2019 Monitoring health and health system performance in the Eastern Mediterranean Region Core indicators and indicators on the health-related Sustainable Development Goals WHO-EM/HST/245/E
2019 Eastern Mediterranean Region WHO-EM/HST/245/E Monitoring health and health system performance in the i i Core indicators and indicators on the health-related Sustainable Development Goals © World Health Organization 2020 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. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Regional Office for the Eastern Mediterranean Monitoring health and health system performance in the Eastern Mediterranean Region: core indicators and indicators on the health-related Sustainable Development Goals 2019 / World Health Organization. Regional Office for the Eastern Mediterranean p. WHO-EM/HST/245/E 1. Delivery of Health Care - statistics & numerical data 2. Health Status Indicators 3. Health Information Systems 4. Socioeconomic Factors 5. Social Determinants of Health - statistics & numerical data 6. Healthcare Financing 7. Health Systems Plans - Eastern Mediterranean Region I. Title II Regional Office for the Eastern Mediterranean (NLM Classification: W 84) Contents Foreword .................................................................................................................................................................................................................................. 4 Demographic and socioeconomic determinants ................................................................................................................................... 5 Health determinants and risks .............................................................................................................................................................................. 7 Health status (mortality) ............................................................................................................................................................................................. 9 Health status (morbidity, 2018) ........................................................................................................................................................................ 11 Health status (neglected tropical diseases, 2018) ............................................................................................................................ 12 Health financing ............................................................................................................................................................................................................... 13 Health workforce ........................................................................................................................................................................................................... 14 Country capacity ............................................................................................................................................................................................................. 15 Service delivery ................................................................................................................................................................................................................ 16 Coverage of selected interventions ............................................................................................................................................................... 17 List of regional core health indicators ........................................................................................................................................................ 19 Annex: Metadata for new SDG indicators ................................................................................................................................................ 20 Health information and research in the Eastern Mediterranean Region at a glance ......................................... 24 4 Monitoring health and health system performance in the Eastern Mediterranean Region Foreword Reliable and timely health information is essential for policy development, proper health management, evidence-based decision-making, rational use of resources, and the monitoring and evaluation of the public health situation, health care delivery and outcomes. WHO’s thirteenth general programme of work (GPW 13) for 2019–2023 emphasizes the use of data for health policy development and implementation. The focus in GPW 13 on the three “1 billion” goals (1 billion more people with universal health coverage, 1 billion more people better protected from health emergencies, 1 billion more lives made healthier) underlines the need for greater capacity in data collection, research and health information within countries and WHO. Moreover, measuring progress on the Sustainable Development Goals creates even greater demand for producing effective data and information. Both SDG and GPW 13 indicators require subnational disaggregation of data for assessing progress made on the equity dimensions of care and population needs. Improvement in health information not only relies on the generation and collection of valid data, it also requires the appropriate management and analysis of the data. The provision of the data presented in the framework aims to enhance evidence-informed decision-making, in line with our other activities to strengthen the capacities of ministries of health in the use of evidence in policy development. The strengthening of health information systems is a priority for WHO in the Region, as highlighted in Vision 2023, our regional vision for public health. Intensive work with Member States since 2012 has resulted in a clear framework for health information systems. The core indicators focus on three main components: 1) monitoring health determinants and risks; 2) assessing health status, including morbidity and cause-specific mortality; and 3) assessing health system response. The regional core indicators were endorsed by the WHO Regional Committee for the Eastern Mediterranean at its 61st session in 2014, after which Member States started to adopt and report on the indicators. In 2016, the core indicator list was expanded in consultation with Member States to add a set of additional SDG indicators, bringing the total number of core indicators to 75. This year’s report replicates the innovative design that was adopted in 2018, and welcomed by Member States. All SDG 3 indicators are now included in the core list, and we are also reporting for the first time on the coverage of birth and death registration in the Region, a key area of policy interest. These indicators, although they were formally part of the core indicators, were not reported in previous annual reports. Now with improvements and better availability of data in most countries of the Region, they have been added to the report. WHO will continue its efforts to support countries of the Region in strengthening national health information systems. This includes comprehensive health information system assessments, developing national strategies, and improving national capacity in death certification and analysis, International Classification of Disease (ICD) coding and (where appropriate) use of DHIS2 platforms to enhance the reporting of routine data. Additionally, we are working closely with Member States to develop national household survey plans, streamline processes and ensure that key information is available to countries in a timely manner. This publication uses available data drawn from multiple sources, including figures provided by Member States, the latest World Health Statistics publications, the Global Health Observatory, and estimates developed by United Nations agencies including WHO. Every effort has been made to incorporate the most comprehensive, recent and reliable data, and to validate the data with countries within a very short time-frame. I would welcome your input and observations on the data presented here. Dr Ahmed Al-Mandhari WHO