Monitoring progress towards the vision of Healthy Islands in the Pacific 2017 by Alexander Pascual

Monitoring progress towards the vision of Healthy Islands in the Pacific 2017 First progress report

ďťż

© World Health Organization 2018 ISBN 978 92 9061 854 6 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercialShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules). Suggested citation. Monitoring progress towards the vision of healthy islands in the Pacific 2017: first progress report. Manila, Philippines. World Health Organization Regional Office for the Western Pacific. 2018. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. 1. Healthy people programs. 2. Health promotion. 3. Pacific islands. I. World Health Organization Regional Office for the Western Pacific. (NLM Classification: WA300LA1) Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: wpropuballstaff@who.int Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any thirdparty-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.

CONTENTS Abbreviations �� v Foreword �� vi Part I. Introduction ��1 1. Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Development of the Framework. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2.1 Early versions of the HIMF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2.2 Current version. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3. Data sources, validation and data quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3.1 Data sources and validation process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3.2 Data availability and quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4. Proposed next steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Part II. Progress report �� 7 1. 2. 3.

Strong leadership, governance and accountability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.1 Health worker density. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.2 Health expenditure per capita . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.3 Evidence of annual health review, plan and budget. . . . . . . . . . . . . . . . . . . . . . . . 8 1.4 International Health Regulations core capacity score. . . . . . . . . . . . . . . . . . . . . . . . . 9 1.5 Death registration coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Avoidable diseases and premature deaths are reduced. . . . . . . . . . . . . . . . . . . . . . . . . 11 2.2 Heavy episodic drinking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.3 Insufficiently physically active adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.4 Intimate partner violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.5 Tobacco excise taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.6 Excise tax on alcoholic drinks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.7 Excise tax on the retail price of sugar-sweetened beverages . . . . . . . . . . . . . . 16 2.8 Access to essential NCD drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.9 Cervical cancer screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.10 Service coverage for people with increased risk of CVD . . . . . . . . . . . . . . . . . . 17 2.11 Service coverage for people with severe mental health disorders. . . . . . . . . . 17 2.12 Contraceptive prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.13 HIV prevalence among the general population. . . . . . . . . . . . . . . . . . . . . . . . . . 20 2.14 Tuberculosis incidence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.15 Lower-extremity amputations among patients with diabetes. . . . . . . . . . . . . . 22 2.16a Maternal deaths & 2.16b Maternal mortality ratio. . . . . . . . . . . . . . . . . . . . . . . . . 22 2.17 Mortality rate from road traffic injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2.18a Deaths due to suicide among adults and 2.18b Adult suicide mortality rate. . 24 2.19 Risk of premature death from target NCDs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 2.20 Life expectancy at birth: both sexes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Children are nurtured in body and mind. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.1 Exclusive breastfeeding rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3.2 Children who are obese. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 3.3 Inadequate physical activity in adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3.4 Obesity in adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.5 Birth registration coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.6 Evidence of healthy food policies in schools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.7 Antenatal care coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 CONTENTS

iii

3.8 Births attended by skilled health personnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.9 Immunization coverage for DTP3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.10 Immunization coverage for measles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.11 HPV vaccine coverage among adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 3.12 HIV prevalence among pregnant women. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 3.13 Adolescent birth rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 3.14 Low birthweight among newborns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 3.15 Neonatal mortality rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 3.16 Children who are stunted. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 3.17 Under-5 mortality rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3.18 Child and adolescent suicide rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Ecological balance is promoted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.1 Population using clean fuels for cooking, heating and lighting. . . . . . . . . . . . . 42 4.2 Resilience to climate change and natural disasters . . . . . . . . . . . . . . . . . . . . . . . 42 4.3 Population using improved drinking-water sources. . . . . . . . . . . . . . . . . . . . . . . 43 4.4 Population using improved sanitation facilities. . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.5 Number of vector-borne disease outbreaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Annexes ��45 Annex Annex Annex Annex

1. Summary of key milestones of developing the framework. . . . . . . . . . . . . . . . . 45 2. Healthy Islands Monitoring Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 3. Healthy Islands indicators across the results chain. . . . . . . . . . . . . . . . . . . . . . . . 59 4. Health-related SDG Pacific Headline Indicators (as of March 2017). . . . . . . . . . . . 60

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

ABBREVIATIONS BMI body mass index CRVS civil registration and vital statistics CVD cardiovascular diseases DTP3 diphtheria, tetanus toxoid and pertussis vaccine (three doses) GHO Global Health Observatory GSHS Global School-based Health Survey HIIP Health Information and Intelligence Platform HIMF Healthy Islands Monitoring Framework HoH Heads of Health HPV human papillomavirus IHR (2005) International Health Regulations (2005) JRF Joint Reporting Form MANA Pacific Monitoring Alliance for Noncommunicable Disease Action MMR maternal mortality ratio NCD noncommunicable disease NMDI National Minimum Development Indicators (Pacific Community) PHMM Pacific Health Ministers Meeting PICs Pacific island countries and areas SDG Sustainable Development Goal SPC Pacific Community SSB sugar-sweetened beverage STEPS WHO STEPwise Approach to Surveillance TB tuberculosis UNICEF United Nations Childrenâ&#x20AC;&#x2122;s Fund UNSD United Nations Statistics Division WHO World Health Organization

ABBREVIATIONS

FOREWORD At the first Pacific Health Ministers Meeting in 1995, the health ministers declared their vision of Healthy Islands. Findings from the 20-year review in 2015 concluded that the Healthy Islands vision should remain as the unifying vision for health development in the Pacific. The 11th Pacific Health Ministers Meeting in 2015, however, recognized the absence of a monitoringand-evaluation mechanism to track the progress towards the vision of Healthy Islands and tasked the World Health Organization (WHO) Secretariat to develop a monitoring framework and reporting mechanism. The task is related with: 1) strengthening Pacific leadership, governance and accountability; 2) improving the quality of data and evidence for policy- and decision-making, resource allocation, and the tracking of progress; and 3) ensure reliable and timely data on key health indicators in the 2015 Yanuca Island Declaration. This document provides a progress report in the development of the Healthy Islands Monitoring Framework and presents the first progress report at the 12th Pacific Health Ministers Meeting in Rarotonga, Cook Islands, on 28â&#x20AC;&#x201C;30 August 2017. It offers a snapshot of achievements and challenges, as well as opportunities and priority actions, for indicators defined in the Healthy Islands Monitoring Framework.

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

PART I. INTRODUCTION 1.

Background

In 1995 in Fiji, Pacific health ministers declared their vision of Healthy Islands in the Yanuca Island Declaration.1 They envisioned Healthy Islands where: 1. 2. 3. 4. 5.

Children are nurtured in body and mind Environments invite learning and leisure People work and age with dignity Ecological balance is a source of pride The ocean which sustains us is protected.2

A 20-year review of the Healthy Islands vision was conducted in 2015. Findings from the review concluded that Healthy Islands should remain the unifying vision for the development of the health sector in the Pacific.3 Following the review, ministers at the 11th Pacific Health Ministers Meeting (PHMM) in April 2015 committed to develop, with the assistance of technical agencies, the Healthy Islands Monitoring Framework (HIMF) and core indicators to track progress towards the vision of Healthy Islands. It was agreed that the proposed Sustainable Development Goals (SDGs) would be used as a basis for indicators supporting the vision, and that the progress reports would be presented at the biennial PHMM. The agreed early principles of the Framework included: yy yy yy

Indicators must have a strong link to the SDGs and include a range of process and outcome measures. The Framework must not replicate other existing regional frameworks. It is necessary to measure indicators that are going to change on an annual basis, while at the same time including indicators that can track long-term progress towards outcomes. The Framework includes a set of core/minimum indicators, and countries can choose to expand from this set.

Development of the Framework

2.1

Early versions of the HIMF

Working groups for each of four topic areas developed the first draft of the HIMF in September 2015. Since then, the Framework has gone through five major rounds of revisions including: 1) at the October 2015 PHMM in Guam; 2) at a February 2016 side meeting at the Pacific Islands Regional Meeting on Civil Registration and Vital Statistics; 3) by health information managers and health information experts in March 2016; 4) at the April 2016 Heads of Health (HoH) meeting; 5) and at the May 2016 Pacific Health Information Network (PHIN) meeting. At each stage, reviewers were given the opportunity to provide comments on the relevance 1

2015 Yanuca Island Declaration on health in Pacific island countries and territories [pdf]. In 11th Pacific Health Ministers Meeting, 15–17 April 2015, Suva, Fiji (http://iris.wpro.who.int/handle/10665.1/12508, accessed 9 August 2017).

This last statement was added after the 1999 Pacific Health Ministers Meeting in Palau.

The first 20 years of the journey towards the vision of Healthy Islands in the Pacific [pdf], Suva, Fiji: WHO; 2015 (http://iris.wpro.who.int/handle/10665.1/10928, accessed 9 August 2017). PART I. INTRODUCTION

of proposed indicators for monitoring progress towards the overall Healthy Islands vision, the feasibility of collecting data on the indicators, the usefulness of “optional” indicators and the mechanisms of data collection. Milestones in the development of the Framework are included in Annex 1. A preliminary version of this report was tabled at the April 2016 HoH meeting. It was based on an earlier version of the HIMF, which had 52 mandatory and 27 optional indicators. Of the 22 Pacific island countries and areas contacted in the initial data collection process, 15 provided partial or complete data and seven did not respond. Based on data availability, country response rates and results from a short survey (see Box 1), HoH agreed to reduce the number of mandatory indicators to 48 in April 2017. Survey on the Healthy Islands Monitoring Framework (April 2016) A 10-question survey was sent to country health information focal points to get feedback on the Framework and on the data collection process. However, it should be noted that given a low response rate (23%), this survey does not reflect the region as a whole. •

Overall, respondents felt that the Framework was easy to use, with clear instructions that facilitated the process.

•

Respondents agreed that having some of the indicators pre-populated with data was helpful, but the majority also noted that some of the data were incorrect and the process of crosschecking data with various websites was time-consuming. There was a general feeling that the Framework is an important step forward in improving data collection and in monitoring progress towards the Healthy Islands vision: •

•

However, respondents also commented on the substantial time required for data collection, which ranged from at least two days to over one week, with the majority describing difficulties in sourcing data from multiple departments and organizations: •

•

“…ample time and notice for data submission is important in order to prepare us for data submission, especially those countries who are…setting up databases…”

There was a clear consensus that the Framework is too long and complicated, and there was a strong desire to reduce the number of indicators and to focus on those that can be measured: • •

•

“I think it is great that we have a common ground to report on along with other countries. With this, comes improvement in our data.”

“The size of the Framework is way too long and is a burden on countries…” “Some indicators were very easy. Some were just unrealistic to be sourced in our country at this stage, e.g. service coverage for people with CVD [cardiovascular diseases].”

Respondents also reflected on the limited sense of country ownership over the Framework, and they strongly urged the Heads of Health (HoH) to consider how the information will be used in planning and decision-making: • • •

“It appears that the framework is attempting to please too many parties and gives the impression that the framework is development partner driven…” “I am guessing many of these data may not be used for anything. If they are not going to be used by the target audience, then don’t collect them.” “HoH need to consider how they will use this information. If it is not going to be used, then it should not be collected.”

2.2 Current version Currently, the final draft of the HIMF includes 48 mandatory indicators (see Annex 2) . The Framework is divided into four main sections that correspond to the 2015 Yanuca Island Declaration. In line with agreed key principles, the indicators cover a range of process and outcome measures (see Annex 3) . Process measures are likely to be of more interest to the Heads of Health (HoH) and are more sensitive to change, and as such, are appropriate for annual reporting. Outcome measures of interest to ministers have also been included to provide countries with inspirational targets and goal-setting information; however, these are 2

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

less likely to vary on an annual basis. Where possible, indicator definitions have been sourced from global frameworks to ensure harmonization and adherence to international standards, notably the SDG Pacific Headline Indicators (see Annex 4) . The 48 mandatory indicators have been separated into core and complementary indicators: 33 core indicators (to be updated every one to two years) and 15 complementary indicators (to be updated as survey data are updated, generally every five to 10 years). Of the core and complementary indicators, 42 (88%) are already being collected and reported as part of existing regional or global monitoring frameworks. In addition to the mandatory indicators, 31 optional indicators are proposed that would be selectively reported on, subject to national priorities and reporting systems. Countries will not be required to provide data on these optional indicators as part of the Framework, but rather are encouraged to incorporate these into their national reporting frameworks, where appropriate.

Data sources, validation and data quality

3.1

Data sources and validation process

Efforts were made to retrieve baseline data for all 48 mandatory indicators for the 22 Pacific island countries and areas (PICs). Data for the HIMF are collected and validated as part of a two-stage process: 1. Where possible, data for each indicator is pre-populated into Excel data collection forms using regional or global databases regularly compiled and maintained by international agencies: a. WHO Global Health Observatory (GHO) data repository; b. WHO GHO World Health Statistics (WHS) data visualization dashboard and data tables for the SDG indicators; c. Pacific Community (SPC) National Minimum Development Indicators; d. the Pacific Monitoring Alliance for Noncommunicable Disease Action (MANA) dashboard; and e. WHO Regional Office for the Western Pacific Health Information and Intelligence Platform (HIIP). Data in these databases are mainly based on: yy data periodically reported to these agencies based on the country’s health facility information systems (for example, the WHO/United Nations Children’s Fund (UNICEF) Joint Reporting Form (JRF) for immunization coverage), and disease surveillance systems (for example, WHO global databases for tuberculosis); yy data from periodic national-level population- or school-based surveys – for example, demographic and health surveys, multiple indicator cluster surveys, WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS), and Global School-based Health Surveys (GSHS) – conducted as part of major global initiatives, or other national health surveys that use standardized methodologies; yy data from WHO global reports, including data collected periodically from Member States for alcohol, tobacco and noncommunicable disease (NCD) reports, among others; and yy modelling and estimation conducted by WHO and partner agencies, especially for those indicators where little or no empirical data exist.

