Agenda item 7.1 SEA/ACM/Meet.1/7.11 16 June 2008 Millennium Development Goals The Fifty-fifth World Health Assembly in 2002 reaffirmed its commitment to the UN Millennium Declaration and the related Millennium Development Goals (MDGs) through Resolution WHA 55.19. In 2002, the Fifty-fifth Session of WHO Regional Committee for South-East Asia discussed the MDGs and the commitment of the Member countries to these development goals. The Twenty-second Meeting of Ministers of Health of countries of the South-East Asia Region in September 2004 reviewed the progress made towards achieving MDGs in the Region and recommended that Member States should identify specific challenges and develop appropriate intervention programmes, with the support of all partners in health, that focus on the health needs of the underprivileged and poorest segments of the population. A High-Level Forum on the MDGs in Asia and the Pacific met in Tokyo in June 2005 and reviewed the progress made and challenges faced by countries in Asia and the Pacific and highlighted actions that can be initiated at the country level. The Fifty- eighth World Health Assembly in May 2005 requested Member States to reaffirm the MDGs as critical for health development, and to develop nationally relevant “roadmaps” that incorporate the actions as a guide to accelerating progress towards achieving health-related MDGs. The work of WHO on MDGs has not only formed an integral part of its activities but has also contributed to the collective efforts of the UN. Ten out of the 11 SEA Region Member countries have submitted at least one country report on the progress in achieving MDGs to the UN Secretary-General. The Inter-Agency and Expert Group on MDGs revised the monitoring framework of MDGs and some of their targets and indicators in November 2007 to facilitate better monitoring of progress in achieving MDGs (Annexure 1). Agenda Item 11.2 of the WHA 61 was on monitoring of the achievements of the health-related Millennium Development Goals. Observing the slow progress in achieving health-related MDGs, the resolution on “monitoring of the achievements of the health-related Millennium Goals” was passed (Annexure 2). The views and recommendations of the ACM on this agenda item will be submitted to the Twenty-sixth Meeting of Ministers of Health for its consideration. Meeting of the Advisory Committee (ACM) to review technical matters to be discussed at the Sixty-first Session of the Regional Committee WHO/SEARO, New Delhi, 30 June – 3 July 2008
SEA/ACM/Meet.1/7.1 Page 1 1. Regional overview 1. A review of the regional situation in achieving health-related MDGs at the midway point is important for Member countries to ascertain the progress of achieved. It will also enable them to accelerate implementation if the progress is not satisfactory and to go beyond MDGs if it is satisfactory. The levels of progress in achieving MDGs in the Region vary from country to country. Figure 1 graphically presents the country-level progress in the 2000- 2007 period. Ten countries in the Region have prepared at least one Millennium Development Goals Progress Report and three of them have prepared two reports each. Bhutan has prepared three progress reports during this period. Figure 1: Progress towards achieving health-related MDGs in SEA Region (2000-2007) Note: Quantitative and qualitative assessment of progress from the 1990 baseline to reach the targets for 2015 (based on evidence derived from the available country MDG reports, technical programme areas and other reports pointing towards the rate of progress at the end of 2007. Water and sanitation figures are for the year 2004, which is the latest available.) On track = based on the benchmark for the annual rate of success to achieve the targets by 2015. Slow progress = required annual rate of success to achieve the targets is lower than expected. Very slow progress = required annual rate of success to achieve the targets is much lower than expected or no difference is observed from baseline data. G7.T9 – Solid fuel G7.T10 – Water G6, T8 – TB, G6, T8 – Malaria G8. T17 – Essential drugs G7.T11 – Sanitation G6, T7 – HIV/AIDS, G5. T6 – Maternal mortality G4. T5 – U5MR, IMR,Measles G1.T2 – Underweight for age <5 yrs TLSTHA SRL NEPMMRMAVINOINDDPRK BHU BAN Selected goals and targets On track Slow progress Very slow progress Source : Country MDG Reports SEA/ACM/Meet.1/7.1 Page 2 2. The progress on Target 2 of Goal 1 (reduction in numbers of underweight children) needs to be accelerated as only three countries show a good progress rate whereas seven countries are making slow progress and that of one Member country is considerably slower than the rest. 3. Goal 4 (reduction of under-five mortality, infant mortality and immunization against measles) also shows a similar pattern with four countries having made palpable progress and six countries slow progress. One Member country has, however, registered very slow progress. 