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Monitoring Health in the Sustainable Development Goals: 2017 update

August 1, 2017 World Health Organization

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Monitoring Health in the Sustainable Development Goals

2017

Monitoring Health in the Sustainable Development Goals

2017

Monitoring Health in the Sustainable Development Goals: 2017 update ISBN: 978 92 9022 604 8 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.. Suggested citation. Monitoring Health in the Sustainable Development Goals: 2017 update. New Delhi: World Health Organization, Regional Office for South-East Asia; 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-partyowned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.

Contents

Introduction by the Regional Director Navigating this report PART 1: An overview of the current status across the 11 countries in the South-East Asia Region on the health and health-related SDGs targets PART 2: Country specific SDG data profiles

1 3

5 9

Bangladesh 13 Bhutan 17 The Democratic People’s Republic of Korea 21

India 25 Indonesia 29 Maldives 33 Myanmar 37 Nepal 41 Sri Lanka 45

Thailand 49 Timor Leste 53

Monitoring Health in the Sustainable Development Goals

iii

Introduction by the Regional Director

I am committed to publishing a regional report every year on progress on the health Sustainable Development Goals (SDGs), which will be presented to the Regional Committee. This new publication provides an update to last year’s first analysis of Health in the Sustainable Development Goals: where we are now in the South-East Asia Region; what next. That report included 11 individual profiles of Member States of the South-East Asia (SEA) Region, with data on a set of health and health-related SDG targets. This year’s report follows the same format.

What is new in this publication? First, there is an overview of how near or far countries are from achieving the 2030 SDG health targets. This is possible for 16 out of the 38 indicators presented here, for which global targets have been set. In future, we will be able to report in this way for progressively more indicators, as global targets are agreed upon. I note that several Member States have already met some of the global SDG targets, or are near to doing so. Child and maternal mortality are two examples. This is welcome, but not a cause for complacency. I encourage Member States to set national targets that reflect their own priorities for progress. Conversely, stunting stands out as an indicator where many Member States are far from the global SDG target. Second, the final indicators of the global SDG indicator framework agreed to earlier this year are used in this report. This includes the revised universal health coverage (UHC) indicator on financial protection. We also report here for the first time on childhood obesity; on two additional indicators on health spending, and on completeness of cause-of-death data. Two indicators stand out because few Member States currently have national data on these: completeness of cause-of-death data, which affects noncommunicable disease (NCD) reporting, and access to medicines. Both these areas are priorities for the Regional Office in its efforts to improve the quality and completeness of data in the Region. Trends are always more informative than one-off statistics. This publication includes updated data where they are available, and we will continue to expand this aspect of the report. There is a concerted effort to report on equity, but this remains a major challenge. I encourage all Member States to reinforce efforts to generate more disaggregated data to better capture who is being left behind. We are all aware that SDG 3 on health is comprehensive: “Ensure healthy lives and promote well-being for all at all ages.” The SDG Declaration emphasizes that to achieve

Monitoring Health in the Sustainable Development Goals

this goal, “we must achieve universal health coverage and access to quality health care. No one must be left behind.” This places UHC at the centre of SDG3. SDG3 is also positioned as a contributor to and beneficiary of many other goals, emphasizing the point that an integrated approach to sustainable development is needed. Tracking progress towards UHC, and the health and health-related SDG targets is therefore a vital part of the 2030 Sustainable Development Agenda, and will foster accountability for progress and results. In February 2017, the Regional Office held a technical consultation1 on “Monitoring the Health-related Sustainable Development Goals (SDGs)”, which addressed many data issues and the burden of monitoring the health SDGs. Almost all of the health and healthrelated SDG3 targets can be linked to those in global strategies and plans adopted by the World Health Assembly. The main outcomes from the technical consultation were an emphasis on the importance of using disaggregated data for equity analysis; the need for strengthening civil registration and vital statistics (CRVS) systems; aligning the SDGs with existing monitoring and evaluation (M&E) frameworks and setting national targets, and linking data from both the public and private sectors. Most of the health and health-related SDG targets and indicators are straightforward. In several Member States, many of the health and health-related SDG indicators are already embedded in national M&E frameworks, with reasonably good data available. This report includes the most recent and best available data for 25 indicators under the 13 health SDG3 targets, plus 13 indicators across eight other health-related SDG targets. The health and health-related SDG indicators cover all major health priorities, including the unfinished and expanded Millennium Development Goals agenda; new priorities such as NCDs, mental health, injuries and environmental issues; “means of implementation targets” on health systems, and the determinants of health. Regular monitoring of progress is an essential ingredient of change. I hope this yearly publication contributes to maintaining the momentum around the Sustainable Development Agenda, to which we are all committed.

Dr Poonam Khetrapal Singh Regional Director

1 World Health Organization, Regional Office for South-East Asia. Background paper for regional technical consultation on Monitoring the Health-Related Sustainable Development Goals (SDGs), 9–10 February 2017, New Delhi, India, (http://www.searo.who.int/entity/health_situation_trends/background_paper_mnitoring_the_health_ related_sdgs.pdf?ua=1, accessed 31 July 2017).

Monitoring Health in the Sustainable Development Goals

Navigating this report

A note on indicator definitions and data The health and health-related SDG indicators have been mapped to and populated according to the United Nations SDG metadata standards.2 Almost all the health-related SDG indicators used in this report are aligned with these global definitions and consistent with data and indicators presented in the WHO World health statistics 2017.3 However, three health SDG3 indicators have been modified to better fit the regional context, which are described in the box below. SDG target 3.3.3 3.8.7 Indicator Malaria Incidence(per 1000 population at risk) Population at risk sleeping under insecticide-treated bed nets (%) Health worker density for physicians, psychiatrists and surgeons Revised definition Includes only confirmed cases Population at risk sleeping under insecticide-treated bed nets or using indoor residual spraying (%) Health worker density for physicians, nurses and midwives

3.c.

The final date for all data presented in this report is 30 June 2017.

Part 1 of this report is an overview of the current status of the health and healthrelated SDG targets across the 11 Member States of the WHO South-East Asia Region. Global targets have already been agreed to and adopted for 16 out of 25 health SDG indicators. Four categories are used to signal the status of these 16 indicators4: achieved; near or far from the target (two categories), and national target not yet available.

“Achieved” indicates that countries have already met the target. Whether countries are “near” or “far” from the 2030 targets is determined in one of two ways: zz

For SDG targets based on percentage progress and a 100% goal, “near” is greater than or equal to 75% progress and “far” is less than 75% progress. Where absolute values are used as SDG targets, “near” and “far” criteria are based on technical advice from subject matter experts in the WHO Regional Office.

“No national target” means the indicator values cannot be colour-coded to show progress because nationally specified targets are not yet available.

2 United Nations. SDG indicators metadata repository (https://unstats.un.org/sdgs/metadata/, accessed 4 July 2017). 3 World health statistics 2017: monitoring health for the SDGs. Geneva: World Health Organization; 2017 (http://www.who.int/gho/publications/world_health_statistics/2017/en/, accessed 12 June 2017). 4 There are altogether 26 health SDGs indicators. Only 25 indicators are reported in this report. This is because SDG indicator 3.5.1 coverage of treatment interventions (pharmacological, psychological rehabilitation and aftercare services) for substance use disorders, is not currently reported by WHO as there are no data available.

Monitoring Health in the Sustainable Development Goals

Part 2 of this report presents individual health SDG profiles of Member States, as was done in 2016. These SDG profiles contain more detailed information on progress towards each health and health-related SDG target. Looking forward, countries will need to set national targets for those that are not yet specified globally. These targets should be feasible and achievable, given the country context. This also implies that countries would need new and improved data collection efforts for certain indicators, and the capacity to use disaggregated data stratified by different dimensions of equity to measure and address health inequalities. Altogether, stronger health information systems are required to generate routine and high-quality statistics for effective monitoring of the SDG targets. The Regional Office will continue to report annually on progress towards all of the national health and health-related SDG targets, and support the further development of national information system platforms.

Monitoring Health in the Sustainable Development Goals

PART I An overview of the current status across the 11 countries in the South-East Asia Region on the health and health-related SDGs targets

An overview of the current status across the 11 countries in the Health-related SDG indicators 3.1.1 Maternal mortality ratio (per 100 000 live births) 3.1.2 Proportion of births attended by skilled health personnel (%) 3.2.1 Under-five mortality rate (per 1000 live births) 3.2.2 Neonatal mortality rate (per 1000 live births) 3.3.1 New HIV infections among adults 15-49 years old (per 1000 uninfected population) 3.3.2 TB incidence (per 100 000 population) 3.3.3 Malaria incidence (per 1000 population at risk) 3.3.4 Hepatitis B incidence 3.3.5 Reported number of people requiring interventions against NTDs 3.4.1 Probability of dying from any of CVD, cancer, diabetes, CRD between age 30 and exact age 70 (%) 3.4.2 Suicide mortality rate (per 100 000 population) 3.5.2 Total alcohol per capita (> 15 years of age) consumption, in litres of pure alcohol 3.6 Road traffic mortality rate (per 100 000 population) 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods (%) 3.7.2 Adolescent birth rate (per 1000 women aged 15-19 years) 3.8.1 Coverage of essential health services 3.8.2 Financial protection when using health services 3.9.1 Mortality rate attributed to household and ambient air pollution (per 100 000 population) 3.9.2 Mortality rate attributed to exposure to unsafe WASH services (per 100 000 population) 3.9.3 Mortality rate from unintentional poisoning (per 100 000 population) 3.a.1 Prevalence of tobacco use among persons 15 years and older (%) 3.b.1 Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.2 Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country 3.c Skilled health professionals density (physicians/nurses/midwives per 10 000 population) 3.d Average of 13 International Health Regulations core capacity scores 1.a General government health expenditure as % of general government expenditure 2.2.1 Prevalence of stunting in children under 5 (%) 2.2.2 Prevalence of wasting in children under 5 (%) 2.2.3 Prevalence of overweight in children under 5 (%) 6.1 Proportion of population using improved drinking-water sources (%) 6.2 Proportion of population using improved sanitation (%) 7.1 Proportion of population with primary reliance on clean fuels (%) 11.6 Annual mean concentrations of fine particulate matter (PM2.5) in urban areas (µg/m3) 13.1 Average death rate due to natural disasters(per 100 000 population) 16.1.1 Mortality rate due to homicide (per 100 000 population) 16.1.2 Estimated direct deaths from major conflicts (per 100 000 population) 16.9.1 Birth registration coverage SDG target 70 per 100 000 live births To be determined 25 per 1000 live births 12 per 1000 live births 0 per 1000 uninfected population 80% reduction in TB incidence compared with 2015 baselinee 90% reduction in malaria incidence with 2015 baseline To be determined 0 1/3 reduction from 2012 baseline To be determined 10% reduction in harmful use of alcohol 50% reduction 100% To be determined 100% % of household spending more than 10% on health To be determined To be determined To be determined 30% reduction in current tobacco use To be determined To be determined 44.5/10 000 100% To be determined 40% reduction between 2010 and 2025 < 5% No increase in childhood overweight 100% 100% 100% population not using solid fuel for cooking 10(µg/m3) To be determined To be determined To be determined 100% BAN 176 42.1 37.6 23.3 0.01 225 2.4 49 839 493 21.5 5.5 0.2 13.6 72.6 113 50 14.1 68.6 6 0.3 43 65 1.02 7.4 76 5.7 36.1 14.3 1.4 87 61 10 88.8 0.1 2.9 <0.1 20.2 BHU 148 74.6 32.9 18.3 155 0.06 227 111 23.1 11.7 0.5 15.1 84.6 28.4 66 58.9 7.1 0.9 25 4.55 19.9 76 8 21.2 4.3 2.6 100 50 68 39 0 1.5 0 100

17.19.2 Completeness of cause-of-death data (%)

80% – – Monitoring Health in the Sustainable Development Goals Progress towards 2030 Targets: Achieved Near Far No national target

South-East Asia Region on the health and health-related SDGs targets DPRK 82 100 24.9 13.5 561 0.6 6 082 191 26.5 0 3.9 20.8 76.7 0.7 76 238.4 1.4 2.3 1.13 73.7 73 – 27.9 4 0 100 82 7 31.4 0.2 0 100 – IND 174 81.4 47.7 27.7 0.11 217 1 497 396 247 23.3 15.7 5 16.6 63.9 28.1 57 133.7 27.4 1.9 35 0.2 30.2 98 5 38.4 21 1.9 94 40 34 65.7 0.2 4 0.1 79.7 INO 126 83.1 27.2 13.5 0.5 395 3.2 111 437 132 26.6 2.9 0.6 15.3 79 48.4 56 4.4 85 3.6 0.5 36 0.32 29.2 99 5.7 36.4 13.5 11.5 87 61 57 17.8 0.1 4.3 <0.1 67 MAV 68 94.8 8.6 4.9 53 1 892 12.4 8.6 1.7 3.5 42.7 13.7 64 15.3 0.6 0.6 20 1.65 118.1 60 26.6 18.9 10.6 6.5 99 98 >95 – 0 3.5 0 MMR 178 60.2 50 26.4 0.41 365 5.7 41 292 086 24.5 4.3 2.2 20.3 74.9 36 51 128.2 10.4 1.8 41 43 3 84 3.6 29.2 7 1.3 81 80 9 56.6 0.1 3.9 1.6 81.3 – NEP 258 58 35.8 22.2 0.08 156 0.1 9 18 850 311 21.8 6 2.5 17 56 88 64 103.2 12.9 0.6 31 66 4.32 29.3 72 11.2 35.8 9.7 0.3 92 46 26 74.3 7.2 3.3 <0.1 58.1 – SRL 30 98.6 9.8 5.4 0.05 65 33 229 17.7 35.3 4.1 17.4 69.4 20.3 64 8.5 125.4 3.3 0.4 25 1.21 29.8 79 11.2 14.7 21.4 0.6 96 95 19 28.5 0.4 3.1 <0.1 97 93 THA 20 99.1 12.3 6.7 0.2 172 0.7 145 141 16.2 16 7.2 36.2 89.2 51 77 2.3 64 1.9 0.5 27 0.49 29.3 98 13.3 10.5 5.4 8.2 98 93 76 27.3 0.3 4 0.7 99.5 81 TLS 215 29.9 52.6 22.3 498 0.1 1 170 044 20.7 7.1 1 16.6 38.3 51 46 0.9 91.6 10.3 1 56 10.8 20.3 66 2.4 50.2 11 1.5 72 41 <5 15 0 4.4 0 55 –

10 – 100 Monitoring Health in the Sustainable Development Goals

PART 2 Country specific SDG data profiles

This section provides country specific data profiles for the eleven countries of the SouthEast Asia Region. A set of SDG health-related indicators are presented. For each country there is a comprehensive list of references showing data source and year.

~~ Bangladesh ~~ Bhutan ~~ The Democratic People’s Republic of Korea ~~ India ~~ Indonesia ~~ Maldives ~~ Myanmar ~~ Nepal ~~ Sri Lanka ~~ Thailand ~~ Timor Leste

Monitoring Health in the Sustainable Development Goals

Bangladesh Population (000s)¹ Urban population² Poverty² GDP per capita² (Current US$)

160 996

34.3%

18.5

(ppp< < $1.90 $1.90 a (ppp aday) day)

Total health expenditure as share of GDP³

1211.7

2.8%

Monitoring the health SDG goal: Indicators of overall progress Life expectancy 100 Age (years) 65 56 72 62

Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Bangladesh, from 2000 (65.3 years) to 2015 (71.8 years), the life expectancy at birth has improved by 6.5 years. Healthy life expectancy⁵ reflects overall health of the country's population. In Bangladesh, from 2000 (56.3 years) to 2015 (62.3 years), healthy life expectancy has improved by 6.0 years.

