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