Achieving the health-related MDGs in the Western Pacific Region 2010

Page 1

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.

5


4

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.

6


5

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

zz

Faster progress towards the health MDGs will depend on better health systems to deliver effective interventions.

zz

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.

19



Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.