Achieving the health-related Millennium Development Goals in the Western Pacif ic Region
2010 1
4
5
6
7
“These Millennium Development Goals are a promise of world leaders. They’re a blueprint to help those most vulnerable and poorest people, to lift them out of poverty. This promise must be met.”
—UN Secretary-General Ban Ki-moon
8
The Millennium Development Goals zz
In 2000, 189 heads of state adopted the UN Millennium Declaration.
zz
Eight Millennium Development Goals (MDGs) were established to be met by 2015 by working together to reduce poverty and hunger, and tackle ill-health, lack of education, gender inequity, lack of access to clean water and environmental degradation.
1
Health MDGs scorecard for WHO regions World
Africa
Americas
Eastern Mediterranean
Europe
South-East Asia
Western Pacific
60
127
18
72
13
59
21
Measles immunization
81
73
93
83
94
75
93
Maternal mortality2
260
620
66
320
21
240
51
Skilled birth attendant
66
47
92
59
96
49
92
62
24
71
43
68
58
83
HIV/AIDS prevalence
0.8
4.9
0.5
0.2
0.5
0.3
0.1
Malaria mortality
17
104
0.5
7.5
–
2.1
0.3
TB treatment
86
79
82
88
67
88
92
Water
87
61
96
83
98
86
90
Sanitation
60
34
87
61
94
40
62
Under-5 mortality1 4
per 1000 live births (2009)
% coverage (2008)
per 100 000 live births (2008) 5
% births (2000–2008)
Contraceptive use
% married women aged 15–49 (2000–2008) % adults aged 15–49 (2007) 6
per 100 000 population (2006)
success rate % (2007)
7
% using improved sources (2008)
% using improved facilities (2008) On track
Insufficient progress
Off track
Source: World Health Statistics 2010.
2
The scorecards reveal clear priorities
zz
The Western Pacific Region is making better progress towards the health MDGs than other WHO regions.
zz
But progress is unequally spread both within and between countries, with rural and poor populations lagging behind.
zz
Reducing the number of maternal and child deaths is the most urgent and obvious priority.
zz
An estimated 13 000 maternal deaths occurred in the Region in 2008, with poor women being most affected.
zz
On the positive side, child mortality rates have improved significantly with under-5 deaths dropping by two thirds since 1990.
zz
HIV/AIDS prevalence is low, stable or decreasing: at 1% or less in all countries in the Region.
3
Health MDGs scorecard for LMICs* in the Western Pacific Region (with population ≥ 250 000)
4
Solomon Islands
Viet Nam
32
36
14
58
88
60
97
65
250
94
100
56
100
100
39
60
43
88
32
–
66
–
51
–
79
0.1
0.2
0.5
0.1
0.9
<0.1
–
0.5
<0.1
–
0.2
0.1
–
9.7
<0.1
4.1
<0.1
94
94
81
92
72
89
39
89
92
92
Water11
61
89
–
57
100
76
40
91
70**
94
Sanitation11
29
55
–
53
96
50
45
76
32**
75
China
Fiji
Lao PDR
Malaysia
Mongolia
89
21
18
61
6
41
69
Measles immunization4
92
94
94
59
95
94
Maternal mortality2
290
38
26
580
31
Skilled birth attendant5
44
98
99
20
40
87
–
HIV/AIDS prevalence6, 7
0.8
0.1
Malaria mortality8, 9
1.4
TB treatment10
Under–5 mortality3 per 1000 live births (2008)
% coverage (2009)
per 100 000 live births (2008) 5
% births (2000–2009)
Contraceptive use5
% married women aged 15–49 (2000–2008) % adults aged 15–49 (2007) 6
per 100 000 population (2008)
success rate % (2007)
7
Papua New Philippines Guinea
Cambodia
% using improved sources (2008)
% using improved facilities (2008) On track
Insufficient progress
Off track
* LMICs – Low- and middle-income countries; **Data applies to 2006, source #12. Refer to page 18 for health MDGs scorecard colour code for LMICs in the Western Pacific Region.
