Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update

2018 update Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South- East Asia Region 9 789290 226628 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region 2018 update Health in the SDGs.indd 1 30-08-2018 11:00:03 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update ISBN: 978 92 9022 662 8 © World Health Organization 2018 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. 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Printed in India Health in the SDGs.indd 2 30-08-2018 11:00:03 iiiMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Contents Introduction by the Regional Director 1 Part 1: Progress towards universal health coverage and health-related SDGs: highlights 3 Part 2: Strengthening SDG monitoring, with a focus on improvements in mortality statistics 17 Part 3: Country-specific SDG data profiles 23 Bangladesh 27 Bhutan 31 Democratic People’s Republic of Korea 35 India 39 Indonesia 43 Maldives 47 Myanmar 51 Nepal 55 Sri Lanka 59 Thailand 63 Timor-Leste 67 Annex: Indicator definitions and data 71 Health in the SDGs.indd 3 30-08-2018 11:00:03 Health in the SDGs.indd 4 30-08-2018 11:00:03 1Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Introduction by the Regional Director It is a great pleasure to introduce the third annual report on progress towards universal health coverage (UHC) and the health-related Sustainable Development Goals (SDGs) in the South-East Asia (SEA) Region. This year’s report follows a format similar to the 2016 and 2017 reports, but has some new features which I would like to highlight. Part 1 provides, as previously, regional highlights of progress on UHC and the health-related SDG targets. For UHC, both dimensions – access to needed health care, and financial protection – are analysed using the agreed upon SDG indicators. Encouragingly, overall essential health service coverage has improved in all Member States since 2010, according to the latest figures, with the essential service coverage index estimates now ranging from 49%–85%. I am also pleased that in this year’s publication we are able to report on financial protection using the SDG indicator of financial protection for the first time. The SDG indicator measures the proportion of the population spending more than 10% of their total household expenditure on health care. This, called catastrophic health expenditure, is a better measure of lack of financial protection than out-of-pocket payment, the proxy that was previously used. There are big differences in catastrophic levels of health spending between countries, ranging from 2%–20% of the population. This is not unexpected, and it is helpful to now have this analysis for most SEA Region countries, as a starting point for future monitoring up to 2030. For both aspects of UHC, there remains much to do in the South-East Asia Region if we are to contribute significantly to the global target of one billion more people with UHC by 2023 under the new WHO Global Programme of Work. For the first time a section on trends in equity over time is included in this report, using several SDG indicators. This is to help keep the spotlight on the critical SDG commitment to “leave no one behind”, and the need to narrow the gap, whether it be between rich and poor, the well and less-well educated, and rural and urban areas. There are some welcome successes in reducing inequities as well as some persistent gaps. Altogether I am encouraged by the increased attention to equity monitoring, but note the need for better and different approaches to tracking exclusion from care (for example, health of mobile populations, migrants, and the urban poor), which was first discussed at the 2016 regional consultation on health in the sustainable development goals, and which remains a challenge. Part 2 reflects on how we are doing in monitoring the SDGs, and the information system developments needed to strengthen UHC and health SDG monitoring. In most Member States, the health-related SDG indicators are now embedded in national M&E frameworks, and attention to equity monitoring is increasing. In this report, there is a particular focus on better cause of death data through improved civil registration and vital statistics (CRVS) systems, because we will report to the Seventy-first Session of Health in the SDGs.indd 1 30-08-2018 11:00:04 2 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update the Regional Committee on the “Regional Strategy for strengthening the role of the health sector for improving civil registration and vital statistics (CRVS) (2015–2024)”. Implementation is progressing, though more work is needed to improve cause-of-death data which are needed to adequately measure the 14 mortality-related indicators in the SDGs. Part 3 presents the now familiar individual Member State health SDG profiles. There are new sections this year on equity and on the status of CRVS systems. The profiles also include trend information where possible. It is encouraging that there are more national data and fewer global estimates than in previous annual reports, because data quality and availability are improving. I hope this year’s publication contributes to maintaining the momentum around the Sustainable Development Agenda, to which we are all committed. Dr Poonam Khetrapal Singh Regional Director WHO South-East Asia Region Health in the SDGs.indd 2 30-08-2018 11:00:04 PART I Progress towards universal health coverage and health-related SDGs in the South-East Asia Region: highlights 3 Health in the SDGs.indd 3 30-08-2018 11:00:04 Health in the SDGs.indd 4 30-08-2018 11:00:04 5Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update This section provides a regional overview of progress towards UHC and health-related SDG targets, together with some analysis of equity trends. More details are included in the individual country profiles in Part 3 of this report. The final date for all data presented in this report is 30 June 2018. Almost all of the health-related SDG indicators used are aligned with the global definitions and consistent with data and indicators presented in the WHO World health statistics 2018.1 The Annex of this report explains why five health-related SDG indicators have been modified to better fit the regional context. Universal health coverage Universal health coverage is about all people getting the care they need, without financial hardship. In the health SDG monitoring framework, UHC is SDG target 3.8, and it has two indicators: to monitor progress on access to essential health services (3.8.1), and to monitor financial protection (3.8.2). Coverage of essential health services is measured using the “UHC health coverage, service coverage index”. This was originally developed in 2015 by WHO, and has been used in the South-East Asia Region since 2016. This year, the United Nations Statistics Commission Inter-Agency Expert Group upgraded the UHC essential services coverage index from a ‘Tier III’ to a ‘Tier II’ indicator. This means the indicator has been validated and should be used by Member States. Financial protection has until now been reported in the South-East Asia Region using a proxy indicator – out-of-pocket payment on health as a share of total health spending. This year, the report uses the SDG indicator for financial protection, which measures catastrophic health expenditure. This is also an SDG Tier II indicator. Essential health services coverage The UHC service coverage index, as in previous years, is made up of 16 indices in four areas: reproductive, maternal, newborn, and child health; infectious diseases; noncommunicable diseases; and health service capacity, access and health security. Overall, the Regional average for the UHC essential health services index is 64% in 2018 compared with 44% in 2010. Figure 1 shows the changes from 2010 to 2018 with significant improvements in all eleven SEA Region countries. Despite improvements, there remains much to do to advance essential service coverage. In approximate numbers, over 800 million people in the Region are estimated to still not have sufficient access to essential health services. 1 World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization: 2018. Health in the SDGs.indd 5 30-08-2018 11:00:04 6 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Fig. 1: Changes in essential health services coverage in Member States of the SEA Region, 2010 to 20182 2010 level 2018 level Global average 64 85 78 72 72 68 64 62 61 50 50 49 0 20 40 60 80 100 Th ai la n d D P R K or ea Bh ut an M al di ve s Sr i L an ka In di a N ep al In do ne si a Ba ng la d es h M ya nm ar Ti m or -L es te U H C s er vi ce c ov er ag e in de x Financial protection This year, the SDG indicator 3.8.2 is used to report on financial protection in the South- East Asia Region for the first time. SDG Indicator 3.8.2 is defined as the proportion of the population that has household expenditures on health greater than 10% of their total household expenditure. Data are available for nine Member States in the Region; and the most recent available survey data were used3. On average, 14.3% (median 5.3%) of households in the Region spend more than 10% of their household spending on health. Trend data are not yet available, but will be in the short to medium term. In approximate numbers, at least 65 million people are pushed into extreme poverty because of paying for health care in this Region. Looking at the two dimensions of UHC together To compare the relative situation for the two dimensions of UHC across countries in the Region, Figure 2 shows UHC health service coverage index and catastrophic health expenditure values, plotted together. To show how the SEA Region stands in relation to the global situation, global median figures for both dimensions are included (grey lines)4. Thailand, Bhutan and Sri Lanka fall above the global median for both UHC service coverage and financial protection. 2 Health information platform for WHO South-East Asia Region. New Delhi: World Health Organization; 2018 (http://hip.searo.who.int) and DHS / MICS data 2007–2016. 3 See individual country profiles reference lists for the year of data used. 4 World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization: 2018. Health in the SDGs.indd 6 30-08-2018 11:00:04 7Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Fig. 2: Comparison of health services coverage and financial protection in nine Member States of the SEA Region by income level, 20185 0510152025 25 50 75 100 Sri Lanka Bangladesh Bhutan India Indonesia Maldives Nepal Thailand Timor-Leste 64 Global median Parameter 3 7. 3 G lo ba l m ed ia n Legend Low income Lower middle-income Higher middle-income Proportion of population with household expenditure on health >10% of total household expenditure or income Less is better M o re is b et te r U H C s er vi ce c ov er ag e in de x Regional highlights on UHC € Essential health service coverage has improved overall in all countries since 2010. € There has been progress in the measurement of financial protection, with a first analysis using the SDG indicator for nine countries. Trends will be monitored as new survey data becomes available. € Three countries in the Region lie above the global median for both service coverage and financial protection. eqUity: what is known aboUt who is being left behind? Regional inequalities in essential service coverage From a regional point of view, information on different dimensions of health equity, and associated trends, remains limited. 5 Health information platform for the WHO South-East Asia Region. New Delhi: World Health Organization; 2018 (http://hip.searo.who.int/dhis) Health in the SDGs.indd 7 30-08-2018 11:00:04 8 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update First, analyses of regional variations in service coverage by income, education, and by urban versus rural populations, have been updated. For the Region as a whole, access to care continues to be worse for the poor, those with less education and – to a lesser degree – those living in rural areas. Figure 3 provides an updated regional overview of inequalities in seven health service coverage areas. Fig. 3: Inequalities in coverage of essential health services by income group, urban versus rural households, and level of education across the South-East Asia Region6 0 20 40 60 80 100 Contraceptive satisfied needs ANC4+ visits Birth attended by skilled personnel PNC (with in 2 days) DTP3 coverage Antibiotic treatment for pneumonia under-5 Improved source of drinking water Contraceptive satisfied needs ANC4+ visits Birth attended by skilled personnel PNC (with in 2 days) DTP3 coverage Antibiotic treatment for pneumonia under-5 Improved source of drinking water Contraceptive satisfied needs ANC4+ visits Birth attended by skilled personnel PNC (with in 2 days) DTP3 coverage Antibiotic treatment for pneumonia under-5 Improved source of drinking water Richest Poorest 0 20 40 60 80 100 Urban Rural 0 50 100 Secondary or more No education Increased attention to monitoring inequalities within countries Five Member States in the Region have begun more systematic equity analyses, including Indonesia (see box), Bangladesh, Sri Lanka, Nepal and Myanmar, to better understand the within country disparities, and track progress with policies designed to reduce inequities. They have used the WHO Health Equity Analysis Toolkit. The results are beginning to be used to inform policy and planning. Trend data on inequalities are especially informative, and even more limited. Some examples are provided here that illustrate trends in inequalities in health and health care within countries. € Variations in premature mortality between men and women, over time 6 DHS / MICS data, 2007-2016 Health in the SDGs.indd 8 30-08-2018 11:00:05 9Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Measuring health inequalities The state of health inequality: Indonesia7 report covers 11 health topics, drawing data from about 53 health indicators, which were disaggregated by eight dimensions of inequality. Findings were derived from analysis of cross-cutting examinations of disaggregated data estimates and summary measures looking at patterns of health inequality. Health inequalities were observed, to varying extents, for the featured dimensions of inequality, which included economic status, education, occupation, employment status, age, sex, place of residence and subnational region. These analyses revealed additional insights into the strengths and weaknesses of the health sector, policy implications and opportunities for intervention. Figure 4 shows trends in probability of premature mortality due to noncommunicable diseases among males versus females since 2000 for all countries in the Region. In general, premature mortality is going down. In most cases, it is lower for females than for males. Fig. 4: Probability (%) of dying between exact ages 30 and 70 from any of cardiovascular disease, cancer, diabetes, or chronic respiratory illness in the SEA Region, 2000–20168 Pr ob ab ili ty o f dy in g (% ) Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Sri Lanka Thailand Timor-Leste Nepal Pr ob ab ili ty o f dy in g (% ) Pr ob ab ili ty o f dy in g (% ) 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 2000 2005 2010 2015 10 20 30 40 Sex Male Female € Variations in access to basic sanitation, over time In terms of trends in inequalities in services depending on where people live, there are some data on trends in the availability of basic sanitation in urban and rural areas between 2000 and 2015 (see Figure 5). As is well known, generally urban areas have 7 State of health inequality: Indonesia. Geneva: World Health Organization; 2017. 8 Global health observatory, Geneva: World Health Organization; 2018 Health in the SDGs.indd 9 30-08-2018 11:00:05 10 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update greater access to basic sanitation. The size of the urban/rural difference varies between countries. In some countries the gap between urban and rural areas has narrowed. Fig. 5 . Basic sanitation service coverage by geographical areas in the SEA Region, 2000–20159 Legend Urban Rural Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Sri Lanka Thailand Timor-Leste Nepal 100 80 60 40 20 Ba si c sa ni ta tio n co ve ra ge (% ) 2005 2010 2015 100 80 60 40 20 2005 2010 2015 100 80 60 40 20 2005 2010 2015 100 80 60 40 20 2005 2010 2015 100 80 60 40 20 Ba si c sa ni ta tio n co ve ra ge (% ) 2005 2010 2015 100 80 60 40 20 2005 2010 2015 100 80 60 40 20 2005 2010 2015 100 80 60 40 20 2005 2010 2015 100 80 60 40 20 Ba si c sa ni ta tio n co ve ra ge (% ) 2005 2010 2015 100 80 60 40 20 2005 2010 2015 100 80 60 40 20 2005 2010 2015 € Variations in health service coverage by income group, over time Figure 6 illustrates inequalities in antenatal care by income group, between 2000 and 2016 for countries with trend data. It is well known that higher income groups tend to get more antenatal care than lower income groups. In Sri Lanka however, the difference is small. Regional highlights on equity € Inequalities in health and health service coverage persist. Analysis of trends over time show there are examples both of gaps being narrowed, and of persistent gaps. € Member States are giving more attention to equity analysis, and it is essential that this is maintained. € Given the SDG commitment to “leave no one behind”, there is a need to go beyond the traditional dimensions of equity analysis, and develop creative ways to look at other aspects of exclusion such as migrants, mobile populations or the urban poor. More details and trend analysis results are highlighted in the individual SDG profiles in Part 3 of this report. 