Achieving the health-related Millennium Development Goals in the Western Pacif ic Region
2010
1 4 5 6 7 8
“These Millennium Development Goals are a promise of world leaders.
They’re a blueprint to help those most vulnerable and poorest people, to lift them out of poverty.
This promise must be met.”
—
UN Secretary-General Ban Ki-moon1
The Millennium Development Goals
z In 2000, 189 heads of state adopted the UN Millennium Declaration.
z Eight Millennium Development Goals
(MDGs) were established to be met by 2015 by working together to reduce poverty and hunger, and tackle ill-health, lack of education, gender inequity, lack of access to clean water and environmental degradation.
2
World Africa Americas Eastern
Mediterranean Europe South-East
Asia Western Pacific
4 Under-5 mortality1
per 1000 live births (2009) 60 127 18 72 13 59 21
Measles immunization
% coverage (2008) 81 73 93 83 94 75 93
5
Maternal mortality2
per 100 000 live births (2008) 260 620 66 320 21 240 51
Skilled birth attendant
% births (2000–2008) 66 47 92 59 96 49 92
Contraceptive use
% married women aged 15–49
(2000–2008) 62 24 71 43 68 58 83
6
HIV/AIDS prevalence
% adults aged 15–49 (2007) 0.8 4.9 0.5 0.2 0.5 0.3 0.1
Malaria mortality
per 100 000 population (2006) 17 104 0.5 7.5 – 2.1 0.3
TB treatment
success rate % (2007) 86 79 82 88 67 88 92
7
Water
% using improved sources (2008) 87 61 96 83 98 86 90
Sanitation
% using improved facilities (2008) 60 34 87 61 94 40 62
Health MDGs scorecard for WHO regions
On track Insufficient progress Off track Source: World Health Statistics 2010.
3
The scorecards reveal clear priorities
z The Western Pacific Region is making better progress towards the health MDGs than other WHO regions.
z But progress is unequally spread both within and between countries, with rural and poor populations lagging behind.
z Reducing the number of maternal and child deaths is the most urgent and obvious priority.
z An estimated 13 000 maternal deaths occurred in the Region in 2008, with poor women being most affected.
z On the positive side, child mortality rates have improved significantly with under-5 deaths dropping by two thirds since 1990.
z HIV/AIDS prevalence is low, stable or decreasing: at 1% or less in all countries in the Region.
4 Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon
Islands Viet Nam
4 Under–5 mortality3
per 1000 live births (2008) 89 21 18 61 6 41 69 32 36 14
Measles immunization4
% coverage (2009) 92 94 94 59 95 94 58 88 60 97
5
Maternal mortality2
per 100 000 live births (2008) 290 38 26 580 31 65 250 94 100 56
Skilled birth attendant5
% births (2000–2009) 44 98 99 20 100 100 39 60 43 88
Contraceptive use5
% married women aged 15–49
(2000–2008) 40 87 – 32 – 66 – 51 – 79
6
HIV/AIDS prevalence6, 7
% adults aged 15–49 (2007) 0.8 0.1 0.1 0.2 0.5 0.1 0.9 <0.1 – 0.5
Malaria mortality8, 9
per 100 000 population (2008) 1.4 <0.1 – 0.2 0.1 – 9.7 <0.1 4.1 <0.1
TB treatment10
success rate % (2007) 94 94 81 92 72 89 39 89 92 92
7
Water11
% using improved sources (2008) 61 89 – 57 100 76 40 91 70** 94
Sanitation11
% using improved facilities (2008) 29 55 – 53 96 50 45 76 32** 75
On track Insufficient progress Off track
Health MDGs scorecard for LMICs* in the Western Pacific Region (with population ≥ 250 000)
* LMICs – Low- and middle-income countries; **Data applies to 2006, source #12.
Refer to page 18 for health MDGs scorecard colour code for LMICs in the Western Pacific Region.
5 Cook
Islands Kiribati Marshall Islands, the
Micronesia, the Fed.
