UHC and SDG Country Profile 2018 Australia

Transcription

1 UHC and SDG Country Profile 2018 Australia Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 High income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 80 Australia 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The vision of the Department of Health Strategic Intent is "Better health and wellbeing for all Australians, now and for future generations." The purpose of the strategic intent is to lead and shape Australia s health and aged care system and support outcomes through evidence based policy, well targeted programs, and best practice regulation. It focuses on three priorities: better health and ageing outcomes and reduced inequality; affordable, accessible, efficient, and high quality health and aged care system; and better sport outcomes. Based on estimates of the financial burden for health, more than people (1% of the population) incurred high out-of-pocket health payments, which suggest gaps in financial protection for health. People in the poorest quintile seem to be most vulnerable to out-of-pocket expenses. The majority of SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, Australia fared relatively well in reproductive, maternal, newborn and child health (RMNCH), in infectious diseases, in urban and environmental health, and in health system resources and service capacity. However, challenges remain in noncommunicable disease (NCD) prevention and control; Australia has one of the highest rates of per capita alcohol consumption in the Region. Disaggregated data relating to some population groups are currently unavailable. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 1.1% Australia 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 6 tracer indicators > 80 5 tracer indicators Service capacity and access Note: Refer to page 2 Compared to other countries in the Western Pacific Region, Australia has high coverage of essential services. 0 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 14 indicators > 70% 0 indicators 40 70% 2 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Australia 1

2 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 100 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 90 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Australia? Financial risk protection by place of residence and economic status 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 4.0% Rural Urban Poorest (q1) 0.2% 0.3% 0.1% 0.1% Second poorest (q2) Middle (q3) 2010 How does Australia compare to other countries in the Region? Second richest (q4) Richest (q5) Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 3.5 physicians per 1000 pop (2015); 13.7 psychiatrists per pop (2015); 20.3 surgeons per pop (2015) c No estimate; regional or imputed value used as placeholder 6% 5% KHM VNM CHN 4% JPN KOR 3% 2% PHL MNG 1% LAO FJI AUS MYS 0% UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Australia

3 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Australia has a value of 88%, meaning it has performed at 88% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Australia from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 98% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 87% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 84% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ % e TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a % 77% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 100% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 3.b.2 Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Australia being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Australia 3

4 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Australia was the Household Expenditure Survey (HES), Australian Bureau of Statistics from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Australia does not report data to this tool. WPR/2018/DHS/001 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Australia

5 UHC and SDG Country Profile 2018 Brunei Darussalam Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 High income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 80 Brunei Darussalam 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, Brunei Darussalam has high coverage of essential services. Relatively low out-of-pocket spending suggests a low risk of financial hardship. However, as health services are predominantly government subsidized, further efforts to support sustainable financing are required. The UHC index indicates some gaps in tuberculosis (TB) detection and treatment, as well as concerns with the prevalence of tobacco use and raised blood pressure. The majority of SDG 3 indicators are close to the target Compared to other countries in the Region, Brunei Darussalam fared relatively well with indicators for SDG 3, including those for reproductive, maternal, newborn and child health (RMNCH), for urban and environmental health, and for health system resources and capacity. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Brunei Darussalam 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 7 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 The Vision 2035 and Health Strategy aimed to introduce the key elements of the new Ministry of Health strategy, in line with Wawasan Brunei 2035 and focused on comprehensive healthcare system that emphasises service excellence, embraces and practices healthy lifestyle, sustainability through resource optimization, innovation and excellence, effective policies and regulations that ensure protection for all, and transparent and proactive governance. 1 tracer indicator < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 14 indicators > 70% 0 indicators 40 70% 1 indicator < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Brunei Darussalam 1

6 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) noncommunicable diseases (NCDs); and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 97 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category 2 Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value Brunei Darussalam 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), c 83 Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 86 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 72 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Brunei Darussalam? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.5 physicians per 1000 pop (2015); 4.3 psychiatrists per pop (2015); 22.5 surgeons per pop (2015) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Brunei Darussalam compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB NIU BRN VUT NRU 60 TUV Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of

7 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Brunei Darussalam has a value of 86%, meaning it has performed at 86% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% < 40% How far is Brunei Darussalam from the SDG targets? SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 98% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 97% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 3.1% 96% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 73% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 3.b.2 Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Brunei Darussalam being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Brunei Darussalam 3

8 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Brunei Darussalam does not report data to this tool. WPR/2018/DHS/002 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Brunei Darussalam

9 UHC and SDG Country Profile 2018 Cambodia Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 55 Cambodia 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The vision of the Health Strategic Plan is for Cambodians to "have better health and wellbeing, thereby contributing to sustainable socioeconomic development." To achieve this, the plan sets out health development goals including: improving reproductive health and reducing maternal, child, and new-born mortality; reducing morbidity and mortality due to communicable and noncommunicable diseases; and making health system more accountable and responsive to health needs of the population. Out-of-pocket spending remains a particular challenge and is high by regional standards, with an estimated 3.8% of households incurring high out of pocket health payments, which suggests gaps in financial protection for health. The data show a large variation between quintiles, with catastrophic expenditures greatest in the wealthiest quintiles due to seeking services in the private sector and overseas, and limited access to services in the poorest quintiles. While service coverage remains relatively high for maternal and child health and for immunization services, key challenges include the provision of noncommunicable disease (NCD) services, tuberculosis (TB) and hepatitis detection and treatment, and access to improved sanitation. Several SDG 3 indicators are close to the target Cambodia shows relatively advanced progress towards newborn and child health indicators and some infectious disease indicators. However, significant progress is required to achieve maternal mortality and family planning targets, and relatively large inequities persist in the adolescent birth rate and in neonatal and under 5 mortality. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 4.8% Cambodia 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 2 tracer indicators > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 Cambodia has relatively low coverage of many essential services. It continues to face significant challenges in access to and quality of services and capacity for service delivery, compared to other countries in the Western Pacific Region. 5 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 8 indicators > 70% 6 indicators 40 70% 4 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Cambodia 1

10 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) reproductive, maternal, newborn and child health (RMNCH); (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 33 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis detection and treatment (%), HIV antiretroviral treatment (%), Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), c 100 Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Cambodia? Financial risk protection by place of residence and economic status 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 5.4% 2.6% 1.3% Rural Urban Poorest (q1) 2.6% 2.5% Second poorest (q2) Middle (q3) % Second richest (q4) 10.0% Richest (q5) How does Cambodia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.2 physicians per 1000 pop (2015); 0.3 psychiatrists per pop (2014); 0.8 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder 6% 5% VNM CHN 4% KHM JPN 3% KOR 2% PHL MNG 1% LAO FJI AUS 0% MYS UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Cambodia

11 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Cambodia has a value of 47%, meaning it has performed at 47% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Cambodia from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 82% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 78% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 32% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 74% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ % e TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ % e Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 2.8% 97% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 42% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Cambodia being left behind?²⁶ Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) 79% 99% 91% 99% 8% SDG Under-5 mortality rate (per 1000 live births) % % % % SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods 95% 98% 3% 97% 97% 0% SDG Adolescent birth rate (per 1000 women aged years) % % SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) 72% 96% 26% 82% 93% 12% Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Source: DHS, 2014 Cambodia 3