Regional Director for the Eastern Mediterranean 5Core indicators and indicators on the health-related Sustainable Development Goals Country Population 2018 Population growth Life expectancy at birth (years) Life expectancy at birth (years), 2016g Total Urban (000s) % % Y T M F Y T M F Afghanistan 31 575 24 3.3 2017 62.7 61.0 64.5 2016 62.7 61.0 64.5 Bahrain 1 501a 100 5.4 2017 77.2a 76.5 78.1 2016 79.1 78.6 79.6 Djibouti 860e … … … 63.8 62.2 65.5 2016 63.8 62.2 65.5 Egypt 92 115a 42 2.4 2015 70.5 70.5 73.3 2017 70.5 68.2 73.0 Iran, Islamic Republic of 79 926 b 74 1.2 2016 75.7 74.6 76.9 2016 75.7 74.6 76.9 Iraq 38 124 70 2.5 2018 71.1 70.0 72.3 2018 69.8 67.5 72.2 Jordan 10 309 90 2.4 2018 73.5 72.8 74.2 2018 74.3 72.7 76.0 Kuwait 4 564 100 10.8 2018 82.1 81.1 83.3 2018 74.8 73.9 76.0 Lebanon 4 485 … 1.4 2018 76.3 75.1 77.7 2016 76.3 75.1 77.7 Libya 6 588 85 3.0 2017 71.9 69.0 75.0 2016 71.9 69.0 75.0 Morocco 35 220 62 1.1 2017 75.8 74.2 77.4 2015 76.0 74.8 77.0 Oman 4 602 … 2.9 2018 77.0 75.0 79.1 2018 77.0 75.3 79.5 Pakistan 207 774a 36 2.4 2017 68.0 66.0 70.0 2017 66.5 65.7 67.4 Palestine 4 854 85 2.6 2018 73.8a 72.3 75.4 2016 73.8a 72.3 75.4 Qatar 2 760 100 1.3 2018 80.7 79.0 82.5 2018 78.1 77.3 79.9 Saudi Arabia 33 414 83 2.4 2018 75.0 73.7 76.4 2018 74.8 73.5 76.5 Somalia 12 316d 42 2.9 2014 56.7 58.4 55.0 2017 55.4 53.7 57.3 Sudan 41 985 31 2.8 2016 65.1 63.4 66.9 2016 65.1 63.4 66.9 Syrian Arab Republic 15 353 a … 2.2 2018 63.8 59.4 68.9 2016 63.8 59.4 68.9 Tunisia 11 435 68 1.2 2017 75.4 74.5 78.1 2017 76.0 74.1 78.1 United Arab Emirates 9 304 84 2.0 2017 79.7 78.1 81.5 2017 78.5 76.0 81.0 Yemen 28 170 29 3.4 2018 64.0 64.0 65.0 2018 65.3 63.9 66.8 a 2017 b 2016 c 2015 d 2014 e 2013 f Country reported, 2018 g Data as reported in World Health Statistcs 2019 report T Total M Male F Female Y Reference year for the data provided … Not available for 2013–2017 or not reported Demographic and socioeconomic determinants (1/2) 6 Monitoring health and health system performance in the Eastern Mediterranean Region Demographic and socioeconomic determinants (2/2) Country Literacy rate (15–24 years) Net primary school enrolment ratio per 100 school-age children Population below the international poverty line Total fertility Adolescent fertility (15–19 years) Rate (R) T M F T M F Per woman Per 1000 girls % % % Y Ratio Ratio Ratio Y % Y R Y R Y Afghanistan 54 68 39 2017 56 66 46 2017 … … 5.1 2018 62.0 2018 Bahrain … …. … …. … … … … … … 1.9 2017 13.4 2017 Djibouti … … … … 59 63 55 2014 … … 3.4 2013 20.6 2016 Egypt 93 … … 2015 53 52 48 2015 26.4 2014 3.5 2014 56.0 2016 Iran, Islamic Republic of 97 97 96 2016 99 99 98 2016 0.2 2017 … … 34.2 2017 Iraq … 78 … 2013 92e 94 83 2014 17.0 2014 3.9 2018 55.0 2018 Jordan 95 97 93 2018 100 100 100 2018 … … 2.7 2018 27.0 2018 Kuwait 100 100 100 2018 100 100 100 2018 … … 1.8 2017 0.0 2017 Lebanon … … … … 93 97 90 2013 … … 1.8 2017 13.1 2018 Libya 100 92d 83d 2015 98 99 98 2016 … … 3.4 2014 10.9 2016 Morocco 89 93 86 2016 82 82 81 2017 2.2 2014 2.4 2017 19.4 2018 Oman 97 97 98 2018 98 99 98 2018 0.0 2014 3.9 2018 10.5 2018 Pakistan 57 68 45 2015 57 60 53 2015 39.0 2016 3.6 2017 46.0 2018 Palestine 99 99 99 2018 98 98 99 2018 29.2 2017 4.4 2017 48.0 2016 Qatar 99 99 99 2017 96 96 97 2017 0.1 2017 1.8 2017 9.8 2017 Saudi Arabia 99 99 99 2017 96 96 96 2018 … … 1.9 2018 7.4 2018 Somalia … … … … 17 18 17 2014 … … 6.4 2015 64.0 2016 Sudan 60 56 60 2014 76 77 76 2014 36.1 2015 5.2 2014 87.0 2016 Syrian Arab Republic … … … … … … … … … … 3.0 2013 54.0 2016 Tunisia … … … … 97 97 97 2016 15.2 2015 2.2 2017 3.0 2016 United Arab Emirates 95 95 94 2018 95 95 95 2017 0.01 2018 2.3 2017 6.4 2017 Yemen … … … … … … … … 48.6 2014 4.4 2013 67.0 2013 0 2 4 6 7 Number of children per woman Somalia Sudan Afghanistan Yemen Palestine Oman Iraq Pakistan Egypt Libya Djibouti Syrian Arab Republic Jordan Morocco United Arab Emirates Tunisia Saudi Arabia Bahrain Qatar Lebanon Kuwait Total fertility rate Net primary school enrolment ratio per 100 school-age children No data available ≤ 59 60–89 90–94 95–97 98+ 7Core indicators and indicators on the health-related Sustainable Development Goals Health determinants and risks (1/2) Country Biological Nutritional Low birth weight among newborns Exclusive breastfeeding 0–5 months of age Y Adults (18+ years) (age-standardized) Children under 5 who are Y Youth (13–18 years) Adults (18+ years), 2016 (age- standardized Anaemia among women of reproductive age (15–49 years) Y Raised blood glucose, 2014 Raised blood pressure, 2015 stunted wasted overweight obese Overweight Obesity Y Overweight Obesity % % % % % % % % % % % % % Afghanistan … 57.5 2018 11.9 30.6 36.6 9.5e 5.4e 2.0e 2018 … … … 23.0 5.5 42.0 2016 Bahrain 10.3 10.7 2017 11.5 21.4 5.6 3.2 4.9 1.3 2017 … … … 65.8 29.8 45.9 2017 Djibouti 29.8 49.3e 2014 8.1 26.8 33.5 17.8 8.1 … 2013 … … … 38.6 13.5 32.7 2016 Egypt 7.0 39.7d 2017 17.9 25.0 22.3 9.5 20.4f 8.5 2014 27.4 8.5 2014 63.5 32.0 28.5 2016 Iran, Islamic Republic of 7.9 53.1 c 2017 12.1 19.7 4.8 4.3 2.9 0.6 2017 20.6 11.3 2016 61.6 25.8 30.5 2016 Iraq 7.1 37.4 2018 17.4 25.2 9.9 2.5 6.6 … 2018 … … … 64.6 30.4 29.1 2016 Jordan 17.0 26.0 2018 16.8 21.0 7.7 2.4 4.4 … 2013 … … … 69.6 35.5 43.0 2018 Kuwait 11.8 6.9 2018 19.6 23.6 7.3 2.6 7.9 3.7 2018 21.9 29.7 2018 73.4 37.9 37.8 2018 Lebanon 8.8 14.8d 2018 13.4 20.7 7.3 6.6 16.7 6.3 2015 … … … 67.9 32.0 31.2 2016 Libya 7.1 67.0 2015 15.9 23.7 21.0 6.5 22.0 10.5 2015 … … … 66.8 32.5 32.5 2016 Morocco 15.4d 35.0 2018 13.7 26.1 15.1a 4.7 10.8a 2.9 2018 … … … 60.4 26.1 36.9 2016 Oman 11.6 23.2 2017 13.5 24.8 11.4 9.3 3.1 1.1 2017 29.0 12.5 2015 62.6 27.0 27.8 2017 Pakistan 22.0 48.4 2018 12.4 30.5 40.2 17.7 9.5 … 2018 … … … 28.4 8.6 42.7 2018 Palestine 6.3 38.6d 2018 … … 7.4 1.2 8.2 … 2014 … … … … … 27.0 2013 Qatar 9.4 29.3e 2017 18.9 22.4 2.3 2.8 8.3 2.3e 2016 44.9 22.4 2018 71.7 35.1 27.7 2016 Saudi Arabia 8.5 41.4 2018 17.4 23.3 7.0 4.8 8.1 0.7 2018 … … … 69.7 35.4 43.7 2018 Somalia … … … 6.8 32.9 42.1 13.2 … … 2015 … … … 28.4 8.3 44.4 2016 Sudan 32.3d 55.4 2017 10.0 30.2 38.2 16.3 3.0 … 2014 … … … 28.9 8.6 53.6 2016 Syrian Arab Republic 9.4 d 25.8 2016 14.6 24.5 1.5 0.4 0.7a 0.7a 2018 … … … 61.4 27.8 24.5 2016 Tunisia 7.5 13.5 2016 12.5 23.2 8.3 2.8c 17.2 2.3e 2016 … … … 61.6 26.9 31.2 2016 United Arab Emirates 10.8 59.7 2017 11.8 f 28.8f …. … … … … 38.4 16.6 2016 67.9f 27.8f 30.3 2016 Yemen 16.3e 11.5 2014 11.3 30.7 47.0 16.3 2.0 0.4 2014 … … … 48.8 17.1 69.6 2016 Raised blood pressure among adults (18+ years), age−standardized No data available ≤ 25.0 25.1+ 0 5 10 15 20 Percentage Kuwait Qatar Egypt Saudi Arabia Iraq Jordan Libya United Arab Emirates Syrian Arab Republic Morocco Oman Lebanon Tunisia Pakistan Iran, Islamic Republic of Afghanistan Bahrain Yemen Sudan Djibouti Somalia Palestine Raised blood glucose among adults (18+ years), age−standardized Raised blood glucose among adults (18+ years), age−standardized 8 Monitoring health and health system performance in the Eastern Mediterranean Region Country Behavioural Environmental, 2019 Insufficient physical activity (13–18 years), 2016 Insufficient physical activity (18+ years), 2016 Tobacco use (13–15 years)h Tobacco use (15+ years)h, 2015 (age- standardized) Harmful use of alcohol (15+ years) Access to improved drinking water Access to improved sanitation facilities % T M F T M F Litres per calendar year per 1000 population% % % % Y % % % Y % % Afghanistan 88.1 … … … … … … … … … … 67 43 Bahrain 81.0 … 17.7 25.0 10.1 2015 21.9 31.5 4.2 … … 100 100 Djibouti 85.2 … 15.2 17.8 11.1 2013 9.9 18.6 1.1 … … 76 64 Egypt 87.5 31.0 13.6 18.1 8.2 2014 22.2 44.2 0.2 … … 100 94 Iran, Islamic Republic of 56.4 33.2 … … … … 10.0 19.3 0.7 2.1 2016 95 88 Iraq 85.0 52.0 14.1 19.4 8.6 2016 … … … … … 97 94 Jordan 84.8 … 24.0 33.9 13.8 2014 38.4d 65.5d 10.2d … … 99 97 Kuwait 84.3 60.9f 16.7 24.2 9.8 2016 18.5 31.0 1.6 … … 100 100 Lebanon 82.1 36.4 11.3 18.8 5.1 2013 25.1 32.6 17.6 … … 93 98 Libya 83.2 36.4 … … … ... … … … … … 99 100 Morocco 87.3 26.2 6.0 7.3 4.4 2016 18.6 37.7 0.5 … … 87 89 Oman 83.8 32.9 … … … … 9.1 12.8 0.3ext … … 92 100 Pakistan 