Accelerating Equitable Achievement of the MDGs Closing Gaps in Health and Nutrition Outcomes
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Transcript of 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
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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’.
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Asia-Pacific compares well with Africa but not Latin America
II. INEQUALITIES AND DISPARITIES
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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.
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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
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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
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But many countries spend too little
Total health expenditures as share of GDP (%)
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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
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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
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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.
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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
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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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