12 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Cambodia National Health Accounts Report, WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Cambodia was the Cambodia Socioeconomic Survey (CSES), National Institute of Statistics from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Cambodia, the tool used the Demographic and Health Survey (DHS) conducted in WPR/2018/DHS/003 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Cambodia

13 UHC and SDG Country Profile 2018 China Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 Upper middle income Income Gini coefficient³ (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 76 China 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The 13th Five-Year Plan for Health Sector Development ( ) and the 13th Five- Year Plan on Deepening the Medical System Reform set out China s strategic direction and define tasks for implementation. The action plan for a Healthy China includes: disease prevention and treatment and basic public healthcare services; promote maternal and infant health; birth defect prevention and treatment; strengthening the provision of community-level medical services; impart and innovate traditional Chinese medicine; smarter healthcare; popular fitness, and food and medicine safety. Based on 2007 survey data, 4.8% of the population incurred high out-ofpocket health payments, which suggests gaps in financial protection for health; the wealthiest quintiles are more affected by catastrophic expenditures. The majority of SDG 3 indicators are close to the target Compared to other countries in the Region, China fared relatively well with SDG 3 indicators, particularly in reproductive, maternal, newborn and child health (RMNCH). China has made major progress in malaria elimination, but an unfinished agenda for tuberculosis (TB) and other infectious diseases requires attention. However, challenges remain in noncommunicable disease (NCD) prevention and control and in urban and environmental health, specifically with regard to male smoking, alcohol consumption per capita, and mortality attributed to household and ambient air pollution for which China has one of the highest rates in the Region. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 4.8% China 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 5 tracer indicators > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 Compared to other countries in the Western Pacific Region, China has relatively high coverage of essential services. 2 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 11 indicators > 70% 0 indicators 40 70% 5 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 China 1

14 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% Service capacity and access 100 < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), c 74 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 79 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), c 75 Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in China? Financial risk protection by place of residence and economic status 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 4.9% 4.6% 3.5% Rural Urban Poorest (q1) 4.4% Second poorest (q2) 5.5% 5.1% 5.3% Middle (q3) Second richest (q4) Richest (q5) How does China compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* 6% 5% 4% 3% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.5 physicians per 1000 pop (2011); 1.7 psychiatrists per pop (2014); 21.6 surgeons per pop (2012) c No estimate; regional or imputed value used as placeholder KHM VNM JPN CHN KOR 2% PHL MNG 1% FJI AUS LAO MYS 0% UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 China

15 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, China has a value of 96%, meaning it has performed at 96% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is China from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 98% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 97% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ % e Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 1.8% 99% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 35% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in China being left behind?²⁶ Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) 100% 100% 0% SDG Under-5 mortality rate (per 1000 live births) % SDG Neonatal mortality rate (per 1000 live births) % SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Source: 2017 China Health and Family Planning Statistical Yearbook China 3

16 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in China was the China Household Income Project Series (CHIP), University of Michigan from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For China, the tool used the China Health and Family Planning Statistical Yearbook conducted in WPR/2018/DHS/004 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 China

17 UHC and SDG Country Profile 2018 Cook Islands Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² N/A Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 41 Cook Islands 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The Ministry of Health s new health strategic plan- Takai anga Angaanga Tutara A Te Marae Ora: Cook Islands National Health Strategic Plan , aims to "provide accessible, affordable health care and equitable health services of the highest quality, by and for all in order to improve the health status of people living in the Cook Islands." Cook Islands has relatively low out-of-pocket spending as a percentage of gross domestic product, which suggests a low risk of financial hardship. Based on the UHC index, major challenges remain in NCD prevention and control, specifically tobacco use and the prevalence of raised blood pressure. Only a few SDG 3 indicators are reported Compared to other countries in the Region for SDG 3 indicators, Cook Islands is relatively close to the targets for RMNCH, except for the adolescent birth rate. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Cook Islands 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 3 tracer indicators > 80 2 tracer indicators Service capacity and access Note: Refer to page 2 Compared to other countries in the Western Pacific Region, Cook Islands has relatively high coverage in reproductive, maternal, newborn and child health (RMNCH) services, except in family planning and noncommunicable disease (NCD) control. 6 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 6 indicators > 70% 2 indicators 40 70% 1 indicator < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Cook Islands 1

18 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 51 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), c 59 Antenatal care, 4+ visits (%), c 74 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 86 Tuberculosis detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Cook Islands? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.5 physicians per 1000 pop (2015); 0 psychiatrists per pop (2015); 11.2 surgeons per pop (2015) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Cook Islands compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB NIU BRN VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Cook Islands

19 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Cook Islands has a value of 48%, meaning it has performed at 48% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Cook Islands from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 98% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 97% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ 3.a.1 Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ 3.a.1 Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Cook Islands being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Cook Islands 3

20 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Cook Islands does not report data to this tool. WPR/2018/DHS/005 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Cook Islands

21 UHC and SDG Country Profile 2018 Japan Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 High income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 80 Japan 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Health policy in 2017 in Japan has 8 main policies: 1) establishment of a medical care system for the future, 2) promotion of innovations in the pharmaceutical and medical device industries, 3) an attempt at "new medical care", 4) enhancing sustainability of health insurance systems to protect a sense of security in our daily life, 5) towards realizing improved medical care by the medical fee revision, 6) promoting disease prevention/health promotion to optimize medical expenditure, 7) realizing a society in which people can live with a sense of security even though they have cancer, 8) preventing the occurrence/spread of infectious diseases to support the safety and security of the people Compared to other countries in the Wester Pacific Region, Japan has high coverage of esential services. Based on 2008 survey data, 4.2% of the population incurred high out-of-pocket health payments, which suggests gaps in financial protection for health; further study is required. The UHC index indicates challenges in noncommunicable disease (NCD) prevention and control, specifically a high prevalence of raised blood pressure and tobacco use. The majority of SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, Japan fared well in reproductive, maternal, newborn and child health(rmnch), as well as in infectious diseases and in health system resources and capacity. However, challenges remain in NCD prevention and control, especially regarding alcohol consumption per capita. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 4.2% Japan 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 6 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 2 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 11 indicators > 70% 1 indicator 40 70% 2 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Japan 1

22 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% Service capacity and access 100 < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), c 97 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 89 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 72 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Japan? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Japan compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* 6% 5% 4% 3% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 2.3 physicians per 1000 pop (2012); 8.4 psychiatrists per pop (2014); 16.8 surgeons per pop (2013) c No estimate; regional or imputed value used as placeholder KHM VNM CHN JPN KOR 2% PHL MNG 1% LAO AUS FJI MYS 0% UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of financial hardship Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Japan

23 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Japan has a value of 97%, meaning it has performed at 97% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Japan from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 97% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a % 82% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 64% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 3.b.2 Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Japan being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Japan 3

24 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Japan was the Japan Household Panel Survey (JHPS), Panel Data Research Center at Keio University from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Japan does not report data to this tool. WPR/2018/DHS/007 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Japan