9 Global health observatory, Geneva: World Health Organization; 2018 11Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Fig. 6: Antenatal care services (four or more visits) received by the poorest and richest women in selected SEA Region countries, 2000–201610 Bangladesh India Indonesia Nepal Sri Lanka* Timor-Leste Quintile 1 (poorest) Quintile 5 (richest) 100 80 60 40 20 0 100 80 60 40 20 0 100 80 60 40 20 0 Pe rc en ta ge 2000 2005 2010 2015 80 60 40 20 0 Pe rc en ta ge 2000 2005 2010 2015 80 60 40 20 0 2000 2005 2010 2015 2000 2005 2010 20152000 2005 2010 2015 100 80 60 40 20 0 2000 2005 2010 2015 Year *Contains data for ANC services provided by skilled health personnel by wealth quintile without mentioning the number of ANC covered. other sdg health-related targets: regional highlights Reproductive, maternal and child health Since 2000, maternal and under-five mortality rates have declined faster in the SEA Region than in any other region, by 69% and 67%, respectively. Neonatal mortality is reducing at a slower rate than overall child mortality (see Figure 7). Four Member States are below the global SDG targets for child mortality and three are below for maternal mortality. A substantial increase in institutional deliveries has occurred in the Region. The Region has eliminated maternal and neonatal tetanus. Child stunting still comprises 40% of the global burden. Infectious diseases Trends in major communicable diseases vary (see Figure 8). New HIV infections and deaths from AIDS continue to decline. Thailand has eliminated mother-to-child transmission of HIV and congenital syphilis (the first country in Asia to do so). Estimated TB incidence rates have been decreasing in most member states, albeit while they have been relatively constant in Bangladesh, Nepal, Sri Lanka and Timor-Leste since 2015. TB mortality estimates have increased for Nepal, Thailand and Timor-Leste since 2015. The Region still accounts for 45% of the global TB incidence, 50% of global deaths and 35% of the global estimated cases of multidrug resistance TB cases. The Region has made substantial progress in reducing malaria, with a 46% and 60% reduction in reported 10 DHS / MICS data, 2007-2016 Health in the SDGs.indd 11 30-08-2018 11:00:05 12 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update malaria cases and deaths between 2010 and 2016 respectively. Sri Lanka and Maldives have been certified malaria free. In terms of neglected tropical diseases (NTDs), which are quintessentially diseases of “those left behind” there is significant progress: four out of the eight endemic Member States in the Region have now reached the elimination threshold for lymphatic filariasis (LF) and three (Maldives, Sri Lanka and Thailand) have had their status validated. Nepal has eliminated trachoma as public health problem. Fig. 7: Trends in mortality in the WHO South-East Asia Region, 1990–201611 0 200 400 600 1990 1995 2000 2005 2010 2015 2016 Maternal mortality ratio (per 100 000 live births) Under-five mortality rate (per 1000 live births) Neonatal mortality rate (per 1000 live births) M or ta lit y ra te Fig. 8: Trends in major communicable diseases in the WHO South-East Asia Region, 2000–201612 0 50 100 150 200 250 300 350 0 5 10 15 20 25 2000 2005 2010 2015 2016 Malaria Incidence/1000 population at risk HIV/TB co-infection (percentage) TB incidence/100000 TB in ci de nc e M al ar ia in ci de nc e H IV /T B co -in fe ct io n 11 Global health observatory, Geneva: World Health Organization; 2018 12 Global TB report 2017, Global Malaria Report 2017, Geneva: World Health Organization and UNAIDS portal (http://aidsinfo.unaids.org/) Health in the SDGs.indd 12 30-08-2018 11:00:05 13Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Noncommunicable diseases (NCDs) and risk factors NCDs are on the rise and are currently responsible for 8.9 million deaths annually in the SEA Region (64% of all deaths in the Region) out of which 4.4 million deaths are premature (between the ages of 30 and 69 years). Regular reporting on NCDs is new, and trend data are limited with some estimates available (see Figure 9 ). Trend data on risk factors are also limited, although for alcohol and tobacco data is accumulating and all Member States now have 1–2 years of trend information. This is a major focus for support from the Regional Office. One rising health challenge in the Region is the disproportionate rise in global preventable deaths due to household air pollution (40%), with limited improvement in access to clean fuels and technologies at the household level since 2012. Fig. 9: Trends in disability-adjusted life years (DALYs) in the WHO South-East Asia Region 2000–201513 0% 20% 40% 60% 80% 100% 2000 2004 2015 Communicable Diseases Injuries Noncommunicable diseases Health systems Health workforce (doctors, nurses and midwives) density in the SEA Region has improved since 2014 (see Figure 10). Eight Member States are now above the original (2006) WHO human resources for health (HRH) threshold of 22.8 doctors, nurses and midwives per 10 000 population. More details on health workforce density and distribution for five cadres (doctors, nurses, midwives, dentists and pharmacists) are reported in the companion publication14. 13 Global health observatory, Geneva: World Health Organization; 2018 14 The Decade for Health Workforce Strengthening in the SEA Region 2015-2024: second review of progress, challenges and opportunities. New Delhi: World Health Organization; 2018. Health in the SDGs.indd 13 30-08-2018 11:00:06 14 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Fig. 10: Trends in availability of health workers in SEA Region countries 2014–201715 140 120 100 80 60 40 20 0 Maldives 2014 (or nearest year before 2014) 2017 (or most recent year after 2014) DPR Korea Thailand Nepal Sri Lanka India Timor-Leste 44.5/10 000: Global Strategy on HRH 2016 22.8/10 000: World Health Report 2006 Indonesia Bhutan Myanmar Bangladesh D en si ty o f he al th w or ke rs p er 1 0 00 0 po pu la tio n On access to essential medicines, currently only three Member States have recent national data on availability of medicines. Otherwise, information comes from smaller case studies. In 2018, some Member States will use a new WHO application to collect data on the availability of medicines, with an initial focus on antimicrobials and medicines for common NCDs. On International Health Regulations (IHR) Core Capacity, four Member States – India, Indonesia, Thailand and Sri Lanka – have declared compliance. strategic issUes, conclUsions and the way forward UHC remains central to making progress on the health-related SDGs. It is encouraging to see improvement across all Member States in access to a range of essential health services. On financial protection, the only trend data currently available is based on out- of-pocket payments, and here the direction of change is more mixed across countries. Some limited comment can be made on trends in health inequalities. Variations in health service coverage in the Region have reduced slightly since 2015. Encouragingly, measurement of inequalities within Member States is getting more attention. Progress continues on the unfinished MDG agenda – maternal health, child health and communicable diseases – for which data are also more complete. For the newer 15 Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018 Health in the SDGs.indd 14 30-08-2018 11:00:06 15Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update targets, especially NCDs, it is too early to comment on trends since the SDGs were launched, but encouragingly many Member States now have one or two years of data. Member States of the Region have taken major steps forward on monitoring the health-related SDGs. All Member States have now embedded the health SDG indicators in national monitoring frameworks and have reviewed the availability of health-related SDG data. Eight Member States have begun setting their national health SDG targets, taking into account feasibility of measurement and achievability of results. New and improved data collection efforts are needed for certain indicators, as is greater capacity to monitor equity trends. Altogether, stronger health information systems are required to generate routine and high-quality statistics for effective monitoring of UHC and the health SDG targets, and steps being taken are discussed in Part 2 on this document. Greater transparency and accountability are facilitated both by this annual review, and through the online health information platform for the WHO South-East Asia Region16. 16 http://hip.searo.who.int/dhis/ Health in the SDGs.indd 15 30-08-2018 11:00:06 Health in the SDGs.indd 16 30-08-2018 11:00:06 PART 2 Strengthening SDG monitoring, with a focus on mortality statistics 17 Health in the SDGs.indd 17 30-08-2018 11:00:06 Health in the SDGs.indd 18 30-08-2018 11:00:06 19Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Reliable information is essential for measuring progress towards UHC and the health SDGs, and for making adjustments as needed to national health policies and priorities. A national health information system (HIS), which includes civil registration and vital statistics (CRVS) systems, is a key component of any national health system. Well-functioning health information systems help stimulate better health system performance. In order to define targets for UHC and other health SDG indicators, and to monitor progress, decision-makers and managers at different levels need to have the skills and supporting information system capacity to produce, analyse, disseminate and use accurate and timely health information. In this year’s report, this section focuses on the need for more reliable vital statistics on births, deaths and causes of death. These data from CRVS systems are required for reporting on 14 health-related SDG mortality indicators, and in particular for improved monitoring of noncommunicable diseases. Five strategic areas of the Regional Strategy for strengthening the role of the health sector for improving CRVS: € Strategic Area 1: Legal and organizational framework for CRVS € Strategic Area 2: Political commitment and intersectoral collaboration for national capacity-building, partnership, advocacy and outreach € Strategic Area 3: Birth and death registration – completeness and coverage € Strategic Area 4: Recording cause of death, ensuring completeness and quality € Strategic Area 5: Creating demand for health and vital statistics, enabling service delivery and planning through use in (a) evidence-based decision-making, and (b) linkages to other activities. The health sector plays a critical role in accelerating the development and strengthening of CRVS systems. Its role is often described in terms of the activities of health institutions, which act as informants of the occurrence of births and deaths, and enable the certification of cause of death by physicians. This information is crucial for generating statistics to guide health policy and planning and its importance has been recognized in the SEA Region through adoption of the “Regional Strategy for strengthening the role of the health sector for improving civil registration and vital statistics (CRVS) (2015–2024)”17 by the Regional Committee in 2014.18 17 Regional Strategy for strengthening the role of the health sector for improving CRVS (2015–2024). New Delhi: WHO Regional Office for South-East Asia; 2015. (http://www.searo.who.int/entity/health_situation_trends/ regional_strategy_for_strengthening_the_role_of_the_health_sector_for_improving_crvs.pdf?ua=1, accessed 23 May 2018). 18 Covering every birth and death: improving civil registration and vital statistics. New Delhi: World Health Organization, Regional Office for South-East Asia; 2014 (SEA/RC67/R2; http://apps.who.int/iris/ handle/10665/136970, accessed 30 July 2018). Health in the SDGs.indd 19 30-08-2018 11:00:06 20 Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update improving vital statistics Improving these three types of vital statistics – birth and death registration and reliable mortality statistics – are goals of the Regional Strategy. Figure 11 presents the status for countries in the SEA Region from the best available recent information. Baseline data collected at the time of development of the CRVS Strategy in 2013 and 2014 are not presented below as much of this information could not be adequately validated. Fig. 11: Birth and death registration coverage and cause-of-death data availability for countries in the WHO SEA Region, 201719 0 10 20 30 40 50 60 70 80 90 100 Ba ng la d es h Bh ut an D P R K or ea In di a In do ne si a M al di ve s M ya nm ar N ep al Sr i L an ka Th ai la n d Ti m or -L es te Birth registration Death registration Cause of death (CoD) ** ** * Cause of death data available from unverified sources. Birth registration coverage is more than 80% in seven countries and above 50% in all countries in the Region. Death registration coverage lags behind birth registration coverage across the Region. Cause-of-death (CoD) data availability varies considerably in the Region and is mostly of poor quality. Several countries continue to use sample vital registration sites and surveys (Bangladesh, India, Indonesia and Nepal) in the absence of fully functioning CRVS systems capable of generating adequate cause-of-death data and statistics for policy and planning. This is a strategic interim approach taken by countries. 19 CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document) and DHS / MICS data 2007–2016. For Bangladesh only, Report on Bangladesh Sample Vital Statistics 2017. Bangladesh Bureau of Statistics, 2018 Health in the SDGs.indd 20 30-08-2018 11:00:06 21Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Member States of the SEA Region have been actively engaged in regional and national activities to strengthen CRVS systems. There is an increase in political commitment to health sector initiatives for CRVS development, support for CRVS development plans, coordination by stakeholders and partners, expansion in knowledge-sharing, and use of tools and techniques for improving CRVS performance. Two specific CRVS strengthening interventions are underway in several countries in the SEA Region to address issues in improving the completeness and quality of CoD data to improve the reliability of the mortality statistics generated and used. € A Start-Up Mortality List (SMoL) tool based on a simplified set of International Classification of Diseases, version 10 (ICD-10) codes has been introduced to five countries (Bangladesh, Bhutan, Indonesia, Nepal and Timor-Leste) to improve the completeness, quality and use of CoD data captured from health facilities. € A harmonized set of new WHO standards for verbal autopsy is being used by three countries (Bangladesh, India and Indonesia) and is under review for use by other countries (Myanmar, Nepal and Sri Lanka) to improve the quality of CoD data for deaths occurring in communities outside of health facilities. conclUsions € Civil registration of births and deaths is increasing, though at different rates. However, there is still very little information available on cause of death, and what exists is of relatively poor quality. € Within the health sector, the use of WHO standards for death certification, and for classifying causes of death according to the ICD-10 standard, is expanding in all countries in the Region, but more intensified action is needed. Here, more use could be made of SMoL to expand the coverage of medically certified and classified cause-of-death data to better know what people are dying from. € Strengthening CRVS as a whole requires action beyond the health sector, and by multiple stakeholders. The MoH has a role to play. Greater advocacy within the governments is needed for larger and more coordinated investments in CRVS to improve the completeness, reliability and utility of mortality statistics and to better understand the burden of disease, particularly from NCDs. € CRVS systems also need to link better with the overall health information system in a country. This is increasingly possible with new information technologies, but also needs sustained political support, inter-institutional agreement and sometimes legislative revision. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the progress of UHC and the health-related SDGs. Health in the SDGs.indd 21 30-08-2018 11:00:06 Health in the SDGs.indd 22 30-08-2018 11:00:06 PART 3 Country specific SDG data profiles 23 Health in the SDGs.indd 23 30-08-2018 11:00:06 Health in the SDGs.indd 24 30-08-2018 11:00:06 25Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update This section provides country-specific data profiles for the 11 countries of the WHO South-East Asia Region. A set of health-related SDG indicators are presented. For each country there is a comprehensive list of references showing data source and year. ~ Bangladesh ~ Bhutan ~ Democratic People’s Republic of Korea ~ India ~ Indonesia ~ Maldives ~ Myanmar ~ Nepal ~ Sri Lanka ~ Thailand ~ Timor-Leste Health in the SDGs.indd 25 30-08-2018 11:00:06 Health in the SDGs.indd 26 30-08-2018 11:00:06 27BangladeshMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update 72% 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. Bangladesh Urban population¹ 35.9% Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Bangladesh, from 2000 (65.3 years) to 2016 (72.7 years), the life expectancy at birth has improved by 7.4 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Bangladesh, from 2000 (56.3 years) to 2016 (63.3 years), healthy life expectancy has improved by 7.0 years. Population (000s)¹ 166 368 Poverty² 18.5 GDP per capita² (Current US$) 1516.5 Current health expenditure as share of GDP³ 3.0% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 73 56 6365 Life expectancy at birth Healthy life expectancy Monitoring the health SDG goal: Indicators of overall progress (ppp < $1.90 a day) 5.7% 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). Universal health coverage: At the centre of the health goal HEALTH SERVICE COVERAGE A summary measure of essential health services coverage, a composite service coverage index, is used: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. FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 3.4% or approximately 5 234 000 people are being pushed into poverty because of out-of-pocket health spending³. Catastrophic expenditure on health: 13.9% of people spent more than 10% of their household's total expenditure on health care³. