Achieving the health-related Millennium Development Goals in the Western Pacif ic Region
2012 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, eight Millennium Development Goals (MDGs) were established and adopted by 189 heads of state in the United Nations Millennium Declaration.
zz
There are three years left before the 2015 deadline. Some countries have achieved their goals, while others have much work to do to reach the targets.
zz
After 2015, efforts must be sustained to achieve the original goals and to overcome new health challenges such as noncommunicable diseases, mental health disorders, injuries and the consequences of violence.
1
Health MDGs scorecard for WHO regions World
Africa
Americas
Eastern Mediterranean
Europe
South-East Asia
Western Pacific
57
119
18
68
14
57
19
Measles immunization
85
76
93
85
95
79
97
Maternal mortality
210
480
63
250
20
200
49
Skilled birth attendant
69
48
93
59
98
59
91
63
24
75
42
71
58
80
HIV/AIDS prevalence2
0.8
4.7
0.5
0.2
0.4
0.3
0.1
Malaria mortality
12
94
0.1
2.5
0
2.9
0.2
TB treatment
87
80
76
88
68
89
93
Water
89
63
96
85
98
90
92
Sanitation
63
34
87
66
92
43
69
Under-5 mortality 4
per 1000 live births (2010)
% coverage (2010)
per 100 000 live births (2010) 5
% births (2005–2011)
Contraceptive use
% married women aged 15–49 (2005–2010) % adults aged 15–49 (2010) 6
per 100 000 population (2008)
% success rate (2009)
7
% using improved sources (2010)
% using improved facilities (2010) On track
Insufficient progress
Off track
Refer to page 16 for health MDGs scorecard colour code criteria
Source: World Health Statistics 2012
2
The scorecards reveal clear priorities
zz
Countries and areas in the Western Pacific Region are making remarkable progress towards achieving the health-related MDGs. Several gaps still remain.
zz
There are large disparities in progress both between and within countries.
zz
An estimated 12 000 maternal deaths and 467 000 child deaths occurred in the Region in 2010. Further reduction of maternal and child death remains a high priority in most low- and middle-income countries.
zz
New infections and AIDS-related deaths in the Region have stabilized over the last five years, whereas prevalence of HIV has increased slightly since 2000 as more people living with HIV are obtaining antiretroviral treatment.
zz
Weak health systems, health inequities and difficulties in sustaining gains are some of the factors that will affect achieving the MDG targets.
zz
Achieving universal coverage to ensure people can access quality health services without facing catastrophic financial expenses is key to sustaining progress for all MDGs.
3
Health MDGs scorecard for LMICs* in the Western Pacific Region (with population ≥ 250 000)
4
Solomon Islands
Viet Nam
29
27
23
60
79
73
96
63
230
99
93
59
99
99
40
62
70
84
38
–
66
36
51
35
80
0.1
0.2
0.5
<0.1
0.9
<0.1
–
0.4
<0.1
–
0.4
0.1
–
9.2
<0.1
2.5
<0.1
95
95
94
93
78
88
72
89
88
92
Water10
64
91
98
67
100
82
40
92
–
95
Sanitation10
31
64
83
63
96
51
45
74
–
76
China
Fiji
Lao PDR
Malaysia
Mongolia
Under-5 mortality3
51
18
17
54
6
32
61
Measles immunization4
93
99
82
69
95
98
Maternal mortality5
250
37
26
470
29
Skilled birth attendant6
71
96
100
37
51**
85
–
HIV/AIDS prevalence2, 7
0.5
0.1
Malaria mortality8
0.9
TB treatment9
per 1000 live births (2010)
% coverage (2011)
per 100 000 live births (2010) 5
% births (2006–2010)
Contraceptive use6
% married women aged 15–49 (2005–2008) % adults aged 15–49 (2009) 6
per 100 000 population (2010)
% success rate (2009)
7
Papua New Philippines Guinea
Cambodia
% using improved sources (2010)
% using improved facilities (2010) On track
Insufficient progress
Off track
Refer to page 16 for health MDGs scorecard colour code criteria
* LMICs – Low- and middle-income countries ** Cambodia Demographic Health Survey 2010
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
9
49
26
42
40
22
19
20
16
33
14
Measles immunization4
89
90
89
92
100
100
80
67
99
98
92
Maternal mortality5
–
–
–
100
–
–
–
100
110
–
110
100
98
86
100
97
100
100
81
98
93
74
–
36
45
–
36
–
33
29
–
31
38
HIV/AIDS prevalence2, 7
–
–
–
–
–
–
–
–
–
–
–
Malaria mortality8
–
–
–
–
–
–
–
–
–
–
0
TB treatment9
–
97
84
88
–
–
75
90
83
88
96
Water10
–
–
94
–
88
100
85
96
100
98
90
100
–
75
–
65
100
100
98
96
85
57
per 1000 live births (2010)
% coverage (2011)
per 100 000 live births (2010) 5
Skilled birth attendant6 % births (2006–2010)
Contraceptive use6
% married women aged 15–49 (2000–2009) % adults aged 15–49 (2009) 6
per 100 000 population (2010)
% success rate (2009)
7
% using improved sources (2010)
Sanitation10
% using improved facilities (2010)
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
5
The nutritional status of children under 5 years has improved.