25 UHC and SDG Country Profile 2018 Kiribati Objectives Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Key Messages Overall progress towards universal health coverage (UHC) The primary goal of the Kiribati Health Strategic Plan is to improve population health and health equity through continuous improvement in the quality and responsiveness of health services, and by making the most effective and efficient use of available resources Compared to other countries in the Western Pacific Region, Kiribati has relatively low coverage of essential services. The UHC index indicates relatively limited service capacity and access. Country statistics Health system Population¹ GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 40 Kiribati 40 Region (lowest) The population in Kiribati is at relatively low risk of, although this may indicate limited access to health services. Based on the UHC index, major challenges remain in the prevention and control of infectious diseases and noncommunicable diseases (NCDs), especially access to improved sanitation and the prevalence of raised blood pressure. Majority of SDG 3 indicators are far from the targets Compared to other countries in the Region, gaps exist in reproductive, maternal, newborn and child health (RMNCH), except in maternal mortality rate and skilled birth attendance. Kiribati s under-5 and neonatal mortality rates are among the highest in the Region, while the use of family planning is among the lowest rates regionally. Gaps exist in the prevention and control of infectious diseases and NCDs and in urban and environmental health. Kiribati has one of the Region s highest rates of male and female smoking, tuberculosis (TB) incidence and mortality attributed to unintentional poisoning. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Kiribati 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 1 tracer indicator > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 6 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 3 indicators > 70% 3 indicators 40 70% 8 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Kiribati 1

26 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) reproductive, maternal, newborn and child health (RMNCH); (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 62 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Kiribati? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.2 physicians per 1000 pop (2013); 1.8 psychiatrists per pop (2015); 3.6 surgeons per pop (2015) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Kiribati compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% SLB NIU BRN KIR VUT NRU 60 TUV Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Kiribati

27 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Kiribati has a value of 53%, meaning it has performed at 53% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Kiribati from the SDG targets? < 40% SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 97% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 58% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 0% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 50% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a % 22% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 0% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Kiribati being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Kiribati 3

28 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Kiribati does not report data to this tool. WPR/2018/DHS/008 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Kiribati

29 UHC and SDG Country Profile 2018 Lao People s Democratic Republic Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ Key Messages Overall progress towards universal health coverage (UHC) The Health Sector Reform Framework provides a road map to build a resilient health system and achieve UHC by 2025, including a consequent increase of domestic spending on health. General government health expenditures as a percentage of total government expenditures have been gradually increased from 3.4% to 5.9% over the past four years. Access to, coverage of and the use of essential health services are improving, but remain limited compared to other countries in the Western Pacific Region. The number of health workers per people has increased, but remains among the lowest in the Region. Challenges include the prevention, detection and management of infectious diseases and noncommunicable diseases (NCDs), as well as reproductive, maternal, newborn and child health (RMNCH), in which progress has been slow compared to other countries in the Region. Majority of SDG 3 indicators are far from the targets Notable progress has been made in improving maternal health and reaching the Millennium Development Goal (MDG) targets. However, further efforts are required as the maternal, neonatal and under-5 mortality rates remain among the highest in the Region, and skilled birth attendance is among the lowest. There are gaps in NCD prevention and control and urban and environmental health. The country has one of the highest rates of male smoking and of mortality attributed to exposure to unsafe water, sanitation and hygiene (WASH) services. Inequities in skilled birth attendance and child immunization are apparent. UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 48 Lao People s Democratic Republic 40 Region (lowest) 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 0.7% Lao People s Democratic Republic 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 2 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 6 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 2 indicators > 70% 5 indicators 40 70% 10 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Lao People s Democratic Republic 1

30 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% Service capacity and access 34 < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in the Lao People s Democratic Republic? Financial risk protection by place of residence and economic status 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 1.5% 1.8% 0.7% 0.9% 1.6% 2.1% 3.2% Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does the Lao People s Democratic Republic compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* Service capacity and access 11 6% 5% 4% 3% 2% 1% 0% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.2 physicians per 1000 pop (2012); 0 psychiatrists per pop (2014); 1 surgeon per pop (2014) c No estimate; regional or imputed value used as placeholder LAO KHM PHL VNM JPN CHN MNG AUS FJI MYS KOR UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Lao People s Democratic Republic

31 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Lao People s Democratic Republic has a value of 11%, meaning it has performed at 11% of the bestperforming country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% < 40% How far is the Lao People s Democratic Republic from the SDG targets? SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 0% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 60% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 40% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 53% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ % e Are population groups in the Lao People s Democratic Republic being left behind?²⁶ Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) 11% 91% 88% 31% 80% 61% SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) 37% 81% 55% 52% 68% 23% Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 9.1% 85% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 15% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Source: Multiple Indicator Cluster Survey, 2011 Lao People s Democratic Republic 3

32 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Lao People s Democratic Republic National Health Accounts Report ( ). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in the Lao People s Democratic Republic was the Lao Expenditure and Consumption Survey (LECS), National Statistics Center from 2007/ Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For the Lao People s Democratic Republic, the tool used the Multiple Indicator Cluster Survey (MICS) conducted in WPR/2018/DHS/009 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Lao People s Democratic Republic

33 UHC and SDG Country Profile 2018 Malaysia Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 Upper middle income Income Gini coefficient³ (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 70 Malaysia 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The 11th Malaysia Plan identified health as a key component of the plan s major thrust improving well-being for all. This will focus on addressing underserved populations, improving health system delivery to enhance efficiency and effectiveness, and intensifying collaboration with the private sector and Non-Governmental Organizations (NGOs). Compared to other countries in the Western Pacific Region, Malaysia has relatively high coverage of essential services. Despite Malaysia having relatively high out-of-pocket spending as a percentage of current health expenditures (36%), the population is at low risk of. The UHC index indicates gaps in family planning, prevalence of raised blood pressure, and in infectious diseases prevention and control, specifically HIV treatment and tuberculosis (TB) detection and treatment, for which a recent increase in incidence might be further monitored. Based on Malaysia s national health sector strategy, TB detection and treatment is lower than the national target. Several SDG 3 indicators are close to the target Compared to other countries in the Region, Malaysia fared relatively well in reproductive, maternal, newborn and child health (RMNCH), in urban and environmental health, and in health system resources and service capacity. However, further efforts are required in noncommunicable disease (NCD) prevention and control, specifically to address male smoking. The results also indicate gaps on HIV prevention and control. Compared to other countries, Malaysia has a relatively high road-traffic mortality rate. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 0.0% Malaysia 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 4 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 4 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 14 indicators > 70% 2 indicators 40 70% 1 indicator < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Malaysia 1

34 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 89 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 87 Tuberculosis detection and treatment (%), HIV antiretroviral treatment (%), Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Malaysia? Financial risk protection by place of residence and economic status 0.10% 0.08% 0.06% 0.04% 0.02% 0.00% 0.03% 0.04% 0.00% Rural Urban Poorest (q1) 0.01% Second poorest (q2) 0.05% Middle (q3) % Second richest (q4) 0.04% Richest (q5) How does Malaysia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.3 physicians per 1000 pop (2011); 0.8 psychiatrists per pop (2014); 6.9 surgeons per pop (2011) c No estimate; regional or imputed value used as placeholder 6% 5% KHM VNM CHN 4% JPN 3% KOR 2% PHL MNG AUS 1% LAO FJI MYS 0% UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Malaysia

35 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Malaysia has a value of 89%, meaning it has performed at 89% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Malaysia from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 98% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 96% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 95% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ % e TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ % e Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 1.4% 100% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 44% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Malaysia being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Malaysia 3

36 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Malaysia was the Household Expenditure Survey (HES), Department of Statistics Malaysia from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Malaysia does not report data to this tool. WPR/2018/DHS/010 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Malaysia

