Achieving the health-related Millennium Development Goals in the Western Pacif ic Region 2012 1 4 5 6 7 8 “ese Millennium Development Goals are a promise of world leaders. ey’re a blueprint to help those most vulnerable and poorest people, to liſt them out of poverty. is promise must be met.” —UN Secretary-General Ban Ki-moon
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Achieving the health-related Millennium Development Goals in the Western Pacif ic Region
20121 4 5 6 7 8
“These Millennium Development Goals are a promise of world leaders.
They’re a blueprint to help those most vulnerable and poorest people, to lift them out of poverty.
This promise must be met.” —UN Secretary-General Ban Ki-moon
1
The Millennium Development Goals
z In 2000, eight Millennium Development Goals (MDGs) were established and adopted by 189 heads of state in the United Nations Millennium Declaration.
z There are three years left before the 2015 deadline. Some countries have achieved their goals, while others have much work to do to reach the targets.
z After 2015, efforts must be sustained to achieve the original goals and to overcome new health challenges such as noncommunicable diseases, mental health disorders, injuries and the consequences of violence.
2
World Africa Americas Eastern Mediterranean Europe South-East
On track Insufficient progress Off trackSource: World Health Statistics 2012
Refer to page 16 for health MDGs scorecard colour code criteria
3
The scorecards reveal clear priorities
z Countries and areas in the Western Pacific Region are making remarkable progress towards achieving the health-related MDGs. Several gaps still remain.
z There are large disparities in progress both between and within countries.
z An estimated 12 000 maternal deaths and 467 000 child deaths occurred in the Region in 2010. Further reduction of maternal and child death remains a high priority in most low- and middle-income countries.
z New infections and AIDS-related deaths in the Region have stabilized over the last five years, whereas prevalence of HIV has increased slightly since 2000 as more people living with HIV are obtaining antiretroviral treatment.
z Weak health systems, health inequities and difficulties in sustaining gains are some of the factors that will affect achieving the MDG targets.
z Achieving universal coverage to ensure people can access quality health services without facing catastrophic financial expenses is key to sustaining progress for all MDGs.
4
Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon
Islands Viet Nam
4Under-5 mortality3
per 1000 live births (2010) 51 18 17 54 6 32 61 29 27 23
Measles immunization4
% coverage (2011) 93 99 82 69 95 98 60 79 73 96
5
Maternal mortality5
per 100 000 live births (2010) 250 37 26 470 29 63 230 99 93 59
Health MDGs scorecard for LMICs* in the Western Pacific Region (with population < 250 000)
Due to very small population size and low incidence and prevalence of some diseases, there are no estimates for some indicators; small population size also makes classification of progress towards MDG targets infeasible.
6
Figure 1. Prevalence of underweight children under 5 years of age (%) in LMICs in the Western Pacific Region, 1983 –2011.
Source: Global Health Observatory database. Geneva, WHO, Accessed September 2012 (http://apps.who.int/ghodata/)
Cambodia
China
Lao PDR
Malaysia
Mongolia
Papua New Guinea
Philippines
Solomon Islands
Viet Nam
Vanuatu
0% 10% 20% 30% 40% 50%
1989
1996
1990
1993
1990
1992
1983
1990
1993
1996
2011
2010
2006
2006
2005
2005
2008
2007
2008
2007
Earliest data available Latest data available Target
MDG 1 Eradicate extreme poverty and hungerMDG target: Halve, between 1990 and 2015, the proportion of people who suffer from hunger
1
Breast feeding
In 8 of 13 Western Pacific countries reporting, exclusive breastfeeding rate is <50%, although the norm should be about 95% in all countries.
Low birth weight (LBW)
Maternal nutrition should be improved to reduce LBW rates, which are now more than 3 times the norm in 18 of 31 countries reporting.11
Anaemia in women and children
Fortification, supplementation, deworming and improved diets can greatly reduce anaemia, which is still >20% in pregnant women11 and preschoolers12 in about half the countries reporting.
Figure 2. Prevalence of stunting and overweight among children under 5 years of age (%) in selected countries in the Western Pacific Region, 1981-2011.
