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Technical briefing on Millennium Development Goals Session 1 Progress and major challenges that remain
Technical briefing on Millennium Development Goals
Session 1
Progress and major challenges that remain
The health-related MDGsThe health-related MDGs
8 MDG goals, 3 health-focused (MDGs 4, 5 and 6)
9 health-related targets, MDGs 1, 4, 5, 6, 7, 8
23 indicators
Progress & ChallengesProgress & Challenges
Pace of progress: getting there?
Progress the same for different interventions?
Progress and inequities – what differences? Between regions Between countries Within countries
Challenges: daunting, but doable and measureable?
Progress & ChallengesProgress & Challenges
Pace: getting there?
Progress across interventions
Inequities:
Between regions,
Between countries
Within countries
Challenges: daunting, doable, measureable?
Health-related MDGs – global progressHealth-related MDGs – global progress
UnderweightMDG1Child mortalityMDG 4Measles immunizationMaternal mortalityMDG 5Skilled birth attendantContraceptive prevalenceHIV/AIDS incidenceMDG 6Tuberculosis treatment successMalaria impactSafe waterMDG 7SanitationEssential medicinesMDG 8
Is the pace of change sufficient? MDG 4: Reduce child mortality
Is the pace of change sufficient? MDG 4: Reduce child mortality
0
10
20
30
40
50
60
70
80
90
100
1990 1995 2000 2005 2010 2015
Target: 2/3 reduction from 1990 levels
Achievement by 2008: 1/3 reduction
Dea
ths
per 1
000
live
birth
s
0.5
0 1 2 3 4 5 6
MDG Required annual pace of decline
Lancet estimates 1990-2008
UN estimates 1990-2005New UN estimates - in preparation
Is the pace of change sufficient? MDG 5: Improve maternal health Is the pace of change sufficient? MDG 5: Improve maternal health
Annual average rate of change %
Malaria:
38 countries on track to reduce the malaria-related burden of disease
9 African countries; 29 outside Africa
Is the pace of change sufficient? MDG 6: Combat AIDS, malaria and other diseases
Is the pace of change sufficient? MDG 6: Combat AIDS, malaria and other diseases
0
50
100
150
200
250
300
350
19911992
19931994
19951996
19971998
19992000
20012002
20032004
20052006
20072008
per 1
00 0
00 p
opul
atio
n
Prevalence of TB
0
0.5
1
1.5
2
2.5
3
3.5
4
1990199119921993199419
95199619
97199819
99200020
01200220
0320042005200620072008
Num
ber o
f peo
ple
(in m
illio
ns)
Incidence of HIV infection
Progress towards the health-related MDGsProgress towards the health-related MDGs
Pace: getting there?
Progress diverges across interventions
Inequities:
Between regions,
Between countries
Within countries
Challenges: daunting, doable, measureable?
Progress across interventions: the fast and the slowProgress across interventions: the fast and the slow
00.5
11.5
22.5
33.5
44.5
2002 2003 2004 2005 2006 2007 2008
FAST - scale-up of people receiving ARVs in low- and middle-income countries
Millions
0
10
20
30
40
50
60
70
80
90
100
1990-1999 2000-2008
SLOW – coverage of skilled attendant at delivery, especially in Africa
Skilled birth attendant%
Receiving ARVs
FAST but from a low baseline – household ownership of insecticide-treated mosquito nets
SLOW but picking up – coverage of measles immunization
0
10
20
30
40
50
60
70
80
90
100
1990 2000 2008
Measles immunization
Progress across interventions: the fast and the slowProgress across interventions: the fast and the slow
0
10
20
30
40
50
60
70
80
90
100
2004 2005 2006 2007 2008
ITN ownership% %
FAST – Access to safe water in low-income and lower middle income countries
SLOW – access to sanitation, globally, and in low-income and middle-income countries
Progress across interventions: the fast and the slowProgress across interventions: the fast and the slow
0
10
20
30
40
50
60
70
80
90
100
1990 2008
Low-income Lower middle income
Access to safe water%
0
10
20
30
40
50
60
70
80
90
100
1990 2008
Low-income African region
Access to sanitation%
0
20
40
60
80
100
Variation in coverage across interventions; low- and lower middle-income countries
Variation in coverage across interventions; low- and lower middle-income countries
AN
C 1
+
AN
C 4
+
Skill
ed b
irth
atte
ndan
t
PMTC
T
DPT
3
Mea
sles
ITN
s<5
OR
T
AR
I tre
atm
ent
Con
trac
eptio
n
TB tr
eatm
ent
succ
ess
AR
Vsfo
r H
IV/A
IDS
Dipping in and out of the health care system
Progress towards the health-related MDGsProgress towards the health-related MDGs
Progress: getting there?