37 UHC and SDG Country Profile 2018 Marshall Islands Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 Upper middle income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 40 Marshall Islands 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, the Marshall Islands has relatively low coverage of essential services. The UHC index also indicates relatively limited service capacity and access. The population in the Marshall Islands faces a relatively high risk of financial hardship. Based on the UHC index, major challenges remain in the prevention and control of infectious and noncommunicable diseases (NCDs) and in service capacity and access, specifically in the prevalence of raised blood pressure, which is high compared to other countries in the Region. Only a few SDG 3 indicators are reported Compared to other countries in the Region, the Marshall Islands is far from reaching the targets in reproductive, maternal, newborn and child health (RMNCH), except in the rates of skilled birth attendance and of neonatal and under-5 mortality; immunization and adolescent births might require further monitoring. Gaps exist in infectious diseases prevention and control and in health system resources and capacity; the Marshall Islands has one of the highest rates of tuberculosis (TB) incidence compared to other countries in the Region. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Marshall Islands 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 2 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 The 3-Year Rolling Strategic Plan , focuses on health as a shared responsibility. The mission is "to strengthen the commitment on healthy islands concept in implementing health promotion to protect and promote healthy lifestyles to improve the lives of the people through primary health, and to build the capacity of Ministry of Health, communities, families and partners to actively participate and coordinate preventive services programs and activities as the core resources in primary health care services." 6 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 3 indicators > 70% 2 indicators 40 70% 4 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Marshall Islands 1

38 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 43 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), c 59 Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 62 Tuberculosis detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), c 49 Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in the Marshall Islands? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, c Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.5 physicians per 1000 pop (2012); 0 psychiatrist per pop (2014); 11.4 surgeons per pop (2011) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does the Marshall Islands compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB NIU BRN VUT NRU 60 TUV Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Marshall Islands

39 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Marshall Islands has a value of, meaning it has performed at of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% < 40% How far is the Marshall Islands from the SDG targets? SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² Proportion of births attended by skilled health personnel (%)¹³ % 83% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 40% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 70% e Adolescent birth rate (per 1000 women aged years)¹⁶ e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 24% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ 3.a.1 Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ 3.a.1 Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in the Marshall Islands being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Marshall Islands 3

40 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Marshall Islands does not report data to this tool. WPR/2018/DHS/011 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Marshall Islands

41 UHC and SDG Country Profile 2018 Federated States of Micronesia Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 60 Federated States of Micronesia 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, the Federated States of Micronesia has relatively high coverage of essential services. The Federated States of Micronesia has relatively low out-of-pocket spending, which suggests a low risk of. The UHC index indicates major challenges in infectious and noncommunicable diseases (NCDs), specifically in tobacco use, prevalence of raised blood pressure and access to improved sanitation. A few SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, the Federated States of Micronesia fared relatively well in reproductive, maternal, newborn and child health (RMNCH). However, gaps exist in immunization coverage, with the Federated States of Micronesia having one of the lowest coverage rates in the Region. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Federated States of Micronesia 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 0 tracer indicators > 80 5 tracer indicators Service capacity and access Note: Refer to page 2 In 2014, the recommendations from a Health Summit were translated into the Framework for Sustainable Health Development ( ). The framework aims to ensure that people and communities are healthy and enjoy universal access to quality health services and essential health services. 6 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 5 indicators > 70% 4 indicators 40 70% 2 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Federated States of Micronesia 1

42 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 70 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), c 59 Antenatal care, 4+ visits (%), c 74 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 65 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), c 49 Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in the Federated States of Micronesia 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, c Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.2 physicians per 1000 pop (2009); 1 psychiatrists per pop (2014); 10.6 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does the Federated States of Micronesia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for ÿ nancial protection (OOPS/GDP per capita, %)* Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN FSM SGP AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB NIU BRN VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Federated States of Micronesia

43 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Federated States of Micronesia has a value of 70%, meaning it has performed at 70% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% < 40% How far is the Federated States of Micronesia from the SDG targets? SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 47% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 18% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ 3.a.1 Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ 3.a.1 Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in the Federated States of Micronesia being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Federated States of Micronesia 3

44 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Micronesia (Fed States of) does not report data to this tool. WPR/2018/DHS/012 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Federated States of Micronesia

45 UHC and SDG Country Profile 2018 Mongolia Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 63 Mongolia 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The State Policy on Health ( ) was introduced to extend the average life expectancy of Mongolians by improving quality and inclusivity of healthcare services through disease prevention; introducing new evidence-based diagnostics and treatment; and ensuring proper system of health sector financing in order to meet the health needs and demand of the population. Compared to other countries in the Western Pacific Region, Mongolia has relatively high coverage of essential services. Based on 2014 survey data, more than people (1.7% of the population) made high out-of-pocket health payments, which indicates gaps in financial protection for health. Based on the UHC index, major challenges remain in the prevention and control of infectious diseases and noncommunicable diseases (NCDs), specifically tuberculosis (TB) detection and treatment, HIV antiretroviral treatment and access to improved sanitation. Several SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, Mongolia shows advanced progress in reproductive, maternal, newborn and child health (RMNCH), except for family planning. Gaps exist in NCD prevention and control and in urban and environmental health, specifically in total alcohol consumption, male smoking, and mortality attributed to unintentional poisoning and household and ambient air pollution. Based on the reported indicators, there are no apparent inequities across residence and wealth quintiles. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 1.7% Mongolia 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 3 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 5 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 10 indicators > 70% 2 indicators 40 70% 5 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Mongolia 1

46 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 88 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis detection and treatment (%), HIV antiretroviral treatment (%), c 33 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), c 78 Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Mongolia? Financial risk protection by place of residence and economic status 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 1.5% 1.8% 0.7% 0.9% Rural Urban Poorest (q1) Second poorest (q2) 1.6% Middle (q3) % Second richest (q4) 3.2% Richest (q5) How does Mongolia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 2.9 physicians per 1000 pop (2011); 0.5 psychiatrists per pop (2011); 14.1 surgeons per pop (2013) c No estimate; regional or imputed value used as placeholder 6% 5% KHM VNM CHN 4% JPN 3% KOR 2% PHL MNG AUS 1% LAO FJI MYS 0% UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Mongolia

47 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Mongolia has a value of 76%, meaning it has performed at 76% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Mongolia from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 98% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 98% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 51% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 97% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ % e TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 5.3% 92% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 34% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Mongolia being left behind?²⁶ Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) 98% 99% 2% 98% 99% 1% SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) 91% 96% 5% 91% 94% 3% Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Source: MICS, 2010 Mongolia 3

48 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Mongolia was the Mongolia Household Income and Expenditure Survey (HIES), National Statistical Office from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Mongoliathe tool used the Multiple Indicator Cluster Survey (MICS) conducted in WPR/2018/DHS/013 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Mongolia