0 2000 Life expectancy at birth 2007 2015 Healthy life expectancy

HEALTH SERVICE COVERAGE A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁶ Child immunization coverage (DPT3)⁷ Care seeking behaviour suspected pneumonia⁶ 73 36 94 42 Latest available data (2010-2016)

FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 3.3% or approximately 5 250 000 people are being pushed into poverty because of out-of-pocket health spending.¹⁸ Catastrophic expenditure on health: 14.1% of people spent more than 10% of their household's total expenditure on health care.¹⁸ Out-of-pocket expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection. Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

Infectious diseases Coverage (%) 100 50 0 TB detected and treated⁸

53 15 HIV antiretroviral therapy coverage⁹

Insecticide-treated bednets/indoor residual spray coverage for malaria prevention¹⁰

Access to improved sanitation¹¹

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Mean fasting plasma blood pressure in glucose¹³ (mmol/L) population¹² Cervical cancer screening Tobacco non-use¹⁴

82 51 57 67% GDP 2014 Estimated total government expenditure, 2014 or latest available year

5.7% 5.7% 5.7%

Service capacity, access and health security Coverage (%) 100 50 0

76 33 17 Health security: IHR compliance¹¹

Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated government expenditure on health, 2014 or latest available year

Density of hospital Heath worker beds¹⁵, expressed as density¹⁶, expressed % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000

Access to essential medicines¹⁷

UHC services coverage index of essential health services To provide a summary measure of coverage, an index of national service coverage is computed by averaging service coverage values across the 16 tracer indicators. The UHC coverage index ranges from 0% to 100%, with 100% implying full coverage across a range of services. UHC services coverage index 100 Coverage (%) 50

This profile provides an overview of the current status of achieving better health towards the 13 targets under the Sustainable Development Goal #3 (SDG3): Ensure healthy lives and promote well-being for all at all ages. All 25 SDG3 indicators plus other selected health-related indicators are presented where data is available.

50 0

UHC services coverage index

Monitoring Health in the Sustainable Development Goals

Bangladesh

Variation, urban versus rural⁶ Percentage of demand for family planning satisfied 100 80 Improved source of sanitation 60 40 20 0

Equity: Leave no one behind Variation by income⁶ Percentage of demand for family planning satisfied 100 80 Births attended by skilled health personnel Improved source of sanitation 60 40 20 0 Births attended by skilled health personnel

PNC (within 2 days)

DTP3 Coverage

PNC (within 2 days)

DTP3 Coverage

Care seeking behaviour for children with suspected pneumonia Urban Rural

Care seeking behaviour for children with suspected pneumonia Richest Poorest

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁹ (%) Prevalence of raised blood pressure among adults aged ≥18 years¹² (%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years²⁰ (%) Female 4.9 24.9 9.3 Male 1.8 24.5 10.3

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile for some high-burden countries, 2009 to 2016²¹ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDGs emphasis on equity SDG target 17.18 emphasizes the need for disaggregated data. By 2020, enhance capacity-building support to developing countries to increase significantly the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographical location and other characteristics relevant in national contexts.

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²² MMR [100 000 live births ] 750 Coverage (%) 100 MR [1000 live births] Births attended by skilled health personnel²³ 150 100 Child mortality²⁴

500 399

50 32 18

88.0

250 176

50 0

42.6

37.6 23.3

0 2000 2005 2010 2015

0 2007 2011 2014

2000

2005

2010 Neonatal

2015

Children under-five

Bangladesh

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁵ TB incidence [100 000 pop.] HIV IR [1000 uninfected pop.]

TB incidence²⁶ Malaria IR [1000 pop. at risk] 500 400 300 200 100 0 225 225

Malaria incidence²⁷ 20 15 10 5 0 4.7 2.4

Indicators

Year

Bangladesh

Regional estimate -

0.4

Hepatitis B incidence

0.2

<0.1 0.0

0.01 2011 2012 2013 2014 2015

2011 2012 2013 2014 2015

2011 2012 2013 2014 2015 Malaria incidence is calculated for confirmed malaria cases

Number of people requiring interventions 2015 against neglected tropical diseases¹¹

49,839,493

726,474,894

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases¹¹ (%) Suicide mortality rate¹¹ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption¹¹ Mortality rate from road traffic injuries¹¹ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁶ (%) Adolescent birth rate⁶ (per 1000 women aged 15 to19 years) Mortality rate attributed to household and ambient air pollution¹¹ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services¹¹ (per 100 000 population) Mortality rate attributed to unintentional poisoning¹¹ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁴ Prevalence of tobacco smoking among persons 15 years and older-Male¹⁴ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis¹⁷ Total net official development assistance to medical research and basic health per capita (constant 2014 US$¹¹ Health workforce Health worker density¹⁶ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹¹ 3.d.1 2016 76 80 3.7.1 2014 72.6 74.1 0

SDG target 3.4.1

Year 2015

Bangladesh 21.5

Regional estimate 23.2

Total alcohol per capita (age 15+ years) consumption²⁸

3.4.2 3.5.2 3.6.1

2015 2016 2013

5.5 0.2 13.6

12.9 4 17 Litres

0.0

0.2

2003

2008

2010

2015

2016

3.7.2

2014

113

33.9 Adolescent birth rate [women aged 15-19 yrs]

Adolescent birth rate (per 1000 women aged 15 to 19 years)²³ 150 126 113 100

Mortality due to environmental pollution 3.9.1 3.9.2 3.9.3 2012 2012 2015 68.6 6 0.3 119.9 20.1 1.5

3.a.1 3.a.1

2015 2015

29 58

18 52

0 2007 2011 2014

Premature NCD mortality rate²⁹ Premature NCD mortality rate (per 100 000 pop) 1000

3.b.1

2014

750

3.b.2

2014

1.02

0.47

500

3.c.1

2016

7.4

250

0 2000 Female 2005 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Bangladesh

General government health expenditure Indicators General government health expenditure as % of general government expenditure¹¹ Child nutrition Children under 5 years who are stunted⁶ Children under 5 years who are wasted⁶ Children under 5 years who are overweight⁶ Drinking water services and sanitation Proportion of population using improved drinking water sources¹¹ Proportion of population using improved sanitation¹¹ Clean household energy Proportion of population with primary reliance on clean fuel¹¹ Ambient air pollution Air pollution level in cities¹¹ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹¹ ( per 100 000 people) Homicide and conflicts Mortality rate due to homicide¹¹ (per 100 000 population) Estimated direct deaths from major conflicts¹¹ (per 100 000 population) Birth registration Birth registration coverage⁶ Cause-of-death data Completeness of cause-of-death data¹¹ (%) 17.19.2 13.1.2 11.6.2 7.1 2.2.1 2.2.2 2.2.3

Other health-related SDGs SDG target 1.a Year 2014 Bangladesh 5.7 Regional estimate Proportion (%) 100

Prevalence of children under 5 years of age who are stunted³⁰

9.3

2014 2014 2014

36.1 14.3 1.4

33.8 15.3 5.3

51 36

0 2004 2007 2011 2014

6.1 6.2

2015 2015

87 61

92 49 Proportion (%) 50

Prevalence of children under 5 years of age who are wasted³⁰

2014

25 14.5 14.3

2014

58.8 0 2004 2007 2011 2014

2011-2015

0.10

0.3 15

Prevalence of children under 5 years who are overweight³⁰

16.1.2 16.9.1

2011-2015 2014 2005-2015

< 0.1 20.2 -

0.1 11

Proportion (%)

16.1.1

2015

2.9

0.9

1.4

2004

2007

2011

2014

Note: A dash (-) implies relevant data are not available

References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 12 June 2017. 4.World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 2 June 2017. 5.World Health Organization. Global Health Observatory data: Healthy life expectancy . Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 2 June 2017. 6.Bangladesh Demographic and Health Survey 2014. https://dhsprogram.com/pubs/pdf/FR311/FR311.pdf -accessed 12 June 2017. 7.World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage. 8.World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. See for TB detection and treatment: case detection rate x TB treatment success rate. 9.UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 10.World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 11.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 12.World Health Organization. WHO global database on blood pressure, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease. The prevalence of raised BP has been rescaled based on a minimum value of 50%. 13.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 14.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 15. World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 16.As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 17.Bangladesh Service Provision Assessment (SPA) survey 2014. http://dhsprogram.com/publications/publication-SPA23-SPA-Final-Reports.cfm - accessed 3 June 2017. See for access to essential medicine; a proxy, using essential medicines for RMNCAH. 18. Ministry of Health and Family Welfare and World Health Organization, Bangladesh 2016. 19.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 20.World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 21.DHS/MICS; 2009-2016. 22.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 23.Bangladesh DHS 2007, Bangladesh DHS 2011 Bangladesh DHS 2014. 24. Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 25.UNAIDS 2017 estimates for incidence rate among (15-49). http://aidsinfo.unaids.org - accessed 12 June 2017. 26.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 27.Calculated. World Health Organization. World Malaria report. Geneva, 2016. http://www.who.int/malaria/publications/world-malaria-report-2016/en/ - accessed 10 June 2017. 28.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 29.World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. 30.Bangladesh DHS 2004, Bangladesh DHS 2007, Bangladesh DHS 2011, Bangladesh DHS 2014.

Bangladesh

Monitoring Health in the Sustainable Development Goals

Bhutan Population (000s)¹ Urban population² Poverty² (ppp day) (ppp < < $1.90 $1.90 a day)

GDP per capita² (Current US$)

775

38.6%

2.2%

2656.0

Total health expenditure as share of GDP³

3.6%

Life expectancy 100 Age (years)

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Bhutan, from 2000 (60.2 years) to 2015 (69.8 years), the life expectancy at birth has improved by 9.6 years. Healthy life expectancy⁵ reflects overall health of the country's population. In Bhutan, from 2000 (52.9 years) to 2015 (61.2), healthy life expectancy has improved by 8.3 years. 2007 2015

60 53

70 61

0 2000 Life expectancy at birth Healthy life expectancy

Universal health coverage: At the centre of the health goal The goal of universal health coverage (UHC) is that all people and communities receive the health care they need, without suffering financial hardship. Monitoring UHC requires measuring health service coverage and financial protection (SDG target 3.8). A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁶ Child immunization coverage (DPT3)⁷ Care seeking behaviour suspected pneumonia⁶ 85 78 99 Latest available data (2010-2016) 74

HEALTH SERVICE COVERAGE

FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: Insufficient data Catastrophic expenditure on health: Insufficient data

Infectious diseases Coverage (%) 100 50 0 Tuberculosis detection and treatment⁸ HIV antiretroviral therapy Insecticide-treated coverage⁹ bednets/indoor residual spray coverage for malaria prevention¹⁰ Access to improved sanitation¹¹ 100 72 50 23

Out-of-pocket expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection.

Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

Noncommunicable diseases Coverage (%) 100 44

25% 8.03% 8.03% 8.03% 75

50 0

GDP 2014

Prevalence of normal Mean fasting plasma blood pressure in glucose¹³ (mmol/L) population¹²

Cervical cancer screening¹⁴

Tobacco non-use¹⁵ Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated total government expenditure, 2014 or latest available year Estimated government expenditure on health, 2014 or latest available year

Service capacity, access and health security Coverage (%) 100 50 0 Density of hospital Heath worker Health security: IHR beds¹⁶, expressed as density¹⁷, expressed compliance¹¹ % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Access to essential medicines 100 45 76

UHC services coverage index of essential health services To provide a summary measure of UHC services coverage index coverage, an index of national 100 service coverage is computed by 66 averaging service coverage values across the 16 tracer indicators. The 50 UHC coverage index ranges from 0% to 100%, with 100% implying full 0 coverage across a range of services. UHC services coverage index Coverage (%)

Monitoring Health in the Sustainable Development Goals

Bhutan

Variation, urban versus rural⁶ Percentage of demand for family planning satisfied 100 80 Improved source of sanitation 60 40 20 0 Care seeking behaviour for children with suspected pneumonia DTP3 Coverage Urban Rural

Equity: Leave no one behind

Variation by income⁶ Percentage of demand for family planning satisfied 100 80

Births attended by skilled health personnel

Improved source of sanitation

60 40 20 0

Births attended by skilled health personnel

PNC (within 2 days)

Care seeking behaviour for children with suspected pneumonia DTP3 Coverage Richest Poorest

PNC (within 2 days)

Data not available

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁸ (%) Prevalence of raised blood pressure among adults aged ≥18 years¹² (%) Prevalence of raised fasting blood glucose among adults aged ≥18 years¹⁹(%) Female 8.2 27.6 11.5 Male 4.2 28.5 11.9

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile in some high-burden countries, 2009 to 2016²⁰ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²¹ MMR [100 000 live births ] 750 500 423

Births attended by skilled health personnel²² 100 Coverage (%) 75 65

Child mortality²³ 150 MR [1000 live births] 100 80

50 24

250 148

50 33 33 18

0 2000 2005 2010 2015

0 2000 2005 2010 2012

0 2000 Children under-five

2005

2010 Neonatal

2015

Bhutan

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among TB incidence [100 000 pop.]

