WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Fifty-eighth session Jeju, Republic of Korea 10-14 September 2007 Provisional agenda item 11
WPR/RC58/5 26 July 2007 ORIGINAL: ENGLISH
PROGRESS TOWARDS ACHIEVING THE MILLENNIUM DEVELOPMENT GOALS
In September 2000, at the United Nations Millennium Summit, world leaders agreed to a set of time-bound and measurable goals and targets for combating poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women. These goals and targets are now popularly referred to as the Millennium Development Goals (MDGs). Countries and areas in the Western Pacific Region have made progress towards achieving many of the MDGs. However, that progress has been uneven across goals, across countries and within countries. Tackling the MDGs is critically important given the Region’s absolute contribution to the global burden of disease. Effective technical interventions exist to address the health-related MDGs, but the key challenge is to ensure that those interventions reach the people who most need them. Inequalities in health status and in access to health services hamper efforts to achieve the goals. As social and other non-health factors impact health, meeting the health-related MDGs will require multisectoral investments and action in areas such as poverty reduction, education and gender equality. Improvements in the accessibility, quality and efficiency of health systems are of critical importance. Progress also will depend on increasing domestic and external investments in health. Country ownership of and leadership on MDG-based strategies are central to progress and require the involvement of multiple stakeholders, including governments, nongovernmental organizations, civil society, the private sector and other interested parties. The Regional Committee is asked to note the importance of accelerating progress towards achieving the Millennium Development Goals.
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1. INTRODUCTION
In September 2000, at the United Nations Millennium Summit, world leaders agreed to a set of time-bound and measurable goals and targets for combating poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women. These goals and targets are now popularly referred to as the Millennium Development Goals (MDGs). The MDGs consist of eight goals, accompanied by specific time-bound targets and indicators to measure progress toward the targets by 2015. Goals 1 to 7, which are interconnected and mutually reinforcing, focus on reducing poverty, hunger, illiteracy, gender inequality, child and maternal mortality, disease, and environmental degradation. Goal 8 aims to strengthen the means to achieve the first seven goals by establishing a global partnership for development. Three of the eight MDGs (Goals 4, 5 and 6) refer explicitly to health, while three others (Goals 1, 7 and 8) are health-related (see Annex ). Moreover, better health is central to the achievement of all the MDGs, both as an end in itself and as a major contributor to the overarching goal of poverty reduction. Improvements in health also depend on and contribute to the achievement of other goals in areas such as education and the environment.
2. CURRENT SITUATION
Countries and areas in the Western Pacific Region have moved toward achieving many of the MDGs. However, progress has been uneven across goals, across countries, and within countries. Goal 1: Eradicate extreme poverty and hunger A number of countries in the Region have reached the annual rate of reduction necessary to achieve the target of halving the proportion of people suffering from hunger between 1990 and 2015. Nevertheless, low-income countries have been progressing more slowly. Goal 4: Reduce child mortality The progress towards the targets for infant and under-5 mortality reductions in the Western Pacific Region is mixed, with under-5 mortality rates ranging from less than 4 per 1000 live births in some
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countries to over 100 per 1000 live births in other countries. Furthermore, while some countries seem to be on track, marked disparities may exist within countries themselves, calling for tailored approaches to reducing mortality. Overall, achieving the MDGs related to child survival in the Region will need substantial reductions in neonatal mortality. Goal 5: Improve maternal health A shortage of trend data in most countries makes it difficult to appraise the likelihood of attaining the maternal health target of reducing the maternal mortality ratio (MMR) by three quarters by 2015. A few of the seven priority countries where the MMR is unacceptably high—Cambodia, China, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam—are not on track to meet the target. Some countries in the Western Pacific Region have demonstrated that progress is possible, even with limited resources, though time and commitment are required. Successful reductions in these and other countries were largely due to skilled attendance at delivery, functioning referral systems, available essential obstetric care, policies promoting equitable access to reproductive health services including family planning, and antenatal, delivery and postpartum care. Goal 6: Combat HIV/AIDS, malaria and other diseases HIV: For most heavily affected countries in the Western Pacific Region, as demonstrated in Cambodia, large-scale prevention programmes have succeeded in containing the spread of HIV and in averting new infections. The goal of halting or reversing the spread of HIV is difficult but achievable. Moreover, the epidemic seems to be growing, particularly in Papua New Guinea, and at lower levels in many other countries in the Region. Tuberculosis: The Western Pacific Region achieved the 2005 global TB control targets for case detection and treatment success. Both targets were met in 15 of the 37 countries and areas in the Region, including China, the Philippines and Viet Nam–the three countries in the Region included on the global list of 22 countries with a high burden of TB. Major challenges for countries in the Region will be to sustain the achievements and to optimize the quality and ensure equitable access to TB services in order to achieve the TB-related MDG targets. In addition, countries will need to respond to drug-resistant TB through a programmatic approach and address the HIV-TB co-infection by promoting synergies between TB and HIV/AIDS activities.