4. Efforts to achieve Goal 5 (reduction of maternal mortality) needs serious attention of everybody concerned as only three countries have made good progress whereas the rest have been very slow and unlikely to achieve the targets by 2015 with their current rate of success. 5. There has been slow progress over Goal 6 (combat HIV/AIDS, malaria and other diseases) in most countries of the SEA Region except Maldives and Thailand. The estimated HIV prevalence shows an increase in the majority of countries and HIV prevalence among female commercial sex workers and intravenous drug users is on the rise. In some countries, however, a decline in HIV prevalence in the antenatal attendees has been observed. 6. An estimated 1.2 billion people or 83% of the total population of the SEA Region lives in malaria-risk areas. All countries except Maldives have indigenous malaria transmission, predominantly plasmodium vivax. Sri Lanka is targeting eradication of local transmission of malaria by 2012, which will transcend MDG targets. 7. Trends in tuberculosis prevalence rates reveals SEA Region countries may be on track in achieving the MDGs. This is also supported by trends in treatment success and case detection rates. 8. Goal 7 (ensure environmental sustainability: access to safe drinking water and improvement in sanitation) calls for further accelerated work in the area of sanitation. Available data indicate that the majority of SEA Region countries have made important strides towards increasing water supply coverage during the last decade. However, 14% of the population of the Region (approximately 212 million people) still lack access to improved water supply while as many as 900 million people lack access to improved sanitation. 9. As far as Goal 8 (develop global partnership for development: access to affordable essential drugs) (Target: in cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries) is concerned, access to essential medicines has been, and will continue to be the core element of health care in the Region. Member countries are bolstering their national drug policies, promoting rational use and ensuring quality, safety and efficacy. With the expansion of the private sector in health care, access to essential medicines has become an important issue. SEA/ACM/Meet.1/7.1 Page 3 2. Issues • The analyzed data suggest that Thailand has achieved all the MDG targets and goals and hence it is going ahead with “MDG Plus”. • Maldives needs to achieve two targets from Goal 7, i.e. sanitation and use of solid fuel. • Sri Lanka may achieve four goals and needs to work on Goal No. 1 and Target 7 of Goal No. 6 envisages reduction of estimated HIV positives. • All the other countries have revealed mixed level of progress in achieving MDG targets and goals and need to make extra effort to achieve all the goals. • Those countries having made good progress towards achieving MDGs need to reinforce the gains and make the extra efforts to fulfill all other unaccomplished targets. • Although the countries have attained different levels of progress with national- level data, comparisons between regions, provinces and districts shows significant deviations from the mean national data. Analyses of disaggregated data by geographical regions and other variables reveals that some special geographical regions and population sub-groups need special assistance and interventions to reach related MDG targets and goals. 3. Strategic approaches/policy options to accelerate the progress of health MDGs 11. Slow progress can be overcome by adopting strategies to achieve MDGs through the primary care approach, strengthening of health systems, massive scale-up of existing health programmes, substantially increased investments in the social sector, and carefully planned focused interventions in specific areas. • Sustainable high-level political commitment and work with development partners is necessary towards strengthening the national health systems, including health information systems, for monitoring progress with the MDGs. • A dedicated effort is required to mobilize resources for collective action for health. This means increased funding from national budgets, much higher levels of development assistance for health, and harmonized and more effective approaches to delivering aid. • Health needs are to be addressed within a broad developmental framework which prioritizes growth with equity, social