SIXT TY-FIFTH WORLD W HEA ALTH ASS SEMBLY Prov visional age enda item 13.5
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M Monitor ring of the ach hievem ment of f the he ealth-re elated ennium m Deve elopmen nt Goa als Mille Progres ss in the achievem ment of th he health h-related Millenni ium Dev velopmen nt Goals, and glob bal health h goals af fter 2015 5 Repo ort by the Secretariat S t
1. In response e to requests s in resolutio ons WHA63 3.15 and WH HA63.24, thi is report sum mmarizes the e latest t trends in progress p towards achieve ement of the e health-relat ted Millenni ium Develop pment Goals s and s specific targ gets.1 It also o describes progress of f the efforts to reduce child morta ality through h preve ention and tre eatment of pneumonia, p a as requested in resolution n WHA63.24 4, and to redu uce perinatal l eport include and n neonatal mor rtality. In add dition, this re es comments s on the form mulation of global g health h goals s after 2015. . An earlier version of this report was w noted by b the Execu utive Board at its 130th h sessio on.2
CUR RRENT ST TATUS AND D TRENDS S 2. In 2011, more m than a decade d after r world leade ers adopted the Millenni ium Develop pment Goals s and t their targets s, substantial l progress h has been made in redu ucing child a and materna al mortality, , idity and mortality impro oving nutriti ion, and red ducing morbi m due to HIV inf fection, tuberculosis and d malar ria. Progress s in countries s that have t the highest rates of mortality has acc celerated in recent r years, , even though large e gaps persis st between an nd within co ountries. The current tren nds form a go ood basis for r tive action and expansion n of successf ful approach hes to overco ome the chall lenges posed d intensified collect by mu ultiple crises s and large in nequalities. 3. Childhood malnutrition n is the und derlying cau use of death in an estim mated 35% of o all deaths s amon ng children under u five ye ears of age. T The proportion of such children c in de eveloping co ountries who o The relevan nt specific targe ets are: for Goa al 1, Target 1.C C: Halve, betwe een 1990 and 2 2015, the propo ortion of people e who su uffer from hung ger; for Goal 4, Target 4.A: Re educe by two th hirds, between 1990 and 2015,, the under-five e mortality rate; ; for Go oal 5, Target 5.A: 5 Reduce by y three quarters s, between 199 90 and 2015, th he maternal mo ortality ratio, and a Target 5.B: : Achiev ve, by 2015, un niversal access to t reproductive e health; for Go oal 6, Target 6.A A: Have halted by 2015 and begun to reverse e the spr read of HIV/AI IDS, Target 6.B B: Achieve, by 2010, universa al access to trea atment for HIV V/AIDS for all those t who need d it, and d Target 6.C: Have H halted by 2015 2 and begun n to reverse the e incidence of malaria m and oth her major diseas ses; for Goal 7, , Target t 7.C: Halve, by y 2015, the pro oportion of peop ple without sus stainable access s to safe drinkin ng-water and basic b sanitation; ; and fo or Goal 8, Targ get 8.E: In coop peration with p pharmaceutical companies, pro ovide access to o affordable ess sential drugs in n develo oping countries. . 2 1
See docume ent EB130/2012 2/REC/2, summ mary records of the third meetin ng, section 3, an nd the fourth meeting. m
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were underw weight is est timated to ha ave declined d from 29% to t 18% betw ween 1990 an nd 2010. Thi is rate of progress is close to what w is required to meet t the relevant target but is unevenly di istributed be etween and within r regions. 4. Globa cant progress s has been m made in reduc cing mortalit ty in children n under five years ally, signific of age. Bet tween 1990 and 2010, under-five u m mortality dec clined by 35%, from an estimated rate r of 88 deaths pe er 1000 live births to 57. The global r rate of declin ne has accele erated in the past decade, from 0. The annua 1.9% per an nnum betwee en 1990 and 2000 to 2.5% % per annum m between 20 000 and 2010 al rate of decline m more than do oubled in the e African Re egion, where e almost half f all child de eaths occur, rising from 1.1% t to 2.6% over r the same periods. Yet, most countries in this Re egion are no ot likely to ac chieve the target of f a two-third ds reduction from f 1990 le evels of mort tality by the year 2015. G Globally, 37 out of 143 low- an nd middle-in ncome count tries will hav ve reached th hat target by y 2015 if the e pace of pro ogress remains the same as dur ring the perio od 2005–201 10. In 20 5. 