Accelerating Equitable Achievement of the MDGs Closing Gaps in Health and Nutrition Outcomes potx

Accelerating Equitable Achievement of the MDGs
Closing Gaps in Health and Nutrition Outcomes

Contents
Foreword vii
Acknowledgements viii
Abbreviations ix
OVERVIEW

Accelerating Equitable Achievement of the MDGs: 1
Closing Gaps in Health and Nutrition Outcomes
 Diagnosing disparities 1
  Disparitiesbetweencountries 1
  Disparitieswithincountries 2
 Closing the health gaps 3
  1. Addressthesocialdeterminantsof health 3
  2. Expandaccesstoprimaryhealthcare 3
  3. Integratechildandmaternalhealthintoacontinuumofcare 3
  4. Actonthehealthneedsoftheurbanpoor 4
  5. Devisesustainablefinancialstrategies 4
  6. Improvethegovernanceof healthsystems 4
  7. Enhancetheaffordabilityof medicinesthroughgenerics 4
  8. Strengtheninternationalpartnershipandregionalcooperation 5

Mutual inspiration 5
CHAPTER I
MDGs in Asia and the Pacific: where we stand 7
Asia and the Pacific on the global stage 12
Health – diagnosing the deficits 12

  Feedingourchildren 12
  Preventingchilddeaths 12
  Preventingmaternaldeaths 15
  Providingsafedrinkingwater 23
  Ensuringaccesstobasicsanitation 23
Number of people in off-track countries who will gain 27
if targets are reached
Chapter I Endnote 28
CHAPTER II
Diagnosing disparities 29
The extent of disparities 30
Measuring disparities between countries and over time 30
Why some countries do better than others in health 35
  Economicgrowth 36
  Healthexpenditure 36
  Bettergovernance 36
  Numberofhealthpersonnel 36
  Genderequalityandwomen’sdevelopment 38
  Infrastructure 38
  Childimmunization 40
  Sanitationandwatersupplies 40
  Populationgrowth 40
  Literacy  40
Accounting for disparities 40
Disparities within countries 41
  Raisingtheattainmentlevelswhilereducingdisparities 45
Explaining disparities within countries 46
  Urban-ruralgaps 49
  Caste,ethnicityandlanguagegroup 53
  Theimportanceof economicstatus 53

  Regionaldifferencesinpoliciesandprogrammes 53
Mining the data 55
Chapter II Endnotes 55
CHAPTER III
Closing the health gaps 57
  1. Addressthesocialdeterminantsof health 57
  2. Expandaccesstoprimaryhealthcare 59
  3. Integratechildandmaternalhealthintoacontinuumofcare 61
  4. Actonthehealthneedsoftheurbanpoor 62
  5. Devisesustainablefinancialstrategies 63
  6. Improvethegovernanceof healthsystems 69
  7. Enhancetheaffordabilityof medicinesthroughgenerics 70
  8. Strengtheninternationalpartnershipandregionalcooperation 71

Mutual inspiration 72
Chapter III Endnotes 73
CHAPTER IV
Way Forward 75
MDGs Beyond 2015 76
Chapter IV Endnotes 77
BIBLIOGRAPHY 78
STATISTICAL APPENDIX 00
Technical Note 1: MDG progress classification 81
Technical Note 2: Factors explaining disparities between 85
countries
Technical Note 3: Accounting for disparities between 88
countries
Technical Note 4: Analysis of disparities within countries 90
Technical Note 5: Selected MDG Indicators 97
BOXES