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DTP3)⁶ 0 50 100 C ov er ag e (% ) 97 62 37 42 Reproductive, maternal, newborn and child health Latest available data (2010-2017) Tuberculosis treatment coverage⁷ HIV antiretroviral therapy coverage⁸ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁹ Access to basic sanitation¹⁰ 0 50 100 C ov er ag e (% ) 62 16 36 47 Infectious diseases Prevalence of normal blood pressure in population¹⁰ Tobacco non-use¹¹ Prevalence of normal fasting glucose level¹¹ Cervical cancer screening 0 50 100 C ov er ag e (% ) 90 75 65 Noncommunicable diseases Health security: IHR compliance¹⁰ Access to essential medicines¹⁴ Density of hospital beds¹⁵, expressed as % of global threshold, 18/10 000¹² Heath worker density, expressed as % of new global threshold, 44.5/10 000¹³ 0 50 100 C ov er ag e (% ) 78 65 33 19 Service capacity, access and health security 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 0 50 100 C ov er ag e (% ) 50 UHC services coverage index Out-of-pocket expenditure, as % of the health expenditure (2015) Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. 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. 5.7% ( p < . a day) 2.8% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 27 30-08-2018 11:00:07 28 Bangladesh Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Variation by income Equity : Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by geography SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation¹⁰ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ Variation by education 2000 2005 2010 2015 0 50 100 M or ta lit y R at e Under five mortality⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (modern) prevalence rate⁵ Rural Urban 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Full Immunization⁵ No education Secondary school+ Primary school Strengthening civil registration and vital statistics (CRVS) SDGs emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Maternal mortality ratio¹⁷ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 399 176 Births attended by skilled health personnel⁵ 2007 2011 2014 0 50 100 C ov er ag e (% ) 18 32 42 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 43 20 88 34 Child mortality¹⁸ Children under-five Neonatal Quintile 5 (richest) Quintile 1 (poorest) 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 84 .2 85 .0 86 . 4 87 .4 Death registration¹⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 50.0 Cause of death¹⁶ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 87 .2 85 .9 85 .4 85 .2 Birth registration¹⁵ Health in the SDGs.indd 28 30-08-2018 11:00:07 29BangladeshMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update New HIV infections among adults 15 to 49 years⁸ 2012 2013 2014 2015 2016 0.0 0.2 0.4 HI V IR [1 00 0 un in fe ct ed p op .] 0.01 0.02 Malaria incidence⁹ 2012 2013 2014 2015 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] 1.6 3.9 TB incidence⁷ 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] 225 221 Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s Communicable diseases (SDG target 3.3) Indicators SDGtarget Year Bangladesh Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 21.6 23.1 Noncommunicable diseases and injuries Tobacco use among persons (15+ yrs) and older - Female 3.a.1 2017 25.2 Tobacco use among persons (15+ yrs) and older - Male 3.a.1 2017 46.0 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis¹⁴ 3.b.1 2014 65 Total net official development assistance to medical research and basic health per capita¹⁴ 3.b.2 2016 1.25 - - Essential medicines and vaccines International Health Regulations Core Capacity Index⁴ 3.d.1 2017 78 73 National and global health risks Note: A dash (-) implies relevant data are not available Health worker density¹³ (per 10 000 population) 3.c.1 2017 8.3 - Health workforce 0.00.0 Malaria incidence is calculated for confirmed malaria cases Indicators Year Bangladesh Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 1.38 Number of people requiring interventions against neglected tropical diseases⁴ 2016 47,848,224 0.70 671,797,672 Suicide mortality rate⁴ (per 100 000 population) 3.4.2 2016 5.9 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 <0.05 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2013 13.6 13.2 4.5 17 2007 2011 2016 0 50 100 150 Ad ol es ce nt b irt h ra te [ w om en a ge d 15 -1 9 yr s] 83.5 126.0 Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁹ Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) 3.7.1 2014 72.5 Adolescent birth rate¹⁹ (per 1000 women aged 15 to19 years) 3.7.2 2016 78 75.1 33 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 149 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 11.9 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.3 164 15.4 1.8 Mortality due to environmental pollution 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D M or ta lit y ra te (p er 1 00 0 00 ) Total NCD Mortality¹⁰ Female Male Health in the SDGs.indd 29 30-08-2018 11:00:08 30 Bangladesh Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Country Bangladesh Prevalence of children under 5 years who are overweight⁵ 2004 2007 2014 0 8 15 Pr op or tio n (% ) Prevalence of children under 5 years of age who are wasted⁵ 2004 2007 2011 2014 0 25 50 Pr op or tio n (% ) Prevalence of children under 5 years of age who are stunted⁵ 2004 2007 2011 2014 0 50 100 Pr op or tio n (% ) 36.1 50.6 Children under 5 years who are stunted⁴ 2.2.1 2014 36.1 Children under 5 years who are wasted⁴ 2.2.2 2014 14.3 Children under 5 years who are overweight⁴ 2.2.3 2014 1.4 33.8 15.3 5.3 Child nutrition Other health-related SDGs Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 18 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 58.6 57.3 Ambient air pollution Number of deaths by disaster⁴ ( per 100 000 people) 13.1.2 2016 <0.1 0.3 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 2.9 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2011-16 < 0.1 4 0.1 Homicide and conflicts Birth registration coverage¹⁵ 16.9.1 2016 46.5 - Birth registration Note: A dash (-) implies relevant data are not available Completeness of cause-of-death data⁴ (%) 17.19.2 2016 - 10 Cause-of-death data Indicators SDGtarget Year Bangladesh Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 2.8 9.3 General government health expenditure 14.5 14.3 0.9 1.4 Proportion of population using improved drinking water sources⁴ 6.1 2015 56 Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation References 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 9 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 9 July 2018). 3. Global health expenditure database. Geneva: World Health Organization; June 2016 (http://apps.who.int/nha/database, accessed 9 July 2018). 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization; 2018. (http://www.who.int/gho/publications/world_health_statistics/2018/en/, accessed 9 July 2018). 5. Bangladesh demographic and health survey 2014. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International; 2014(https://dhsprogram.com/pubs/pdf/FR311/FR311.pdf, accessed 9 July 2018). 6. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization(http://apps.who.int/immunization_monitor- ing/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 9 July 2018). 7. Global tuberculosis report 2017.Geneva: World Health Organization; 2017(http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516, accessed 9 July 2018). 8. UNAIDS 2016 estimates for coverage of people receiving ART. (http://aidsinfo.unaids.org, accessed 9 July 2018). 9. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 9 July 2018). 10. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 9 July 2018). 11. CVD vs Tobacco factsheet http://www.searo.who.int/entity/ncd_tobacco_surveillance/documents/ban_wntd_18/en/ - accessed 20 June 2018. 12. World health statistics 2013. Geneva: World Health Organization, 2013. (http://apps.who.int/iris/bitstream/handle/10665/82058/WHO_HIS_HSI_13.1_eng.pdf, accessed 9 July 2018). 13. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 14. Saha, Tulshi. Bangladesh Service provision Assessment Survey 1999-2000. Calverton, Maryland: National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ORC Macro; 2002 (https://dhsprogram.com/pubs/pdf/SPA2/SPA2.pdf, accessed 9 July 2018). 15. Report on Bangladesh Sample Vital Statistics 2013-2014, 2017-2018. Dhaka: Bangladesh Bureau of Statistics (https://www.bbs.gov.bd). Note: The 2014 Bangladesh Demographic and Health Survey reported birth registration coverage as 20.2%. 16. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 17. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 18. 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): UNICEF, World Health Organization, World Bank, United Nation; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 19. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 30 30-08-2018 11:00:08 31BhutanMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update 80% 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. Bhutan Urban population² 40.8% Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Bhutan, from 2000 (60.2 years) to 2016 (70.6 years), the life expectancy at birth has improved by 10.4 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Bhutan, from 2000 (52.9 years) to 2016 (60.7 years), healthy life expectancy has improved by 7.8 years. Population (000s)¹ 817 Poverty³ 2.2% GDP per capita³ (Current US$) 3110.2 Current health expenditure as share of GDP³ 3.5% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 53 6160 71 Life expectancy at birth Healthy life expectancy Monitoring the health SDG goal: Indicators of overall progress (ppp < $1.90 a day) 5.7% 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). Universal health coverage: At the centre of the health goal HEALTH SERVICE COVERAGE A summary measure of essential health services coverage, a composite service coverage index, is used: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. FINANCIAL PROTECTION Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 0.3% or approximately 2 000 people are being pushed into poverty because of out-of-pocket health spending³. Catastrophic expenditure on health: 4.1% of people spent more than 10% of their household's total expenditure on health care³. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DTP3)⁶ 0 50 100 C ov er ag e (% ) 9985 78 74 Reproductive, maternal, newborn and child health Latest available data (2010-2017) HIV antiretroviral therapy coverage⁷ Tuberculosis treatment Coverage⁷ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ 0 50 100 C ov er ag e (% ) 100 36 80 63 Infectious diseases Prevalence of normal blood pressure in population¹⁰ Cervical cancer screening¹¹ Tobacco non-use¹² Prevalence of normal fasting glucose level¹⁰ 0 50 100 C ov er ag e (% ) 72 64 75 88 Noncommunicable diseases Density of hospital beds¹³, expressed as % of global threshold, 18/10 000 Heath worker density¹⁴, expressed as % of new global threshold, 44.5/10 000 Health security: IHR compliance¹⁰ Access to essential medicines 0 50 100 C ov er ag e (% ) 100 44 73 Service capacity, access and health security 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 0 50 100 C ov er ag e (% ) 72 UHC services coverage index Out-of-pocket expenditure, as % of the health expenditure (2015) Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. 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. 5.7%20% ( p < a day) 9.1% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 31 30-08-2018 11:00:09 32 Bhutan Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update No data Variation by income Equity : Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by geography SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Births attended by skilled health personnel⁵ 2000 2005 2010 2012 2016 0 50 100 C ov er ag e (% ) 24 49 65 75 58 Maternal mortality ratio¹⁷ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 423 148 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 33 18 80 32 Child mortality¹⁸ Children under-five Neonatal SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Variation by education 2000 2005 2010 2015 0 50 100 M or ta lit y ra te Under 5 mortality⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (Modern) prevalence rate⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 82.7 Birth Registration¹⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 81.0 Death Registration¹⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 50.0 Cause of death¹⁶ No data 2000 2005 2010 2015 0 Pe rc en ta ge Full Immunization⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ Strengthening Civil Registration and Vital Statistics (CRVS) Rural Urban 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation¹⁰ Quintile 1 (poorest) Quintile 5 (richest) No data No education Secondary school + Primary school Health in the SDGs.indd 32 30-08-2018 11:00:10 33BhutanMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Current data are insufficient to determine trend 0.0 0.2 0.4 HI V IR [1 00 0 un in fe ct ed p op .] Malaria incidence⁹ 2012 2013 2014 2015 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] 2.8 0.27 TB incidence⁷ 2011 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] 211 178 Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s Communicable diseases (SDG target 3.3) Indicators SDGtarget Year Bhutan Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 23.3 23.1 Noncommunicable diseases and injuries Tobacco use among persons (18-69 yrs) and older - Female 3.a.1 2014 13.6 Tobacco use among persons (18-69 yrs) and older - Male 3.a.1 2014 33.6 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 2.57 - - Essential medicines and vaccines International Health Regulations Core Capacity Index¹⁰ 3.d.1 2017 73 73 National and global health risks Note: A dash (-) implies relevant data are not available Health worker density¹⁴ (per 10 000 population) 3.c.1 2017 19.3 - Health workforce 0.6 0.0 Malaria incidence is calculated for confirmed malaria cases Indicators Year Bhutan Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 0.81 Number of people requiring interventions against neglected tropical diseases⁴ 2016 241,761 0.70 671,797,672 Suicide rate⁴ (per 100,000 population) 3.4.2 2016 11.4 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 0.6 Mortality rate from road traffic injuries⁴(per 100,000 population) 3.6.1 2016 15.1 13.2 4.5 17.0 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op .) Total NCD mortality¹⁰ Female Male 2010 2012 2016 0 50 100 150 Ad ol es ce nt b irt h ra te [w om en t a ge d 15 -1 9 yr s] 28 59 Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁹ Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods(%)⁵ 3.7.1 2016 84.6 Adolescent birth rate¹⁹ (per 1000 women aged 15 to19 years) 3.7.2 2014 28.4 75.1 33 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 124.5 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 4.0 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.6 164.0 15.4 1.8 Mortality due to environmental pollution Health in the SDGs.indd 33 30-08-2018 11:00:10 34 Bhutan Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years who are overweight⁵ 1999 2008 2010 0 8 15 Pr op or tio n (% ) Prevalence of children under 5 years of age who are wasted⁵ 2008 2010 0 50 100 Pr op or tio n (% ) Prevalence of children under 5 years of age who are stunted⁵ 2008 2010 0 50 100 Pr op or tio n 33.634.9Children under 5 years who are stunted⁴ 2.2.1 2010 33.6 Children under 5 years who are wasted⁴ 2.2.2 2010 5.9 Children under 5 years who are overweight⁴ 2.2.3 2010 7.6 33.0 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources⁴ 6.1 2015 34 Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 52 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 35.4 57.3 Ambient air pollution Number of deaths by disaster⁴ ( per 100 000 people) 13.1.2 2016 0.00 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 1.7 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2016 0 4.1 0.1 Homicide and conflicts Birth registration coverage¹⁵ 16.9.1 2015 100 - Birth registration Note: A dash (-) implies relevant data are not available Completeness of cause-of-death data¹⁶ (%) 17.19.2 2016 - 10 Cause-of-death data Indicators SDGtarget Year Bhutan Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 9.1 8.5 General government health expenditure 4.7 5.9 3.9 7.6 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 10 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 10 July 2018). 3. Global health expenditure database. Geneva: World Health Organization; June 2016 (http://apps.who.int/nha/database, accessed 10 July 2018). 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization；2018 （http://www.who.int/gho/mortality_burden_disease/life_tables/en/ , accessed 10 July 2018）. 