010, global measles m imm munization co overage was 85% among g children ag ged 12–23 months. m More count tries are now w achieving high levels of immuniza ation covera age; in 2010,, 65% of Me ember States reach hed at least 90% covera age, and in h half WHO’s regions cov verage of mo ore than 90% % was maintained. . Between 2000 2 and 2010, the estim mated numb ber of measles deaths de ecreased by 74%, accounting for about on ne fifth of the e overall decl line in child mortality. Neve 6. ertheless, nea arly 20% of the deaths in n children un nder the age of five year rs – mostly due d to pneumonia and diarrhoe eal diseases – continue to o be preventa able by vacci ines. Efforts are being made to expand inte erventions against a pneu umonia, as called for by the Health Assemb mbly in reso olution WHA63.24 on accelera ated progres ss towards a achievement t of Millenn nium Develo opment Goal l 4 to reduce child d mortality: prevention and treatme ent of pneum monia, and against a diarr rhoeal diseas ses. A rapidly incr reasing numb mber of count tries in the A African Reg gion, the Reg gion of the A Americas an nd the Eastern Med diterranean Region R have introduced p pneumococc cal conjugate e vaccines in the past yea ar with support from m the GAVI I Alliance. Jo oint statemen nts by UNIC CEF and WH HO on clinica al managem ment of children wit th diarrhoea and pneumo onia have be een used by several coun ntries to form mulate policies on increasing a access to car re through trained and su upervised community health workers s. By 2010, 30 3 out of 68 count tries being monitored m by y the Count tdown to 20 015 initiative e1 had adopt pted the poli icy on community case manag gement of pn neumonia an nd eight oth her countries moved tow wards adoptin ng the policy in the e course of 2010. 2 7. Altho ough the redu uction in ma aternal death hs has been noteworthy, n down d to an e estimated 28 87 000 in 2010 from m 543 000 in i 1990, the rate of decli ine is just ov ver half that necessary in n order to ac chieve Target 5.A: reducing the e maternal mortality m ratio o by three qu uarters betwe een 1990 and d 2015. The rate r of decline in t the maternal mortality ra atio between n 1990 and 2010 2 globall ly was 3.1% % per annum m, with lower rates in the Regio on of the Am mericas and t the Eastern Mediterranea M an Region (2 2.5% and 2.6% per pectively). Approximate A ely a quarter r of the coun ntries with the highest m maternal mortality annum, resp ratio in 1990 (≥100 maternal deaths per 100 000 0 live births) have made in nsufficient o or no progres ss. In or 8. rder to reduc ce maternal deaths, wom men need ac ccess to effective interve entions and good5 to 49 years who quality repr roductive-hea alth care. Fo or the period 2005–2010, , 63% of wo omen aged 15 were marrie ed or in a consensual c union u were u using some form f of con ntraception. T The proporti ion of women rec ceiving anten natal care at a least once e during pregnancy wa as about 81% % for the period p 2005–2011, , but the figu ure dropped to around 5 55% for the recommend ded minimum m of four vis sits or Coun ntdown to 2015 for Maternal l, Newborn and d Child Survival (http://www.countdown201 15mnch.org/, ac ccessed 26 March 2012 2). 1