MDG 1 Eradicate extreme poverty and hunger
1
Undernutrition remains an important public health problem and obesity is increasing.
MDG target: Halve, between 1990 and 2015, the proportion of people who suffer
from hunger
The prevalence of underweight children under 5 has been further reduced in the LMICs in the Western Pacific Region.
Chronic undernutrition prevails in under-5 children in the majority of countries. At least one third of countries have a growing problem of overweight in children. Acute malnutrition is still a significant problem in several countries in the Region.
Figure 1. Prevalence of underweight children under 5 years of age (%) in LMICs in the Western Pacific Region, 1983 –2011. Earliest data available Cambodia China
2011 2010
Malaysia
2006 1992 2005
Philippines
1983 2008
2007
Viet Nam Vanuatu
1993
1990
Papua New Guinea
Solomon Islands
1996
2006
2005
Target
1990
Lao PDR
Mongolia
Latest data available
1990
1989 2008
1993
1996 2007
0% 10% 20% 30% 40% 50%
Source: Global Health Observatory database. Geneva, WHO, Accessed September 2012 (http://apps.who.int/ghodata/)
Figure 2. Prevalence of stunting and overweight among children under 5 years of age (%) in selected countries in the Western Pacific Region, 1981-2011. Australia Cambodia China Fiji Japan Kiribati Lao PDR Malaysia Mongolia Nauru Papua New Guinea Philippines Samoa Singapore Solomon Islands Tuvalu Vanuatu Viet Nam
0
8.2 40.9
1.9 9.4
6.6 2.2
4.3 8.3
2.9
34.4
15.9
47.6
1.3 17.2
5.5
27.5
14.2
Overweight*
24.0
2.8
32.3
3.3
2.6
4.4
6.4 6.2 32.8
2.5 6.3
10.0 25.9
4.7
30.5
3.0
0
Stunted*
43.9
3.4
10
20
30
40
50
Source: Global Health Observatory database. Geneva, WHO, Accessed September 2012 (http://apps.who.int/ghodata/). * Latest available data from the period 1981-2011
Interventions should focus on improving nutrition and alleviating hunger in the underserved and hard-to-reach populations, and especially on children, adolescents and women. Breast feeding
Low birth weight (LBW)
Anaemia in women and children
In 8 of 13 Western Pacific countries reporting, exclusive breastfeeding rate is <50%, although the norm should be about 95% in all countries.
Maternal nutrition should be improved to reduce LBW rates, which are now more than 3 times the norm in 18 of 31 countries reporting.11
Fortification, supplementation, deworming and improved diets can greatly reduce anaemia, which is still >20% in pregnant women11 and preschoolers12 in about half the countries reporting. 6
4
MDG 4 Reduce child mortality MDG target: Reduce by two thirds, between 1990 and 2015, the under-5 mortality rate
Measles incidence in the Western Pacific Region has substantially decreased to 11.6 per million population in 2011. Twenty-five countries have already achieved measles elimination as of the end of 2011. Figure 3: Proportion of 1-year-old children immunized against measles in LMICs in the Western Pacific Region, 2011.
