Living conditions have improved greatly since 2000 even for the world's poorest people, but billions remain mired in "layers of inequality." That is the assessment from the Bill & Melinda Gates Foundation's third annual report on progress toward UN Sustainable Development Goals - 17 measures that most countries have pledged to try to reach by 2030. Those efforts are falling short, says Bill Gates, who spoke to VOA English to Africa's Linord Moudou. Below is the transcript of the interview.
Q: Thank you so much for your time. The Bill and Melinda Gates Foundation just released its 2019 Goalkeeper's report to keep track on progress made on the SDGs. First of all why was it important for the foundation to take that road on keeping track on the SDGs?
A: Well I hope everyone is tracking these sustainable development goals, but often in the richer countries there's a lot of distraction. And so the opportunity once a year to take this General Assembly meeting and say 'Okay, during this week, let's take this report card that all the countries agreed to and see how we're doing. Are there some heroes we should talk about or are there some things that went better than we expected? Where are we falling behind?' We get several hundred people we call goalkeepers and we try and energize them. These are people are working on the goals in innovative ways. They want to meet each other, they want to hear from leaders, and we celebrate what's gone on while making sure, because we're very numeric, that we do a report that really reminds us that as much progress as we're making, you know, a child in many countries still over 10% are dying before the age of 5, in richer countries it's less than 1%. So the idea that any place in the world is still 10%, some almost 15%, that's outrageous and it should galvanize us to do a better job.
Q: This is the third edition of The Goalkeepers report. What did you find significant this this year?
A: Well the big thing we did this year is we not only looked at each country and saw okay, what's the progress on education and health during the last 20 years? We even went within the country. So we did it what we called the district level and we saw that even there, if you didn't have a collapse or a war, health and education have improved. So progress is happening almost everywhere, but we saw that within a country, you have these huge differences. You know, the best part of India is like a rich country, the worst part of India is like a really poor, poor country. Within Nigeria you have huge differences. And so hopefully that's inspiring to say, okay well it's going well in the good part of the country and how do we accelerate a conversion, because you know, you can use the federal budget to help with dollars, you can use the ideas there. In some ways it should be easier to spread best practices within a country than it is between countries. We need to do both. And Africa has, if you look at each area, has a lot of exemplars and it has some where things have not progressed nearly as much
Q: So when you look at the disparities in the report focuses on inequalities, what do you think in terms of the role that government should play when you're talking about Africa for example. What is the responsibility of government and are they doing enough?
A: Well the government has the primary role. The only way that the education system and the health system can ever work super well is if the government's collecting enough in taxes and then spending that money, picking the right workers, those workers are showing up, the quality of that work, you know, is the line at the primary health care centers too long? Are they running out of the vaccines when the mothers come a long distance to get there? You know, all the outsiders can do is help government. Now in a few places like Somalia, the government's not active. So you know, until the government comes into place, a non-government organization can often work with the villages and create some substitute, but that, you know, that is more a long term solution. It's by working with the government, helping them build systems increase their capacity, that the country can be self-sufficient on their own
Q: Now you mentioned Nigeria and the area you've been a strong advocate of vaccine vaccination and also fighting to ensure that children don't have polio this year in Nigeria marked a milestone which is reaching three years without polio. Can I have your reaction to that how does this make you feel?
A: Well there's a lot of credit to go around - Nigeria engaged, the heroes are the women who went out and went house to house, even up in the northwest, northeast at some risk to their lives in doing that. So it's a wondrous effort, we're not done. We have to get to zero cases. And we still have some vaccine-derived cases in Africa, and we still have some wild type cases in Pakistan and Afghanistan. But here's another milestone where it's been three years since any wild polio case has been seen in Africa. We worried that, you know, it could spread back into Africa from Pakistan or Afghanistan, so we're working intensely there. But, you know, those health systems can be improved, and we learned a lot about primary health care in this effort and that's why we're engaged, particularly with the states in the north, trying to help them get the vaccination rates up. They start below 30% whereas some countries are, as they should be, over 90%. And so there are best practices. You know, I work with Aliko Dangote, we're committed to help those northern states get their primary health care into a strong position.
Q: And speaking of Mr. Dangote, last year you were in Chad to also promote vaccination and raising awareness against polio. What did you make of that experience? What did you find in terms of people on the ground how much do you do they understand the needs to vaccinate the children and the strength of polio really even when there no case, the fact that polio remains a latent threat.
A: Well, the number of deaths we could avoid that's from northern Nigeria going east, that's the area of the world, where still more than 10 percent of the children die. And that's partly because of malaria. It's partly because the primary health care systems need to be a lot better. Chad has less resources. There are parts of the country that actually do quite well on vaccinations so spreading those practices I think is valuable. You know, Mr. Dangote came to Seattle this summer. We spent several days talking about how our foundations are working together to take on nutrition and other challenges. He'll, he and whoever who runs his foundation will be participating in our goal keepers this year.
Q: Okay. And the Sustainable Development Goal 3 aims to ensure a healthy lives and promote well-being for all at all ages. This is a very ambitious goal. And so how do we get there? How what do you think?