49 UHC and SDG Country Profile 2018 Nauru Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 Upper middle income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 51 Nauru 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The vision of the Nauru Health Strategic Plan for is "a healthy and peaceful nation that values and supports human rights and dignity through the provision of quality care and services." Five key areas have been identified and focus on strengthening health system capacity and capability to meet health service needs, demand and expectations, on strengthening and improving community preventive and health care services, on providing high quality clinical care and services, and supporting the clinical and health programme role and functions of the Ministry. Despite relatively high geographic coverage of essential services provided at the primary and secondary levels, there are opportunities for further enhancements in overall service coverage. Nauru has relatively low out-of-pocket spending, which suggests a low risk of. Based on the UHC index, major challenges remain in noncommunicable disease (NCD) prevention and control, as well as reproductive, maternal, newborn and child health (RMNCH), specifically neonatal care and diabetes and its complications. Only a few SDG 3 indicators are reported Compared to other countries in the Region for SDG 3 indicators, Nauru shows relatively close proximity to targets in some aspects of RMNCH, specifically skilled birth attendance, under-5 mortality and immunization coverage. However, the adolescent birth rate and family planning have some of the highest and lowest values, respectively, in the Western Pacific Region. Gaps exist in the prevention and control of NCDs: Nauru has one of the highest rates of male and female smoking prevalence in the Region. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Nauru 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 2 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 6 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 6 indicators > 70% 1 indicator 40 70% 5 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Nauru 1

50 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 43 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), c 59 Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Nauru? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, c Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1 physicians per 1000 pop (2010); 0 psychiatrists per pop (2011); 9.8 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Nauru compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB NIU BRN VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Nauru

51 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Nauru has a value of 0%, meaning it has performed at 0% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Nauru from the SDG targets? < 40% SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² Proportion of births attended by skilled health personnel (%)¹³ % 95% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 80% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 10% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 76% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a % 0% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 44% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Nauru being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Nauru 3

52 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Nauru does not report data to this tool. WPR/2018/DHS/014 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Nauru

53 UHC and SDG Country Profile 2018 New Zealand Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 High income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 80 New Zealand 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, New Zealand has high coverage of essential services. New Zealand has relatively low out-of-pocket spending, which suggests a low risk of. The UHC index indicates gaps in noncommunicable disease (NCD) prevention and control. The majority of SDG 3 indicators are close to the target Compared to other countries in Region for SDG 3 indicators, New Zealand fared well in reproductive, maternal, newborn and child health (RMNCH), as well as in infectious diseases and in urban and environmental health. Gaps exist in NCD prevention and control, specifically in total alcohol consumption. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A New Zealand 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 6 tracer indicators > 80 5 tracer indicators Service capacity and access Note: Refer to page 2 The New Zealand Health Strategy: Future direction outlines the high-level direction for New Zealand s health system over the 10 years. It lays out some of the challenges and opportunities the system faces and identifies five strategic themes, including: people-powered; closer to home; value and high performance; one team; and smarter system for the changes that will take them toward this future. 0 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 11 indicators > 70% 0 indicators 40 70% 2 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 New Zealand 1

54 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 99 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), c 97 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 86 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 72 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in New Zealand? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 3 physicians per 1000 pop (2015); 18 psychiatrists per pop (2015); 18.3 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does New Zealand compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN PNG WSM TON NZL 0% KIR SLB NIU BRN VUT NRU 60 TUV Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 New Zealand

55 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, New Zealand has a value of 83%, meaning it has performed at 83% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is New Zealand from the SDG targets? < 40% SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % e Proportion of births attended by skilled health personnel (%)¹³ % 95% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 82% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 79% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ 3.a.1 Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ 3.a.1 Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 3.b.2 Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in New Zealand being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) New Zealand 3

56 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, New Zealand does not report data to this tool. WPR/2018/DHS/015 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 New Zealand

57 UHC and SDG Country Profile 2018 Niue Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² N/A Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 64 Niue 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, Niue has high coverage of essential services. Niue has relatively low out-of-pocket spending as a percentage of gross domestic product, which suggests a low risk of. Based on the UHC index, gaps remain in family planning and in the prevalence of raised blood pressure. Several SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, Niue shows close proximity to the targets in reproductive, maternal, newborn and child health (RMNCH), as well as infectious diseases and noncommunicable diseases (NCDs), except in alcohol consumption per capita. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Niue 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 4 tracer indicators > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 The vision of the Niue Health Strategic Plan (NHSP), ( ) is is a healthy population, well supported by quality health services. In support of that Vision, the goal of the NHSP is to ensure that all those living in Niue are encouraged and supported to live healthy lives and has three objectives: to improve the health of those living in Niue; to continually improve the quality of health services; and to ensure that health services are efficient and value for money. 3 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 9 indicators > 70% 1 indicator 40 70% 1 indicator < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Niue 1

58 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 51 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), c 59 Antenatal care, 4+ visits (%), c 74 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 64 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), c 84 Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Niue? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, c Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.8 physicians per 1000 pop (2008); 0 psychiatrists per pop (2011); 62.1 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Niue compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB BRN VUT NIU NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Niue

59 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Niue has a value of 88%, meaning it has performed at 88% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Niue from the SDG targets? < 40% SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 98% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 97% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a % 80% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 92% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Niue being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Niue 3

60 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Niue does not report data to this tool. WPR/2018/DHS/016 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Niue

61 UHC and SDG Country Profile 2018 Palau Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 High income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ N/A Key Messages Overall progress towards universal health coverage (UHC) The Ministry of Health Strategic Plan outlines the strategic priorities; to provide accessible and high quality patient-centred hospital services; provide accessible and high quality primary and preventive services; ensure effective partnerships are developed and maintained; value the people and support their growth and development; and ensure that the administrative and support services are accountable and sustainable. Compared to other countries in the Western Pacific Region, Palau has high coverage of essential services. Palau has relatively low out-of-pocket spending, which suggests a low risk of. Based on the UHC index, challenges remain in the prevention and control of infectious and noncommunicable diseases (NCDs), specifically tuberculosis (TB) detection and treatment and the prevalence of raised blood pressure. Several SDG 3 indicators are close to target Compared to other countries in the Region for SDG 3 indicators, Palau fared relatively well in reproductive, maternal, newborn and child health (RMNCH). Several SDG indicators are not reported. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 69 Palau 40 Region (lowest) 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Palau 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 4 tracer indicators > 80 2 tracer indicators Service capacity and access Note: Refer to page 2 5 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 7 indicators > 70% 0 indicators 40 70% 1 indicator < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Palau 1

62 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 96 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), c 59 Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 79 Tuberculosis detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Palau? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, c Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.4 physicians per 1000 pop (2010); 4.9 psychiatrists per pop (2011); 12.5 surgeons per pop (2015) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Palau compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB NIU BRN VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Palau

63 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Palau has a value of 76%, meaning it has performed at 76% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Palau from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 96% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 95% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ 3.a.1 Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ 3.a.1 Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Palau being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Palau 3

64 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Palau does not report data to this tool. WPR/2018/DHS/017 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Palau