States of Nauru Niue Palau Samoa Tonga Tuvalu Vanuatu
4 Under-5 mortality3
per 1000 live births (2008) 15 48 36 39 45 28 15 26 19 36 33
Measles immunization4
% coverage (2009) 78 82 94 86 99 99 75 49 99 90 52
5
Maternal mortality2
per 100 000 live births (2008) – – – – – – – – – – –
Skilled birth attendant5
% births (2000–2009) 100 90 95 88 97 100 100 100 99 100 93
Contraceptive use5
% married women aged 15–49
(2000–2008) – 36 – – 36 – 33 – – – –
6
HIV/AIDS prevalence6, 7
% adults aged 15–49 (2007) – – – – – – – – – – –
Malaria mortality8, 9
per 100 000 population (2008) – – – – – – – – – – 0.4
TB treatment10
success rate % (2007) 100 93 96 65 100 – – 92 93 75 93
7 Water11
% using improved sources (2008) 95** 65** 94 94** 90 100 89** 88** 100 97 83
Sanitation11
% using improved facilities (2008) 100 33** 73 25** 50 100 67** 100 96 84 52
Due to very small population size and low incidence and prevalence of some diseases, there are no estimates for some indicators; small population size also makes
classification of progress towards MDG targets infeasible. * LMICs – Low- and middle-income countries; **Data applies to 2006, source #12.
Health MDGs scorecard for LMICs* in the Western Pacific Region
(with population < 250 000)
6 MDG target: Reduce by two thirds, between 1990 and 2015, the under-5 mortality rate
MDG 4 Reduce child mortality
4
Child mortality in the Western Pacific Region has been significantly reduced.
Cambodia, the Lao People’s Democratic Republic, Papua New Guinea and Mongolia still have very high numbers of child deaths.
Figure 1: Proportion of 1-year-old children immunized against measles in LMICs in the Western Pacific Region, 2009.4
Only a few LMICs in the Region have been able to consistently achieve at least 95% immunization coverage for each of the past three years.
At least 65% of all child deaths in the Western Pacific Region are caused by neonatal conditions, pneumonia and diarrhoea, with an increasing proportion occurring in the neonatal period.
Table 1: Causes of under-5 mortality in the Western Pacific Region, 2008.5
Neonatal
causes
45.5 %
Malaria0.6 %
Pneumonia
16.0 %
HIV/AIDS0.4 %
Injuries
6.8 %
Measles0.4 %
Diarrhoea
4.0 %
Others26.2 %
≥ 90% coverage
< 90% coverage
Measles immunization reaching:
All maps in the document are stylized and not to scale. The boundaries shown and the designations used on the maps used in this document do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. White lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2010. All rights reserved.
Focus should be on reaching more remote, underserved, rural and poor populations to increase or maintain 95% immunization coverage for measles and other vaccine- preventable diseases.
7 MDG target: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
MDG 5 Improve maternal health
5
Maternal mortality has been reduced in the LMICs of the Region.
Cambodia, the Lao People’s Democratic Republic and Papua New Guinea have unacceptably high numbers of maternal deaths.
Figure 2: Births attended by skilled health personnel in LMICs in the Western Pacific Region, 2000–2009.5
Wide variation across LMICs in the coverage of skilled attendance at delivery, and coverage is low in countries where most maternal deaths occur.
≥ 85%
60%–85%
<60%
Proportion of births attended by skilled health personnel (%)
Contraceptive prevalence rate remains low in most LMICs in the Western Pacific, and data availability for this indicator is also an issue.
Figure 3: Contraceptive prevalence rate (%) in LMICs in the Western Pacific Region, 2000–2008.5
87
33 36 36
79 51
66 32
Cambodia 40 China Lao PDR Mongolia Philippines Viet Nam
Kiribati Nauru Palau Countries with population ≥ 250 000
Countries with population < 250 000
MDG SCORECARD
Generating accurate data on maternal mortality is difficult and depends on robust, accurate and timely vital statistics.
8 MDG target: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
MDG 6 Combat HIV/AIDS, malaria and other diseases
6
HIV / AIDS
Malaria
Figure 4: HIV prevalence rate among population aged 15–49 years in selected LMICs in the Western Pacific Region, 1990–2007.6, 7
Figure 5: Proportion of children under-5 sleeping under insecticide-treated bednets in LMICs in the Western Pacific Region, 2004–2009.8
1 400 000 people are living with HIV or AIDS in the Western Pacific Region, and only 31% of people with HIV have access to antiretroviral drugs (2008).
The Region has avoided a major HIV epidemic, with HIV prevalence relatively low and stabilizing.
Condom use and coverage of preventive interventions for most- at-risk populations are increasing.
Malaria incidence and mortality have been decreasing since 1990.
Where data are available, they show that use of insecticide- treated bednets among children under 5 is low.
Malaria is endemic in some countries in the Region, and is often linked to poverty.