5. Bhutan national health survey 2012. Thimphu: Ministry of Health, Royal Government of Bhutan; 2012 (http://www.health.gov.bt/publications/national-health-survey/, 10 July 2018). 6. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization (http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 11 July 2018). 7. Global tuberculosis report 2017.Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516, accessed 11 July 2018). 8. UNAIDS 2016 estimates for coverage of people receiving ART. UNAIDS (http://aidsinfo.unaids.org, accessed 11 July 2018). 9. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 21 July 2018). 10. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 21 July 2018). 11. National survey for noncommunicable disease risk factors and mental health using WHO STEPS approach in Bhutan, 2014. New Delhi: World Health Organization, Regional Office for South-East Asia; 2015 (http://www.who.int/ncds/surveillance/steps/Bhutan_2014_STEPS_Report.pdf, accessed 11 July 2018). 12. CVD vs Tobacco factsheet http://www.searo.who.int/entity/ncd_tobacco_surveillance/documents/bhu_wntd_18/en/ - accessed 20 June 2018 13. World health statistics 2013. Geneva: World Health Organization; 2013. 14. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 17. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 18. 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): UNICEF, World Health Organization, World Bank, United Nation; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 19. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 34 30-08-2018 11:00:11 35Democratic People’s Republic of KoreaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update UHC services coverage index of essential health services Public spending on health is determined by the capacity of the government to raise revenues and allocate it to health. Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: Insufficient data Catastrophic expenditure on health: Insufficient data A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁴ Pregnancy care⁴ Care seeking behaviour suspected pneumonia⁴ Child immunization coverage (DTP3)⁵ 0 50 100 C ov er ag e (% ) 100 71 80 96 Reproductive, maternal, newborn and child health 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. Life expectancy 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 2016 (71.9 years), the life expectancy at birth has improved by 6.5 years. Healthy life expectancy³ reflects overall health of the country's population. In Democratic People's Republic of Korea, from 2000 (58.7 years) to 2016 (64.6 years), healthy life expectancy has improved by 5.9 years. Democratic People's Republic of Korea 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). Population (000s)¹ 25 611 Monitoring the health SDG goal: Indicators of overall progress Urban population² 61.7% Poverty Relevant data is not available GDP per capita (Current US$) Relevant data is not available Total health expenditure as share of GDP Relevant data is not available 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 59 6565 72 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 78 UHC services coverage index Latest available data (2010-2017) HIV antiretroviral therapy coverage Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁶ Access to basic sanitation⁷ (%) Tuberculosis treatment Coverage⁸ 0 50 100 C ov er ag e (% ) 30 77 87 Infectious diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure in population⁷ Cervical cancer screening Tobacco non-use Prevalence of normal fasting glucose level⁷ 0 50 100 C ov er ag e (% ) 82 94 Noncommunicable diseases Current data are insufficient for analysis Current data are insufficient for analysis (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. Health security:IHR compliance⁷ Density of hospital beds⁹ , expressed as % of global threshold, 18/10 000 Heath worker density¹⁰, expressed as % of new global threshold, 44.5/10 000 Access to essential medicines 0 50 100 C ov er ag e (% ) 100 100 67 Service capacity and access (p . ) Health in the SDGs.indd 35 30-08-2018 11:00:12 36 Democratic People’s Republic of Korea Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹³ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 128 82 Births attended by skilled health personnel⁴ 2009 2010 2016 0 50 100 C ov er ag e (% ) 100 10097 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 27 11 60 20 Child mortality¹⁴ Children under-five Neonatal 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, location and other characteristics relevant in national contexts. Leaving no one behind Variation by geography SDGs emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs Strengthening Civil Registration and Vital Statistics (CRVS) Variation by sex Variation by education Urban Rural 2005 2010 Year 2005 2010 Year 0 50 100 Pe rc en ta ge 89.6 83.8 Postnatal care (with in 48 hrs)⁴ Urban Rural 2005 2010 Year 2005 2010 Year 0 50 100 Pe rc en ta ge 93.4 57.0 Under five children with symptoms of Pneumonia treated with antibiotics⁴ Male Female 2005 2010 Year 2005 2010 Year 0 10 20 30 Pe rc en ta ge 32.4 32.4 Stunting⁴ Male Female 2005 2010 Year 2005 2010 Year 0 50 100 Pe rc en ta ge 85.8 80.3 Under five children with symptoms of Pneumonia treated with antibiotics by sex⁴ secondary secondary+ 2005 2010 Year 2005 2010 Year 0 50 100 Pe rc en ta ge 100.0 80.5 100.0 96.5 Antenatal care coverage⁴ Secondary school Secondary school + 2005 2010 Year 2005 2010 Year 0 50 100 Pe rc en ta ge 88.2 92.7 Breast feeding⁴ 2000 2005 2010 2015 Year 0 50 100 Pe rc en ta ge 100.0 Birth registration¹¹ 2000 2005 2010 2015 Year 0 50 100 Pe rc en ta ge 80.0 Death registration¹² 2000 2005 2010 2015 Year 0 50 100 80.0 Cause of Death¹² Health in the SDGs.indd 36 30-08-2018 11:00:12 37Democratic People’s Republic of KoreaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Current data are insufficient to determine trend Malaria incidence⁶ 2012 2013 2014 2015 2016 0 5 10 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption³ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s 3.3 3.9 New HIV infections among adults 15 to 49 years Indicators Year DPRK Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years³ (%) 2015 0.53 Number of people requiring interventions against neglected tropical diseases³ 2016 5,214,937 0.70 671,797,672 Communicable diseases (SDG target 3.3) TB incidence⁸ 2012 2013 2014 2015 2016 0 200 400 600 TB in ci de nc e [1 00 0 00 p op .] 513 Indicators SDGtarget Year DPRK Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases³ (%) 3.4.1 2016 25.6 23.1 Noncommunicable diseases and injuries Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods³ (%) 3.7.1 2007-17 - Adolescent birth rate¹⁵ (per 1000 women aged 15 to 19 years) 3.7.2 2008 0.7 75.1 33.0 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution³ (per 100 000 population) 3.9.1 2016 - Mortality rate attributed to exposure to unsafe WASH services³ (per 100 000 population) 3.9.2 2016 1.4 Mortality rate attributed to unintentional poisoning³ (per 100 000 population) 3.9.3 2016 1.9 164 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons and older - Female 3.a.1 - - Tobacco use among persons and older - Male 3.a.1 - - - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita³ 3.b.2 2016 0.9 - - Essential medicines and vaccines Health worker density¹⁰ (per 10 000 population) 3.c.1 2017 81.4 - Health workforce Malaria incidence is calculated for confirmed malaria cases International Health Regulations Core Capacity Index⁹ 3.d.1 2017 67 73 National and global health risks Current data are insufficient to determine trend Note: A dash (-) implies relevant data are not available 0.93 0.5 2000 2005 2010 2015 0 250 500 750 1000 1250 1500 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op ) Total NCD Mortality rate⁹ Female Male Suicide mortality rate³ (per 100 000 population) 3.4.2 2016 - Total alcohol per capita (age 15+ years) consumption³ 3.5.2 2016 3.9 Mortality rate from road traffic injuries³ (per 100 000 population) 3.6.1 2016 20.8 13.2 4.5 17.0 Adolescent birth rate (per 1000 women aged 15 10 19 years) Health in the SDGs.indd 37 30-08-2018 11:00:13 38 Democratic People’s Republic of Korea Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years who are overweight⁴ 2004 2014 0 7.5 15 Pr op or tio n (% ) 0 Prevalence of wasting in children under 5 years of age⁴ 2004 2014 0 25 50 Pr op or tio n (% ) 4.0 8.5 Prevalence of stunting in children under 5 years of age⁴ 2004 2014 0 50 100 Pr op or tio n (% ) 27.9 43.1 Other health-related SDGs Proportion of population using improved drinking water sources³ 6.1 2015 - Proportion of population using improved sanitation³ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel³ 7.1 2016 11 41 Clean household energy Air pollution level in cities³ (PM 2.5) (µg/m³) 11.6.2 2016 31.0 57.3 Ambient air pollution Number of deaths by disaster³ (per 100 000 people) 13.1.2 2016 0.30 0.2 Natural disasters Mortality rate due to homicide³ (per 100 000 population) 16.1.1 2016 4.4 Estimated direct deaths from major conflicts³ (per 100 000 population) 16.1.2 2011-2015 <0.1 4.1 0.1 Homicide and conflicts Birth registration coverage¹¹ 16.9.1 2009 100 - Birth registration Note: A dash (-) implies relevant data are not available Indicators SDGtarget Year DPRK Regional estimate General government health expenditure as % of general government expenditure³ 1.a 2015 - 8.5 General government health expenditure Completeness of cause-of-death data¹²(%) 17.19.2 2016 - 10 Cause-of-death data Children under 5 years who are stunted⁴ 2.2.1 2014 27.9 Children under 5 years who are wasted⁴ 2.2.2 2014 4.0 Children under 5 years who are overweight⁴ 2.2.3 2014 0.0 33.0 15.2 3.4 Child nutrition References 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 9 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 9 July 2018). 3. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization; 2018. (http://www.who.int/gho/publications/world_health_statistics/2018/en/, accessed 9 July 2018). 4. Democratic People’s Republic of Korea – socio-economic, demographic and health survey 2014. Pyongyang: Central Bureau of Statistics, United Nations Population Fund; 2015 (http://kp.one.un.org/content/dam/unct/dprk/docs/2014%20SDHS%20Report_E_final.pdf, accessed 11 July 2018). 5. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization(http://apps.who.int/immunization_monitor- ing/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 9 July 2018). 6. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 9 July 2018). 7. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 9 July 2018). 8. Global tuberculosis report 2017. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516-eng.pdf?sequence=1, accessed 11 July 2018). 9. World health statistics 2013. Geneva: World Health Organization; 2013. (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf, accessed 11 July 2018). 10. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 11. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 12. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 13. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 14. 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): UNICEF, World Health Organization, World Bank, United Nation; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 15. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 38 30-08-2018 11:00:13 39IndiaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 4.2% or approximately 52.5 million people are being pushed into poverty because of out-of-pocket health spending³ Catastrophic expenditure on health: 17.3% of people spent more than 10% of their household's total expenditure on health care³ Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DPT3)⁶ 0 50 100 C ov er ag e (% ) 64 51 78 87 Reproductive, maternal, newborn and child health 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. UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In India, from 2000 (62.5 years) to 2016 (68.8 years), the life expectancy at birth has improved by 6.3 years. Healthy life expectancy⁴ reflects overall health of the country's population. In India, from 2000 (54.2 years) to 2016 (59.3 years), healthy life expectancy has improved by 5.1 years. India 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). Population (000s)¹ 1 354 052 Monitoring the health SDG goal: Indicators of overall progress Urban population² 33.6% Poverty³ 21.2% GDP per capita³ (Current US$) 1939.6 Current health expenditure as share of GDP³ 4.0% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 54 5963 69 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 64 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2015) HIV antiretroviral therapy coverage⁷ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ (%) Tuberculosis treatment Coverage¹⁰ 0 50 100 C ov er ag e (% ) 49 37 44 63 Infectious diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure level in population⁹ Prevalence of normal fasting glucose level⁹ Tobacco non-use¹¹ Cervical cancer screening 0 50 100 C ov er ag e (% ) 74 91 71 Noncommunicable diseases Health security: IHR compliance⁹ Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹², expressed as % of new global threshold, 44.5/10 000 Access to essential medicines 0 50 100 C ov er ag e (% ) 95 50 64 Service capacity, access and health security (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 5.05% 65.0% 5.05% (pp ) 3.4% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 39 30-08-2018 11:00:14 40 India Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Variation by wealth SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁴ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 374 174 Births attended by skilled health personnel⁵ Null 2013 0 50 100 C ov er ag e (% ) 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 45 25 91 43 Child mortality¹⁵ Children under-five Neonatal Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence Strengthening Civil Registration and Vital Statistics (CRVS) Variation by education 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁹ Rural Urban 2000 2005 2010 2015 0 50 100 M or ta lit y ra te Under five mortality⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive(modern) prelavence rate⁵ 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting among under 5⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Full Immunization⁵ Quintile 5 (richest) Quintile 1 (poorest) 2005 2010 2015 0 50 100 Pe rc en ta ge 88.384.482.0 69.0 Birth Registration¹³ 2005 2010 2015 0 50 100 Pe rc en ta ge 76.6 70.966.963.4 Death Registration¹³ 2005 2010 2015 0 50 100 Pe rc en ta ge 16.914.313.510.5 Cause of Death¹³ SDGs emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. No education Primary school Secondary school+ Health in the SDGs.indd 40 30-08-2018 11:00:15 41IndiaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Adolescent birth rate (per 1000 women aged 15 to 19 years) 2012 2014 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2011 2012 2013 2014 2015 2016 0 3 6 9 Li tre s 3 5.7 New HIV infections among adults 15 to 49 years⁷ 2011 2013 2015 0.0 0.2 0.4 H IV IR [1 00 0 un in fe ct ed p op .] Indicators Year India Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years ⁴(%) 2015 0.51 Number of people requiring interventions against neglected tropical diseases⁴⋅ 2016 458,855,231 0.70 671,797,672 Communicable diseases (SDG target 3.3) TB incidence⁷ 2011 2013 2015 0 100 200 300 400 500 TB IR [1 00 0 00 p op .] 211 247 Indicators SDGtarget Year India Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 23.3 23.1 Noncommunicable diseases and injuries Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) 3.7.1 2016 72.0 Adolescent birth rate⁴ (per 1000 women aged 15 to 19 years) 3.7.2 2016 28.1 75.1 33.0 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 184.3 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 18.6 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 2.4 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (15+ yrs) and older - Female¹¹ 3.a.1 2016-17 14.2 Tobacco use among persons (15+ yrs) and older - Male¹¹ 3.a.1 2016-17 42.4 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 0.28 - Essential medicines and vaccines Health worker density¹² (per 10 000 population) 3.c.1 2016 27.5 - Health workforce Malaria incidence is calculated for confirmed malaria cases International Health Regulations Core Capacity Index⁹ 3.d.1 2017 95 73 National and global health risks Note: A dash (-) implies relevant data are not available 1.2 0.9 0.10.1 Suicide mortality rate⁴ (per 100 000 population) 3.4.2 2016 16.3 Total alcohol per capita⁴ (age 15+ years) consumption 3.5.2 2016 5.7 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2016 16.6 13.2 4.5 17 Total NCD mortality⁹ 2000 2005 2010 2015 Year 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op ) Female Male Current data are insufficient to determine trend Malaria Incidence⁸ Health in the SDGs.indd 41 30-08-2018 11:00:15 42 India Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years who are overweight⁵ 1998-99 2005-06 0 8 15 Pr op or tio n (% ) Prevalence of stunting in children under 5 years of age⁵ 2005-06 2013 2015-2016 0 50 100 Pr op or tio n (% ) Children under 5 years who are stunted⁵ 2.2.1 2015-16 38.4 Children under 5 years who are wasted⁵ 2.2.2 2015-16 21.0 Children under 5 years who are overweight⁵ 2.2.3 2015-16 2.1 33.0 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources⁴ 6.1 2015 - Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2015 41 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2015 68 57.3 Ambient air pollution Number of deaths by disaster⁴ per 100 000 people) 13.1.2 2015 0.2 0.3 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2015 4.1 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2015 <0.1 4 0.1 Homicide and conflicts Birth registration coverage¹³ 16.9.1 2015 88.3 - Birth registration Prevalence of wasting in children under 5 years of age⁵ 2005-06 2013 2015-2016 0 25 50 Pr op or tio n (% ) 47.9 38.4 20 21 Note: A dash (-) implies relevant data are not available Completeness of cause-of-death data¹³ (%) 17.19.2 2015 17 10 Cause-of-death data Indicators SDGtarget Year India Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 3.4 8.5 General government health expenditure 4 2.1 References 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 9 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 9 July 2018). 