A: Well the world has made a lot of progress, and we're not asking any country to do something that's never been done before. You know, childhood deaths have been cut in half. The new vaccines, getting out a part of that, incomes going up are part of that. You know, there's a lot of things that correlate with these improvements - having girls get more education, treating women better so they come together and talk about are they getting the services they deserve, and making sure all the mothers understand best practices about prenatal care. Women's groups have been a tactic in Asia, Bangladesh and India in particular, and now they're being tried out in parts of Africa in a culturally appropriate way. We're hoping that that becomes a significant tool in Africa as well.
Q: Now speaking of poverty and there have been a lot of focus on that and investment over the years in reducing poverty in the world. And your foundation is very, very much been significant in doing that. And yet many people still live in extreme poverty. So what is the failure in poverty reduction in the world? What needs to be done differently perhaps?
A: Well in that case, I hope we can retain the incredible progress we've made. We were helped by a number of Asian countries where they, they ran their economy very, very well. So China is now not just a middle income country but quite a well off middle income country. You know, India is far lower income, they're at that low end of middle income. So those are great exemplars, Indonesia, Vietnam. The world has done quite well on this. The people who remain in extreme poverty are farmers, a lot of them are subsistence farmers either in Southeast Asia or Africa. So helping educate them about credit for fertilizer, better seeds, how they can store water or how they can use chickens to supplement their income. Particularly if we focus on the women and the crops, and things that they work on, we can uplift a lot of those farmers. Now we have the headwind that, you know, sometimes the government's not running good agriculture programs. We have population growth, we have climate change. So it's not going to be easy to keep extreme poverty going down as quickly as it did in the last 20 years.
Q: And now you've talked about population. The report says that regions in the Sahel, in Afghanistan, Pakistan and India have one of, some of the highest fertility rates in the world. How do you address when we talk about population, how do you address this position among some in the developing world, that say that promoting family planning may be an attempt to reduce a certain population.
A: Well in fact the, as countries get healthy, that is if you reduce the child to death rate, families voluntarily choose to have less children. As you educate women, more families voluntarily choose to have less children. And so what we're about is just making sure people have on a voluntary basis access to these tools. And we do surveys on a very regular basis to understand, did you go to find its stock was out?
Did you feel some pressure to use it, which would be inappropriate? Now in the history of family planning there have been cases where governments put too much pressure on people. But the good news is that even without inappropriate pressure as we uplift families they will choose to space their births more which helps a lot with the health, and in some cases have, have less children.
Q: And now speaking of education, the report shows also that the gender gap in education is closing but would persist in sub-Saharan Africa for the foreseeable future. So how can this be addressed to improve future outcomes in education for young girls?
A:Yeah, so Asia, by and large, eliminated the gender gap at both primary and secondary school. Within Africa, there are countries that do better on the gender gap than others. But I'd also highlight that the quality of the learning experience is still something we can do a lot. There are kids who are in school for long periods of time and yet their ability to read sentences or do simple math is not very good. And so helping to train the teachers, making sure we're picking the teachers in the right way. We have still some work to do on access, particularly in secondary school. But then we also have work to do on quality. And education in some ways is harder than health because in health, if we add a new vaccine, you know, someday we'll have a malaria vaccine, someday we'll have a TB or an HIV vaccine. So you know, I can say that within my lifetime, these infectious diseases will be greatly reduced. In education, it's every day, you know, training the teachers well, making sure they're doing their job well, making sure it's properly funded, making sure the cultural message that yes the girls should be here, and that they have a positive, safe experience as part of their schooling. You know, that, you know, every year we just have to get slightly better, so we can have education empowering people, and that's really where Africa will thrive. There are few exemplars like Vietnam, for its level of wealth runs a fantastic education system because of the teacher personnel effort they put in..
Q: So in a case like this with education, for example, what is the role of communities? How can they be part of the solution in helping support the work that philanthropist organizations or even governments attempt to do to improve the quality of life of communities?
A: Well, education is something where the parents can get involved, whether it's after school programs, you know, talking to the kids that aren't engaging or may be disruptive, you know, sports programs, demanding to the government that you know the right things happen. Communities are I think our best bet. Parents, actually, you know they may not be experts on vaccines but if their kid's not learning, they should be activated. And you know whether it's at the local level or their federal level, their expectations should be quite high compared to what's going on right now.
Q: OK now let's talk about climate. The report talks about climate adaptation. To what extent is it possible to stop climate change, or is adaptation of the way of the future?
A: Well we certainly need to do both .I wish I could tell you that the mitigation effort that is reducing the greenhouse gases, would be so successful that we wouldn't have to worry about adaptation. But even in the best case we will have over two degrees of warming. And so whether it's droughts or big heat, periods of heat agriculture in Africa's going to be tougher in the future than it is today. One of the key things from the commission which I was one of the co-chairs saw belonged Ban Ki-Moon and several other people is that we need to make better seeds. The seed research system in the world is underfunded and yet if we fund it properly we'll come up with seeds that are more productive and can deal with the heat, or the flood or need less water. And there's been some progress on that but you know Africa whose agricultural productivity is less than a quarter of say Europe or the United States, you know we can close that gap. And it's a bit about seeds. It's a bit about education. It's a bit about credit for fertilizer. All those things should allow us to get nutrition levels to improve, even in the face of the challenges.