BoxI-1 Ensuringcomparabledata 8
BoxI-2 DataonHIV 10
BoxI-3 Reproductivehealth 28

BoxIII-1 UnlikelyalliancesforreducingHIV-relatedstigma 58
BoxIII-2 PrimaryhealthcareinChina 59
BoxIII-3 Expenditureonpreventiveandpublichealth 60
BoxIII-4 NewfacilitiesreduceinfantmortalityinBihar,India 60
BoxIII-5 Mongolia’ssuccessinreducingmaternalmortality 63
BoxIII-6 Totalhealthexpendituresasashareof grossdomesticproduct 64
BoxIII-7 Out-of-pocketexpensesasashareof privatehealthexpenditures 65
BoxIII-8 Healthexpendituregaps 68
BoxIII-9 MarginalbudgetingforbottlenecksinPakistan 69
TABLES
TableI-1 Countrygroupsonandoff trackfortheMDGs 9
TableI-2 Countriesonandoff trackfortheMDGs 11
TableI-3 Rateof progressneededforoff-trackcountriestomeet 15
   thechildnutritiontarget
TableI-4 Rateof progressneededforoff-trackcountriestomeet 17
   theunder-5mortalitytarget
TableI-5 Rateof progressneededforoff-trackcountriestomeet 19
   thematernalmortalitytarget
TableI-6 Rateof progressneededforoff-trackcountriestomeet 21
   theskilledbirthattendancetarget
TableI-7 Rateof progressneededforoff-trackcountriestomeet 22
   theantenatalcaretarget
TableI-8 Rateof progressneededforoff-trackcountriestomeet 23
   thesafedrinkingwatertarget
TableI-9 Rateof progressneededforoff-trackcountriestomeet 26
   thebasicsanitationtarget

TableI-10 Potentialgainsifoff-trackcountriescanmeettheirtargets 27

TableII-1 GiniandTheilindicesof inter-countrydistributionof MDGindicators 34
TableII-2 FactorsconsideredtoexplaindisparitiesforselectedMDGindicators 43
FIGURES
FigureI-1 AsiaandthePacificcomparedwithSub-SaharanAfricaand 13
    LatinAmericaandtheCaribbean
FigureI-2 TheAsia-Pacificshareof thedevelopingworld’sdeprivedpeople 14
FigureI-3 Progressinreducingtheproportionofunder-5childrenunderweight 14
FigureI-4 Progressinreducingunder-5mortality 16
FigureI-5 Progressinreducingmaternalmortality 18
FigureI-6 Progressinincreasingskilledbirthattendance 20
FigureI-7 Progressinexpandingantenatalcare 22
FigureI-8 Progressinimprovingaccesstosafedrinkingwater 24
FigureI-9 Progressinexpandingaccesstobasicsanitation 25
FigureI-10 Progressincontraceptiveprevalencerateandadolescentbirth 28
    rateinAsiaandthePacific
FigureII-1 Proportionofpopulationbelow$1.25(PPP)perday,percent,2004 30
FigureII-2 Netenrolmentinprimaryeducation,percent,2009 31
FigureII-3 Infantmortalityrateper1,000livebirths,2010 31
FigureII-4 Under-5mortalityrateper1,000livebirths,2010 31
FigureII-5 Maternalmortalityrateper100,000livebirths,2008 32
FigureII-6 Incidenceof underweightchildren,percent,latestyear 32
FigureII-7 HIVprevalenceamongpopulation15-24yearsold,percent,2009 32
FigureII-8 Inter-countrydisparityinprevalenceofunderweightchildren 33
    under5,1995-2005
FigureII-9 Contributiontodisparitiesbysubregion,selectedMDGindicators 35
FigureII-10Cross-countryvariationinunder-5mortalityexplainedby 37
    differencesinpercapitahealthspending
FigureII-11Cross-countryvariationinmaternalmortalityexplained 37

    bydifferencesincorruptioncontrol
FigureII-12Cross-countryvariationinmaternalmortalityexplainedbydifferences 38
    inpercentageof birthsattendedbyskilledhealthpersonnel
FigureII-13Cross-countryvariationinchildmortalityexplained 39
    bydifferencesingenderdevelopment
FigureII-14Birthsattendedbyskilledhealthpersonneland 39
    theextentofpavedroads
FigureII-15Contributionstointer-countrydisparitiesfor 41
    threeMDGhealth-relatedindicators
FigureII-16Healthdisparitiesacrosssub-nationaljurisdictionsin 42
    twolargecountries
FigureII-17Health-relateddisparitiesacrossjurisdictionsintwosmallcountries 42
FigureII-18Disparitiesandattainmentinhealth-relatedMDGtargets 44
FigureII-19Driversof disparitiesinunderweightprevalenceamong 46
    under-5children
FigureII-20Driversof disparitiesintheprevalenceofunder-5mortality 47
FigureII-21Driversof disparitiesinthecoverageofantenatalcare 48
    (atleastonevisit)
FigureII-22Driversof disparitiesinaccesstoimprovedsanitation 49
FigureII-23Under-5childrenunderweight,urbanandrural, 50
    byhouseholdwealth,IndiaandNepal
FigureII-24Accesstowaterandsanitation,urbanandrural, 51
    byhouseholdwealth,thePhilippinesandIndonesia
FigureII-25Accesstoantenatalcare,urbanandrural,byhouseholdwealth, 52
    AzerbaijanandTimor-Leste
FigureII-26Accesstoskilledbirthattendants,urbanandrural, 52
    byhouseholdwealth,MaldivesandBangladesh
FigureII-27Thepotentialforreducingregionaldisparitieswithincountries 54

