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

Achieving the health-related Millennium Development Goals in the Western Pacif ic Region 2010 1 4 5 6 7 8 These Millennium Development Goals are a promise of world leaders. They re a blueprint to help those most vulnerable and poorest people, to lift them out of poverty. This promise must be met. UN Secretary-General Ban Ki-moon

The Millennium Development Goals z In 2000, 189 heads of state adopted the UN Millennium Declaration. z Eight Millennium Development Goals (MDGs) were established to be met by 2015 by working together to reduce poverty and hunger, and tackle ill-health, lack of education, gender inequity, lack of access to clean water and environmental degradation. 1

Health MDGs scorecard for WHO regions World Africa Americas Eastern Mediterranean Europe South-East Asia Western Pacific 4 Under-5 mortality 1 per 1000 live births (2009) 60 127 18 72 13 59 21 5 6 Measles immunization % coverage (2008) Maternal mortality 2 per 100 000 live births (2008) Skilled birth attendant % births (2000 2008) Contraceptive use % married women aged 15 49 (2000 2008) HIV/AIDS prevalence % adults aged 15 49 (2007) Malaria mortality per 100 000 population (2006) 81 73 93 83 94 75 93 260 620 66 320 21 240 51 66 47 92 59 96 49 92 62 24 71 43 68 58 83 0.8 4.9 0.5 0.2 0.5 0.3 0.1 17 104 0.5 7.5 2.1 0.3 TB treatment success rate % (2007) 86 79 82 88 67 88 92 7 Water % using improved sources (2008) 87 61 96 83 98 86 90 Sanitation % using improved facilities (2008) 60 34 87 61 94 40 62 On track Insufficient progress Off track Source: World Health Statistics 2010. 2

The scorecards reveal clear priorities z The Western Pacific Region is making better progress towards the health MDGs than other WHO regions. z But progress is unequally spread both within and between countries, with rural and poor populations lagging behind. z Reducing the number of maternal and child deaths is the most urgent and obvious priority. z An estimated 13 000 maternal deaths occurred in the Region in 2008, with poor women being most affected. z On the positive side, child mortality rates have improved significantly with under-5 deaths dropping by two thirds since 1990. z HIV/AIDS prevalence is low, stable or decreasing: at 1% or less in all countries in the Region. 3

Health MDGs scorecard for LMICs* in the Western Pacific Region (with population 250 000) Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam 4 Under 5 mortality 3 per 1000 live births (2008) 89 21 18 61 6 41 69 32 36 14 5 6 Measles immunization 4 % coverage (2009) Maternal mortality 2 per 100 000 live births (2008) Skilled birth attendant 5 % births (2000 2009) Contraceptive use 5 % married women aged 15 49 (2000 2008) HIV/AIDS prevalence 6, 7 % adults aged 15 49 (2007) Malaria mortality 8, 9 per 100 000 population (2008) 92 94 94 59 95 94 58 88 60 97 290 38 26 580 31 65 250 94 100 56 44 98 99 20 100 100 39 60 43 88 40 87 32 66 51 79 0.8 0.1 0.1 0.2 0.5 0.1 0.9 <0.1 0.5 1.4 <0.1 0.2 0.1 9.7 <0.1 4.1 <0.1 TB treatment 10 success rate % (2007) 94 94 81 92 72 89 39 89 92 92 7 Water 11 % using improved sources (2008) 61 89 57 100 76 40 91 70 ** 94 Sanitation 11 % using improved facilities (2008) 29 55 53 96 50 45 76 32 ** 75 On track Insufficient progress Off track * LMICs Low- and middle-income countries; **Data applies to 2006, source #12. Refer to page 18 for health MDGs scorecard colour code for LMICs in the Western Pacific Region. 4

Health MDGs scorecard for LMICs* in the Western Pacific Region (with population < 250 000) Cook Islands Kiribati Marshall Islands, the Micronesia, the Fed. States of Nauru Niue Palau Samoa Tonga Tuvalu Vanuatu 4 Under-5 mortality 3 per 1000 live births (2008) 15 48 36 39 45 28 15 26 19 36 33 5 6 Measles immunization 4 % coverage (2009) Maternal mortality 2 per 100 000 live births (2008) Skilled birth attendant 5 % births (2000 2009) Contraceptive use 5 % married women aged 15 49 (2000 2008) HIV/AIDS prevalence 6, 7 % adults aged 15 49 (2007) Malaria mortality 8, 9 per 100 000 population (2008) 78 82 94 86 99 99 75 49 99 90 52 100 90 95 88 97 100 100 100 99 100 93 36 36 33 0.4 TB treatment 10 success rate % (2007) 100 93 96 65 100 92 93 75 93 7 Water 11 % using improved sources (2008) 95 ** 65 ** 94 94 ** 90 100 89 ** 88 ** 100 97 83 Sanitation 11 % using improved facilities (2008) 100 33 ** 73 25 ** 50 100 67 ** 100 96 84 52 Due to very small population size and low incidence and prevalence of some diseases, there are no estimates for some indicators; small population size also makes classification of progress towards MDG targets infeasible. * LMICs Low- and middle-income countries; **Data applies to 2006, source #12. 5