400 300 200 100 0 211 155

Malaria IR [1000 pop. at risk]

adults 15 to 49 years²⁴

TB incidence²⁵ 500 20 15 10 5 0

Malaria incidence²⁶

Indicators Hepatitis B incidence Number of people requiring interventions against neglected tropical diseases¹¹

Year

Bhutan

Regional estimate -

0.27

0.06

2015

227111

726,474,894

Current data are insufficient to determine trend

2011 2012 2013 2014 2015

Malaria incidence is calculated for confirmed malaria cases. in 2015 only 1 district was at pop. at risk

2011 2012 2013 2014

Total alcohol per capita (age 15+ years) consumption³⁰

3.4.2 3.5.2 3.6.1

2015 2016 2013

11.7 0.5 15.1

12.9 4 17

0.2

0.5

3.7.1

2010

84.6

74.1

2003

2008

2010

2015

2016

Mortality due to environmental pollution Mortality rate attributed to household and ambient air pollution¹¹ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services¹¹ (per 100 000 population) Mortality rate attributed to unintentional poisoning¹¹ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁵ Prevalence of tobacco use among persons 15 years and older-Male¹⁵ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis Total net official development assistance to medical research and basic health per capita¹¹ (constant 2014 US$) Health workforce Health worker density¹⁷ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹¹ 3.d.1 2016 76 80 3.b.1 3.9.1 3.9.2 3.9.3 2012 2012 2015 58.9 7.1 0.9 119.9 20.1 1.5

Adiolescent Birth Rate [women aged 15-19 yrs]

3.7.2

2012

28.4

33.9

Adolescent birth rate (per 1000 women aged 15 to 19 years)⁶⋅²⁹ 150

100

50 28.4

3.a.1 3.a.1

2015 2015

14 34

18 52 Premature NCD mortality rate (per 100 000 pop)

0 2010 2012

Premature NCD mortality rate³¹ 1000

750

3.b.2

2015

4.55

0.47

500

3.c.1

2016

19.9

250

0 2000 2005 Female 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Bhutan

General government health expenditure Indicators General government health expenditure as % of general government expenditure¹¹ Child nutrition Children under 5 years who are stunted³² Children under 5 years who are wasted³² Drinking water services and sanitation Proportion of population using improved drinking water sources¹¹ Proportion of population using improved sanitation¹¹ Clean household energy Proportion of population with primary reliance on clean fuel¹¹ Ambient air pollution Air pollution level in cities¹¹ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹¹ (per 100 000 people) Homicide and conflicts Mortality rate due to homicide¹¹ (per 100 000 population) Estimated direct deaths from major conflicts¹¹(per 100 000 population) Birth registration Birth registration coverage⁶ Cause-of-death data Completeness of cause-of-death data¹¹ (%) 6.1 6.2

Other health-related SDGs SDG target 1.a 2.2.1 2.2.2 Year 2014 2015 2015 2015 2015 2015 Bhutan 8 21.2 4.3 2.6 100 50 Regional estimate Proportion (%) Prevalence of children under 5 years of age who are stunted³³ 100

9.3 33.8 15.3 5.3 92 49

50 35 21

Children under 5 years who are overweight³² 2.2.3

0 2008 2010 2015 Prevalence of children under 5 years of age who are wasted³³

50 Proportion (%)

7.1

2014

11.6.2

2014

58.8

4.7

4.3

2008

2010

2015

13.1.2

2011-2015

0.3 15

Prevalence of children under 5 years who are overweight³³

16.1.2

2011-2015

0.1

Proportion (%)

16.1.1

2015

1.5

7.5 4.4 2.6

16.9.1 17.19.2

2010 2005-2015

100 -

0 2008 2010 2015

Note: A dash (-) implies relevant data are not available

References

1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3. World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 4 July 2017. 4.World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5.World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6.Bhutan MICS 2010. https://mics-surveys-prod.s3.amazonaws.com/MICS4/South%20Asia/Bhutan/2010/Final/Bhutan%202010%20MICS_English.pdf – accessed 12 June 2017. 7.World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage . 8.World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. See for TB detection and treatment : case detection rate x TB treatment success rate. 9.UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 10.World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 11.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 12. World Health Organization. WHO global database on blood pressure, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease.The prevalence of raised BP has been rescaled based on a minimum value of 50%. 13.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 14.World Health Organization, Regional Office for South-East Asia. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan. New Delhi, 2014. http://www.who.int/chp/steps/Bhutan_2014_STEPS_Report.pdf?ua=1 – accessed 12 June 2017. 15.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 16.World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 17. As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population 18.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 19.World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 20.DHS/MICS; 2009-2016. 21.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 22. Bhutan National Health Survey 2000, Population and housing census of Bhutan 2005, Bhutan MICS 2010, Bhutan National Health Survey 2012. 23.Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 24. See for New HIV infections among adults 15-49 years. Country reported value: 2011=0.07, 2012=0.03, 2015=0.01; Data Source:Country reported programme data from HIV/AIDs Epidemic update, NACP, DoPH, MoH, 2016. 25.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 26.Calculated. World Health Organization.World Malaria report. In 2015, Malaria incidence (per 1000 person) is calculated for only 1 district (pop. at risk). Malaria incidence value=2.9. 27.See for total alcohol per capita (age 15+ years) consumption. Country reported value: 2014=8.2; Data Source: Bhutan STEPS Survey 2014. 28.See for mortality rate from road traffic accident . Country Reported value: 2011=15; Data Source: Disability Prevention Program. 29.Bhutan National Health Survey 2012. Ministry of Health, Bhutan. http://www.health.gov.bt/wp-content/uploads/moh-files/nationalHealthSurvey2012.pdf - accessed 7 June 2017. 30.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 31. World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. 32.Bhutan National Nutrition Survey 2015. 33.Bhutan National Nutrition Survey 2008, Bhutan MICS 2010, Bhutan National Nutrition Survey 2015

Bhutan

Monitoring Health in the Sustainable Development Goals

Democratic People's Republic of Korea Population (000s)¹ Urban population² Poverty

25 155

60.9%

(ppp a day) day) (ppp < < $1.90 a

GDP per capita (Current US$) Relevant data is not available

Total health expenditure as share of GDP Relevant data is not available

Relevant data is not available

Life expectancy 100 Age (years)

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth³ provides an indication of overall mortality of a country's population. In Democratic People's Republic of Korea, from 2000 (65.4 years) to 2015 (70.6 years), the life expectancy at birth has improved by 5.2 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Democratic People's Republic of Korea, from 2000 (58.7 years) to 2015 (64.0 years), healthy life expectancy has improved by 5.3 years.

65 59

71 64

0 2000 Life expectancy at birth

2007

2015

Healthy life expectancy

HEALTH SERVICE COVERAGE A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁵ Pregnancy care⁶ Child immunization coverage (DPT3)⁶ Care seeking behaviour suspected pneumonia⁶ 77 94 96 Latest available data (2010-2016) 80

Infectious diseases Coverage (%) 100 50 0 Tuberculosis detection HIV antiretroviral therapy Insecticide-treated and treatment⁸ (%) coverage bednets/indoor residual spray coverage for malaria prevention⁹ 73 28

Out-of-pocket expenditure In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection.

Public spending on health is determined by the capacity of the government to raise revenues and allocate it to health.

Access to improved sanitation⁵ (%)

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Mean fasting plasma blood pressure in glucose¹¹ (mmol/L) population¹⁰ Cervical cancer screening Tobacco non-use 99 64

Service capacity and access Coverage (%) 100 50 0 Density of hospital Heath worker Health security:IHR beds¹² , expressed as density¹³, expressed compliance⁵ % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Access to essential medicines Current data are insufficient for analysis Current data are insufficient for analysis 100 100 73

UHC services coverage index of essential health services To provide a summary measure of UHC services coverage index coverage, an index of national 100 service coverage is computed by 76 averaging service coverage values across the 16 tracer indicators. The 50 UHC coverage index ranges from 0% to 100%, with 100% implying full 0 coverage across a range of services. UHC services coverage Index Coverage (%)

Monitoring Health in the Sustainable Development Goals

Democratic People’s Republic of Korea

Equity: Leave no one behind

Variation by income

Births attended by skilled health personnel

PNC (within 2 days)

Data not available Current data are insufficient for analysis

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁴ (%) Prevalence of raised blood pressure among adults aged ≥18 years¹⁰ (%) Prevalence of raised fasting blood glucose among adults aged ≥18 years¹⁵ (%) Female 3.7 16.9 5.9 Male 2.0 19.1 5.8

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile for some high-burden countries, 2009 to 2016¹⁶ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDGs emphasis on equity SDG target 17.18 emphasizes the need for disaggregated data.By 2020, enhance capacity-building support to developing countries to increase significantly the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographical location and other characteristics relevant in national contexts

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁷ MMR [100 000 live births ] 750 100 500 Coverage (%) Births attended by skilled health personnel¹⁸ 97

Child mortality¹⁹ 150 MR [1000 live births] 100 60 27

100

250 128

50 0

0 2000 2005 2010

25 14

2015

0 2009 2010

Children under-five

2000

2005

2010

Neonatal

2015

Democratic People’s Republic of Korea

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁰ TB incidence [100 000 pop.] 600 464 464

TB incidence²¹ 561

Malaria incidence²² Malaria IR [1000 pop. at risk] 20 15 10 5 0 0.75 0.6

Indicators Hepatitis B incidence Number of people requiring interventions against neglected tropical diseases⁵

Year

DPRK

Regional estimate -

400

200 0

2015

6,082,191

726,474,894

Current data are insufficient to determine trend

2011 2012 2013 2014 2015

2012

2014

2016

Malaria incidence is calculated for confirmed malaria cases

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁵ (%) Suicide mortality rate²³ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption⁵ Mortality rate from road traffic injuries⁵ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) Adolescent birth rate⁵ (per 1000 women aged 15 to 19 years) SDG target 3.4.1 3.4.2 3.5.2 3.6.1 Year 2015 2014 2016 2013 DPRK 26.5 0 3.9 20.8 Regional estimate 23.2 12.9 4 17 Litres 6 9

Total alcohol per capita (age 15+ years) consumption²⁵

3.9

3.3

3.7.1

2005-2015

76.7

74.1

0 2003 2008 2010 2015 2016

3.7.2

2005-2015

0.7

33.9 Adolescent birth rate (per 1000 women aged 15 10 19 years)

Mortality due to environmental pollution Mortality rate attributed to household and ambient air pollution⁵ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services⁵ (per 100 000 population) Mortality rate attributed to unintentional poisoning⁵ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female Prevalence of tobacco use among persons 15 years and older-Male²⁴ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis Total net official development assistance to medical research and basic health per capita⁵ (constant 2014 US$) Health workforce Health worker density¹³ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index⁵ 3.d.1 2016 73 80 3.a.1 3.a.1 18 52 Premature NCD mortality rate (per 100 000 pop) 1000

3.9.1

2012

238.4

119.9

3.9.2

2012

1.4

20.1

3.9.3

2015

2.3

1.5

Current data are insufficient to determine trend

Premature NCD Mortality rate²⁶

3.b.1

750

3.b.2

2014

1.13

0.47

500

3.c.1

2016

73.7

250

0 2005 Female 2010 2000 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Democratic People’s Republic of Korea

General government health expenditure Indicators General government health expenditure as % of general government expenditure⁵ Child nutrition Children under 5 years who are stunted²⁷ Children under 5 years who are wasted²⁷ Children under 5 years who are overweight⁵ Drinking water services and sanitation Proportion of population using improved drinking water sources⁵ Proportion of population using improved sanitation⁵ Clean household energy Proportion of population with primary reliance on clean fuel⁵ Ambient air pollution Air pollution level in cities⁵ (PM 2.5) (µg/m³) Natural disasters

Other health-related SDGs SDG target 1.a Year 2009 DPRK – Regional estimate 9.3 Proportion (%) 100

Prevalence of stunting in children under 5 years of age²⁹

43.1 27.9

2.2.1 2.2.2 2.2.3 6.1 6.2

2012 2012 2005-2016 2015 2015

27.9 4 0 100 82

33.8 15.3 5.3 92 49

0 2004 2009 2012

Prevalence of wasting in children under 5 years of age²⁹ 50 Proportion (%)

7.1

2009

25 8.5

11.6.2

2009

31.4

58.8

0 2004 2009

4.0

2012

Number of deaths by disaster⁵ (per 100 000 13.1.2 people) Homicide and conflicts Mortality rate due to homicide (per 100 000 population) Estimated direct deaths from major conflicts⁵ (per 100 000 population) Birth registration Birth registration coverage⁶ Cause-of-death data Completeness of cause-of-death data⁵ (%) 17.19.2 Note: A dash (-) implies relevant data are not available

2011-2015

0.20

0.3 15 Proportion (%)

Prevalence of children under 5 years who are overweight²⁹

16.1.1 16.1.2

2015 2011-2015

4 0.1

7.5

16.9.1

2009 2005-2015

100 -

0 2004

0 2009 2012

References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators 2016.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3.World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 4.World Health Organization. Global Health Observatory data: Healthy life expectancy . Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 5.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 6.DPRK MICS 2009. https://www.unicef.org/dprk/MICS_DPRK_2009.pdf - accessed 12 June 2017. 7.World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage. 8.World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017.See for TB detection and treatment: case detection rate x TB treatment success rate. 9.World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 10.World Health Organization. WHO global database on blood pressure, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease.The prevalence of raised BP has been rescaled based on a minimum value of 50%. 11.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 12.World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 13.As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 14.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 15.World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 16.DHS/MICS; 2009-2016. 17. WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. See for Maternal Mortality Ratio. Country reported value: 2011=72, 2013=65.2, 2014=62.7,2015=82; Data Source: Central Bureau of Statistics, DPRK, 2016. 18.MICS 2009, RH Report survey 2010. See for Births attended by skilled health personnel.country reported value:2011= 99, 2012=99.1,2013= 99,2014=99.3,2015=100; Data source: Ministry of Health, 2016. 19.Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. See for U-5MR. Country Reported value :2011=23.9, 2012=22.7, 2013=21.2, 2014=20. See for NMR. Country Reported value:2011=9.7, 2012=9.1, 2013=8.8, 2014=7.6; Data Source: Central Bureau of Statistics, DPRK, 2016. 20.See for New HIV infections among adults 15-49 years. Country Reported value:2011=0, 2012=0, 2013=0, 2014=0, 2015=0; Data Source: Ministry of Health DPRK, 2016. 21.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 22.Calculated. World Health Organization. World Malaria report. Geneva, 2016. http://www.who.int/malaria/publications/world-malaria-report-2016/en/ - accessed 10 June 2017. 23.Country reported value. Data Source: Ministry of Health DPRK, 2016. 24.See for tobacco use. Country Reported value for adult population with tobacco use-male: 43.9; Data source: Smoking prevalence survey 2013, DPRK. 25.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 26.World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. 27.DPRK National Nutrition Survey 2012 28.See for Birth registration coverage. Country reported value: 2014=98, Data source: Central Bureau of Statistics, Ministry of Public Health, DPRK, 2016. 29.DPRK National Nutrition Survey 2004, DPRK MICS 2009, DPRK National Nutrition Survey 2012.

Democratic People’s Republic of Korea

Monitoring Health in the Sustainable Development Goals

India Population (000s)¹ Urban population² Poverty² (ppp day) (ppp < < $1.90 $1.90 a day)

GDP per capita² (Current US$)

1 311 051

32.7%

21.2%

1593.3

Total health expenditure as share of GDP³

4.7%

Life expectancy 100 Age (years)

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In India, from 2000 (62.5 years) to 2015 (68.3 years), the life expectancy at birth has improved by 5.8 years. Healthy life expectancy⁵ reflects overall health of the country's population. In India, from 2000 (54.2 years) to 2015 (59.6 years), healthy life expectancy has improved by 5.4 years. 2007 2015

62.5 54.2

68.3 59.5

0 2000 Life expectancy at birth Healthy life expectancy

HEALTH SERVICE COVERAGE A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁷ Child immunization coverage (DPT3)⁸ Care seeking behaviour suspected pneumonia⁷ 64 87 51 Latest available data (2010-2015) 73

FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: Insuﬃcient data Catastrophic expenditure on health: Insuﬃcient data

Infectious diseases Coverage (%) 100 50 0 Tuberculosis detection and treatment⁹ HIV antiretroviral therapy Insecticide-treated coverage¹⁰ bednets/indoor residual spray coverage for malaria prevention¹¹ 44 44 25

Out-of-pocket expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection.

Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

Access to improved sanitation⁶ (%)

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Mean fasting plasma blood pressure level in glucose¹³ (mmol/L) population¹² Cervical cancer screening Tobacco non-use¹⁴ 49 76 65

5.05% 5.05% 5.05% 62.4% GDP 2014 Estimated total government expenditure, 2014 or latest available year

Service capacity, access and health security Coverage (%) 100 50 0 Density of hospital Heath worker Health security: IHR beds¹⁵, expressed as density¹⁶, expressed compliance⁶ % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Access to essential medicines 50 98 68

Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated government expenditure on health, 2014 or latest available year

UHC services coverage index of essential health services UHC services coverage index To provide a summary measure of coverage, an index of national 100 service coverage is computed by averaging service coverage values 57 across the 16 tracer indicators. The 50 UHC coverage index ranges from 0% to 100%, with 100% implying full 0 coverage across a range of services. UHC services coverage Index Coverage (%)

Monitoring Health in the Sustainable Development Goals

India

Variation, urban versus rural⁷ Births attended by skilled health personnel 100 80 Improved source of sanitation 60 40 20 0

Equity: Leave no one behind

Variation by income

PNC (within 2 days)

Care seeking behaviour for children with suspected pneumonia

Percentage of demand for family planning satisfied

DTP3 Coverage Urban Rural Data not available at the time of analysis

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁷ (%) Prevalence of raised blood pressure among adults aged ≥ 18 years¹² (%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years¹⁹ (%) Female 5.1 24.7 8.3 Male 2.3 26.6 9.1

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile in some high-burden countries, 2009 to 2016¹⁹ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth index quintile

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²⁰ MMR [100 000 live births ] 750 Coverage (%) 500 374

Births attended by skilled health personnel²¹ 100 MR [1000 live births] 81 81

Child mortality²² 150 100

250 174

50 0

48 28

0 2000 2005 2010 2015

0 2005-2006 2013 2015-2016

2000 Children under-five

2005

2010 Neonatal

2015

India

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²³ HIV IR [1000 uninfected pop.] TB IR [100 000 pop.] 0.4

TB incidence²⁴ Malaria IR [1000 pop. at risk] 500 400 300 200 100 0 20 15 10 5 0

Malaria incidence²⁵

Indicators Hepatitis B incidence

Year

India

Regional estimate -

241

217

0.2 0.1 0.1

0.0

1.2

1.0

2011 2012 2013 2014 2015

2011 2012 2013 2014 2015 Malaria incidence is calculated for confirmed malaria cases

Number of people requiring interventions against 2015 neglected tropical diseases⁶⋅²⁶

497,396,247 726,474,894

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁶ (%) Suicide mortality rate⁶⋅²⁷ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption⁶ Mortality rate from road traffic injuries⁶⋅²⁸(per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods (%) Adolescent birth rate⁶ (per 1000 women aged 15 to 19 years) SDG target 3.4.1 Year 2015 India 23.3 Regional estimate 23.2 6 Litres 9

Total alcohol per capita (age 15+ years) consumption²⁹

3.4.2 3.5.2 3.6.1

2015 2016 2013

15.7 5 16.6

12.9 4 17

3.7.1

2005-2015

63.9

74.1

0 2011 2012 2013 2014 2015 2016

3.7.2

2005-2015

28.1

33.9

Adolescent birth rate (per 1000 women aged 15 to 19 years)

Mortality due to environmental pollution Mortality rate attributed to household and ambient air pollution⁶ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services⁶ (per 100 000 population) Mortality rate attributed to unintentional poisoning⁶ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁴ Prevalence of tobacco smoking use persons 15 years and older-Male¹⁴ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis Total net official development assistance to medical research and basic health per capita⁶ (constant 2014 US$) Health workforce Health worker density¹⁶ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index⁶ 3.d.1 2016 98 80 3.9.1 3.9.2 3.9.3 2012 2012 2015 133.7 27.4 1.9 119.9 20.1 1.5

3.a.1 3.a.1

2015 2015

20 48

18 52 Premature NCD mortality rate (per 100 000 pop) 1000

Current data are insufficient to determine trend

Premature NCD mortality rate³⁰

3.b.1

750

3.b.2

2014

0.2

0.47

500

3.c.1

2005-2013

30.2

250

0 2000 2005 Female 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

India

Other health-related SDGs General government health expenditure Indicators General government health expenditure as % of general government expenditure⁶ Child nutrition Children under 5 years who are stunted⁷ Children under 5 years who are wasted⁷ Children under 5 years who are overweight⁶ Drinking water services and sanitation Proportion of population using improved drinking water sources⁶ Proportion of population using improved sanitation⁶ Clean household energy Proportion of population with primary reliance on clean fuel⁶ Ambient air pollution Air pollution level in cities⁶ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster⁶⋅³¹(per 100 000 people) Homicide and conflicts Mortality rate due to homicide⁶⋅³² (per 100 000 population) Estimated direct deaths from major conflicts⁶ (per 100 000 population) Birth registration Birth registration coverage⁷ Cause-of-death data Completeness of cause-of-death data⁶ (%) Note: A dash (-) implies relevant data are not available

SDG target 1.a

Year 2014

India 5

Regional estimate Proportion (%)

100

Prevalence of stunting in children under 5 years of age²¹

9.3

2.2.1 2.2.2 2.2.3 6.1 6.2

2015-2016 2015-2016 2005-2006 2015 2015

38.4 21 1.9 94 40

33.8 15.3 5.3 92 49

48 38

0 2005-06 2013 2015-2016

Prevalence of wasting in children under 5 years of age²¹ 50 Proportion (%)

7.1

2014

11.6.2

2014

65.7

58.8

13.1.2

2011-2015

0.20

0.3 15

2005-06

2013

2015-2016

Prevalence of children under 5 years who are overweight²¹

16.1.1 16.1.2

2012 2011-2015

4 0.1

4 0.1 Proportion (%)

16.9.1 17.19.2

2015-2016 2005-2015

79.7 10

1.9

0 2005-06 2013 2015-2016

References

1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2. The World Bank. World development indicators. Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3. World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 4 July 2017. 4. World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5. World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6. World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 7. India NHFS-IV 2015-2016 Factsheet. http://rchiips.org/NFHS/pdf/NFHS4/India.pdf - accessed 12 June 2017. 8. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage 9. World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. See for TB detection and treatment: case detection rate x TB treatment success rate. 10. UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 11. World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 12. World Health Organization. WHO global database on blood pressure, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease. The prevalence of raised BP has been rescaled based on a minimum value of 50%. 13. World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 14. World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 15. World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 16. As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 17. World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 18. World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 19. DHS/MICS; 2009-2016. 20. WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 21. NFHS-III 2005-2006, Rapid Survey on children 2013-2014, NHFS-IV 2015-2016 Factsheet. 22. Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 23. UNAIDS 2017 estimates for incidence rate among (15-49). http://aidsinfo.unaids.org - accessed 12 June 2017. 24. World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 25. Calculated. World Health Organization. World Malaria report. Geneva, 2016. http://www.who.int/malaria/publications/world-malaria-report-2016/en/ - accessed 10 June 2017. 26. See for number of people requiring interventions against NTD. Country reported value: 2011=609000000, 2012=594000000, 2013=498000000, 2014=480000000; Data source: WHO PCT data bank, 2016. 27. See for suicide rate. Country reported value: 2011=11.2, 2012=11.2,2013=11, 2014=10.6; Data source: National Crime records Bureaus 2014 . 28. See for mortality rate from road traffic injuries. Country reported value: 2011=11.73,2012=11.33,2013=10.89,2014=10.98,2015=11.67; Data Sour ce: Ministry of road transport and highways, 2016. 29. World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 30. World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. 31. See for number of deaths, missing persons and persons affected by disaster. Country reported value: 2013=1.7, 2014=1.5; Data Source: Accidental Deaths by Causes attributable to Nature during 2013 & 2014 National Crime records Bureau 2014. 32. See for mortality rate from road traffic injuries. Country reported value: 2011=11.73 ,2012=11.33,2013=10.89,2014=10.98,2015=11.67; Data Sour ce: Ministry of road transport and highways, 2016.

India

Monitoring Health in the Sustainable Development Goals

Indonesia Population (000s)¹ Urban population² Poverty² (ppp day) (ppp < < $1.90 a day)

GDP per capita² (Current US$)

257 564

53.7%

8.3%

3346.5

Total health expenditure³ as share of GDP

2.8%

Life expectancy 100 Age (years) 66 59

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Indonesia, from 2000 (66.3 years) to 2015 (69.1 years), the life expectancy at birth has improved by 2.8 years. Healthy life expectancy⁵ reflects overall health of the country's population. In Indonesia, from 2000 (59.4 years) to 2015 (62.1 years), healthy life expectancy has improved by 2.7 years.

69 62

0 2000 Life expectancy at birth

2007

2015

Healthy life expectancy

HEALTH SERVICE COVERAGE A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁶ Child immunization coverage (DPT3)⁷ Care seeking behaviour suspected pneumonia⁶ 79 85 81 Latest available data (2010-2015) 75

FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 0.8% or approximately 2 000 000 people are being pushed into poverty because of out-of-pocket health spending.¹⁷ Catastrophic expenditure on health: 4.4% of people spent more than 10% of their household's total expenditure on health care.¹⁷ Out-of-pocket expenditure³ Public spending on health³ is In most cases, high determined by the capacity of the government to raise revenues and percentage of out-of-pocket allocate it to health. expenditure out of the total health expenditure is associated with low financial protection

Infectious diseases Coverage (%) 100 50 0 Tuberculosis detection and treatment⁸ 55 27 9 HIV antiretroviral therapy coverage⁹ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention¹⁰ Access to improved sanitation¹¹ 61

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Mean fasting plasma blood pressure level glucose¹³ (mmol/L) in population¹² Cervical cancer screening Tobacco non-use¹⁴ 53 100 64

47%

5.7% 5.7% 5.7%

GDP 2014 Estimated total government expenditure, 2014 or latest available year

Service capacity, access and health security Coverage (%) 100 50 0 Density of hospital Heath worker Health security: IHR beds¹⁵, expressed as density¹⁶, expressed compliance¹¹ % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Access to essential medicines 33 99 66

Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated government expenditure on health, 2014 or latest available year

50 0

UHC services coverage Index

Monitoring Health in the Sustainable Development Goals

Indonesia

Variation, urban versus rural⁶ Percentage of demand for family planning satisfied 100 80 Improved source of sanitation 60 40 20 0

Equity: Leave no one behind

Variation by income⁶ Percentage of demand for family planning satisfied 100 80

Births attended by skilled health personnel

Improved source of sanitation

60 40 20 0

Births attended by skilled health personnel

PNC (within 2 days)

DTP3 Coverage

PNC (within 2 days)

DTP3 Coverage

Care seeking behaviour for children with suspected pneumonia Urban Rural

Care seeking behaviour for children with suspected pneumonia Richest Poorest

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁸ (%) Prevalence of raised blood pressure among adults aged ≥ 18 years¹² (%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years¹⁹ (%) Female 8.1 23.1 8.0 Male 3.5 24.3 7.4

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Children under-five mortality rate inequality by maternal education and wealth quintile in some high burden countries, 2009 to 2016²⁰ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²¹ MMR [100 000 live births ] 750 500 Coverage (%) 100 MR [1000 live births] 83.1

Births attended by skilled health personnel²² 150 100

Child mortality²³

250 0

265 126

41.5

50 0

52 22 27 14

2000

2005

2010

2015

0 2002-2003 2007 2012

2000 Children under-five

2005

2010 Neonatal

2015

Indonesia

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁴ HIV IR [1000 uninfected pop.] TB incidence [100 000 pop.] 0.5 0.5

TB incidence²⁵ 410 395

Malaria incidence²⁶ Malaria IR [1000 pop. at risk] 20 15 10 5 2.4

Indicators

Year

Indonesia

500 400 300 200 100 0

Regional estimate -

0.4

Hepatitis B incidence

0.2

3.2

0.0

2011 2012 2013 2014 2015

2011 2012 2013 2014 2015 Malaria incidence is calculated for confirmed malaria cases

Number of people requiring interventions against 2015 neglected tropical diseases¹¹

111437132

726,474,894

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases¹¹ (%) Suicide mortality rate¹¹ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption¹¹ Mortality rate from road traffic injuries¹¹ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁶(%) Adolescent birth rate⁶ (per 1000 women aged 15 to 19 years) Mortality rate attributed to household and ambient air pollution¹¹ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services¹¹ (per 100 000 population) Mortality rate attributed to unintentional poisoning¹¹ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁴ Prevalence of tobacco smoking among persons 15 years and older-Male¹⁴ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis Total net official development assistance to medical research and basic health per capita (constant 2014 US$) Health workforce Health worker density²⁶ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹⁴ SDG target 3.4.1 Year 2015 Indonesia 26.6 Regional estimate 23.2 6 Litres 9

Total alcohol per capita (age 15+ years) consumption²⁷

3.4.2 3.5.2 3.6.1

2015 2016 2013

2.9 0.6 15.3

12.9 4 17

3.7.1

2012

74.1

0.1

0.6

2005

2008

2010

2015

2016

3.7.2

2012

48.4

33.9 150 Adolescent birth rate [women aged 15-19 years]

Adolescent birth rate (per 1000 women aged 15 to 19 years)⁶

Mortality due to environmental pollution 3.9.1 3.9.2 3.9.3 2012 2012 2015 85 3.6 0.5 119.9 20.1 1.5

100

62 50

3.a.1 3.a.1

2015 2015

5 67

18 52 Premature NCD mortality rate (per 100 000 pop)

1997

2003

2012

Premature NCD mortality rate²⁸ 1000

3.b.1

750

3.b.2

2014

0.32

0.47

500

3.c.1

2016

29.2

250

3.d.1

2016

0 2000 Female 2005 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Indonesia

Other health-related SDGs General government health expenditure Indicators SDG target Year Indonesia

Regional estimate Proportion (%)

100

Prevalence of children under 5 years of age who are stunted²⁹

General government health expenditure as % of general government expenditure¹¹ Child nutrition Children under 5 years who are stunted²⁸ Children under 5 years who are wasted²⁸ Drinking water services and sanitation Proportion of population using improved drinking water sources¹¹ Proportion of population using improved sanitation¹¹ Clean household energy Proportion of population withprimary reliance on clean fuel¹¹ Ambient air pollution Air pollution level in cities¹¹ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹¹ (per 100 000 people) Homicide and conflicts Mortality rate due to homicide¹¹ (per 100 000 population) Estimated direct deaths from major conflicts¹¹ (per 100 000 population) Birth registration Birth registration coverage⁶ Cause-of-death data Completeness of cause-of-death data¹¹ (%)

1.a

2014

5.7

9.3

40.1

2.2.1 2.2.2

2013 2013 2013 2015 2015

36.4 13.5 11.5 87 61

33.8 15.3 5.3 92 49

36.4

Children under 5 years who are overweight.. 2.2.3 6.1 6.2

0 2007 2010 2013

Prevalence of children under 5 years of age who are wasted²⁹ 50 Proportion (%)

7.1

2014

25 14.8 13.5

11.6.2

2014

17.8

58.8

0 2007 2010 2013

13.1.2

2011-2015

0.10

0.3 15

Prevalence of children under 5 years who are overweight²⁹

16.1.2

2011-2015

<0.1

0.1

Proportion (%)

16.1.1

2015

4.3

11.2

11.5

16.9.1

2012

17.19

2005-2015

2007

2010

2013

Note: A dash (-) implies relevant data are not available

References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2017. 2.The World Bank. World development indicators .Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3. World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 4 July 2017. 4.World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5.World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6. Indonesia Demographic and Health Survey 2012. http://dhsprogram.com/pubs/pdf/FR275/FR275.pdf - accessed 12 June 2017. 7. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage 8. World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. 9. UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 10.World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 11.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 12. World Health Organization. WHO global database on blood glucose, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease 13. World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes 14.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 15. World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access 16.As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population 17.World Bank 2010. 18.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 19.World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 20.DHS/MICS; 2009-2016 21.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. See for maternal mortality ratio. Country reported value: 2015=305; Data Source: Population Census inter-census 2015 22. Indonesia DHS 2002-2003, Indonesia DHS 2007, Indonesia DHS 2012 23.Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 24.UNAIDS 2017 estimates for incidence rate among (15-49). http://aidsinfo.unaids.org - accessed 12 June 2017. 25. World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. See for TB incidence. Country reported value. 2011=136, 2012=138, 2013=134.6, 2014=113, 2015=118; Data Source: Indonesia Health Profile / CDC Directorate, Ministry of Health 26.Calculated from World Malaria Report. See for malaria incidence. Country reported value: 2011=1.75, 2012=1.69, 2013=1.38, 2014=0.99,2015=0.85; Data Source: Ministry of Health 27.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 28.National report on basic health research, Riskesdas, 2013. Jakarta, Indonesia 29.Indonesia DHS 2007, Indonesia DHS 2012, National report on basic health research, Riskesdas, 2013

Indonesia

Monitoring Health in the Sustainable Development Goals

Maldives Population (000s)¹ Urban population² Poverty²

364

45.5%

7.3%

(ppp day) (ppp < < $1.90 $1.90 a day)

GDP per capita² (Current US$)

8395.8

Total health expenditure as share of GDP³

13.7%

Life expectancy 100 Age (years) 69.6 61.7

Monitoring the health SDG goal: Indicators of overall progress 78.5 69.6

Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Maldives, from 2000 (69.6 years) to 2015 (78.5 years), the life expectancy at birth has improved by 8.9 years. Healthy life expectancy⁵ reflects overall health of the country's population. In Maldives, from 2000 (61.7 years) to 2015 (69.5 years), healthy life expectancy has improved by 7.8 years.