4
Health MDGs scorecard for LMICs* in the Western Pacific Region (with population < 250 000)
4
Cook Islands
Kiribati
Marshall Islands, the
Micronesia, the Fed. States of
Nauru
Niue
Palau
Samoa
Tonga
Tuvalu
Vanuatu
Under-5 mortality3
15
48
36
39
45
28
15
26
19
36
33
Measles immunization4
78
82
94
86
99
99
75
49
99
90
52
Maternal mortality2
–
–
–
–
–
–
–
–
–
–
–
100
90
95
88
97
100
100
100
99
100
93
–
36
–
–
36
–
33
–
–
–
–
HIV/AIDS prevalence6, 7
–
–
–
–
–
–
–
–
–
–
–
Malaria mortality8, 9
–
–
–
–
–
–
–
–
–
–
0.4
TB treatment10
100
93
96
65
100
–
–
92
93
75
93
Water11
95**
65**
94
94**
90
100
89**
88**
100
97
83
Sanitation11
100
33**
73
25**
50
100
67**
100
96
84
52
per 1000 live births (2008)
% coverage (2009)
per 100 000 live births (2008) 5
Skilled birth attendant5 % births (2000–2009)
Contraceptive use5
% married women aged 15–49 (2000–2008) % adults aged 15–49 (2007) 6
per 100 000 population (2008)
success rate % (2007)
7
% using improved sources (2008)
% using improved facilities (2008)
Due to very small population size and low incidence and prevalence of some diseases, there are no estimates for some indicators; small population size also makes classification of progress towards MDG targets infeasible.
* LMICs – Low- and middle-income countries; **Data applies to 2006, source #12.
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MDG 4 Reduce child mortality MDG target: Reduce by two thirds, between 1990 and 2015, the under-5 mortality rate
Only a few LMICs in the Region have been able to consistently achieve at least 95% immunization coverage for each of the past three years. Figure 1: Proportion of 1-year-old children immunized against measles in LMICs in the Western Pacific Region, 2009.4
Measles immunization reaching: ≥ 90% coverage
Child mortality in the Western Pacific Region has been significantly reduced. Cambodia, the Lao People’s Democratic Republic, Papua New Guinea and Mongolia still have very high numbers of child deaths. At least 65% of all child deaths in the Western Pacific Region are caused by neonatal conditions, pneumonia and diarrhoea, with an increasing proportion occurring in the neonatal period. Table 1: Causes of under-5 mortality in the Western Pacific Region, 2008.5
< 90% coverage
Neonatal causes
Pneumonia
Injuries
Diarrhoea
45.5% 16.0% 6.8% 4.0%
Malaria
HIV/AIDS
Measles
Others
0.6% 0.4% 0.4% 26.2%
Focus should be on reaching more remote, underserved, rural and poor populations to increase or maintain 95% immunization coverage for measles and other vaccinepreventable diseases. All maps in the document are stylized and not to scale. The boundaries shown and the designations used on the maps used in this document do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2010. All rights reserved.
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MDG SCORECARD
MDG 5 Improve maternal health MDG target: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Wide variation across LMICs in the coverage of skilled attendance at delivery, and coverage is low in countries where most maternal deaths occur.
Maternal mortality has been reduced in the LMICs of the Region. Cambodia, the Lao People’s Democratic Republic and Papua New Guinea have unacceptably high numbers of maternal deaths.
Figure 2: Births attended by skilled health personnel in LMICs in the Western Pacific Region, 2000–2009.5
Proportion of births attended by skilled health personnel (%) ≥ 85%
60%–85% <60%
Contraceptive prevalence rate remains low in most LMICs in the Western Pacific, and data availability for this indicator is also an issue. Figure 3: Contraceptive prevalence rate (%) in LMICs in the Western Pacific Region, 2000–2008.5 Countries with population ≥ 250 000 Cambodia China Lao PDR Mongolia Philippines Viet Nam
40 87 32 66 51 79
Countries with population < 250 000 Kiribati Nauru Palau
36 36
33
Generating accurate data on maternal mortality is difficult and depends on robust, accurate and timely vital statistics. 7
6
MDG 6 Combat HIV/AIDS, malaria and other diseases MDG target: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
1 400 000 people are living with HIV or AIDS in the Western Pacific Region, and only 31% of people with HIV have access to antiretroviral drugs (2008).