20
43 17
67 41
36 28
40
95 Cambodia
Lao PDR Papua New Guinea Philippines Solomon Islands Vanuatu
HIV prevalence rate
0.0 0.5 1.0 1.5 2.0 2.5
1990 1995 2000 2005 2010
Cambodia
Malaysia
Viet Nam
Fiji Lao People’s Democratic Republic
Papua New Guinea
China 0.1
0.2 0.3 0.4
Mongolia
20042006 20072008 2009
Tuberculosis
Multidrug-resistant and extensively drug-resistant TB threaten TB control efforts in the Region.
The Region is on track to achieve the goal of halving TB prevalence and mortality by 2015.
DOTS coverage in LMICs remains high, while the case detection rate is 70% (2008) and the treatment success rate above 85% (2007).
9 MDG target: Halve, between 1990 and 2015, the proportion of
people who suffer from hunger
MDG 1 Eradicate extreme poverty and hunger
1
Figure 6: Prevalence of underweight children under 5 years of age (%) in LMICs with ≥ 250 000 population, 1983–2008.5
The prevalence of underweight children under 5 has been reduced in the populous LMICs in the Western Pacific.
Cambodia China Lao PDR Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam
0% 10% 20% 30% 40% 50%
1996
1994 1999
1983 1993 1989
1993 2005
2003 2007
2008 1992
2008
2006 2005
2002
Earliest data available Latest data available Target
The number of underweight children in Lao PDR and Papua New Guinea is still of concern.
Pacific island countries lack data on nutrition.
MDG target: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation
MDG 7 Ensure environmental sustainability
7
Solomon Islands
Cambodia Lao PDR
Micronesia, Fed. States of
Palau Mongolia
Marshall Islands Papua New Guinea Viet Nam
Kiribati Vanuatu Philippines Tuvalu China Tonga Malaysia
Cook Islands
Niue Samoa
The Region is on track to reach the MDG target for use of improved drinking-water sources and sanitation facilities.
Access to safe water and sanitation is still very low in many countries, especially in rural areas.
Figure 7: Proportion of population using an improved drinking-water
source in LMICs in the Western Pacific Region, 2006–2008.11, 12 Figure 8: Proportion of population using an improved sanitation facility in LMICs in the Western Pacific Region, 2006–2008.11, 12
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%
Urban Rural
Urban Rural Papua New Guinea
Mongolia Solomon Islands
Cambodia Kiribati
Lao PDR
Vanuatu China
Cook Islands Viet Nam
Philippines Samoa Malaysia Micronesia, Fed. States of
Tuvalu Niue Tonga
Marshall Islands
Palau
8
MDG target: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries
MDG 8 Develop a global partnership for development
Access to essential medicines is limited by high out-of-pocket payments.
Sale of counterfeit and substandard medicines is a problem across the Region, endangering public safety.
Irrational use of medicines is increasing the risk of drug resistance.
10
z Faster progress towards the health MDGs will depend on better health systems to deliver effective interventions.
z Effective and affordable interventions exist to address much of the burden of disease. To deliver these, countries need to scale up staff, medicines, infrastructure and information, especially in remote and underserved areas.
z Requires coherent health policies, comprehensive health strategies, and the prioritization of health in national development plans.
z Better health requires coherent policies and a comprehensive approach that also addresses the social, environmental and economic determinants of ill-health.
z Strategies that seek synergies between programmes get better results and can accelerate progress towards the MDGs.
z Greater investment in health information systems is needed to monitor health outcomes and the performance of health systems.
= Improving
health outcomes National health
policy and strategy
11
Policy to outcomes
The comprehensive national health plan which describes the
• context, needs and priorities
• structure and governance
• functions and financing
• targets and monitoring
Based on the Three Ones;
• one plan
• one coordinating framework
• one monitoring system
National health policy and strategy
Service delivery and infrastructure Health workforce Health information
Medical products and technology
Financing
Leadership and governance
National health system
Counselling and education
Clinical interventions, e.g.
diagnosis and treatment of disease
Protective interventions, e.g. vaccination
Enabling environment, e.g.
water and sanitation, public health legislation
Socioeconomic interventions, e.g. housing, education Leadership and governance
Interventions and programmes
Reduced mortality and morbidity
Reduced risks and threats to health
Reduced inequities in health
Improved health of women and children
Better health outcomes Policy
framework National
National development policy and plan
Poverty reduction strategy
Legislative framework
Global
Millennium Declaration and Development Goals
Primary Health Care reforms Paris Declaration on Aid Effectiveness
Abuja Declaration (2001)
International Health Regulations (2005) Framework Convention on Tobacco Control
12
z Health systems are designed to deliver a set of effective clinical and public health interventions over the life course to achieve better health outcomes.
z Increased investment is needed in interventions and systems that improve the health of women and children, who together represent 80% of the population.
z Expanded family planning services, and a better continuum of care between different levels of the health system and across different stages of the life-cycle, will result in fewer maternal and child deaths.
z Essential protective and clinical interventions such as immunization and treatment of disease are necessary but insufficient; socioeconomic factors must also be addressed.
z Different interventions can contribute to multiple outcomes. LMICs should consider combined approaches, such as immunization services with growth monitoring, distribution of bednets and micronutrient supplements.
