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Rising to the challenges *
Health-related millennium development goals
FETP India
* Source: World Bank publication of the same name
Competency to be gained from this lecture
Understand the importance of millennium development goals to drive targeted,
outcome-oriented public health efforts
Key elements
• Millennium development goals• Indicators for the goals• Progress towards the goals
Origins of the millennium development goals
• United nations summit, 2001• Endorsement by 147 heads of state• Eight goals• Most of goals directly or indirectly
health related• Outcome oriented
1990-2015 perspective
The goals
The millennium development goals
1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development
The goals
Millennium development goals directly related to health
1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development
The goals
Goal1: Eradicate extreme poverty and hunger
• Cut by half the proportion of people who suffer from hunger between 1990 and 2015
• Implications: Average annual reduction of 2.7 percent
The goals
Goal 4: Reduce child mortality
• Reduce under five mortality by two thirds between 1990 and 2015
• Implications: Average annual reduction of 4.3 percent
The goals
Goal 5: Improve maternal health
• Reduce maternal mortality ratio by three quarters between 1990 and 2015
• Implications: Average annual reduction of 5.4 percent
The goals
Goal 6: Combat HIV/AIDS, malaria and other diseases
• Halt and begin to reverse the spread of these diseases by 2015
The goals
Goal 7: Ensure environmental sustainability
• Cut in half the proportion of people without sustainable access to drinking water by 2015
The goals
Goal 8: Develop a global partnership for development
• Provide access to affordable essential drugs in developing countries
The goals
Eradicate extreme poverty and hunger: Indicators for goal 1
• Indicators Prevalence of underweight children < 5 years of age Proportion of population below minimum level of
dietary energy consumption
• Core intermediate indicators Percentage of children 6-59 month of age who
received one dose of vitamin A in the past six months
Proportion of infants under six months who are exclusively breastfed
Indicators
Reduce child mortality:Indicators for goal 4
• Indicators Under-five mortality rate Infant mortality rate Measles immunization among children
under one
• Selected additional core intermediate indicator Proportion of infants under 6 months
exclusively breastfed Indicators
Improve maternal health:Indicators for goal 5
• Indicators Maternal mortality ratio Proportion of births attended by skilled
health personnel
• Selected additional core intermediate indicators Contraceptive prevalence rate Percentage of women receiving antenatal
care Indicators
Combat HIV/AIDS: Indicators for goal 6
• Indicators HIV prevalence among 15-24 years old pregnant women Condom use rate of the contraceptive prevalence rate Number of children orphaned by HIV/AIDS
• Additional core intermediate indicators Percentage of people using a condom during most
recent higher risk sexual encounter Percentage of STI clients who are diagnosed and
treated according to guidelines Percentage of HIV-positive women receiving anti-
retroviral treatment during pregnancy to prevent mother to child transmission of HIV
Indicators
Combat malaria: Indicators for goal 6
• Indicators Prevalence and death rate associated with malaria Proportion of population in malaria risk areas using
effective malaria prevention and treatment measures
• Additional core intermediate indicators Percentage of patients with uncomplicated malaria who
receive treatment within 24 hours of onset of symptoms Percentage of children under 5 sleeping under
insecticide treated bed nets Percentage of pregnant women sleeping under
insecticide treated bed nets Percentage of pregnant women who have taken
chemoprophylaxis or drug treatment for malariaIndicators
Combat tuberculosis: Indicators for goal 6
• Indicators Prevalence and death rate associated with
tuberculosis Proportion of tuberculosis cases detected
and cured under DOTS
• Additional core intermediate indicators Percentage of estimated new smear-positive
tuberculosis cases registered under the DOTS approach
Indicators
Ensure environmental sustainability:Indicators for goal 7
• Proportion of population with sustainable access to an improved water source, urban and rural
• Proportion of urban population with access to improved sanitation
Indicators
Develop a global partnership for development: Indicator for goal 7
• Proportion of population with access to affordable essential drugs on a sustainable basis
Indicators
How is the world doing with the millennium development goals?
• 80% of the world population lives in countries on track for the target of the malnutrition goal
• 38% of countries accelerated the rate of decline of under 5 mortality during the 1990s
• Progress for under 5 mortality too slow • Sub-Saharan African countries lagging
behind • Poorest countries are the slowest to progress
Progress
How is South Asia doing on the millennium development goals?
Progress
Population weighted average 1990s yearly % change
Proportion of countries on track for target
Proportion of population living in countries on track for target
Under weight prevalence
-3.5% 33.3% 86.4%
Under five mortality
-2.6% 25% 9.7%
Maternal mortality
-2.9% 12.5% 0%
Goal 1: Progress on eradication of hunger in India, 1990-2001
0%
10%
20%
30%
40%
50%
60%
70%
1990 1995 2001
Years
Pro
port
ion (
%)
< 5 childmalnutrition (%)
Population belowminimumrequirements (%)
Source: World development indicators database, April 2004 Progress
Goal 4: Progress on reduction of child mortality in India, 1990-2001
0
20
40
60
80
100
120
140
1990 1995 2001
Years
Rate
per
1000
< 5 mortality rate
Infant mortalityrate
Source: World development indicators database, April 2004 Progress
Goal 5: Progress on improvement of maternal health in India, 1990-2001
00.050.1
0.150.2
0.250.3
0.350.4
0.45
1990 1995 2001
Years
Pro
port
ion (
%)
Births attended byskilled health staff
Source: World development indicators database, April 2004 Progress
Goal 6: Progress on combating tuberculosis in India, 1995-2002
0%
5%
10%
15%
20%
25%30%
35%
1995
1996
1997
1998
1999
2000
2001
2002
Years
Pro
port
ion (
%)
Case detection
Source: World development indicators database, April 2004 Progress
Goal 7: Progress on environmental sustainability in India, 1990-2001
0%10%20%30%40%50%60%70%80%90%
1990 2001
Years
Pro
port
ion (
%)
Access to improvedwater sourceAccess to improvedsanitation
Source: World development indicators database, April 2004 Progress
If they can’t be reached, why do the millennium development goals
matter?• Progress can be quickened irrespective of
the target• Improvement require a focus on the poor• Goals help focus on outcome to work at
all levels• Household• Health system• Communities
• Goals remind what can be achieved
Progress
Making progress towards the millennium development goals
• Use available effective intervention The technology is here, it must be used
• Increase government targeted spending for health
• Work across interrelated areas• Combat diseases• Involve donors
Progress
Take home messages
• The millennium development goals provide guidance towards outcome-oriented inter-related development efforts
• Indicators are available to monitor progress towards the goals
• Targeted efforts towards effective interventions will make a difference