FigureIII-1 Under-5mortalityandpercapitaexpenditureonhealth 66

FigureIII-2 AssociationbetweenpublichealthexpenditureandGDP, 67
    selectedcountries
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Asia-Pacific Regional MDG Report 2011/12
Foreword
A
tatimeofwidespreadfinancialuncertaintyandeconomicslowdowntheworldisturningtotheAsia-Pacific
regionasasourceof globaleconomicgrowth.Astheyear2015approaches,theworldwillalsobelooking
towardsourregiontosustainamuch broadersetof objectives–theMillennium DevelopmentGoals
(MDGs).
Thereasonispartlydemographic.TheAsia-Pacificregionhasmorethan60percentofglobalpopulation.Strong
achievementinourregion,whetherinpovertyreduction,orineducation,orhealth,orenvironmentalprotectionwill
inevitablybolstertheglobalaverages.Inmanyrespects,AsiaandthePacifichasindeedbeenleadingtheway.Thanks
tostrongeconomicgrowth,theregionasawholeiswellontracktomeetthegoalofhalvingpovertybetween
1990and2015–theyearbywhichallthegoalsaretobeachieved.Forsomeoftheothergoals,however,regional
progresshasbeenlessimpressive–andthereareoftenstrikingcontrastsinachievementbothbetweencountries
andwithinthem.
This is the latest in a series of  Asia-Pacific MDG reports produced since 2004 by the Economic and Social
Commission for Asia and the Pacific/Asian Development Bank/United Nations Development Programme
(ESCAP/ADB/UNDP)regionalpartnershiptosupporttheachievementoftheMDGs.Employinganow-familiar
systemofcolour-coded‘trafficlight’charts,thereportshavetrackedprogressoneachindicator–signallingwhich
countriesandsubregionsareon-oroff-tracktomeeteachof thegoals.
Inaddition,thisyear’sreportunderlinestheextentofdisparitiesacrosstheregion,lookingespeciallyatthewide
gapsinthegoalsrelatedtohealthandnutritionwheretheregionisparticularlyunder-performing.Evencountries
thathavebeenmakingrapideconomicprogressstillloseshockingnumbersofchildrenbeforetheirfifthbirthday
aswellasthousandsofmotherswhodieunnecessarily,asaconsequenceofthenaturalprocessofchildbirth.The
reportalsorevealsmanyopportunitiesforimprovinghealthoutcomes–highlightingthepoliciesandprogrammes
which,whenbackedbycommitmentandadequateresources,couldhelpmaketheAsia-Pacificregionadrivingforce
behindtheglobalachievementof alltheMDGs.
TheMDGsareverydiverseandinevitablytranscendtheinterestsandresponsibilitiesofanysingleinternational

organization.Thereporthasthereforeemergedfromwideconsultations,notjustwithinandbetweenthethree
partnerorganizations,butalsomanyotherUNagencies,particularlythisyearUNAIDS,UNICEF,UNFPAand
WHO,andwearegratefultoeveryonewhohascontributeddata,analysisandinsights.Wehopethattheresulting
reportwillstimulatefurtherdebateandaboveallthesustainedactionneededacrosstheregiontoaccelerateequitable
achievementoftheMDGs.
Noeleen Heyzer
Under-Secretary-Generalof the
UnitedNationsand
ExecutiveSecretaryofESCAP
Bindu N. Lohani
Vice-President
AsianDevelopmentBank
Ajay Chhibber
UNAssistantSecretary-Generaland
UNDPAssistantAdministrator
andDirectorforAsiaandthePacific
viii
Asia-Pacific Regional MDG Report 2011/12
Acknowledgements
T
his is the sixth report thathas been prepared under the ESCAP/ADB/UNDP regional partnership
programmeonachievingtheMillenniumDevelopmentGoalsinAsiaandthePacificregion.Thereport
continuestobethemostauthoritativeregionalassessmentof theprogresssofarachievedandobstacles
encounteredinachievingtheMDGsinAsiaandthePacificregion.Itprovidesabasisforconductingpolicy
dialogueatseniorlevelandgeneratingregionalconsensusonsomeof themostpressingdevelopmentissues
facingtheregion.
Thereporthasbeenpreparedunderthedirectsupervisionandguidanceof Dr.NoeleenHeyzer,Under-Secretary-
Generalof theUnitedNationsandExecutiveSecretaryof ESCAP,Dr.AjayChhibber,UNAssistantSecretary-
General,UNDPAssistantAdministratorandDirectorforAsiaandthePacific,andDr.UrsulaSchaeffer-Preuss
andDr.BinduN.Lohani,formerandpresentVice-Presidents,AsianDevelopmentBank.

