Rising to the challenges *

1. Rising to the challenges * Health-related millennium development goals FETP India * Source: World Bank publication of the same name

2. Competency to be gained from this lecture Understand the importance of millennium development goals to drive targeted, outcome-oriented public health efforts

3. Key elements • Millennium development goals • Indicators for the goals • Progress towards the goals

4. 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

5. The millennium development goals • Eradicate extreme poverty and hunger • Achieve universal primary education • Promote gender equality • Reduce child mortality • Improve maternal health • Combat HIV/AIDS, malaria and other diseases • Ensure environmental sustainability • Develop a global partnership for development The goals

6. Millennium development goals directly related to health • Eradicate extreme poverty and hunger • Achieve universal primary education • Promote gender equality • Reduce child mortality • Improve maternal health • Combat HIV/AIDS, malaria and other diseases • Ensure environmental sustainability • Develop a global partnership for development The goals

7. 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

8. 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

9. 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

10. Goal 6: Combat HIV/AIDS, malaria and other diseases • Halt and begin to reverse the spread of these diseases by 2015 The goals

11. Goal 7: Ensure environmental sustainability • Cut in half the proportion of people without sustainable access to drinking water by 2015 The goals

12. Goal 8: Develop a global partnership for development • Provide access to affordable essential drugs in developing countries The goals

13. 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

14. 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

15. 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

16. 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

17. 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 malaria Indicators

18. 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

19. 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

20. Develop a global partnership for development: Indicator for goal 7 • Proportion of population with access to affordable essential drugs on a sustainable basis Indicators

21. 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

22. How is South Asia doing on the millennium development goals? Progress

23. Goal 1: Progress on eradication of hunger in India, 1990-2001 7 0 % 6 0 % < 5 c h i l d 5 0 % m a l n u t r i t i o n ( % ) 4 0 % Proportion (%) 3 0 % P o p u l a t i o n b e l o w m i n i m u m 2 0 % r e q u i r e m e n t s ( % ) 1 0 % 0 % 1 9 9 0 1 9 9 5 2 0 0 1 Y e a r s Progress Source: World development indicators database, April 2004

24. Goal 4: Progress on reduction of child mortality in India, 1990-2001 1 4 0 1 2 0 1 0 0 < 5 m o r t a l i t y r a t e 8 0 Rate per 1000 6 0 I n f a n t m o r t a l i t y r a t e 4 0 2 0 0 1 9 9 0 1 9 9 5 2 0 0 1 Y e a r s Progress Source: World development indicators database, April 2004

25. Goal 5: Progress on improvement of maternal health in India, 1990-2001 0 . 4 5 0 . 4 0 . 3 5 0 . 3 0 . 2 5 B i r t h s a t t e n d e d b y Proportion (%) 0 . 2 s k i l l e d h e a l t h s t a f f 0 . 1 5 0 . 1 0 . 0 5 0 1 9 9 0 1 9 9 5 2 0 0 1 Y e a r s Progress Source: World development indicators database, April 2004

26. Goal 6: Progress on combating tuberculosis in India, 1995-2002 3 5 % 3 0 % 2 5 % 2 0 % Proportion (%) C a s e d e t e c t i o n 1 5 % 1 0 % 5 % 0 % 1995 1996 1997 1998 1999 2000 2001 2002 Y e a r s Progress Source: World development indicators database, April 2004

27. Goal 7: Progress on environmental sustainability in India, 1990-2001 9 0 % 8 0 % 7 0 % 6 0 % A c c e s s t o i m p r o v e d 5 0 % w a t e r s o u r c e Proportion (%) 4 0 % A c c e s s t o i m p r o v e d 3 0 % s a n i t a t i o n 2 0 % 1 0 % 0 % 1 9 9 0 2 0 0 1 Y e a r s Progress Source: World development indicators database, April 2004

28. 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

29. 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

30. 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