HIV / AIDS
Figure 4: HIV prevalence rate among population aged 15–49 years in selected LMICs in the Western Pacific Region, 1990–2007.6, 7 2.5
HIV prevalence rate
2.0
1.5 Cambodia Papua New Guinea
1.0
Viet Nam
0.5 0.4 0.3 0.2
Malaysia Lao People’s Democratic Republic
Fiji
0.1 0.0 1990
1995
Malaria
2000
2005
China Mongolia
The Region has avoided a major HIV epidemic, with HIV prevalence relatively low and stabilizing. Condom use and coverage of preventive interventions for mostat-risk populations are increasing.
2010
Malaria is endemic in some countries in the Region, and is often linked to poverty.
Tuberculosis Multidrug-resistant and extensively drug-resistant TB threaten TB control efforts in the Region. The Region is on track to achieve the goal of halving TB prevalence and mortality by 2015. DOTS coverage in LMICs remains high, while the case detection rate is 70% (2008) and the treatment success rate above 85% (2007).
Figure 5: Proportion of children under-5 sleeping under insecticide-treated bednets in LMICs in the Western Pacific Region, 2004–2009.8 Cambodia
20
43
Lao PDR Papua New Guinea
17
40 67
Philippines
41
Solomon Islands Vanuatu
2004 2006 2007 2008 2009
28
95
Malaria incidence and mortality have been decreasing since 1990. Where data are available, they show that use of insecticidetreated bednets among children under 5 is low.
36
8
1
7
MDG 1 Eradicate extreme poverty and hunger
MDG 7 Ensure environmental sustainability MDG target: Halve, by 2015, the proportion of people without sustainable access to safe drinking
water and basic sanitation
MDG target: Halve, between 1990 and 2015, the proportion of
people who suffer from hunger
The prevalence of underweight children under 5 has been reduced in the populous LMICs in the Western Pacific. Figure 6: Prevalence of underweight children under 5 years of age (%) in LMICs with ≥ 250 000 population, 1983–2008.5 Earliest data available Cambodia
Latest data available
2008
China
2002
Target
2006
1994
Mongolia 2005
1999
Papua New Guinea 2005
1983
Philippines 2003
1993
Solomon Islands 2007
Viet Nam 0%
1989
10%
2008 20%
1993 30%
The number of underweight children in Lao PDR and Papua New Guinea is still of concern. Pacific island countries lack data on nutrition. 8
40%
Access to safe water and sanitation is still very low in many countries, especially in rural areas. Figure 7: Proportion of population using an improved drinking-water source in LMICs in the Western Pacific Region, 2006–2008.11, 12
1996
1992
Lao PDR
The Region is on track to reach the MDG target for use of improved drinking-water sources and sanitation facilities.
50%
Figure 8: Proportion of population using an improved sanitation facility in LMICs in the Western Pacific Region, 2006–2008.11, 12 Solomon Islands Cambodia Lao PDR Micronesia, Fed. States of Palau Mongolia Marshall Islands Papua New Guinea Viet Nam Kiribati Vanuatu Philippines Tuvalu China Tonga Malaysia Urban Cook Islands Rural Niue Samoa
Papua New Guinea Mongolia Solomon Islands Cambodia Kiribati Lao PDR Vanuatu China Cook Islands Viet Nam Philippines Samoa Malaysia Micronesia, Fed. States of Tuvalu Niue Urban Tonga Rural Marshall Islands Palau 0% 20% 40% 60% 80% 100%
0% 20% 40% 60% 80% 100%
MDG 8 Develop a global partnership for development MDG target: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries
Access to essential medicines is limited by high out-of-pocket payments.