Child mortality in the Western Pacific Region has been significantly reduced. Malaysia and Mongolia have achieved MDG 4 targets, while China, the Lao People’s Democratic Republic, Cambodia, the Philippines and Viet Nam are most likely to reach the targets by 2015. Figure 4 . Under-5 mortality rate (per 1000 live births), 1990 baseline, 2015 target and progress to date, in LMICs with ≥ 250 000 population in WPR. Cambodia China
≥ 90% coverage < 90% coverage
10
30
17
Lao PDR Malaysia
Measles immunization reaching:
48
18 16
Fiji
18
Mongolia
32
Papua New Guinea
Viet Nam
107 36 61
30
Philippines Solomon Islands
145
54
48 6 6
121
51
40
27
15 17
59
29
20
23
90
1990 baseline
45
2010 2015 Target
51
Source: Levels & Trends in Child Mortality Report 2011. Estimates developed by the UN Interagency Group for Child Mortality Estimation, 2011.
In the Western Pacific Region, 54% of under-five child deaths occurred during the neonatal period. The leading causes of under-five mortality in the Region are pneumonia, preterm birth complications and birth asphyxia.
All maps in the document are stylized and not to scale. The boundaries and names shown and the designations used on this map do not imply the expression of an opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or areas or its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border line for which there may not yet be full agreement. © WHO 2012. All rights reserved.
Table 1: Causes of under-5 mortality in the Western Pacific Region, 2010 Prematurity
Focus should be on reaching more remote, underserved populations with services for essential newborn care; timely antibiotic treatment for pneumonia; and maintaining the gains in immunization coverage.
Pneumonia Birth asphyxia Congenital anomalies Injuries Diarrhoea
17% 16% 14% 12% 9% 4%
Neonatal sepsis Measles Malaria HIV/AIDS Others
Source: Global Health Observatory database. Geneva, WHO, accessed September 2012 (http://apps.who.int/ghodata/)
3% 1% 0% 0% 22% 7
5
MDG 5 Improve maternal health MDG target: Reduce by three quarters, between 1990 and 2015, the maternal
mortality ratio
There is a decreasing trend in the maternal mortality ratio (MMR) of most countries in the Region. The MMR of the Lao People’s Democratic Republic, Cambodia and Papua New Guinea are still high. Figure 5. Trends in Maternal mortality ratio (per 100 000 live births) in LMICs with ≥ 250 000 population in the Western Pacific Region, 1990-2010. 1800
Access to skilled birth attendants and family planning services are critical to the achievement of MDG 5
Proportion of births attended by skilled health personnel (%) ≥ 85%
60%–85% <60%
Maternal mortality ratio
Figure 6. Proportion of deliveries assisted by skilled birth attendants in LMICs in the Western Pacific Region, 2005-2011.
1600
1600
1990 2000
1400
2010
1200 1000
870
830
800 600
510
400
470
200 0
390
250 120
Cambodia
61 37
China
32 31 26
Fiji
Lao PDR
53 39 29
120 96 63
Malaysia
Mongolia
310 230
170
240 120 99
Papua Philippines New Guinea
150 120
93
Solomon Islands
100 59
Viet Nam
Source: Trends in maternal mortality: 1990 to 2010. Estimates developed by WHO, UNICEF, UNFPA and The World Bank. WHO, 2012.
Contraceptive prevalence remains low in some low- and middle-income countries in the Region. Figure 7. Contraceptive prevalence rate in LMICs with ≥ 250 000 population in the Western Pacific Region, 2005-2010 Source: World Health Statistics 2012
51a
Cambodia China
85
Lao PDR
38
Mongolia
Increased efforts are needed for better maternal health care and to address perinatal health problems, especially for poor and vulnerable populations. Improving accountability for financial resources and health outcomes is critical to reach the objectives of the Global Strategy for Women’s and Children’s Health.
66
Papua New Guinea
36
Philippines
51
Solomon Islands
35
Viet Nam
80 0
Source: World Health Statistics 2012
20 a
40 60 Contraceptive prevalence rate (%) Cambodia Demographic Health Survey 2010
80
100
8
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
Malaria Malaria mortality and morbidity have
been steeply declining since 1990 in 10 endemic countries in the Region. Figure 9. Areas with artemisinin resistance development in the Mekong subregion.
There are 1.3 million people living with HIV and AIDS in the Western Pacific Region, and only 43% of people in need of antiretroviral therapy have access to ARV in 2010.