Delivering effective interventions
in the Western Pacific Region
13
Interventions over the life course
PRE-PREGNANCY PREGNANCY BIRTH POSTNATAL CHILDHOOD ADOLESCENCE ADULT/OLDER AGE
Socioeconomic interventions
Enabling environment
Protective interventions
Clinical interventions
Counselling and education
Housing, Education, Employment, Early childhood development, Empowerment of women and gender equity Safe water and improved sanitation, Reducing stigma and discrimination, Encouraging physical activity, Better nutrition, Road safety, and Health legislation
Family planning Growth monitoring Family planning
Vitamin A, micronutrients Cancer screening
Deworming and other preventive treatment for NTDs Preventing mother-to-child transmission of HIV
Immunization
Insecticide-treated nets and indoor residual spraying Intermittent
preventive malaria treatment
Antenatal care Safe delivery Management of
childhood illness
Early detection, diagnosis and treatment of noncommunicable diseases (NCDs): cardiovascular disease, diabetes, cancer and asthma
Postpartum and newborn care
Diagnosis and treatment of HIV/AIDS, TB, malaria, neglected tropical diseases (NTDs), and other infectious diseases Promotion of healthy lifestyle (alcohol, diet, smoking, physical activity, etc.)
Promoting breastfeeding
Sexual and reproductive health counselling Sexual and reproductive health counselling
Increasing individual effort needed
Increasing population impact
14
z Paying for care directly—out-of-pocket payments—prevents millions of people from using health services and can lead to impoverishment.
z In Asia and the Pacific, 105 million people suffer financial catastrophe and over 70 million are impoverished each year because they have to pay for health care.
z In six LMICs in the Region, out-of-pocket payments account for over 40% of total health expenditure.
z Financing policies that seek to pool risk and resources—for example through insurance or tax-based finance—offer better financial protection
z A basic package of health services costs US$ 35 – US$ 50 per person per year. Globally, low-income countries spend just US$ 25 per person per year on health, of which US$ 10 is out-of-pocket expenditure.
z Spending on health in low-income countries needs to increase from US$ 31 billion now to US$ 67 billion – US$ 76 billion by 2015. The bulk of this money will come from domestic sources, though many LMICs will also require aid for the foreseeable future.
z Aid for health must be predictable, sustained, aligned with national priorities and provided in ways that minimize transaction costs.
Sustained and equitable f inancing to achieve the MDGs
Figure 9: Source of health financing as proportion of total expenditure on health for LMICs in the Western Pacific Region, 2008.13
Tuvalu Niue Marshall Islands Micronesia, Fed. States of Solomon Islands Cook Islands Samoa Kiribati Papua New Guinea Vanuatu Mongolia Palau Nauru Tonga Fiji China Malaysia Viet Nam Philippines Cambodia Lao PDR
0% 20% 40% 60% 80% 100%
Out-of-pocket Private pre-paid plans Other private Government
15
1 4 5
6 7 8
Supporting national ef forts
to achieve the MDGs is core business for WHO
z Setting norms and standards—such as treatment guidelines and health service standards—is a core WHO function, underpinning our technical support for the MDGs.
z WHO’s analytic work on social and economic determinants highlights the magnitude and nature of broader risks to health.
z WHO uses its technical expertise and convening power to assist national authorities as they seek to develop coherent and well-
costed national strategies.
z In countries with many donors, WHO plays a key role in assisting governments to coordinate development partners and to ensure alignment between external assistance and domestic priorities.
z A key function in relation to the MDGs is the collection and dissemination of data on health status.