Q: And the commission, the global commission, as you mentioned states that investing one point eight trillion dollars over the next decades in five key areas would lead to seven point one trillion dollars in benefits. What are some of those five key areas? I know you mentioned that.
A: Well, the top of the list is helping subsistence farmers. Most of the very poor people in the world are farmers. A lot of them are near the equator where the heat is going to be, you know, very difficult. Some crops are not, you'll have to shift which crops you go grow in order to, to have higher productivity. There are a lot of things having to do with the sea level rise where if you build mangrove forests, they hold the soil in them. They're able to reduce the amount of flooding and the land loss that takes place. There's a lot of things about early warning systems. Sadly, you know we're going to continue to have storms with slightly greater intensity because of climate change and so the resilience there is very important. Some of the things in the report are fairly inexpensive like those warning systems, mangrove forests, even better seeds. A few billion dollars over the next five years will make a huge difference there. Some of them like building seawalls, you know that's very difficult. Irrigating farms, very difficult but we're going to have to tackle all of these things. You know the tragedy is that the poorest who are going to suffer the most from climate change are exactly the people who did nothing to cause it.
Q: A state minister, Ethiopian state minister, cap out wrote a letter in which he talks about the Ethiopian experience, how the drought experience in 2015 was as bad as the one in 1984, yet the devastation and death was not the same. What lessons can be learned from the Ethiopian experience?
A: Well Ethiopia, in terms of raising agricultural output and helping their smallholder farmers, really did a fantastic job. Our foundation was lucky enough to be somewhat involved. The Ministry of Agriculture worked with what they called the Agriculture Transformation Agency, and so there were a lot of international ideas brought in, a lot of young Ethiopians were brought in to be part of this effort. And so, for a number of crops, the productivity has gone up substantially every year. So even when one part of the country had some crop failure, they were able to take their domestic productivity with government policies and make sure that there wasn't the same type of famine that was very dramatic if you go back to the 1980s. So it is a very hopeful case. Africa can grow a lot more food.
Q: So far the Bill and Melinda Gates Foundation has invested more than 15 billion dollars in projects relevant to Africa. What do you, how do you measure success and the impact that this investment has made over the years and what keeps you up at night?
A: Well we're thrilled that the partnerships we have working with the countries that give aid, working with the countries in Africa on their programs to support them. Our progress in global health is better than we expected. We have a lot of challenges. We're not done with polio. And then once we're done with polio, we'll take on malaria. Malaria deaths are down but still 400,000 kids, mostly in Africa, dying every year. We don't have a lot of the tools. I'd hoped we'd have an HIV vaccine by now. We'll get one, I think, within a decade, but that's taken longer than we expected. There are some projects that are in a fairly early stage. This idea of a reinvented toilet, so it's cheap, that even in urban Africa everybody can have a toilet in their own home and it just processes the waste without having a big, expensive sewer system. So that may take another 10 years before it's really available. There's even some risk, you know, can we get that price down as much as we want to? So you know, we're here to partner with the governments, you know, we are excited that the work has come along. Of course we worry about, you know, instability and climate change and you know, all sorts of things that are headwinds for this work. But you know, the moral importance of this work, to help those who are most in need, you know, treat lives as having equal value, that really energizes us.
Q: So to the younger in that small village somewhere we have high hopes of having access to education to the farmer who is going through a drought in hopes that the rain would fall into the man that was fighting to keep her son from catching malaria every day. If they were to ask you why do you care, what would you say to them?
A: I think everybody cares about other humans. If those problems were in your neighborhood, as you walked by, you could see the kid with fever, and you could see the child who wasn't getting enough food, or you could see a child who wasn't able to go to school, you would be 'Okay, these are my neighbors, I see it.' And you know, at that very direct level, you would be emotionally engaged and you would fix it. It is a challenge that these problems are far away, and not many people get a chance to go and see both the need and the progress that's taken place. The more people who visit the better, because it's a very rare person who doesn't come back and really deeply affected, and say 'Okay, this has got to be more of a priority for me.' To do whatever we can do to pitch in and help out. But you know, in the digital world, we still haven't been able to create that sense that yes, you know, I met the mother whose child is at risk. I've seen these kids who are malnourished. So we're, you know, we're looking for young Africans who can you know, make the case, who can be leaders, you know really take charge of the continent and figure out, you know, where these new tools can accelerate the income improvement, and the you know gender equality, education, the things that you know every human on the planet deserves.
Q: And finally Mr. Gates, what is a goalkeeper?
A: Well, the goalkeepers are people who pick some part of the sustainable development goals they are very personally committed to, that they're going to put long hours in, they're going to recruit other people, they're going to create visibility, they're going to think about the role of innovation, perhaps new digital tools, the role of activism to get their government to pay more attention. We need a lot of goalkeepers. I mean, there's a lot of goals. They all kind of go together and help each other, but we've got to energize a whole generation to really be able to achieve those targets.