cohesion, social protection, SEA/ACM/Meet.1/7.1 Page 4 empowerment of the poor, and protection of natural resources, particularly safe water for human consumption. Health strategies should, therefore, be firmly rooted in overall public policy and its implementation should primarily aim at reduction of poverty. • Greater investment in public health and strengthened health systems are needed. Effective and equitable health systems are a prerequisite to meet and sustain the goal related to combating HIV/AIDS, malaria and other diseases, and targets associated with immunization and safe motherhood. These include health programmes focusing on specific conditions or diseases and increased coverage and access which promote more equitable health outcomes, so long as they contribute materially to strengthening health systems. • Health systems cannot function effectively without well-trained and adequately paid staff. The question of human resources for health involve different aspects but they relate essentially to shortages. Action is needed in relation to salaries and incentives, investment in pre- and in-service training, adjustment of staffing and skill mix, filling of immediate gaps in service delivery, harmonization of donor-led initiatives and the migration of health professionals. • Gender concerns are fundamental to the MDGs. Efforts to achieve the Goals must be informed by an understanding of gender inequities and also promote empowerment of women. • Health strategies and policies should incorporate equity concerns. The MDGs could even be achieved without necessarily improving the holistic health status of the poorest and most vulnerable people, who are typically the most onerous to reach. National averages may also not reveal huge disparities between the health status of different population groups. Addressing this challenge will require a more equitable health system, in particular a fairer distribution of good quality health services, which are usually concentrated in urban centres serving populations which are economically better placed. The health system may itself be a cause for accentuating poverty. For example, health-care payments may push the poor or near-poor into destitution or lack of access to care may create life-long disability or impairment which in turn may limit earning capacity. • Attention needs to be given to environmental factors that have an impact on human health in order to limit the exposure of populations, in particular poorer groups, to natural hazards and destruction or degradation of natural resources. SEA/ACM/Meet.1/7.1 Page 5 4. WHO’s support for achieving the MDGs 12. In recognition of the pressing need to accelerate efforts to reach the MDGs WHO would continue to pay greater emphasis on strategic approaches outlined above in its workplans and budget. Although the Goals do not represent the entirety of the scope of work of WHO, they are central to the support it provides to Member States and are also milestones against which the Organization’s overall contribution to health development can be measured. 13. The WHO Secretariat will work closely with Member States on ways in which the MDGs should be operationalized in the WHO planning process and the same reflected in the programme budgets and Medium-term Strategic Plan 2008-2013. The Eleventh General Programme of Work covers the period 2006-2015. This time frame was specifically chosen to correspond with the year of 2015, which is the target for achieving the Goals. 14. Technical units of the WHO Regional Office and country offices will assist Member countries in monitoring of MDGs, data analysis, problem identification, designing effective interventions and advocacy. WHO will also assist Member countries to implement recommendations of the Regional Consultation held in June 2008 on “Utilization of Health Information for Decision-Making” to strengthen the MDG monitoring mechanism in Member countries. 15. The SEA Regional Office appointed a Task Force on Health MDGs with specific terms of reference to monitor the progress of the implementation activity. A high-level consultation to accelerate progress towards achieving maternal and child health-Millennium Development Goals (MDGs 4 & 5) in South-East Asia is scheduled to be held at Ahmedabad, India, during October 2008. 5. Future action 16. Policy directives need to be issued at the national level to: • Raise awareness of MDGs among high-level policy-makers; • Divert adequate resources to accelerate the implementation of MDGs; • Collect, compile, analyze and present MDG-related data by gender, geographical distribution and by other relevant variables; • Design effective interventions, implement and monitor the progress; and • Prepare periodic progress reports and disseminate the same among partners. 