PART I. INTRODUCTION

2. Countries and areas are then contacted to validate the pre-populated data and to provide proper references and documentation and to provide national data or additional data that may have been omitted. To ensure maximum comparability of data between countries and over time, while also continuing to build and strengthen country health information systems, data from both regional and global databases, as well as country data, are used. Data are presented together on the same graph (see for example Fig. 1). Graphs have a legend, which provides information on the specific data sources. Country data are plotted using marker points, as opposed to vertical bars, for the regional and global data. If a country has endorsed the global data estimation, but also provided its own data as part of the data collection rounds, then both data values are included. Latter year is associated with national data and marked with an asterisk and N/A denotes data that is not available for the report.

3.2 Data availability and quality For the second round of data collection, country focal points were asked to recheck the pre-populated data and provide any updates. Overall, 21 of the 22 PICs contacted in the first and second rounds of data collection provided some form of data. As discussed previously, the majority of indicators in the HIMF can be sourced from existing regional and global mechanisms and frameworks, with 18 indicators directly aligned with the SDG monitoring framework. By using regional and global data with standardized definitions and data collection methods, data quality and comparability are ensured, while avoiding the burden of additional data collection. While the best attempts have been made to obtain information from global sources or directly from countries on all variables, there are still a number of indicators without baseline data. This is most commonly due to the fact that such data simply do not exist for those countries and global-modelled estimations are not available. For example, data availability is more challenging in countries and areas that are not participating in many of the established WHO reporting mechanisms. Further, some indicators are not being routinely collected as part of existing mechanisms, and so these data need to be sourced directly from the country â&#x20AC;&#x201C; either from local health information systems or special surveys. The extent of missing data can be determined from the number of countries and areas that have or have not been able to supply data for the indicators (Table 1).

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Table 1. Indicators with limited baseline data available Indicator 1.3

PICs with no baseline data available for the report

3.18

Evidence of annual health review, plan and budget Service coverage for people with increased risk for cardiovascular diseases (CVD) Service coverage for people with severe mental health disorders Lower-extremity amputations among patients with diabetes Human papillomavirus (HPV) vaccine coverage among adolescents Child and adolescent suicide rate

4.2

Resilience to climate change and natural disasters

4.5

Number of vector-borne disease outbreaks

2.10 2.11 2.15 3.11

11 17 18 16 17* 16

* Note, the low number of countries providing data for this indicator reflects in part the fact that only 11 countries have included HPV vaccine in their routine immunization schedules.

Four indicators in the framework are harmonized with the MANA Dashboard for NCD Action to view progress a gainst agreed key NCD actions. At the time of drafting the baseline report, not all MANA indicator data were available for all the countries due to ongoing country processes. Once the MANA Dashboard data has been endorsed by all countries, it will be included in this Framework as well. While the majority of the data sourced from regional and global mechanisms and frameworks is recent, 20 indicators have country datapoints that are more than 10 years old, and among these, five indicators have country datapoints that are more than 20 years old. There is also variance between survey methods and instruments used both between countries and over time, for example, changing indicator definitions, or country adaptations to age ranges. In some cases this caused countries difficulty in reporting information in the manner specifically requested in the monitoring Framework. Lastly, it should be noted that country data are not age-standardized, while global data are formatted and analysed for global and regional comparisons. These are major limiting factors in terms of comparability of data within and between countries, and these factors highlight the importance of continuing to build local and regional health information systems for providing timely and comparable data.

Proposed next steps

1. Once the data from this progress report has been cleared by the Pacific health ministers, consider uploading the data on public websites (WHO and/or SPC) so that people can easily view it. 2. In 2019, after two years of implementation, review the appropriateness and usefulness of the Framework and adjust the number of indicators, if necessary. While there was a concern that the overall Healthy Islands vision would be lost if its range was reduced to a small number of indicators, the current number of mandatory indicators is restricting the breadth of analysis that can be conducted. In addition, consider reassigning selected core indicators to complementary indicators. 3. For the next progress report, consider having special topics in the report so that some groups of indicators can be analysed in more detail with time trends and more disaggregation, including exploration of correlations among different indicators.

PART I.â&#x20AC;&#x192;INTRODUCTION

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Â© WHO

PART II. PROGRESS REPORT 1.

Strong leadership, governance and accountability

1.1

Health worker density

The density of skilled health workers varies considerably across the Pacific region, with approximately half of the countries and areas above the global average (Fig. 1). Some countries have yet to reach the WHO goal of 44.5 health workers per 10 000 population by 2030. Fig. 1. Density of skilled health workers (physicians, nurses and midwives) 120

Density (per 10 000 population)

100

WHO WHS

WPRO HIIP

WPR average (2011)

Global average (2013)

Wallis & Futuna (2008)

Vanuatu (2012)

Tuvalu (2009)

Tonga (2010) (2016)*

Tokelau (2012)

Solomon Is. (2011)

Samoa (2008)

RMI (2012)

PNG (2010)

Palau (2010)

Niue (2008)

Nauru (2007)

N. Caledonia (2013) (2015)*

Kiribati (2013)

Guam (N/A

FSM (2009)

Fr. Polynesia (2009) (2016)*

Fiji (2009) (2016)*

Cook Islands (2009)

CNMI (N/A)

American Samoa (2003)

Country data*

Note: The data point for Pitcairn Islands (400 health workers per 10 000 population) has not been plotted on this graph due to the country’s small population Am. Samoa = American Samoa, CNMI = Commonwealth of the Northern Mariana Islands, Fr. Polynesia = French Polynesia, FSM = Federated States of Micronesia, N. Caledonia = New Caledonia, PNG = Papua New Guinea, RMI = the Marshall Islands, Solomon Is. = Solomon Islands, WPR = Western Pacific Region

PART II. PROGRESS REPORT

1.2

Health expenditure per capita

There is a great deal of variation in per capita health expenditure (Fig. 2). Fig. 2. Total health expenditure per capita 4000

Expenditure per capita ($US)

3500 3000 2500 2000 1500 1000 500

WHO GHO

WPRO HIIP

SPC NMDI

WPR average (2014)

Global average (2014)

Wallis & Futuna (2008)

Vanuatu (2014)

Tuvalu (2014)

Tonga (2014) (2013-14)*

Tokelau (2010-2011)

Solomon Is. (2014)

Samoa (2014) (2015)*

RMI (2014)

PNG (2014)

Pitcairn Is. (N/A)

Palau (2014)

Niue (2014)

N. Caledonia (2012) (2015)*

Nauru (2014)

Kiribati (2014) (2016)*

Guam (2010)

FSM (2014)

Fiji (2014) (2015)*

Fr. Polynesia (2008) (2015)*

Cook Is. (2014) (2015-16)*

CNMI (2000) (2002)*

Am. Samoa (2003)

Country data*

SPC NMDI = Pacific Community National Minimum Development Indicators

1.3

Evidence of annual health review, plan and budget

This indicator measures the evidence of a formally communicated annual health plan with a budget, and with formal review processes in place. Of the 10 countries and areas that provided data on this indicator, six ranked themselves at the highest score, demonstrating that their annual health plans are developed, communicated and resourced, with annual reviews and reports available (Table 2). Table 2. Evidence of annual health review, plan and budget, PICs (2015–2016) Score 0 1 2 3

Description No evidence of annual health plan or annual budget There is evidence that an annual health plan is in development, or no reports or reviews are available Annual health plan with budget is developed, communicated and resourced Annual health plan with budget is developed, communicated and resourced, and annual review and report are available

2016 assessment – – Niue (2016), Samoa (2015–2016), Tokelau (2016), Vanuatu (2016) Cook Islands (2015–2016), Fiji (2016–2017), French Polynesia (2016), Kiribati (2016), New Caledonia (2015), Palau (2015), Tonga (2016)

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

1.4 International Health Regulations core capacity score All national and global health risks require full implementation of the International Health Regulations (2005), or IHR (2005), which include the core capacities of basic health system functions that focus on issues related to health security (Fig. 3). There remains much variation between countries. Fig. 3. Average of 13 IHR (2005) core capacity scores 100

Percentage (%)

WPR average (2010-16)

Wallis & Futuna (N/A)

Vanuatu (2015)

Tuvalu (2015)

Tonga (2013)

Tokelau (N/A)

Global average (2010-16)

WHO WHS

Solomon Is. (2015)

Samoa (2015)

RMI (2013)

PNG (2014)

Pitcairn Is. (N/A)

Palau (2016)

Niue (2014)

New Caledonia (N/A)

Nauru (2014)

Kiribati (2014)

Guam (N/A)

FSM (2016)

Fr. Polynesia (N/A)

Fiji (2014)

Cook Is. (2016)

CNMI (N/A)

Am. Samoa (N/A)

Note: Data are only currently collected from WHO Member States.

PART II.â&#x20AC;&#x192;PROGRESS REPORT

1.5

Death registration coverage

Monitoring the status of civil registration and vital statistics (CRVS) is the first step in providing guidance and assistance to those in need. At the most basic level, knowing how many people die each year – and the causes of their deaths – is critical in terms of monitoring overall population health and planning for health services. Overall, PICs are doing markedly better in terms of death registration in comparison to the global average of 51% (Fig. 4). Fig. 4. Percentage of deaths that are formally registered within the civil registration system in a given year 100

Percentage (%)

UNSD

WPR average (2007-13)

Global average (2007-13)

Wallis & Futuna (ND)

Vanuatu (1994)

Tuvalu (2000)

Tonga (2002) (2005-09)

Tokelau (ND) (2016)

Solomon Is. (1994)

Samoa (2002)

RMI (2001)

PNG (2004)

Pitcairn Is. (ND)

Palau (ND) (2015)

Niue (2000)

N. Caledonia (1999)

Nauru (1996)

Kiribati (2002)

FSM (1994)

Guam (2003)

Fr. Polynesia (1994)

Fiji (2010) (2016)

Cook Is. (2012)

CNMI (ND) (2015)

Am. Samoa (1993)

Country

ND = no data Note: For countries and areas that reported a range (i.e. 10–15 or >90), the lower value was plotted on the graph.

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Avoidable diseases and premature deaths are reduced

2.1

Smoking prevalence

The proportion of current smokers varies greatly across countries, with Kiribati and Nauru reporting rates approximately double the Western Pacific Region and global averages (Fig. 5). The majority of countries and areas that provided national data from a populationbased, risk-factor survey reported prevalence rates higher than the Western Pacific Region and global averages. While adult risk-factor surveys undertaken with the WHO STEPS instrument are the primary data sources for adult smoking in the region, PICs can vary in survey methodology, including sample selection and question design, limiting comparability. Fig. 5. Age-standardized prevalence of tobacco smoking among adults (aged 15+ or 18+ years)

WHO WHS

Global average (2015)

WPR average (2015)

Vanuatu (2011)

Wallis & Futuna (2009)

Tuvalu(2006)

Tonga (2015)

Tokelau (2014)

Solomon Is. (2015)

Samoa (2015)

RMI (2002)

PNG (N/A)

Pitcairn Is. (N/A)

Palau (N/A)

Niue (2015)

N. Caledonia (2015)

Nauru (2015)

Kiribati (2015)

Guam (2015)

FSM (2006)

Fiji (2015) (2011)*

Fr. Polynesia (2010)

Cook Is. (2011)

CNMI (2011)

Am. Samoa (2004)

Percentage (%)

Country data*

PART II.â&#x20AC;&#x192;PROGRESS REPORT

2.2 Heavy episodic drinking The WHO estimates that 5.9% of all Western Pacific Region deaths in 2012 were attributable to alcohol consumption.4 While adult risk factor surveys using the WHO STEPS instrument are the primary data source on alcohol use in the region, PICs can vary in survey methodology, including sample selection and question design, limiting comparability. In looking at data from the global database and country data, there is significant variation among countries in rates of heavy episodic drinking (Fig. 6). Fig. 6. Heavy episodic drinking among adults (aged 15+ or 18+ years) in the past 30 days 50

Percentage (%)

WHO GIASH

Wallis & Futuna (N/A)

Vanuatu (2010)

Tuvalu (N/A)

Tonga (2010)

Tokelau (2014)

Solomon Is. (2010) (2015)*

Samoa (2010)

RMI (N/A)

PNG (2010)

Pitcairn Is. (N/A)

Palau (2011)

Niue (2010)

N. Caledonia (2015)

Nauru (N/A)

Kiribati (2010)

Guam (2015)

FSM (2010)

Fr. Polynesia (2010)

Fiji (2010) (2011)*

Cook Is. (2015)

CNMI (2016)

Am. Samoa (2004)

Country data*

Note: The global definition of heavy episodic drinking was updated in 2014 to align with the definition used by WHO Global Information Systems on Alcohol and Health (GIASH) â&#x20AC;&#x201C; adults aged 15+ or 18+ years who report drinking six (60 g) or more standard drinks in a single drinking occasion. While all countries and datapoints have been displayed on the graph, direct comparisons between GIASH and country data are limited due to this.

Health at a glance: Asia/Pacific 2016. Measuring progress towards universal health care coverage. Organisation for Economic Co-operation and Development and WHO. Paris: OECD Publishing; 2016.