3. Global health expenditure database. Geneva: World Health Organization; June 2016 (http://apps.who.int/nha/database, accessed 9 July 2018). 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization; 2018. (http://www.who.int/gho/publications/world_health_statistics/2018/en/, accessed 9 July 2018). 5. National Family Health Survey (NFHS-4) 2015-16. Mumbai: International Institute for Population Sciences; 2017 (http://www.rchiips.org/nfhs, accessed 11 July 2018). 6. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization(http://apps.who.int/immunization_monitoring/glob- alsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 9 July 2018). 7. UNAIDS 2016 estimates for coverage of people receiving ART. UNAIDS (http://aidsinfo.unaids.org, accessed 9 July 2018). 8. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 9 July 2018). 9. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 9 July 2018). 10. Factsheet 2018: India. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://apps.who.int/iris/bitstream/handle/10665/272672/wntd_2018_india_fs.pdf?sequence=1, accessed 11 July 2018). 11. World health statistics 2013. Geneva: World Health Organization; 2013 (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf, accessed 11 July 2018). 12. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 13. Office of the Registrar General & Census Commissioner, India, Ministry of Home Affairs, Government of India (RGI) (http://censusindia.gov.in/ - accessed 9 July 2018). 14. 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): UNICEF, World Health Organization, World Bank, United Nation; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 15. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 42 30-08-2018 11:00:16 43IndonesiaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update 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 spending³. Catastrophic expenditure on health: 3.6% of people spent more than 10% of their household's total expenditure on health care³. Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DPT3)⁶ 0 50 100 C ov er ag e (% ) 79 85 69 81 Reproductive, maternal, newborn and child health 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 UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Indonesia, from 2000 (66.3 years) to 2016 (69.3 years), the life expectancy at birth has improved by 3 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Indonesia, from 2000 (59.4 years) to 2016 (61.7 years), healthy life expectancy has improved by 2.3 years. Indonesia 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). Population (000s)¹ 266 795 Monitoring the health SDG goal: Indicators of overall progress Urban population² 54.7% Poverty³ 6.5% GDP per capita³ (Current US$) 3846.9 Current Health expenditure³ as share of GDP 3.3% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 59 62 66 69 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 61 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2014) HIV antiretroviral therapy coverage⁷ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ Tuberculosis treatment Coverage¹⁰ 0 50 100 C ov er ag e (% ) 100 13 68 36 Infectious diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure level in population⁹ Prevalence of normal fasting glucose level⁹ Tobacco non-use¹¹ Cervical cancer screening 0 50 100 C ov er ag e (% ) 76 92 64 Noncommunicable diseases Health security: IHR compliance⁹ Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹³, expressed as % of new global threshold, 44.5/10 000 Access to essential medicines 0 50 100 C ov er ag e (% ) 99 33 55 Service capacity, access and health security (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 48% 5.7% 5... (pp ) 6.6% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 43 30-08-2018 11:00:17 44 Indonesia Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Variation by wealth SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁶ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 265 126 Births attended by skilled health personnel⁵ 2002-2003 2007 2012 0 50 100 C ov er ag e (% ) 88.6 41.5 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 22.3 13.7 52.3 26.0 Child mortality¹⁷ Children under-five Neonatal Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence Strengthening Civil Registration and Vital Statistics (CRVS) 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁹ Rural Urban 2000 2005 2010 2015 0 50 100 M or ta lit y ra te Under five mortality⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (Modern) prevalence rate⁵ Quintile 5 (richest) Quintile 1 (poorest) 2000 2005 2010 2015 0 Pe rc en ta ge Stunting⁵ Variation by education No data 2000 2005 2010 0 50 100 Pe rc en ta ge Full immunization⁵ No education Secondary+ Primary 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 71 .3 68 .5 66 .6 53 .4 Birth registration¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 6 5. 0 Death registration¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 60 .0 Cause of Death¹⁵ SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Health in the SDGs.indd 44 30-08-2018 11:00:17 45IndonesiaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁸ 1997 2003 2012 2014 0 50 100 150 Ad ol es ce nt b irt h ra te [w om en a ge d 15 -1 9 ye ar s] Malaria incidence⁸ 2012 2013 2014 2015 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2005 2008 2010 2015 2016 0 3 6 9 Li tre s 0.1 0.8 New HIV infections among adults 15 to 49 years⁷ 2012 2013 2014 2015 2016 0.0 0.2 0.4 H IV IR [1 00 0 un in fe ct ed p op .] Indicators Year Indonesia Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 1.07 Number of people requiring interventions against neglected tropical diseases⁴ 2016 101,813,236 0.70 671,797,672 Communicable diseases (SDG target 3.3) TB incidence⁷ 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] 391407 Indicators SDGtarget Year Indonesia Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 26.4 23.1 Noncommunicable diseases and injuries Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵(%) 3.7.1 2007-17 77.9 Adolescent birth rate¹⁸ (per 1000 women aged 15 to 19 years) 3.7.2 2014 40.1 75.1 33.0 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 112.4 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 7.1 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.4 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (15+ yrs) and older - Female 3.a.1 2011 4.5 Tobacco use among persons (15+ yrs) and older - Male 3.a.1 2011 67.5 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 0.51 - - Essential medicines and vaccines Health worker density¹³ (per 10 000 population) 3.c.1 2017 24.4 - Health workforce Malaria incidence is calculated for confirmed malaria cases International Health Regulations Core Capacity Index⁹ 3.d.1 2017 99 73 National and global health risks Note: A dash (-) implies relevant data are not available 0.5 0.32 2.4 0.8 Suicide mortality rate⁴ (per 100 000 population) 3.4.2 2016 3.4 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 0.8 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2013 15.3 13.2 4.5 17 Total NCD mortality⁹ 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op ) Female Male 62 40.1 Health in the SDGs.indd 45 30-08-2018 11:00:18 46 Indonesia Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years of age who are wasted⁵ 2007 2010 2012 0 25 50 Pr op or tio n (% ) Prevalence of children under 5 years of age who are stunted⁵ 2007 2010 2012 0 50 100 Pr op or tio n (% ) 36.4 40.1 Children under 5 years who are stunted⁵ 2.2.1 2012 36.4 Children under 5 years who are wasted⁵ 2.2.2 2012 13.5 Children under 5 years who are overweight⁵ 2.2.3 2012 11.5 33.0 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources⁴ 6.1 2015 - Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 58 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 16.4 57.3 Ambient air pollution Number of deaths by disaster⁴ (per 100 000 people) 13.1.2 2012-16 <0.1 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 4.5 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2012-16 <0.1 Birth registration coverage¹⁴ 16.9.1 2016 72.5 4.1 0.1 - Homicide and conflicts 14.8 13.5 Note: A dash (-) implies relevant data are not available Indicators SDGtarget Year Indonesia Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 7.4 8.5 General government health expenditure Prevalence of children under 5 years who are overweight⁵ 2007 2010 2012 0 8 15 Pr op or tio n (% ) Completeness of cause-of-death data¹⁵ (%) 17.19.2 2007-16 - 10 Cause-of-death data 11 12 References 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 9 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 9 July 2018). 3. Global health expenditure database. Geneva: World Health Organization; June 2016 (http://apps.who.int/nha/database, accessed 11 July 2018). 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization; 2018. (http://www.who.int/gho/publications/world_health_statistics/2018/en/, accessed 9 July 2018). 5. Indonesia demographic and health survey 2012. Jakarta, Indonesia: BPS, BKKBN, Kemenkes, and ICF International; 2013 (https://dhsprogram.com/pubs/pdf/fr275/fr275.pdf, accessed 11 July 2018). 6. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization (http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 9 July 2018). 7. UNAIDS 2016 estimates for coverage of people receiving ART. UNAIDS (http://aidsinfo.unaids.org, accessed 11 July 2018). 8. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 9 July 2018). 9. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 9 July 2018). 10. World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516, accessed 11 July 2018). 11. Factsheet 2018: Indonesia. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://apps.who.int/iris/bitstream/handle/10665/272673/wntd_2018_indonesia_fs.pdf?sequence=1, accessed 11 July 2018). 12. World health statistics 2013. Geneva: World Health Organization; 2013 (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf, accessed 11 July 2018). 13. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 14. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 17. 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): UNICEF, World Health Organization, World Bank, United Nation; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 18. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 46 30-08-2018 11:00:19 47MaldivesMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 1.5% or approximately 5 000 people are being pushed into poverty because of out-of-pocket health spending³. Catastrophic expenditure on health: 19.9% of people spent more than 10% of their household's total expenditure on health care³. Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DPT3)⁷ 0 50 100 C ov er ag e (% ) 43 90 75 99 Reproductive, maternal, newborn and child health 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. UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Maldives, from 2000 (69.6 years) to 2016 (78.4 years), the life expectancy at birth has improved by 8.8 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Maldives, from 2000 (61.7 years) to 2016 (69.8 years), healthy life expectancy has improved by 8.1 years. Maldives 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). Population (000s)¹ 444 Monitoring the health SDG goal: Indicators of overall progress Urban population² 30.3% Poverty³ 7.3% GDP per capita³ (Current US$) 10536.8 Current health expenditure as share of GDP³ 11.5% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 62 7070 78 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 72 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2014) HIV antiretroviral therapy coverage⁶ Access to basic sanitation⁸ Tuberculosis treatment Coverage⁹ Insecticide treated bednets/indoor residual spray coverage for malaria prevention 0 50 100 C ov er ag e (% ) 19 96 80 Infectious diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure in population⁸ Prevalence of normal fasting glucose level⁸ Tobacco non-use¹⁰ Cervical cancer screening 0 50 100 C ov er ag e (% ) 76 89 80 Noncommunicable diseases Health security:IHR compliance⁸ Density of hospital beds¹¹, expressed as % of global threshold, 18/10 000 Heath worker density¹², expressed as % of new global threshold, 44.5/10 000 Access to essential medicines 0 50 100 C ov er ag e (% ) 100 100 60 Service capacity, access and health security (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 16% (ppp ) 22.8% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 47 30-08-2018 11:00:20 48 Maldives Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁴ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 163 68 Births attended by skilled health personnel⁵ 2009 2014 0 50 100 150 C ov er ag e (% ) 94.8 95.6 2000 2005 2010 2015 2016 0 10 20 30 40 50 M R [1 00 0 liv e bi rth s] 25.7 4.8 44.4 8.5 Child mortality¹⁵ Children under-five Neonatal Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence Variation by income Strengthening Civil Registration and Vital Statistics (CRVS) Variation by education 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁸ Rural Urban 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Under five mortality⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antinatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (modern) prevalence rate⁵ Quintile 5 (richest) Quintile 1 (poorest) 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ No education Secondary school+ Primary school 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Full Immunization⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 99.0 92.5 73.0 Birth registration⁵ʹ¹³ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 90.1 Death Registration¹³ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 100.0 Cause of Death¹³ SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Health in the SDGs.indd 48 30-08-2018 11:00:21 49MaldivesMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁶ 2011 2014 2017 0 50 100 150 Ad ol es ce nt b irt h ra te [w om en a ge d 15 -1 9 ye ar s] 15.7 13.3 14.0 Malaria incidence 2011 2012 2013 2014 2015 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2010 2015 2016 0 3 6 9 Li tre s 1.2 2.7 New HIV infections among adults 15 to 49 years Indicators Year Maldives Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 0.19 Number of people requiring interventions against neglected tropical diseases⁴ 2016 1,937 0.7 671,797,672 Communicable diseases (SDG target 3.3) TB incidence⁹ 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 ,0 00 p op .] 4940 Indicators SDGtarget Year Maldives Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 13.4 23.1 Noncommunicable diseases and injuries Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) 3.7.1 2009 42.7 Adolescent birth rate¹⁶ (per 1000 women aged 15 to 19 years) 3.7.2 2014 12.9 74.1 33.9 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 25.6 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 0.3 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.0 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (15-64 yrs) and older - Female 3.a.1 2011 4.4 Tobacco use among persons (15-64 yrs) and older - Male 3.a.1 2011 36.0 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 1.29 - - Essential medicines and vaccines Health worker density¹² (per 10 000 population) 3.c.1 2015 118.3 - Health workforce Malaria incidence is calculated for confirmed malaria cases.Only small number of imported cases have been reported Current data are insufficient to determine trend International Health Regulations Core Capacity Index⁸ 3.d.1 2017 63 73 National and global health risks Note: A dash (-) implies that relevant data are not available Suicide mortality rate⁴ (per 100 000 population) 3.4.2 2016 2.3 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 2.7 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2013 3.5 13.2 4 17 Total NCD mortality⁸ 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op ) Female Male Malaria free since 1984 Health in the SDGs.indd 49 30-08-2018 11:00:21 50 Maldives Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years who are overweight⁵ 1997-98 2009 0 7.5 15 Pr op or tio n (% ) Prevalence of children under 5 years of age who are wasted⁵ 1997-98 2009 0 25 50 Pr op or tio n (% ) 22 Prevalence of children under 5 years of age who are stunted⁵ 1997-98 2001 2009 0 50 100 Pr op or tio n (% ) Children under 5 years who are stunted⁵ 2.2.1 2009 20.3 Children under 5 years who are wasted⁵ 2.2.2 2009 10.2 Children under 5 years who are overweight⁵ 2.2.3 2009 6.5 20.3 15.3 4.7 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources⁴ 6.1 2015 - Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 94 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 7.7 57.3 Ambient air pollution Number of deaths by disaster⁴ (per 100 000 people) 13.1.2 2011-2015 0 0.3 Natural disasters Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2012-16 0.9 Mortality rate due to homicide (per 100 000 population)⁴ 16.1.1 2016 3.4 0.1 4 Homicide and conflicts Birth registration coverage¹³ 16.9.1 2014 99 - Birth Registration Note: A dash (-) implies that relevant data are not available Indicators SDGtarget Year Maldives Regional estimate General government health expenditure as % of general government expenditure³ 1.a 2015 22.8 9.3 General government health expenditure Completeness of cause-of-death data¹³ (%) 17.19.2 2014 100 11 Cause-of-death data 6. 