17. Detailed Graphs are provided from pages 6-13 for additional information. SEA/ACM/Meet.1/7.1 Page 6 Detailed Graphs 0 10 20 30 40 50 60 70 80 90 100 Bangladesh Timor-Leste Nepal India Maldives Myanmar Bhutan Indonesia Sri Lanka Thailand DPR Korea P r ev al ence i n p e r cen t a ge 1990 2005 2015 Target Fig. 2: Prevalence of underweight among under-5 children in SEA Region countries (Halve b/w 1990-2015) (UN MDG Goal-G1, T2, I4) Baseline data for 1990 for Timor-Leste and Maldives are estimates and 2015 is target set as MDG Source : Country reports on MDG Reference year of data for 2005 vary from 2000 to 2005 48 50 57 98 32 24 11 12 21 40 53 0 20 40 60 80 100 120 140 160 180 200 Nepal Myanmar Bangladesh Bhutan India Indonesia Thailand Maldives DPR Korea Sri Lanka Timor-Leste I n f a n t d e a t hs ( pe r 1 0 0 0 l i v e bi r t hs ) 1990 2005 Fig. 3: Infant Mortality Rate in SEA Region countries (1990-2005) Source : Country reports on MDG Reference year of data for 2005 vary from 2000 to 2005 HFA 2000 target of IMR < 50 SEA/ACM/Meet.1/7.1 Page 7 0 20 40 60 80 100 120 140 160 180 200 Nepal Bangladesh Myanmar India Bhutan Indonesia Thailand Maldives DPR Korea Sri Lanka Timor-Leste D e a t hs o f unde r f i v e year s ol d ch i l d r e n ( p e r 1 000 l i ve b i r t h s ) 1990 2005 2015 Target Fig. 4: Under-5 mortality rate in SEA Region countries (Reduce by two-thirds b/w 1990-2015) (UN MDG Goal-G4, T5, I13) Baseline data for 1990 for Timor-Leste is an estimate and 2015 is target set as MDG Source : Country reports on MDG Reference year of data for 2005 vary from 2000 to 2005 HFA 2000 target of U5MR < 70 0 20 40 60 80 100 12345678 P r o b a b ilit y o f a c h i e v in g M D G 4 (%) Mean annual percentage decline in U5MR Myanmar Timor-Leste India Bangladesh Indonesia Nepal Thailand Bhutan Sri Lanka Maldives 4.3 Two-third reduction in child mortality (MDG4 target) is equivalent to annual decline of 4.3% Fig. 4a: Tracking progress on MDG-4 (reduction in child mortality) in SEA Region countries 2005 If no extra push ( in business-as-usual scenario) : Those will reach to 2015 target : Maldives, Sri Lanka Those with >60% probability to reach 2015 target : Bhutan, Thailand Those with >40-<60 probability to reach 2015 target : Nepal, Indonesia, Bangladesh Those with <20% probability to reach 2015 target : Timor-Leste, India, Myanmar Source : Lancet 2007;370:1040-54 ChristopherJ L Murray et al SEA/ACM/Meet.1/7.1 Page 8 1 10 100 1,000 10,000 India Bangladesh Indonesia Myanmar Nepal Thailand Sri Lanka Timor-Leste Childhood Post- neonatal Neonatal 2,103,000 307,000 192,000 90,000 52,000 13,000 4,000 5,000 Total number of deaths in childern under-5 in SEAR during 2005 (2,769,000) Note : (a) Data for DPR Korea not available (b) Under-5 deaths estimated below one thousand each in Bhutan and Maldives) Source : Lancet 2007;370:1040-54 ChristopherJ L Murray et al Fig. 4b: Total number of deaths in children aged below in SEA Region countries during 2005 0 100 200 300 400 500 600 700 800 900 1000 Timor-Leste Bangladesh Bhutan Nepal Maldives India Indonesia Myanmar DPR Korea Sri Lanka Thailand M a t e rn al d eat h s p e r 10 0, 0 00 L i v e b i r t h s 1990 2005 2015 Target Fig. 5: Maternal Mortality Ratio (Reduce by three-quarters b/w 1990-2015) (UN MDG Goal-G5,T6, I16) Baseline data for 1990 for Timor-Leste is an estimate and 2015 is target set as MDG Source : Country reports on MDG Reference year of data for 2005 vary from 2000 to 2005 HFA 2000 target of MMR < 200 SEA/ACM/Meet.1/7.1 Page 9 15 24 34 41 48 51 85 87 91 5 7 3232 54 72 87 13 20 98 68 97 98 0 10 20 30 40 50 60 70 80 90 100 Bangladesh Nepal Bhutan Timor-Leste India Indonesia Maldives Myanmar Sri Lanka DPR Korea Thailand Per centage 1990 2005 Fig. 6: Proportion of births attended by skilled health personnel Source : Country reports on MDG Reference year of data for 2005 vary from 2000 to 2005 99.4 94.0 90.6 74.9 69.7 68.7 68.2 65.4 64.1 63.0 59.0 56.5 53.7 48.9 48.8 47.8 47.6 46.6 44.0 41.6 41.0 38.5 32.7 31.1 31.0 30.2 29.3 27.8 27.2 24.7 0 20 40 60 80 100 120 Kerala Tamil Nadu Karnataka Punjab Delhi M anipur Sikkim Tripura West Bengal Orissa Rajasthan M adhya Pradesh Assam Bihar Uttar Pradesh Fig. 7: Variation in perentage of deliveries assisted by health personnel at state level in India ( 2005-06) Source: India, National Family Health Survey (NFHS-III), 2005-06 Percentage SEA/ACM/Meet.1/7.1 Page 10 7,500 5,000 70,000 193,000 339,000 2,500,000 541,000 <100 <500 <100 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000 India Thailand Myanmar Indonesia Nepal Bangladesh Sri Lanka Bhutan