Sale of counterfeit and substandard medicines is a problem across the Region, endangering public safety.
Irrational use of medicines is increasing the risk of drug resistance. 9
Improving National health = health outcomes policy and strategy
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Faster progress towards the health MDGs will depend on better health systems to deliver effective interventions.
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Effective and affordable interventions exist to address much of the burden of disease. To deliver these, countries need to scale up staff, medicines, infrastructure and information, especially in remote and underserved areas.
zz
Requires coherent health policies, comprehensive health strategies, and the prioritization of health in national development plans.
zz
Better health requires coherent policies and a comprehensive approach that also addresses the social, environmental and economic determinants of ill-health.
zz
Strategies that seek synergies between programmes get better results and can accelerate progress towards the MDGs.
zz
Greater investment in health information systems is needed to monitor health outcomes and the performance of health systems.
10
Policy to outcomes Policy framework Global
National
Millennium Declaration and Development Goals
National development policy and plan
Primary Health Care reforms
Poverty reduction strategy
Paris Declaration on Aid Effectiveness Abuja Declaration (2001) International Health Regulations (2005)
Legislative framework
National health policy and strategy
The comprehensive national health plan which describes the • context, needs and priorities • structure and governance • functions and financing • targets and monitoring Based on the Three Ones; • one plan • one coordinating framework • one monitoring system
National health system
Service delivery and infrastructure Health workforce Health information Medical products and technology Financing Leadership and governance
Interventions and programmes
Better health outcomes
Counselling and education
Reduced mortality and morbidity
Clinical interventions, e.g. diagnosis and treatment of disease
Reduced risks and threats to health
Protective interventions, e.g. vaccination Enabling environment, e.g. water and sanitation, public health legislation
Reduced inequities in health Improved health of women and children
Socioeconomic interventions, e.g. housing, education Leadership and governance
Framework Convention on Tobacco Control 11
Delivering effective interventions in the Western Pacific Region
zz
Health systems are designed to deliver a set of effective clinical and public health interventions over the life course to achieve better health outcomes.
zz
Increased investment is needed in interventions and systems that improve the health of women and children, who together represent 80% of the population.
zz
Expanded family planning services, and a better continuum of care between different levels of the health system and across different stages of the life-cycle, will result in fewer maternal and child deaths.
zz
Essential protective and clinical interventions such as immunization and treatment of disease are necessary but insufficient; socioeconomic factors must also be addressed.
zz
Different interventions can contribute to multiple outcomes. LMICs should consider combined approaches, such as immunization services with growth monitoring, distribution of bednets and micronutrient supplements.
12
Interventions over the life course
PRE-PREGNANCY
PREGNANCY
BIRTH
POSTNATAL
CHILDHOOD
ADOLESCENCE
ADULT/OLDER AGE
Promoting breastfeeding Sexual and reproductive health counselling
Sexual and reproductive health counselling
Promotion of healthy lifestyle (alcohol, diet, smoking, physical activity, etc.) Diagnosis and treatment of HIV/AIDS, TB, malaria, neglected tropical diseases (NTDs), and other infectious diseases Antenatal care
Clinical interventions
Safe delivery
Postpartum and newborn care
Management of childhood illness Early detection, diagnosis and treatment of noncommunicable diseases (NCDs): cardiovascular disease, diabetes, cancer and asthma
Increasing population impact
Family planning Protective interventions
Preventing mother-to-child transmission of HIV
Growth monitoring
Intermittent preventive malaria treatment
Vitamin A, micronutrients
Family planning Cancer screening
Increasing individual effort needed
Counselling and education
Deworming and other preventive treatment for NTDs
Immunization Insecticide-treated nets and indoor residual spraying
Enabling environment
Socioeconomic interventions
Safe water and improved sanitation, Reducing stigma and discrimination, Encouraging physical activity, Better nutrition, Road safety, and Health legislation
Housing, Education, Employment, Early childhood development, Empowerment of women and gender equity
13
Sustained and equitable f inancing to achieve the MDGs zz
zz
zz
zz
zz
zz
zz
Paying for care directly—out-of-pocket payments—prevents millions of people from using health services and can lead to impoverishment. In Asia and the Pacific, 105 million people suffer financial catastrophe and over 70 million are impoverished each year because they have to pay for health care.