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

2.3 Insufficiently physically active adults As shown in Fig. 7, Wallis and Futuna, as well as Cook Islands, reported more than half of their adult population were insufficiently physically active. These were followed by Kiribati, the Marshall Islands and Nauru (all 40% or more). This is in contrast to countries such as Niue and Vanuatu that reported less than 10% of adults as being physically inactive. Fig. 7. Age-standardized prevalence of insufficiently physically active adults (aged 18+ years) 80

WHO GHO

WPRO HIIP

Vanuatu (2010)

Tuvalu(2006)

Tokelau (2014)

Samoa (2010)

RMI (2010)

PNG (2010)

Pitcairn Is. (N/A)

Palau (2011)

Niue (2010)

N. Caledonia (2015)

Nauru (2010)

Kiribati (2010)

Guam(2015)

FSM (2010)

Fiji (2010) (2011)*

CNMI (N/A)

Percentage (%)

Country data*

PART II.â&#x20AC;&#x192;PROGRESS REPORT

2.4 Intimate partner violence As shown in Fig. 8, there are high rates of intimate partner violence in the region, with seven countries reporting that more than 60% of women experience physical or sexual violence in their lifetime. This indicator is sourced from survey data (primarily demographic and health surveys), but nine countries were not able to provide data for this round of reporting. Fig. 8. Percentage of girls and women (aged 15+ years) who have ever experienced physical and/or sexual violence by an intimate partner 80

Percentage (%)

SPC NMDI

Country data*

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Wallis & Futuna (N/A)

Vanuatu (2011)

Tuvalu (2007)

Tonga (2007)

Tokelau (2016)

Solomon Is. (2009)

Samoa (2006)

RMI (2007) (2012-13)*

PNG (2010)

Pitcairn Is. (N/A)

Palau (N/A)

Niue (N/A)

N. Caledonia (N/A)

Nauru (N/A)

Kiribati (2010)

Guam (2010)

FSM (N/A)

Fr. Polynesia (2004)

Fiji (1999)

Cook Is. (2010) (2013)*

CNMI (N/A)

Am. Samoa (N/A)

2.5 Tobacco excise taxes Data on tobacco excise tax is collected as part of Global Tobacco Surveillance, and used for the Pacific MANA Dashboard for NCD Action,5 whereby countries are assessed on the strength of their implementation of various NCD-related policy initiatives. A summary of countries and areas that have data available on this indicator as part of the draft dashboards is provided in Table 3. Table 3: Legislation is in place to reduce affordability of tobacco products by increasing tobacco excise taxes Score – – 0 1 2

Description No excise tax is collected on cigarettes Tobacco excise tax legislation is being developed or cigarette excise tax is 20% or less of retail price Cigarette excise tax is 21–30% of retail price Cigarette excise tax is 31–50% of retail price Cigarette excise tax is 51–70% of retail price

Cigarette excise tax is 71% or more of retail price

2016 assessment Niue, Vanuatu Cook Islands, French Polynesia, Samoa, Tonga New Caledonia, Wallis and Futuna

2.6 Excise tax on alcoholic drinks Data on alcohol taxes are also being collected as part of the Pacific MANA Dashboard for NCD Action. A summary of countries and areas that have reported on this indicator as part of the draft dashboards is provided in Table 4. Table 4. Inflation-adjusted alcohol taxies system on beer, wine and spirits is in place Score – – 0

Description No alcohol excise tax is collected Alcohol excise taxation system is being developed based on beverage type or ethanol content Alcohol excise taxation system is in place and based on beverage type or ethanol content

2016 assessment -

Alcohol excise taxation system is in place and based on beverage type or ethanol content, and is applied across all beverage types or if bands are applied, excise tax is based on the ethanol content at the top of each band, and excise tax is reviewed or adjusted for inflation annually for at least one beverage type Alcohol excise taxation system is in place and based on beverage type or ethanol content, and is applied across all beverage types or if bands are applied, excise tax is based on the ethanol content at the top of each band, and excise tax is reviewed or adjusted for inflation annually for all beverage types Same as for 2, and excise tax is stated by the Government as an important public health tool to reduce alcohol consumption/ harm

Cook Islands, CNMI, French Polynesia, Nauru New Caledonia, Niue, Samoa, Solomon Islands, Tonga, Vanuatu –

Fiji

Wallis and Futuna

Pacific MANA Dashboard for NCD Action. In Pacific NCD Network [website]. Noumea, New Caledonia: SPC; 2016 (http://www.pacificncdnetwork.org/pacific-mana.html, accessed 10 August 2017). PART II. PROGRESS REPORT

2.7 Excise tax on the retail price of sugar-sweetened beverages Data on excise tax on the retail price of sugar-sweetened beverages (SSBs) is being collected as part of the Pacific MANA Dashboard for NCD Action, as part of the indicator “fiscal policies are in place to make healthy food choices easier and cheaper, and to discourage unhealthy food choices”. For the HIMF, countries were also asked to self-assess, based on the simple assessment criteria provided. A summary of countries and areas that have reported on this indicator is provided in Table 5. Table 5. Evidence of excise tax on the retail price of sugar-sweetened beverages Score 0

Description No SSB excise tax

SSB tax legislation in development, or SSB excise tax is < 20% of retail price

SSB excise tax over 20% of retail price

2016 assessment New Caledonia, Palau, Tokelau Commonwealth of the Northern Mariana Islands, Fiji, Kiribati, French Polynesia, Niue, the Marshall Islands, Samoa, Tonga, Vanuatu Cook Islands, Nauru

2.8 Access to essential NCD drugs Data on access to essential NCD drugs are being collected as part of the Pacific MANA Dashboard for NCD Action. A summary of countries and areas that have reported on this indicator is provided in Table 6. Table 6. Essential NCD drugs are available and accessible in public-sector primary health-care facilities Score – – 0 1

Description No essential drug list exists, or not all drugs listed are on the essential drug list All drugs listed are on the essential drug list All drugs listed are on the essential drug list, and a system is in place to monitor availability All drugs listed are on the essential drug list, and a system is in place to monitor availability, and monitoring reports are available, and stock-outs were reported in more than 50% of facilities in the last 12 months All drugs listed are on the essential drug list, and a system is in place to monitor availability, and monitoring reports are available, and stock-outs were reported in less than 50% of facilities in the last 12 months All drugs listed are on the essential drug list, and a system is in place to monitor availability, and monitoring reports are available, and no stock-outs were reported in facilities in the last 12 months

2016 assessment

Nauru, Tonga, Vanuatu Cook Islands, Samoa Fiji

Niue

French Polynesia, New Caledonia, Wallis and Futuna

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

2.9 Cervical cancer screening In some countries and areas, coverage estimates are mainly from facility information systems. Also, the latest revision of the STEPS instrument includes question on cervical cancer screening coverage. Cook Islands and Tokelau both reported over three quarters of eligible women had received screening for cervical cancer (Table 7). Table 7. Coverage of the national cervical cancer screening programme Category Less than 10% 10–50%

51–70% 71% or more No data or Not applicable

Regional/Global data Federated States of Micronesia (2015) Fiji (2015) Palau (2015) Papua New Guinea (2015) Tuvalu (2015) Vanuatu (2015) – – Cook Islands Kiribati Nauru Niue Pitcairn Islands

Country data French Polynesia (2014) Solomon Islands (2015)

Guam (2015) New Caledonia (2016) Tokelau (2014) Cook Islands (2015) Marshall Islands Samoa Tonga Wallis and Futuna

2.10 Service coverage for people with increased risk of CVD Cardiovascular disease (CVD) covers a range of diseases related to the circulatory system, including ischaemic heart disease and cerebrovascular disease (or stroke). The eighth target in the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013– 2020 states at least 50% of eligible people should receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. According to WHO recommendations, the preferred measure for the indicator is a population-based survey. However, only the latest revision of the STEPS instrument includes all the questions needed to calculate the indicator. As a result, coverage estimates provided by five PICs are mainly based on health facility information systems (Table 8). Table 8. Service coverage for people with increased risk of CVD Country/Area Cook Islands Fiji New Caledonia Palau Tokelau

Service coverage

Year

80% 4% 100% 75% 100%

2016 2011 2016 2016 2016

2.11 Service coverage for people with severe mental health disorders The Sixty-sixth World Health Assembly adopted a comprehensive Mental Health Action Plan 2013–2020 to address the challenge of bridging the mental health treatment gap. The plan sets out a global vision and road map for mental health, including increasing service coverage for people with severe mental health disorders by 20% by 2020. Service coverage refers to the proportion of people with severe mental disorders served by mental health PART II. PROGRESS REPORT

systems (outpatient facilities, day-care facilities, psychiatric wards in general hospitals and mental hospitals). Baseline values were not available at the global level. Since most PICs doÂ notÂ routinely conduct their own population-based mental health surveys, the coverage estimates are based on facility information systems.6 Four PICs were able to provide data for this indicator (Table 9). Table 9. Service coverage for people with severe mental health disorders Country Fiji New Caledonia Niue Tokelau

Service coverage

Year

46% 100% 100% 65%

2016 2016 2016 2016

Calculating the denominator (population at risk) for indicators 2.10 and 2.11 is difficult, and countries providing data may have used different methodologies, reducing intercountry comparisons. MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

2.12 Contraceptive prevalence The SDGs set a target of ensuring universal access to reproductive health care services by 2030, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. Overall, 16 countries reported less than half of women of reproductive age as using any method of contraception. Apart from Guam, all countries and areas in the region fall below the global average for contraceptive use, with considerable variation among countries (Fig. 9). Fig. 9. Percentage of women (aged 15–49 years) who are sexually active and who are currently using, or whose sexual partner is using, at least one method of contraception

WHO GHO

WPRO HIIP

SPC NMDI

Global average (2008-15)

WPR average (2008-15)

Wallis & Futuna (N/A)

Tuvalu (2007)

Vanuatu (2013) (2013)*

Tonga (2012) (2016)*

Tokelau (2016)

Solomon Is. (2007) (2015)*

Samoa (2014)

RMI (2007) (2010)*

PNG (2006)

Pitcairn Is. (N/A)

Palau (2010)

Niue (2001)

New Caledonia (2012) (2015)*

Nauru (2007)

Kiribati (2009)

Guam (2010)

FSM (2009)

Fr. Polynesia (2005)

Fiji (2013) (2016)*

Cook Is. (2001-05) (2015)*

CNMI (2012)

Am. Samoa (N/A)

Percentage (%)

Country data*

PART II. PROGRESS REPORT

2.13 HIV prevalence among the general population The SDGs make a bold commitment to end the AIDS epidemics, together with other communicable diseases, by 2030. HIV prevalence in the Pacific has been low at 0.1%. As shown in Fig. 10, HIV rates continue to be low across the region, with most countries reporting a prevalence equal to or less than zero. Papua New Guinea, with a 0.7% prevalence, has the highest prevalence rate in the Western Pacific Region, and is also higher than the global average (0.5%). Fig. 10. Estimated percentage of adults (aged 15–49 years) with HIV, whether or not they have developed symptoms of AIDS 1

Percentage (%)

0.8

0.6

0.4

0.2

WHO GHO

WPRO HIIP

UNAIDS

Country

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

WPR average (2015)

Global average (2015)

Wallis & Futuna (ND)

Vanuatu (2014)

Tuvalu (2014)

Tonga (2014)

Tokelau (2004)

Solomon Is. (2013) (2015)

Samoa (2012-2014)

RMI (2015)

PNG (2013) (2015)

Pitcairn Is. (ND)

Niue (ND)

Palau (2014)

Nauru (2014)

N. Caledonia (2009) (2015)

Kiribati (2014)

Guam (ND)

FSM (2014)

Fiji (2014)

Fr. Polynesia (2010) (2016)

Cook Is. (2014)

CNMI (ND) (2004)

Am. Samoa (ND)

2.14 Tuberculosis incidence Tuberculosis (TB) was declared a global health emergency by WHO in 1993, and the WHOcoordinated Stop TB Partnership set targets of halving TB prevalence and deaths by 2015, compared with a 1990 baseline. The SDGs foresee the end of the TB epidemic by 2030.7 Kiribati, the Marshall Islands and Papua New Guinea all reported incidence rates at least double the global average (Fig.Â 11). Just over half of PICs were able to provide their own national data for this indicator. While most datapoints closely matched those from the global database, a notable exception is Tokelau. However, given the small population, this is likely due to stochastic (random) variation. Fig. 11. Estimated TB incidence per 100 000 population

Rate (per 100 000 population)

600 500 400 300 200 100

WHO GHO

WPRO HIIP

SPC NMDI

Global average (2015)

WPR average (2015)

Wallis & Futuna (2007)

Vanuatu (2015)

Tuvalu (2015)

Tonga (2015)

Tokelau (2012) (2015)*

Solomon Is. (2015)

Samoa (2015) (2015)*

RMI (2015)

PNG (2014)

Pitcairn Is. (2016)

Palau (2015) (2015)*

Niue (2015)

New Caledonia (2010-13) (2015)*

Nauru (2015)

Kiribati (2015) (2016)*

Guam (2010-13)

FSM (2015)

Fiji (2015)

Fr. Polynesia (2009) (2016)*

Cook Is. (2015) (2016)*

CNMI (2010-13) (2016)*

Am. Samoa (2009)

Country data*

Health at a glance: Asia/Pacific 2016. Measuring progress towards universal health care coverage. Organisation for Economic Co-operation and Development and WHO. Paris: OECD Publishing; 2016. PART II.â&#x20AC;&#x192;PROGRESS REPORT

2.15 Lower-extremity amputations among patients with diabetes PICs were asked to provide data on the rate per 100 000 population of lower-extremity amputations among patients with diabetes. Only six countries provided data, and amputation rates show a strong variation among countries, which indicates that the surveillance or reporting approach is variable in the region or is lacking (Table 10). Table 10. Lower-extremity amputations among patients with diabetes Country