4 MDG 4 Reduce child mortality MDG target: Reduce by two thirds, between 1990 and 2015, the under-5 mortality rate Only a few LMICs in the Region have been able to consistently achieve at least 95% immunization coverage for each of the past three years. Figure 1: Proportion of 1-year-old children immunized against measles in LMICs in the Western Pacific Region, 2009. 4 Measles immunization reaching: 90% coverage < 90% coverage Child mortality in the Western Pacific Region has been significantly reduced. Cambodia, the Lao People s Democratic Republic, Papua New Guinea and Mongolia still have very high numbers of child deaths. At least 65% of all child deaths in the Western Pacific Region are caused by neonatal conditions, pneumonia and diarrhoea, with an increasing proportion occurring in the neonatal period. Table 1: Causes of under-5 mortality in the Western Pacific Region, 2008. 5 Neonatal causes 45.5% Malaria 0.6% Pneumonia 16.0% HIV/AIDS 0.4% Injuries 6.8% Measles 0.4% Diarrhoea 4.0% Others 26.2% Focus should be on reaching more remote, underserved, rural and poor populations to increase or maintain 95% immunization coverage for measles and other vaccinepreventable diseases. All maps in the document are stylized and not to scale. The boundaries shown and the designations used on the maps used in this document do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2010. All rights reserved. 6

5 MDG 5 Improve maternal health MDG target: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Wide variation across LMICs in the coverage of skilled attendance at delivery, and coverage is low in countries where most maternal deaths occur. Figure 2: Births attended by skilled health personnel in LMICs in the Western Pacific Region, 2000 2009. 5 Proportion of births attended by skilled health personnel (%) MDG SCORECARD Maternal mortality has been reduced in the LMICs of the Region. Cambodia, the Lao People s Democratic Republic and Papua New Guinea have unacceptably high numbers of maternal deaths. Contraceptive prevalence rate remains low in most LMICs in the Western Pacific, and data availability for this indicator is also an issue. 85% 60% 85% <60% Figure 3: Contraceptive prevalence rate (%) in LMICs in the Western Pacific Region, 2000 2008. 5 Countries with population 250 000 Cambodia China Lao PDR Mongolia Philippines Viet Nam 32 40 51 66 79 87 Countries with population < 250 000 Kiribati Nauru Palau 33 36 36 Generating accurate data on maternal mortality is difficult and depends on robust, accurate and timely vital statistics. 7

6 MDG 6 Combat HIV/AIDS, malaria and other diseases MDG target: Have halted by 2015 and begun to reverse the spread of HIV/AIDS HIV / AIDS Figure 4: HIV prevalence rate among population aged 15 49 years in selected LMICs in the Western Pacific Region, 1990 2007. 6, 7 HIV prevalence rate 2.5 2.0 1.5 1.0 0.5 0.4 Malaria Cambodia 1 400 000 people are living with HIV or AIDS in the Western Pacific Region, and only 31% of people with HIV have access to antiretroviral drugs (2008). Papua New Guinea Viet Nam 0.3 Malaysia 0.2 Fiji Lao People s Democratic Republic China 0.1 Mongolia 0.0 1990 1995 2000 2005 2010 Malaria is endemic in some countries in the Region, and is often linked to poverty. Figure 5: Proportion of children under-5 sleeping under insecticide-treated bednets in LMICs in the Western Pacific Region, 2004 2009. 8 The Region has avoided a major HIV epidemic, with HIV prevalence relatively low and stabilizing. Condom use and coverage of preventive interventions for mostat-risk populations are increasing. Tuberculosis Multidrug-resistant and extensively drug-resistant TB threaten TB control efforts in the Region. The Region is on track to achieve the goal of halving TB prevalence and mortality by 2015. DOTS coverage in LMICs remains high, while the case detection rate is 70% (2008) and the treatment success rate above 85% (2007). Cambodia Lao PDR Papua New Guinea Philippines Solomon Islands Vanuatu 17 20 28 43 40 41 36 67 2004 2006 2007 2008 2009 95 Malaria incidence and mortality have been decreasing since 1990. Where data are available, they show that use of insecticidetreated bednets among children under 5 is low. 8