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more. The propor rtion of birth hs attended b by skilled per rsonnel – cru ucial for redu ucing perina atal, neonatal l and m maternal dea aths – was ab bove 90% in n three of the e six WHO regions r for th he period of f 2005–2011. . Howe ever, improv vements are needed in r regions such h as the African Region,, where cove erage is still l under r 50%. 9. n of neonatal n dea aths fell from m 4.4 millio on in 1990 to 3.1 milli ion in 2010. . The total number Neon natal mortalit ty rates decli ined from 32 2 per 1000 liv ve births to 23 2 per 1000 l live births ov ver the same e period – a 28% re eduction. Th his is a slowe er decline tha an for child mortality ov verall, and th he proportion n of deaths in child dren under fiv ve years old t that occur in n the neonata al period incr reased from 37% 3 in 1990 0 to 40% in 2010. Progress P in developing d re regions has been b uneven, ranging from m a 19% decline in subSahar ran Africa and a Oceania and 33% in n southern Asia A to more than 50% in n northern Africa, A Latin n Amer rica and the Caribbean, and eastern n Asia. The estimated gl lobal numbe er of stillbirt ths fell from m 3.0 m million in 199 95 to 2.6 mi illion in 200 09, with the rate of stillb births declini ing by about 15%, from m 22 pe er 1000 births in 1995 to 19 per 1000 births in 200 09. 10. Early postn natal care is s crucial for r the preven ntion and ma anagement o of conditions that cause e neona atal death. WHO W and its s partners ar re supporting g the strengthening of th he capabilitie es of healthcare w workers to prevent p or ma anage the ma ajor perinata al and neonat tal diseases, including ho ome visits to o newb born children. In addition, WHO is gatherin ng more evi idence on t the most cost-effective e interv ventions, including simpl ler antibiotic c treatment re egimens for treatment t of f neonatal sep psis. 11. About half f the world’s s population is at risk of f malaria, an nd an estimat ted 216 mill lion cases of f malar ria led to 655 000 deaths s in 2010, 86 6% of which h concerned children und der the age of o five years. . In the e WHO Afri ican Region, a total of ei ight countrie es and one ar rea showed a reduction of o more than n 50% in either con nfirmed malaria cases or r malaria adm missions and d deaths. In other WHO regions, the e numb ber of reporte ed cases of confirmed c m malaria decrea ased by more e than 50% i in 35 of the 53 countries s with ongoing tran nsmission be etween 2000 0 and 2010 and a downwar rd trends of 25%–50% were w seen in n four o other countri ies. The estim mated incide ence of malar ria fell by 17 7% globally b between 200 00 and 2010. . Cove erage with in nterventions such s as the d distribution of o insecticide e-treated bed dnets and ind door residual l spray ying has grea atly increased d and needs to be sustain ned in order to prevent re esurgence of f disease and d death hs. 12. The annual l global num mber of new cases of tub berculosis ha as been slow wly falling sin nce 2006. In n 2010, there were an estimated d 8.8 million n new cases, of which about 13% inv volved people e living with h HIV, and 5.7 mil llion of these e cases were e reported by y national tu uberculosis p programmes. In 2010, an n estim mated 1.1 mi illion HIV-negative peop ple died from m tuberculosis, and an additional 350 3 000 died d from HIV-associa ated tubercul losis. Mortal lity due to tu uberculosis has h fallen by j just over on ne-third since e 1990. In 2009, th he treatment success rate e reached 87 7% worldwid de, the third successive year y that the e target t of 85% (fir rst set by the e Health Ass sembly in 19 991) has bee en exceeded.. All WHO’s s six regions s are on n track to ac chieve Targe et 6.C in term ms of tubercu ulosis incide ence rates fal lling by 2015. However, , multi idrug-resistan nt tuberculos sis continues s to pose prob blems. 13. Globally, in i 2010, an estimated e 2.7 7 million pe eople were newly infecte ed with HIV, 15% fewer r than t the 3.1 millio on people ne ewly infected d in 2001. In 22 countries s in sub-Saha aran Africa a similar rate e of de ecline was observed o dur ring the past t decade, bu ut this region n still accou unted for 70% % of all the e peopl le who acqu uired HIV inf fection globa ally. There were w an estim mated 34 mi illion people e living with h HIV at the end of o 2010, an increase from m previous years. y As acc cess to antire etroviral ther rapy in lowand m middle-incom me countries improves (1 16 times mor re people we ere treated in n 2010 than in i 2003), the e popul lation living g with HIV will w continue e to grow si ince fewer people p are dy dying from AIDS-related A d cause es.