86.9 41.5 10.7 13.3 6.6 2013 16.2 29.5 2.3 … … 91 60 Palestine … 75.3 17.3 23.6 11.0 2014 … … … … … 97 97 Qatar 88.0 36.8 12.1 15.7 8.7 2018 16.4 21.4 0.6 … … 100 100 Saudi Arabia … 85.1a … … … … 14.1a 23.1a 0.7a … … 100 100 Somalia … … … … … … … … … … … 52 38 Sudan 90.3 … 11.7 14.5 7.3 2014 … … … … … 60 37 Syrian Arab Republic 87.5 … … … … … … … … … … 97 91 Tunisia 81.5 30.4 … … … … 28.3 56.9 0.9 … … 96 91 United Arab Emirates 81.9 70.8 f 12.7 17.8 7.7 2016 9.1f 15.7f 2.4f … … 98 99 Yemen 86.4 … 18.7 23.9 9.9 2014 14.3 23.6 5.0 … … 63 59 Health determinants and risks (2/2) Country Neonatal Infant Under-5 Neonatal Infant Under-5 Maternal mortality ratio Age-standardized mortality rates by major cause, 2016 Mortality rate per 1000 live births, UN- IGME 2017 estimates Country reported Per 100 000 live births, UN-MMEIG 2017 estimate Country reported Per 100 000 population R R R R R R Y Ratio Ratio Y Communicable diseases Noncommunicable diseases Injuries Afghanistan 39 52 68 … … … … 638 … … 250 852 153 Bahrain 3 6 7 4 6 8 2017 14 15 2017 15a 158a 17a Djibouti 32 52 62 … … … … 248 … … 428 610 100 Egypt 12 19 22 7 15 20 2018 37 44 2017 62a 827 35a Iran, Islamic Republic of 9 13 15 9 12 15 2017 16 19 2017 44 561 50 Iraq 17 19 30 14 … 23 2018 79 34 2018 68 646 162 Jordan 10 15 17 11 17 19 2018 46 30 2018 44 614 50 Kuwait 4 7 8 5 7 9 2018 12 6 2018 164 579 45 Lebanon 5 7 8 5 7 10 2018 29 13 2018 24 575 36 Libya 7 11 12 7 11d 13d 2017 72 9 2015 59 660 113 Morocco 14 20 23 14 18 22 2018 70 73 2015 77 525 35 Oman 5 10 11 6 9 11 2018 19 15 2018 46 469 49 Pakistan 44 61 75 42 62 74 2018 140 165 2017 233 713 56 Palestine 12 18 21 … … … … 40 … … 2a 521a 26a Qatar 4 7 8 4 6 8 2018 9 4 2018 19 465 44 Saudi Arabia 4 6 7 4 6 9 2018 17 12 2018 67 562 71 Somalia 39 80 127 39 80 … 2017 829 … … 718 645 164 Sudan 30 44 63 33 52 68 2014 295 … … 228 745 96 Syrian Arab Republic 9 14 17 12 19 24 2018 31 … … 41 654 443 Tunisia 8 11 13 9 14 … 2017 43 … … 48 538 40 United Arab Emirates 5 8 9 4 6 8 2017 3 3 2017 40 (10) f 499 (103)f 36 (13)f Yemen 27 43 55 26 43 53 2013 164 … … 172 881 102 0 10 20 30 40 Percentage Jordan Tunisia Lebanon United Arab Emirates Egypt Bahrain Morocco Kuwait Qatar Pakistan Yemen Saudi Arabia Iran, Islamic Republic of Djibouti Oman Syrian Arab Republic Sudan Somalia Palestine Libya Iraq Afghanistan Tobacco use among persons 15+ years, age−standardized Tobacco use among persons 15+ years, age−standardizedAccess to improved drinking water ≤ 60 61–90 91–97 98+ h WHO Report on the Global Tobacco Epidemic, 2017 9Core indicators and indicators on the health-related Sustainable Development Goals Country Neonatal Infant Under-5 Neonatal Infant Under-5 Maternal mortality ratio Age-standardized mortality rates by major cause, 2016 Mortality rate per 1000 live births, UN- IGME 2017 estimates Country reported Per 100 000 live births, UN-MMEIG 2017 estimate Country reported Per 100 000 population R R R R R R Y Ratio Ratio Y Communicable diseases Noncommunicable diseases Injuries Afghanistan 39 52 68 … … … … 638 … … 250 852 153 Bahrain 3 6 7 4 6 8 2017 14 15 2017 15a 158a 17a Djibouti 32 52 62 … … … … 248 … … 428 610 100 Egypt 12 19 22 7 15 20 2018 37 44 2017 62a 827 35a Iran, Islamic Republic of 9 13 15 9 12 15 2017 16 19 2017 44 561 50 Iraq 17 19 30 14 … 23 2018 79 34 2018 68 646 162 Jordan 10 15 17 11 17 19 2018 46 30 2018 44 614 50 Kuwait 4 7 8 5 7 9 2018 12 6 2018 164 579 45 Lebanon 5 7 8 5 7 10 2018 29 13 2018 24 575 36 Libya 7 11 12 7 11d 13d 2017 72 9 2015 59 660 113 Morocco 14 20 23 14 18 22 2018 70 73 2015 77 525 35 Oman 5 10 11 6 9 11 2018 19 15 2018 46 469 49 Pakistan 44 61 75 42 62 74 2018 140 165 2017 233 713 56 Palestine 12 18 21 … … … … 40 … … 2a 521a 26a Qatar 4 7 8 4 6 8 2018 9 4 2018 19 465 44 Saudi Arabia 4 6 7 4 6 9 2018 17 12 2018 67 562 71 Somalia 39 80 127 39 80 … 2017 829 … … 718 645 164 Sudan 30 44 63 33 52 68 2014 295 … … 228 745 96 Syrian Arab Republic 9 14 17 12 19 24 2018 31 … … 41 654 443 Tunisia 8 11 13 9 14 … 2017 43 … … 48 538 40 United Arab Emirates 5 8 9 4 6 8 2017 3 3 2017 40 (10) f 499 (103)f 36 (13)f Yemen 27 43 55 26 43 53 2013 164 … … 172 881 102 UN-IGME: United Nations Inter-agency Group for Child Mortality Estimation UN-MMEIG: United Nations Maternal Mortality Estimation Inter-Agency Group Health status (mortality) (1/2) Maternal mortality ratio per 100 000 live births ≤ 10 11–20 21–50 51–100 101–250 251+ 10 Monitoring health and health system performance in the Eastern Mediterranean Region Country Cancer (all types) Tuberculosis HIV Hepatitis B Malaria Measles Incidence Case notification Estimated number of new infections Number of newly reported cases Hepatitis B incidence ratem Incidence of confirmed cases Total number of reported cases Incidence Rate per 100 000 population Per 100 000 population Per 1000 population Per 1 000 000 population R R N N R N R Afghanistan 100.2 131 840 184 500 8.90 294 691 62.32 Bahrain 105.2 10 …. 40 180 0.00 53o 0.00 Djibouti 87.9 200 540 226 600 26.50 25 319 32.37 Egypt 156.9 8 3 600 2 365 800 0.00 356o 0.24 Iran, Islamic Republic of 141.6 11 4 400 2 055 20 … 625 n 0.05 Iraq 105.5 19 … … 60 0.00 12o 13.17 Jordan 157.8 4 < 100 41 1 000 0.00 41o 0.00 Kuwait 121.8 20 < 100 50 100 0.00 299o 8.13 Lebanon 242.8 10 < 200 162 200 0.00 146o 164.24 Libya 120.3 27 < 500 … 300 … 9 152.22 Morocco 139.6 86 900 1 560 450 0.00 480o 0.23 Oman 103.3 5 < 500 145 400 … 921n 0.00 Pakistan 114.0 170 22 000 1 424 2 800 1.94 965 555 155.98 Palestine 158.6 1 … 4 … 0.00 0 0.00 Qatar 97.3 27 < 100 39 20 0.00 464o 0.73 Saudi Arabia 88.7 8 450 533 300 0.01 2 711n 32.35 Somalia 120.8 111 < 500 891 10 500 2.38 31 030 656.03 Sudan 95.9 48 5 200 … 2 900 39.60 3 581 302p 107.25 Syrian Arab Republic 169.9 15 < 100 59 400 0.00 16 o 13.47 Tunisia 115.4 27 < 500 166 760 0.00 100o 1.05 United Arab Emirates 108.9 1 … 47 24 0.00 3 238 o 13.21a Yemen 76.1 35 1 100 … 2 500 8.55 192 901 362.14 Country Probability of dying between age 30 and exact age 70 from any of cardiovascular disease, cancer, diabetes, chronic respiratory diseases, 2016 Mortality rate from road traffic injuries Mortality rate attributed to household and ambient air pollution, 2016 Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene, 2016 Mortality rate attributed to household and ambient air pollution, 2018 Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene, 2016 Suicide mortality rate Country reported, 2018 WHO estimate, 2016 Per 100 000 population Per 10 000 population Per 100 000 population Country reported Country reported Per 100 000 % R R R R R R R Afghanistan 29.8 5.3 15.1 95 13.9 … … … Bahrain 11.3 4.9a 6.9 15 < 0.1 4.2 0.7 … Djibouti 19.6 … 23.5 99 31.3 … … … Egypt 27.7 5.9 9.7 73 2.0 … … … Iran, Islamic Republic of 14.8 19.9 aj 20.5 35 1.0 … … … Iraq 21.3 15.0 20.7 35 3.0 … … 1.1 Jordan 19.2 7.7 24.4 26 0.6 … … … Kuwait 17.4 10.0 17.6 37 <0.1 … … 1.5 Lebanon 17.9 9.9c 23.8 52 0.8 … … … Libya 20.1 37.1 26.1 43 0.6 … … … Morocco 12.4 11.0 19.6 40 1.9 … … … Oman 17.8 13.8 16.1 22 < 0.1 … … 0.4 Pakistan 24.7 2.4 14.3 113 19.6 17.3 … … Palestine 21.0c 5.4 5.3 26k 1.8k … … … Qatar 15.3 7.1 9.5 13 <0.1 … … 2.0 Saudi Arabia 16.4 17.7 28.8 39 <0.1 … … 1.6 Somalia 21.8 … 27.1 152 86.6 … … … Sudan 26.0 6.0c 25.7 105 17.0 … … … Syrian Arab Republic 21.8 3.5 26.5 44 3.7 … … … Tunisia 16.1 12.8 22.8 57 1.0 … … 3.3b United Arab Emirates 11.1 a 3.8 18.1 16 < 0.1 … … 1.5a Yemen 30.6 … 26.9 90 10.2 … … … j Calendar year 1 March 2017–28 February 2018 k Data from Institute for Health Metrics and Evaluation (IHME) Health status (mortality) (2/2) 0 10 20 30 40 Number per 100 000 population Saudi Arabia Somalia Yemen Syrian Arab Republic Libya Sudan Jordan Lebanon Djibouti Tunisia Iraq Iran, Islamic Republic of Morocco United Arab Emirates Kuwait Oman Afghanistan Pakistan Egypt Qatar Bahrain Palestine Mortality rate from road traffic injuries WHO estimates Reported Mortality rate from road traffic injuries 11Core indicators and indicators on the health-related Sustainable Development Goals Country Cancer (all types) Tuberculosis HIV Hepatitis B Malaria Measles Incidence Case notification Estimated number of new infections Number of newly reported cases Hepatitis B incidence ratem Incidence of confirmed cases Total number of reported cases Incidence Rate per 100 000 population Per 100 000 population Per 1000 population Per 1 000 000 population R R N N R N R Afghanistan 100.2 131 840 184 500 8.90 294 691 62.32 Bahrain 105.2 10 …. 