9 6. 5 10.2 20.3 46.7 References 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 9 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 9 July 2018). 3. Global health expenditure database. Geneva: World Health Organization; June 2016 (http://apps.who.int/nha/database, accessed 11 July 2018). 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization; 2018. (http://www.who.int/gho/publications/world_health_statistics/2018/en/, accessed 9 July 2018). 5. Maldives demographic and health survey 2009. Calverton, Maryland: MOHF and ICF Macro; 2010 (https://dhsprogram.com/publications/publication-fr237-dhs-final-reports.cfm, accessed 11 July 2018). 6. WHO vaccine-preventable diseases: monitoring system. 2018 global summary. Geneva: World Health Organization (http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK, accessed 9 July 2018). 7. UNAIDS 2016 estimates for coverage of people receiving ART. UNAIDS (http://aidsinfo.unaids.org, accessed 11 July 2018). 8. Global health observatory. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 9 July 2018). 9. Global tuberculosis report 2017.Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516, accessed 11 July 2018). 10. Factsheet 2018: Maldives. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://apps.who.int/iris/bitstream/handle/10665/272674/wntd_2018_maldives_fs.pdf?sequence=1, accessed 11 July 2018). 11. World health statistics 2013. Geneva: World Health Organization; 2013 (http://www.who.int/gho/publications/world_health_statistics/EN_WHS2013_Full.pdf, accessed 11 July 2018). 12. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 13. Demographic Health Survey 2009 and Regional action framework on civil registration and vital statistics in Asia and the Pacific. Bangkok: UNESCAP (https://www.unescap.org/resources/regional-action-framework-civil-registration-and-vital-statistics-asia-and-pacific, accessed 9 July 2018). 14. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 15. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 16. 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): UNICEF, World Health Organization, World Bank, United Nation; 2015 (http://www.childinfo.org/, accessed 9 July 2018). 17. Global malaria report 2017. Geneva: World Health Organization; 2017 (http://www.who.int/malaria/publications/world-malaria-report-2017/en/, accessed 9 July 2018). 18. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 50 30-08-2018 11:00:22 51MyanmarMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: Insufficient data Catastrophic expenditure on health: Insufficient data A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DPT3)⁶ 0 50 100 C ov er ag e (% ) 75 59 58 75 Reproductive, maternal,newborn and child health 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 UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Myanmar, from 2000 (62.1 years) to 2016 (66.6 years), the life expectancy at birth has improved by 4.5 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Myanmar, from 2000 (54.7 years) to 2016 (58.4 years), healthy life expectancy has improved by 3.8 years. Myanmar 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). Population (000s)¹ 53 856 Monitoring the health SDG goal: Indicators of overall progress Urban population² 30.3% Poverty Relevant data is not available GDP per capita³ (Current US$) 1298.9 Current health expenditure as share of GDP³ 4.9% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 55 58 62 67 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 50 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2015) HIV antiretroviral therapy coverage⁷ Insecticide-treated bednets or Indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ (%) Tuberculosis treatment Coverage¹⁰ 0 50 100 C ov er ag e (% ) 55 53 65 72 Infectious diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure level in population⁹ Prevalence of normal fasting glucose level⁹ Cervical cancer screening¹⁰ Tobacco non-use¹¹ 0 50 100 C ov er ag e (% ) 75 93 46 4 Noncommunicable diseases Health security:IHR compliance⁹ Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹³, expressed as % of new global threshold, 44.5/10 000 Access to essential medicines¹⁴ 0 50 100 C ov er ag e (% ) 62 33 40 43 Service capacity, access and healthy security (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 74% (ppp ) 4.9% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 51 30-08-2018 11:00:23 52 Myanmar Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Variation by wealth SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁶ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 308 178 Births attended by skilled health personnel⁵ 2010 2015-2016 0 50 100 C ov er ag e (% ) 71 60 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 37 25 82 51 Child mortality¹⁷ Children under-five Neonatal Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence Variation by education 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁹ Rural Urban 2000 2005 2010 2015 0 50 100 M or ta lit y ra te Under five mortality rate⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (Modern)⁵prevalence rate Quintile1 (Poorest) Quintile5 (Richest) 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Full immunization⁵ No education Secondary school + Primary school 2000 2005 2010 2015 0.0 50.0 100.0 Pe rc en ta ge 82.9 72.4 Birth registration⁵ 2000 2005 2010 2015 0 50 100 50.0 Death registration¹⁵ 2000 2005 2010 2015 0 Pe rc en ta ge Cause of Death No data SDGs emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Health in the SDGs.indd 52 30-08-2018 11:00:24 53MyanmarMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁸ 2007 2016 0 50 100 150 Ad ol es ce nt b irt h ra te [w om en a ge d 15 -1 9 ye ar s] 36 17 Malaria incidence⁸ 2011 2012 2013 2015 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s 0.3 4.8 New HIV infections among adults 15 to 49 years⁷ 2012 2013 2014 2015 2016 0.0 0.2 0.4 H IV IR [ 10 0 un in fe ct ed p op .] Indicators Year Myanmar Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 2.03 Number of people requiring interventions against neglected tropical diseases⁴ 2016 39,343,021 0.7 671,797,672 Communicable diseases (SDG target 3.3) TB incidence¹⁰ 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] 361376 Indicators SDGtarget Year Myanmar Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 24.2 23.1 Noncommunicable diseases and injuries Health worker density¹³ (per 10 000 population) 3.c.1 2017 17.9 - Health workforce Malaria incidence is calculated for confirmed malaria cases International Health Regulations Core Capacity Index⁴ 3.d.1 2017 62 73 National and global health risks Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵(%) 3.7.1 2015-2016 75 Adolescent birth rate¹⁸ (per 1000 women aged 15 to 19 years) 3.7.2 2014 36 75.1 33.0 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 156.4 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 12.6 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 1.4 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (25-64 yrs) and older - Female¹¹ 3.a.1 2014 29.1 Tobacco use among persons (25-64 yrs) and older - Male¹¹ 3.a.1 2014 79.8 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis¹⁴ 3.b.1 2015 43 Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 2.78 - - Essential medicines and vaccines Note: A dash (-) implies relevant data are not available 0.5 0.22 11.7 3.5 Suicide mortality rate⁴ (per 100 000 population) 3.4.2 2016 7.8 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 4.8 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2013 20.3 13.2 4.5 17 Total NCD mortality⁹ 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op .) Female Male Health in the SDGs.indd 53 30-08-2018 11:00:25 54 Myanmar Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years of age who are wasted⁵ 2003 2009-10 2015-2016 0 25 50 Pr op or tio n (% ) Prevalence of children under 5 years of age who are stunted⁵ 2003 2009-10 2015-2016 0 50 100 Pr op or tio n (% ) 29.2 40.6 Other health-related SDGs References 1. World population prospects: the 2017 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2017 (http://esa.un.org/wpp/, accessed 9 July 2018). 2. World urbanization prospects: the 2018 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division; 2018 (https://esa.un.org/unpd/wup/DataQuery/, accessed 9 July 2018). 3. Global health expenditure database. Geneva: World Health Organization; June 2016 (http://apps.who.int/nha/database, accessed 11 July 2018). 4. World health statistics 2018: monitoring health for the SDGs. Geneva: World Health Organization; 2018. (http://www.who.int/gho/publications/world_health_statistics/2018/en/, accessed 9 July 2018). 5. Myanmar demographic and health survey 2015-16. Nay Pyi Taw, Myanmar, and Rockville, Maryland USA: Ministry of Health and Sports and ICF; 2017 ( https://dhsprogram.com/pubs/pdf/FR324/FR324.pdf, accessed 13 July 2018). 6. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK -accessed 20 June 2018.See for DTP3 coverage: a proxy for immunization coverage. 7. UNAIDS 2016 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 20 June 2018. 8. World Health Organization. Global Malaria Report 2017. http://www.who.int/malaria/publications/world-malaria-report-2017/en/ - accessed 20 June 2018. 9. Global Health Observatory: http://www.who.int/gho/en/ - accessed 20 June 2018. 10. Fact Sheet: STEPS Survey Myanmar 2014. World Health Organization, 2016. 11. Factsheet 2018: Myanmar. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://apps.who.int/iris/bitstream/handle/10665/272686/wntd_2018_myanmar_fs.pdf?sequence=2, accessed 13 July 2018) 12. World Health Organization. World Health Statistics 2013. Geneva, 2013. 13. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 14. Nation-wide service availability and readiness assessment (SARA). Myanmar: Ministry of Health, Myanmar and World Health Organization; 2015 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 17. 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 20 June 2018 18. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Proportion of population using improved drinking water sources⁴ 6.1 2015 - Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 18 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 34.6 57.3 Ambient air pollution Number of deaths by disaster⁴ .. 13.1.2 2012-16 <0.1 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 4.1 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2012-16 1.9 4.1 0.1 Homicide and conflicts Birth registration coverage⁵ 16.9.1 2015-16 81 - Birth registration 10.7 7.0 Note: A dash (-) implies relevant data are not available Indicators SDGtarget Year Myanmar Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2016 4.9 8.5 General government health expenditure Completeness of cause-of-death data⁴ (%) 17.19.2 2005-2015 - 10 Cause-of-death data Prevalence of children under 5 years who are overweight⁵ 2003 2009-10 2015-16 0 7.5 15 Pr op or tio n (% ) 2.4 1.3 Children under 5 years who are stunted⁵ 2.2.1 2015-2016 29.2 Children under 5 years who are wasted⁵ 2.2.2 2015-2016 7.0 Children under 5 years who are overweight⁵ 2.2.3 2015-2016 1.3 33.0 15.2 3.4 Child nutrition Health in the SDGs.indd 54 30-08-2018 11:00:25 55NepalMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 1.7% or approximately 473 000 people are being pushed into poverty because of out-of-pocket health spending³ Catastrophic expenditure on health: 10.7% of people spent more than 10% of their household's total expenditure on health care³ Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DPT3)⁶ 0 50 100 C ov er ag e (% ) 56 69 85 91 Reproductive, maternal, newborn and child health 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. UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides indication of overall mortality of a country's population. In Nepal, from 2000 (62.5 years) to 2016 (70.2 years), the life expectancy at birth has improved by 7.7 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Nepal, from 2000 (55.1 years) to 2016 (61.3 years), healthy life expectancy has improved by 6.2 years. Nepal 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). Population (000s)¹ 29 624 Monitoring the health SDG goal: Indicators of overall progress Urban population² 19.3% Poverty³ 15% GDP per capita³ (Current US$) 835.1 Current health expenditure as share of GDP³ 6.1% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 55 6163 70 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 62 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2015) HIV antiretroviral therapy coverage⁷ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ (%) Tuberculosis treatment Coverage¹⁰ 0 50 100 C ov er ag e (% ) 40 43 46 70 Infectious diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure level in population⁹ Prevalence of normal fasting glucose level⁹ Tobacco non-use¹¹ Cervical cancer screening 0 50 100 C ov er ag e (% ) 71 89 69 Noncommunicable diseases Health security: IHR compliance⁹ Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹³, expressed as % of new global threshold, 44.5/10 000 Access to essential medicines 0 50 100 C ov er ag e (% ) 100 22 75 Service capacity, access and health security (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 60% 11.2% (ppp ) 5.5% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 55 30-08-2018 11:00:27 56 Nepal Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Variation by wealth SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁷ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 548 258 Births attended by skilled health personnel.. 2006 2011 2014 2016 0 50 100 C ov er ag e (% ) 58 19 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 39 21 81 35 Child mortality¹⁸ Children under-five Neonatal Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence Strengthening Civil Registration and Vital Statistics (CRVS) Variation by education 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁹ Rural Urban 2000 2005 2010 2015 0 50 100 150 M or ta lit y ra te Under five mortality rate⁵ʹ¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (Modern) prevalence rate⁵ʹ¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ʹ¹⁴ 2000 2005 2010 2015 0 20 40 60 Pe rc en ta ge Stunting⁵ʹ¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Immunization⁵ʹ¹⁴ No education Secondary school + Primary school Quintile 1 (poorest) Quintile 5 (richest) 2000 2005 2010 2015 0 20 40 60 80 Pe rc en ta ge 56.258.1 42.3 Birth registration⁵ʹ¹⁴ 2000 2005 2010 2015 0 20 40 60 80 Pe rc en ta ge 75.0 Death registration¹⁵ 2000 2005 2010 2015 0 20 40 60 80 Pe rc en ta ge 50.0 Cause of Death¹⁶ SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Health in the SDGs.indd 56 30-08-2018 11:00:27 57NepalMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁹ 2006 2011 2014 2016 0 50 100 150 Ad ol es ce nt b irt h ra te (w om en a ge d 15 -1 9 yr s) Malaria incidence⁸ 2012 2013 2014 2015 2016 0 1 2 3 4 5 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s 0.2 2.0 New HIV infec�ons among adults 15 to 49 years⁷ 2012 2013 2014 2015 2016 0.0 0.2 0.4 HI V IR [1 00 0 un in fe ct ed p op .] <0.1 0.03 Indicators Year Nepal Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 0.31 Number of people requiring interventions against neglected tropical diseases⁴ 2016 17,552,881 0.70 671,797,672 Communicable diseases (SDG target 3.3) TB incidence¹⁰ 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] 154161 Indicators SDGtarget Year Nepal Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 21.8 23.1 Noncommunicable diseases and injuries Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) 3.7.1 2016 56.1 Adolescent birth rate¹⁹ (per 1000 women aged 15 to 19 years) 3.7.2 2015 88 74.1 33.0 Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 193.8 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 19.8 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.4 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (15-64 yrs) and older - Female¹¹ 3.a.1 2013 14.1 Tobacco use among persons (15-64 yrs) and older - Male¹¹ 3.a.1 2013 48.1 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 2016 - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 2.47 - - Essential medicines and vaccines Health worker distribution¹³ (per 10 000 population) 3.c.1 2017 33.5 - Health workforce Malaria incidence is calculated for confirmed malaria cases International Health Regulations Core Capacity Index⁴ 3.d.1 2017 22 73 National and global health risks Note: A dash (-) implies relevant data are not available 0.09 0.1 98 88 Suicide mortality rate⁴ (per 100 000 population) 3.4.2 2016 8.8 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 2.0 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2016 17 13.2 4.5 17.0 Total NCD mortality⁹ 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op .) Female Male Health in the SDGs.indd 57 30-08-2018 11:00:28 58 Nepal Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years who are stunted⁵ 2006 2011 2014 2016 0 50 100 Pr op or tio n (% ) 36 49 Children under 5 years who are stunted⁵ 2.2.1 2016 35.8 Children under 5 years who are waste⁵ 2.2.2 2016 9.7 Children under 5 years who are overweight⁵ 2.2.3 2016 1.2 33 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources⁴ 6.1 2015 27 Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 28 41 Clean household energy Prevalence of children under 5 years who are wasted⁵ 2006 2011 2014 2016 0 25 50 Pr op or tio n (% ) 10 13 Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 99.5 57.3 Ambient air pollution Number of deaths by disaster⁴ (per 100 000 people) 13.1.2 2012-16 7.0 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 3.3 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2012-16 <0.1 4.1 0.1 Homicide and conflicts Birth registration coverage⁵ 16.9.1 2016 56.2 - Birth registration Note: A dash (-) implies relevant data are not available Indicators SDGtarget Year Nepal Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 5.5 8.5 General government health expenditure Completeness of cause-of-death data¹⁶ (%) 17.19.2 2007-16 - 10 Cause-of-death Prevalence of children under 5 years who are overweight⁵ 2006 2011 2014 2016 0 7.5 15 Pr op or tio n (% ) 0.6 1.2 References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2017 Revision, 2017. http://esa.un.org/wpp/ -accessed 20 June 2018. 