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14. The term “negle ected tropica al diseases” covers a gr roup of 17 diseases tha at are endem mic in 149 countrie es,1 affecting g more than a billion peo ople. With th he exception n of dengue a and leishman niasis, these diseases rarely cause c outbreaks and thr rive in the poorest, p mos st marginaliz ized communities, causing sev vere pain, per rmanent disa ability and de eath. WHO has h reached a turning po oint in its effo orts to overcome t these diseases thanks to a coordin nated and in ntegrated ap pproach, ado opted since 2007, involving th he simultane eous use of multiple m safe e and high-q quality donate ed medicine s.With fewe er than 1100 cases reported in 2011, dracu unculiasis is s on the ver rge of eradic cation withou ut the use of o any medication or vaccine. 15. Work k on drinkin ng-water and d basic sanita ation is cov vered by Tar rget 7.C nam mely: to halv ve, by 2015, the p proportion of f the populat tion without sustainable access to sa afe drinking-water. The world has met the e Target with h respect to drinking-wat d ter; in 2010, 89% of the population used an imp proved source of d drinking-wate er compared d with 76% in 1990. Pr rogress has been b impres ssive, nevertheless disparities e exist between n WHO regions. Althoug gh coverage is above 90% % in four of f the six regio ons, it remains low w in the African Region and Eastern n Mediterran nean Region. Based on t the current rate r of progress, th hese two regi ions will fall short of th he 2015 targe et. With rega ard to basic sanitation, current rates of pro ogress are too o slow for th he Target to be met, both h globally an nd within W WHO regions (with the exceptio on of the We estern Pacific c Region). In n 2010, 2500 0 million peo ople lacked a access to imp proved sanitation fa acilities and 72% of these lived in rur ral areas. Th he number of f people in ur rban areas without w improved sa anitation is in ncreasing be ecause of rap id growth in urban popul lations. 16. Altho ough nearly all a countries publish an e essential med dicines list, the t availabili ity of medici ines at public healt th facilities is often lim mited. Survey ys in more than 70 mainly low- an nd middle-in ncome countries in ndicate that the t average availability of selected generic med dicines at he ealth facilitie es was only 42% in the publi ic sector and 64% in t the private sector. s The availability of medicine es for treatment o of chronic, noncommun nicable disea ases is part ticularly poo or when co ompared wit th the availability of medicin nes for acut te illness. In n a study of o 40 countries, the me ean public sector availability of generic medicines m for chronic no oncommunicable diseases was 36%, while in the e same facilities av vailability of medicines for fo acute illne ess was 53.5 5%. Lack of medicines in n the public sector forces patie ents to purcha ase medicine es privately, with generic c medicines in i the private e sector costi ing on 0% more tha an their international ref ference price e. Such low public-secto or availabilit ty and average 610 high private e-sector pric ces drive ma any families – particular rly those wit th a member r suffering from f a chronic non ncommunicab ble disease – into catastro ophic povert ty.
GLOBAL L HEALTH H GOALS AFTER A 201 15 17. With just four years to go bef fore the end of 2015, it is s clear that much m work re remains to be e done if the health h-related Mil llennium De evelopment G Goals are to be achieved d. At the sam me time, the world faces new c challenges th hat need to be b reflected in the way in i which pro ogress is mea asured after 2015. The views o of Member States S can hel lp to shape th he debate on n this subject.
1 The diseases concerned are: den ngue, rabies, tra achoma, Burul li ulcer, endem mic treponemato oses, leprosy, Chagas disease, huma an African tryp panosomiasis, le eishmaniasis, c cysticercosis, dr racunculiasis, echinococcosis, e , foodborne trematode infections, lym mphatic filariasi is, onchocercias sis, schistosomi iasis and soil-tr ransmitted helm minthiases.
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18. Unfinished d business. Reporting R on n achieveme ents has improved, but it t will still be some time e befor re achieveme ent of the ex xisting Goal ls can be ful lly assessed. It is clear, nevertheless s, that many y count tries – partic cularly the poorest p – wil ll need susta ained efforts beyond 201 15 to enable the original l Goals s to be attain ned. Moreove er, as gaps in n income lev vels within and between countries pe ersist or even n widen n, the focus on o inequities s and their co onsequences s for health will w also beco ome sharper. One way to o accelerate progre ess has been to focus on n specific are eas where ac chievements lag behind expectation. . Exam mples includ de the Unit ted Nations Secretary-G General’s Global G Strate egy for Wo omen’s and d Child dren’s Health h, the recom mmendations s of the Un nited Nation ns Commissi ion on Infor rmation and d Acco ountability fo or Women’s s and Childr ren’s Health h,1 and the Political P Dec claration on HIV/AIDS: : intensifying our efforts e to elim minate HIV/A AIDS.2 The Rio Political l Declaration n on Social Determinants D s ealth3 specifi ically addresses the issue e of inequity. of He 19. New challe enges to hea alth. All cou untries face common c challenges relati ting to the he ealth of their r popul lations, man ny of which h go beyond d the health h sector: rap