1 MDG 1 Eradicate extreme poverty and hunger MDG target: Halve, between 1990 and 2015, the proportion of people who suffer from hunger 7 MDG 7 Ensure environmental sustainability MDG target: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation The prevalence of underweight children under 5 has been reduced in the populous LMICs in the Western Pacific. Figure 6: Prevalence of underweight children under 5 years of age (%) in LMICs with 250 000 population, 1983 2008. 5 Earliest data available Latest data available Target The Region is on track to reach the MDG target for use of improved drinking-water sources and sanitation facilities. Access to safe water and sanitation is still very low in many countries, especially in rural areas. Cambodia China Lao PDR Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam 2005 2002 1999 2007 1992 1989 2005 2003 1983 2008 1993 0% 10% 20% 30% 40% 50% The number of underweight children in Lao PDR and Papua New Guinea is still of concern. Pacific island countries lack data on nutrition. 1993 2008 2006 1994 1996 Figure 7: Proportion of population using an improved drinking-water Figure 11, 12 source in LMICs in the Western Pacific Region, 2006 2008. Papua New Guinea Mongolia Solomon Islands Cambodia Kiribati Lao PDR Vanuatu China Cook Islands Viet Nam Philippines Samoa Malaysia Micronesia, Fed. States of Tuvalu Niue Tonga Marshall Islands Palau Urban Rural 8: Proportion of population using an improved sanitation 11, 12 facility in LMICs in the Western Pacific Region, 2006 2008. Solomon Islands Cambodia Lao PDR Micronesia, Fed. States of Palau Mongolia Marshall Islands Papua New Guinea Viet Nam Kiribati Vanuatu Philippines Tuvalu China Tonga Malaysia Cook Islands Niue Samoa 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Urban Rural 8 MDG 8 Develop a global partnership for development MDG target: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries Access to essential medicines is limited by high out-of-pocket payments. Sale of counterfeit and substandard medicines is a problem across the Region, endangering public safety. Irrational use of medicines is increasing the risk of drug resistance. 9

National health policy and strategy = Improving health outcomes z Faster progress towards the health MDGs will depend on better health systems to deliver effective interventions. z Effective and affordable interventions exist to address much of the burden of disease. To deliver these, countries need to scale up staff, medicines, infrastructure and information, especially in remote and underserved areas. z Requires coherent health policies, comprehensive health strategies, and the prioritization of health in national development plans. z Better health requires coherent policies and a comprehensive approach that also addresses the social, environmental and economic determinants of ill-health. z Strategies that seek synergies between programmes get better results and can accelerate progress towards the MDGs. z Greater investment in health information systems is needed to monitor health outcomes and the performance of health systems. 10

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

Delivering effective interventions in the Western Pacific Region z Health systems are designed to deliver a set of effective clinical and public health interventions over the life course to achieve better health outcomes. z Increased investment is needed in interventions and systems that improve the health of women and children, who together represent 80% of the population. z Expanded family planning services, and a better continuum of care between different levels of the health system and across different stages of the life-cycle, will result in fewer maternal and child deaths. z Essential protective and clinical interventions such as immunization and treatment of disease are necessary but insufficient; socioeconomic factors must also be addressed. z Different interventions can contribute to multiple outcomes. LMICs should consider combined approaches, such as immunization services with growth monitoring, distribution of bednets and micronutrient supplements. 12

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

Sustained and equitable f inancing to achieve the MDGs z Paying for care directly out-of-pocket payments prevents millions of people from using health services and can lead to impoverishment. z In Asia and the Pacific, 105 million people suffer financial catastrophe and over 70 million are impoverished each year because they have to pay for health care. z In six LMICs in the Region, out-of-pocket payments account for over 40% of total health expenditure. z Financing policies that seek to pool risk and resources for example through insurance or tax-based finance offer better financial protection z A basic package of health services costs US$ 35 US$ 50 per person per year. Globally, low-income countries spend just US$ 25 per person per year on health, of which US$ 10 is out-of-pocket expenditure. z Spending on health in low-income countries needs to increase from US$ 31 billion now to US$ 67 billion US$ 76 billion by 2015. The bulk of this money will come from domestic sources, though many LMICs will also require aid for the foreseeable future. z Aid for health must be predictable, sustained, aligned with national priorities and provided in ways that minimize transaction costs. Figure 9: Source of health financing as proportion of total expenditure on health for LMICs in the Western Pacific Region, 2008. 13 Tuvalu Niue Marshall Islands Micronesia, Fed. States of Solomon Islands Cook Islands Samoa Kiribati Papua New Guinea Vanuatu Mongolia Palau Nauru Tonga Fiji China Malaysia Viet Nam Philippines Cambodia Lao PDR 0% 20% 40% 60% 80% 100% Out-of-pocket Other private Private pre-paid plans Government 14