Figure 9: Source of health financing as proportion of total expenditure on health for LMICs in the Western Pacific Region, 2008.13 Tuvalu Niue Marshall Islands Micronesia, Fed. States of Solomon Islands
In six LMICs in the Region, out-of-pocket payments account for over 40% of total health expenditure.
Cook Islands
Financing policies that seek to pool risk and resources—for example through insurance or tax-based finance—offer better financial protection
Papua New Guinea
A basic package of health services costs US$ 35 – US$ 50 per person per year. Globally, low-income countries spend just US$ 25 per person per year on health, of which US$ 10 is out-of-pocket expenditure. Spending on health in low-income countries needs to increase from US$ 31 billion now to US$ 67 billion – US$ 76 billion by 2015. The bulk of this money will come from domestic sources, though many LMICs will also require aid for the foreseeable future. Aid for health must be predictable, sustained, aligned with national priorities and provided in ways that minimize transaction costs.
Samoa Kiribati
Vanuatu Mongolia Palau Nauru Tonga Fiji China Malaysia Viet Nam Philippines Cambodia Lao PDR 0% 20% 40% 60% 80% 100%
Out-of-pocket Other private
Private pre-paid plans Government
14
Supporting national ef forts to achieve the MDGs is core business for WHO
zz
zz zz
zz
zz
1
4
5
6
7
8
Setting norms and standards—such as treatment guidelines and health service standards—is a core WHO function, underpinning our technical support for the MDGs. WHO’s analytic work on social and economic determinants highlights the magnitude and nature of broader risks to health. WHO uses its technical expertise and convening power to assist national authorities as they seek to develop coherent and wellcosted national strategies. In countries with many donors, WHO plays a key role in assisting governments to coordinate development partners and to ensure alignment between external assistance and domestic priorities. A key function in relation to the MDGs is the collection and dissemination of data on health status.
15
Tables MDG 1
MDG 4
Prevalence of underweight children (%)
1990 –1999 2000–2009
MDG 5
Infant mortality rate per 100 000 live births
Measles immunization % coverage
Under-5 mortality rate per 100 000 live births
2015 Target
1990
2000
2008
2015 target
1990
2000
2008
2015 target
Maternal mortality ratio per 100 000 live births
Proportion of Contraceptive births attended prevalence by skilled health rate (%) personnel (%)
1990
2009
1990
2000
2008
2015 target
1990– 1999
2000– 2009
2000–2008
Countries with ≥ 250 000 population Cambodia
43
29
21
85
80
69
28
117
106
89
39
34
92
690
470
290
173
34
44
40
China
15
7
8
37
30
18
12
46
36
21
15
98
94
110
60
38
28
89
98
87
Fiji
7
…
4
19
16
16
6
22
18
18
7
84
94
40
32
26
10
99
99
…
Lao PDR
36
32
18
108
64
48
36
157
86
61
52
32
59
1200
790
580
300
7
20
32
Malaysia
18
…
9
16
9
6
5
18
10
6
6
70
95
56
39
31
14
81
100
…
Mongolia
11
5
5
71
49
33
24
98
63
41
33
92
94
130
93
65
33
99
100
66
25 (1983)
18
13
67
57
53
22
91
77
69
30
67
58
340
290
250
85
51
39
…
Papua New Guinea Philippines
26
21
13
42
28
26
14
61
36
32
20
85
88
180