65 UHC and SDG Country Profile 2018 Papua New Guinea Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 41 Papua New Guinea 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The National Health Plan focuses on improving service delivery and primary health care. The priority strategy of the plan is back to basics, with a focus on: rehabilitation as the foundation of the primary health care system; improving maternal health and child survival, and reducing the burden of communicable diseases. The health sector will also focus on promoting a healthy lifestyle and improving the preparedness for disease outbreaks and emerging population on health issues. Compared to other countries in the Western Pacific Region, Papua New Guinea has relatively low coverage of essential services. The UHC index also indicates relatively limited service capacity and access. Based on out-of-pocket spending, the population in Papua New Guinea is at relatively low risk of, but this may indicate limited access to health services. Major challenges remain in the prevention and control of infectious and noncommunicable diseases (NCDs), as well as reproductive, maternal, newborn and child health (RMNCH). The majority of SDG 3 indicators are far from the targets Compared to other countries in the Region for SDG 3 indicators, Papua New Guinea is far from the targets in RMNCH. Its rates of maternal, neonatal and under-5 mortality are among the highest in the Region; whereas, skilled birth attendance, immunization and family planning are among the lowest. Major gaps exist in the prevention and control of infectious diseases and NCDs, and in urban and environmental health. Papua New Guinea has a relatively high incidence of malaria and a high mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services, compared to other countries in the Region. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Papua New Guinea 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 0 tracer indicators > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 8 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 2 indicators > 70% 0 indicators 40 70% 14 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Papua New Guinea 1

66 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 33 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Papua New Guinea? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, c Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.1 physicians per 1000 pop (2010); 0.1 psychiatrists per pop (2014); 0.5 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Papua New Guinea compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS WSM FJI JPN PNG TON NZL 0% KIR SLB NIU BRN VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Papua New Guinea

67 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Papua New Guinea has a value of 39%, meaning it has performed at 39% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% < 40% How far is Papua New Guinea from the SDG targets? SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 22% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 24% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 7% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 26% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ % e TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ % e Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ 3.a.1 Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ 3.a.1 Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Papua New Guinea being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Papua New Guinea 3

68 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Papua New Guinea does not report data to this tool. WPR/2018/DHS/018 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Papua New Guinea

69 UHC and SDG Country Profile 2018 Philippines PROVISIONAL Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 58 Philippines 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) In the Philippine Health Agenda , under the motto "All for Health towards Health for All", universal health coverage is the platform for health and development in the Philippines, driven by action within and outside the health sector. Reducing health inequities is singled out as the most important priority among three health guarantees: ensuring financial protection for the poorest people; improving health outcomes with no disparities; and building health service delivery networks for more responsiveness Compared to other countries in the Western Pacific Region, coverage of some essential services in the Philippines is slightly below the regional average. High coverage exists for reproductive, maternal, newborn and child health (RMNCH) services and for some communicable disease prevention and control interventions, compared to other countries in the Region. Based on estimates of the financial burden for health, 1.4% of the population incurred high out-of-pocket health payments, which suggest gaps in financial protection for health; catastrophic expenditure is greatest in the wealthiest quintile and might require further monitoring. Based on the UHC index, major challenges remain in infectious disease prevention and control and in service capacity and access, specifically family planning, male tobacco use and HIV antiretroviral treatment. Few SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, the Philippines is far from reaching some targets in RMNCH, noncommunicable diseases (NCDs), and urban and environmental health. Gaps exist in infectious diseases prevention and control. The Philippines has one of the highest rates of tuberculosis incidence in the Region. A recent increase in HIV prevalence might be further monitored. Relatively large inequities in skilled birth attendance, neonatal and under-5 mortality, and the adolescent birth rate have been identified. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 1.4% Philippines 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 3 tracer indicators > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 4 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 6 indicators > 70% 9 indicators 40 70% 3 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Philippines 1

70 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% Service capacity and access 49 < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), Access to improved sanitation (%), aaa Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in the Philippines? Financial risk protection by place of residence and economic status 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 0.4% 0.5% Ru ral Urban Poorest (q1) Second poores t (q2) 1.2% Middle (q3) % Second richest (q4) How does the Philippines compare to other countries in the Region? 3.4% Richest (q5) Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* 6% 5% 4% 3% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 1.1 physicians per 1000 pop (2004); 0.5 psychiatrists per pop (2014); 4.3 surgeons per pop (2015) c No estimate; regional or imputed value used as placeholder KHM VNM CHN 2% MNG PHL 1% LAO AUS FJI MYS 0% UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east JPN KOR Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Philippines

71 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Philippines has a value of 47%, meaning it has performed at 47% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is the Philippines from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 55% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 69% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 24% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 63% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ * TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ *Note: A recent increase in incidence might be further monitored Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 8.5% 86% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 44% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ 3.c.1 Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in the Philippines being left behind?²⁶ Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) 46% 97% 52% 68% 85% SDG Under-5 mortality rate (per 1000 live births) % % SDG Neonatal mortality rate (per 1000 live births) % % SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods 72% 75% 3% 76% 79% 3% SDG Adolescent birth rate (per 1000 women aged years) % % SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) 79% 93% 16% 85% 88% 4% Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Source: DHS, 2013 Philippines 3

72 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Philippines was the Philippine Family Income and Expenditure Survey (FIES), Philippine Statistics Authority from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Philippines, the tool used the Demographic and Health Survey (DHS) conducted in WPR/2018/DHS/019 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Philippines

73 UHC and SDG Country Profile 2018 Republic of Korea Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 High income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 80 Republic of Korea 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, the Republic of Korea has high coverage of essential services. Based on estimates of the financial burden for health, slightly less than 2 million people (3.9% of the population) incurred high out-of-pocket health payments, which suggest gaps in financial protection for health. People in the poorest quintiles seem to be most vulnerable to out-of-pocket expenses. The majority of SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, the Republic of Korea fared well in reproductive, maternal, newborn and child health (RMNCH), in infectious disease prevention and control, in urban and environmental health, and in health system resources and service capacity. However, challenges remain in noncommunicable disease (NCD) prevention and control. The Republic of Korea has one of the highest rates of male smoking and alcohol consumption per capita. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) 3.9% Republic of Korea 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 6 tracer indicators > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 Ministry of Health and Welfare (MoHW) annual work plan for 2018 focuses on three major domains: 1) support for better life, 2) expanding national responsibility in order to improve people's quality of life, and 3) strengthening community engagement. 1 tracer indicator < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 13 indicators > 70% 0 indicators 40 70% 3 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Republic of Korea 1

74 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 100 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 72 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in the Republic of Korea? Financial risk protection by place of residence and economic status 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 3.4% Rural Urban Poorest (q1) % 4.7% 3.1% 3.2% Second poorest (q2) Middle (q3) % Second richest (q4) 4.5% Richest (q5) How does the Republic of Korea compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Financial risk protection (SDG 3.8.2)* Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 2.2 physicians per 1000 pop (2015); 7 psychiatrists per pop (2015); 62 surgeons per pop (2015) c No estimate; regional or imputed value used as placeholder 6% 5% KHM VNM CHN 4% JPN 3% KOR 2% PHL MNG 1% LAO FJI MYS 0% AUS UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam *Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Republic of Korea

75 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Republic of Korea has a value of 100%, meaning it has performed at 100% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% < 40% How far is the Republic of Korea from the SDG targets? SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 96% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 95% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ % e Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 4.2% 94% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 30% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 3.b.2 Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in the Republic of Korea being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Republic of Korea 3

76 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Estimates of indicator SDG are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Republic of Korea was the Korea Household Income and Expenditure Survey (HIES), Statistics Korea from Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Republic of Korea does not report data to this tool. WPR/2018/DHS/020 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Republic of Korea