40 180 0.00 53o 0.00 Djibouti 87.9 200 540 226 600 26.50 25 319 32.37 Egypt 156.9 8 3 600 2 365 800 0.00 356o 0.24 Iran, Islamic Republic of 141.6 11 4 400 2 055 20 … 625 n 0.05 Iraq 105.5 19 … … 60 0.00 12o 13.17 Jordan 157.8 4 < 100 41 1 000 0.00 41o 0.00 Kuwait 121.8 20 < 100 50 100 0.00 299o 8.13 Lebanon 242.8 10 < 200 162 200 0.00 146o 164.24 Libya 120.3 27 < 500 … 300 … 9 152.22 Morocco 139.6 86 900 1 560 450 0.00 480o 0.23 Oman 103.3 5 < 500 145 400 … 921n 0.00 Pakistan 114.0 170 22 000 1 424 2 800 1.94 965 555 155.98 Palestine 158.6 1 … 4 … 0.00 0 0.00 Qatar 97.3 27 < 100 39 20 0.00 464o 0.73 Saudi Arabia 88.7 8 450 533 300 0.01 2 711n 32.35 Somalia 120.8 111 < 500 891 10 500 2.38 31 030 656.03 Sudan 95.9 48 5 200 … 2 900 39.60 3 581 302p 107.25 Syrian Arab Republic 169.9 15 < 100 59 400 0.00 16 o 13.47 Tunisia 115.4 27 < 500 166 760 0.00 100o 1.05 United Arab Emirates 108.9 1 … 47 24 0.00 3 238 o 13.21a Yemen 76.1 35 1 100 … 2 500 8.55 192 901 362.14 Health status (morbidity, 2018) Measles incidence per 1 000 000 population 0.00 0.01–2.00 2.01–10.00 10.01–100.00 100.01+ m Cumulated incidence of chronic HBV infection in children 5 years of age n Of which locally transmitted cases were 20 (Islamic Republic of Iran: zero indigenous cases for the first time), 30 (Oman: introduced cases), 194 (Saudi Arabia: only 61 of them were indigenous cases) o Imported cases; no local transmission p of which 1 606 833 were confirmed 0 50 100 150 200 Cases per 100 000 population Tuberculosis case notification, 2018 Djibouti Pakistan Afghanistan Somalia Morocco Sudan Yemen Tunisia Qatar Libya Kuwait Iraq Syrian Arab Republic Iran, Islamic Republic of Lebanon Bahrain Saudi Arabia Egypt Oman Jordan United Arab Emirates Palestine Tuberculosis case notification, 2018 12 Monitoring health and health system performance in the Eastern Mediterranean Region Country Number of people requiring interventions against neglected tropical diseases Population at risk of neglected tropical diseases (subject to treatment campaigns) Dracunculiasisq Leishmaniasis Leprosy Rabies Mycetoma Lymphatic filariasis Onchocerciasis Schistosomiasis Soil-transmitted helminthiases Trachoma N N Afghanistan 0 32 079 45 … … … … … 13 547 677 … Bahrain 0 0 2 … … … … … … … Djibouti 0 37 … … … … … … 110 561b … Egypt 0 572 543 … … 0 … 5 021 586 … 1 736 759 Iran, Islamic Republic of 0 12 423 19 … … … … … … 0 Iraq 0 19 026 … 11 … … … … 2 170 486b … Jordan 0 345 0 … … … … … … … Kuwait 0 … 6 … … … … … … … Lebanon 0 214 0 … … … … … … … Libya 0 2 833 1b 2 … … … … … … Morocco 0 6 909 13 … … … … … … 0 Oman 0 2 1 … … 0 … 0 … 0 Pakistan 0 26 427 403 … … … … … 31 683 212b 3 177 676 Palestine 0 273 … … … … … … … … Qatar 0 4 19 0 0 0 0 0 0 0 Saudi Arabia 0 921 9 0 … 0 … 96 1 870 … Somalia 0 858 1576 … … … … 2 011 376 1 450 981 … Sudan 0 8 001 551 … 633 9 738 546 456 851 7 959 348 1 138 906 4 067 620 Syrian Arab Republic 0 77 307 2 0 … … … … 1 925 000 … Tunisia 0 4 797 2 4 … … … … … … United Arab Emirates 0 0 0 1 0 0 0 12 0 22 Yemen 0 4 569 357 … … … 628 728 1 660 313 6 940 852 1 455 523 Health status (neglected tropical diseases, 2018) q All countries are certified free of dracunculiasis except Sudan Monitoring framework for neglected tropical diseases in the Eastern Mediterranean Region Output Indicators Baseline (2018) 2019 2021 Dracunculiasis: Sudan supported to achieve certification of interruption of transmission and disease-free status Certification process completed 0 0 1 Onchocerciasis: Yemen supported to achieve elimination as a public health problem by 2021 and Sudan by 2026 Number of countries achieving (interruption of transmission) 0 0 4 Schistosomiasis: Somalia, Sudan and Yemen supported to implement Mass Drug Administration. Egypt, Iraq, Libya and Tunisia to achieve elimination as a public health problem by 2021 Number of countries achieving the set goals 0 0 4 Lymphatic filariasis: Yemen supported to achieve elimination as a public health problem by 2019; and Sudan by 2026 Number of countries achieving elimination as a public health problem 0 1 0 Trachoma: 7 countries supported to achieve elimination of trachoma as a public health problem Number of countries achieving elimination as a public health problem 2 3 7 Soil-transmitted helminthiasis: all endemic countries supported to achieve deworming coverage of at least 75% of eligible school-age children Number of countries achieving at least 75% coverage of eligible school- age children 2 ... 4 Cutaneous leishmaniasis: all endemic countries supported to achieve detection and reporting of 75% of estimated incident cases, and treatment of 90% of all detected cases Number of countries achieving the set goals ... ... 8 Visceral leishmaniasis: all endemic countries supported to achieve detection, reporting and treatment of 90% of the estimated incident cases and zero deaths, Number of countries achieving the set goals 0 ... 8 Leprosy: all endemic countries supported to achieve zero G2D (visible deformities) among newly-detected cases and zero Number of countries reporting zero G2D (visible deformities) among newly detected cases 11 13 13 Number of countries reporting zero children among newly-detected cases 14 14 15 Mycetoma: all endemic countries supported to achieve the following goals: capacities on diagnosis and treatment of mycetoma; community sensitization implemented, and referral system; mycetoma included in the national surveillance system Number of countries achieving the set goals 0 1 4 13Core indicators and indicators on the health-related Sustainable Development Goals q All countries are certified free of dracunculiasis except Sudan r country data Health financing Out-of-pocket expenditure (OOPS) as percentage of current health expenditure Country Per capita current health expenditure (CHE) Out-of-pocket expenditure (OOPS) as percentage of CHE Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE) Incidence of catastrophic expenditure at 25% of household consumption or income Incidence of impoverishment due to out-of- pocket health expenditure Population with catastrophic health expenditurer Population impoverished due to out-of-pocket health expenditurer US$ exchange rate % % Y % % Y % % Y Afghanistan 57 77.4 2.0 2016 2.0 4.52 2013 24.7 9.6 2017 Bahrain 1099 28.0 8.4 2016 … … … … … … Djibouti 70 25.8 3.1 2016 … … … … … … Egypt 131 62.0 4.2 2016 … … … 4.4 1.1 2013 Iran, Islamic Republic ofr 415 38.8 22.6 2016 3.8 0.01 2013 2.1 0.5 2017 Iraq 153 78.5 1.7 2016 … … … … … … Jordan 224 28.0 12.0 2016 … … … … … … Kuwait 1068 16.1 6.2 2016 … … … … … … Lebanon 662 32.1 14.3 2016 … … … … … … Libya … … … … … … … … … … Morocco 171 48.6 9.1 2016 … … … … … … Oman 648 5.9 7.6 2016 0.1 … … … … … Pakistan 40 65.2 3.9 2016 … 0.12 2016 0.6 0.9 2014 Palestiner 329 41.9 13.7 2017 0.5 0.87 2015 1.0 … 2018 Qatar 1827 6.2 6.3 2016 … … … 0.0 0.0 2017 Saudi Arabia 1147 14.3 10.1 2016 … … … … … … Somalia … … … … … … … … … … Sudan 152 73.9 10.7 2016 3.3 … … … … … Syrian Arab Republic … … … … … … … … … … Tunisia 257 39.9 13.7 2016 2.7 0.09 2015 … … … United Arab Emirates 1323 18.6 7.9 2016 … … … … … … Yemen … … … … 4.2 3.48 2014 … … … 0 500 1,000 1,500 2,000 US dollars Qatar United Arab Emirates Saudi Arabia Bahrain Kuwait Lebanon Oman Iran, Islamic Republic of Palestine Tunisia Jordan Morocco Iraq Sudan Egypt Djibouti Afghanistan Pakistan Yemen Syrian Arab Republic Somalia Libya Current health expenditure per capita, 2018 Current health expenditure per capita, 2018 No data available ≤ 30.0 30.1–50.0 50.1–70.0 70.1+ 14 Monitoring health and health system performance in the Eastern Mediterranean Region Country Personnel per 10 000 population Registered recent graduates of health profession educational institutions per 100 000 population Physicians Nursing and