accelerating equitable achievement of the mdgs closing gaps in health and nutrition outcomes

Accelerating Equitable Achievement of the MDGs

Closing Gaps in Health and Nutrition Outcomes

Shiladitya ChatterjeeRegional Advisor on the MDGs

Asian Development Bank

Accelerating Equitable Achievement of the MDGs

Closing Gaps in Health and Nutrition Outcomes

Chapter 1 : Progress and statusChapter 2 : Inequalities and disparitiesChapter 3 : Health and nutritionChapter 4 : Looking forward beyond

2015 Conclusions: Implications for public

sector management2

I. STATUS AND PROGRESS

3

Mixed progress since 1990

Access to improved sanitation, rural

Access to improved sanitation, urban

Access to clean water, rural

Access to clean water, urban

Child mortality rate

Maternal mortality rate

Women in non-agricultural wage employment

Gender parity, tertiary

Gender parity, secondary

Gender parity, primary

Primary completion rate

Primary enrollment rate

Underweight children

Income poverty

- 20 40 60 80 100 120 140 160 180 200 220

Latest2015 Forecast2015 Target

Distance to goal achieved by ADB developing member countries since 1990, %4

Regional and sub-regional performance

Source: Staff calculations based on the United Nations MDG Database and World Population Prospects 2010; UNESCO Institute of Statistics for the education-related indicators under Goals 2 and 3, except ‘Reaching last grade’.

5

Asia-Pacific compares well with Africa but not Latin America

II. INEQUALITIES AND DISPARITIES

7

Extent of Disparities Between Countries

Incomepoverty

103.00

0

20

40

60

80

100

East and Northeast

Asia

North and Central Asia South and Southwest Asia Southeast Asia The Pacific

0

20

40

60

East and Northeast

Asia

North and Central Asia South and Southwest Asia Southeast Asia

0

10

20

30

40

50

East and Northeast Asia

North and Central Asia South and Southwest Asia Southeast Asia The Pacific

Infantmortality

Underweightchildren

• The wide disparities in MDG outcomes between countries is evident from the figures below.

8

In many cases, such disparities are widening over time

Ealier Year

Gini coefficient

Later Year

Gini coefficient

1 GDP per capita (2000$) 1990 0.739 2010 0.7532 $1.25 per day poverty 1997 0.426 2004 0.4523 Underweight children 1995 0.296 2005 0.4544 Under-5 mortality 1990 0.378 2009 0.3875 Maternal mortality 1990 0.579 2008 0.5936 TB incidence 1990 0.405 2008 0.447

Gini indices of inter-country distribution of income and selected MDG indicators

Indicator

9

Disparities within countries are also large

Source: Demographic and Health Survey.

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III. HEALTH - THE MAJOR LAGGING SECTOR

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Health spending is critical

Sources: United Nations MDG database for child mortality and World Bank, World Development Indicators online database for health expenditure per capita.

Cross-country variation in child mortality explained by differences in health spending

12

But many countries spend too little

Total health expenditures as share of GDP (%)

13

Forcing large out of pocket expenses in many countries

• Rich should pay for health care – but it must be subsidized for poor

• Costs can be reduced if production of generics is expanded

Spending on more health personnel is critical

• Lack of attendance of skilled health staff at births increases maternal deaths

• Emphasis on primary health care needed

15

Public health services must be effective and corruption-free • Corruption

harms health outcomes

• Public health services less effective in preventing maternal and child deaths than private services

16

More basic infrastructure to support health services necessary

• Better roads improve the proportion of births attended by skilled health staff as shown below.

• Better access to water and sanitation also improve health MDGs

Births attended by skilled health personnel and the extent of paved roads

Sources : The World Bank, World Development Indicators online database for GDP per capita, electricity consumption, and percent of paved road networks; and the United Nations MDG database for skilled birth attendance, access to sanitation and safe drinking water.

17

Better health also depends on empowering women and targeting the socially discriminated

• Women’s education and empowerment− Reduces maternal

and child deaths − Improves family

nutrition− Spreads

awareness of breast feeding and birth spacing

• Lower castes remain deprived in South Asia

ARM

AZEBAN

CAM

PRC

GEO

INDINO

KAZKYR

LAO

MAL

MLD

MONNEP

PAK

PNG

PHI

RUS

SIN

SRI

TAJ

THATUR

UZB

VIE

1.0

2.0

3.0

4.0

5.0

-1.0 -0.8 -0.6 -0.4 -0.2 0.0

ln (U

5 m

orta

lity)

ln (Gender-related development index)

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IV. LOOKING FORWARD

19

Task ahead remains challenging

1990 Latest 20151,878 1,863 1,783

134 83 69 11 9 8

1,574 871 701 36 22 19

856 466 367 7 3 3

77 15 11 0.31 0.14 0.10

1 7 …

Number of people deprived (in millions)

Source: UNESCAP, ADB and UNDP. Accelerating Equitable Achievement of the MDGs: Closing Gaps in Health and Nutrition Outcomes, Asia-Pacific Regional MDG Report . February 2012.

0 10 20 30 40 50 60 70 80

Underweight childrenWithout basic sanitation

Infected with TBLiving below $1.25/dayBirths without skilled birth attendanceWithout safe drinking waterChild deathsOut of primary schoolMaternal deathsLiving with HIV

Asia-Pacific's share of the developing world's deprived people (%)

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The Global Development Agenda beyond 2015

• Ending Asian deprivations will remain critical for Asia’s future

• Rio +20 will shortly begin a process for developing a new set of development goals

• UN Secretary General has called for defining a “new generation of sustainable development goals building on the MDGs”

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Conclusions

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Implications for public sector management

• The task of achieving the MDGs (or SDGs in future) will fall mainly on the public sector

• Improving PSM is therefore critical – as in health – Effectiveness of public health services key for health

outcomes– Adoption of proper strategies and policies, backed by

adequate provision of financial and human resources and infrastructure, is critical

– Efficient implementation and monitoring are essential

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THANK YOU

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