16 MDG 5
Maternal mortality ratio per 100 000 live births
Proportion of births attended by skilled health
personnel (%)
Contraceptive prevalence
rate (%)
1990 2000 2008 2015 target 1990–
1999 2000–
2009 2000–2008
690 470 290 173 34 44 40
110 60 38 28 89 98 87
40 32 26 10 99 99 …
1200 790 580 300 7 20 32
56 39 31 14 81 100 …
130 93 65 33 99 100 66
340 290 250 85 51 39 …
180 120 94 45 53 60 51
130 110 100 33 85 43 …
170 91 56 43 77 88 79
… … … … 100 100 …
… … … … 85 90 36
… … … … 95 95 …
… … … … 93 88 …
… … … … … 97 36
… … … … … 100 …
… … … … 100 100 33
… … … … 100 100 …
… … … … … 99 …
… … … … 99 100 …
… … … … 89 93 …
Tables
MDG 4
Infant mortality rate per 100 000 live births
Under-5 mortality rate per 100 000 live births
Measles immunization
% coverage
1990 2000 2008 2015
target 1990 2000 2008 2015
target 1990 2009
85 80 69 28 117 106 89 39 34 92
37 30 18 12 46 36 21 15 98 94
19 16 16 6 22 18 18 7 84 94
108 64 48 36 157 86 61 52 32 59
16 9 6 5 18 10 6 6 70 95
71 49 33 24 98 63 41 33 92 94
67 57 53 22 91 77 69 30 67 58
42 28 26 14 61 36 32 20 85 88
31 30 30 10 38 37 36 13 70 60
39 24 12 13 56 30 14 19 88 97
16 15 14 5 18 17 15 6 67 78
65 49 38 22 89 63 48 30 75 82
39 32 30 13 48 39 36 16 52 94
45 38 32 15 58 47 39 19 81 86
8 41 36 6 9 51 45 7 … 99
31 17 22 … 31 22 28 … 99 99
18 14 13 6 21 16 15 7 98 75
40 28 22 13 50 34 26 17 89 49
19 18 17 6 22 20 19 8 86 99
42 35 30 14 53 42 36 18 95 90
23 25 27 8 27 29 33 9 66 52
MDG 1
Prevalence of underweight children (%)
1990 –1999 2000–2009 2015 Target Countries with ≥ 250 000 population
Cambodia 43 29 21
China 15 7 8
Fiji 7 … 4
Lao PDR 36 32 18
Malaysia 18 … 9
Mongolia 11 5 5
Papua New Guinea 25 (1983) 18 13
Philippines 26 21 13
Solomon Islands 16 (1989) 12 8
Viet Nam 37 20 18
Countries with < 250 000 population
Cook Islands … … …
Kiribati … … …
Marshall Islands … … …
Micronesia, Fed. States of … … …
Nauru … … …
Niue … … …
Palau … … …
Samoa 2 … 1
Tonga … … …
Tuvalu … 2 …
Vanuatu 11 … 5
17 MDG 7
Proportion of population using improved drinking-water source (%)
Proportion of population using improved sanitation facility (%)
Urban Rural Urban Rural
1990 2008 1990 2008 1990 2008 1990 2008
52 81 33 56 38 67 5 18
97 98 56 82 48 58 38 52
92 … … … 92 … … …
78 72 37 51 56 86 10 38
94 100 82 99 88 96 81 95
81 97 27 49 67 64 25 32
89 87 32 33 78 71 42 41
93 93 76 87 70 80 46 69
94 94 65 65 98 98 18 18
88 99 51 92 61 94 29 67
99 98 87 88 100 100 91 100
76 77 33 53 36 46 21 20
94 92 97 99 77 83 41 53
93 95 87 94 55 61 20 14
… 90 … … … 50 … …
100 100 100 100 100 100 100 100
73 79 98 94 76 96 54 52
99 90 89 87 100 100 98 100
100 100 100 100 98 98 96 96
92 98 89 97 86 88 76 81
91 96 49 79 53 66 30 48
Tables
Countries with ≥ 250 000 population Cambodia
China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam
Countries with < 250 000 population Cook Islands
Kiribati Marshall Islands Micronesia, Fed. States of Nauru
Niue Palau Samoa Tonga Tuvalu Vanuatu
MDG 6`
HIV prevalence rate (%) among population aged 15–49 years
Malaria mortality rate per 100 000
population
Tuberculosis treatment success
rate (%)
1990 1995 2001 2007 1990 2008 cohort
1995 cohort 2007
0.7 1.2 1.5 0.8 10.5 1.4 91 94
… … 0.1 0.1 0.0 <0.1 93 94
… <0.1 0.1 0.1 … … 86 81
… <0.1 <0.1 0.2 9.0 0.2 70 92
… 0.1 0.1 0.5 0.2 0.1 69 72
… … … 0.1 … … 74 89
<0.1 0.1 0.5 0.9 11.1 9.7 56 39
… … … <0.1 1.5 <0.1 60 89
… … … … 10.3 4.1 65 92
… 0.1 0.3 0.5 5.1 <0.1 89 92
… … … … … … 100 100
… … … … … … 87 93
… … … … … … 25 96
… … … … … … 80 65
… … … … … … … 100
… … … … … … … …
… … … … … … 67 …
… … … … … … 80 92
… … … … … … 75 93
… … … … … … … 75
… … … … 21.5 0.4 85 93
18