Maldives DPR Korea Timor-Leste Nu m b er o f c ase s 2001 2006 Fig. 8: Estimated HIV prevalence in SEA Region countries Source : WHO/SEARO, HIV/AIDS Unit, May 2007 (based on country reports) Fig. 9: HIV prevalence among female sex workers in select SEA Region countries (1992-2005) 0 10 20 30 40 50 60 70 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 P e r c en t age Jakarta, Indonesia Sorong, Indonesia Kathmandu, Nepal Myanmar Mumbai, India HIV continues to spread among sex workers Source: National AIDS Programme, 2005 SEA/ACM/Meet.1/7.1 Page 11 0 10 20 30 40 50 60 70 199 1 1 992 19 93 1994 199 5 1996 1 997 1998 19 99 200 0 2001 2002 2 003 20 04 2005 Pe r c e n ta g e Thailand Delhi, India Kathmandu, Nepal Jakarta, Indonsesia Fig.10: HIV prevalence among injecting drug users in select SEA Region countries (1991–2005) HIV continues to remain high or sharply increasing or among injecting drug users Source: National AIDS Programme, 2005 Fig.11: HIV prevalence among antenatal attendees in select SEA Region countries (1991-2006) 0 1 2 3 1 991 1 992 1 993 1 9 94 1 995 1 996 1 997 1 998 1 999 2 00 0 2 0 01 2 002 2 003 2 004 2 005 2 00 6 HIV prev alence (% ) Myanmar Thailand Tamil Nadu, India HIV on the decline in Myanmar, Thailand, and Tamil Nadu in India SEA/ACM/Meet.1/7.1 Page 12 Fig. 12: HIV prevalence is decreasing or stabilizing in some countries of SEA Region 1, 777 , 2 53 28 7, 384 272 , 6 34 13 5, 194 53 , 8 75 26, 018 20, 33 8 19 , 1 62 433,326 6,728 39,164 1,825 4,962 48,121 151,508 29,782 1,640 1,817,093 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000 India Sri Lanka Thailand Myanmar Bangladesh Indonesia Nepal Bhutan DPR Korea Maldives Timor-Leste N u m b er of cases 1990 2005 Fig. 13: Reported cases of malaria in SEA Region countries Source : WHO/SEARO, Malaria Unit, May 2007 0.0 0.5 1.0 1.5 2.0 19 85 19 86 19 87 19 8 8 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 1 9 9 9 2 0 0 0 20 0 1 20 02 20 03 20 04 20 05 20 06 20 07 % a d ul t p opul a t i on i n f e c t e d w i th H I V Thailand Myanmar Nepal India SEA/ACM/Meet.1/7.1 Page 13 621 570 440 428 417 374 355 151 109 179 170 630 1,200 262 299 244 713 406 80 174 204 53 0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200 Timor-Leste Bangladesh Nepal India Indonesia DPR Korea Myanmar Bhutan Thailand Maldives Sri Lanka TB p r ev a l e n ce p e r 1 0 0, 0 0 0 po p u l a t i on 1990 2005 Fig. 14: Tuberculosis prevalence rate in SEA Region Source : WHO, Global Tuberculosis Control Report 2007 SEA/ACM/Meet.1/7.1 Page 14 Annexure 1 Revised MDG monitoring framework including new targets and indicators, as noted by the 62 nd General Assembly, and new numbering, as recommended by the Inter-Agency and Expert Group on MDG Indicators at its 12 th meeting, 14 November 2007 (All indicators should be disaggregated by sex and urban/rural as far as possible) Millennium Development Goals (MDGs) Goals and Targets (from the Millennium Declaration) Indicators for monitoring progress Goal 1: Eradicate extreme poverty and hunger Target 1.A: Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day 1.1 Proportion of population below $1 (PPP) per day 1 1.2 Poverty gap ratio 1.3 Share of poorest quintile in national consumption Target 1.B: Achieve full and productive employment and decent work for all, including women and young people 1.4 Growth rate of GDP per person employed 1.5 Employment-to-population ratio 1.6 Proportion of employed people living below $1 (PPP) per day 1.7 Proportion of own-account and contributing family workers in total employment Target 1.C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger 1.8 Prevalence of underweight children under-five years of age 1.9 Proportion of population below minimum level of dietary energy consumption Goal 2: Achieve universal primary education Target 2.A: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling 2.1 Net enrolment ratio in primary education 2.2 Proportion of pupils starting grade 1 who reach last grade of primary 2.3 Literacy rate of 15-24 year-olds, women and men Goal 3: Promote gender equality and empower women Target 3.A: Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 3.1 Ratios of girls to boys in primary, secondary and tertiary education 3.2 Share of women in wage employment in the non- agricultural sector 3.3 Proportion of seats held by women in national parliament Goal 4: Reduce child mortality Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate 4.1 Under-five mortality rate 4.2 Infant mortality rate 4.3 Proportion of 1 year-old children immunised against measles 1 For monitoring country poverty trends, indicators based on national poverty lines should be used, where available. SEA/ACM/Meet.1/7.1 