Lower extremity amputation/100 000 population

Year

0.2 12.3 2.7 90 77 0

2015 2016 2016 2016 2016 2016

Cook Islands Fiji Kiribati Palau Samoa Tokelau

2.16a Maternal deaths & 2.16b Maternal mortality ratio The SDGs set a target of reducing the global maternal mortality ratio (MMR) to less than 70 per 100Â 000 live births by 2030.8 While all countries and areas reported an MMR lower than the global average (Fig. 12), American Samoa, Kiribati, Papua New Guinea, Solomon Islands and Tonga had rates at least double the average in the Western Pacific Region. There are some considerable differences between global and country data; however, this is likely due to small numbers (total deaths and population), and under-reporting of maternal deaths in the region. Fig. 12. Maternal mortality ratio per 100 000 live births

Rate (per 10 000 live births)

250

200

150

100

WHO GHO

WPRO HIIP

Country data*

World health statistics 2016: monitoring health for the SDGs. Geneva: WHO; 2016. MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Global average (2015)

WPR average (2015)

Wallis & Futuna (1996)

Vanuatu (2015) (2015)*

Tuvalu (2010)

Tonga (2015) (2016)*

Solomon Is. (2015) (2015)*

Tokelau (2006-09) (2016)*

Samoa (2015)

RMI (2015) (2007-11)*

PNG (2015)

Pitcairn Is. (2016)

Niue (2015) (2007-11)*

Palau (2015) (2010-16)*

N. Caledonia (2012) (2015)*

Nauru (N/A)

Kiribati (2015) (2016)*

Guam (2012)

FSM (2015)

Fr. Polynesia (2011) (2013)*

Fiji (2015) (2016)*

Cook Is. (2015)

CNMI (2012) (2015)*

Am. Samoa (2013) (2010-13)*

2.17 Mortality rate from road traffic injuries Road traffic injuries and unintentional injuries are included in SDG 3 (healthy lives and well-being), with targets related to violence and disasters part of other goals.9 Halving the number of global deaths and injuries from road traffic accidents by 2020 (SDG target 3.6) is an ambitious goal given the dramatic increase in vehicle numbers. As shown in Fig. 13, both Cook Islands and Solomon Islands have mortality rates higher than the global and Western Pacific Region averages, with Papua New Guinea, Vanuatu and Samoa either equal to or very close to the comparator averages. Fig. 13. Estimated road traffic death rate per 100 000 population

Rate (per 10 000 live births)

250

200

150

100

WPRO HIIP

Global average (2015)

WPR average (2015)

Wallis & Futuna (1996)

Vanuatu (2015) (2015)*

Tuvalu (2010)

Tonga (2015) (2016)*

Tokelau (2006-09) (2016)*

Solomon Is. (2015) (2015)*

Samoa (2015)

RMI (2015) (2007-11)*

PNG (2015)

Pitcairn Is. (2016)

Palau (2015) (2010-16)*

Niue (2015) (2007-11)*

Nauru (N/A)

WHO GHO

N. Caledonia (2012) (2015)*

Kiribati (2015) (2016)*

Guam (2012)

FSM (2015)

Fiji (2015) (2016)*

Fr. Polynesia (2011) (2013)*

Cook Is. (2015)

CNMI (2012) (2015)*

Am. Samoa (2013) (2010-13)*

Country data*

ibid. PART II.â&#x20AC;&#x192;PROGRESS REPORT

2.18a Deaths due to suicide among adults and 2.18b Adult suicide mortality rate As shown in Fig. 14, suicide rates in the region are comparatively high, with the majority of countries providing data on this indicator having rates equal to or higher than the Western Pacific Region and global averages. Fig.14. Age-standardized suicide mortality rate per 100 000 population 100

Percentage (%)

80 60 40 20

WHO WHS

Global average (2015)

WPRO average (2015)

Wallis & Futuna (N/A)

Vanuatu (2015)

Tuvalu (N/A)

Tonga (2015)

Tokelau (N/A)

Solomon Is. (2015)

Samoa (2015)

RMI (2008)

PNG (2015)

Pitcairn Is. (2016)

Palau (2008)

Niue (2007-11)

New Caledonia (N/A)

Nauru (N/A)

Kiribati (2015)

Guam (N/A)

FSM (2015)

Fr. Polynesia (2012)

Fiji (2015)

Cook Is. (2009-13)

CNMI (2015)

Am. Samoa (2010-12)

Country data*

2.19 Risk of premature death from target NCDs As shown in Fig. 15, the situation in the region is dire, with all countries and areas included in the World Health Statistics Dashboard having rates of premature mortality from NCDs higher than Western Pacific and global averages. For countries providing national data on this indicator, primarily from CRVS systems, the situation is similarly concerning, with the majority also having rates higher than Western Pacific and global averages. Fig. 15. Probability of dying between ages 30â&#x20AC;&#x201C;70 from any CVD, cancer, diabetes or chronic respiratory conditions

Percentage (%)

100 80 60 40 20

WHO WHS

Country data*

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Global average (2015)

WPR average (2015)

Vanuatu (2015)

Wallis & Futuna (N/A)

Tuvalu (N/A)

Tonga (2015)

Tokelau (N/A)

Solomon Is. (2015)

Samoa (2015)

RMI (2008)

PNG (2015)

Pitcairn Is. (2016)

Palau (2008)

Niue (2007-11)

New Caledonia (N/A)

Nauru (N/A)

Kiribati (2015)

Guam (N/A)

FSM (2015)

Fr. Polynesia (2012)

Fiji (2015)

Cook Is. (2009-13)

CNMI (2015)

Am. Samoa (2010-12)

2.20 Life expectancy at birth: both sexes Life expectancy at birth is the best-known measure of population health status, and is often used to gauge a country’s level of health development. Life expectancy at birth for the Western Pacific Region reached 78 years on average in 2015, well above the global average. However, a large regional divide persists (Fig. 16). Fig. 16. Life expectancy at birth, both sexes 100

WPRO HIIP

SPC NMDI

UNDP

Global average (2010-15)

WPR average (2010-15)

Wallis & Futuna (2012)

Vanuatu (2009)

Tuvalu (2010)

Tonga (2008-11)

Tokelau (1990) (2016)

Solomon Is. (2009)

Samoa (2011)

RMI (2011)

PNG (2000)

Pitcairn Is. (2016)

Palau (2001-05)

Niue (2007-11)

New Caledonia (2012)

Nauru (2011-13)

Guam (2012)

Kiribati (2010)

FSM (2010)

Fr. Polynesia (2013) (2016)*

Fiji (2010) (2016)*

Cook Is. (2006-12) (2009-15)*

Am. Samoa (2012)

CNMI (2010) (2015)*

Years of life (at birth)

Country data*

PART II. PROGRESS REPORT

Children are nurtured in body and mind

3.1

Exclusive breastfeeding rate

In 2012, the World Health Assembly endorsed a Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition,10 which specified a set of six global nutrition targets. One of those targets aims to increase the rate of exclusive breastfeeding in the first six months to at least 50% by 2025. As demonstrated in Fig. 17, nine countries and areas already have met this target, with at least half of their infants being exclusively breastfed. Fig. 17. Infants (0â&#x20AC;&#x201C;5 months of age) who are fed exclusively with breast milk 80

Percentage (%)

WHO GHO

WHO WHS

WPRO HIIP

Global average (2007-14)

WPR average (2007-14)

Wallis & Futuna (N/A)

Vanuatu (2007) (2013)*

Tuvalu (2007)

Tonga (2012) (2016)*

Tokelau (2014)

Solomon Is. (2007) (2015)*

Samoa (2009)

RMI (2007)

PNG (2006)

Pitcairn Is. (N/A)

Palau (1999)

Niue (N/A)

N. Caledonia (1997)

Nauru (2007)

Kiribati (2009)

Guam (N/A)

FSM (1999)

Fr. Polynesia (2001) (2011)*

Fiji (2004) (2016)*

Cook Is. (2016)

CNMI (N/A)

Am. Samoa (1997)

Country data*

Comprehensive implementation plan on maternal, infant and young child nutrition [pdf]. In: WHO Institutional Repository for Information Sharing [website]. Geneva: WHO; 2014 (http://apps.who.int/iris/ bitstream/10665/113048/1/WHO_NMH_NHD_14.1_eng.pdf?ua=1, accessed 10 August 2017). MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

3.2 Children who are obese Data for this indicator are primarily collected via demographic and health surveys, which include a standardized methodology to measure childhood obesity. Overweight among children under 5 years of age is defined as weight-for-height greater than two standard deviations of the WHO Child Growth Standards.11 However, survey methodology can vary in areas, limiting comparisons (Fig. 18). Fig. 18. Percentage of obese – body mass index (BMI) by age more than 2 standard deviations from the mean, children (aged 0–5 years) 35 Percentage (%)

30 25 20 15 10 5

SPC NMDI

Wallis & Futuna (N/A)

Vanuatu (2007) (2013)*

Tuvalu (2007)

Tonga (N/A)

Tokelau (2011)

Solomon Is. (2007) (2015)*

Samoa (N/A)

RMI (N/A)

PNG (N/A)

Pitcairn Is. (N/A)

Palau (N/A)

Niue (N/A)

New Caledonia (2012)

Nauru (2007)

Kiribati (2009)

Guam (2014)

FSM (N/A)

Fr. Polynesia (2014)

Fiji (N/A)

Cook Is. (2015)

CNMI (2013-14)

Am. Samoa (1995)

Country data*

WHO Child Growth Standards [website]. Geneva: WHO (http://www.who.int/childgrowth/en/, accessed 10 August 2017). PART II. PROGRESS REPORT

3.3 Inadequate physical activity in adolescents The GSHS and other surveys assess behavioural risk factors and protective factors, including physical activity commonly implemented in the region, among young people aged 13 to 17 years. New Caledonia, the Northern Mariana Islands and Vanuatu reported the highest levels of physical activity with around half of their adolescents meeting the minimum standard (Fig. 19). The situation is markedly worse for the majority of other countries in the region, with nine countries reporting less than one quarter of their adolescents engaging in adequate levels of physical activity on a daily basis. Fig. 19. Adolescents (aged 13â&#x20AC;&#x201C;15/17 years) participating in less than 60 minutes of moderate-to vigorous-intensity physical activity daily 100 90 80

Percentage (%)

70 60 50 40 30 20 10

GSHS

Other youth risk factor survey

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Wallis & Futuna (2015)

Vanuatu (2011)

Tuvalu (2013)

Tonga (2010)

Tokelau (2014)

Solomon Is. (2011)

Samoa (2011)

RMI (N/A)

PNG (N/A)

Pitcairn Is. (N/A)

Palau (N/A)

Niue (2010)

New Caledonia (2014)

Nauru (2011)

Kiribati (2011)

Guam (2015)

FSM (N/A)

Fr. Polynesia (2015)

Fiji (2016)

Cook Is. (2015)

CNMI (2015)

Am. Samoa (N/A)

3.4 Obesity in adolescents The GSHS and other surveys assess the behavioural risk factors and protective factors commonly implemented in the region for obesity among young people aged 13–17 years. American Samoa, Cook Islands, Niue, and Wallis and Futuna, all reported more than one third of their adolescents as being obese (Fig. 20). This is in comparison to countries such as Kiribati, Fiji, Solomon Islands and Vanuatu, with rates of 8% or less. Fig. 20. Percentage of obese (BMI by age more than 2 standard deviations from the mean) among adolescents (aged 13–15/17) years) 40 35

25 20 15 10 5

SPC NMDI

GSHS

Wallis & Futuna (2015)

Vanuatu (2011)

Tuvalu (2013)

Tonga (2010)

Tokelau (2011)

Solomon Is. (2011)

Samoa (2011)

RMI (N/A)

PNG (N/A)

Pitcairn Is. (N/A)

Palau (N/A)

Niue (2010)

New Caledonia (2012)

Nauru (2011)

Kiribati (2011)

Guam(2015)

FSM (N/A)

Fr. Polynesia (2015)

Fiji (2016)

Cook Is. (2015)

CNMI (2008)

Am. Samoa (1995)

Percentage (%)

Other youth risk factor survey

PART II. PROGRESS REPORT

3.5 Birth registration coverage As shown in Fig. 21, the region is doing particularly well in terms of birth registration, with 12 countries having registration rates of 90% or more, well above the global average of 71%. There is considerable variation though, with Tokelau and Solomon Islands registering less than half of all births. Fig. 21. Estimated level of coverage of birth registration 100

Percentage (%)

WHO GHO

Other

Global average (2015)

EAP average (2015)

Wallis & Futuna (N/A)

Vanuatu (2013) (2015)*

Tuvalu (2007)

Tonga (2012)

Tokelau (2016)

Solomon Is. (N/A)

Samoa (2014)

RMI (2007)

PNG (N/A)

Pitcairn Is. (N/A)

Niue (2009)

Palau (2010)

Nauru (2007)

N. Caledonia (1999) (2015)*

Kiribati (2009)

FSM (N/A)

Guam (2003)

Fr. Polynesia (1994) (2016)*

Fiji (2009)

Cook Is. (2013) (2015)*

CNMI (2015)

Am. Samoa (1993)

Country data*

EAP = East Asia and the Pacific (UNICEF country grouping) Other = UNICEF (global and EAP averages) and United Nations Statistics Division (American Samoa, French Polynesia, Guam, New Caledonia) Note: For countries and areas that reported a range (i.e. 10â&#x20AC;&#x201C;15 or > 90), the lower value was plotted on the graph.