midwifery Dentists Pharmacists Physicians Nursing and midwifery Dentists Pharmacists R R R R Y R R R R Y Afghanistan 4.0 3.2 0.4 0.7 2018 66.3 57.2 31.1 15.3 2018 Bahrain 22.6 45.4 3.7 5.4 2017 … … … … … Djibouti … … … … … … … … … … Egypt 8.2 15.5 2.1 4.9 2018 12.0 11.5 1.8 13.6 2016 Iran, Islamic Republic of 15.4 21.3 4.0 3.0 2018 5.3 7.3 1.8 1.3 2017 Iraq 9.1 21.2 3.1 3.3 2018 9.4 20.3 2.8 3.3 2017 Jordan 23.0 33.2 7.2 13.1 2018 10.2 6.2 2.6 6.4 2016 Kuwait 25.3 67.2 7.2 6.9 2018 1.7 0.2 1.4 0.6 2018 Lebanon 31.2 37.4 15.6 19.8 2018 … … … … … Libya 22.9 68.8 8.8 6.2 2018 … 2.0 4.3 0.8 2017 Morocco 6.7 8.5 1.0 2.6 2017 2.8 10.6 … … 2017 Oman 21.0 44.0 3.1 5.9 2018 0.8 2.0 0.2 0.6 2016 Pakistan 9.6 4.9 1.0 1.6 2018 7.5 4.6 1.8 1.5 2017 Palestine 21.5 25.9 7.1 11.2 2018 14.6 33.7 7.6 8.2 2018 Qatar 25.0 73.2 6.3 9.0 2018 0.3 0.5 … 0.04 2017 Saudi Arabia 26.4 55.2 5.0 8.7 2018 6.3 7.8 4.7 4.0 2018 Somalia … … … … … … … … … … Sudan 2.8 33.5 2.1 2.4 2018 1.0 … … … 2014 Syrian Arab Republic 11.7 14.0 6.8 9.6 2018 3.4 2.6 3.8 5.3 2017 Tunisia 13.0 38.9s 3.1 2.3 2017 … … … … … United Arab Emirates 24.8 57.9 6.0 8.5 2017 4.8 5.1 6.2 4.1 2017 Yemen 1.7 6.3 0.2 1.0 2018 … … … … … Health workforce s Paramedical personnel including technicians, nurses and nursing assistants 0 5 10 15 Density Lebanon Libya Kuwait Jordan Palestine Syrian Arab Republic United Arab Emirates Qatar Saudi Arabia Iran, Islamic Republic of Bahrain Tunisia Oman Iraq Sudan Egypt Pakistan Morocco Afghanistan Yemen Somalia Djibouti Density of dentists per 10 000 population Density of dentists per 10 000 populationDensity of pharmacists per 10 000 population No data available ≤ 5.0 5.1–10.0 10.1+ 15Core indicators and indicators on the health-related Sustainable Development Goals Country International Health Regulations (IHR) technical areas IHR annual reporting 2018 JEE score 2016– 2018 UHC service coverage index, 2017t Health information system, 2015 Completeness of cause-of- death data, 2017 Detect Prevent Respond Points of entry and other IHR related hazards Birth registration coverage Deaths registration coverage R R R R Y % % % Afghanistan 34.7 50.8 42.9 20.0 2016 35 40 37 62 19 … Bahrain 72.0 86.2 88.6 60.0 2016 88 79 77 100 100 96 Djibouti 33.0 43.0 26.0 23.0 2018 37 33 47 65 17 … Egypt 76.0 81.5 75.7 86.7 2018 82 79 68 100 99 94 Iran, Islamic Republic of … … … … … … … 72 98 95 90 Iraq 41.3 52.3 44.2 53.3 2018 82 47 61 88 75 65 Jordan 53.3 63.1 57.1 46.7 2016 48 56 76 100 85 65t Kuwait 72.0 73.8 75.7 76.7 2017 56 74 76 100 100 59 Lebanon 54.7 58.5 48.6 56.7 2016 58 54 73 99 99 … Libya 44.0 54.0 34.0 37.0 2018 41 43 64 98 90 … Morocco 53.3 56.9 77.1 60.0 2016 75 53 70 96 62 29 Oman 81.3 75.4 90.0 80.0 2017 100 82 69 99 95 74 Pakistan 42.7 52.3 45.7 60.0 2016 51 48 45 40 35 … Palestine … … … … … 18 … 64 97 86 … Qatar 64.0 72.3 70.0 60.0 2016 87 68 68 100 100 50 Saudi Arabia 60.0 66.0 73.0 77.0 2018 69 75 74 99 98 98 Somalia 24.0 38.5 37.1 20.0 2016 31 31 25 7 0 … Sudan 53.3 50.8 65.7 43.3 2016 65 55 44 67 28 … Syrian Arab Republic … … … … … 75 … 60 85 65 … Tunisia 54.7 66.2 57.1 50.0 2016 66 58 70 99 99 29 United Arab Emirates 85.3 84.6 98.6 90.0 2017 95 90 76 100 100 59 Yemen … … … … … 52 … 42 53 10 … t UHC: universal health coverage index Country capacity 0 20 40 60 80 UHC index Bahrain United Arab Emirates Kuwait Jordan Saudi Arabia Lebanon Iran, Islamic Republic of Tunisia Morocco Oman Qatar Egypt Palestine Libya Iraq Syrian Arab Republic Djibouti Pakistan Sudan Yemen Afghanistan Somalia UHC service coverage index 2017 2015 UHC service coverage index 16 Monitoring health and health system performance in the Eastern Mediterranean Region Country Availability of selected essential medicines in public and private health facilities, 2018 Medical devices, 2013 Primary health care facilities Hospital beds Surgical wound infection Annual outpatient visits per capita Density per million population of selected medical devices in public and private health facilities Public Private Computed tomography Radiotherapy Magnetic resonance imaging Mammographs Per 10 000 population % R R Y % Y Ratio Y Afghanistan … … 0.2 … 0.1 0.0 0.8 3.9 2017 … … 2.1 2017 Bahrain 100.0b … 2.3d … 2.3d 29.5d 0.2 17.2 2017 … … 4.9 2017 Djibouti … … … … … … 0.6 14.0 2013 … … 2.6 2013 Egypt … … … 0.8 … … 0.6 14.3 2015 … … 0.5 2014 Iran, Islamic Republic of 96.7 e 96.7e 9.5b 0.9b 3.8b 19.0b 3.5 16.2 2018 … … 4.1 2015 Iraq … … 2.2 0.2 1.6 35.4 0.7 13.2 2017 … … 1.7 2017 Jordan 100.0 100.0 5.5 0.8 2.1 129.1 7.0 14.0 2018 1.7 2018 0.3 2018 Kuwait 100.0 100.0 5.5f 0.9f 5.3f 3.5f 0.2d 19.3 2018 2.7 2017 1.4 2018 Lebanon 75.4e 87.2e 25.1 1.9 8.3 370.2 0.5 27.3b 2018 … … 6.2 2013 Libya … 13.0 9.7 1.0 5.2 … 2.1 32.0 2017 … … 3.0 2016 Morocco … 52.2e 2.0a 0.4 0.3a 1.9a 0.8 10.0 2017 … … 0.7 2016 Oman … … 7.2a 6.0a 1.6a 125.3a 0.5 14.8 2018 … … 3.4 2018 Pakistan … … 0.3 0.1 0.2 1.6 0.5 6.3 2018 … … 1.2 2018 Palestine 100.0 97.0 … … … … 1.6 13.3 2018 … … 1.8 2018 Qatar 98.0a … 9.1a 2.9a 11.2a 225.1a 3.2 12.3 2017 0.5 2017 4.3 2013 Saudi Arabia 97.0 … 6.7f 0.2f 3.1f 3.1f 0.7 22.5 2018 2.0 2017 4.5 2018 Somalia … … … … … … 1.9 8.7 2013 … … … … Sudan 53.7a 69.3a 1.1 0.2 0.3 12.9 1.5 6.6 2018 … … … … Syrian Arab Republic 93.0 e 98.2e … 0.3 … … 0.8 12.6 2018 … … 10.0 2017 Tunisia 70.0e … 8.9 1.6 2.0 22.6 1.9 21.8 2013 … … … … United Arab Emirates 100.0 a 100.0a … 0.6 … … 3.8 14.4 2017 0.7 2017 2.6 2017 Yemen … … 3.6 0.1 1.1 17.6 1.4 0.1 2018 … … … … Service delivery 0 20 40 60 80 Density Sudan Libya Lebanon Saudi Arabia Tunisia Kuwait Bahrain Iran, Islamic Republic of Oman United Arab Emirates Egypt Jordan Djibouti Palestine Iraq Syrian Arab Republic Qatar Morocco Somalia Pakistan Afghanistan Yemen Density of hospital beds per 10 000 population Density of hospital beds per 10 000 populationAvailability of selected essential medicines in public health facilities No data available ≤ 69.9 70.0–89.9 90.0+ 17Core indicators and indicators on the health-related Sustainable Development Goals Country Demand for family planning satisfied with modern methods (UN Population Division estimate, 2017) Antenatal care coverage (1+ visits) Antenatal care coverage (4+ visits) Skilled birth attendence Children under 5 with diarrhoea treated with oral rehydration therapy, 2018 DTP3-containing vaccine/ pentavalent coverage among children under 1 year, 2018 Measles immunization coverage, 2018 Coverage of service for severe mental health disorders Treatment coverage for opioid dependence, 2015 % % % % Y % % % % Y Afghanistan 44.9 63.8 20.9 58.8 2018 48.5 87 82 … … Very limited (1–10%) Bahrain 61.6 100.0 99.1 100.0 2017 … 99 99 3.6 2015 More than 40% Djibouti 44.9 … … … … … 84 86 … … … Egypt 81.0 90.3 87.8 91.5 2015 30.0d 95 94 20.0 2015 Limited (11–20%) Iran, Islamic Republic of 77.3 98.4 96.3 99.3 2015 85.0 c 99 99 56.0 2015 More than 40% Iraq 61.8 52.0 35.0 91.1 2018 81.0 84 83 37.0 2013 … Jordan 61.9 98.0 83.2 99.6 2018 40.0d 96 92 … … … Kuwait 64.6 100.0e 59.8e 100.0 2018 … 91 98 100.0 2015 100%f Lebanon 63.8 94.0 90.0 … 2018 100.0d 94 92 … … … Libya 47.0 99.0 66.3 99.0 2014 60.7d 97 97 … … … Morocco 78.5 88.5 60.9 86.6 2018 10.8a 99 99 … … Limited (11–20%) Oman 38.0 99.4 76.3 98.6 2018 … 99 99 100.0 2017 … Pakistan 51.7 87.4 51.4 69.3 2018 37.4 72 66 … … Very limited (1–10%) Palestine … 100.0 95.5d 100.0 2018 31.5d 100 100 100.0 2018 … Qatar 63.9 100.0 85.0 100.0 2018 … 98 99 100.0 2017 … Saudi Arabia 73.2 98.0e 98.0 99.4 2018 100.0 96 96 100.0 2018 100%f Somalia 48.3 24.2 3.3 38.4 2014 … 69 70 … … … Sudan 33.3 79.1 50.7 77.0 2014 59.3d 93 88 … … … Syrian Arab Republic 60.0 … … … … 93.4 66 80 65.0 2018 … Tunisia 74.7 99.3 86.4 98.6 2016 76.0d 97 96 … … … United Arab Emirates 60.9 100.0 97.3 100.0 2017 100.0 a 99 99 100.0 2013 Substantial (21–40%)b Yemen 58.3 60.6 25.1 44.7 2013 28.0d 80 72 … … … Coverage of selected interventions (1/2) 0 20 40 60 80 85 Percentage Egypt Morocco Iran, Islamic Republic of Tunisia Saudi Arabia Kuwait Qatar Lebanon Jordan Iraq Bahrain United Arab Emirates Syrian Arab Republic Yemen Pakistan Somalia Libya Djibouti Afghanistan Oman Sudan Demand for family planning satisfied with modern methods, 2017 Measles immunization coverage, 2018 ≤ 80 81–90 91–95 96+ Demand for family planning satisfied with modern methods, 2017 18 Monitoring health and health system performance in the Eastern Mediterranean Region Country Tuberculosis treatment success rate of new and relapse TB cases notified, 2017 Suspected malaria cases that have had a diagnostic test Percentage of population sleeping under insecticide- treated nets Adults and children currently receiving ARV therapy among all adults and children living with HIV, estimates, 2018v Key populations at higher risk who have received an HIV test in the past 12 months and know their results % % % Y % PWID SW MSM % Y Afghanistan 91 96 18.2d,u 2018 13 22.5 5.9 17.4 2014 Bahrain 68b 100 N/A 2017 72a … … … … Djibouti 85 100 … … 30 … 99.4 … 2014 Egypt 86 100 N/A 2018 31 95.4 30.2a 96.7a 2018 Iran, Islamic Republic of 86 100 56.5 c 2018 20 27.6e 70.6 … 2017 Iraq 92 100 N/A 2018 … … … … … Jordan 56 100 N/A 2018 84 … … … … Kuwait 89 100 N/A 2018 62 100.0 … … 2018 Lebanon 84 99 N/A 2018 60 … ... 