HIV / AIDS
Figure 8. HIV prevalence rate among population aged 15-49 years in LMICs with ≥ 250 000 population in the Western Pacific Region, 1990-2009. 1.60
Cambodia
1.40
HIV prevalence
1.20 1.00
Papua New Guinea
0.80 0.60
Malaysia
0.40 0.20 0.00
China 1990
1995
Viet Nam
Mongolia 2000
Lao PDR Philippines
Fiji 2005
2009 2010
Source: Global Health Observatory database. Geneva, WHO, accessed September 2012 (http://apps.who. int/ghodata/)
The Region has a relatively low HIV prevalence, and the epidemic has shown signs of stabilizing. Condom use and coverage of preventive interventions for mostat-risk populations are increasing but still not enough. Access of population groups to services such as antiretroviral therapy remains low in most low- and middle-income countries.
Rates of TB in the Region have dropped significantly since 1990. The challenge remains to find and cure TB in high risk groups and vulnerable populations that lack access to care.
Tuberculosis
NB: Circles: old data (<Oct 2011) Triangles: new data (Nov 2011)
Threats to sustaining the gains made in malaria control include the development of artemisinin resistance in Cambodia and Viet Nam (Figure 9) and dwindling financial resources in many endemic countries.
Figure 10. Distribution of notified MDR-TB cases in WPR, 2010.
Multidrug-resistant and extensively drug-resistant TB threatens gains achieved in the last decade. 9
7
MDG 7 Ensure environmental sustainability
The Region has already reached the targets for use of improved drinking water sources and sanitation facilities.
MDG target: Halve, by 2015, the proportion of people without sustainable access to
safe drinking water and basic sanitation
Access to improved drinking water sources and improved sanitation facilities is still very low in many countries, especially in rural areas. Strong political leadership and commitment are needed to further improve the coverage of drinking water and sanitation
Figure 11. Proportion of population using an improved drinking-water source in LMICs by residence type, 2010.10 Cambodia
Cambodia
China
China Cook Islands
Cook Islands Fiji
Fiji
Lao PDR
Lao PDR
Malaysia
Malaysia
Marshall Islands
Marshall Islands
Mongolia
Mongolia
Nauru
Nauru
Niue
Niue
Palau
Palau
Papua New Guinea
Papua New Guinea
Philippines
Philippines
Samoa
Samoa
Tonga
Tonga
Tuvalu
Tuvalu
Vanuatu
Vanuatu
Urban Rural
Viet Nam 0
8
Figure 12. Proportion of population using improved sanitation facility in LMICs by residence type, 2010.10
20
Urban Rural
Viet Nam 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
Availability and access to affordable quality-assured essential medicine needs further improvement in most low- and middle-income countries in the Region.
Adequate financing is key to ensuring availability of essential medicines, which is consistently lower in the public than in the private sector. Weak enforcement of medicine regulations results in the sale of counterfeit and substandard medicine.
Majority of the LMICs had an updated medicines list and had developed national medicines policies. 10
Improving equity on MDGs
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Health is a human right for all. Governments play a crucial role developing policies and plans to promote health among populations that are most in need.
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Health inequities are widening. Reducing health inequities can be achieved by analyzing how groups in countries may benefit disproportionately from policies and programmes; addressing social determinants of health; and expanding access to primary health care with adequate financial protection.
Figure 13. Overall progress but increasing disparities: Under-five mortality - rural/urban rates, selected countries.
Note: Years indicate the year of DHS. Data for Papua New Guinea have yet to be officially released. Source: UNESCAP, UNDP, ADB. Achieving the Millennium Development Goals in an era of global uncertainty: AsiaPacific Regional Report 2009/10. Bangkok, United Nations, 2010. Available online at: http://www.mdgasiapacific.org/ files/shared_folder/documents/Regional_MDG_Report_2009-10.pdf[accessed 20 July 2010].
zz
Relatively high costs and direct out-of-pocket payments impede access to and lower coverage of MDG-related services and increase poverty.
zz
Other barriers to accessing quality services in addition to costs facing those with the greatest need include remoteness, low level of knowledge, and other sociocultural issues.
zz
Monitoring health equity can be achieved by disaggregating and analyzing information by income, sex, ethnicity and other relevant stratifiers to track changes in progress of MDGs in different groups. 11
Universal health coverage and the Millennium Development Goals
zz
Universal health coverage means that all people have access to quality health services when needed without facing catastrophic financial expenses.
zz
Universal coverage ensures that the population is adequately covered by financial arrangements to ensure access to needed health care services.
zz
Universal coverage requires access to a continuum of integrated people-centred health services at every stage of each individualâ&#x20AC;&#x2122;s life.
zz
Universal coverage promotes the provision of a timely delivered package of services that are of good quality and value.
zz
Universal coverage is essential to the achievement of all the health-related MDGs.