 ESCAP-ADB-UNDPteam,whichcoordinatedandpreparedthereport,consistedof thefollowingmembers:
 ESCAP:NageshKumar,SyedNuruzzaman,JanSmit,YanhongZhang,HarumiShibata,NobukoKajiura,
 ClovisFreireandYichunWang
 ADB:ShiladityaChatterjee,GuanghuaWan,YuanZhangandVivianFrancisco
 UNDP:NicholasRosellini,AnuradhaRajivan,ThangavelPalanivel,BiploveChoudharyandTaimurKhilji
 Substantive contributionswere received fromBobVerbruggen andAmalaReddyofUNAIDS, Saramma
 MathaiofUNFPA,FranceBegin,HenkvanNorden,MaheshPatel,TeerapongPraphotjanapornandQimti
 Paienjtonof UNICEFandMarkLandry,JunGaoandThereseMariaReginaldoofWHO.

The report team met periodically to review thedraft chapters and engaged in wider consultations with the
membersof theUNDGandtheRegionalCoordinationMechanismbasedinBangkok.
 
The report team thanks the following for their support, comments and technical inputs: Dipa Bagai, Indu
Bhushan,ThereseBjork,MarcusBrand,DouglasBrooks,RuangkhaoRyceChanchai,KritsanaChonweerawong,
CliftonCortez, Edgar Dante,SupapornDaophises, MichelleDomingo, BartEdes,Josephine Ferre,Haishan
Fu, Chris Garroway,DanielaGasparikova,FrancyneHarrigan,Aynul Hasan, Kim Luisa Henderson,Hubert
Jenny,NitishJha,HenrikFredborgLarsen,AmyLeung,LauraLopez,IosefaMaiava,Shun-ichiMurata,Maya
Nyagolova, Naylin Oo, Marisa Panyachiva, Churairat Phunphichit, Yana V. Rodgers, Iva Sebastian, Solongo
Sharkhuu,MarinusW.Sikkel,RobertSpaull,ScottStandley,CraigSteffensen,RamaswamySudarshan,Guntur
Sugiyarto, Pauline Tamesis,Kewal Krishan Thapar, Kazuyuki Uji, FatmaGül Ünal, YumikoYamamoto and
MarinYari.
Theteam’sappreciationgoestotheUNAsia-PacificMDGsCommunitiesof PracticeandADBCommunitiesof
PracticeonEducation,Energy,Environment,Gender,GovernanceandPublicManagement,Health,Transport
andWaterwhomadesubstantivecontributionsforthepreparationofthisreport.Appreciationalsogoesto
UNDPcountryofficesinChina,LaoPDR,DemocraticPeople’sRepublicof Korea,India,Samoa,SriLanka,
VietNam,Cambodia,Mongolia,SolomonIslands,andWHOandUNICEFofficesinChina.
The report was edited by Peter Stalker. It was designed by Suki Dixon. Dussadee Nunthavichitra, Patchara
ArunsuwannakornandWannapornSridamaprovidedalladministrativesupport.
ix
Asia-Pacific Regional MDG Report 2011/12