92.3 2018 Libya 59b 100 N/A 2018 44 … … … … Morocco 88 100 N/A 2017 65 36.1 40.1 58.1a 2018 Oman 51 100 N/A 2018 41 0.5 … … 2014 Pakistan 93 92 34.8d 2018 10 39.3 45.0 44.7 2016 Palestine 100 100 N/A 2016 … … … … … Qatar 64 100 N/A 2017 100a … … … … Saudi Arabia 94 100 89.0 2018 94a 90.0 … … 2018 Somalia 86 99 19.8e 2015 30 … 20.0 … 2014 Sudan 80 78 34.7b,u 2018 15a … 84.2 16.9d 2018 Syrian Arab Republic 86 100 N/A 2018 20 … … b … Tunisia 89 100 N/A 2018 39 28.6 7.7 20.0e 2017 United Arab Emirates 88 100 N/A 2018 … … … … … Yemen 89 95 7.1e,u 2017 21a … 21 … 2018 Coverage of selected interventions (2/2) PWID: People who inject drugs SW: Sex workers MSM: Men who have sex with men u In targeted areas v WHO/UNAIDS modelled HIV estimates N/A: Not applicable Adults and children currently receiving ARV therapy among all adults and children living with HIV, 2017 No data available ≤ 20 21–40 41–60 61–80 81+ 0 20 40 60 80 100 Percent Tuberculosis treatment success rate of new and relapse TB cases notified in 2017 Palestine Saudi Arabia Pakistan Iraq Afghanistan Yemen Tunisia Kuwait United Arab Emirates Morocco Syrian Arab Republic Somalia Iran, Islamic Republic of Egypt Djibouti Lebanon Sudan Bahrain Qatar Libya Jordan Oman Tuberculosis treatment success rate of new and relapse cases notified in 2017 19Core indicators and indicators on the health-related Sustainable Development Goals Health determinants and risks Demographic and socioeconomic determinants Population size Population growth rate Total fertility rate Adolescent fertility rate (15–19 years) Net primary school enrolment Population below the international poverty line Literacy rate among persons 15–24 years Access to improved drinking water Access to improved sanitation facilities Risk factors Low birth weight among newborns Exclusive breastfeeding rate 0–5 months of age Children under 5 who are stunted Children under 5 who are wasted Children under 5 who are overweight Children under 5 who are obese Overweight (13–18 years) Obesity (13–18 years) Overweight (18+ years) Obesity (18+ years) Tobacco use among persons 13–15 years Tobacco use among persons 15+ years Harmful use of alcohol (15+ years) Insufficient physical activity (18+ years) Raised blood glucose among persons 18+ years Raised blood pressure among persons 18+ years Anaemia among women of reproductive age Health status Life expectancy and mortality Life expectancy at birth Neonatal mortality rate Infant mortality rate Under-five mortality rate Maternal mortality ratio Mortality rate by main cause of death (age-standardized) Mortality between ages 30 and 70 from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases Mortality rate from road traffic injuries Mortality rate attributed to household and ambient air pollution Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene Suicide mortality rate Morbidity Cancer incidence by type of cancer Tuberculosis notification rate Estimated number of new HIV infections cases Incidence of hepatitis B Incidence of confirmed malaria cases Incidence of measles cases Number of people requiring interventions against neglected tropical diseases Population at risk of neglected tropical diseases (subject to treatment campaigns) Health financing Per capita current health expenditure Out-of-pocket expenditure as % of current health expenditure Domestic general government health expenditure as % of general government expenditure Incidence of catastrophic expenditure at 25% of household consumption or income Incidence of impoverishment due to out-of-pocket health expenditure Population with catastrophic health expenditure Population impoverished due to out-of-pocket health expenditure Health workforce Density of health workers: a- physicians, b-nurses, c- midwives, d-pharmacists, e- dentists Density of recent graduates of registered health profession educational institutions Country capacity International Health Regulations (IHR) technical areas IHR annual reporting Joint external evaluation (JEE) score Health information system Birth registration coverage Death registration coverage Medicines and medical devices Availability of selected essential medicines in health facilities Density per million population of selected medical devices in public and private health facilities Service delivery Density of primary health care facilities Hospital bed density Surgical wound infection rate Annual number of outpatient department visits, per capita Service coverage Demand for family planning satisfied with modern methods Antenatal care coverage (1+; 4+) Births attended by skilled health personnel Children under 5 with diarrhoea receiving oral rehydration therapy DTP3/pentavalent immunization coverage rate among children under 1 year of age Measles immunization coverage rate (MCV1) Coverage of service for severe mental health disorders Treatment coverage for opioid dependence Tuberculosis treatment success rate Percentage of suspected malaria cases that have had a diagnostic test Percentage of population sleeping under insecticide- treated nets Antiretroviral therapy (ART) coverage among all adults and children living with HIV Percentage of key populations at higher risk (people who inject drugs, sex workers, men who have sex with men) who have received an HIV test in the past 12 months and know their results UHC service coverage index Health system response List of regional core health indicators 0 20 40 60 80 100 Percent Tuberculosis treatment success rate of new and relapse TB cases notified in 2017 Palestine Saudi Arabia Pakistan Iraq Afghanistan Yemen Tunisia Kuwait United Arab Emirates Morocco Syrian Arab Republic Somalia Iran, Islamic Republic of Egypt Djibouti Lebanon Sudan Bahrain Qatar Libya Jordan Oman 20 Monitoring health and health system performance in the Eastern Mediterranean Region Annex. Metadata for new SDG indicators Incidence of catastrophic expenditure at 10% or 25% of household consumption or income Abbreviated name Indicator name Domain Subdomain Associated terms Definition Numerator Denominator Disaggregation/additional dimension Method of measurement Method of estimation Measurement frequency Monitoring and evaluation framework Incidence of catastrophic expenditure at 10% or 25% of household consumption or income insert [SDG 3.8.2] Percentage of population with large household expenditures on health as a share of total household expenditure or income Health systems Health system strengthening (HSS) Health financing Proportion of the population with large household expenditure on health as a share of total household expenditure or income. Total number of people with large household expenditure on health as a share of total household expenditure or income (i.e. greater than 10% and 25%). Age (<5) Total number of people Subnational variables available in survey data. Information on household location (urban vs rural); the gender, age and education of the head of the household; household composition (for example, the number of children < 5 years of age, people