Supporting national ef forts to achieve the MDGs is core business for WHO 1 4 5 z Setting norms and standards such as treatment guidelines and health service standards is a core WHO function, underpinning our technical support for the MDGs. z WHO s analytic work on social and economic determinants highlights the magnitude and nature of broader risks to health. z WHO uses its technical expertise and convening power to assist national authorities as they seek to develop coherent and wellcosted national strategies. z In countries with many donors, WHO plays a key role in assisting governments to coordinate development partners and to ensure alignment between external assistance and domestic priorities. z A key function in relation to the MDGs is the collection and dissemination of data on health status. 6 7 8 15

Tables MDG 1 MDG 4 MDG 5 Prevalence of underweight children (%) Infant mortality rate per 100 000 live births Under-5 mortality rate per 100 000 live births Measles immunization % coverage Maternal mortality ratio per 100 000 live births Proportion of births attended by skilled health personnel (%) Contraceptive prevalence rate (%) Countries with 250 000 population 1990 1999 2000 2009 2015 Target Cambodia 43 29 21 China 15 7 8 Fiji 7 4 Lao PDR 36 32 18 Malaysia 18 9 Mongolia 11 5 5 Papua New Guinea 25 (1983) 18 13 Philippines 26 21 13 Solomon Islands 16 (1989) 12 8 Viet Nam 37 20 18 Countries with < 250 000 population Cook Islands Kiribati Marshall Islands Micronesia, Fed. States of Nauru Niue Palau Samoa 2 1 Tonga Tuvalu 2 Vanuatu 11 5 1990 2000 2008 2015 target 1990 2000 2008 2015 target 1990 2009 85 80 69 28 117 106 89 39 34 92 37 30 18 12 46 36 21 15 98 94 19 16 16 6 22 18 18 7 84 94 108 64 48 36 157 86 61 52 32 59 16 9 6 5 18 10 6 6 70 95 71 49 33 24 98 63 41 33 92 94 67 57 53 22 91 77 69 30 67 58 42 28 26 14 61 36 32 20 85 88 31 30 30 10 38 37 36 13 70 60 39 24 12 13 56 30 14 19 88 97 16 15 14 5 18 17 15 6 67 78 65 49 38 22 89 63 48 30 75 82 39 32 30 13 48 39 36 16 52 94 45 38 32 15 58 47 39 19 81 86 8 41 36 6 9 51 45 7 99 31 17 22 31 22 28 99 99 18 14 13 6 21 16 15 7 98 75 40 28 22 13 50 34 26 17 89 49 19 18 17 6 22 20 19 8 86 99 42 35 30 14 53 42 36 18 95 90 23 25 27 8 27 29 33 9 66 52 1990 2000 2008 2015 target 1990 1999 2000 2009 2000 2008 690 470 290 173 34 44 40 110 60 38 28 89 98 87 40 32 26 10 99 99 1200 790 580 300 7 20 32 56 39 31 14 81 100 130 93 65 33 99 100 66 340 290 250 85 51 39 180 120 94 45 53 60 51 130 110 100 33 85 43 170 91 56 43 77 88 79 100 100 85 90 36 95 95 93 88 97 36 100 100 100 33 100 100 99 99 100 89 93 16

Tables MDG 6` MDG 7 HIV prevalence rate (%) among population aged 15 49 years Malaria mortality rate per 100 000 population Tuberculosis treatment success rate (%) Proportion of population using improved drinking-water source (%) Proportion of population using improved sanitation facility (%) Urban Rural Urban Rural Countries with 250 000 population Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam Countries with < 250 000 population Cook Islands Kiribati Marshall Islands Micronesia, Fed. States of Nauru Niue Palau Samoa Tonga Tuvalu Vanuatu 1990 1995 2001 2007 1990 2008 cohort 1995 cohort 2007 0.7 1.2 1.5 0.8 10.5 1.4 91 94 0.1 0.1 0.0 <0.1 93 94 <0.1 0.1 0.1 86 81 <0.1 <0.1 0.2 9.0 0.2 70 92 0.1 0.1 0.5 0.2 0.1 69 72 0.1 74 89 <0.1 0.1 0.5 0.9 11.1 9.7 56 39 <0.1 1.5 <0.1 60 89 10.3 4.1 65 92 0.1 0.3 0.5 5.1 <0.1 89 92 100 100 87 93 25 96 80 65 100 67 80 92 75 93 75 21.5 0.4 85 93 1990 2008 1990 2008 1990 2008 1990 2008 52 81 33 56 38 67 5 18 97 98 56 82 48 58 38 52 92 92 78 72 37 51 56 86 10 38 94 100 82 99 88 96 81 95 81 97 27 49 67 64 25 32 89 87 32 33 78 71 42 41 93 93 76 87 70 80 46 69 94 94 65 65 98 98 18 18 88 99 51 92 61 94 29 67 99 98 87 88 100 100 91 100 76 77 33 53 36 46 21 20 94 92 97 99 77 83 41 53 93 95 87 94 55 61 20 14 90 50 100 100 100 100 100 100 100 100 73 79 98 94 76 96 54 52 99 90 89 87 100 100 98 100 100 100 100 100 98 98 96 96 92 98 89 97 86 88 76 81 91 96 49 79 53 66 30 48 17