Abbreviations
ADB AsianDevelopmentBank
AIDS acquiredimmunodeficiencysyndrome
ASEAN AssociationofSouth-EastAsianNations
CIS CommonwealthofIndependentStates
CO
2
 Carbondioxide
DHS DemographicandHealthSurvey
ESCAP EconomicandSocialCommissionforAsiaandthePacific
FAO FoodandAgricultureOrganization
FDI foreigndirectinvestment
FTA freetradeagreement
GAVI GlobalAllianceforVaccinesandImmunization
GDI Gender-relateddevelopmentindex
GDP grossdomesticproduct
HIV humanimmunodeficiencyvirus
IAEG Inter-AgencyandExpertGrouponMDGIndicators(IAEG)
ILO InternationalLabourOrganization
IMF InternationalMonetaryFund
LAC LatinAmericaandtheCaribbean
LDC leastdevelopedcountry
LLDC landlockeddevelopingcountry
MDGs MillenniumDevelopmentGoals
MICS MultipleIndicatorClusterSurvey
NCD non-communicabledisease
NGO non-governmentalorganization
ODA officialdevelopmentassistance
PPP purchasingpowerparity
SAARC SouthAsianAssociationforRegionalCooperation

SIDS Smallislanddevelopingstates
TB tuberculosis
TRIPS TradeRelatedIntellectualPropertyRights
UNWomen UnitedNationsEntityforGenderEqualityandtheEmpowermentofWomen
UNDP UnitedNationsDevelopmentProgramme
UNESCO UnitedNationsEducational,ScientificandCulturalOrganization
UNFPA UnitedNationsPopulationFund
UNICEF UnitedNationsChildren’sFund
WDI WorldDevelopmentIndicators
WFP WorldFoodProgramme
WHO WorldHealthOrganization

1
Asia-Pacific Regional MDG Report 2011/12
OVERVIEW
T
he Asia-Pacific region has already taken
considerable strides towards achieving the
MDGs.Between1990and2009theregionas
awholereducedtheproportion of  peoplelivingon
lessthan$1.25perdayfrom50to22percent,andasa
resultisfirmlyontracktomeetthepovertygoal.The
regionhasalsoachievedthetargetsforanumberof 
othergoals.Ongender,forexample,ithassuccessfully
reduced gender inequalityin primary, secondary and
tertiaryeducation.Onhealth,ithasbeguntoreduce
theprevalenceof HIVandhasstoppedthespreadof 
tuberculosis.Andontheenvironment,ithasincreased
theproportionof landareathatiscoveredbyforests
or has protected status, while also reducing the

consumption of  ozone-depleting substances. At the
householdlevel,ithasmorethanhalvedtheproportion
of peoplewithoutaccesstosafedrinkingwater.
On the other hand, Asia and the Pacific region is
stilllagginginsome majorareas.Indeeditisbehind
schedulefortenofthe22indicatorsforwhichreliable
dataisavailableandthereforeassessedinthisreport.
It has, for example, yet to ensure that all children
complete primary school. Nor has it managed to
extend basic sanitation sufficiently rapidly with over
1.8billionpersonsremainingdeprivedinthisrespect.
IthasalsofailedtoreduceCO
2
emissions.
Most disturbing ofall however, it hasbeen slow to
prevent people going hungry, stop children dying
beforetheirfifthbirthday,andpreventmothersdying
fromcausesrelatedtochildbirth.Moreover,onmost
indicators, because of the region’s large population,
it is also home to a high proportion of the world’s
deprivedpeople.
Nevertheless,manycountriesintheregionarewithin
reachofseveralMDGtargets.Withacceleratedefforts
substantial progress can still be made in the time
remaining.
Diagnosing disparities
Disparities between countries
In addition to speeding up progress, efforts will be
needed to bridge the wide disparities that prevail in
socialattainmentsbetweencountrieswhichtheregional

averagesconceal.AcrossAsiaandthePacificthereare
striking disparities in the MDG attainments. Many
people have prospered while large numbers still live
inmiserableconditions.Thisisnotjustunacceptable,
italsoposes threatstonational economicandsocial
stability–andcanleadtofrictionbetweencountries
while hampering the prospects of greater regional
cooperation.
Even for poverty there are marked differences in
achievement.Theregionalaveragefortheproportion
Accelerating Equitable Achievement
of the MDGs: Closing Gaps in
Health and Nutrition Outcomes
The Asia-Pacific region has registered impressive progress on many
Millennium Development Goal (MDG) indicators, but is still lagging
on some important targets, particularly those related to health.
Across the region there are striking disparities in achievement, both
between and within countries. If they are to reach the MDG targets
many countries will need to step up their efforts to extend health
services to their most vulnerable people.
2
Asia-Pacific Regional MDG Report 2011/12
OVERVIEW: Accelerating equitable achievement of the MDGs: closing the gaps in health and nutrition
of  the population living below the $1.25-per-day
poverty level is around 22 per cent, but the rate
rangesfrom0percentinMalaysiato55percentin
Nepal.Foreducation,forwhichmostcountrieshave
performed fairly well,thegaps tend to be narrower.
But for health indicators the gaps are often much
wider.Forinfant mortality,forexample,theregional