Pace: too slow?
Progress diverges across interventions
Inequities:
Between regions,
Between countries
Within countries
Challenges: daunting, doable, measureable?
Health-related MDGs – Scorecard 2010Health-related MDGs – Scorecard 2010AFR AMR EMR EUR SEA WPR World
Child Mortality
Measles immunization
Maternal mortality
Skilled birth attendant
Contraceptive use
HIV/AIDS incidence
TB treatment success
Malaria impact
MDG 4
MDG 5
MDG 6
Progress towards the health-related MDGsProgress towards the health-related MDGs
Progress: getting there?
Pace: too slow?
Progress diverges across interventions
Inequities:
Between regions,
Between countries
Within countries
Challenges: daunting, doable, measureable?
Striking declines in under five mortality 1990-2008
Progress towards the health-related MDGsProgress towards the health-related MDGs
Progress: getting there?
Pace: too slow?
Progress diverges across interventions
Inequities:
Between regions,
Between countries
Within countries
Challenges: daunting, doable, measureable?
The poorest are least likely to use health care: especially use of skilled care during childbirth The poorest are least likely to use health care: especially use of skilled care during childbirth
0
20
40
60
80
100
Poorest 20% Middle 20% Least poor20%
Perc
enta
geMeasles immunization coverage Skilled birth attendants
Data for 47 developing countries
Progress towards the health-related MDGsProgress towards the health-related MDGs
Progress: getting there?
Pace: too slow?
Progress diverges across interventions
Inequities:
Between regions,
Between countries
Within countries
Challenges: daunting, doable, measureable?
Don't turn away now Don't turn away now
~ .5 m cases multidrug resistant TB
1 m malaria deaths
2.7 m new HIV infections
3 m diarrhoea & pneumonia deaths in children
5 m people in need without access to ARVs
8.8 m deaths in children under 5 years
1100 m people without access to sanitation
Accelerate and maintain momentum and solidify the gains; sustain high level political commitment
Ensure sustainability of resources in times of economic crisis
Strengthen health systems to deliver integrated interventions across the life course.
Promote implementation research to learn from successes and failures across countries and interventions.
Build sound information systems that can generate high frequency data to monitor change.
Addressing the challenges Addressing the challenges
Who's counting?Who's counting?
40 million babies born but not registered each year
40 million people die unregistered each year
85 countries, with 66% of the world's population do not have reliable cause of death statistics
"….. the consequences of inadequate systems for civil registration – that is, counting births and deaths and recording the cause of death….. Without these fundamental health data, we are working in the dark. We may also be shooting in the dark. Without these data, we have no reliable way of knowing whether interventions are working, and whether development aid is producing the desired health outcomes."
Dr Margaret Chan, Director-General 12 November 2007
ConclusionsConclusions
Pace of progress: 1990s pace was slow, but much better progress in recent years
Interventions: new interventions doing better than the old, but more effort required to achieve and sustain universal coverage
Inequities: large, especially for African region, selected countries within regions and within countries almost everywhere
Challenges: daunting indeed, but doable, given continuing commitment and resources, strengthened health systems, and better information and research.
