Millennium Development Goals Carla AbouZahr Coordinator, Statistics, Monitoring and Analysis Department of Health Statistics and Informatics World Health Editors Network Geneva 18 May 2008

Summary Some good news Some good news Some mixed Some mixed Continuing challenges - mortality Continuing challenges - mortality Understanding the nature of the problem Understanding the nature of the problem What needs to be done by What needs to be done by Countries Countries Development partners Development partners WHO WHO

In 2006, childhood deaths fell below 10 million Measles immunization increased since 1990 Underweight prevalence has declined: 58 countries on track to achieve MDG1 76 developing countries on track to reach MDG target on safe drinking water

Use of insecticide treatment bed nets has increased But coverage far short 60% Abuja Declaration target The number of people living with HIV continues to rise but is lower than previously estimated

Child mortality: few countries will achieve MDG 4 *MDG4 = 4.3% annual reduction Source: Christopher Murray Institute for Health Metrics and Evaluation

Progress toward MDG4 Rapid progress is possible. Further analysis of these “well performing” countries under way. No country in sub-Saharan Africa  The 10 countries with least progress are in sub-Saharan Africa Contextual factors  High HIV prevalence  Conflict

Infections and diarrhoea kill most under 5s But one in three deaths occurs in 1st month Source: WHO, World Health Report 2005 Malnutrition

MDG5: Risk of pregnancy and childbirth UNICEF, UNFPA, World Bank estimates for 2005

None of these countries are in sub-Saharan Africa or South Asia Even among the ten “best performers” 7 have ratios over of 13 countries with highest MMRs are in sub-Saharan Africa Progress toward MDG5  High HIV prevalence (>5%, 8/10)  Armed conflict (2/10)

Interventions able to be scheduled routinely (antenatal care) have higher coverage than those needing functional health systems and 24-hour availability (care during delivery, treatment of childhood illnesses) Of 18 life-saving interventions for mothers and children, only vaccinations are reaching 80% coverage

Failures in coverage of care

The poor are least likely to access care: Unmet need for care (coverage gap) higher for poorest than for richest

What can countries do? Invest in health systems Recognize that health services often contribute to increasing inequities Remove financial barriers (user fees, etc) Prioritize diseases of the poor Deploy/improve services where the poor live Employ appropriate delivery channels Monitor implementation, coverage and impact with an equity lens

What can the development community do? Invest in health systems Embed health in social and economic planning; multisectoral response Ensure long-term predictable aid Hold all partners accountable for their performance against international agreements

What will WHO do? Strengthen health situation and trends monitoring: global health observatory Equity focus: poverty, gender, geography Cause-specific mortality trends. Monitor global health initiatives and their impact on health services. Enhance understanding of data limitations and need for investments in health information systems

World Health Statistics 2008 Country-by-country health indicators Ten highlights in global health Understanding the data and estimates