Achieving the health-related Millennium Development Goals in the Western Pacif ic Region

Transcription

1 Achieving the health-related Millennium Development Goals in the Western Pacif ic Region 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

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3 The Millennium Development Goals z In 2000, 189 heads of state adopted the UN Millennium Declaration. z 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

4 Health MDGs scorecard for WHO regions World Africa Americas Eastern Mediterranean Europe South-East Asia Western Pacific 4 Under-5 mortality 1 per 1000 live births (2009) Measles immunization % coverage (2008) Maternal mortality 2 per live births (2008) Skilled birth attendant % births ( ) Contraceptive use % married women aged ( ) HIV/AIDS prevalence % adults aged (2007) Malaria mortality per population (2006) TB treatment success rate % (2007) Water % using improved sources (2008) Sanitation % using improved facilities (2008) On track Insufficient progress Off track Source: World Health Statistics

5 The scorecards reveal clear priorities z The Western Pacific Region is making better progress towards the health MDGs than other WHO regions. z But progress is unequally spread both within and between countries, with rural and poor populations lagging behind. z Reducing the number of maternal and child deaths is the most urgent and obvious priority. z An estimated maternal deaths occurred in the Region in 2008, with poor women being most affected. z On the positive side, child mortality rates have improved significantly with under-5 deaths dropping by two thirds since z HIV/AIDS prevalence is low, stable or decreasing: at 1% or less in all countries in the Region. 3

6 Health MDGs scorecard for LMICs* in the Western Pacific Region (with population ) Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam 4 Under 5 mortality 3 per 1000 live births (2008) Measles immunization 4 % coverage (2009) Maternal mortality 2 per live births (2008) Skilled birth attendant 5 % births ( ) Contraceptive use 5 % married women aged ( ) HIV/AIDS prevalence 6, 7 % adults aged (2007) Malaria mortality 8, 9 per population (2008) < < < <0.1 TB treatment 10 success rate % (2007) Water 11 % using improved sources (2008) ** 94 Sanitation 11 % using improved facilities (2008) ** 75 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

7 Health MDGs scorecard for LMICs* in the Western Pacific Region (with population < ) Cook Islands Kiribati Marshall Islands, the Micronesia, the Fed. States of Nauru Niue Palau Samoa Tonga Tuvalu Vanuatu 4 Under-5 mortality 3 per 1000 live births (2008) Measles immunization 4 % coverage (2009) Maternal mortality 2 per live births (2008) Skilled birth attendant 5 % births ( ) Contraceptive use 5 % married women aged ( ) HIV/AIDS prevalence 6, 7 % adults aged (2007) Malaria mortality 8, 9 per population (2008) TB treatment 10 success rate % (2007) Water 11 % using improved sources (2008) 95 ** 65 ** ** ** 88 ** Sanitation 11 % 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

8 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, Measles immunization reaching: 90% coverage < 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, Neonatal causes 45.5% Malaria 0.6% Pneumonia 16.0% HIV/AIDS 0.4% Injuries 6.8% Measles 0.4% Diarrhoea 4.0% Others 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 All rights reserved. 6

9 5 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. Figure 2: Births attended by skilled health personnel in LMICs in the Western Pacific Region, Proportion of births attended by skilled health personnel (%) MDG SCORECARD 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. Contraceptive prevalence rate remains low in most LMICs in the Western Pacific, and data availability for this indicator is also an issue. 85% 60% 85% <60% Figure 3: Contraceptive prevalence rate (%) in LMICs in the Western Pacific Region, Countries with population Cambodia China Lao PDR Mongolia Philippines Viet Nam Countries with population < Kiribati Nauru Palau Generating accurate data on maternal mortality is difficult and depends on robust, accurate and timely vital statistics. 7

10 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 HIV / AIDS Figure 4: HIV prevalence rate among population aged years in selected LMICs in the Western Pacific Region, , 7 HIV prevalence rate Malaria Cambodia 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). Papua New Guinea Viet Nam 0.3 Malaysia 0.2 Fiji Lao People s Democratic Republic China 0.1 Mongolia Malaria is endemic in some countries in the Region, and is often linked to poverty. Figure 5: Proportion of children under-5 sleeping under insecticide-treated bednets in LMICs in the Western Pacific Region, 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. 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 DOTS coverage in LMICs remains high, while the case detection rate is 70% (2008) and the treatment success rate above 85% (2007). Cambodia Lao PDR Papua New Guinea Philippines Solomon Islands Vanuatu Malaria incidence and mortality have been decreasing since Where data are available, they show that use of insecticidetreated bednets among children under 5 is low. 8