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

3.6 Evidence of healthy food policies in schools Data on the evidence of healthy food policies in schools is being collected as part of the Pacific MANA Dashboard for NCD Action, whereby countries are assessed on the strength of their implementation of various NCD-related policy initiatives. Countries were also asked to self-assess, based on assessment criteria provided. A summary of countries and areas that have reported on this indicator is provided in Table 11. Table 11. Policies are in place relating to the provision and promotion of healthy food choices in schools Score – – 0

1 2 3

Description No government (Ministry of Health or Education) policies or guidelines The Ministry of Health and/or Education are developing policies or guidelines There is a mandatory government policy or guideline that covers 1 area listed

There is a mandatory government policy or guideline that covers 2 areas listed There is a mandatory government policy or guideline that covers 3 areas listed There is a mandatory government policy or guideline that covers 4 areas listed Areas: Healthy food/beverages provided in school canteens Healthy food/beverages sold in vending machines or school shop Healthy food/ beverages used in fundraising Education and promotion of healthy food/beverage choices Healthy food/beverages at school events.

2016 assessment Nauru, Tonga, Wallis and Futuna American Samoa Cook Islands, Northern Mariana Islands, Tonga, Tokelau, Vanuatu Samoa Fiji, Niue, New Caledonia French Polynesia

PART II. PROGRESS REPORT

3.7 Antenatal care coverage WHO currently recommends a minimum of four antenatal visits, and antenatal care coverage is being monitored to ensure progress towards universal access to reproductive health. In 15 countries, more than three quarters of pregnant women receive four or more antenatal care visits, higher than the Western Pacific Region average and global average (62% and 64%, respectively), as shown in Fig.Â 22. Such high rates of antenatal care may be linked with the relatively low rates of maternal mortality seen in the region (Indicator 2.16b). Fig. 22. Women aged 15â&#x20AC;&#x201C;49 years with a live birth who received antenatal care, four times or more 100

Percentage (%)

WHO GHO

WPRO HIIP

SPC NMDI

Country

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

WPR average (2013)

Global average (2013)

Wallis & Futuna (ND)

Vanuatu (2013)

Tuvalu (2007)

Tonga (2012)

Tokelau (2011)

Solomon Is. (2007)

Samoa (2014)

RMI (2011)

PNG (2010)

Pitcairn Is. (ND)

Palau (2010)

Niue (2000-2008)

New Caledonia (2012)

Nauru (2007)

Kiribati (2009)

Guam (ND)

FSM (2009)

Fiji (2010)

Fr. Polynesia (2004)

Cook Is. (2008)

CNMI (ND)

Am. Samoa (ND)

3.8 Births attended by skilled health personnel For most countries in the region, almost all births are attended by a skilled health professional – such as a doctor, nurse or midwife – with rates above 90% for 16 countries (Fig. 23). In Papua New Guinea, just over one half of births are attended by skilled health personnel, a rate below both the Western Pacific Region average and the global average. Fig. 23. Percentage of live births attended by skilled health personnel (doctors, nurses or midwives) 100

WHO WHS

WPRO HIIP

Global average (2010-2016)

WPR average (2010-2016)

Wallis & Futuna (ND)

Vanuatu (2013)

Tuvalu (2007)

Tonga (2012)

Tokelau (2011)

Samoa (2014)

SPC NMDI

Solomon Is. (2007)

RMI (2011)

PNG (2006)

Pitcairn Is. (ND)

Palau (2015)

Niue (2011)

Nauru (2007)

New Caledonia (2011)

Kiribati (2010)

Guam (2010)

FSM (2009)

Fr. Polynesia (2010)

Fiji (2013)

CNMI (2012)

Cook Is. (2009)

Am. Samoa (2013)

Percentage (%)

Country

PART II. PROGRESS REPORT

3.9 Immunization coverage for DTP3 Coverage of the third dose of the diphtheria, tetanus toxoid and pertussis (DTP3) vaccine is used as a proxy for immunization system performance. If a country has high DTP3 coverage (1-year-old children who have received three doses of DTP), it is likely that it has systems in place that can also deliver other vaccines. Fig. 24 shows good levels of immunization in the region, with 17 countries immunizing more than 90% of children for DTP3. Fig. 24. 1-year-old children who have received three doses of the diphtheria, tetanus toxoid and pertussis vaccine in a given year 100

Percentage (%)

WPRO HIIP

WHO JRF

Country

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Global average (2015)

WPR average (2015)

Wallis & Futuna (2015)

Vanuatu (2016)

Tuvalu (2016)

Tonga (2016) (2016)

Tokelau (2015) (2016)

Solomon Is. (2016) (2015)

Samoa (2016) (2015)

RMI (2016)

PNG (2016)

Pitcairn Is. () (2016)

Palau (2016) (2015)

Niue (2015)

Nauru (2015)

WHO GHO

New Caledonia (2015)

Kiribati (2016) (2016)

Guam (2015)

FSM (2016)

Fr. Polynesia (2015) (2011)

Fiji (2016) (2016)

Cook Is. (2016) (2015)

CNMI (2011)

Am. Samoa (2008)

3.10 Immunization coverage for measles There is considerable variation in reported coverage, both among and within countries and between years, and levels of development of national coverage and surveillance systems are not yet adequate to ensure countries remain measles-free in the event of importations of virus. Importantly, 13 countries have measles vaccination coverage of less than 95%, which has been regarded as the threshold for elimination. Ten countries all report measles immunization coverage equal to or above the Western Pacific Region average of 96% (Fig. 25), with another three countries equal to or above the global average (85%). Fig. 25. Children at 1 year of age who have received at least one dose of measlescontaining vaccine in a given year 100

WHO GHO

WHO JRF

Global average (2015)

WPR average (2015)

Wallis & Futuna (2015)

Vanuatu (2016)

Tuvalu (2016)

Tonga (2016) (2016)

Tokelau (2015) (2016)

Solomon Is. (2016) (2015)

RMI (2016)

Samoa (2016) (2015)

PNG (2016)

Pitcairn Is. (ND) (2016)

Palau (2016) (2015)

Niue (2015)

Nauru (2015)

New Caledonia (2015)

Kiribati (2016) (2016)

Guam (2015)

FSM (2016)

Fr. Polynesia (2015) (2011)

Fiji (2016) (2016)

CNMI (2011)

Cook Is. (2016) (2015)

Am. Samoa (2008)

Percentage (%)

Country

PART II.â&#x20AC;&#x192;PROGRESS REPORT

3.11 HPV vaccine coverage among adolescents Since their licensure in 2006, human papillomavirus (HPV) vaccines have been progressively introduced in many countries, including 11 PICs, mainly targeting young adolescent girls aged 10–14 years. HPV vaccination coverage of 70% in girls has been regarded as the threshold for optimum cost-effectiveness.12 Five PICs reported HPV vaccine coverage rates as shown in Table 12. Table 12. HPV vaccine coverage among adolescents Country

HPV vaccination coverage

Year

79% 56% 78% > 90% 42%

2016 2016 2011–2012 2016 2016

Cook Islands Fiji Kiribati Palau New Caledonia

3.12 HIV prevalence among pregnant women As shown in Fig. 26, the region continues to have low rates of HIV among pregnant women, with 14 countries and areas reporting zero prevalence among this group. Papua New Guinea reported the highest prevalence at 0.4%, followed by Fiji at 0.1%. Fig. 26. Pregnant women aged 15–24 years who are tested for HIV during an antenatal care (ANC) visit and have positive test results 1

Percentage (%)

0.8

0.6

0.4

0.2

UNAIDS

Wallis & Futuna (2016)

Vanuatu (2014)

Tuvalu (2014)

Tonga (2014) (2016)*

Tokelau (2004) (2016)*

Solomon Is. (2008)

Samoa (2015)

RMI (2015)

PNG (2013)

Pitcairn Is. (N/A)

Palau (2014)

Niue (N/A)

New Caledonia (N/A)

Nauru (2014)

Kiribati (2014)

Guam (N/A)

FSM (2014)

Fr. Polynesia (2016)

Fiji (2014)

Cook Is. (2014)

CNMI (N/A)

Am. Samoa (N/A)

Country data*

Canfell K, Chesson H, Kulasingam SL, Berkhof J, Diaz M, Kim JJ. Modelling preventative strategies against human papillomavirus-related disease in developed countries. Vaccine. 2012; 30: F157–F167 MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

3.13 Adolescent birth rate As demonstrated in Fig. 27, the Marshall Islands, Nauru and Vanuatu all have adolescent birth rates that are at least one-and-a-half times higher than the global average. There is considerable variation among countries, ranging from a high of 105 per 1000 women aged 15–19 in Nauru, to the low of 14 in Niue for women of the same age. Fig. 27. Births to women aged 15–19 years

100 80 60 40 20

WHO WHS

SPC NMDI

Global average (2015)

WPR average (2015)

Wallis & Futuna (N/A)

Vanuatu (2013) (2011-13)*

Tuvalu (2007)

Tonga (2011) (2016)*

Tokelau (2006-2011)

Samoa (2007)

Solomon Is. (2008) (2015)*

RMI (2011)

PNG (2004)

Pitcairn Is. (N/A)

Niue (2009)

WPRO HIIP

Palau (2010)

New Caledonia (2012)

Nauru (2011)

Kiribati (2010) (2016)*

Guam (2013)

FSM (2010)

Fr. Polynesia (2013) (2010)*

Fiji (2008) (2016)*

Cook Is. (2011) (2015)*

CNMI (2013) (2015)*

Am. Samoa (2012)

Rate (per 1000 women aged 15–19)

120

Country data*

PART II. PROGRESS REPORT

3.14 Low birthweight among newborns In 2012, the World Health Assembly endorsed the Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition, which specified a set of six global nutrition targets. One of those targets aims for a 30% reduction in low birthweight by 2025. Both Kiribati and Nauru report high levels of low birthweight among newborns, at over double the global average (Fig. 28). PICs, including American Samoa, Cook Islands, Guam, Niue, the Commonwealth of the Northern Mariana Islands, Tokelau, Tonga, and Wallis and Futuna, all reported rates below the Western Pacific Region average of 6%. Fig. 28. Percentage of live born infants that weigh less than 2500 grams 30

Percentage (%)

25 20 15 10 5

WHO GHO

WPRO HIIP

Country data*

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Global average (2007-13)

WPR average (2007-13)

Wallis & Futuna (1990)

Vanuatu (2013)

Tuvalu (2002-2007)

Tonga (2009) (2016)*

Tokelau (2011) (2016)*

Solomon Is. (2002-07) (2015)*

RMI (2011)

SPC NMDI

Samoa (2004-09) (2014)*

PNG (2010)

Pitcairn Is. (N/A)

Palau (2010) (2014)*

Niue (2005)

New Caledonia (2012) (2015)*

Nauru (2002-07)

Kiribati (2010) (2016)*

Guam (2012)

FSM (2009)

Fr. Polynesia (2010)

Fiji (2007) (2016)*

Cook Is. (2009) (2015)*

Am. Samoa (2015)

CNMI (2014) (2015)*

3.15 Neonatal mortality rate Kiribati, Nauru and Papua New Guinea have neonatal mortality rates higher than the global average of 19 deaths per 1000 live births. An additional 10 countries all have rates higher than the Western Pacific Region average (Fig. 29). Given the small populations and small numbers of absolute deaths, single-year data should be interpreted with caution, as they are likely to be influenced by stochastic (random) variation. Fig. 29. Probability that a child will die during the first 28 completed days of life 30

20 15 10 5

WHO GHO

WPRO HIIP

SPC NMDI

Global average (2007-13)

WPR average (2007-13)

Vanuatu (2013)

Wallis & Futuna (1990)

Tuvalu (2002-2007)

Tonga (2009) (2016)*

Tokelau (2011) (2016)*

Solomon Is. (2002-07) (2015)*

Samoa (2004-09) (2014)*

RMI (2011)

PNG (2010)

Pitcairn Is. (N/A)

Palau (2010) (2014)*

Niue (2005)

New Caledonia (2012) (2015)*

Nauru (2002-07)

Kiribati (2010) (2016)*

FSM (2009)

Guam (2012)

Fr. Polynesia (2010)

Fiji (2007) (2016)*

Cook Is. (2009) (2015)*

CNMI (2014) (2015)*

Am. Samoa (2015)

Percentage (%)

Country data*

PART II.â&#x20AC;&#x192;PROGRESS REPORT

3.16 Children who are stunted Nauru, Papua New Guinea, Solomon Islands and Vanuatu and all have rates higher than the global average for stunting among children (Fig. 30). In comparison, Cook Islands, Niue, Palau and Samoa fall below the Western Pacific Region average of 7%. Fig. 30. Stunting (height-for-age less than 2 standard deviations of the WHO Child Growth Standards mean) among children aged 0â&#x20AC;&#x201C;5 years 60

Percentage (%)

WPRO HIIP

Country data*

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Global average (2005-16)

WPR average (2005-16)

Wallis & Futuna (N/A)

Vanuatu (2013)

Tuvalu (2007)

Tonga (2012)

Tokelau (N/A)

Solomon Is. (2006-07) (2015)*

Samoa (1999)

RMI (2007)

PNG (2009-11)

Pitcairn Is. (N/A)

Palau (2010)

Niue (2005)

Nauru (2004)

WHO WHS

New Caledonia (2011)

Kiribati (2009)

Guam (N/A)

FSM (2005)

Fr. Polynesia (N/A)

Fiji (2004)

Cook Is. (2016)

CNMI (N/A)

Am. Samoa (N/A)

3.17 Under-5 mortality rate As part of the SDGs, the United Nations has set a target of reducing under-5 mortality to at least as low as 25 per 1000 live births by 2030. As shown in Fig. 31, while there is considerable variation in the region, overall, rates remain high, with 13 countries reporting rates higher than the Western Pacific Region average. Fig. 31. Probability of a child born in a specific year or period dying before reaching the age of 5 years 60

Rate (per 1000 live births)

50 40 30 20 10

WHO WHS

WPRO HIIP

WPR average (2015)

Global average (2015)

Wallis & Futuna (N/A)

Vanuatu (2015) (2008-13)