12
Civil registration and vital statistics (CRVS) underpin MDGs
Lack of progress in improving CRVS is â&#x20AC;&#x153;the single most critical development failure over the past 30 years.â&#x20AC;? â&#x20AC;&#x201D;Richard Horton, The Lancet 2007
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Civil registration and vital statistics (CRVS) systems are the best population and demographic data source for providing inputs for 42 out of the 60 MDG indicators.
zz
Functioning CRVS systems improve the accuracy, completeness and timeliness of mortality statistics and enhances monitoring of burden of disease.
zz
Counting births and deaths, with medically certified cause of death, is achievable with careful integration of events occurring in health facilities with those captured through the civil registration process within communities.
zz
Strengthening CRVS requires leadership and coordination across multiple sectors, including health, statistics, and civil registration.
13
Tables MDG 1
MDG 4
Prevalence of underweight children (%) WHO Regions
1983– 1999
MDG 5
Infant mortality rate per 1000 live births
2005– 2011
2015 Target
1990
Under-5 mortality rate per 1000 live births
Measles immunization % coverage
2010
2015 Target
1990
2010
2015 Target
1990
Proportion of births attended by skilled health personnel (%)
Maternal mortality ratio per 100 000 live births
Contraceptive prevalence rate (%)
2010
1990
2000
2010
2015 Target
1990 – 1999
2005– 2011
1990– 1999
2005– 2010
Africa
…
…
…
104
75
35
172
119
57
58
76
820
720
480
205
…
48
…
24
Americas
…
…
…
34
14
11
42
18
14
80
93
100
80
63
25
…
93
…
75
Eastern Mediterranean
…
…
…
74
51
25
100
68
33
66
85
430
360
250
108
…
59
…
42
Europe
…
…
…
27
12
9
33
14
11
83
95
44
29
20
11
…
98
…
71
South-east Asia
…
…
…
78
44
26
111
57
37
59
79
590
370
200
148
…
59
…
58
Western Pacific
…
…
…
37
16
12
48
19
16
94
97
140
77
49
35
…
91
…
80
World
…
…
…
61
40
20
88
57
29
73
85
400
320
210
100
…
69
…
63
1983– 1999
2005– 2011
2015 Target
1990
2010
2015 Target
1990
2010
2015 Target
1990
2011
1990
2000
2010
2015 Target
1990– 1999
2006– 2010
1990– 1999
2000– 2010
Cambodia
43
29
21
87
43
29
121
51
40
34
93
830
510
250
208
34
71
20
51
China
13
3
6
38
16
13
48
18
16
98
99
120
61
37
30
89
96
84
85
Fiji
7
…
3
25
15
8
30
17
10
84
82
32
31
26
8
99
100
…
…
Lao PDR
40
32
20
100
42
33
145
54
48
32
69
1600
870
470
400
7
37
20
38
Malaysia
22
13
11
15
5
5
18
6
6
70
95
53
39
29
13
81
99
55
…
Mongolia
11
5
5
76
26
25
107
32
36
92
98
120
96
63
30
99
99
60
66
Papua New Guinea
25
18
12
65
47
22
90
61
30
67
60
390
310
230
98
51
40
26
36
Philippines
30
21
15
42
23
14
59
29
20
85
79
170
120
99
43
53
62
49
51
Countries with ≥ 250 000 population
Solomon Islands
16
12
8
36
23
12
45
27
15
70
73
150
120
93
38
85
70
…
35
Viet Nam
37
20
18
37
19
12
51
23
17
88
96
240
100
59
60
77
84
72
80
1983– 1999
2005– 2011
2015 Target
1990
2010
2015 Target
1990
2010
2015 Target
1990
2011
1990
2000
2010
2015 Target
1990– 1999
2006– 2010