11 1 MDG 1 Eradicate extreme poverty and hunger MDG target: Halve, between 1990 and 2015, the proportion of people who suffer from hunger 7 MDG 7 Ensure environmental sustainability MDG target: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation 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 population, Earliest data available Latest data available Target The Region is on track to reach the MDG target for use of improved drinking-water sources and sanitation facilities. Access to safe water and sanitation is still very low in many countries, especially in rural areas. Cambodia China Lao PDR Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam % 10% 20% 30% 40% 50% The number of underweight children in Lao PDR and Papua New Guinea is still of concern. Pacific island countries lack data on nutrition Figure 7: Proportion of population using an improved drinking-water Figure 11, 12 source in LMICs in the Western Pacific Region, 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 Tonga Marshall Islands Palau Urban Rural 8: Proportion of population using an improved sanitation 11, 12 facility in LMICs in the Western Pacific Region, 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 Cook Islands Niue Samoa 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Urban Rural 8 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

12 National health policy and strategy = Improving health outcomes z Faster progress towards the health MDGs will depend on better health systems to deliver effective interventions. z 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. z Requires coherent health policies, comprehensive health strategies, and the prioritization of health in national development plans. z Better health requires coherent policies and a comprehensive approach that also addresses the social, environmental and economic determinants of ill-health. z Strategies that seek synergies between programmes get better results and can accelerate progress towards the MDGs. z Greater investment in health information systems is needed to monitor health outcomes and the performance of health systems. 10

13 Policy to outcomes Policy framework National health policy and strategy National health system Interventions and programmes Better health outcomes Global National Millennium Declaration and Development Goals Primary Health Care reforms Paris Declaration on Aid Effectiveness National development policy and plan Poverty reduction strategy Legislative framework 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 Service delivery and infrastructure Health workforce Health information Medical products and technology Financing Counselling and education Clinical interventions, e.g. diagnosis and treatment of disease Protective interventions, e.g. vaccination Enabling environment, e.g. water and sanitation, public health legislation Reduced mortality and morbidity Reduced risks and threats to health Reduced inequities in health Improved health of women and children Abuja Declaration (2001) Leadership and governance Socioeconomic interventions, e.g. housing, education International Health Regulations (2005) Leadership and governance Framework Convention on Tobacco Control 11

14 Delivering effective interventions in the Western Pacific Region z Health systems are designed to deliver a set of effective clinical and public health interventions over the life course to achieve better health outcomes. z Increased investment is needed in interventions and systems that improve the health of women and children, who together represent 80% of the population. z 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. z Essential protective and clinical interventions such as immunization and treatment of disease are necessary but insufficient; socioeconomic factors must also be addressed. z 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

15 Interventions over the life course PRE-PREGNANCY PREGNANCY BIRTH POSTNATAL CHILDHOOD ADOLESCENCE ADULT/OLDER AGE Promoting breastfeeding Increasing population impact Counselling and education Clinical interventions Protective interventions Enabling environment Family planning Preventing mother-to-child transmission of HIV Growth monitoring Family planning Intermittent preventive malaria treatment Immunization 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 Safe delivery Postpartum and Management of newborn care childhood illness Insecticide-treated nets and indoor residual spraying Early detection, diagnosis and treatment of noncommunicable diseases (NCDs): cardiovascular disease, diabetes, cancer and asthma Vitamin A, micronutrients Sexual and reproductive health counselling Deworming and other preventive treatment for NTDs Cancer screening Safe water and improved sanitation, Reducing stigma and discrimination, Encouraging physical activity, Better nutrition, Road safety, and Health legislation Increasing individual effort needed Socioeconomic interventions Housing, Education, Employment, Early childhood development, Empowerment of women and gender equity 13

16 Sustained and equitable f inancing to achieve the MDGs z Paying for care directly out-of-pocket payments prevents millions of people from using health services and can lead to impoverishment. z 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. z In six LMICs in the Region, out-of-pocket payments account for over 40% of total health expenditure. z Financing policies that seek to pool risk and resources for example through insurance or tax-based finance offer better financial protection z 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. z Spending on health in low-income countries needs to increase from US$ 31 billion now to US$ 67 billion US$ 76 billion by The bulk of this money will come from domestic sources, though many LMICs will also require aid for the foreseeable future. z Aid for health must be predictable, sustained, aligned with national priorities and provided in ways that minimize transaction costs. Figure 9: Source of health financing as proportion of total expenditure on health for LMICs in the Western Pacific Region, Tuvalu Niue Marshall Islands Micronesia, Fed. States of Solomon Islands Cook Islands Samoa Kiribati Papua New Guinea 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