aged 60 or more years, the number of females); and other socioeconomic variables are useful for equity analysis. Household expenditures on health refer to out-of-pocket payments (OOPs–SHA 2011). OOPs are likely to expose households to financial hardship in particular when they exceed a pre-defined threshold of a household’s budget or non-subsistence spending. When this happens they are characterized as being catastrophic. Within the SDG monitoring framework (SDG indicator 3.8.2), proportion of the population facing financial hardship is measured as the population weighted average of the number of households with “large household expenditures on health” (OOPs) as a share of total household expenditure or income (household’s budget). Large is defined as OOPs exceeding 10% or 25% total household expenditure or income. Household’s sample weight multiplied by the household size is used to obtain representative numbers per person. If the sample is self- weighting then only the household size is used as the weight. For more information about the SDG indicator 3.8.2 please see O’Donnell O, van Doorslaer E, Wagstaff A, Lidelow M. Analysing health equity using household survey data: a guide to techniques and their implementation. Washington, DC: The World Bank; 2008. To fully understand progress towards universal health coverage within the SDG monitoring framework, SDG indicator 3.8.2 should be monitored jointly with SDG indicator 3.8.1 on coverage of essential health services. SDGs indicators are part of a broader universal health coverage monitoring agenda often tailored to specific regions and countries to enable appropriate policy responses. At the regional and country level, there are other indicators used to measure catastrophic expenditures, and at the regional level, there are other indicators used to measure financial hardship. These include a definition of catastrophic OOPs (large health expenditures) in relation to non-subsistence spending in addition to indicator 3.8.2. The global incidence of the proportion of the population with “large household expenditures on health” (OOPs) as a share of total household expenditure or income (household’s budget) using both thresholds 10% and 25% is estimated as the population weighted average of the country level share of people with catastrophic expenditures for a reference year. Incidence at the country level for the reference year is estimated using different methods depending upon the availability of information for that country around or at the reference year. Every 1–5 years depending on implementation of population-based household expenditure surveys led by national statistics offices Impact 21Core indicators and indicators on the health-related Sustainable Development Goals Preferred data sources Other possible data sources Further information and related links Key requirements for the selection of a data source is the availability of information on both household total expenditure and household expenditures on health, from a nationally representative population-based survey; the three most common data sources are household budget surveys, household income and expenditure surveys, and socioeconomic or living standards surveys. These surveys are typically implemented by or in close collaboration with national statistical bureaus. Health surveys with a module collecting expenditure data on both household total expenditure (including on food, housing and utilities) and household expenditure on health A system of health accounts – 2011 edition. Geneva: Organization for Economic Co-operation and Development/ Eurostat/World Health Organization; 2011 (https://www.who.int/health-accounts/methodology/sha2011. pdf?ua=1, accessed 1 October 2019). Incidence of impoverishment due to out-of-pocket health expenditure Abbreviated name Indicator name Domain Subdomain Associated terms Definition Numerator Denominator Disaggregation/additional dimension Method of measurement Proportion of the population with impoverishing health expenditure [links to SDG target 3.8] Proportion of the population with impoverishing health expenditure Health systems Health system strengthening (HSS) Health financing Proportion of the population where a household’s total consumption expenditure or income including household expenditure on health is greater than the poverty line but the household’s total consumption expenditure or income excluding household expenditure on health is below the poverty line. Total number of people whose household’s total consumption expenditure or income including household expenditure on health is greater than the poverty line but the household’s total consumption expenditure or income excluding household expenditure on health is below the poverty line. Total population Subnational variables available in survey data. Information on household location (urban vs rural), the gender, age and education of the head of the household, and other socioeconomic variables are useful for equity analysis. A household’s expenditure on health are defined as formal and informal payments made at the time of getting any type of care (preventive, curative, rehabilitative, palliative or long term care) provided by any type of provider. These payments include the part not covered by a third party such as an insurer. With this definition they correspond to OOPs. The headcount ratio of impoverishing health expenditure aims to capture the impact of OOPs on poverty. The idea is simple: OOPs result in fewer economic resources to spend on other basic necessities identified by a poverty line to such an extent that in some cases a household’s position in relation to such a pre-defined poverty line, before and after spending out-of-pocket on health, changes. Impoverishment can be computed as the difference in the incidence of poverty based on a household’s total consumption expenditure or income, gross and net, on OOPs. A household’s sample weight multiplied by the household size is used to obtain representative numbers per person. If the sample is self-weighting then only the household size is used as the weight. Poverty lines can be defined in different ways. At the global level to demonstrate the interdependency between SDG target 1.1 (eradication of extreme poverty) and SDG target 3.8 (universal health coverage), the international poverty line of US$ 1.90 per day per capita using 2011 purchasing power parities for private consumption shall be used. Such a line tends to be too low for most upper-middle income and high income countries. It might therefore be useful to use a poverty line defined as 50% of median daily household consumption or income per capita. This type of relative line comes closest to the one used by OECD. Ultimately the choice of the poverty line should be tailored to inform evidence-based policy changes at global, regional and national levels. The use of national and regional poverty is critical to fully understand the impact of OOPs on poverty. This indicator is not an official SDG indicator per se but links SDG target 3.8 on achieving universal health coverage directly to SDG target 1.1 on poverty eradication. It is an important complement to SDG indicator 3.8.2. To fully understand progress towards universal health coverage it needs to be monitored jointly with SDG indicator 3.8.1. 