0 2000 Life expectancy at birth

2007

2015

Healthy life expectancy

Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁶ 43 90

Child immunization coverage (DPT3)⁷

Care seeking behaviour suspected pneumonia⁶ 98

Infectious diseases Coverage (%) 100 50 0 30

Out-of-pocket expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection.

Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

19 Access to improved sanitation¹⁰

Noncommunicable diseases Coverage (%) 100 50 0 51

Tuberculosis detection HIV antiretroviral therapy Insecticide treated and treatment⁸ coverage⁹ bednets/indoor residual spray coverage for malaria prevention 98

18%

26.6%

26.6% 80

GDP 2014

Prevalence of normal Mean fasting plasma blood pressure in glucose¹² (mmol/L) population¹¹

Cervical cancer screening

Tobacco non-use¹³ Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated total government expenditure, 2014 or latest available year Estimated government expenditure on health, 2014 or latest available year

Service capacity, access and health security Coverage (%) 100 50 0 Density of hospital Heath worker beds¹⁴, expressed as density¹⁵, expressed % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Health security:IHR compliance¹⁰ Access to essential medicines 100 100 60

50 0 UHC services coverage Index

Monitoring Health in the Sustainable Development Goals

Maldives

Variation, urban versus rural⁶ Percentage of demand for family planning satisfied 100 80 Improved source of sanitation 60 40 20 0

Equity: Leave no one behind

Variation by income⁶ Percentage of demand for family planning satisfied 100 80

Births attended by skilled health personnel

Improved source of sanitation

60 40 20 0

Births attended by skilled health personnel

PNC (within 2 days)

DTP3 Coverage

PNC (within 2 days)

DTP3 Coverage

Care seeking behaviour for children with suspected pneumonia Urban Rural Data not available Richest

Care seeking behaviour for children with suspected pneumonia Poorest Data not available

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁶(%) Prevalence of raised blood pressure among adults aged ≥ 18 years¹¹ (%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years¹⁷ (%) Female 10.8 21.9 10.7 Male 5.5 26.9 11.1

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most categories, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile in some high-burden countries, 2009 to 2016¹⁸ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁹ MMR [100 000 live births ] 750 500 Coverage (%) 100 Births attended by skilled health personnel⁶ 94.8

Child mortality²⁰ 150 MR [1000 live births] 100

250 163

50 0

44.4 25.7 8.6 4.9

0 2000 2005 2010

2015

0 2009

2000 Children under-five

2005

2010 Neonatal

2015

Maldives

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years TB incidence [100,000 pop.]

TB incidence²¹ Malaria IR [1000 pop. at risk] 500 400 300 200 100 0 53

Malaria incidence²² 20 15 10 5 0

Indicators Hepatitis B incidence Number of people requiring interventions against neglected tropical diseases⁶

Year -

Maldives -

Regional estimate -

2015

1,892

726,474,894

Current data are insufficient to determine trend

2011 2012 2013 2014 2015

2011 2012 2013 2014 2015 Malaria incidence is calculated for confirmed malaria cases.Only small number of imported cases have been reported

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases¹⁰ (%) Suicide mortality rate¹⁰ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption¹⁰ Mortality rate from road traffic injuries¹⁰ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁶ (%) Adolescent birth rate²³ (per 1000 women aged 15 to 19 years) Mortality rate attributed to household and ambient air pollution⁶ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services⁶ (per 100 000 population) Mortality rate attributed to unintentional poisoning⁶ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹³ Prevalence of tobacco use among persons 15 years and older-Male¹³ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis Total net official development assistance to medical research and basic health per capita¹⁰ (constant 2014 US$) Health workforce Health worker density¹⁵ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹⁰ 3.d.1 2016 60 80 3.b.1 SDG target 3.4.1 3.4.2 3.5.2 3.6.1 Year 2015 2015 2016 2013 Maldives 12.4 8.6 1.7 3.5 Regional estimate 23.2 12.9 Litres 6 9

Total alcohol per capita (age 15+ years) consumption²⁴

4 17

3 1.7

3.7.1

2009

42.7

74.1 0

1.2

2010

2015

2016

3.7.2

2014

13.7

33.9 Adolescent birth rate [women aged 15-19 years] 150

Adolescent birth rate (per 1000 women aged 15 to 19 years)²³

Mortality due to environmental pollution 3.9.1 3.9.2 3.9.3 2012 2012 2015 15.3 0.6 0.6 119.9 20.1 1.5

100

3.a.1 3.a.1

2015 2015

4 36

18 52

15.7

13.3

0 2011 2014

Premature NCD mortality rate²⁵ Premature NCD mortality rate (per 100 000 pop) 1000

750

3.b.2

2014

1.65

0.47

500

3.c.1

2016

118.1

250

0 2000 Female 2005 2010 Male 2015

Note: A dash (-) implies that relevant data are not available

Monitoring Health in the Sustainable Development Goals

Maldives

General government health expenditure Indicators General government health expenditure as % of general government expenditure¹⁰ Child nutrition Children under 5 years who are stunted⁶ Children under 5 years who are wasted⁶

Other health-related SDGs SDG target 1.a Year 2014 Regional Maldives estimate Proportion (%) Prevalence of children under 5 years of age who are stunted²⁶ 100

26.6

9.3

2.2.1 2.2.2

2009 2009 2009

18.9 10.6 6.5

33.8 15.3 5.3

Children under 5 years who are overweight⁶ 2.2.3 Drinking water services and sanitation Proportion of population using improved drinking water sources¹⁰ Proportion of population using improved sanitation¹⁰ Clean household energy Proportion of population with primary reliance on clean fuel¹⁰ Ambient air pollution Air pollution level in cities¹⁰ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹⁰ (per 100 000 people) Homicide and conflicts Mortality rate due to homicide¹⁰ (per 100 000 population) Estimated direct deaths from major conflicts¹⁰ (per 100 000 population) Birth Registration Birth registration coverage⁶ Cause-of-death data Completeness of cause-of-death data¹⁰ (%) 17.19.2 Note: A dash (-) implies that relevant data are not available

0 1997-98 2001 2009

6.1 6.2

2015 2015

99 98

92 49 Proportion (%) 50

Prevalence of children under 5 years of age who are wasted²⁶

7.1

2014

> 95

11.6.2

2014

58.8 0 1997-98 2001

2009

13.1.2

2011-2015

0.3 15

Prevalence of children under 5 years who are overweight²⁶

16.1.1 16.1.2

2015 2011-2015

3.5 0

4 0.1 Proportion (%)

7.5

6. 9

6. 5

16.9.1

2009

92.5

2005-2015

100

0 1997-98 2001 2009

References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators 2016.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 12 June 2017. 4.World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5.World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6.Maldives Demographic and Health Survey 2009. http://dhsprogram.com/pubs/pdf/FR237/FR237.pdf - accessed 12 June 2017. 7. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage. 8.World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. See for TB detection and treatment: case detection rate x TB treatment success rate. 9.World Health Organization. World health statistics 2015. Geneva, 2015. http://apps.who.int/iris/bitstream/10665/170250/1/9789240694439_eng.pdf?ua=1&ua=1 –accessed 3 June 2017. 10.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 11.World Health Organization. WHO global database on blood glucose, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease.The prevalence of raised BP has been rescaled based on a minimum value of 50%. 12.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 13.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 14.World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 15.As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 16.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 17.World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 18.DHS/MICS; 2009-2016. 19. WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva, 2015. http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 20. Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 21.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 22.Malaria unit, SEARO, 2016. 23.United Nations, Department of Economic and Social Affairs, Population Division. World Fertility Data 2015. New York. http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml - accessed 3 June 2017. 24.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 25.World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. 26.Vulnerability and poverty assessment 1998, MICS 2001, DHS 2009.

Maldives

Monitoring Health in the Sustainable Development Goals

Myanmar Population (000s)¹ Urban population² Poverty (ppp day) (ppp < < $1.90 $1.90 a day) Relevant data is not available

GDP per capita² (Current US$)

53 897

34.1%

1161.5

Total health expenditure as share of GDP³

2.3%

Life expectancy 100 Age (years)

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Myanmar, from 2000 (62.1 years) to 2015 (66.6 years), the life expectancy at birth has improved by 4.5 years. Healthy life expectancy⁵ reflects overall health of the country's population. In Myanmar, from 2000 (54.7 years) to 2015 (59.2 years), healthy life expectancy has improved by 4.5 years. 2007 2015

62.1 54.7

66.6 59.2

0 2000 Life expectancy at birth Healthy life expectancy

HEALTH SERVICE COVERAGE A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal,newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁶ Child immunization coverage (DPT3) ⁶ Care seeking behaviour suspected pneumonia⁶ 80 75 59 75 Latest available data (2010-2016 58

Infectious diseases Coverage (%) 100 61 83 47

Out-of-pocket expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure associated with low financial protection

Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

50 0

Tuberculosis detection HIV antiretroviral therapy and treatment⁸ (%) coverage⁹

Insecticide-treated bednets or Indoor residual spray coverage for malaria prevention ⁸

Access to improved sanitation¹¹ (%)

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Mean fasting plasma blood pressure level glucose¹³ (mmol/L) in population¹² 51 4 100 59

51%

GDP 2014

Cervical cancer screening¹⁴

Tobacco non-use¹⁵ Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated total government expenditure, 2014 or latest available year Estimated government expenditure on health, 2014 or latest available year

Service capacity, access and healthy security Coverage (%) 100 50 0 Density of hospital Heath worker beds¹⁶, expressed as density¹⁷, expressed % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Health security:IHR compliance¹¹ Access to essential medicines¹⁸ 33 36 84 43

50 0

UHC services coverage Index

Monitoring Health in the Sustainable Development Goals

Myanmar

Variation, urban versus rural⁶ Percentage of demand for family planning satisfied 100 Improved source of sanitation 80 60 40 20 0

Equity: Leave no one behind

Variation by income⁶ Percentage of demand for family planning satisfied 100 80

Births attended by skilled health personnel

Improved source of sanitation

60 40 20 0

Births attended by skilled health personnel

PNC (within 2 days)

DTP3 Coverage

PNC (within 2 days)

DTP3 Coverage

Care seeking behaviour for children with suspected pneumonia Urban Rural Richest

Care seeking behaviour for children with suspected pneumonia Poorest Data not available

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁹ (%) Prevalence of raised blood pressure among adults aged ≥ 18 years¹² (%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years²⁰ (%) Female 5.4 24.2 7.9 Male 2.0 24.9 6.9

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile in some high-burden countries, 2009 to 2016²¹ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²² MMR [100 000 live births ] 750 500 308 178

Births attended by skilled health personnel²³ 100 Coverage (%) 71 60

Child mortality²⁴ 150 MR [1000 live births] 100 82

250 0

50 0

50 37 26

2000

2005

2010

2015

0 2010 2015-2016

2000 Children under-five

2005

2010 Neonatal

2015

Myanmar

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁵ HIV IR [100 uninfected pop.] TB incidence [100 000 pop.] 0.5

TB incidence²⁶ 380

Malaria incidence²⁵ Malaria IR [1000 pop. at risk] 20 15 11.7

Indicators

Year

Myanmar

500 400 300 200 100 0 365

Regional estimate -

0.4

Hepatitis B incidence

10 5 0 5.7

0.2

0.0

2011 2012 2013 2014 2015

2011 2012 2013 2015 Malaria incidence is calculated for confirmed malaria cases

Number of people requiring interventions 2015 against neglected tropical diseases⁵

41 292 086

726,474,894

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases¹¹ (%) Suicide mortality rate¹¹ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption¹¹ Mortality rate from road traffic injuries¹¹ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵(%) Adolescent birth rate⁵ (per 1000 women aged 15 to 19 years) Mortality rate attributed to household and ambient air pollution¹¹ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services¹¹ (per 100 000 population) Mortality rate attributed to unintentional poisoning¹¹ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁵ Prevalence of tobacco use among persons 15 years and older-Male¹⁵ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis¹⁸ Total net official development assistance to medical research and basic health per capita¹¹ (constant 2014 US$) Health workforce Health worker density¹¹ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹¹ 3.d.1 2016 84 80 3.b.1 2015 43 3.7.1 2015-2016 75 74.1 0

SDG target 3.4.1 3.4.2 3.5.2 3.6.1

Year 2015 2015 2016 2013

Myanmar 24.5 4.3 2.2 20.3

Regional estimate 23.2 12.9 4 17 Litres

Total alcohol per capita (age 15+ years) consumption²⁸

2.2

0.3

2005

2010 Year

2015

Mortality due to environmental pollution 3.9.1 3.9.2 3.9.3 2012 2012 2015 128.2 10.4 1.8 119.9 20.1 1.5

Adolescent birth rate [women aged 15-19 years]

3.7.2

2015-2016

33.9

150

Adolescent birth rate (per 1000 women aged 15 to 19 years)²⁹

100

36 17

3.a.1 3.a.1

2015 2015

21 74

18 52

0 2007 2015-2016

Premature NCD mortality rate³⁰ Premature NCD mortality rate (per 100 000 pop.) 1000

750

3.b.2

2014

0.47

500

3.c.1

2016

24.6

250

0 2000 Female 2005 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Myanmar

General government health expenditure Indicators General government health expenditure as % of general government expenditure¹¹ Child nutrition Children under 5 years who are stunted⁶ Children under 5 years who are wasted⁶ Children under 5 years who are overweight⁶ Drinking water services and sanitation Proportion of population using improved drinking water sources¹¹ Proportion of population using improved sanitation¹¹ Clean household energy Proportion of population with primary reliance on clean fuel¹¹ Ambient air pollution Air pollution level in cities¹¹ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹¹ (per 100 000 people) Homicide and conflicts Mortality rate due to homicide¹¹ (per 100 000 population) Estimated direct deaths from major conflicts¹¹ (per 100 000 population) Birth registration Birth registration coverage⁶ Cause-of-death data SDG target 1.a

