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Rising to the challenges *
Health-related millennium development goals
FETP India
* Source: World Bank publication of the same name
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Competency to be gained from this lecture
Understand the importance of millennium development goals to drive targeted,
outcome-oriented public health efforts
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Key elements
• Millennium development goals• Indicators for the goals• Progress towards the goals
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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
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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
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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
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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
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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
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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
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Goal 6: Combat HIV/AIDS, malaria and other diseases
• Halt and begin to reverse the spread of these diseases by 2015
The goals
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Goal 7: Ensure environmental sustainability
• Cut in half the proportion of people without sustainable access to drinking water by 2015
The goals
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Goal 8: Develop a global partnership for development
• Provide access to affordable essential drugs in developing countries
The goals
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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
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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
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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
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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
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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
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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
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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
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Develop a global partnership for development: Indicator for goal 7
• Proportion of population with access to affordable essential drugs on a sustainable basis
Indicators
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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
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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%
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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
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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
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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
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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
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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
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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
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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
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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