Tuvalu (2015)

Tonga (2015) (2016)*

Tokelau (2011) (2016)*

Solomon Is. (2015)

Samoa (2015)

RMI (2015)

PNG (2015)

Pitcairn Is. (2016)

Palau (2015) (2016)*

Niue (2015)

New Caledonia (2012) (2015)*

Nauru (2015)

Kiribati (2015) (2016)*

Guam (2012)

FSM (2015)

Fr. Polynesia (2013) (2013)*

Fiji (2015) (2016)*

Cook Is. (2015) (2009-15)*

CNMI (2012) (2015)*

Am. Samoa (2012)

Country data*

3.18 Child and adolescent suicide rate Six PICs were able to provide data on this indicator (expressed as the number of deaths per 100Â 000 population for children and adolescents aged less than 18 years) (Table 13). Table 13. Child and adolescent suicide rate Country/Area American Samoa Northern Mariana Islands, Commonwealth of the Cook Islands Fiji French Polynesia Niue

Adolescent suicide rate/100 000

Year

0.0

2016

0.0

2015

0.0 1.8 3.4 0.0

2015 2016 2013 2016

PART II.â&#x20AC;&#x192;PROGRESS REPORT

Ecological balance is promoted

4.1

Population using clean fuels for cooking, heating and lighting

The use of solid fuels and kerosene in households is associated with increased mortality from pneumonia and other acute lower-respiratory diseases among children, as well as increased mortality from chronic obstructive pulmonary disease, cerebrovascular and ischaemic heart diseases, and lung cancer among adults.13 As shown in Fig. 32, six countries are above the Western Pacific Region average, with 63â&#x20AC;&#x201C;96% of the population using clean fuels. There is considerable variation among countries. Fig. 32. Population using clean fuels and technologies for cooking, heating and lighting 100

Percentage (%)

WHO WHS

Global average (2014)

WPR average (2014)

Wallis & Futuna (N/A)

Vanuatu (2014)

Tonga (2014)

Tuvalu (2014)

Tokelau (2016)

Solomon Is. (2014) (2015)*

Samoa (2014)

RMI (2014)

PNG (2014)

Pitcairn Is. (N/A)

Palau (2014)

Niue (2014)

New Caledonia (2015)

Nauru (2014)

Kiribati (2014)

FSM (2014)

Guam (N/A)

Fr. Polynesia (N/A)

Fiji (2014)

Cook Is. (2014)

CNMI (N/A)

Am. Samoa (N/A)

Country data*

4.2 Resilience to climate change and natural disasters No PICs were able to provide data on this indicator.

Household air pollution and health. Fact sheet No. 292, World Health Organization. Updated February 2016 MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

4.3 Population using improved drinking-water sources As shown in Fig. 33, in the majority of countries more than 80% of the population has access to improved drinking-water sources (the indicator for safely managed water supplies was not yet available14), with only Kiribati, the Federated States of Micronesia, Papua New Guinea and Solomon Islands falling below the Western Pacific Region average and global average. Fig. 33. Population using an improved drinking-water source 100

Percentage (%)

WPRO HIIP

Global average (2012)

WPR average (2012)

Wallis & Futuna (2008)

Vanuatu (2015) (2015)*

Tuvalu (2015)

Tonga (2015) (2016)*

Tokelau (2015)

Samoa (2015) (2015)*

Solomon Is. (2015) (2015)*

RMI (2015)

PNG (2015)

Pitcairn Is. (2016)

Palau (2010)

Niue (2015)

Nauru (2015)

WHO WHS

New Caledonia (2015) (2014)*

Kiribati (2015)

Guam (2015)

FSM (2015)

Fr. Polynesia (2015) (2016)*

Fiji (2015)

CNMI (2015)

Cook Is. (2015)

Am. Samoa (2015)

Country data*

“Safely managed water services” refers to the use of an improved drinking-water source, which is located on premises, available when needed, and free of faecal and priority chemical contamination. The indicator is a step up from the previous Millennium Development Goal indicator (improved water sources) defined as “one that, by nature of its construction or through active intervention, is protected from outside contamination, in particular from contamination with faecal matter”. It is anticipated that by August 2017, PICs will be able to report on their baseline for safely managed water services. PART II. PROGRESS REPORT

4.4 Population using improved sanitation facilities Only approximately two thirds of the population in the region have access to improved sanitation facilities (the indicator for safely managed sanitation services is not yet available15), with people living in Kiribati, Papua New Guinea and Solomon Islands experiencing the lowest sanitation coverage levels in the region (Fig. 34). Fig. 34. Population using an improved sanitation facility 100

Percentage (%)

WHO WHS

WPRO HIIP

Global average (2012)

WPR average (2012)

Wallis & Futuna (2008)

Vanuatu (2015)

Tuvalu (ND) (2012)

Tonga (2015) (2016)

Tokelau (2015)

Solomon Is. (2015) (2015)

Samoa (2015) (2015)

RMI (2015)

PNG (2015)

Palau (2015)

Pitcairn Is. (ND)

Niue (2015)

New Caledonia (2015) (2014)

Nauru (2015)

Kiribati (2015)

FSM (2015)

Guam (2015)

Fr. Polynesia (2015) (2016)

Fiji (2015)

Cook Is. (2015)

CNMI (2015)

Am. Samoa (2012)

Country

4.5 Number of vector-borne disease outbreaks Nine PICs provided data on this indicator for 2016 (absolute number of vector-borne disease outbreaks) (Table 14). Table 14. Number of vector-borne disease outbreaks Country Cook Islands Micronesia, Federated States of Fiji Niue Solomon Islands Vanuatu French Polynesia New Caledonia Tokelau 15

Number of vector-borne disease outbreaks 0 1 (dengue) 2 1 1 3 0 1 0

“Safely managed sanitation services” refers to the use of an improved sanitation facility which is not shared with other households, and where excreta is safely disposed of in situ or excreta is transported and treated offsite. The indicator is a step up from the previous Millennium Development Goal indicator (improved sanitation services) defined as “one that hygienically separates human excreta from human contact”. It is anticipated that by August 2017, PICs will be able to report on their baseline for safely managed sanitation facilities. MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

ANNEXES

Annex 1. Summary of key milestones of developing the framework March

2015

April

July August September October February

2016

March April May July September February

March

2017

April May June

July August

• The first 20 years of the journey towards the vision of Healthy Islands in the Pacific is published. • Four Working Groups are established in preparation for the PHMM and background papers are released: (1) Strengthening leadership, governance and accountability; (2) Nurturing children in body and mind; (3) Reducing avoidable disease burden and premature deaths; and (4) Promoting ecological balance for health. • 11th Pacific Health Ministers Meeting held on Yanuca Island, Fiji. • Recommendations: Monitor progress and achievements towards the Healthy Islands vision. This requires a reporting system with operational targets and indicators based on existing indicators and frameworks, developed at the country level and supported by robust country health information systems. • Meeting of the PHMM Secretariat (WHO, SPC and Fiji Ministry of Health) to discuss timeline and principles for development of monitoring framework. • Meeting Report: 11th Pacific Health Ministers Meeting Report is published. • Proposed indicators drafted by core working group members (technical staff from WHO and SPC) and distributed for comments. • Version 1.0 of the Healthy Islands Monitoring Framework developed. • Update on Monitoring Framework presented at the Sixty-sixth session of the WHO Regional Committee for the Western Pacific in Guam. • Healthy Islands Monitoring Framework side meeting held for health information managers attending the Pacific Civil Registration and Vital Statistics Regional Meeting in Noumea, New Caledonia. • Version 2.0 of the Framework developed. • Version 2.0 sent to country health information managers and senior health information officers, and regional partners for comments. • Version 3.0 of the Framework developed. • Version 3.0 discussed, refined and finalized at the Heads of Health Meeting. • Version 4.0 of the Framework developed. • Version 4.0 discussed, refined and updated by health information managers and senior health information officers at the Pacific Health Information Network’s regional meeting. • Version 5.0 of the Framework developed. • Draft data collection forms developed. • Data collection forms refined. • Pre-population of country data. • Versions 5.1–5.3 of the Framework developed, based on data availability and standard indicator definitions used across the region. • Version 5.3 of the Framework sent to Heads of Health. • Data collection forms (Version 5.3) sent to country health information managers and focal points. • Heads of Health meeting (25–28 April) to discuss First Draft Report on the Healthy Islands Monitoring Framework. • Version 6.0 of the Framework developed. • Draft data collection forms developed. • Data collection forms refined. • Versions 6.1–6.6 of the Framework developed, based on data availability and standard indicator definitions used across the region. • Pre-population of country data. • Data collection forms (V6.4) sent to country health information managers and focal points. • Metadata dictionary drafted. • Second Draft Report on the Healthy Islands Monitoring Framework developed. • Pacific Health Ministers Meeting to discuss Final Draft Report on the Healthy Islands Monitoring Framework. PART II. PROGRESS REPORT 45

Annex 2. Healthy Islands Monitoring Framework Table 1. Healthy Islands indicators

No.

Indicator name Definitiona

Links to regional and global monitoring frameworks

Data sourcesb

Data availabilityc

1. Strong leadership, governance and accountability CORE indicators 1.1 Health worker density

Skilled health worker* density per 10 000 population * Defined as physicians, nurses and midwives

1.2

Health expenditure per capita

Per capita total expenditure on health* (US$) * Includes government and other sources of funds

1.3

1.4

Evidence of annual health review, plan and budget

International Health Regulations (IHR 2005) core capacity score

Evidence of a formally communicated, annual health plan with budget, with formal review processes in place Average of 13 IHR (2005) core capacity scores

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.c.1); Resolution WHA67.24; Global Strategy on Human Resources for Health: Workforce 2030

Primary source: World Health Statistics SDG Dashboard; WHO Regional Office for the Western Pacific Health Information and Intelligence Portal (HIIP) Country database: Administrative Very high information systems (health worker registry); national health workforce database

Published reports: WHO World Health Statistics 2017: Monitoring Health for the SDGs Pacific Community Primary source: SPC National Minimum NMDI, HIIP Development Country database: Indicators (SPC NMDI) (PH-HS-1.3) Administrative information systems; Very high National Health Accounts

–

Published reports: OECD Health at a Glance Primary source: Report from key informant Low

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.d.1); IHR (2005)

Primary source: World Health Statistics SDG Dashboard Country database: Annual IHR monitoring questionnaire Published reports: WHO World Health Statistics 2017: Monitoring Health for the SDGs

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

High

No.

Indicator name Definitiona

1.5

Death registration coverage

Percentage of deaths that are registered (with age and sex) in a given time period (one year)

Links to regional and global monitoring frameworks

Data sourcesb

Regional Action Framework on Civil Registration and Vital Statistics (CRVS) (Goal 1)

Primary source: United Nations Statistics Division (UNSD) coverage of civil registration system

2. Avoidable diseases and premature deaths are reduced CORE indicators 2.5 Tobacco excise Evidence of 2011 United taxes legislation Nations Political to reduce Declaration on affordability of Non-communicable tobacco products Diseases; Western by increasing Pacific Regional tobacco excise Action Plan for taxes the Prevention and Control of Noncommunicable Diseases (2014– 2020); WHO Framework Convention on Tobacco Control (WHO FCFC) (Tobacco Free Pacific) 2.6 Excise tax Evidence of an 2011 United Nations on alcoholic inflation-adjusted Political Declaration drinks alcohol excise on NCDs; Western taxation system Pacific Regional on beer, wine and Action Plan for spirits the Prevention and Control of Noncommunicable Diseases (2014– 2020); Global Strategy to Reduce the Harmful Use of Alcohol 2.7 Excise tax on Excise duties 2011 United Nations the retail price levied on imported Political Declaration of sugarand/or locally on NCDs; Western sweetened produced SSBs Pacific Regional beverages of at least 20% Action Plan for (SSBs) of retail price; or the Prevention fiscal import tax and Control of imposed on raw Noncommunicable materials for local Diseases (2014– producers to an 2020) equivalent level

Country database: CRVS systems; population-based (preferably nationally representative) survey; census

Data availabilityc

Very high

Primary source: Pacific MANA Dashboard/ report from key informant Regional or global database: WHO Global Health Observatory (GHO) data repository Published reports: WHO Report on the Global Tobacco Epidemic, 2015

Primary source: Pacific MANA Dashboard/ Report from key informant Regional or global database: WHO GHO data repository Published reports: WHO Global Status Report on Alcohol and Health 2014

High

Indicator updated since last reporting round

Primary source: Pacific MANA Dashboard/ Report from key informant Low

PART II. PROGRESS REPORT

No.

Indicator name Definitiona

2.8

Access to essential NCD drugs

2.10

2.13

2.14

Links to regional and global monitoring frameworks

Essential NCD drugs available and accessible in public health sector primarycare facilities

2011 United Nations Political Declaration on NCDs; Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014– 2020) Service Proportion of 2011 United Nations coverage for eligible people Political Declaration people with receiving drug on NCDs; Global increased risk therapy and Action Plan for for CVD counselling to the Prevention prevent heart and Control of attacks and Noncommunicable strokes Diseases 2013– 2020; Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014– 2020) HIV prevalence Estimated number Declaration of among the of people living Commitment general with HIV, whether on HIV/AIDS population or not they (United Nations have developed General Assembly symptoms of AIDS Special Session)

Tuberculosis Estimated number (TB) incidence of new and relapse TB cases arising in a given year, expressed as a rate per 100 000 population

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.3.2); SPC NMDI (PH-CD-1.2); Global Plan to End TB 2016–2020

Data sourcesb Primary source: Pacific MANA Dashboard/ Report from key informant Regional or global database: WHO GHO data repository

Indicator updated since last reporting round

Primary source: Population-based (preferably nationally representative) riskfactor survey; routine facility information systems Published reports: WHO Very low Global Status Report on NCDs 2014

Primary source: UNAIDS country reports, HIIP Country database: Active facility-based surveillance system with key population estimates; key population health surveys; national population health surveys

Very high

Regional or global database: WHO GHO data repository Primary source: WHO GHO data repository, HIIP Country database: High-quality TB surveillance system (linked to routine facility information system); Very high population-based health surveys with TB diagnostic testing Regional or global database: SPC NMDI Published reports: WHO Global Tuberculosis Report 2016

Data availabilityc

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

No.