Page 15 Goal 5: Improve maternal health Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio 5.1 Maternal mortality ratio 5.2 Proportion of births attended by skilled health personnel Target 5.B: Achieve, by 2015, universal access to reproductive health 5.3 Contraceptive prevalence rate 5.4 Adolescent birth rate 5.5 Antenatal care coverage (at least one visit and at least four visits) 5.6 Unmet need for family planning Goal 6: Combat HIV/AIDS, malaria and other diseases Target 6.A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS 6.1 HIV prevalence among population aged 15-24 years 6.2 Condom use at last high-risk sex 6.3 Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS 6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years Target 6.B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it 6.5 Proportion of population with advanced HIV infection with access to antiretroviral drugs Target 6.C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases 6.6 Incidence and death rates associated with malaria 6.7 Proportion of children under 5 sleeping under insecticide- treated bednets and Proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs 6.8 Incidence, prevalence and death rates associated with tuberculosis 6.9 Proportion of tuberculosis cases detected and cured under directly observed treatment short course Goal 7: Ensure environmental sustainability Target 7.A: Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources 7.1 Proportion of land area covered by forest 7.2 CO2 emissions, total, per capita and per $1 GDP (PPP), and consumption of ozone-depleting substances 7.3 Proportion of fish stocks within safe biological limits 7.4 Proportion of total water resources used Target 7.B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss 7.5 Proportion of terrestrial and marine areas protected 7.6 Proportion of species threatened with extinction Target 7.C: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation 7.7 Proportion of population using an improved drinking water source 7.8 Proportion of population using an improved sanitation facility Target 7.D: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers 7.9 Proportion of urban population living in slums 2 2 The actual proportion of people living in slums is measured by a proxy, represented by the urban population living in households with at least one of the four characteristics: (a) lack of access to improved water supply; (b) lack of access to improved sanitation; (c) overcrowding (3 or more persons per room); and (d) dwellings made of non-durable material. SEA/ACM/Meet.1/7.1 Page 16 Goal 8: Develop a global partnership for development Target 8.A: Develop further an open, rule-based, predictable, non-discriminatory trading and financial system Includes a commitment to good governance, development and poverty reduction – both nationally and internationally Target 8.B: Address the special needs of the least developed countries Includes: tariff and quota free access for the least developed countries’ exports; enhanced programme of debt relief for heavily indebted poor countries (HIPC) and cancellation of official bilateral debt; and more generous ODA for countries committed to poverty reduction Target 8.C: Address the special needs of landlocked developing countries and small island developing States (through the Programme of Action for the Sustainable Development of Small Island Developing States and the outcome of the twenty-second special session of the General Assembly) Target 8.D: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term Some of the indicators listed below are monitored separately for the least developed countries (LDCs), Africa, landlocked developing countries and small island developing States. Official development assistance (ODA) 8.1 Net ODA, total and to the least developed countries, as percentage of OECD/DAC donors’ gross national income 8.2 Proportion of total bilateral, sector-allocable ODA of OECD/DAC donors to basic social services (basic education, primary health care, nutrition, safe water and sanitation) 8.3 Proportion of bilateral official development assistance of OECD/DAC donors that is untied 8.4 ODA received in landlocked developing countries as a proportion of their gross national incomes 8.5 ODA received in small island developing States as a proportion of their gross national incomes Market access 8.6 Proportion of total developed country imports (by value and excluding arms) from developing countries and least developed countries, admitted free of duty 8.7 Average tariffs imposed by developed countries on agricultural products and textiles and clothing from developing countries 8.8 Agricultural support