Other health-related SDGs Year 2014 Myanmar 3.6 Regional estimate Proportion (%) 100

Prevalence of children under 5 years of age who are stunted³¹

9.3

2.2.1 2.2.2 2.2.3

2015-2016 2015-2016 2015-2016

29 7 1.3

33.8 15.3 5.3

41 29

0 2003 2009-10 2015-2016

6.1 6.2

2015 2015

81 80

92 49 Proportion (%) 50

Prevalence of children under 5 years of age who are wasted³¹

7.1

2014

25 10.7 7.0

11.6.2

2014

56.6

58.8

0 2003 2009-10 2015-2016 Prevalence of children under 5 years who are overweight³¹ 15 Proportion (%)

13.1.2

2011-2015

0.1

0.3

16.1.1 16.1.2

2015 2011-2015

3.9 1.6

4 0.1

7.5

16.9.1

2015-2016 2005-2015

81 -

2.4

1.9

Note: A dash (-) implies relevant data are not available

Completeness of cause-of-death data¹¹ 17.19.2 (%)

0 2003 2009-10 2015-16

References

1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators 2016.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 12 June 2017. 4.World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5.World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6. Myanmar Demographic and Health Survey 2015-2016. http://dhsprogram.com/pubs/pdf/FR324/FR324.pdf - accessed 12 June 2017 7. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage. 8.World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. See for TB detection and treatment: case detection rate x TB treatment success rate. 9.UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 10.World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 11.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 12.World Health Organization. WHO global database on blood pressure, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease. The prevalence of raised BP has been rescaled based on a minimum value of 50%. 13.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 14.World Health Organization. Report on national survey of diabetes mellitus and risk factors for non-communicable diseases in Myanmar. 2014. http://www.who.int/chp/steps/Myanmar_2014_STEPS_Report.pdf?ua=1 – accessed 12 June 2017. 15.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 16.World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 17. As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 18.Ministry of Health, Myanmar and World Health Organization, Myanmar. Nation–wide service availability and readiness assessment (SARA).Myanmar,2015. 19. World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 20. World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 21. DHS/MICS; 2009-2016. 22.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 23.Myanmar MICS 2009-2010, Myanmar DHS 2015-2016. 24.Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 25.UNAIDS 2017 estimates for incidence rate among (15-49). http://aidsinfo.unaids.org - accessed 12 June 2017. 26.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 27.Calculated. World Health Organization. World Malaria report. Geneva, 2016. http://www.who.int/malaria/publications/world-malaria-report-2016/en/ - accessed 10 June 2017 28.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 29.Myanmar fertility and reproductive health survey 2007, Myanmar DHS 2015-2016. 30. World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. 31.Myanmar MICS 2003, Myanmar MICS 2009-2010, Myanmar DHS 2015-2016.

Myanmar

Monitoring Health in the Sustainable Development Goals

Nepal Population (000s)¹ Urban population² Poverty² (ppp day) (ppp < < $1.90 $1.90 a day)

GDP per capita² (Current US$)

28 514

18.6%

15%

743.3

Total health expenditure as share of GDP³

5.8%

Life expectancy 100 Age (years)

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁴ provides indication of overall mortality of a country's population. In Nepal, from 2000 (62.5 years) to 2015 (69.2 years), the life expectancy at birth has improved by 6.7 years. Healthy life expectancy⁵ reflects overall health of the country's population. In Nepal, from 2000 (55.1 years) to 2015 (61.1 years), healthy life expectancy has improved by 6.0 years. 2007 2015

63 55

69 61

0 2000 Life expectancy at birth Healthy life expectancy

Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁶ 56 69

91 50

Child immunization coverage (DPT3)⁷

Infectious diseases Coverage (%) 100 50 0 Tuberculosis detection and treatment⁹ (%) HIV antiretroviral therapy Insecticide-treated coverage¹⁰ bednets/indoor residual spray coverage for malaria prevention¹¹ 100 69 31

Care seeking behaviour suspected pneumonia⁸

Out-of pocket-expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection.

Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

Access to improved sanitation¹² (%) 11.2% 11.2%

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Mean fasting plasma blood pressure level in glucose¹⁴ (mmol/L) population¹³ Cervical cancer screening Tobacco non-use¹⁵

83 41

48% 69 GDP 2014 Estimated total government expenditure, 2014 or latest available year Estimated government expenditure on health, 2014 or latest available year

Service capacity, access and health security Coverage (%) 100 50 0 Density of hospital Heath worker beds¹⁶, expressed as density¹⁷, expressed % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Health security: IHR compliance¹² Access to essential medicines¹⁸ 100 66 72 66

Out-of-pocket expenditure, as % of the health expenditure (2014)

UHC services coverage index of essential health services UHC services coverage index To provide a summary measure of coverage, an index of national 100 service coverage is computed by 64 averaging service coverage values across the 16 tracer indicators. The 50 UHC coverage index ranges from 0% to 100%, with 100% implying full 0 coverage across a range of services. UHC services coverage Index Coverage (%)

Monitoring Health in the Sustainable Development Goals

Nepal

Variation, urban versus rural⁶ Percentage of demand for family planning satisfied 100 80 60 Improved source of sanitation 40 20 0

Equity: Leave no one behind

Variation by income⁶ Percentage of demand for family planning satisfied 100 80 60

Births attended by skilled health personnel

Improved source of sanitation

40 20 0

Births attended by skilled health personnel

DTP3 Coverage

PNC (within 2 days)

DTP3 Coverage

PNC (within 2 days)

Urban

Rural

Richest

Poorest

Data not available

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁹(%) Prevalence of raised blood pressure among adults aged ≥ 18 years¹³(%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years²⁰ (%) Female 5.3 29.5 9.5 Male 2.2 29.7 11.7

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers.The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile for some high-burden countries, 2009 to 2016²¹ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²² MMR [100 000 live births ] 750 500 Coverage (%) 548

Births attended by skilled health personnel²³ 100 MR [1000 live births] 150 100 81

Child mortality²⁴

50 19

250 0 2000 2005 2010

258

50 0

36 22

2015

0 2006 2011 2014 2016

2000 Children under-five

2005

2010 Neonatal

2015

Nepal

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁵ TB incidence [100 000 pop.] HIV IR [1000 uninfected pop.] 500 400 300 200 100 0 162 156

TB incidence²⁶ Malaria IR [1000 pop. at risk] 20 15 10 5 0

Malaria incidence²⁷

Indicators Hepatitis B incidence²⁸ Number of people requiring interventions against neglected tropical diseases¹²

Year

Nepal

Regional estimate -

0.4

2014

9.0

0.2 <0.1

0.1

0.0

0.13

0.1

2015

18 850 311 726,474,894

2011 2012 2013 2014 2015

2011 2012 2013 2014 2015 Malaria incidence is calculated for confirmed malaria cases

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases¹² (%) Suicide mortality rate¹² (per 100 000 population) Total alcohol per capita (age 15+ years) consumption¹² Mortality rate from road traffic injuries¹² (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁶ (%) Adolescent birth rate⁶ (per 1000 women aged 15 to 19 years) Mortality due to environmental pollution Mortality rate attributed to household and ambient air pollution¹² (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services¹² (per 100 000 population) Mortality rate attributed to unintentional poisoning¹² (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁵ Prevalence of tobacco use among persons 15 years and older-Male¹⁵ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis¹⁸ Total net official development assistance to medical research and basic health per capita¹² (constant 2014 US$) Health workforce Health worker distribution¹² (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹² 3.d.1 2016 72 80 3.b.1 66 3.a.1 3.a.1 2015 2015 14 48 18 52 Premature NCD mortality rate (per 100 000 pop.) 1000

SDG target 3.4.1 3.4.2 3.5.2 3.6.1

Year 2015 2015 2016 2013

Nepal 21.8 6 2.5 17

Regional estimate 23.2 12.9 4 17 Litres

Total alcohol per capita (age 15+ years) consumption²⁹

3 2.5

3.7.1

2016

74.1

0.2

2003

2008

2010

2015

2016

3.7.2

2016

33.9 Adolescent birth rate (women aged 15-19 yrs) 150

Adolescent birth rate (per 1000 women aged 15 to 19 years)²²

3.9.1 3.9.2 3.9.3

2012 2012 2015

103.2 12.9 0.6

119.9 20.1 1.5

100

98 88

0 2006 2011 2014 2016

Premature NCD mortality rate³⁰

750

3.b.2

2014

4.32

0.47

500

3.c.1

2016

29.3

250

0 2000 Female 2005 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Nepal

General government health expenditure Indicators General government health expenditure as % of general government expenditure¹² Child nutrition Children under 5 years who are stunted⁶ Children under 5 years who are waste⁶ Children under 5 years who are overweight⁶ Drinking water services and sanitation Proportion of population using improved drinking water sources¹² Proportion of population using improved sanitation¹² Clean household energy Proportion of population with primary reliance on clean fuel¹² Ambient air pollution Air pollution level in cities⁵ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹² (per 100 000 people) Homicide and conflicts Mortality rate due to homicide¹² (per 100 000 population) Estimated direct deaths from major conflicts¹² (per 100 000 population) Birth registration Birth registration coverage⁸ Cause-of-death Completeness of cause-of-death data¹² (%) 2.2.1 2.2.2 2.2.3

Other health-related SDGs SDG target 1.a Year 2014 Nepal 11.2 Regional estimate 9.3 Proportion (%) 100

Prevalence of children under 5 years who are stunted²²

49 36

2016 2016 2016

35.8 9.7 0.3

33.8 15.3 5.3

0 2006 2011 2014 2016

6.1 6.2

2015 2015

92 46

92 49 Proportion (%)

Prevalence of children under 5 years who are wasted²²

25 13 0 10

7.1

2014

11.6.2

2014

74.3

58.8

2006

2011

2014

2016

13.1.2

2011-2015

7.20

0.3

Prevalence of children under 5 years who are overweight²² 15

Proportion (%)

16.1.1 16.1.2 16.9.1 17.19.2

2015 2011-2015 2014 2005-2015

3.3 <0.1 58.1 -

4 0.1 -

7.5

0.6

1.2

2006

2011

2014

2016

Note: A dash (-) implies relevant data are not available

References 1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators 2016.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3. World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 12 June 2017. 4. World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5.World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6. Nepal DHS Key Indicator Survey 2016. https://dhsprogram.com/pubs/pdf/PR88/PR88.pdf - accessed 12 June 2017. 7. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage. 8. Nepal MICS 2014. http://unicef.org.np/uploads/files/597341286609672028-final-report-nmics-2014-english.pdf - accessed 12 June 2017. 9. World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. See for TB detection and treatment: case detection rate x TB treatment success rate. 10.UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 11.World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 12. World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 13. World Health Organization. WHO global database on blood glucose, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease. The prevalence of raised BP has been rescaled based on a minimum value of 50%. 14.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 15. World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. 16.World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 17. As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 18.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 19. World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 20. DHS/MICS; 2009-2016. 21.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 22. Nepal DHS 2006, Nepal DHS 2011, Nepal MICS 2014, Nepal DHS 2016 23. Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 24. UNAIDS 2017 estimates for incidence rate among (15-49). http://aidsinfo.unaids.org - accessed 12 June 2017. 25.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 26.Calculated. World Health Organization. World Malaria report. Geneva, 2016. http://www.who.int/malaria/publications/world-malaria-report-2016/en/ - accessed 10 June 2017. 27.See for Hepatitis B incidence. Country reported value: 2011=5.2, 2012-6.9, 2013=7.7, 2014=9.0, Data Source: Ministry of Health and Population, Nepal. Annual report: department of health services 2070/71 (2013/2014). Kathmandu, 2014. http://dohs.gov.np/wp-content/uploads/2014/04/Annual_Report_2070_71.pdf - accessed 12 June 2017. 28.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 29. World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017.

Nepal

Monitoring Health in the Sustainable Development Goals

Sri Lanka Population (000s)¹ Urban population² Poverty ² (ppp day) (ppp < < $1.90 $1.90 a day)

GDP per capita² (Current US$)

20 715

18.4%

1.9%

3926.2

Total health expenditure as share of GDP³

3.5%

Life expectancy 100 Age (years) 72 64

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Sri Lanka, from 2000 (71.5 years) to 2015 (74.9 years), the life expectancy at birth has improved by 3.4 years. Healthy life expectancy⁵ reflects overall health for the country's population. In Sri Lanka, from 2000 (63.9 years) to 2015 (67.0 years), healthy life expectancy has improved by 3.1 years.

75 67

0 2000 Life expectancy at birth

2007

2015

Healthy life expectancy

HEALTH SERVICE COVERAGE A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁷ Child immunization coverage (DPT3)⁸ Care seeking behaviour suspected pneumonia⁷ 95 58 19 96 69 99 58 Latest available data (2010-2016)

FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 0.4% or approximately 82 000 people are being pushed into poverty because of out-of-pocket health spending.¹⁷ Catastrophic expenditure on health: 8.5% of people spent more than 10% of their household's total expenditure on health care.¹⁷ Out-of-pocket expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

Infectious diseases Coverage (%) 100 50 0 Tuberculosis detection and treatment⁹

HIV antiretroviral therapy coverage¹⁰

Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁹

Access to improved sanitation⁶ (%)

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Mean fasting plasma blood pressure in glucose¹² (mmol/L) population¹¹ Cervical cancer screening¹³ Tobacco non-use¹⁴ 55 25 86 75

42%

11.2% 11.2% 11.2%

11.2%

GDP 2014 Estimated total government expenditure, 2014 or latest available year

Service capacity, access and health security Coverage (%) 100 50 0 Density of hospital Heath worker beds¹⁵, expressed as density¹⁶, expressed % of global threshold, as % of new global 18/10 000 threshold, 44.5/10 000 Health security:IHR compliance⁶ Acess to essential medicines 100 67 71

Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated government expenditure on health, 2014 or latest available year

UHC services coverage index of essential health services To provide a summary measure of UHC services coverage index coverage, an index of national 100 service coverage is computed by 64 averaging service coverage values across the 16 tracer indicators.The 50 UHC coverage index ranges from 0% to 100%, with 100% implying full 0 coverage across a range of services. UHC services coverage index Coverage (%)

Monitoring Health in the Sustainable Development Goals

Sri Lanka

Equity: Leave no one behind Variation, urban versus rural⁷ Percentage of demand for family planning satisfied 100 80 Improved source of sanitation 60 40 20 0 Care seeking behaviour for children with suspected pneumonia Care seeking behaviour for children with suspected pneumonia Births attended by skilled health personnel Improved source of sanitation

Variation by income⁷ Percentage of demand for family planning satisfied 100 80 60 40 20 0 Births attended by skilled health personnel

PNC (within 2 days)

DTP3 Coverage Urban Rural Richest

DTP3 Coverage Poorest Data not available

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁸ (%) Prevalence of raised blood pressure among adults aged ≥18 years¹¹ (%) Prevalence of raised fasting blood glucose among adults aged ≥18 years¹⁹ (%) Female 9.1 21.6 7.7 Male 3.3 23.0 7.0

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile for some high-burden countries, 2009 to 2016²⁰ Maternal education Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²¹ MMR [100 000 live births] 750 500 Coverage (%) 100 Births attended by skilled health personnel²² 94 96 99

Child mortality²³ 150 MR [1000 live births] 100

250 0 57 30

50 0 16 10 10 5

2000

2005

2010

2015

0 1993 2000 2007

Children under-five

2000

2005

2010

Neonatal

2015

Sri Lanka

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁴ TB incidence [100 000 pop.] HIV IR [1000 uninfected pop.]