1990– 1999
2000– 2010
Cook Islands
…
…
…
17
8
6
20
9
7
67
89
…
…
…
…
…
100
…
…
Kiribati
11
…
…
64
39
21
87
49
29
75
90
…
…
…
…
…
98
…
36
Marshall Islands
…
…
…
40
22
13
51
26
17
52
89
…
…
…
…
…
86
…
45
Micronesia, Fed. States of
…
…
…
44
34
15
56
42
19
81
92
140
130
100
…
…
100
…
…
Nauru
…
5
…
32
32
11
40
40
13
…
100
…
…
…
…
…
97
…
36
Niue
…
…
…
12
19
4
14
22
5
99
100
…
…
…
…
…
100
…
…
Palau
…
…
…
27
15
9
33
19
11
98
80
…
…
…
…
…
100
…
33
Samoa
2
…
0.9
23
17
8
27
20
9
89
67
260
150
100
…
…
81
…
29
Tonga
…
…
…
21
13
7
25
16
8
86
99
67
87
110
…
…
98
…
…
Tuvalu
…
2
…
44
27
15
57
33
19
95
98
…
…
…
…
93
…
31
Vanuatu
11
12
5
31
12
10
39
14
13
66
92
120
110
…
…
74
…
38
Countries with < 250 000 population
220
14
Tables MDG 6`
MDG 7
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 (%) National
Urban
Proportion of population using improved sanitation facility (%)
Rural
National
Urban
Rural
1990
1995
2000
2010
2006
2008
2000
2009
1990
2010
2015 Target
1990
2010
1990
2010
1990
2010
2015 Target
1990
2010
1990
2010
Africa
…
…
3.0
4.7
104
94
71
80
50
63
75
84
84
36
50
29
34
65
47
46
21
25
Americas
…
…
0.3
0.5
0.5
0.1
76
76
91
96
96
97
99
75
86
80
87
90
88
91
60
74
Eastern Mediterranean
…
…
0
0.2
7.5
2.5
81
88
84
85
92
95
93
72
77
52
66
76
84
85
31
51
Europe
…
…
0.1
0.4
…
0
75
68
96
98
98
99
99
89
95
91
92
96
94
94
83
88
South-east Asia
…
…
0.2
0.3
2.1
2.9
50
89
71
90
86
89
95
65
87
25
43
63
55
64
15
33
Western Pacific
…
…
0
0.1
0.3
0.2
90
93
71
92
86
97
98
58
86
36
69
68
64
80
22
60
World
…
…
0.5
0.8
17
12
69
87
76
89
88
95
96
62
81
49
63
75
76
79
27
46
1990
1995
2000
2009
2005
2010
1995
2009
1990
2010
2015 Target
1990
2010
1990
2010
1990
2010
2015 Target
1990
2010
1990
2010
0.5
1.4
1.3
0.5
2.0
0.9
91
95
31
64
66
48
87
29
58
9
31
55
36
73
5
20
WHO Regions
Countries with ≥ 250 000 population Cambodia China
…
…
…
0.1
<0.1
<0.1
93
95
67
91
84
97
98
56
85
24
64
62
48
74
15
56
Fiji
<0.1
<0.1
<0.1
0.1
…
…
86
94
84
98
92
94
100
77
95
61
83
81
90
94
40
71
Lao PDR
<0.1
<0.1
<0.1
0.2
1.3
0.4
70
93
45*
67
72
…
77
…
62
26*
63
63
…
89
…
50
Malaysia
0.1
0.3
0.4
0.5
0.1
0.1
69
78
88
100
94
94
100
82
99
84
96
92
88
96
81
95
Mongolia
<0.1
<0.1
<0.1
<0.1
…
…
74
88
54
82
77
74
100
27
53
49*
51
75
…
64
…
29
Papua New Guinea
<0.1
0.1
0.4
0.9
12.2
9.2
56
72
41
40
71
89
87
32
33
47
45
74
78
71
42
41
Philippines
<0.1
<0.1
<0.1
<0.1
0.2
<0.1
60
89
85
92
93
93
93
77
92
57
74
79
69
79
45
69
…
…
…
…
7.5
2.5
65
88
…
…
…
…
…
…
…
…
…
…
98
98
…
…
<0.1
0.1
0.2
0.4
<0.1
<0.1
89
92
57
95
79
88
99
49
93
37
76
69
63
94
30
68
1990
1995
2000
2009
2005
2010
1995
2009
1990
2010
2015 Target
1990
2010
1990
2010
1990
2010
2015 Target
1990
2010
1990
2010
Cook Islands
…
…
…
…
…
…
100
…
94
…
…
99
98
87
…
96
100
98
100
100
91
100
Kiribati
…
…
…
…
…
…
87
97
48
…
…
76
…
33
…
26
…
…
36
…
21
…
Marshall Islands
…
…
…
…
…
…
25
84
95
94
98
94
92
97
99
64
75
82
77
83
41
53
Micronesia, Fed. States of
…
…
…
…
…
…
80
88
89
…
…
93
…
87
…
29
…
…
55
…
20
…
Nauru
…
…
…
…
…
…
…