Source: Global Health Observatory database. Geneva, WHO, Accessed September 2012 (http://apps.who.int/ghodata/). * Latest available data from the period 1981-2011
Undernutrition remains an important public health problem and obesity is increasing.
Interventions should focus on improving nutrition and alleviating hunger in the underserved and hard-to-reach populations, and especially on children, adolescents and women.
6
The nutritional status of children under 5 years has improved.
The prevalence of underweight children under 5 has been further reduced in the LMICs in the Western Pacific Region.
Overweight*
Stunted*
Viet NamVanuatu
TuvaluSolomon Islands
SingaporeSamoa
PhilippinesPapua New Guinea
NauruMongoliaMalaysiaLao PDRKiribati
JapanFiji
ChinaCambodiaAustralia
0 10 20 30 40 50
8.20
40.91.9
9.46.6
4.3
8.32.2
2.934.4
15.947.6
1.317.2
27.55.5
14.224.0
2.843.9
3.432.3
3.3
6.24.4
2.6
6.4
32.82.5
10.0
25.94.7
6.3
30.53.0
�� Chronic undernutrition prevails in under-5 children in the majority of countries.�� At least one third of countries have a growing problem of overweight in children. �� Acute malnutrition is still a significant problem in several countries in the Region.
7
Viet Nam
Solomon Islands
Philippines
Papua New Guinea
Mongolia
Malaysia
Lao PDR
Fiji
China
Cambodia
2015 Target
1990 baseline
2010
12151
40
48
3017
10
1816
14554
4818
66
10732
36
6190
3059
2920
45
1551
2317
27
MDG 4 Reduce child mortalityMDG target: Reduce by two thirds, between 1990 and 2015, the under-5 mortality rate
4
Figure 3: Proportion of 1-year-old children immunized against measles in LMICs in the Western Pacific Region, 2011.
≥ 90% coverage
< 90% coverage
Measles immunization reaching:
Table 1: Causes of under-5 mortality in the Western Pacific Region, 2010
Prematurity 17% Neonatal sepsis 3%
Pneumonia 16% Measles 1%
Birth asphyxia 14% Malaria 0%
Congenital anomalies 12% HIV/AIDS 0%
Injuries 9% Others 22%
Diarrhoea 4%
Source: Global Health Observatory database. Geneva, WHO, accessed September 2012 (http://apps.who.int/ghodata/)
Figure 4 . Under-5 mortality rate (per 1000 live births), 1990 baseline, 2015 target and progress to date, in LMICs with ≥ 250 000 population in WPR.
Source: Levels & Trends in Child Mortality Report 2011. Estimates developed by the UN Interagency Group for Child Mortality Estimation, 2011.
Child mortality in the Western Pacific Region has been significantly reduced.
7
Malaysia and Mongolia have achieved MDG 4 targets, while China, the Lao People’s Democratic Republic, Cambodia, the Philippines and Viet Nam are most likely to reach the targets by 2015.
� In the Western Pacific Region, 54% of under-five child deaths occurred during the neonatal period.
� The leading causes of under-five mortality in the Region are pneumonia, preterm birth complications and birth asphyxia.
� Measles incidence in the Western Pacific Region has substantially decreased to 11.6 per million population in 2011.
� Twenty-five countries have already achieved measles elimination as of the end of 2011.
Focus should be on reaching more remote, underserved populations with services for essential newborn care; timely antibiotic treatment for pneumonia; and maintaining the gains in immunization coverage.
Figure 5. Trends in Maternal mortality ratio (per 100 000 live births) in LMICs with ≥ 250 000 population in the Western Pacific Region, 1990-2010.
Figure 6. Proportion of deliveries assisted by skilled birth attendants in LMICs in the Western Pacific Region, 2005-2011.
Figure 7. Contraceptive prevalence rate in LMICs with ≥ 250 000 population in the Western Pacific Region, 2005-2010
≥ 85%60%–85%<60%
Proportion of births attended by skilled health personnel (%)
� Increased efforts are needed for better maternal health care and to address perinatal health problems, especially for poor and vulnerable populations.