estimate for OECD countries as a percentage of their gross domestic product 8.9 Proportion of ODA provided to help build trade capacity Debt sustainability 8.10 Total number of countries that have reached their HIPC decision points and number that have reached their HIPC completion points (cumulative) 8.11 Debt relief committed under HIPC and MDRI Initiatives 8.12 Debt service as a percentage of exports of goods and services Target 8.E: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries 8.13 Proportion of population with access to affordable essential drugs on a sustainable basis Target 8.F: In cooperation with the private sector, make available the benefits of new technologies, especially information and communications 8.14 Telephone lines per 100 population 8.15 Cellular subscribers per 100 population 8.16 Internet users per 100 population SEA/ACM/Meet.1/7.1 Page 17 Annexure 2 Resolution of 61 st World Health Assembly SIXTY-FIRST WORLD HEALTH ASSEMBLY WHA61.18 Agenda item 11.12 24 May 2008 Monitoring of the achievement of the health-related Millennium Development Goals The Sixty-first World Health Assembly, Recalling the 2005 World Summit Outcome and the commitments taken by the international community to fully implement the Millennium Development Goals; Concerned by the relatively slow progress made, especially in the sub-Saharan African countries, in achieving the Millennium Development Goals, and in particular the health-related Goals; Concerned by the fact that achievement of Millennium Development Goals varies from country to country and from goal to goal; Concerned that the high rate of morbidity and mortality are underpinned by social determinants of health and high levels of malnutrition and noting that these social determinants of health may further undermine achievements of the health-related Millennium Development Goals; Recalling the General Assembly resolution 60/265 dated 12 July 2006 on follow-up to the development outcome of the 2005 World Summit, including the Millennium Development Goals and the other internationally agreed development goals, and the WHO Medium-term strategic plan 2008–2013; Welcoming the Secretariat’s report on monitoring achievement of the health-related Millennium Development Goals; 1 Underlining in particular the need to build sustainable national health systems; strengthen national capacities; fully honour financing commitments made by national governments and their development partners in order to better fill many of the resource gaps in the health sector; to take concrete, effective and timely action in implementing all agreed commitments on aid effectiveness and to increase predictability of aid; Reaffirming the commitments by many developed countries to achieve the target of 0.7% of gross national income for official development assistance by 2015 and to reach at least 0.5% of gross national income for official development assistance by 2010, as well as the target of 0.15% to 0.20% ____________________________ 1 Document A61/15. SEA/ACM/Meet.1/7.1 Page 18 WHA61.18 for least developed countries, and urge those developed countries that have not yet done so to make concrete efforts in this regard in accordance with their commitments. 1. DECIDES: (1) to include the monitoring of the achievement of the health-related Millennium Development Goals as a regular item on the agenda of the Health Assembly; (2) to support the United Nations Secretary-General’s call to action, including the United Nations High-Level Event on the Millennium Development Goals (New York, 25 September 2008); 2. URGES Member States: to continue sustaining high-level political commitments and work with development partners towards strengthening the national health systems including health information system for monitoring Millennium Development Goals progress. 3. REQUESTS the Director-General: (1) to submit annually a report on the status of progress made, including on main obstacles and ways to overcome them, according to the new monitoring framework, in achievement of the health-related Millennium Development Goals, through the Executive Board to the Health Assembly; (2) to that effect, to continue to cooperate closely with all other United Nations and international organizations involved in the process of achieving the Millennium Development Goals in the framework of WHO’s Medium-term strategic plan 2008–2013; (3) to work with all relevant partners to help to ensure that action on the health-related Millennium Development Goals is one of the main themes of the United Nations High-Level Event on the Millennium Development Goals (New York, 25 September 2008). Eighth plenary meeting, 24 May 2008 A61/VR/8 = = =