…
98
88
99
98
88
…
…
66
65
83
66
65
…
…
Niue
…
…
…
…
…
…
…
…
100
100
100
100
100
100
100
100
100
100
100
100
100
100
Palau
…
…
…
…
…
…
67
75
80
85
90
73
83
96
96
65
100
83
78
100
36
100
Samoa
…
…
…
…
…
…
80
90
89
96
95
97
96
87
96
99
98
100
100
98
99
98
Tonga
…
…
…
…
…
…
75
83
100
100
100
100
100
100
100
96
96
98
98
98
96
96
Tuvalu
…
…
…
…
…
…
…
88
90
98
95
92
98
89
97
80
85
90
86
88
76
81
Vanuatu
…
…
…
…
4.5
0
85
96
62
90
81
94
98
55
87
…
57
…
…
64
…
54
Solomon Islands Viet Nam
Countries with < 250 000 population
*Data applies to 2000
15
Health MDGs scorecard colour code for the Western Pacific Region
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%
Decreased or no change between 2000 and 2010
Decreased or no change between 2000 and 2010
Decreased or no change between 2000 and 2009
Decreased or no change between 2000 and 2009
Decreased or no change between 2000 and 2009
Significantly decreased
High with little change or decrease
High with no change or increase
≥ 85%
70% – 84%
< 70%
Achieved at least 75% of MDG target Achieved at least 75% of MDG target
Achieved at least 50% of MDG target Achieved at least 50% of MDG target
Achieved less than 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
WHO Regions: HIV/AIDS prevalence % adults aged 15–49 6
Malaria mortality
per 100 000 population
TB treatment success rate % 7
Water
% using improved sources
Sanitation
% using improved facilities
Decreased or no change between 2000 and 2010 LMICs in WPR:
16
Data sources 1 World Health Statistics 2012 [http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf].
2 Global Health Observatory Data Repository [http://apps.who.int/ghodata/?vid=360].
3 Levels & Trends in Child Mortality Report 2011. Estimates developed by the UN Interagency Group for Child Mortality Estimation, 2011.
4 WHO/UNICEF Joint Reporting Form (JRF) on immunization. UNICEF and WHO, 2012.
5 Trends in maternal mortality: 1990 to 2010. Estimates developed by WHO, UNICEF, UNFPA and The World Bank. Geneva, WHO, 2012.
6 Global Health Observatory database. Geneva, WHO. (http://apps.who.int/ghodata/).
7 UNAIDS Report on the global AIDS epidemic 2010 [http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf].
8 World Health Organization. National malaria control programme reports. Submitted by countries to the WHO Western Pacific Regional Office. Manila, WHO, 2012.
9 Global TB database. Geneva, WHO, 2012 (http://www.who.int/tb/country/global_tb_database/en/).
10 WHO/UNICEF Joint Monitoring Programme for water and supply and sanitation. Progress on drinking-water and sanitation: 2012 update report. UNICEF and WHO, 2012. 11 Western Pacific Country Health Information Profiles 2011. Manila, World Health Organization Regional Office for the Western Pacific, 2011. Available from: [http://www.wpro. who.int/publications/PUB_9789290614913.htm]. 12 Worldwide prevalence of anaemia 1993â&#x20AC;&#x201C;2005 : WHO global database on anaemia. Geneva, WHO, 2008.
17