the trajectory established by the MDGs, but for the long-term. In 2015, the Sustainable Development Goals (SDGs) were unveiled, charting the way forward.

The SDGs are, in many respects, an extension of the MDGs: the further reduction and eventual elimination of poverty and hunger, improving health outcomes, providing basic needs such as water and sanitation, increasing further access to education, and ensuring greater gender equality. Simply put, the SDGs are a call for the global development community to do more – more investment, more funding, more political will – to improve the lives and opportunities of those who were left behind during the MDG-era. ‘Doing more’ is only one way to see the SDGs, however. In my view, fulfilling the SDGs poses a much bigger challenge than just doing more.

SDG 1: Eliminate poverty in all its forms, everywhere. Nothing can be more unequivocal, nor wonderfully audacious. The SDGs are not about reducing; they are about eliminating, which means reaching those who have been left behind.

Those who were left behind in the MDG-era were left behind precisely because they were hardest to reach. The left behind were the poorest of the poor, the marginalized, and the invisible. Reaching them will not come about by doing more of the same. Rather, reaching the hardest to reach requires a fundamental change in how we approach development, and specifically how we prioritize development initiatives. As I conclude in a recent essay in the Bulletin of the World Health Organization: “The complicated real-world challenge is actually delivering services to reach those most in need, and more specifically, to those who are hardest to reach”. If we are to successfully meet the SDGs, we need to focus on delivery.

Over the past several decades, through ingenuity and innovation the development community has created many new interventions to improve people’s lives. Global ‘challenge’ programs such as the Gates Foundation’s schemes, the Hult competition, and the Grand Challenges Canada program, among many others, have contributed to the proliferation of innovative and actionable ideas for development: cash transfer programs, nutrition interventions, educational tools, microfinance, mobile money, mobile health, mobile ID, sanitation solutions, maternal and child health interventions, and many others. But while we have created many great development interventions – products, services, policies and programs – in the upstream, we have not yet figured out how to effectively and efficiently deliver these interventions to those who most need them. Engineers and designers are figuring out ways to traverse the ‘first mile’ problem and behavioural economists are generating insights to overcome the ‘last mile’ problem. We have not, however, devoted enough attention to what we might call the “second last mile” problem, or the challenge of delivery.

How do we get important development interventions to the people who most need them? This is a simple question, to be sure, but the answer continues to elude and has proven difficult to answer. For instance, how does one deliver a multi-course vaccine campaign in a slum, where residents do not have an address? How do we deliver an education campaign when four of ten children in Africa did not have their births registered and are consequently without a birth certificate or any other form of identification. As Arjun Appadurai, in his work on slums in India, notes: “A host of local, state-level and federal entities” – essentially agents of the state – “exist with a mandate to rehabilitate or ameliorate slum life. But none of them know exactly who the slum dwellers are, where they live, or how they are to be identified.” The poorest of the poor are essentially invisible.



Professor Wong recently visited South Africa with a team of student researchers examining the success of the country’s birth registration as part of a larger project, “Reaching the Hard to Reach”. Read about more about the trip , and follow @reachprojectUT on Twitter for updates from Wong and his team.