120
94
45
53
60
51
16 (1989)
12
8
31
30
30
10
38
37
36
13
70
60
130
110
100
33
85
43
…
37
20
18
39
24
12
13
56
30
14
19
88
97
170
91
56
43
77
88
79
Cook Islands
…
…
…
16
15
14
5
18
17
15
6
67
78
…
…
…
…
100
100
…
Kiribati
…
…
…
65
49
38
22
89
63
48
30
75
82
…
…
…
…
85
90
36
Marshall Islands
…
…
…
39
32
30
13
48
39
36
16
52
94
…
…
…
…
95
95
…
Micronesia, Fed. States of
…
…
…
45
38
32
15
58
47
39
19
81
86
…
…
…
…
93
88
…
Nauru
…
…
…
8
41
36
6
9
51
45
7
…
99
…
…
…
…
…
97
36
Niue
…
…
…
31
17
22
…
31
22
28
…
99
99
…
…
…
…
…
100
…
Palau
…
…
…
18
14
13
6
21
16
15
7
98
75
…
…
…
…
100
100
33
Samoa
2
…
1
40
28
22
13
50
34
26
17
89
49
…
…
…
…
100
100
…
Solomon Islands Viet Nam
Countries with < 250 000 population
Tonga
…
…
…
19
18
17
6
22
20
19
8
86
99
…
…
…
…
…
99
…
Tuvalu
…
2
…
42
35
30
14
53
42
36
18
95
90
…
…
…
…
99
100
…
Vanuatu
11
…
5
23
25
27
8
27
29
33
9
66
52
…
…
…
…
89
93
…
16
Tables MDG 7
MDG 6` HIV prevalence rate (%) among population aged 15–49 years
Malaria mortality rate per 100 000 population
Tuberculosis treatment success rate (%)
Proportion of population using improved drinking-water source (%) Urban
Proportion of population using improved sanitation facility (%)
Rural
Urban
Rural
1990
1995
2001
2007
1990
2008
cohort 1995
cohort 2007
1990
2008
1990
2008
1990
2008
0.7
1.2
1.5
0.8
10.5
1.4
91
94
52
81
33
56
38
67
5
18
98
56
82
48
58
38
52
…
…
…
92
…
…
…
1990
2008
Countries with ≥ 250 000 population Cambodia China
…
…
0.1
0.1
0.0
<0.1
93
94
97
Fiji
…
<0.1
0.1
0.1
…
…
86
81
92
Lao PDR
…
<0.1
<0.1
0.2
9.0
0.2
70
92
78
72
37
51
56
86
10
38
Malaysia
…
0.1
0.1
0.5
0.2
0.1
69
72
94
100
82
99
88
96
81
95
Mongolia
…
…
…
0.1
…
…
74
89
81
97
27
49
67
64
25
32
87
32
33
78
71
42
41
46
69
<0.1
0.1
0.5
0.9
11.1
9.7
56
39
89
Philippines
…
…
…
<0.1
1.5
<0.1
60
89
93
93
76
87
70
80
Solomon Islands
…
…
…
…
10.3
4.1
65
92
94
94
65
65
98
98
18
18
Viet Nam
…
0.1
0.3
0.5
5.1
<0.1
89
92
88
99
51
92
61
94
29
67
Cook Islands
…
…
…
…
…
…
100
100
99
98
87
88
100
100
91
100
Kiribati
…
…
…
…
…
…
87
93
76
77
33
53
36
46
21
20
Marshall Islands
…
…
…
…
…
…
25
96
94
92
97
99
77
83
41
53
95
87
94
55
61
20
14
Papua New Guinea
Countries with < 250 000 population
Micronesia, Fed. States of
…
…
…
…
…
…
80
65
93
Nauru
…
…
…
…
…
…
…
100
…
90
…
…
…
50
…
…
Niue
…
…
…
…
…
…
…
…
100
100
100
100
100
100
100
100
Palau
…
…
…
…
…
…
67
…
73
79
98
94
76
96
54
52
Samoa
…
…
…
…
…
…
80
92
99
90
89
87
100
100
98
100
100
100
100
98
98
96
96
Tonga
…
…
…
…
…
…
75
93
100
Tuvalu
…
…
…
…
…
…
…
75
92
98
89
97
86
88
76
81
Vanuatu
…
…
…
…
21.5
0.4
85
93
91
96
49
79
53
66
30
48
17
Health MDGs scorecard colour code for LMICs in the Western Pacific Region (with population ≥ 250 000)
4
On Track
Insufficient Progress
Off Track
Achieved at least 75% of MDG target
Achieved at least 50% of MDG target
Achieved less than 50% of MDG target
≥ 90%
< 90%
N/A
Achieved at least 75% of MDG target
Achieved at least 50% of MDG target
Achieved less than 50% of MDG target
Skilled birth attendant
≥ 85%
60% – 84%
< 60%
Contraceptive use
≥ 60%
30% – 59%
< 30%
HIV/AIDS prevalence
Decreased or no change between 2001 and 2007
Increased but still low prevalence between 2001 and 2007
