By the early 1970s, the development movement was running out of steam. The idea that transfers of capital and technical know-how would quickly dispense with gross poverty had proved misconceived. During the previous decade, many developing countries had achieved high rates of economic growth -- increases of 5 per cent or more in GNP -- but little of this had 'trickled down' to the poor. On the contrary, their numbers had swollen -- as had the gap between rich and poor people, and between rich and poor nations. The rates of population growth were partly to blame; but equally important were policies based on simplistic assumptions. This much had become clearer to the growing community of development analysts attached to universities, governments and international organizations. They busily began to diagnose what had gone wrong and set out on the quest for alternatives.
This led to a new climate of development thinking. Since economic growth did not automatically sweep poverty away, development analysts decided that the second Development Decade must also include measures deliberately targeted at the poor -- to help them meet their basic needs for food, water, housing, health and education.
In the past, economists and planners had looked upon these rather as forms of 'consumption' unconnected to economic productivity. Now their thinking began to change. In 1972, Robert McNamara, then President of the World Bank, made what was seen as a landmark statement. Governments in developing countries, he said, should redesign their policies so as to meet the needs of the poorest 40 per cent of their people -- and relieve their poverty directly. The cornerstone of the new development strategy was thus an explicit attack on poverty -- albeit one so mounted as not to damage economic prospects. Its economic slogans were: 'redistribution with growth', and 'meeting basic needs'.
As policy makers began to focus less on economies and more on people, they realized that those bit-players, the humanitarians, had actually met the new criteria for success rather well. While the economic planners had focused on dams and factories, the humanitarians had focused on the village, the community, the family and the individual. They appeared to be putting into effect British economist E. F. Schumacher's concept that 'small is beautiful' -- a proposition that seemed to encapsulate the spirit of the era. NGOs , with their localized mini-projects, already enjoyed an intimate relationship with the poor; UNICEF had similar advantages. Although it worked at one stage removed, its connections with communities were certainly much closer than those of any other player in the UN hierarchy. Within the development club, the programmes supported by the humanitarians, including UNICEF, began to enjoy a new legitimacy.
Figure 6: Total debt as a percentage of GNP increased in all regions over the period 1971-1993. Latin America's high debt levels of the 1980s have since fallen. Sub-Saharan Africa's debt, which has continued to soar, now surpasses its GNP. Source: World Bank, World debt tables 1994-95, volume 2, Washington, D.C., 1994. Note: Data for sub-Saharan Africa excludes South Africa.
Figure 7: The percentage of underfives who are underweight -- one measure of malnutrition -- has dropped in most regions. Improvement has been only marginal between 1975 and 1990 in sub-Saharan Africa. Source: United Nations, Second report on the world nutrition situation, Subcommittee on Nutrition, Geneva, 1992.
The early 1970s saw two events of particular significance for international development. One was the OPEC oil shock, which sent prices soaring and ended the era of cheap energy and cheap industrialization -- and therefore of cheap development. The other was the global food shortage brought about by two disastrous world harvests in 1972 and 1974. The UN responded to the atmosphere of crisis with a series of international conferences: on environment (Stockholm, 1972); population (Bucharest, 1974); food (Rome, 1974); women (Mexico City, 1975); human settlements (Vancouver, 1976); employment (Geneva, 1976); water (Mar del Plata, 1977); and desertification (Nairobi, 1977). Meanwhile, the countries of the developing world were growing in confidence.
Encouraged by the success of the OPEC cartel in 1974, they demanded a new international economic order: a change in relationships among the nations to allow the up-and-coming members of the international community to gain access to world trade and financial markets.
These events and the currents of thinking they unleashed had important repercussions in UNICEF. The oil price hike also meant higher prices for fertilizers and all the equipment needed to increase agricultural production. And the world food shortage had serious implications for the health and well-being of the 500 million children who lived in the countries designated 'most seriously affected'. In 1974, the UNICEF Executive Board made a formal declaration of an 'Emergency for Children'. It was believed that even before the crisis struck, some 10 million children worldwide suffered severe dietary shortage. As the price of food continued to rise, child hunger and malnutrition were bound to increase.