TB incidence²⁵ Malaria IR [1000 pop. at risk] 500 400 300 200 100 0 66 65

Malaria incidence²⁶ 20 15 10 5 0

Indicators Hepatitis B incidence Number of people requiring interventions against neglected tropical diseases⁶

Year -

Sri Lanka -

Regional estimate -

0.4

0.2 <0.1 0.0 0.05

2015

33,229

726474 894

2011 2012 2013 2014 2015

Malaria incidence is calculated for confirmed malaria cases. Only small number of imported malaria cases have been reported.

2013

2014

2015

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁶ (%) Suicide mortality rate⁶ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption⁶ Mortality rate from road traffic injuries⁶ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁶ (%) SDG target 3.4.1 Year 2015 Sri Lanka 17.7 Regional estimate 23.2 6 Litres 9

Total alcohol per capita (age 15+ years) consumption²⁷

3.4.2 3.5.2 3.6.1

2015 2016 2013

35.3 4.1 17.4

12.9 4 17

4.1 3

3.7.1

2005-2015

69.4

74.1

0.3 2003 2008 2010 2015 2016

Adolescent birth rate⁶ (per 1000 3.7.2 women aged 15 to 19 years) Mortality due to environmental pollution Mortality rate attributed to household and ambient air pollution⁶ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services⁶ (per 100 000 population) Mortality rate attributed to unintentional poisoning⁶ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and olderFemale¹⁴ Prevalence of tobacco use among persons 15 years and older-Male¹⁴ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis Total net official development assistance to medical research and basic health per capita⁶ (constant 2014 US$) Health workforce Health worker density¹⁵ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index⁶ 3.d.1 3.c.1 3.b.1 3.9.1 3.9.2 3.9.3

2005-2015

20.3

33.9

Adolescent birth rate (per 1000 women aged 15 to 19 years)

2012 2012 2015

125.4 3.3 0.4

119.9 20.1 1.5

3.a.1 3.a.1

2015 2015

7 44

18 51 1000 Current data are insufficient to determine trend

Premature NCD mortality rate²⁸ Premature NCD mortality rate (per 100 000 pop.)

750

3.b.2

2014

1.21

0.47

500

2016

29.8

250

2010–2016

0 2000 2005 Female 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Sri Lanka

General government health expenditure Indicators General government health expenditure as % of general government expenditure⁶ Child nutrition Children under 5 years who are stunted²⁹ Children under 5 years who are wasted²⁹ Children under 5 years who are overweight²⁹ Drinking water services and sanitation Proportion of population using improved drinking water sources⁶ Proportion of population using improved sanitation⁶ Clean household energy Proportion of population with primary reliance on clean fuel⁶ Ambient air pollution

Other health-related SDGs SDG target 1.a Year 2014 Sri Lanka 11.2 Regional Estimate Proportion (%) 100

Prevalence of children under 5 years who are stunted³⁰

9.3

2.2.1 2.2.2 2.2.3

2012 2012 2012

14.7 21.4 0.6

33.8 15.3 5.3

17.3

14.7

0 2006-07 2009 2012 Prevalence of children under 5 years who are wasted³⁰ 50 Proportion (%)

6.1 6.2

2015 2015

96 95

92 49

7.1

2014

25 14.7

21.4

Air pollution level in cities⁶ (PM 2.5) (µg/m³) 11.6.2 Natural disasters Number of deaths by disaster⁶ (per 100 000 13.1.2 people) Homicide and conflicts Mortality rate due to homicide⁶ (per 100 000 population) Estimated direct deaths from major conflicts⁶ (per 100 000 population) Birth registration Birth registration coverage⁷ Cause-of-death Completeness of cause-of-death data⁶ (%) 17.19.2 16.9.1

2014

28.5

58.8

0 2006-07 2009 2012

2011-2015

0.40

0.3 15 Proportion (%)

Prevalence of children under 5 years who are overweight³⁰

16.1.1 16.1.2

2015 2011-2015

3.1 <0.1

4 0.1

7.5

2006-2007

97.2

1.6 0 2006-07 2009

0.6 2012

2005-2015

Note: A dash (-) implIes relevant data are not available

References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2. The World Bank. World development indicators 2016.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 12 June 2017. 4.World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5.World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 7. Sri Lanka DHS 2006-07. http://www.statistics.gov.lk/social/DHS%20200607%20FinalReport.pdf - accessed 12 June 2017. 8.World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage 9.World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017.See for TB detection and treatment: case detection rate x TB treatment success rate. 10.UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 11.World Health Organization. WHO global database on blood glucose, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease. The prevalence of raised BP has been rescaled based on a minimum value of 50%. 12.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes. 13.Ministry of Health, Nutrition and Indigenous Medicine and World Health Organization. Non Communicable disease risk factor survey. 2015. http://www.who.int/chp/steps/STEPS-report-2015-Sri-Lanka.pdf?ua=1 - accessed 10 June 2017. 14.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 15.World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 16.As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 17.World Bank, 2013. 18.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 19.World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 20.DHS/MICS; 2009-2016. 21.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 22.Sri Lanka DHS 1993, Sri Lanka DHS 2000, Sri Lanka DHS 2006-07. 23.Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 24.UNAIDS 2017 estimates for incidence rate among (15-49). http://aidsinfo.unaids.org - accessed 12 June 2017. 25.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 26.Calculated. World Malaria Report 2016. Geneva: World Health Organization; 2016. 27.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 28.World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. 29.National nutrition and micronutrient survey 2013. 30.Sri Lanka DHS 2006-07. Nutrition and food security survey 2009, National nutrition and micronutrient survey 2013.

Sri Lanka

Monitoring Health in the Sustainable Development Goals

Thailand Population (000s)¹ Urban population² Poverty²

67 959

50.4%

0.0%

(ppp< < $1.90 $1.90 a (ppp aday) day)

GDP per capita² (Current US$)

5814.8

Total health expenditure as share of GDP³

4.1%

Life expectancy 100 Age (years) 71.1 63.4

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Thailand, from 2000 (71.1 years) to 2015 (74.9 years), the life expectancy at birth has improved by 3.8 years. Healthy life expectancy⁵ reflects overall health for the country's population. In Thailand, from 2000 (63.4 years) to 2015 (66.8), healthy life expectancy has improved by 3.4 years.

74.9 66.8

0 2000 Life expectancy at birth

2007

2015

Healthy life expectancy

FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 0.5% or approximately 94 000 people are being pushed into poverty because of out-of-pocket health spending.¹⁷ Catastrophic expenditure on health: 2.3% of people spent more than 10% of their household's total expenditure on health care.¹⁷ Out-of-pocket expenditure³ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection. Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health.

Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁶ Pregnancy care⁶ 89 91

Child immunization coverage (DPT3)⁷

Care seeking behaviour suspected pneumonia⁶ 93

Infectious diseases Coverage (%) 100 50 0 Tuberculosis detection HIV antiretroviral therapy Insecticide-treated and treatment⁸ coverage⁹ bednets/indoor residual spray coverage for malaria prevention¹⁰ Access to improved sanitation¹¹ (%) 81 65

12% 15.6% 15.6%

GDP 2014 Estimated total government expenditure, 2014 or latest available year Estimated government expenditure on health, 2014 or latest available year

UHC services coverage index of essential health services To provide a summary measure of UHC services coverage index coverage, an index of national 100 service coverage is computed by 77 averaging service coverage values across the 16 tracer indicators.The 50 UHC coverage index ranges from 0% to 100%, with 100% implying full 0 coverage across a range of services. UHC services coverage Index Coverage (%)

Monitoring Health in the Sustainable Development Goals

Thailand

Variation, urban versus rural⁶ Percentage of demand for family planning satisfied 100 80 Improved source of sanitation 60 40 20 0

Equity: Leave no one behind

Variation by income⁶ Percentage of demand for family planning satisfied 100 80

Births attended by skilled health personnel

Improved source of sanitation

60 40 20 0

Births attended by skilled health personnel

PNC (within 2 days)

DTP3 Coverage

PNC (within 2 days)

DTP3 Coverage

Care seeking behaviour for children with suspected pneumonia Urban Rural Data not available Richest

Care seeking behaviour for children with suspected pneumonia Poorest Data not available

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁸ (%) Prevalence of raised blood pressure among adults aged ≥ 18 years¹² (%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years¹⁹ (%) Female 11.4 20.3 8.8 Male 5.9 24.2 8.3

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most categories, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile for some high-burden countries, 2009 to 2016²⁰ Mother’s education Bangladesh Myanmar Nepal Timor-Leste 110 55 0 Secondary/Higher 0 Poorest 55 Richest 110 Wealth quintile

SDGs emphasis on equity SDG target 17.18 emphasizes the need for disaggregated data.By 2020, enhance capacity-building support to developing countries to increase significantly the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographical location and other characteristics relevant in national contexts.

None

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²¹ MMR [100 000 live births ] 750 100 500 50 97

Births attended by skilled health personnel²² MR [1000 live births] 100 99

Child mortality²³ 150 100

250 0

50 0 23 13 12 7

0 2005-2006 2012 2015-2016

2000

2005

2015

2000 Children under-five

2005

2010 Neonatal

2015

Thailand

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁴ HIV IR [100 uninfected pop.] TB incidence [100,000 pop.]

TB incidence²⁵ Malaria IR [1000 pop. at risk] 500 400 300 200 100 0 176 172

Malaria incidence²⁶ 20 15 10 5 0 0.7 0.7

Indicators Hepatitis B incidence Number of people requiring interventions against neglected tropical diseases¹¹

Year

Thailand

Regional estimate -

0.4 0.3

0.2

0.0

2015

145141

2011 2012 2013 2014 2015

726474894

2011 2012 2013 2014 2015

Malaria incidence is calculated for confirmed malaria cases

2011 2012 2013 2014 2015

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 yrs of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁶ (%) Suicide mortality rate¹¹ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption¹¹ Mortality rate from road traffic injuries¹¹⋅²⁷ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods²⁸ (%) Adolescent birth rate⁶ (per 1000 women aged 15 to 19 years) SDG target 3.4.1 3.4.2 3.5.2 3.6.1 Year 2015 2015 2016 2013 Thailand 16.2 16 7.2 36.2 Regional estimate 23.2 9

Total alcohol per capita (age 15+ years) consumption³⁰

12.9 4 17 Litres

6 6

3.7.1

2012

89.2

74.1

0 2003 2008 2010 2015 2016

3.7.2

2015-2016

33.9 Adolescent birth rate (women aged 15-19 yrs) 150

Adolescent birth rate (per 1000 women aged 15 to 19 years)⁶⋅²⁸

Mortality due to environmental pollution Mortality rate attributed to household and ambient air 3.9.1 pollution¹¹ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services¹¹ 3.9.2 (per 100 000 population) Mortality rate attributed to 3.9.3 unintentional poisoning¹¹ (per100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁴ Prevalence of tobacco use among persons 15 years and older-Male¹⁴ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis²⁹ Total net official development assistance to medical research and basic health per capita¹¹ (constant 2014 US$) Health workforce Health worker density¹⁶ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹¹ 3.d.1 3.b.1 3.a.1 3.a.1

2012 2012 2015

64 1.9 0.5

119.9 20.1 1.5

100

60 50

2015 2015

8 47

18 52

0 2012 2015-2016

Premature NCD mortality rate³¹ Premature NCD mortality rate (per 100 000 pop.) 1000

750

3.b.2

2014

0.49

0.47

500

3.c.1

2016

29.3

250

2010–2016

0 2000 Female 2005 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Thailand

Other health-related SDGs General government health expenditure Indicators General government health expenditure as % of general government expenditure¹¹ Child nutrition Children under 5 years who are stunted⁶ Children under 5 years who are wasted⁶ Drinking water services and sanitation Proportion of population using improved drinking water sources¹¹ Proportion of population using improved sanitation¹¹ Clean household energy Proportion of population with primary reliance on clean fuel¹¹ Ambient air pollution Air pollution level in cities¹¹ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹¹ (per 100 000 people) Homicide and conflicts Proportion (%)

SDG target 1.a

Year 2014

Regional Thailand estimate 13.3 9.3 33.8 15.3 5.3 92 49 Proportion (%) Proportion (%)

100

Prevalence of children under 5 years of age who are stunted²²

2.2.1 2.2.2

2015-2016 2015-2016 2015-2016 2015 2015

10.5 5.4 8.2 98 93

18.1

Children under 5 years who are overweight⁶ 2.2.3 6.1 6.2

0 2005-06 2012

16.3

2015-2016

Prevalence of children under 5 years of age who are wasted²²

7.1

2014

76.0

11.6.2

2014

27.3

58.8

4.7

6.7

2005-06

2012

2015-2016

13.1.2

2011-2015

0.3

0.3 15

Prevalence of children under 5 years of age who are overweight²²

Mortality rate due to homicide¹¹ (per 100 000 population) Estimated direct deaths from major conflicts¹¹ (per 100 000 population) Birth registration Birth registration coverage⁶ Cause-of-death data Completeness of cause-of-death data¹¹ (%)

16.1.1 16.1.2 16.9.1

2015 2011-2015 2015-2016

4 0.7 99.5

4 0.1 -

7.5

8.0

8.2

17.19

2005-2015

2005-06

2012

2015-2016

Note: A dash (-) implies relevant data are not available

References 1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators 2016.Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3. World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 4 July 2017. 4. World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 5. World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 6.Thailand MICS 2015-2016. https://www.unicef.org/thailand/Thailand_MICS_Full_Report_EN.pdf - accessed 12 June 2017 7. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html -accessed 1 June 2017.See for DTP3 coverage: a proxy for immunization coverage 8. World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. 9.UNAIDS. 2015 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 3 June 2017. 10.World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 11. World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 12.World Health Organization. WHO global database on blood glucose, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease 13. World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes 14.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 15. World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access 16.As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population 17. Ministry of Public Health, Thailand 18. World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 19. World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 20. DHS/MICS; 2009-2016 21.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 22. Thailand MICS 2005-2006, Thailand MICS 2012, Thailand MICS 2015-2016 23.Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 24. UNAIDS 2017 estimates for incidence rate among (15-49). http://aidsinfo.unaids.org - accessed 12 June 2017. 25.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 26. Calculated. World Malaria Report 2016. Geneva: World Health Organization; 2016 See for Malaria incidence rate. Country reported value: 2011=0.24, 2012=0.75, 2013=0.82, 2014=0.57, 2015=0.38; Data Source:Bureau of Vector Borne Diseases, Thailand 27.See for mortality rate from road injuries. Country reported value: 2011=21.9, 2012=21.9, 2013=22.9, and 2014=23.2; Data source: Bureau of Policy and Strategy 28.Thailand MICS 2012. https://www.unicef.org/thailand/57-05-011-MICS_EN.pdf - accessed 12 June 2017 29.See for Proportion of the population with access to affordable medicines and vaccines on a sustainable basis. Country reported Value: 2015=99.9; Data Source: Ministry of Health 30.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 31. World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017.