77 UHC and SDG Country Profile 2018 Samoa Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 Upper middle income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 56 Samoa 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) The Health Sector Plan identifies six objectives including: reinforcing health promotion and prevention; improving access and quality of health care delivery; strengthening governance, human resources, and leadership in the health sector; improving health sector financial management and long term planning of health financing; and increasing harmonizing donor participation Compared to other countries in the Western Pacific Region, Samoa's overall progress towards UHC is at the middle range. The prevalence of raised blood pressure, fasting plasma glucose and tobhacco use are among the major risk factors contributing to the NCD burden of disease. While there is no readily available data to verify the financial protection in health, low out-of-pocket spending as a percentage of gross domestic product, which suggests a low risk of. A few SDG 3 indicators are far from the targets Compared to other countries in the Region for SDG 3 indicators, gaps remain in immunization coverage and family planning. The equity dimension is not known either because the country may not have disaggregated data or these have not been reported published. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Samoa 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 1 tracer indicator > 80 5 tracer indicators Service capacity and access Note: Refer to page 2 While Samoa has an average level of coverage of services for infectious disease control and reproductive, maternal, newborn and child health (RMNCH), a coverage of services for noncommunicable disease (NCD) control is a challenge. 5 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 7 indicators > 70% 3 indicators 40 70% 4 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Samoa 1

78 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 65 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), aaa Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 Hospital beds per population, c Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.5 physicians per 1000 pop (2008); 0.5 psychiatrists per pop (2014); 2.6 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Samoa? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Quadrant North-west South-west North-east South-east NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Samoa compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSMTON 0% KIR SLB NIU BRN VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Samoa

79 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Samoa has a value of 59%, meaning it has performed at 59% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Samoa from the SDG targets? < 40% SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 72% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 0% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 6% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 0% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a % 65% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 49% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Samoa being left behind?²⁶ Poorest Richest Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) 71.7% 94.2% 23% 79.1% 96.9% SDG Under-5 mortality rate (per 1000 live births) % SDG Neonatal mortality rate (per 1000 live births) % 8 4 SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern method 21.2% 26.3% 5% 23.4% 28.2% 5% SDG Adolescent birth rate (per 1000 women aged years) % 69% 100% 17% SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Samoa 3

80 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Samoa does not report data to this tool. WPR/2018/DHS/021 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Samoa

81 UHC and SDG Country Profile 2018 Singapore Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ million GDP per capita (current US$)² Income level² 2017 High income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 80 Singapore 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, Singapore has high coverage of essential services. Singapore has a relatively low out-of-pocket spending, which suggests a relatively low risk of. The UHC index indicates gaps in noncommunicable disease (NCD) and infection disease prevention and control, specifically in the prevalence of raised blood pressure and in tobacco use, HIV treatment, and tuberculosis detection and treatment. The majority of SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, Singapore fared well in reproductive, maternal, newborn and child health (RMNCH), as well as in progress in infectious diseases, urban and environmental health, and health system resources and service capacity. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Singapore 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 6 tracer indicators > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 In 2012, the Ministry of Health launched the Healthcare 2020 Masterplan. Its goals were to improve access, affordability and quality of healthcare services for Singaporeans. A healthy living masterplan was also launched in 2014 and was aimed to promote healthy living as accessible, natural, and effortless for all Singaporeans. 1 tracer indicator < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 14 indicators > 70% 0 indicators 40 70% 1 indicator < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Singapore 1

82 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 100 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), c 97 Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), c 86 Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 53 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Singapore? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Singapore compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.1 physicians per 1000 pop (2010); 0.1 psychiatrists per pop (2014); 0.5 surgeons per pop (2014) c No estimate; regional or imputed value used as placeholder 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN FSM SGP AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR SLB NIU BRN VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Singapore

83 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Singapore has a value of 99%, meaning it has performed at 99% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% How far is Singapore from the SDG targets? SDG < 40% Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 100% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 91% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 92% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % d Malaria incidence (per 1000 population at risk)¹⁴ Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ a.1 5.0% 93% e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ a % 76% e Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 3.b.2 Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Singapore being left behind?²⁶ NO DATA Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) SDG Under-5 mortality rate (per 1000 live births) SDG Neonatal mortality rate (per 1000 live births) SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods SDG Adolescent birth rate (per 1000 women aged years) SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Singapore 3

84 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Singapore does not report data to this tool. WPR/2018/DHS/022 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Singapore

85 UHC and SDG Country Profile 2018 Solomon Islands Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 50 Solomon Islands 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to some of the countries in the Western Pacific Region, Solomon Islands has low coverage of essential services. The UHC index indicates relatively limited service capacity and access. Out-of-pocket spending on health at the point of health service delivery is low, as the private health sector is relatively small and offers limited services. However, indirect expenditures, particularly for transportation to access health care, are significantly high. Major challenges remain in service capacity and access and in infectious disease and noncommunicable disease (NCD) prevention and control, specifically in proxy indicators of the prevalence of raised mean-fasting plasma glucose (mmol/l) and blood pressure levels, tobacco use and access to improved sanitation. A few SDG 3 indicators are far from the targets Limited availability of data, including on causes of death, has resulted in limited evidence for measuring progress towards the NCD targets in the SDGs. Major challenges remain in the prevention and control of infectious diseases and NCDs, and in urban and environmental health. Solomon Islands has among the highest rates of malaria incidence, of mortality attributed to exposure to unsafe water, sanitation and hygiene (WASH) services, and of mortality attributed to unintentional poisoning, compared to other countries in the Region. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Solomon Islands 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 1 tracer indicator > 80 3 tracer indicators Service capacity and access Note: Refer to page 2 The vision of the Strategic plan of the Ministry of Health and Medical Services (MHMS) for the period 2016 to 2020 is: The People of the Solomon Islands will be Healthy, Happy, and Productive." This plan identifies four key result areas that apply across the health sector: improve service coverage; build strong partnerships; improve service quality; and lay the foundation for the future. 7 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 7 indicators > 70% 5 indicators 40 70% 3 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Solomon Islands 1

86 Universal Health Coverage UHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country s health service coverage and financial protection. Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access. How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western. The overall UHC index coverage of essential health services available for 27 Western was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region: > 80% Service capacity and access 39 What tracer indicators are included in the UHC index 6 coverage of essential health services? Tracer category Reproductive, maternal, newborn and child health 8 9 Noncommunicable diseases 10 Indicator value 60 80% < 60% Indicator rescaled score, when applicable. Target: 100% Family planning demand satisfied with modern methods (%), Antenatal care, 4+ visits (%), Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), Care-seeking behaviour for child pneumonia (%), Tuberculosis (TB) detection and treatment (%), HIV antiretroviral treatment (%), c 41 Access to improved sanitation (%), Prevalence of non-raised blood pressure (%), Mean fasting plasma glucose (mmol/l), Tobacco non-use (%), c 49 Service capacity and access 11 What does financial protection measure? Financial protection (SDG 3.8.2) 7 measures direct health payments families incur, typically in the last month, in relation to a household s budget or income. In general, a higher value means increased. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household s budget. How does financial risk protection vary across population groups in Solomon Islands? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0% Hospital beds per population, Reference point: 18 a Health worker density (per population), b Reference point: 10.5 a International Health Regulations compliance (%), a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD) b 0.2 physicians per 1000 pop (2011); 0.2 psychiatrists per pop (2014); 0.9 surgeons per pop (2011) c No estimate; regional or imputed value used as placeholder NO DATA Rural Urban Poorest Second Middle Second Richest (q1) poorest (q3) (q2) richest (q4) (q5) How does Solomon Islands compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Proxy measure for financial protection (OOPS/GDP per capita, %)* Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam * OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis. Quadrant North-west South-west North-east South-east 6% 5% KHM 4% 3% PHL VNM KOR MHL 2% MNG CHN SGP FSM AUS LAO PLW 1% COK MYS FJI JPN NZL PNG WSM TON 0% KIR NIU BRN SLB VUT NRU 60 TUV UHC index coverage of essential health services (SDG 3.8.1) Interpretation Limited coverage of essential health services, and relatively high risk of Limited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services Relatively high coverage of essential health services, and relatively high risk of Relatively high coverage of essential health services, and relatively low risk of 2 Solomon Islands