22 Monitoring health and health system performance in the Eastern Mediterranean Region Measurement frequency Monitoring and evaluation framework Preferred data sources Other possible data sources Further information and related links Every 1–5 years depending on implementation of population-based household expenditure surveys led by national statistics offices Impact A key requirement for the selection of a data source is the availability of information on both household total expenditure and household expenditures on health, from a national population-based survey; the three most common data sources are household budget surveys, household income and expenditure surveys, and socioeconomic or living standards surveys. These surveys are typically implemented by or in close collaboration with national statistical bureaus. Datasets from these surveys are always available to the ministry of health, typically obtained through technical contacts in-country, but may also be available publically or for direct purchase. Health surveys with a module collecting expenditure data on both household total expenditure (including on food, housing and utilities) and household expenditure on health A system of health accounts – 2011 edition. Geneva: Organization for Economic Co-operation and Development/ Eurostat/World Health Organization; 2011 (https://www.who.int/health-accounts/methodology/sha2011. pdf?ua=1, accessed 1 October 2019). Suicide mortality rate Abbreviated name Indicator name Domain Subdomain Associated terms Definition Numerator Denominator Disaggregation/additional dimension Method of measurement Method of estimation Measurement frequency Monitoring and evaluation framework Preferred data sources Other possible data sources Further information and related links Suicide rate [SDG 3.4.2] Suicide rate (per 100 000 population) Health status Injury and violence Mortality by cause Suicide rate per 100 000 population in a specified period Number of suicide deaths in year x 100 000 Population Age, place of residence, sex Death registration data, including cause of death, often with adjustments for underreporting Modelling using multiple inputs, is often used if no complete and accurate data are available Annual if civil registration data are available, otherwise every five years Impact Civil registration and vital statistics system with high coverage and medical certification of cause of death Special studies, national population-based surveys with verbal autopsy, sample or sentinel registration systems Mental Health Action Plan, 2013−2020. Geneva: World Health Organization; 2013 (http://apps.who.int/iris/ bitstream/10665/89966/1/9789241506021_eng.pdf?ua=1, accessed 2 September 2019). World health statistics 2017. Monitoring health for the SDGs. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/10665/255336/1/9789241565486-eng.pdf?ua=1, accessed 2 September 2019). 23Core indicators and indicators on the health-related Sustainable Development Goals Harmful use of alcohol (aged 15+ years) Abbreviated name Indicator name Domain Subdomain Associated terms Definition Numerator Denominator Disaggregation/additional dimension Method of measurement Unrecorded consumption Method of estimation Measurement frequency Monitoring and evaluation framework Preferred data sources Other possible data sources Further information and related links Total alcohol per capita (age 15+ years) consumption [SDG 3.5.2] Total alcohol per capita (age 15+ years) consumption Risk factors Noncommunicable diseases and nutrition Noncommunicable diseases Total alcohol per capita is the total amount (sum of recorded alcohol per capita three-year average and unrecorded alcohol per capita) of alcohol consumed per adult (15+ years) in a calendar year, in litres of pure alcohol. Recorded alcohol consumption refers to official statistics (production, import, export, and sales or taxation data), while unrecorded alcohol consumption refers to alcohol which is not taxed and is outside the usual system of government control. In circumstances in which the number of tourists per year is at least the number of inhabitants, tourist consumption is also taken into account and is deducted from a country’s recorded alcohol per capita. Sum of recorded and unrecorded alcohol consumed in a population during a calendar year, in litres. Age; forms of disease; location (urban/rural) Mid-year resident population aged 15+ for the same calendar year Age, sex, other relevant sociodemographic stratifiers, where available Recorded consumption: Recorded alcohol per capita (15+ years) consumption of pure alcohol is calculated as the sum of beverage-specific alcohol consumption of pure alcohol (beer, wine, spirits, other) from different sources. The first priority in the decision tree is given to government statistics, the second are country-specific alcohol industry statistics in the public domain (Canadian, IWSR-International Wine and Spirit Research, OIV- International Organisation of Vine and Wine, Wine Institute, historically World Drink Trends), and the third is the Food and Agriculture Organization of the United Nations’ (FAO’s) statistical database (FAOSTAT). For countries where the data source is FAOSTAT, unrecorded consumption may be included in the recorded consumption. The first priority in the decision tree is given to nationally representative empirical data, often from general population surveys in countries where alcohol is legal. The second priority are specific other empirical investigations, while the third is expert opinion. Sum of recorded and unrecorded alcohol consumed in a population during a calendar year Annual Outcome National population-based survey, administrative reporting systems for recorded alcohol per capita, and survey data for unrecorded alcohol per capita. The priority of data sources for recorded alcohol per capita consumption should be given to government statistics on sales of alcoholic beverages during a calendar year or data on production, export and import of alcohol in different beverage categories. For countries where government data on sales or production are not available, the preferred data source would be country-specific and publicly available data from the private sector, including alcohol producers, or country-specific data from FAOSTAT which may also include estimates of unrecorded alcohol consumption. For main categories of alcoholic beverages, “beer” includes malt beers, “wine” includes wine made from grapes, “spirits” include all distilled beverages, and “other” includes one or several other alcoholic beverages – such as fermented beverages made from sorghum, maize, millet, rice, or cider, fruit wine, fortified wine, etc. Data sources for unrecorded alcohol consumption include survey data, FAOSTAT data, other data sources such as customs or police data, and expert opinion. Data sets of FAO and United Nations Statistics Division Follow-up to the political declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. Agenda item 13.1 and 13.2, Sixty-sixth World Health Assembly, 20–28 May 2013. Geneva: World Health Organization; 2013 (http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_ R10-en.pdf, accessed 2 October 2019). for mortality and morbidity recording 19 countries use 81 %, 78 % and 76 % of the core indicators were reported by high-income, middle-income and low- income countries, respectively In in the Region, on average2018 have reported cause-specific mortality data in the last 5 years countries15 Low/low middle income 5 Upper middle income 3 High income 2 countries have NOT conducted a census in the last 10 years10 of countries have national bioethics or ethics committees 77% of ministries of health have research coordination unit or national health research strategies 57% research production in the Region increased 4-fold (to 4.2 papers per 100 000 population) 2003 During 2014toalone produce over of all the Region's health-related research publications universities3 10% 3 or 4 Only countries have established national guideline development programmes academic journals in the Region are indexed in PubMed & IMEMR 83 Health information and research in the Eastern Mediterranean Region at a glance 70 % Only of births and of deaths in the Region are registered appropriately and in a timely manner 54 % 5 2 of the Region's research publications countries produce countries systematically use health technology assessment reports in national policy-making each produce less than of the Region's research publications countries10 1% Only 42 WHO collaborating centres are located in the Region
Department of Science, Information and Dissemination emrgoier@who.int World Health Organization Regional Office for the Eastern Mediterranean Monazamet El Seha El Alamia Street, Extension of Abdel Razak El Sanhouri Street P.O. Box 7608, Nasr City Cairo 11371, Egypt