17 Supporting national ef forts to achieve the MDGs is core business for WHO z Setting norms and standards such as treatment guidelines and health service standards is a core WHO function, underpinning our technical support for the MDGs. z WHO s analytic work on social and economic determinants highlights the magnitude and nature of broader risks to health. z WHO uses its technical expertise and convening power to assist national authorities as they seek to develop coherent and wellcosted national strategies. z 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. z A key function in relation to the MDGs is the collection and dissemination of data on health status

18 Tables MDG 1 MDG 4 MDG 5 Prevalence of underweight children (%) Infant mortality rate per live births Under-5 mortality rate per live births Measles immunization % coverage Maternal mortality ratio per live births Proportion of births attended by skilled health personnel (%) Contraceptive prevalence rate (%) Countries with population Target Cambodia China Fiji 7 4 Lao PDR Malaysia 18 9 Mongolia Papua New Guinea 25 (1983) Philippines Solomon Islands 16 (1989) 12 8 Viet Nam Countries with < population Cook Islands Kiribati Marshall Islands Micronesia, Fed. States of Nauru Niue Palau Samoa 2 1 Tonga Tuvalu 2 Vanuatu target target target

19 Tables MDG 6` MDG 7 HIV prevalence rate (%) among population aged years Malaria mortality rate per population Tuberculosis treatment success rate (%) Proportion of population using improved drinking-water source (%) Proportion of population using improved sanitation facility (%) Urban Rural Urban Rural Countries with population Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam Countries with < population Cook Islands Kiribati Marshall Islands Micronesia, Fed. States of Nauru Niue Palau Samoa Tonga Tuvalu Vanuatu cohort 1995 cohort < < <0.1 < < < < <

20 Health MDGs scorecard colour code for LMICs in the Western Pacific Region (with population ) On Track Insufficient Progress Off Track 4 Under-5 mortality per 1000 live births Achieved at least 75% Achieved at least 50% Achieved less than 50% 5 Measles immunization % coverage Maternal mortality per live births Skilled birth attendant % births Contraceptive use % married women aged % < 90% N/A Achieved at least 75% Achieved at least 50% Achieved less than 50% 85% 60% 84% < 60% 60% 30% 59% < 30% HIV/AIDS prevalence % adults aged Decreased or no change between 2001 and 2007 Increased but still low prevalence between 2001 and 2007 Significantly increased between 2001 and Malaria mortality per population Significantly decreased High with little change or decrease High with no change or increase TB treatment success rate % 85% 70% 84% < 70% 7 Water % using improved sources Achieved at least 75% Achieved at least 50% Achieved less than 50% Sanitation % using improved facilities Achieved at least 75% Achieved at least 50% Achieved less than 50% 18

21 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, Trends in maternal mortality: 1990 to 2008: Estimates developed by WHO, UNICEF, UNFPA and The World Bank. WHO, Geneva, ( 3 UN Inter-agency Group for Child Mortality Estimation (IGME). Trends in under-five mortality rates ( ). New York, UNICEF, 2009 ( ufmrcountrydata.php). 4 World Health Organization and United Nations Children s Fund. WHO/UNICEF measles coverage estimates for Geneva, WHO and New York, UNICEF, May Global health observatory database. Geneva, WHO, 2010 [ 6 Joint United Nations Programme on HIV/AIDS. Adult (15-49) HIV prevalence percent by country, Report on the global AIDS epidemic. Geneva, UNAIDS, 2008 ( 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 ( wpro.who.int/topics/malaria/en/). 9 World Health Organization, World malaria report Geneva, WHO, 2009 ( 10 Global TB database. Geneva, WHO, 2010 ( 11 World Health Organization and United Nations Children s Fund. Progress on sanitation and drinking-water: 2010 update report. Geneva, WHO, 2010 [ 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, [ 13 World Health Organization. National Health accounts country health information. Geneva, WHO, 2010 ( Other data source World Health Organization. Health in Asia and the Pacific. India, WHO,

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