87 Sustainable Development Goals World leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed? There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region. The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage. The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Solomon Islands has a value of 42%, meaning it has performed at 42% of the best-performing country. For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used. The SDG performance scorecard colour code for the Western Pacific Region: > 70% 40 70% < 40% How far is Solomon Islands from the SDG targets? SDG Indicator Indicator rescaled score to 0 100% value Target: 100% Maternal mortality ratio (per live births)¹² % d Proportion of births attended by skilled health personnel (%)¹³ % 77% e Under-5 mortality rate (per 1000 live births)¹⁴ % d Neonatal mortality rate (per 1000 live births)¹⁴ % d Infants receiving three doses of hepatitis B vaccine (%) (proxy) % 98% e Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ % 38% e Adolescent birth rate (per 1000 women aged years)¹⁶ % e Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ b % 97% e New HIV infections among adults years old (per 1000 uninfected population)¹⁷ TB incidence (per population)¹⁴ % e Malaria incidence (per 1000 population at risk)¹⁴ % e Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ % Regional Average: 17.1 Suicide mortality rate (per population)¹⁴ Regional Average: 10.8 Total alcohol per capita ( 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ % e Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Female²⁰ 3.a.1 Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) Male²⁰ 3.a.1 Urban and environmental health Road traffic mortality rate (per population)²¹ Regional Average: 17.3 Mortality rate attributed to household and ambient air pollution (per population)²² % e Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per population)²³ % e Mortality rate attributed to unintentional poisoning (per population)¹⁸ % e Health system resources and capacity Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ b Skilled health professionals density (per population)²⁵ c Regional Average: 42.0 Average of 13 International Health Regulations (2005) core capacity scores¹⁴ d % e d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region. Are population groups in Solomon Islands being left behind?²⁶ Poorest Richest Diff Rural Urban Diff SDG Proportion of births attended by skilled health personnel (%) 72% 96% 25% 84% 96% 12% SDG Under-5 mortality rate (per 1000 live births) % % SDG Neonatal mortality rate (per 1000 live births) % % SDG Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods 36% 35% 3% 35% 36% 3% SDG Adolescent birth rate (per 1000 women aged years) % SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%) 78% 89% 12% 82% 89% 7% Minor inequalities (< 10%) Moderate inequalities (10 50%) Major inequalities (> 50%) Source: DHS Solomon Islands 3

88 Technical notes and sources 1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; World Development Indicators. Washington (DC): World Bank ( accessed 26 September 2017). 3 World Development Indicators Washington (DC): World Bank ( accessed October 2013). 4 Global health expenditure database [online database]. Geneva: World Health Organization ( accessed 26 September 2017). 5 WHO life expectancy ( 6 SDG indicator and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data reported to WHO, and published results from household surveys available in UHC Data Portal ( and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage ( pdf?ua=1). 7 Given the limited number of countries for which SDG indicator on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). 8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need. 9 measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation. 10 measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes. 11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats. 12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 ( monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than in 2015 were not included in the analysis. 13 WHO/UNICEF joint global database 2017 ( and The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( accessed 3 November 2017). 15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; Regional aggregates are estimates for the year Model-based estimates and projections of family planning indicators New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 ( 16 World fertility data New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, and , taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 ( accessed 13 April 2016). 17 UNAIDS/WHO estimates; 2016 ( 18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, Geneva: World Health Organization; 2015 ( healthinfo/global_burden_disease/estimates/en/index1). 19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 ( GISAH?showonly=GISAH). 20 WHO global report on trends in prevalence of tobacco smoking Geneva: World Health Organization; 2015 ( bitstream/10665/156262/1/ _eng.pdf, accessed 22 March 2017). 21 Global status report on road safety Geneva: World Health Organization; 2015 ( accessed 22 March 2017). WHO Member States with a population of less than in 2015 who did not participate in the survey for the report were not included in the analysis. 22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization ( WHO Member States with a population of less than population in 2012 were not included in the analysis. 23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 ( accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 ( bitstream/10665/150112/1/ _eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than in 2012 were not included in the analysis. 24 United Nations SDG indicators global database ( accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, Skilled health professionals refer to the latest available values ( ) in the WHO Global Health Workforce Statistics database ( hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors. 26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.the tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Solomon Islands, the tool used the Demographic and Health Survey (DHS). WPR/2018/DHS/023 World Health Organization Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. 4 Solomon Islands

89 UHC and SDG Country Profile 2018 Tonga Objectives Country statistics Health system Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues. Population¹ GDP per capita (current US$)² Income level² 2017 Lower middle income Income Gini coefficient³ N/A 0 (equality) 100 (inequality) Total health expenditure as % of GDP⁴ % Total health expenditure per capita (current US$)⁴ General government health expenditure as % of total health expenditure⁴ % Life expectancy at birth (in years)⁵ UHC Overall Progress UHC index 6 coverage of essential health services (SDG 3.8.1) scale (Target: 100) 62 Tonga 40 Region (lowest) Key Messages Overall progress towards universal health coverage (UHC) Compared to other countries in the Western Pacific Region, Tonga has high coverage of essential services. Tonga has relatively low out-of-pocket spending, which suggests a low risk of. Based on the UHC index, major challenges remain in the prevention and control of noncommunicable diseases (NCDs), specifically in tobacco use and the prevalence of raised blood pressure. Several SDG 3 indicators are close to the target Compared to other countries in the Region for SDG 3 indicators, Tonga shows relatively advanced progress in reproductive, maternal, newborn and child health (RMNCH) and in infectious diseases, except in family planning and immunization. However, gaps exist in NCD prevention and control and in urban and environmental health. Tonga has one of the highest male smoking rates in the Region. The equity dimension is not known either because the country may not have disaggregated data or because data have not been reported to WHO. 80 Region (highest) Financial risk protection: 7 proportion of population with out-ofpocket health spending exceeding 25% of household s budget or income (SDG 3.8.2) N/A Tonga 0.0% Region (lowest) 5.0% Region (highest) Performance scorecard of 13 UHC index coverage of essential health services indicators, in relation to a target of 100% 2 tracer indicators > 80 4 tracer indicators Service capacity and access Note: Refer to page 2 The vision of the National Health Strategic Plan is "to be the highest health care provider in the Pacific as judged by international standards in 2020." The mission is "to improve the health of the nation by providing quality care through promotion of good health, reducing morbidity, disability and premature (death) mortality." 5 tracer indicators < 60 SDG Overall Progress Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets) 7 indicators > 70% 3 indicators 40 70% 4 indicators < 40% Urban and environmental health Health system resources and capacity Note: Refer to page 3 Tonga 1