� Improving accountability for financial resources and health outcomes is critical to reach the objectives of the Global Strategy for Women’s and Children’s Health.
MDG 5 Improve maternal healthMDG target: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Source: Trends in maternal mortality: 1990 to 2010. Estimates developed by WHO, UNICEF, UNFPA and The World Bank. WHO, 2012.
Source: World Health Statistics 2012
Source: World Health Statistics 2012 a Cambodia Demographic Health Survey 2010
There is a decreasing trend in the maternal mortality ratio (MMR) of most countries in the Region. The MMR of the Lao People’s Democratic Republic, Cambodia and Papua New Guinea are still high.
Access to skilled birth attendants and family planning services are critical to the achievement of MDG 5
Contraceptive prevalence remains low in some low- and middle-income countries in the Region.
8
9
Figure 10. Distribution of notified MDR-TB cases in WPR, 2010.
Malaria mortality and morbidity have been steeply declining since 1990 in
10 endemic countries in the Region.
6
HIV / AIDS
Malaria
Tuberculosis
Figure 9. Areas with artemisinin resistance development in the Mekong subregion.
MDG 6 Combat HIV/AIDS, malaria and other diseasesMDG target: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
There are 1.3 million people living with HIV and AIDS in the Western Pacific Region, and only 43%
of people in need of antiretroviral therapy have access to ARV in 2010.
Rates of TB in the Region have dropped significantly since 1990. The challenge
remains to find and cure TB in high risk groups and vulnerable populations that lack access to care.
Threats to sustaining the gains made in malaria control include the development of artemisinin resistance in Cambodia and Viet Nam (Figure 9) and dwindling financial resources in many endemic countries.
Multidrug-resistant and extensively drug-resistant TB threatens gains achieved in the last decade.
�� The Region has a relatively low HIV prevalence, and the epidemic has shown signs of stabilizing.
�� Condom use and coverage of preventive interventions for most-at-risk populations are increasing but still not enough.
�� Access of population groups to services such as antiretroviral therapy remains low in most low- and middle-income countries.
NB:Circles: old data (<Oct 2011)Triangles: new data (Nov 2011)
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
201020092005200019951990
Viet Nam
Philippines
Papua New Guinea
Mongolia
Malaysia
Lao PDR
FijiChina
Cambodia
HIV
pre
vale
nce
Source: Global Health Observatory database. Geneva, WHO, accessed September 2012 (http://apps.who.int/ghodata/)
Figure 8. HIV prevalence rate among population aged 15-49 years in LMICs with ≥ 250 000 population in the Western Pacific Region, 1990-2009.
10
� Majority of the LMICs had an updated medicines list and had developed national medicines policies.
MDG 7 Ensure environmental sustainabilityMDG target: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation
7
Figure 11. Proportion of population using an improved drinking-water source in LMICs by residence type, 2010.10
Figure 12. Proportion of population using improved sanitation facility in LMICs by residence type, 2010.10
MDG 8 Develop a global partnership for developmentMDG target: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries
8
� Access to improved drinking water sources and improved sanitation facilities is still very low in many countries, especially in rural areas.
� Strong political leadership and commitment are needed to further improve the coverage of drinking water and sanitation
0 20 40 60 80 100
Viet Nam
Vanuatu
Tuvalu
Tonga
Samoa
Philippines
Papua New Guinea
Palau
Niue
Nauru
Mongolia
Marshall Islands
Malaysia
Lao PDR
Fiji
Cook Islands
China
Cambodia
RuralUrban
0 20 40 60 80 100
Viet Nam
Vanuatu
Tuvalu
Tonga
Samoa
Philippines
Papua New Guinea
Palau
Niue
Nauru
Mongolia
Marshall Islands
Malaysia
Lao PDR
Fiji
ChinaCook Islands
Cambodia
RuralUrban
The Region has already reached the targets for use of improved drinking water sources and sanitation facilities.
� Adequate financing is key to ensuring availability of essential medicines, which is consistently lower in the public than in the private sector.
� Weak enforcement of medicine regulations results in the sale of counterfeit and substandard medicine.
Availability and access to affordable quality-assured essential medicine needs further improvement in most low- and middle-income countries in the Region.