2.United Nations, Department of Economic and Social Affairs, Population Division (2018). World Urbanization Prospects: The 2018 Revision - https://esa.un.org/unpd/wup/DataQuery/ - accessed 20 June 2018. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 20 June 2018. 4.World Health Organization. World health statistics 2018: Monitoring health for the SDGs. Geneva, 2018. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ - accessed 20 June 2018. 5. Nepal Multiple Indicator Cluster Survey 2014, Final Report. Kathmandu: Central Bureau of Statistics and UNICEF Nepal; 2015 (http://unicef.org.np/uploads/files/597341286609672028-final-report-nmics-2014-english.pdf, accessed 13 July 2018). 6. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK -accessed 20 June 2018.See for DTP3 coverage: a proxy for immunization coverage. 7. UNAIDS 2016 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 20 June 2018. 8. World Health Organization. Global Malaria Report 2017. http://www.who.int/malaria/publications/world-malaria-report-2017/en/ - accessed 20 June 2018. 9. Global Health Observatory: http://www.who.int/gho/en/ - accessed 20 June 2018. 10. World Health Organization. Global tuberculosis report 2017.Geneva,2017 http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516 - accessed 20 June 2018 11. Factsheet 2018: Nepal. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://www.searo.who.int/entity/ncd_tobacco_surveillance/documents/nep_wntd_18/en/, accessed 13 July 2018). 12. World Health Organization. World Health Statistics 2013. Geneva, 2013. 13. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 14. Nepal Demographic Health Survey 2007-2017, accessed 9 July 2018). 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 17. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 18. 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 20 June 2018. 19. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 58 30-08-2018 11:00:29 59Sri LankaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 0.1% or approximately 14 000 people are being pushed into poverty because of out-of-pocket health spending.¹⁷ Catastrophic expenditure on health: 5.3% of people spent more than 10% of their household's total expenditure on health care.¹⁷ Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DPT3)⁶ 0 50 100 C ov er ag e (% ) 74 99 52 99 Reproductive, maternal, newborn and child health 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 UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Sri Lanka, from 2000 (71.5 years) to 2016 (74.9 years), the life expectancy at birth has improved by 3.4 years. Healthy life expectancy⁴ reflects overall health for the country's population. In Sri Lanka, from 2000 (63.9 years) to 2016 (67.0 years), healthy life expectancy has improved by 3.1 years. Sri Lanka 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). Population (000s)¹ 20 877 Monitoring the health SDG goal: Indicators of overall progress Urban population² 18.4% Poverty³ 1.9% GDP per capita³ (Current US$) 4065.2 Current health expenditure as share of GDP³ 3.0% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 64 67 72 75 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 68 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2015) HIV antiretroviral therapy coverage⁷ Access to basic sanitation⁸ (%) Tuberculosis treatment Coverage⁹ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁹ 0 50 100 C ov er ag e (% ) 27 94 64 Infectious diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure in population⁸ Prevalence of normal fasting glucose level⁸ Cervical cancer screening¹⁰ Tobacco non-use¹¹ 0 50 100 C ov er ag e (% ) 78 93 25 74 Noncommunicable diseases Health security:IHR compliance⁸ Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹³, expressed as % of new global threshold, 44.5/10 000 Acess to essential medicines 0 50 100 C ov er ag e (% ) 100 76 71 Service capacity, access and health security (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 38% 11.2% 11.2%11.2% (ppp ) 8.0% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 59 30-08-2018 11:00:30 60 Sri Lanka Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Variation by wealth SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁶ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 57 30 Births attended by skilled health personnel⁵ 1993 2000 2007 2016 0 50 100 150 C ov er ag e (% ) 99 10094 96 2000 2005 2010 2015 2016 0 50 100 M R [1 00 0 liv e bi rth s] 10.1 5.3 16.3 9.4 Child mortality¹⁷ Children under-five Neonatal Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. Strengthening Civil Registration and Vital Statistics (CRVS) Variation by education 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁸ Rural Urban 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Under five mortality⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Demand for family planning satisfied need⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Full Immunization⁵ Quintile 1 (poorest) Quintile 5 (highest) No education Secondary school+ Primary school 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 97.097.2 Birth registration⁵ʹ¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 93.090.0 Death registration¹⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 93.0 82.0 Cause of Death¹⁵ʹ⁴ Health in the SDGs.indd 60 30-08-2018 11:00:30 61Sri LankaMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Indicators SDGtarget Year Sri Lanka Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2015 17.4 23.1 Noncommunicable diseases and injuries Malaria incidence¹⁸ 2013 2014 2015 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s 0.3 4.3 New HIV infections among adults 15 to 49 years⁷ 2012 2013 2014 2015 2016 0.0 0.2 0.4 H IV IR [1 00 0 un in fe ct ed p op .] Indicators Year Sri Lanka Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years⁴ (%) 2015 0.64 Number of people requiring interventions against neglected tropical diseases⁴ 2016 55,720 0.70 671,797,672 Communicable diseases (SDG target 3.3) TB incidence⁹ 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) 3.7.1 2016 74.2 Adolescent birth rate⁵ (per 1000 women aged 15 to 19 years) 3.7.2 2016 30 75.1 - Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 79.8 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 1.2 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.4 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (18-69 yrs) and older - Female¹¹ 3.a.1 2015 5.3 Tobacco use among persons (18-69 yrs) and older - Male¹¹ 3.a.1 2015 45.7 - - Tobacco use Health worker density¹³ (per 10 000 population) 3.c.1 2016 31.7 - Health workforce Malaria incidence is calculated for confirmed malaria cases. Only small number of imported malaria cases have been reported. International Health Regulations Core Capacity Index⁸ 3.d.1 2017 76 80 National and global health risks Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 0.98 - - Essential medicines and vaccines Note: A dash (-) implies relevant data are not available <0.1 0.06 66 65 Suicide mortality rate¹⁹ (per 100 000 population) 3.4.2 2016 14.3 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 4.3 Mortality rate from road traffic injuries¹⁹ (per 100 000 population) 3.6.1 2016 14.2 13.2 4.3 17 Total NCD mortality⁸ 2000 2005 2010 2015 0 250 500 750 1000 To ta l N CD m or ta lit y ra te (p er 1 00 0 00 p op .) Female Male Adolescent birth rate (per 1000 women aged 15 to 19 years) Current data are insufficient to determine trend Health in the SDGs.indd 61 30-08-2018 11:00:31 62 Sri Lanka Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of children under 5 years who are overweight⁵ 2009 2012 2016 0 7.5 15 Pr op or tio n (% ) 2.0 0.8 Prevalence of children under 5 years who are wasted⁵ 2009 2012 2016 0 25 50 Pr op or tio n (% ) Prevalence of children under 5 years who are stunted⁵ 2009 2012 2016 0 50 100 Pr op or tio n (% ) Children under 5 years who are stunted⁵ 2.2.1 2016 17.3 Children under 5 years who are wasted⁵ 2.2.2 2016 15.1 Children under 5 years who are overweight⁵ 2.2.3 2016 2.0 33.0 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved drinking water sources 6.1 - - Proportion of population using improved sanitation 6.2 - - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 26 41 Clean household energy Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 15.1 57.3 Ambient air pollution Number of deaths by disaster⁴ (per 100 000 people) 13.1.2 2012-16 0.3 0.2 Natural disasters Mortality rate due to homicide¹⁹ (per 100 000 population) 16.1.1 2016 2.5 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2011-2015 <0.1 4.1 0.1 Homicide and conflicts Birth registration coverage¹⁴ 16.9.1 2012 97.2 - Birth registration 19.2 17.3 11.8 15.1 Note: A dash (-) implIes relevant data are not available Indicators SDGtarget Year Sri Lanka Regional Estimate General government health expenditure as % of general government expenditure⁴ 1.a 2016 7.9 8.5 General government health expenditure Completeness of cause-of-death data¹⁵(%) 17.19.2 2005-2015 93 10 Cause-of-death References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2017 Revision, 2017. http://esa.un.org/wpp/ -accessed 20 Jun 2018. 2.United Nations, Department of Economic and Social Affairs, Population Division (2018). World Urbanization Prospects: The 2018 Revision - https://esa.un.org/unpd/wup/DataQuery/ - accessed 20 June 2018. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 20 June 2018. 4.World Health Organization. World health statistics 2018: Monitoring health for the SDGs. Geneva, 2018. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ - accessed 20 June 2018. 5. Sri Lanka demographic and health survey 2016. Department of Census and Statistics (DCS) and Ministry of Health, Nutrition and Indigenous Medicine; 2017 (http://www.statistics.gov.lk/social/DHS_2016a/FIST%20PAGE_&_CONTENTS.pdf - accessed 20 June 2018). 6. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK -accessed 20 June 2018.See for DTP3 coverage: a proxy for immunization coverage. 7. UNAIDS 2016 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 20 June 2018. 8. Global Health Observatory: http://www.who.int/gho/en/ - accessed 20 June 2018. 9. World Health Organization. Global tuberculosis report 2017.Geneva,2017 http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516 - accessed 20 June 2018. 10. Fact Sheet: STEPS Survey Sri Lanka 2015. World Health Organization, 2017. 11. Factsheet 2018: Sri Lanka. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://apps.who.int/iris/bitstream/handle/10665/272688/wntd_2018_srilanka_fs.pdf?sequence=1 , accessed 13 July 2018). 12. World Health Organization. World Health Statistics 2013. Geneva, 2013. 13. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 14. Annual Health Bulletin 2015 http://www.health.gov.lk/moh_final/english/public/elfinder/files/publications/AHB/2017/AHB%202015.pdf – accessed 20 June 2018 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 17. 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 20 June 2018. 18. World Health Organization. Global Malaria Report 2017. http://www.who.int/malaria/publications/world-malaria-report-2017/en/ - accessed 20 June 2018 19. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 62 30-08-2018 11:00:32 63Monitoring Health in the Sustainable Development Goals Thailand Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: Insufficient data Catastrophic expenditure on health: 1.9% of people spent more than 10% of their household's total expenditure on health care¹⁷. A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage (DPT3)⁶ 0 50 100 C ov er ag e (% ) 89 91 80 99 Reproductive, maternal, newborn and child health 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. UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Thailand, from 2000 (71.1 years) to 2016 (75.5 years), the life expectancy at birth has improved by 4.4 years. Healthy life expectancy⁴ reflects overall health for the country's population. In Thailand, from 2000 (63.4 years) to 2016 (66.8), healthy life expectancy has improved by 3.4 years. Thailand 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). Population (000s)¹ 69 183 Monitoring the health SDG goal: Indicators of overall progress Urban population² 49.2% Poverty³ 0.1% GDP per capita³ (Current US$) 6593.8 Current health expenditure as share of GDP³ 3.8% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 63 67 71 75 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 85 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2014) HIV antiretroviral therapy coverage⁷ Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁸ Access to basic sanitation⁹ (%) Tuberculosis treatment coverage¹⁰ 0 50 100 C ov er ag e (% ) 100 69 95 59 Infectious diseases HEALTH SERVICE COVERAGE (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. Prevalence of normal blood pressure level in population⁹ Cervical cancer screening Tobacco non-use¹¹ Prevalence of normal fasting glucose level⁹ 0 50 100 C ov er ag e (% ) 78 73 91 Noncommunicable diseases Health security: IHR compliance⁹ Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹³, expressed as % of new global threshold, 44.5/10 000 Access to essential medicines 0 50 100 C ov er ag e (% ) 10097 86 Service capacity, access and health security 12% 15.6% ( p < . a day) 15.3% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 63 30-08-2018 11:00:33 64 Monitoring Health in the Sustainable Development GoalsThailand Variation by wealth SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Maternal mortality ratio¹⁵ 2000 2005 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 25 20 Births attended by skilled health personnel⁵ 2005-2006 2012 2015-2016 0 50 100 10097 99 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 13 7 23 12 Child mortality¹⁶ Children under-five Neonatal Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁹ Rural Urban 2000 2005 2010 2015 0 Pe rc en ta ge Under five mortality⁵ 2000 2005 2010 2015 0 Pe rc en ta ge Antenatal care coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (modern) prevalence rate⁵ Quintile 1 (poorest) Quintile 5 (richest) 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ Variation by education No education Secondary school + Primary school 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Full Immunization⁵ 2000 2005 2010 2015 0.0 50.0 100.0 Pe rc en ta ge 99.599.499.4 Birth registration⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 100.0 84.9 70.1 Death registration¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 81.0 Cause of death⁴ No Data No data Health in the SDGs.indd 64 30-08-2018 11:00:34 65Monitoring Health in the Sustainable Development Goals Thailand Malaria incidence⁸ 2012 2013 2014 2015 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2003 2008 2010 2015 2016 0 3 6 9 Li tre s 5.6 8.3 New HIV infections among adults 15 to 49 years⁷ 2012 2013 2014 2015 2016 0.0 0.2 0.4 H IV IR [1 00 0 un in fe ct ed p op .] Indicators Year Thailand Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 0.17 Number of people requiring interventions against neglected tropical diseases⁴ 2016 64,094 0.70 671,797,672 Communicable diseases (SDG target 3.3) TB incidence¹⁰ 2012 2013 2014 2015 2016 0 100 200 300 400 500 TB in ci de nc e [1 00 ,0 00 p op .] Indicators SDGtarget Year Thailand Regional estimate Mortality between 30 and 70 yrs of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 14.5 23.1 Noncommunicable diseases and injuries Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) 3.7.1 2016 89.2 Adolescent birth rate¹⁷ (per 1000 women aged 15 to 19 years) 3.7.2 2016 51.0 - - Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 61.5 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 3.5 Mortality rate attributed to unintentional poisoning⁴ (per100 000 population) 3.9.3 2016 0.4 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (15+ yrs) and older - Female 3.a.1 2011 8 Tobacco use among persons (15+ yrs) and older - Male 3.a.1 2011 47.2 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 0.37 - 0.47 Essential medicines and vaccines Health worker density¹³ (per 10 000 population) 3.c.1 2017 38.2 - Health workforce Malaria incidence is calculated for confirmed malaria cases International Health Regulations Core Capacity Index⁴ 3.d.1 2017 97 73 National and global health risks Note: A dash (-) implies relevant data are not available 0.3 0.19 176 172 0.98 1.4 Suicide mortality rate⁴ (per 100 000 population) 3.4.2 2016 14.4 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 8.3 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2013 36.2 13.2 4.5 17 Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁷ 2012 2015-2016 0 50 100 150 Ad ol es ce nt b irt h ra te (w om en a ge d 15 -1 9 yr s) 60 51 Female Male Total NCD mortality⁹ 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op .) Health in the SDGs.indd 65 30-08-2018 11:00:35 66 Monitoring Health in the Sustainable Development GoalsThailand Prevalence of children under 5 years of age who are wasted⁵ 2005-06 2012 2015-2016 0 25 50 Pr op or tio n (% ) Prevalence of children under 5 years of age who are stunted⁵ 2005-06 2012 2015-2016 0 50 100 Pr op or tio n (% ) Other health-related SDGs Proportion of population using improved drinking water sources⁴ 6.1 2015 - Proportion of population using improved sanitation⁴ 6.2 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 74 41 Clean household energy Air pollution level in cities (PM 2.5) (µg/m³) 11.6.2 2016 26.6 57.3 Ambient air pollution Number of deaths by disaster⁴ .. 