pid, unplanne ed urbanization; ageing g popul lations; comp petition for scarce s natura al resources; economic un ncertainty; m migration; an nd the impact t of cli imate on the fundamental requiremen nts for health h – clean air, safe and suf fficient drink king-water; a secur re food supply; and adeq quate nutritio on and shelte er. Epidemio ological and demographi ic transitions s impose an increa asingly com mplex burden n of infectio ous diseases in tandem with nonco ommunicable e disea ases, mental health diso orders, injuri ies and the consequenc ces of violen nce. Thus, while much h unfin nished busine ess remains, countries ha ave to face the t growing challenges o of chronic co onditions. In n Septe ember 2011, the United Nations Gen neral Assemb bly at its High-level Me eeting on Pre evention and d Contr rol of Non-c communicab ble Diseases adopted a political dec claration call ling for a multipronged m d camp paign by go overnments, industry an nd civil soc ciety to dea al with the risk factors s for major r 4 nonco ommunicable diseases. Specific indicators and a targets to measur re progress are under r devel lopment. 20. New appro oaches to de evelopment. . Thinking ab bout develop pment has ch hanged. The Millennium m Deve elopment Goals evolved, inter alia, th hrough the series s of Uni ited Nations thematic co onferences in n the 1 1990s when social goal ls were dom minant. With h the except tion of Goa al 8, they are primarily y conce erned with low-income l countries. M Many would now argue – in the fac ce of challen nges such as s clima ate change an nd the impac ct of food an nd financial crises – that t the goals ne need to be recast in ways s that r recognize de evelopment as a a process that affects all societies, with indica ators that can n be used to o measure overall global g progre ess towards s sustainable development. d 21. Defining new n goals: the t process. . The debate e on develop pment goals s after 2015 has already y begun n and will fe eature promi inently in fo orthcoming global g meetin ngs, in partic cular the Rio o+20 United d Natio ons Conferen nce on Susta ainable Deve elopment sch heduled to be held on 13 3–22 June 2012. 2 Within n the U United Nation ns system a Task Team, , on which WHO W is repr resented, is p preparing a report r to the e Secre etary General on the post t-2015 develo opment agen nda. The Secretary will al lso appoint a High Level l Panel l to consider this issue af fter the comp pletion of the e Rio+20 Con nference.
Keeping pro omises, measur ring results: Co ommission on In nformation and d Accountability y for Women’s and Children’s s Health h. Geneva, Wor rld Health Orga anization, 2011. . 2 3 4
1
See United Nations N Genera al Assembly res solution 65/277 7. See docume ent EB130/15, Annex. A See docume ent EB130/6, An nnex.
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22. In de efining new goals, it will be import tant to: iden ntify measure es of global progress towards sustainable developmen nt that go beyond b the purely econ nomic measu ures such a as gross dom mestic product; giv ve emphasis to the challenges of inc creasing emp ployment and d social prot tection; and create stronger lin nks between economic, social and e environmenta al policy (th he three pilla lars of sustainable developmen nt). A broade er conception n of developm ment should favour and not n diminish h the role of health. h Health shou uld therefore e be cast as an importan nt contributo or to social, economic a and environm mental developmen nt, and, critic cally, as the benchmark b fo for measuring g the impact of policies in n all areas. 23. Lear rning from success. s The e process of f developing post-2015 goals g that ma maintain a sen nse of focus while e responding g to new ch hallenges w will not be easy e in the more comp plex politica al and institutional l environmen nt that exists s today. In th his regard, it is important t to acknowle edge the attr ributes of the current framewor rk of the Mill lennium Dev velopment Goals G that hav ve contribute ed to its succ cesses: a focus on a limited number n of goals g that re esonate well with politic cians and th he general public, p measurable indicators, and a a defined d timeline. Ir rrespective of o the specifi ic goals, sim milar attribute es will be needed in the future if a new set of goals is t to have the same s degree of acceptanc ce by a worldwide audience. ith the process of 24. The role of WH HO. Setting new health goals needs to be clearly linked wi WHO refor rm. WHO must m be equip pped to face new challen nges and to complete un nfinished bus siness. The purpose e of this repo ort is to stim mulate discuss sion among Member Sta ates about ho ow future goa als for The expression of a com global healt th should be e framed and d measured. T mmon voice on the part of the health secto or will exert a powerful influence on what will in nevitably be a difficult an nd complex debate d between pa arties in num merous sector rs. At the sa ame time, th here needs to be congru uence betwee en the goals that M Member States advocate for the worl ld and the ov verall priorities for the O Organization itself. In other words, the next t set of health h-related Mil llennium De evelopment Goals G should d closely match the priorities to be defined in i the next General G Progr ramme of Work.
ACTION BY THE HEALTH H ASSEMBLY A Y 25. The H Health Assem mbly is invite ed to note th he report and to provide fu urther guidan nce.
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