Thailand

Monitoring Health in the Sustainable Development Goals

Timor-Leste Population (000s)¹ Urban population ² Poverty³

1 185

32.8%

(ppp < < $1.90 $1.90 aa day) (ppp day)

GDP per capita² (Current US$)

30.3%

1216.9

Total health expenditure as share of GDP⁴

1.5%

Life expectancy 100 Age (years)

Monitoring the health SDG goal: Indicators of overall progress Life expectancy at birth⁵ provides an indication of overall mortality of a country's population. In Timor-Leste, from 2000 (58.7 years) to 2015 (68.3 years), the life expectancy at birth has improved by 9.6 years. Healthy life expectancy⁶ reflects overall health of the country's population. In Timor-Leste, from 2000 (52.2 years) to 2015 (60.7 years), healthy life expectancy has improved by 8.5 years. 2007 2015

58.7 52.2

68.3 60.7

0 2000 Life expectancy at birth Healthy life expectancy

HEALTH SERVICE COVERAGE A new summary measure of health service coverage, a composite service coverage index , is currently under development:16 indicators are derived from four main areas of work: (1) reproductive, maternal, newborn and child health; (2) infectious diseases; (3) noncommunicable diseases; (4) service capacity, access and health security. Reproductive, maternal, newborn and child health Coverage (%) 100 50 0 Family planning coverage⁷ Pregnancy care⁶ Child immunization coverage⁸ (DPT3) Care seeking behaviour suspected pneumonia⁷ 27 47 Latest available data (2010-2016) 76 71

FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 0.1% or approximately 1 600 people are being pushed into poverty because of out-of-pocket health spending.¹⁸ Catastrophic expenditure on health: 0.9% of people spent more than 10% of their household's total expenditure on health care.¹⁸ Out of pocket expenditure⁴ In most cases, high percentage of out-of-pocket expenditure out of the total health expenditure is associated with low financial protection. Public spending on health⁴ is determined by the capacity of the government to raise revenues and allocate it to health.

Communicable diseases Coverage (%) 100 50 0 Tuberculosis detection and treatment⁹ HIV antiretroviral therapy coverage Insecticide-treated bednets/indoor residual spray coverage for malaria prevention¹⁰ Access to improved sanitation¹¹ 48 100 41

9.6%

Noncommunicable diseases Coverage (%) 100 50 0 Prevalence of normal Prevalence of normal blood pressure level blood glucose level in in population¹² population¹³ 45 100

2.4% 44 1

2.4%

GDP 2014 Estimated total government expenditure, 2014 or latest available year

Cervical cancer screening¹⁴

Tobacco non-use¹⁵ Out-of-pocket expenditure, as % of the health expenditure (2014)

Estimated government expenditure on health, 2014 or latest available year

UHC services coverage index of essential health services To provide a summary measure of UHC services coverage index coverage, an index of national 100 service coverage is computed by averaging service coverage values across the 16 tracer indicators.The 46 50 UHC coverage index ranges from 0% to 100%, with 100% implying full coverage across a range of 0 services. UHC services coverage Index Coverage (%)

Monitoring Health in the Sustainable Development Goals

Timor-Leste

Variation, urban versus rural⁷ Percentage of demand for family planning satisfied 100 80 Improved source of sanitation 60 40 20 0

Equity: Leave no one behind Variation by income⁷ Percentage of demand for family planning satisfied 100 80 Births attended by skilled health personnel Improved source of sanitation 60 40 20 0 Births attended by skilled health personnel

PNC (within 2 days)

DTP3 Coverage

PNC (within 2 days)

DTP3 Coverage

Care seeking behaviour for children with suspected pneumonia Urban Rural

Care seeking behaviour for children with suspected pneumonia Richest Poorest

Variation in risk factors, by sex Indicator Adults aged ≥18 years who are obese¹⁹ (%) Prevalence of raised blood pressure among adults aged ≥ 18 years¹² (%) Prevalence of raised fasting blood glucose among adults aged ≥ 18 years²⁰ (%) Female 2.9 28.1 5.5 Male 1.0 26.9 5.4

Tracking inequalities and targeting disadvantaged groups in health service coverage is central to monitoring progress towards UHC. Currently national health information systems and periodic surveys are inadequate for capturing data disaggregated by health equity stratifiers. The SDG target 17.18 highlighted below emphasizes the importance for countries to improve data and statistics available by multiple equity dimensions in all sectors, including health. Measuring the degree of inequity in service coverage is not currently feasible for most indicators, and data is generally only available for indicators in reproductive, maternal, newborn and child health using data from international household health surveys. A relative inequality score based on the ratio of the mean coverages among the poorest populations to the national average can be computed. A value of 100 means no difference at all, whereas the smaller value indicates greater gap between the poorest and the national average. Child under-five mortality rate inequality by maternal education and wealth quintile for some high-burden countries, 2009 to 2016²¹ Maternal education Wealth quintile Bangladesh Myanmar Nepal Timor-Leste 110 None 55 0 Secondary/Higher 0 Poorest 55 Richest 110

SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio²² MMR [100 000 live births ] 750 694

Births attended by skilled health personnel⁷⋅²³ 100 MR [1000 live births] Coverage (%) 150 110

Child mortality²⁴

500

100

50 30 18

250

215

50 0

53 37 22

0 2000 2005 2010 2015

0 2003 2009-2010

2000

2005

2010 Neonatal

2015

Children under-five

Timor-Leste

Monitoring Health in the Sustainable Development Goals

Communicable diseases (SDG target 3.3) New HIV infections among adults 15 to 49 years²⁵ TB incidence [100 000 pop.] 500 400 300 200 100 0 498

TB incidence²⁶ Malaria IR [1000 pop. at risk] 498

Malaria incidence²⁷ 20 15 10 5 0 Malaria incidence is calculated for confirmed malaria cases 0.1 17.1

Indicators Hepatitis B incidence Number of people requiring interventions against neglected tropical diseases¹¹

Year

Timor-Leste

Regional estimate -

Current data are insufficient to determine trend

2015

1 170 044

726474894

2011 2012 2013 2014 2015

2011 2012 20132014 2015

Noncommunicable diseases and injuries Indicators Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases¹¹ (%) Suicide rate¹¹ (per 100 000 population) Total alcohol per capita (age 15+ years) consumption¹¹ Mortality rate from road traffic injuries¹¹ (per 100 000 population) Sexual and reproductive health Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹¹ (%) Adolescent birth rate (per 1000 women aged 15 to 19 years)⁷ Mortality rate attributed to household and ambient air pollution¹¹ (per 100 000 population) Mortality rate attributed to exposure to unsafe WASH services¹¹ (per 100 000 population) Mortality rate attributed to unintentional poisoning⁶ (per 100 000 population) Tobacco use Prevalence of tobacco use among persons 15 years and older-Female¹⁵ Prevalence of tobacco use among persons 15 years and older-Male¹⁵ Essential medicines and vaccines Proportion of the population with access to affordable medicines and vaccines on a sustainable basis Total net official development assistance to medical research and basic health per capita¹¹ (constant 2014 US$) Health workforce Health worker density¹⁷ (per 10 000 population) National and global health risks International Health Regulations Core Capacity Index¹¹ 3.d.1 2010–2016 66 80 3.b.1 SDG target 3.4.1 3.4.2 3.5.2 3.6.1 Year 2015 2015 2016 2013 Timor-Leste 20.7 7.1 1 16.6 Regional estimate 23.2 12.9 4 17 Litres 6 9

Total alcohol per capita (age 15+ years) consumption²⁸

3.7.1

2005-2015

38.3

74.1

0.7

1.0

2008

2010

2015

2016

3.7.2

2009

33.9 Adolescent Birth Rate [women aged 15-19 yrs]

150

Adolescent birth rate (per 1000 women aged 15 to 19 years)⁷⋅²³

Mortality due to environmental pollution 3.9.1 2012 91.6 119.9

100 78

3.9.2

2012

10.3

20.1

3.9.3

2015

1.5

3.a.1 3.a.1

2015 2015

29 71

18 52

0 2003 2009

Premature NCD mortality rate²⁹ Premature NCD mortality rate (per 100 000 pop.) 1000

750

3.b.2

2014

10.8

0.47

500

3.c.1

2016

20.3

250

0 2000 Female 2005 2010 Male 2015

Note: A dash (-) implies relevant data are not available

Monitoring Health in the Sustainable Development Goals

Timor-Leste

Other health-related SDGs General government health expenditure Indicators General government health expenditure as % of general government expenditure¹¹ Child nutrition Children under 5 years who are stunted³⁰ Children under 5 years who are wasted³⁰ Children under 5 years who are overweight³⁰ Drinking water services and sanitation Proportion of population using improved drinking water sources¹¹ Proportion of population using improved sanitation¹¹ Clean household energy Proportion of population with primary reliance on clean fuel¹¹ Ambient air pollution Air pollution level in cities¹¹ (PM 2.5) (µg/m³) Natural disasters Number of deaths by disaster¹¹ ( per 100,000 people) Homicide and conflicts Proportion (%)

SDG target 1.a

Year 2014

Regional Timor-Leste estimate Proportion (%)

Prevalence of stunting in children under 5 years of age³⁰⋅³¹ 100

2.4

9.3

2.2.1 2.2.2 2.2.3

2013 2013 2013

50.2 11.0 1.5

33.8 15.3 5.3

50.2

0 2003 2007-08 2009-10 2013

6.1 6.2

2015 2015

72 41

92 49 Proportion (%)

Prevalence of children under 5 years who are wasted³⁰⋅³¹

7.1

2014

25 14.3 11.0

11.6.2

2014

58.8

0 2003 2007-08 2009-10 2013

13.1.2

2011-2015

0.3 15

Prevalence of children under 5 years who are overweight³⁰⋅³¹

Mortality rate due to homicide¹¹ (per 100 000 population) Estimated direct deaths from major conflicts¹¹ (per 100 000 population) Birth registration Birth registration coverage⁷ Cause-of-death data Completeness of cause-of-death data¹¹ (%)

16.1.1 16.1.2 16.9.1 17.19.2

2015 2011-2015 2009-2010 2005-2015

4.4 0 55 -

4 0.1 0 11

7.5

5.8

1.5 0 2003 2007-08 2009-10 2013

References

Note: A dash (-) implies relevant data are not available

1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2015 Revision, 2015. http://esa.un.org/wpp/ -accessed 6 Jun 2016. 2.The World Bank. World development indicators .Washington, DC. http://databank.worldbank.org/data/reports.aspx?source=world-development-indicators -accessed 12 June 2017. 3. World Bank 2016. Poverty in Timor-Leste 2014. Washington D.C.: World Bank Group. 4.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 12 June 2017. 5. World Health Organization. Global Health Observatory data: life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ -accessed 12 June 2017. 6.World Health Organization. Global Health Observatory data: Healthy life expectancy. Geneva. http://www.who.int/gho/mortality_burden_disease/life_tables/hale/en/ -accessed 12 June 2017. 7.Timor-Leste DHS 2009-2010. http://dhsprogram.com/pubs/pdf/fr235/fr235.pdf - accessed 12 June 2017. 8. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragedtp3.html accessed 3 August 2016. See for DTP3 coverage: a proxy for immunization coverage. 9.World Health Organization. Global tuberculosis report 2016.Geneva, 2016. http://www.who.int/tb/publications/global_report/en/ - accessed 3 June 2017. See for TB detection and treatment: case detection rate x TB treatment success rate. 10. Calculated. World Health Organization. World malaria report 2015. Geneva, 2015. http://www.who.int/malaria/publications/world-malariareport-2015/report/en/ - accessed 3 August 2016. See for Malaria Prevention: a proxy, percentage population at high risk (> 1 API) covered under ITNs or IRS. 11.World Health Organization. World health statistics 2017: Monitoring health for the SDGs. Geneva, 2017. http://www.who.int/gho/publications/world_health_statistics/2017/en/ - accessed 12 June 2017. 12.World Health Organization. WHO global database on blood pressure, 2017. Geneva. http://apps.who.int/gho/data/node.main.A868?lang=en -accessed 1 June 2017. See for raised BP: a proxy for treatment for cardiovascular disease. The prevalence of raised BP has been rescaled based on a minimum value of 50%. 13.World Health Organization estimate. 2008. http://wwwf.imperial.ac.uk/medicine/apps/ezzati/metabolic_risks/glucose/ - accessed 3 June 2017. See for Mean fasting plasma glucose: proxy for Management for diabetes 14.World Health Organization. National survey for noncommunicable disease risk factors and injuries using approach in Timor-Leste. New Delhi, 2014. http://www.who.int/chp/steps/Timor-Leste_2014_STEPS_Report.pdf?ua=1 – accessed 12 June 2017 . 15.World Health Organization, Regional Office for South-East Asia. Monitoring tobacco control among adults in selected Member States of South-East Asia Region – at a glance. New Delhi, 2015. http://www.searo.who.int/tobacco/data/adult_tobacco_brochure_2015.pdf - accessed 3 June 2017. 16.World Health Organization. World health statistics 2013. Geneva, 2013. http://www.who.int/gho/publications/world_health_statistics/2013/en/ - accessed 12 June 2017. See for density of hospital beds; a proxy for basic hospital access. 17.As reported by country, April 2016, HRH workshop. See for health workers density- normalized against global threshold at WHA 2016; 44.5 per 10000 population. 18.World Bank, 2010. 19.World Health Organization. Global Health Observatory data: Obesity. Geneva. http://apps.who.int/gho/data/node.main.A900A?lang=en – accessed 3 June 2017. 20.World Health Organization. Global Health Observatory data: Blood glucose. Geneva. http://www.who.int/gho/ncd/risk_factors/blood_glucose/en/ – accessed 3 June 2017. 21.DHS/MICS; 2009-2016. 22.WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.Geneva,2015.http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/- accessed 3 June 2017. 23.Timor-Leste DHS 2003. http://microdata.worldbank.org/index.php/catalog/1499/download/24991 - accessed 16 June 2017. See for births attended by skilled health personnel . Country reported value: 2011=51, 2012=59, 2013=62, 2014= 63.9, 2015=63; Data Source: HMIS reports, 2011- 2015 (presented in Joint Annual Health Sector Review 2016). 24. Levels & Trends in Child Mortality. Report 2015 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York (NY), Geneva and Washington (DC) http://www.childinfo.org/-accessed 3 June 2017. 25.See for HIV incidence rate. 2011=0.9, 2012=1.4, 2013=1.2, 2014=1.4, 2014=1.3; Data Source: HMIS reports, 2011-2015 (presented in Annual Health Sector review 2016). 26.World Health Organization. WHO global database on Tuberculosis. Geneva, 2017. Geneva. http://www.who.int/tb/country/data/download/en/ - accessed 3 June 2017. 27.Calculated. World Health Organization. World Malaria report. Geneva, 2016. http://www.who.int/malaria/publications/world-malaria-report-2016/en/ - accessed 10 June 2017. 28.World Health Organization. Global Health Observatory data repository: global information system on alcohol and health. Geneva, 2015. http://apps.who.int/gho/data/node.main.GISAH?showonly=GISAH 3 June 2017. 29.World Health Organization. Global Burden of Disease 2000-2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html - accessed 3 June 2017. ..

Timor-Leste

Monitoring Health in the Sustainable Development Goals

ISBN 978 92 9022 604 8

World Health House Indraprastha Estate Mahatma Gandhi Marg New Delhi-110002, India www.searo.who.int

Key facts

Organisation World Health Organization (WHO)

Document type Publications

Adoption date August 1, 2017

Source World Health Organization