13.1.2 2012-16 <0.1 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 5 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2015 0.7 4.1 0.1 Homicide and conflicts Birth registration coverage⁵ 16.9.1 2016 99.5 - Birth registration 18.1 10.5 4.7 5.8 Note: A dash (-) implies relevant data are not available Indicators SDGtarget Year Thailand Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 16.6 8.5 General government health expenditure Children under 5 years who are stunted⁵ 2.2.1 2015-2016 10.5 Children under 5 years who are wasted⁵ 2.2.2 2015-2016 5.8 Children under 5 years who are overweight⁵ 2.2.3 2015-2016 8.2 33.0 15.2 3.4 Child nutrition Completeness of cause-of-death data⁴ (%) 17.19.2 2007-16 85 10 Cause-of-death data Prevalence of children under 5 years of age who are overweight⁵ 2005-06 2012 2015-2016 0 7.5 15 Pr op or tio n (% ) 8.0 8.2 References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2017 Revision, 2017. http://esa.un.org/wpp/ -accessed 20 Jun 2018. 2.United Nations, Department of Economic and Social Affairs, Population Division (2018). World Urbanization Prospects: The 2018 Revision - https://esa.un.org/unpd/wup/DataQuery/ - accessed 20 June 2018. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 20 June 2018. 4.World Health Organization. World health statistics 2018: Monitoring health for the SDGs. Geneva, 2018. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ - accessed 20 June 2018 5. Thailand multiple indicator cluster survey 2015-16. Bangkok: National Statistical Office and United Nations Children’s Fund; 2016 (https://www.unicef.org/thailand/Thailand_MICS_Full_Report_EN.pdf, accessed 13 July 2018). 6. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK -accessed 20 June 2018.See for DTP3 coverage: a proxy for immunization coverage. 7. UNAIDS 2016 estimates for coverage of people receiving ART. http://aidsinfo.unaids.org - accessed 20 June 2018. 8. World Health Organization. Global Malaria Report 2017. http://www.who.int/malaria/publications/world-malaria-report-2017/en/ - acessed 20 June 2018. 9. Global Health Observatory: http://www.who.int/gho/en/ - accessed 20 June 2018 10. World Health Organization. Global tuberculosis report 2017.Geneva,2017 http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516 - accessed 20 June 2018 11. Factsheet 2018: Thailand. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://apps.who.int/iris/bitstream/handle/10665/272690/wntd_2018_thailand_fs.pdf?sequence=1, accessed 13 July 2018). 12. World Health Organization. World Health Statistics 2013. Geneva, 2013. 13. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 14. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 15. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018) 16. 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 20 June 2018 17. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 66 30-08-2018 11:00:36 67Timor-LesteMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Public spending on health³ is determined by the capacity of the government to raise revenues and allocate it to health. Financial protection is measured through two indicators: (1) impoverishment, and (2) catastrophic health expenditure. Impoverishment: 1.0% or approximately 12 000 people are being pushed into poverty because of out-of-pocket health spending³ Catastrophic expenditure on health: 2.9% of people spent more than 10% of their household's total expenditure on health care³ A summary measure of essential health services coverage, a composite service coverage index, is used: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. Family planning coverage⁵ Pregnancy care⁵ Care seeking behaviour suspected pneumonia⁵ Child immunization coverage⁶ (DPT3) 0 50 100 C ov er ag e (% ) 38 47 71 76 Reproductive, maternal, newborn and child health 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. UHC services coverage index of essential health services Life expectancy Life expectancy at birth⁴ provides an indication of overall mortality of a country's population. In Timor-Leste, from 2000 (58.7 years) to 2016 (68.6 years), the life expectancy at birth has improved by 9.9 years. Healthy life expectancy⁴ reflects overall health of the country's population. In Timor-Leste, from 2000 (52.2 years) to 2016 (59.2 years), healthy life expectancy has improved by 7 years. Timor-Leste 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). Population (000s)¹ 1 324 Monitoring the health SDG goal: Indicators of overall progress Urban population ² 30.2% Poverty³ 30.3% GDP per capita³ (Current US$) 2279.2 Current health expenditure as share of GDP³ 3.1% 2000 2007 2015 2016 0 50 100 Ag e (y ea rs ) 52 5959 69 Life expectancy at birth Healthy life expectancy FINANCIAL PROTECTION 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 0 50 100 C ov er ag e (% ) 49 UHC services coverage index Latest available data (2010-2017) Out-of-pocket expenditure, as % of the health expenditure (2015) Insecticide-treated bednets/indoor residual spray coverage for malaria prevention⁷ Tuberculosis treatment coverage⁹ HIV antiretroviral therapy coverage Access to basic sanitation (%) 0 50 100 C ov er ag e (% ) 100 57 41 Communicable diseases HEALTH SERVICE COVERAGE Prevalence of normal blood pressure level in population⁸ Prevalence of normal blood glucose level in population⁸ Cervical cancer screening¹⁰ Tobacco non-use¹¹ 0 50 100 C ov er ag e (% ) 72 94 44 1 Noncommunicable diseases Health security: IHR compliance⁸ Density of hospital beds¹², expressed as % of global threshold, 18/10 000 Heath worker density¹³, expressed as % of new global threshold, 44.5/10 000 Access to essential medicines 0 50 100 C ov er ag e (% ) 100 72 56 Service capacity, access and health security (ppp < $1.90 a day) 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. 25 SDG3 indicators plus other selected health-related indicators are presented where data is available. 10% 2.4% ( p < a day) 4.2% GDP 2015 Estimated total government expenditure, 2015 or latest available year Estimated government expenditure on health, 2015 or latest available year Health in the SDGs.indd 67 30-08-2018 11:00:37 68 Timor-Leste Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Variation by wealth SDG 3: Health targets Maternal and child mortality (SDG target 3.1, 3.2) Equity: Leave no one behind 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, location and other characteristics relevant in national contexts. Variation by residence 2000 2005 2010 2015 2016 0 50 100 150 M R [1 00 0 liv e bi rth s] 37 22 110 50 Child mortality¹⁷ Children under-five Neonatal Maternal mortality ratio¹⁶ 2000 2005 2010 2015 0 250 500 750 M M R [1 00 0 00 li ve b irt hs ] 694 215 Births attended by skilled health personnel⁵ 2003 2009-2010 2016 0 50 100 C ov er ag e (% ) 18 30 57 Strengthening Civil Registration and Vital Statistics (CRVS) Variation by education 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Sanitation⁸ Rural Urban 2000 2005 2010 2015 0 50 100 M or ta lit y ra te Under five mortality rate⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Antenatal coverage⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Contraceptive (modern) prevalence rate⁵ Quintile 5 (richest) Quintile 1 (poorest) 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Stunting⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Full immunization⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 55.2 Birth registration¹⁴ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge 49.0 Death registration¹⁵ 2000 2005 2010 2015 0 50 100 Pe rc en ta ge Cause of Death SDG emphasis on mortality statistics More reliable vital statistics on births, deaths and causes of death from civil registration and vital statistics (CRVS) systems are required for reporting on 14 health-related SDG mortality indicators. Understanding better what people are dying from can lead to stronger health policies and plans, and improve monitoring of the health-related SDGs. No education Primary school Secondary school + No data Health in the SDGs.indd 68 30-08-2018 11:00:38 69Timor-LesteMonitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁸ 2003 2009 2016 0 50 100 150 Ad ol es ce nt B irt h R at e [w om en a ge d 15 -1 9 yr s] 78 51 42 Malaria incidence⁷ 2012 2013 2014 2015 2016 0 5 10 15 20 M al ar ia IR [1 00 0 po p. a t r is k] Total alcohol per capita (age 15+ years) consumption⁴ 2008 2010 2015 2016 0 3 6 9 Li tre s 0.7 2.1 New HIV infections among adults 15 to 49 years Indicators Year Timor-Leste Regionalestimate Hepatitis B surface antigen prevalance among children under 5 years (%)⁴ 2015 0.87 Number of people requiring interventions against neglected tropical diseases⁴ 2016 1,167,125 0.70 671,797,672 Communicable diseases (SDG target 3.3) TB incidence⁹ 20122013 2014 20152016 0 100 200 300 400 500 TB in ci de nc e [1 00 0 00 p op .] Indicators SDGtarget Year Timor-Leste Regional estimate Mortality between 30 and 70 years of age from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases⁴ (%) 3.4.1 2016 19.9 23.1 Noncommunicable diseases and injuries Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods⁵ (%) 3.7.1 2007-16 46.9 Adolescent birth rate (per 1000 women aged 15 to 19 years)¹⁸ 3.7.2 2016 42 75.1 - Sexual and reproductive health Mortality rate attributed to household and ambient air pollution⁴ (per 100 000 population) 3.9.1 2016 139.8 Mortality rate attributed to exposure to unsafe WASH services⁴ (per 100 000 population) 3.9.2 2016 9.9 Mortality rate attributed to unintentional poisoning⁴ (per 100 000 population) 3.9.3 2016 0.4 164.0 15.4 1.8 Mortality due to environmental pollution Tobacco use among persons (18-69 yrs) and older - Female¹¹ 3.a.1 2014 28.9 Tobacco use among persons (18-69 yrs) and older - Male¹¹ 3.a.1 2014 70.6 - - Tobacco use Proportion of the population with access to affordable medicines and vaccines on a sustainable basis⁴ 3.b.1 - - Total net official development assistance to medical research and basic health per capita⁴ 3.b.2 2016 12.1 - - Essential medicines and vaccines Health worker density¹³ (per 10 000 population) 3.c.1 2017 25.0 - Health workforce Malaria incidence is calculated for confirmed malaria cases Current data are insufficient to determine trend International Health Regulations Core Capacity Index⁸ 3.d.1 2017 72 80 National and global health risks Note: A dash (-) implies relevant data are not available 498 498 4.7 0.5 Suicide rate⁴ (per 100 000 population) 3.4.2 2015 4.6 Total alcohol per capita (age 15+ years) consumption⁴ 3.5.2 2016 2.1 Mortality rate from road traffic injuries⁴ (per 100 000 population) 3.6.1 2013 16.6 13.2 4 17 Female Male Total NCD mortality⁸ 2000 2005 2010 2015 0 250 500 750 1000 To ta l N C D m or ta lit y ra te (p er 1 00 0 00 p op .) Health in the SDGs.indd 69 30-08-2018 11:00:38 70 Timor-Leste Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Prevalence of stunting in children under 5 years of age⁵ 2003 2007-08 2009-10 2016 0 50 100 Pr op or tio n (% ) Children under 5 years who are stunted⁵ 2.2.1 2016 46.3 Children under 5 years who are wasted⁵ 2.2.2 2016 25.0 Children under 5 years who are overweight⁵ 2.2.3 2016 6 33.0 15.2 3.4 Child nutrition Other health-related SDGs Proportion of population using improved sanitation⁴ 6.2 2015 - Proportion of population using improved drinking water sources⁴ 6.1 2015 - - - Drinking water services and sanitation Proportion of population with primary reliance on clean fuel⁴ 7.1 2016 7 41 Clean household energy Prevalence of children under 5 years who are wasted⁵ 2003 2007-08 2009-10 2016 0 25 50 Pr op or tio n (% ) Air pollution level in cities⁴ (PM 2.5) (µg/m³) 11.6.2 2016 18.2 57.3 Ambient air pollution Number of deaths by disaster⁴ ( per 100,000 people) 13.1.2 2011-16 0 0.2 Natural disasters Mortality rate due to homicide⁴ (per 100 000 population) 16.1.1 2016 5.1 Estimated direct deaths from major conflicts⁴ (per 100 000 population) 16.1.2 2011-16 0 4.1 0.1 Homicide and conflicts Birth registration coverage¹⁴ 16.9.1 2010 55 - Birth registration 55 50.2 11.0 14.3 Note: A dash (-) implies relevant data are not available Indicators SDGtarget Year Timor-Leste Regional estimate General government health expenditure as % of general government expenditure⁴ 1.a 2015 4.2 8.5 General government health expenditure Completeness of cause-of-death data⁴ (%) 17.19.2 2005-2015 - 10 Cause-of-death data Prevalence of children under 5 years who are overweight⁵ 2003 2007-08 2009-10 2016 0 7.5 15 Pr op or tio n (% ) 5.8 1.5 References 1.United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects, the 2017 Revision, 2017. http://esa.un.org/wpp/ -accessed 20 Jun 2018. 2.United Nations, Department of Economic and Social Affairs, Population Division (2018). World Urbanization Prospects: The 2018 Revision - https://esa.un.org/unpd/wup/DataQuery/ - accessed 20 June 2018. 3.World Health Organization. Global health expenditure database. June 2016. http://apps.who.int/nha/database - accessed 20 June 2018. 4.World Health Organization. World health statistics 2018: Monitoring health for the SDGs. Geneva, 2018. http://www.who.int/gho/mortality_burden_disease/life_tables/en/ - accessed 20 June 2018. 5. Timor-Leste demographic and health survey 2016. Dili: General Directorate of Statistics (GDS), Ministry of Health and ICF; 2018 (https://dhsprogram.com/pubs/pdf/FR329/FR329.pdf, accessed 13 July 2018). 6. World Health Organization. WHO/UNICEF estimates of national immunization coverage: DTP3. Geneva. http://apps.who.int/immunization_monitoring/globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=TLS&commit=OK -accessed 20 June 2018.See for DTP3 coverage: a proxy for immunization coverage 7. World Health Organization. Global Malaria Report 2017. http://www.who.int/malaria/publications/world-malaria-report-2017/en/ - accessed 20 June 2018 8. Global Health Observatory: http://www.who.int/gho/en/ - accessed 20 June 2018 9. World Health Organization. Global tuberculosis report 2017.Geneva,2017 http://apps.who.int/iris/bitstream/handle/10665/259366/9789241565516 - accessed 20 June 2018. 10. Fact Sheet: STEPS Survey Timor-Leste 2014. World Health Organization, 2016. 11. Factsheet 2018: Timor-Leste. New Delhi: World Health Organization, Regional Office for South-East Asia; 2018 (http://apps.who.int/iris/bitstream/handle/10665/272689/wntd_2018_timor-leste_fs.pdf?sequence=1, accessed 13 July 2018). 12. World Health Organization. World Health Statistics 2013. Geneva, 2013. 13. Decade for health workforce strengthening in the South-East Asia Region 2015—2024: Second review of progress, 2018. New Delhi: World Health Organization; 2018. 14. Timor-Leste demographic and health survey 2009 https://dhsprogram.com/pubs/pdf/FR235/FR235.pdf - accessed 20 June 2018 15. CRVS regional action framework reporting 2013-2017. Bangkok: United Nations Economic and Social Commission for Asia and the Pacific; 2018 (unpublished document). 16. Trends in maternal mortality: 1990 to 2015 http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/ - accessed 9 July 2018). 17. 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 20 June 2018 18. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Fertility Data 2017 http://www.un.org/en/development/desa/population/theme/fertility/index.shtml - accessed 20 June 2018 Health in the SDGs.indd 70 30-08-2018 11:00:40 71Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region: 2018 update Annex Indicator definitions and data used The health-related SDG indicators have been mapped to and populated according to the United Nations SDG metadata standards.20 Almost all the health-related SDG indicators used in this report are aligned with these global definitions and are consistent with data and indicators presented in the WHO World health statistics 2018.21 However, four health SDG3 indicators have been modified to better fit the regional context, which are described in the box below. SDG3 indicators on health adjusted for the SEA Region SDG target Indicator Revised definition 3.3.3 Malaria incidence (per 1000 population at risk) Includes only confirmed cases 3.8.1.2 Antenatal care, four or more visits (%) Average between antenatal care, four or more visits (%) and proportion of births attended by skilled health personnel (%) 3.1.8.7 Population at risk sleeping under insecticide-treated bednets (%) Population at risk sleeping under insecticide-treated bednets or using indoor residual spraying (%) 3.c. Health worker density for physicians, psychiatrists and surgeons Health worker density for physicians, nurses and midwives 20 United Nations. SDG indicators metadata repository (https://unstats.un.org/sdgs/metadata/, accessed 15 June 2018). 21 World health statistics 2017: monitoring health for the SDGs. Geneva: World Health Organization; 2018 (http:// www.who.int/gho/publications/world_health_statistics/2018/en/, accessed 15 June 2018). Health in the SDGs.indd 71 30-08-2018 11:00:40 Health in the SDGs.indd 72 30-08-2018 11:00:40 2018 update Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South- East Asia Region 9 789290 226628