At the prompting of Henry Labouisse and his deputy, Dick Heyward, UNICEF was also urgently considering what kind of programme strategy would reach children more cost-effectively. In 1975, the UNICEF Executive Board reviewed the findings of two important studies: one into the priorities for child nutrition in the developing world and another, conducted with WHO , into 'alternative methods of meeting basic health needs'. From their conclusions, together with those of an earlier study into education, UNICEF's own version of the alternative order was rapidly emerging. It was to be known as the 'basic services' approach.
According to UNICEF, development was failing to reach large segments of the poor because existing services for health, education and agricultural extension were modelled along industrialized-country lines. If the poor had to wait for their lives to be improved by such services, they would probably wait forever. Existing services rarely reached as far as the village, and even when they did they were usually unconnected to each other. Worse, they were often unconnected to the villagers' own perception of their needs. As an alternative, UNICEF proposed a range of integrated basic services that would be flexible enough to be adapted by and within the community.
These basic services would also be community dependent. This approach was borrowed from the increasing number of community-based programmes in countries as far apart as Guatemala, Indonesia and Tanzania, which had incorporated a spirit of volunteerism along with traditional systems of mutual self-help (Panel 9). UNICEF had taken advantage of this by training and motivating lay members of the community to perform simple tasks such as baby weighing, early childhood stimulation and basic handpump maintenance. These volunteers could thus act as 'barefoot' workers delivering local services. The relatively few highly trained professionals who up to then had been performing routine activities were freed instead to supervise the cadres of volunteers. In this way, services could be more widely extended without exorbitant extra costs.
In 1976, the UNICEF Executive Board committed itself to the basic services approach. By this time, UNICEF and WHO were already well on the way to agreeing on an alternative approach to health care. They had seen that health care structures in developing countries had evolved mainly into pale facsimiles of the high-tech delivery systems familiar in the industrialized world. Given the lack of resources, this had distorted priorities and led to a disregard of the basic principles of public health. Up to 90 per cent of a developing country's health budget could be absorbed by a handful of city hospitals serving the élite, while out in the countryside villagers were obliged to walk miles to the most rudimentary dispensary. The poor might occasionally receive visits from mobile teams of smallpox eradicators or water engineers, but services they urgently needed -- notably those for maternal and child health -- were rarely available.
At a time when heart transplants and in vitro fertilization were stunning the world, millions of people -- up to three quarters of the population in many countries -- remained beyond the reach of modern health care. Moreover, the sicknesses that afflicted them, or more usually their children, were simple and obvious. The poor were suffering and dying from diarrhoea, fevers and respiratory infections that no longer constituted a threat in the industrialized world and indeed were viewed there in the most pedestrian terms. They were the diseases of poverty. And they were disrupting, and in some cases destroying, the lives of hundreds of millions of children and families.
In 1978, at an international conference in Alma Ata in the then USSR, Ministers of Health from all over the developing world agreed that their health delivery systems must be radically restructured to provide 'primary health care' (PHC) for all their citizens. The critical service was care for mothers and children before, during and after birth. Added to this were emergency first aid, surveillance of young child growth, disease control, family planning, safe water supplies and environmental sanitation. As with basic services, ordinary people would be enlisted in their own preventive care. This radical vision set an ambitious goal, 'Health for All by the Year 2000'.
During the first two Development Decades, UNICEF had argued that working for children was part of a much larger social and economic movement. But this emphasis on development and on other great issues of the day had a drawback. It meant that, even within the humanitarian community, the special needs of childhood and of disadvantaged child groups were in danger of being submerged. Anxious to project children back into the limelight, the Geneva-based International Union for Child Welfare and other child-related NGOs managed to persuade the UN to declare 1979 the International Year of the Child. Initially reluctant to commit its energies to a celebratory and possibly superficial affair, UNICEF was eventually persuaded to play a leading role. IYC proved far from superficial. It was a remarkable success. The children's cause had reached another turning-point.