Health MDGs scorecard colour code for LMICs in the Western Pacific Region (with population 250 000) On Track Insufficient Progress Off Track 4 Under-5 mortality per 1000 live births Achieved at least 75% Achieved at least 50% Achieved less than 50% 5 Measles immunization % coverage Maternal mortality per 100 000 live births Skilled birth attendant % births Contraceptive use % married women aged 15 49 90% < 90% N/A Achieved at least 75% Achieved at least 50% Achieved less than 50% 85% 60% 84% < 60% 60% 30% 59% < 30% HIV/AIDS prevalence % adults aged 15 45 Decreased or no change between 2001 and 2007 Increased but still low prevalence between 2001 and 2007 Significantly increased between 2001 and 2007 6 Malaria mortality per 100 000 population Significantly decreased High with little change or decrease High with no change or increase TB treatment success rate % 85% 70% 84% < 70% 7 Water % using improved sources Achieved at least 75% Achieved at least 50% Achieved less than 50% Sanitation % using improved facilities Achieved at least 75% Achieved at least 50% Achieved less than 50% 18

Data sources 1 Levels & trends in child mortality report 2010: Estimates developed by the UN Inter-agency group for child mortality estimation. United Nations Children s Fund, World Health Organization, The World Bank, United Nations Population Division. UNICEF, New York, 2010. 2 Trends in maternal mortality: 1990 to 2008: Estimates developed by WHO, UNICEF, UNFPA and The World Bank. WHO, Geneva, 2010. (http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf). 3 UN Inter-agency Group for Child Mortality Estimation (IGME). Trends in under-five mortality rates (1960-2009). New York, UNICEF, 2009 (http://www.childinfo.org/mortality_ ufmrcountrydata.php). 4 World Health Organization and United Nations Children s Fund. WHO/UNICEF measles coverage estimates for 1980-2009. Geneva, WHO and New York, UNICEF, May 2010. 5 Global health observatory database. Geneva, WHO, 2010 [http://apps.who.int/ghodata/] 6 Joint United Nations Programme on HIV/AIDS. Adult (15-49) HIV prevalence percent by country, 1990-2007. 2008 Report on the global AIDS epidemic. Geneva, UNAIDS, 2008 (http://data.unaids.org/pub/globalreport/2008/20080813_gr08_prev1549_1190_2007_en.xls). 7 Joint United Nations Programme on HIV/AIDS. Papua New Guinea new HIV estimates. Geneva, UNAIDS, 2010 (unpublished). 8 World Health Organization. National malaria control programme reports. Submitted by countries to the WHO Western Pacific Regional Office. Manila, WHO, 2008 (http://www. wpro.who.int/topics/malaria/en/). 9 World Health Organization, World malaria report 2009. Geneva, WHO, 2009 (http://www.who.int/malaria/world_malaria_report_2009/en/index.html). 10 Global TB database. Geneva, WHO, 2010 (http://www.who.int/tb/country/global_tb_database/en/). 11 World Health Organization and United Nations Children s Fund. Progress on sanitation and drinking-water: 2010 update report. Geneva, WHO, 2010 [http://www.unicef.org/ media/files/jmp-2010final.pdf]. 12 World Health Organization and United Nations Children s Fund. Progress on drinking-water and sanitation: special focus on sanitation. Geneva, WHO and New York, UNICEF, 2008. [http://www.who.int/water_sanitation_health/monitoring/jmp2008/en/index.html]. 13 World Health Organization. National Health accounts country health information. Geneva, WHO, 2010 (http://www.who.int/nha/country/en/). Other data source World Health Organization. Health in Asia and the Pacific. India, WHO, 2008. 19