Health MDGs scorecard colour code for LMICs in the Western Pacific Region (with population ≥ 250 000)
On Track Insufficient Progress Off Track
4 Under-5 mortality
per 1000 live births
Achieved at least 75%
of MDG target Achieved at least 50%
of MDG target Achieved less than 50%
of MDG target Measles immunization
% coverage ≥ 90% < 90% N/A
5
Maternal mortality
per 100 000 live births Achieved at least 75%
of MDG target Achieved at least 50%
of MDG target Achieved less than 50%
of MDG target Skilled birth attendant
% births ≥ 85% 60% – 84% < 60%
Contraceptive use
% married women aged 15–49 ≥ 60% 30% – 59% < 30%
6
HIV/AIDS prevalence
% adults aged 15–45 Decreased or no change
between 2001 and 2007 Increased but still low prevalence
between 2001 and 2007 Significantly increased between 2001 and 2007
Malaria mortality
per 100 000 population Significantly decreased High with little change
or decrease High with no change
or increase TB treatment
success rate % ≥ 85% 70% – 84% < 70%
7 Water
% using improved sources
Achieved at least 75%
of MDG target Achieved at least 50%
of MDG target Achieved less than 50%
of MDG target Sanitation
% using improved facilities Achieved at least 75%
of MDG target Achieved at least 50%
of MDG target Achieved less than 50%
of MDG target
19 1 Levels & trends in child mortality report 2010: Estimates developed by the UN Inter-agency group for child mortality estimation. United Nations Children’s Fund, World Health
Organization, The World Bank, United Nations Population Division. UNICEF, New York, 2010.
2 Trends in maternal mortality: 1990 to 2008: Estimates developed by WHO, UNICEF, UNFPA and The World Bank. WHO, Geneva, 2010.
(http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf).
3 UN Inter-agency Group for Child Mortality Estimation (IGME). Trends in under-five mortality rates (1960-2009). New York, UNICEF, 2009 (http://www.childinfo.org/mortality_
ufmrcountrydata.php).
4 World Health Organization and United Nations Children’s Fund. WHO/UNICEF measles coverage estimates for 1980-2009. Geneva, WHO and New York, UNICEF, May 2010.
5 Global health observatory database. Geneva, WHO, 2010 [http://apps.who.int/ghodata/]
6 Joint United Nations Programme on HIV/AIDS. Adult (15-49) HIV prevalence percent by country, 1990-2007. 2008 Report on the global AIDS epidemic. Geneva, UNAIDS, 2008 (http://data.unaids.org/pub/GlobalReport/2008/20080813_gr08_prev1549_1190_2007_en.xls).
7 Joint United Nations Programme on HIV/AIDS. Papua New Guinea new HIV estimates. Geneva, UNAIDS, 2010 (unpublished).
8 World Health Organization. National malaria control programme reports. Submitted by countries to the WHO Western Pacific Regional Office. Manila, WHO, 2008 (http://www.
wpro.who.int/topics/malaria/en/).
9 World Health Organization, World malaria report 2009. Geneva, WHO, 2009 (http://www.who.int/malaria/world_malaria_report_2009/en/index.html).
10 Global TB database. Geneva, WHO, 2010 (http://www.who.int/tb/country/global_tb_database/en/).
11 World Health Organization and United Nations Children’s Fund. Progress on sanitation and drinking-water: 2010 update report. Geneva, WHO, 2010 [http://www.unicef.org/
media/files/JMP-2010Final.pdf].
12 World Health Organization and United Nations Children’s Fund. Progress on drinking-water and sanitation: special focus on sanitation. Geneva, WHO and New York, UNICEF, 2008. [http://www.who.int/water_sanitation_health/monitoring/jmp2008/en/index.html].
13 World Health Organization. National Health accounts country health information. Geneva, WHO, 2010 (http://www.who.int/nha/country/en/).
Other data source
World Health Organization. Health in Asia and the Pacific. India, WHO, 2008.