Significantly increased between 2001 and 2007
Malaria mortality
Significantly decreased
High with little change or decrease
High with no change or increase
≥ 85%
70% – 84%
< 70%
Water
Achieved at least 75% of MDG target
Achieved at least 50% of MDG target
Achieved less than 50% of MDG target
Sanitation
Achieved at least 75% of MDG target
Achieved at least 50% of MDG target
Achieved less than 50% of MDG target
Under-5 mortality per 1000 live births
Measles immunization % coverage
Maternal mortality per 100 000 live births 5
% births
% married women aged 15–49
% adults aged 15–45 6
per 100 000 population
TB treatment success rate %
7
% using improved sources
% using improved facilities
18
Data sources 1 Levels & trends in child mortality report 2010: Estimates developed by the UN Inter-agency group for child mortality estimation. United Nations Children’s Fund, World Health Organization, The World Bank, United Nations Population Division. UNICEF, New York, 2010. 2 Trends in maternal mortality: 1990 to 2008: Estimates developed by WHO, UNICEF, UNFPA and The World Bank. WHO, Geneva, 2010. (http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf). 3 UN Inter-agency Group for Child Mortality Estimation (IGME). Trends in under-five mortality rates (1960-2009). New York, UNICEF, 2009 (http://www.childinfo.org/mortality_ ufmrcountrydata.php). 4 World Health Organization and United Nations Children’s Fund. WHO/UNICEF measles coverage estimates for 1980-2009. Geneva, WHO and New York, UNICEF, May 2010. 5 Global health observatory database. Geneva, WHO, 2010 [http://apps.who.int/ghodata/] 6 Joint United Nations Programme on HIV/AIDS. Adult (15-49) HIV prevalence percent by country, 1990-2007. 2008 Report on the global AIDS epidemic. Geneva, UNAIDS, 2008 (http://data.unaids.org/pub/GlobalReport/2008/20080813_gr08_prev1549_1190_2007_en.xls). 7 Joint United Nations Programme on HIV/AIDS. Papua New Guinea new HIV estimates. Geneva, UNAIDS, 2010 (unpublished). 8 World Health Organization. National malaria control programme reports. Submitted by countries to the WHO Western Pacific Regional Office. Manila, WHO, 2008 (http://www. wpro.who.int/topics/malaria/en/). 9 World Health Organization, World malaria report 2009. Geneva, WHO, 2009 (http://www.who.int/malaria/world_malaria_report_2009/en/index.html). 10 Global TB database. Geneva, WHO, 2010 (http://www.who.int/tb/country/global_tb_database/en/). 11 World Health Organization and United Nations Children’s Fund. Progress on sanitation and drinking-water: 2010 update report. Geneva, WHO, 2010 [http://www.unicef.org/ media/files/JMP-2010Final.pdf]. 12 World Health Organization and United Nations Children’s Fund. Progress on drinking-water and sanitation: special focus on sanitation. Geneva, WHO and New York, UNICEF, 2008. [http://www.who.int/water_sanitation_health/monitoring/jmp2008/en/index.html]. 13 World Health Organization. National Health accounts country health information. Geneva, WHO, 2010 (http://www.who.int/nha/country/en/).
Other data source World Health Organization. Health in Asia and the Pacific. India, WHO, 2008.
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