10
11
z Health is a human right for all. Governments play a crucial role developing policies and plans to promote health among populations that are most in need.
z Health inequities are widening. Reducing health inequities can be achieved by analyzing how groups in countries may benefit disproportionately from policies and programmes; addressing social determinants of health; and expanding access to primary health care with adequate financial protection.
z Relatively high costs and direct out-of-pocket payments impede access to and lower coverage of MDG-related services and increase poverty.
z Other barriers to accessing quality services in addition to costs facing those with the greatest need include remoteness, low level of knowledge, and other sociocultural issues.
z Monitoring health equity can be achieved by disaggregating and analyzing information by income, sex, ethnicity and other relevant stratifiers to track changes in progress of MDGs in different groups.
Source: UNESCAP, UNDP, ADB. Achieving the Millennium Development Goals in an era of global uncertainty: Asia-Pacific Regional Report 2009/10. Bangkok, United Nations, 2010. Available online at: http://www.mdgasiapacific.org/files/shared_folder/documents/Regional_MDG_Report_2009-10.pdf[accessed 20 July 2010].
Note: Years indicate the year of DHS. Data for Papua New Guinea have yet to be officially released.
12
Universal health coverage and the Millennium Development Goals
z Universal health coverage means that all people have access to quality health services when needed without facing catastrophic financial expenses.
z Universal coverage ensures that the population is adequately covered by financial arrangements to ensure access to needed health care services.
z Universal coverage requires access to a continuum of integrated people-centred health services at every stage of each individual’s life.
z Universal coverage promotes the provision of a timely delivered package of services that are of good quality and value.
z Universal coverage is essential to the achievement of all the health-related MDGs.
13
Lack of progress in improving CRVS is “the single most critical development failure over the past 30 years.” —Richard Horton, The Lancet 2007
z Civil registration and vital statistics (CRVS) systems are the best population and demographic data source for providing inputs for 42 out of the 60 MDG indicators.
z Functioning CRVS systems improve the accuracy, completeness and timeliness of mortality statistics and enhances monitoring of burden of disease.
z Counting births and deaths, with medically certified cause of death, is achievable with careful integration of events occurring in health facilities with those captured through the civil registration process within communities.
z Strengthening CRVS requires leadership and coordination across multiple sectors, including health, statistics, and civil registration.
Civil registration and vital statistics (CRVS) underpin MDGs
14
TablesMDG 1 MDG 4 MDG 5
Prevalence of underweight children (%)
Infant mortality rateper 1000 live births
Under-5 mortality rate per 1000 live births
Measles immunization% coverage
Maternal mortality ratio per 100 000 live births
Proportion of births attended by skilled health personnel (%)
1 World Health Statistics 2012 [http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf].
2 Global Health Observatory Data Repository [http://apps.who.int/ghodata/?vid=360].
3 Levels & Trends in Child Mortality Report 2011. Estimates developed by the UN Interagency Group for Child Mortality Estimation, 2011.
4 WHO/UNICEF Joint Reporting Form (JRF) on immunization. UNICEF and WHO, 2012.
5 Trends in maternal mortality: 1990 to 2010. Estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva, WHO, 2012.
6 Global Health Observatory database. Geneva, WHO. (http://apps.who.int/ghodata/).
7 UNAIDS Report on the global AIDS epidemic 2010 [http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf].
8 World Health Organization. National malaria control programme reports. Submitted by countries to the WHO Western Pacific Regional Office. Manila, WHO, 2012.
9 Global TB database. Geneva, WHO, 2012 (http://www.who.int/tb/country/global_tb_database/en/).
10 WHO/UNICEF Joint Monitoring Programme for water and supply and sanitation. Progress on drinking-water and sanitation: 2012 update report. UNICEF and WHO, 2012.
11 Western Pacific Country Health Information Profiles 2011. Manila, World Health Organization Regional Office for the Western Pacific, 2011. Available from: [http://www.wpro.who.int/publications/PUB_9789290614913.htm].
12 Worldwide prevalence of anaemia 1993–2005 : WHO global database on anaemia. Geneva, WHO, 2008.