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Malaria: In many countries in the Region, progress towards the MDG target of reducing or halting the spread of malaria has been achieved through various interventions. These include the free distribution of insecticide-treated bednets, improved access to more effective antimalarial medications, better training for health workers and indoor residual spraying. In Viet Nam, for example, an integrated package of interventions contributed to an 80% reduction in the mortality rate and a 72% reduction in the morbidity rate between 2001 and 2005. Population movements and rising rates of multidrug resistant strains pose formidable challenges for malaria control, especially in the Greater Mekong Subregion. Access to prevention and treatment for populations in remote areas, where malaria is often concentrated, is also a concern. Goal 7: Ensure environmental sustainability Solid fuels: Interventions that improve access to cleaner fuels and energy practices make multiple contributions to the MDGs by improving air quality and hence health outcomes, and by protecting the environment. While populations in more developed countries, such as Australia, Japan, Malaysia, New Zealand, the Republic of Korea and Singapore, use cleaner fuels, the shift from solid fuels to cleaner fuels in some developing countries has been slow. In Cambodia, the Lao People's Democratic Republic, Papua New Guinea and Solomon Islands more than 90% of their populations are continuing to use solid fuels, which are less friendly to the environment and health. Water and sanitation: Despite progress towards improving water supplies and sanitation over the past decade, nearly 20% of people in the Region lack access to safe water and more than 50% of people in the Region lack access to sanitation. While China is on track to meet the MDG target for safe water, there is a need for the country to accelerate progress on sanitation. Several other countries are not yet on track to achieve the target for safe water, notably Mongolia, Papua New Guinea and the Philippines. Goal 8: Develop a global partnership for development Essential medicines: Improving access to essential medicines is a key element in achieving the MDGs. Progress has been made in the past decade due largely to the implementation of the essential medicines concept and collaborative efforts between governments, international agencies and nongovernmental organizations in improving access to good quality essential medicines. The World Trade Organization’s Agreement on Trade-Related Aspects of International Property Rights (TRIPS) and other multilateral and bilateral trade agreement negotiations accord high priority to public health safeguards for access to medicines.
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3. ACTIONS PROPOSED
Progress towards the MDGs impacts the health and well-being of individuals, households, communities and nations. But achieving the MDGs also is critically important given the Western Pacific Region’s contribution to the global burden of disease. Effective technical interventions exist to reach the health-related MDGs, but the key challenge is ensuring that the interventions reach those people who most need them. Inequalities in health status and in access to health services hamper the efforts of countries to achieve the goals. Some countries might be able to achieve the overall health-related MDGs, while still having populations or areas with poor outcomes. Because social and other non-health factors impact health, meeting the health-related MDGs also will require multisectoral investments and action in areas such as poverty reduction, education and gender equality. Country ownership and leadership of strategies to meet the MDGs are of critical importance. Improvements in the accessibility, quality and efficiency of health systems are crucial for better health outcomes. Progress on the health-related MDGs also will depend on increasing domestic and external investments in health, and in improving the effective use of available resources. Country ownership of MDG-based strategies is central to their progress and requires the involvement of multiple stakeholders, including governments, nongovernmental organizations, civil society, the private sector and other interested parties.
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WPR/RC58/5 page 7 ANNEX Table 1: Millennium development goals with health-related indicators Goal 1: Eradicate extreme poverty and hungera • • Prevalence of underweight children under 5 years of age Proportion of population below minimum level of dietary energy consumption
Goal 4: Reduce child mortalityb • • • Under-5 mortality rate Infant mortality rate Proportion of 1-year-old children immunized against measles
Goal 5: Improve maternal health b • • Maternal mortality ratio Proportion of births attended by skilled health personnel
Goal 6: Combat HIV/AIDS, malaria, and other diseases b • • • • • • • HIV prevalence among people aged 15–24 Condom use rate of the contraceptive prevalence rate Number of children orphaned by HIV/AIDS Prevalence and death rates associated with malaria Proportion of population in malaria risk areas using effective malaria prevention and treatment measures Proportion of tuberculosis (TB) cases detected and cured under directly observed treatment, short course (DOTS) Prevalence and death rates associated with TB
Goal 7: Ensure environmental sustainability a • • • Proportion of population using solid fuels Proportion of population with sustainable access to improved water source, urban and rural Proportion of population with access to improved sanitation
Goal 8: Develop a global partnership for development a • a b
Proportion of population with access to affordable essential drugs on a sustainable basis.
Health-related MDG Health MDG Source: The World Health Report 2003. Shaping the Future. Geneva, World Health Organization, 2003.