Indicator name Definitiona

2.15

Lowerextremity amputation among patients with diabetes

Links to regional and global monitoring frameworks

2011 United Nations Political Declaration on NCDs; Western Pacific Regional Action Plan for *Focusing on lower the Prevention limb amputations, and Control of Noncommunicable excluding digit only and excluding Diseases (2014– 2020) traumatic amputations not associated with diabetes 2.16a Maternal Number of Global Strategy deaths maternal deaths for Women’s, related to Children’s and childbearing in a Adolescents’ Health given time period (2016–2030) (usually one year) 2.16b Maternal Number of 2030 Agenda mortality ratio maternal deaths for Sustainable (MMR) related to Development and childbearing, the SDGs (SDG expressed per indicator 3.1.1); SPC 100 000 live births NMDI (PH-MH-1.2); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

2.17

Mortality rate from road traffic injuries

Proportion of diabetes-related amputations*

Estimated road traffic fatal injury deaths per 100 000 population

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.6.1); Brasilia Declaration on Road Safety, Decade of Action for Road Safety 2011–2020

Data sourcesb Country database: Routine facility information systems; population-based (preferably nationally representative) survey; diabetes registry

Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Civil registration with high coverage and medical certification of cause of death and regular assessment of misreporting and underreporting; population-based (preferably nationally representative) survey; census; special studies

Data availabilityc

Indicator updated since last reporting round

Very high

Regional or global database: SPC NMDI Published reports: WHO World Health Statistics 2017 Primary source: World Health Statistics SDG Dashboard Country database: Civil registration with full coverage; population surveys; police reports; High population-based health surveys with verbal autopsy Published reports: WHO Global Status Report on Road Safety 2015

PART II. PROGRESS REPORT 49

No.

Indicator name Definitiona

2.18a Deaths due to Absolute number suicide among of deaths due to adults suicide among the adult (aged 18+ years) population in a specified time period (usually one year) 2.18b Adult suicide Suicide rate mortality rate per 100 000 population in a specified period (age standardized)

2.19

Risk of premature death from target NCDs

2.20 Life expectancy at birth: both sexes

Percent of 30-year-old people who would die before their 70th birthday from any of CVD, cancer, diabetes or chronic respiratory disease, assuming that she or he would experience current mortality rates at every age and she or he would not die from any other cause of death (e.g. injuries or HIV/AIDS)

Average number of years that a newborn could expect to live if she or he were to pass through life exposed to the sex- and agespecific death rates prevailing at the time of his/her birth, for a specific year, in a given country, territory or geographical area COMPLEMENTARY indicators 2.1 Smoking Age-standardized prevalence prevalence of tobacco smoking among persons aged 15+ years

Links to regional and global monitoring frameworks WHO Mental Health Action Plan 2013–2020

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.6.1); WHO Mental Health Action Plan 2013–2020 2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.4.1); 2011 United Nations Political Declaration on NCDs; Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013– 2020; Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014– 2020) SPC NMDI (PHVS-1.4)

Data sourcesb

Primary source: WHO Pacific Islands Mental Health Network (PIMHnet) questionnaire, Very high HIIP Country database: Civil registration with high coverage; special studies; administrative reporting systems (police reports, hospital records)

High

Published reports: WHO Mental Health Atlas Primary source: World Health Statistics SDG Dashboard Country database: Civil registration with high coverage; populationbased health surveys with verbal autopsy Published reports: WHO World Health Statistics High 2017: Monitoring Health for the SDGs

Primary source: SPC NMDI, HIIP Country database: Civil registration with high coverage; household surveys and population census; sample registration system

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.a.1); WHO Framework Convention on Tobacco Control (WHO FCFC) (Tobacco Free Pacific)

Data availabilityc

Very high

Primary source: World Health Statistics SDG Dashboard Country database: STEPS survey; Very high population-based health survey Published reports: WHO Report on the Global Tobacco Epidemic, 2015

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

No.

Indicator name Definitiona

2.2

Heavy episodic Adults (aged 15+ drinking or 18+ years)* who report drinking six (60 g) or more standard drinks in a single drinking occasion

2.3

2.4

2.9

Insufficiently physically active adults

Intimate partner violence

Links to regional and global monitoring frameworks

2011 United Nations Political Declaration on NCDs; Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014– 2020); WHO Global *Age range will depend on survey Strategy to Reduce the Harmful Use of instrument used Alcohol Age-standardized 2011 United Nations prevalence of Political Declaration insufficiently on NCDs; Global physically active Action Plan for persons aged 18+ the Prevention years and Control of Noncommunicable Diseases 2013– 2020; Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014– 2020) Percentage SPC NMDI of currently (PH-GEN-1.12); partnered girls 2030 Agenda and women aged for Sustainable 15–49 years who Development and have experienced the SDGs (SDG physical and/or indicator 5.2.1); sexual violence Declaration on by their current the Elimination of intimate partner in Violence against the last 12 months Women; United Nations Resolution 58/147 on the Elimination of domestic violence against women

Cervical cancer Coverage of the screening national cervical cancer screening program

Data sourcesb

Data availabilityc

Primary source: WHO GHO Global Information System on Alcohol and Health (GISAH) Country database: STEPS survey; Very high population-based health survey Published reports: WHO Global Status Report on Alcohol and Health 2014 Primary source: WHO GHO data repository Country database: STEPS survey; population-based health survey Published reports: WHO Very high Global Status Report on NCDs 2014

Primary source: SPC NMDI Country database: Population-based (preferably nationally representative) survey Regional or global database: World Health Statistics SDG Dashboard

High

Published reports: WHO Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-partner Sexual Violence 2011 United Nations Primary source: WHO Political Declaration GHO data repository on NCDs; Global Country database: Action Plan for Population-based the Prevention (preferably nationally and Control of Noncommunicable representative) surveys; facility-based data; Diseases 2013– High cancer registry 2020; Western Pacific Regional Published reports: WHO Action Plan for Global Status Report on the Prevention NCDs 2014 and Control of Noncommunicable Diseases (2014– 2020) PART II. PROGRESS REPORT

No.

Indicator name Definitiona

2.11

Service coverage for people with severe mental health disorders

2.12

Contraceptive prevalence

Percentage of peoplewith a severe mental health disorder who are using services

Percentage of women aged 15–49 years who are sexually active, who are currently using, or whose sexual partner is using, at least one method of contraception, regardless of method used

Links to regional and global monitoring frameworks WHO Mental Health Action Plan 2013–2020

SPC NMDI (PH-MH-1.4); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

3. Children are nurtured in body and mind CORE indicators 3.5 Birth Estimated level of 2030 Agenda registration coverage of birth for Sustainable coverage registration Development and the SDGs (SDG indicator 16.9.1); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030); Regional Action Framework on Civil Registration and Vital Statistics (CRVS) (Goal 1) 3.6

Evidence of healthy food policies in schools

Evidence of nationally endorsed policies relating to the provision and promotion of healthy food choices in schools

2011 United Nations Political Declaration on NCDs; Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014– 2020)

Data sourcesb Primary source: Population-based (preferably nationally representative) survey; facility information systems.

Data availabilityc

Very low

Published reports: WHO Mental Health Atlas Primary source: SPCI NMDI Country database: Population-based (preferably nationally representative) survey; routine facility information systems; health facility assessments and surveys

Very high

Primary source: WHO GHO data repository, UNSD coverage of CRVS systems Country database: CRVS system; population-based (preferably nationally representative) survey; census

Very high

Published reports: UNICEF State of the World’s Children; WHO World Health Statistics 2017 Primary source: Pacific MANA Dashboard/ Report from key informant Published reports: WHO School Policy Framework

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Very low

No.

Indicator name Definitiona

3.8

Births attended by skilled health personnel

3.9

3.10

3.11

3.12

Immunization coverage for DTP3

Immunization coverage for measles

Human papillomavirus (HPV) vaccine coverage among adolescents HIV prevalence among pregnant women

Percentage of live births attended by skilled health personnel during a specified time period (usually one year)

One-year-old children who have received three doses of the combined diphtheria, tetanus toxoid and pertussis vaccine in a given year

Percentage of children at 1 year of age who have received at least one dose of measles-containing vaccine in a given year

Female adolescents (aged 13–15 years) who have had three doses of HPV vaccine Pregnant women aged 15–24 years who are tested for HIV during an antenatal care (ANC) visit and have positive test results

Links to regional and global monitoring frameworks 2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.1.2); SPC NMDI (PH-MH-1.3); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

SPC NMDI (PH-CH-1.2); Global Vaccine Action Plan 2011–2020

Data sourcesb Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Routine facility information systems; population-based (preferably nationally representative) survey

Published reports: UNICEF State of the World’s Children; WHO World Health Statistics 2017 Primary source: WHO/ UNICEF Joint Reporting Form (JRF) Country database: Administrative data; immunization surveys

SPC NMDI (PH-SXH-1.2); Declaration of Commitment on HIV/AIDS, United Nations General Assembly Special Session (UNGASS)

Very high

Global Vaccine Action Plan 2011–2020

Very high

Regional or global database: SPC NMDI

SPC NMDI (PH-CH-1.1); Global Vaccine Action Plan 2011–2020

Data availabilityc

Published reports: UNICEF State of the World’s Children; WHO World Health Statistics 2017 Primary source: Administrative data; immunization surveys

Very high

Very low

Primary source: UNAIDS Country reports Country database: Facility information systems; surveillance system

High

Regional or global database: SPC NMDI; WHO GHO data repository

PART II. PROGRESS REPORT

No.

Indicator name Definitiona

3.13

Adolescent birth rate

3.14

3.15

3.17

3.18

Low birthweight among newborns

Neonatal mortality rate

Under-5 mortality rate

Child and adolescent suicide mortality rate

Annual number of births to women aged 15–19 years per 1000 women in that age group

Percentage of live born infants that weigh less than 2500 grams in a given time period (usually one year)

Links to regional and global monitoring frameworks 2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.7.2); SPC NMDI (PH-MH-1.5); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

SPC NMDI (PH-CH-1.4); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

Probability that a child born in a specific year or period will die during the first 28 completed days of life if subject to age-specific mortality rates of that period, expressed per 1000 live births

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.2.2); SPC NMDI (PH-VS-1.3); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

Probability of a child born in a specific year or period dying before reaching the age of 5 years, if subject to agespecific mortality rates of that period, expressed per 1000 live births

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 3.2.1); SPC NMDI (PH-VS-1.1); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

Suicide rate per 100 000 population in a specified period time period (usually one year) for children and adolescents (aged less than 18 years)

Data sourcesb

Data availabilityc

Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Facility information systems; household surveys

Very high

Regional or global database: SPC NMDI Published reports: WHO World Health Statistics 2017 Primary source: SPC NMDIs, HIIP Country database: Administrative information systems; Very high population-based health surveys Published reports: UNICEF State of the World’s Children Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Administrative information system; population-based health Very high surveys Regional or global database: SPC NMDI Published reports: UNICEF State of the World’s Children Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Administrative information system; population-based health Very high surveys Regional or global database: SPC NMDI

Published reports: UNICEF State of the World’s Children Global Strategy Primary source: Civil for Women’s, registration with full Children’s and coverage; special Adolescents’ Health studies; administrative (2016–2030) reporting systems (police reports, hospital records)

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Low

No.

Indicator name Definitiona

COMPLEMENTARY indicators 3.1 Exclusive Infants aged 0–5 breastfeeding months who are rate fed exclusively with breast milk

3.2

3.3

3.4

3.7

Children who are obese

Inadequate physical activity in adolescents

Obesity in adolescents

Antenatal care (ANC) coverage

Percentage of obese – body mass index (BMI) by age more than +2 standard deviations from the mean of the WHO Child Growth Standards) among children aged 0–5 years

Adolescents (aged 13–15 years) participating in less than 60 minutes of moderate to vigorous intensity physical activity daily

Percentage of obese (BMI by age more than +2 standard deviations from the mean of the WHO Child Growth Standards) among adolescents aged 13–15 years Women aged 15–49 years with a live birth who received ANC, four times or more

Links to regional and global monitoring frameworks Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

Data sourcesb

Data availabilityc

Primary source: WHO GHO data repository, HIIP Country database: Routine facility information systems; household surveys; specific populationbased surveys

Published reports: UNICEF State of the World’s Children SPC NMDI (PHPrimary source: SPC CH-1.6); 2011 United NMDI Nations Political Country database: Declaration on Routine growth NCDs; Western monitoring clinical Pacific Regional records; populationAction Plan for based surveys; national the Prevention surveillance systems and Control of Noncommunicable Published reports: Diseases UNICEF State of the (2014–2020); World’s Children Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) 2011 United Nations Primary source: WHO Political Declaration Global School-based on NCDs; Western Health Survey (GSHS) Pacific Regional Country database: Action Plan for School-based or the Prevention population-based and Control of Noncommunicable (preferably nationally representative) survey Diseases (2014– 2020) Published reports: WHO School Policy Framework 2011 United Nations Primary source: WHO Political Declaration Global School-based on NCDs; Western Health Survey (GSHS) Pacific Regional Country database: Action Plan for School-based or the Prevention population-based and Control of Noncommunicable (preferably nationally representative) survey Diseases (2014– 2020) Published reports: WHO School Policy Framework SPC NMDI Primary source: SPC (PH-MH-1.6); NMDI Global Strategy Country database: for Women’s, Household surveys; Children’s and Adolescents’ Health routine facility information systems (2016–2030) Published reports: UNICEF State of the World’s Children

Very high

Low

High

Very high

PART II. PROGRESS REPORT

No.

Indicator name Definitiona

3.16

Children who are stunted

Percentage of stunting (heightfor-age less than −2 standard deviations of the WHO Child Growth Standards median) among children aged 0–5 years

Links to regional and global monitoring frameworks 2030 Agenda for Sustainable Development and the SDGs (SDG indicator 2.2.1); SPC NMDI (PH-CH-1.5); Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030)

Data sourcesb

Data availabilityc

Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Routine growth monitoring clinical records; populationbased surveys; national surveillance systems

High

Regional or global database: SPC NMDI Published reports: UNICEF State of the World’s Children; WHO World Health Statistics 2017: Monitoring Health for the SDGs

4. Ecological balance is promoted CORE indicators 4.2 Resilience to Total dollar climate change value linked with and natural new projects disasters implemented in the past year that have established integrated lowcarbon, climateresilient, disaster risk reduction development strategies 4.3 Population Population using using improved drinkingimproved water sources in drinking-water a specified time sources period (usually one year)

–

Primary source: Report from key informant Indicator updated since last reporting round

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 6.1.1); SPC NMDI (PH-ENV-1.2)

Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Administrative or regulatory frameworks; household surveys; population census Regional or global database: SPC NMDI Published reports: WHO World Health Statistics 2017: Monitoring Health for the SDGs

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

Very high

No.

Indicator name Definitiona

4.4

Population using improved sanitation facilities

Population using improved sanitation facilities in a specified time period (usually one year)

Links to regional and global monitoring frameworks 2030 Agenda for Sustainable Development and the SDGs (SDG indicator 6.2.1); SPC NMDI (PH-ENV-1.4)

Data sourcesb

Data availabilityc

Primary source: World Health Statistics SDG Dashboard, HIIP Country database: Administrative or regulatory frameworks; household surveys; population census Regional or global database: SPC NMDI

Very high

Published reports: WHO World Health Statistics 2017: Monitoring Health for the SDGs COMPLEMENTARY indicators 4.1 Population Percentage of using modern households/ fuels for population using cooking/ modern fuels heating/ and technologies lighting for cooking/ heating/lighting as defined by the recommendations set forth in the WHO guidelines for indoor air quality: household fuel combustion 4.5

b c

Number of vector-borne disease outbreaks

Number of mosquito-borne disease outbreaks in one year

2030 Agenda for Sustainable Development and the SDGs (SDG indicator 7.1.1)

Primary source: World Health Statistics SDG Dashboard Country database: Data from administrative or regulatory frameworks; household surveys; High population census Regional or global database: SPC NMDI

–

Published reports: WHO World Health Statistics 2017: Monitoring Health for the SDGs Primary source: Report from key informant; Pacific Public Health Very low Surveillance Network; country surveillance data

For indicators sourced from the Sustainable Development Goals (SDGs), Pacific Community National Minimum Development Indicators (SPC NMDI), World Health Organization Global Health Observatory (WHO GHO) or WHO Regional Office for the Western Pacific Health Information and Intelligence and Platform (HIIP), indicator definitions have been copied across directly from their respective meta-data dictionaries. Remaining indicator definitions have been adapted from the 2015 Global Reference List of 100 Core Health Indicators (WHO), where possible. Additional information on indicator definitions is contained in the Excel data collection form. The primary source refers to the database, report or other source used to prepopulate data in the Excel data entry forms (where applicable). Data availability is based on the number of countries and areas that were able to provide national data in the first round of data collection (April 2017), or for which regional or global data are available online. Very low: 0–24% of countries reporting data; low: 25–49%; high: 50–74%; very high: 75–100%.

PART II. PROGRESS REPORT

Table 2. Optional indicators related to the Healthy Islands Monitoring Framework HI no.

Health Islands (HI) indicator name

1. Strong O.1.1 O.1.2 O.1.3

leadership, governance and accountability National Health Account Out-of-pocket (OOP) payments for health Unemployment rate

O.1.4

Population living below the poverty line

2. Avoidable diseases and premature deaths are reduced O.2.1 Low fruit and vegetable consumption O.2.2 Evidence of NCD taskforce O.2.3 Status of reaching the milestones for neglected tropical diseases (NTDs) O.2.4 Use of assistive devices among people with disabilities O.2.5 Unmet needs for contraception O.2.6 Prevention of mother-to-child transmission of HIV O.2.7 Gonorrhoea incidence O.2.8 Malaria incidence O.2.9 HIV prevalence among high-risk populations O.2.10 Life expectancy at age 40 years: males O.2.11 Life expectancy at age 40 years: females O.2.12 Top 10 causes of death 3. Children are nurtured in body and mind O.3.1 Evidence of adoption of the Convention on the Rights of the Child O.3.2 Net enrolment ratio in primary school O.3.3 Secondary school completion rates O.3.4 Youth literacy rate O.3.5 Congenital syphilis O.3.6 Infant mortality rate 4. Ecological balance is promoted O.4.1 Urban population living in slums or informal settlements O.4.2 Population in urban areas exposed to outdoor air pollution O.4.3 Official climate financing from developed countries that is incremental to official development assistance (ODA) O.4.4 Share of coastal and marine areas that are protected O.4.5 Area of public and green space as a proportion of total city space O.4.6 Annual change in forest area and land under cultivation O.4.7 Urban solid waste regularly collected and well managed O.4.8 Losses from natural disasters, by climate and non-climaterelated events O.4.9 Typhoid fever incidence

Data sources – WHO GHO (3643) SPC NMDIs (PH-LF-1.2) SDG (1.2.1) SPC NMDI (PH-POV-1.1) – – SPC NMDI (PH-MH-1.8) WHO GHO (2936) – SPC NMDI (PH-VBD-1.2) – SPC NMDI (PH-VS-1.5.1) SPC NMDI (PH-VS-1.5.2) – – SPC NMDI (PH-PEDF-2.11) – SPC NMDI (PH-EDU-1.5) WHO GHO (4493) SPC NMDI (PH-VS-1.2) – – – SDG (14.5.1) – – SDG (11.6.1) SDG (11.5.2) –

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

PART II. PROGRESS REPORT

Inputs and processes

Strong leadership, governance and accountability • (1.1) Health worker density • (1.2) Health expenditure per capita • (1.3) Evidence of annual health review, plan and budget • (1.4) International Health Regulations (IHR 2005) core capacity score • (1.5) Death registration coverage Avoidable diseases and premature deaths are reduced • (2.5) Tobacco excise taxes • (2.6) Excise tax on alcoholic drinks • (2.7) Excise tax on sugarsweetened beverages (SSBs) Children are nurtured in body and mind • (3.5) Birth registration coverage • (3.6) Evidence of healthy food policies in schools Ecological balance is promoted (4.2) Resilience to climate change and natural disasters

Risk factors and behaviours

Avoidable diseases and premature deaths are reduced • (2.1) Smoking prevalence • (2.2) Heavy episodic drinking • (2.3) Insufficiently physically active adults • (2.4) Intimate partner violence Children are nurtured in body and mind • (3.1) Exclusive breastfeeding rate • (3.2) Children who are obese • (3.3) Inadequate physical activity in adolescents • (3.4) Obesity in adolescents Ecological balance is promoted • (4.1) Population using modern fuels for cooking/heating/lighting Avoidable diseases and premature deaths are reduced • (2.8) Access to essential NCD drugs • (2.9) Cervical cancer screening • (2.10) Service coverage for people with increased risk for CVD • (2.11) Service coverage for people with severe mental health disorders • (2.12) Contraceptive prevalence Children are nurtured in body and mind • (3.7) Antenatal care (ANC) coverage Ecological balance is promoted • (4.3) Population using improved drinking-water sources • (4.4) Population using improved sanitation facilities

Outputs

Annex 3. Healthy Islands indicators across the results chain

Avoidable diseases and premature deaths are reduced • (2.13) HIV prevalence among the general population • (2.14) Tuberculosis (TB) incidence • (2.15) Lower-extremity amputation among patients with diabetes Children are nurtured in body and mind • (3.8) Births attended by skilled health personnel • (3.9) Immunization coverage for DTP3 • (3.10) Immunization coverage for measles • (3.11) HPV vaccine coverage among adolescents • (3.12) HIV prevalence among pregnant women Ecological balance is promoted • (4.5) Number of vectorborne disease outbreaks

Outcomes

Avoidable diseases and premature deaths are reduced (2.16a & 2.16b) Maternal mortality (2.17) Mortality rate from road traffic injuries (2.18a & 2.18b) Adult suicide mortality rate (2.19) Risk of premature mortality from target noncommunicable diseases (NCDs) (2.20) Life expectancy at birth: both sexes Children are nurtured in body and mind (3.13) Adolescent birth rate (3.14) Low birth weight among newborns (3.15) Neonatal mortality rate (3.16) Children who are stunted (3.17) Under-5 mortality rate (3.18) Child and adolescent suicide rate

Impact

Annex 4. Health-related SDG Pacific Headline Indicators (as of March 2017) Goal no.

Goal name

No poverty

Zero hunger

SDG target 1.2 By 2030, reduce at least by one half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions 2.2 By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons

HI indicator

1.2.1 Proportion of population living below the national poverty line, by sex and age

O.1.4

2.2.1 Prevalence of stunting (height for age <-2 standard deviations from the median of the WHO Child Growth Standards) among children under 5 years of age 2.2.2 Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight) 3.1.1 Maternal mortality ratio

3.16

Good health 3.1 By 2030, reduce the global and well-being maternal mortality ratio to less than 70 per 100 000 live births 3.1.2 Proportion of births attended by skilled health personnel 3.2 By 2030, end preventable 3.2.1 Under-5 mortality rate deaths of newborns and children under 5 years of age, 3.2.2 Neonatal mortality rate with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births 3.3 By 2030, end the 3.3.2 Tuberculosis incidence epidemics of AIDS, per 100,000 population tuberculosis, malaria and 3.3.5 Number of people neglected tropical diseases requiring interventions against and combat hepatitis, neglected tropical diseases waterborne diseases and other communicable diseases 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol

SDG indicator

3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease 3.5.2 Harmful use of alcohol, defined according to the national context as alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017

3.2 (would require change to definition to weight-forheight from BMI by age) 2.16b 3.8 3.17 3.15

2.14 O.2.3 (would require change to indicator definition) 2.19

2.2 (would require change to indicator definition)

Goal no. 3

Goal name

SDG target

Good health 3.7 By 2030, ensure universal and well-being access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all

Quality education

Gender equality

3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate 3.c Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in leastdeveloped countries and small island developing states 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks 4.1 By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes

SDG indicator 3.7.1 Proportion of women of reproductive age (aged 15–49 years) who have their need for family planning satisfied with modern methods 3.7.2 Adolescent birth rate (aged 10–14 years; aged 15–19 years) per 1000 women in that age group 3.8.1 Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, noncommunicable diseases and service capacity and access, among the general and the most disadvantaged population) 3.a.1 Age-standardized prevalence of current tobacco use among people aged 15 years and older

HI indicator 2.12

3.13

O.2.10 and O.2.11 (would require change to indicator definition)

2.1

3.c.1 Health worker density and 1.1 distribution

3.d.1 International Health Regulations (IHR 2005) capacity and health emergency preparedness

4.1.1 Proportion of children and young people: (a) in grades 2/3; (b) at the end of primary; and (c) at the end of lower secondary achieving at least a minimum proficiency level in reading and mathematics, by sex 4.6 By 2030, ensure that 4.6.1 Proportion of population all youth and a substantial in a given age group achieving proportion of adults, both men at least a fixed level of and women, achieve literacy proficiency in functional and numeracy literacy and numeracy skills, by sex 5.2 Eliminate all forms of 5.2.1 Proportion of everviolence against all women and partnered women and girls girls in the public and private aged 15 years and older spheres, including trafficking subjected to physical, sexual and sexual and other types of or psychological violence by exploitation a current or former intimate partner in the previous 12 months, by form of violence and by age

1.4

O.3.2 and O3.3 (would require change to indicator definition) O.3.4 (would require change to indicator definition) 2.4

PART II. PROGRESS REPORT

Goal no. 6

Goal name

SDG target

Clean water 6.1 By 2030, achieve universal and sanitation and equitable access to safe and affordable drinking water for all 6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations Sustainable 11.5 By 2030, significantly cities and reduce the number of deaths communities and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic product (GDP) caused by disasters, including water-related disasters, with a focus on protecting the poor and people in vulnerable situations 11.6 By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management Life below 14.5 By 2020, conserve at least water 10% of coastal and marine areas, consistent with national and international law and based on the best available scientific information Peace, justice 16.9 By 2030, provide legal and strong identity for all, including birth institutions registration

SDG indicator

HI indicator

6.1.1 Proportion of population 4.3 using safely managed drinkingwater services 6.2.1 Proportion of population using safely managed sanitation services including a hand-washing facility with soap and water

4.4

11.5.2 Direct economic loss in O.4.8 relation to global GDP, damage to critical infrastructure and number of disruptions to basic services, attributed to disasters

11.6.1 Proportion of urban solid waste regularly collected and with adequate final discharge out of total urban solid waste generated, by cities

O.4.7

14.5.1 Coverage of protected areas in relation to marine areas

O.4.4

16.9.1 Proportion of children under 5 years of age whose births have been registered with a civil authority, by age

3.5

MONITORING PROGRESS TOWARDS THE VISION OF HEALTHY ISLANDS IN THE PACIFIC 2017