averageis36per1,000livebirths,buttherateranges
from103inAfghanistanto10orlessinsomeof the
moreadvanceddevelopingcountries.
Worryingly, in some respects, the situation is
deteriorating. Cross-countrydisparitieshavewidened
for some indicators: population in poverty, for
example, underweight children, infant and under-5
mortality, maternal mortality, and TB incidence and
prevalence. More hopefully, for other indicators, the
disparitieshavebeenreduced–forHIVprevalence,for
theenvironmentalindicators,andforalltheeducation
indicators.
Theanalysisinthisreportshowsthatthesedisparities
are largely accounted forby gaps between countries
withinsubregions.Inthecaseof underweightchildren,
forexample,around44percentof theinter-country
disparityresultsfromdifferencesbetweensubregions;
buttheremaining56percentcomesfromdisparities
betweencountrieswithinsubregions,withthewidest
gapsevidentwithinCentralandWestAsia,followedby
thosewithinSouth-EastAsia,andEastAsia.
Whyhavethesehealthgapsarisen?Oneof themost
significantfactorsisdifferencesinhealthspending.In
countries with faster economic growth governments
have been able to raise more revenue for expanding
public health provision, and households have had
more income to pay for services from both public
and private providers. The analysis in this report
shows that countries that spendmore per capita on
health,publicandprivatecombined,havelowerrates

of under-5andmaternalmortalityandhaveasmaller
proportion of children underweight. But public and
privateprovisionmayhavedifferentoutcomes:private
healthexpenditurewasseentoimpactlessinreducing
childmalnutritionwhilepublicexpenditurewasmore
helpfulinthat–highlightingthevalueof preventive
public health measures such as immunization and
controlof diseasessuchasmalariaanddiarrhoea.But
forreducingunder-5andmaternalmortality,thepicture
wasreversed:privateexpenditurewasmoreeffective.
These results underline the importance of  not just
increasingpublichealthexpenditurebutalsoimproving
its quality and effectiveness – by strengthening the
governanceof healthsystemsandensuringsufficient
trained staff. Other important factors are better
infrastructure along with access to improved water
suppliesandsanitation.Alsovitalforchildren’shealth
isthestatusof theirmothers:womenwhoareliterate,
well informed and empowered are in a much better
positiontocareforthemselvesandtheirchildren.
Disparities within countries
JustastherearewidedisparitiesinMDGachievement
between countries, so there can be equally wide
disparitieswithincountries.Indeed,whilethebetteroff 
peopleinAsia-Pacificdevelopingcountrieshavehealth
standards comparable to those in richer developed
countries their fellow citizens are very much worse
off. There are also differences related to location:
typicallythelesshealthyarethoselivinginthepoorest
provincesorstates.Therearealsostrikinghealthgaps

betweenurbanandruralareas,betweenboysandgirls,
andbetweenmoreandlesseducatedsectionsofthe
population.
Asthosethatareleftbehindcatchup,i.e.disparities
narrow,overalllevelsof healthincrease.Thereverse,
however,isnotnecessarilytrue.Manycountrieshave,
forexample,madesignificantimprovementsinaccess
tosafewatersuppliesbutstillhavewidegapsbetween
themostandleastadvantagedhouseholds.
Generally the different types of  disparities overlap
andinteract.Poorerandlesseducatedfamiliesarealso
likely to be those without adequate access to water
andsanitationandtheirchildrenareatgreaterriskof 
malnutrition. As a result, improvements in just one
aspectof theirlivesmightnotmakemuchdifference
totheirhealth.Thebenefitsof betteraccesstowater,
forexample,mightstillbeoutweighedbytheeffects
of  poverty or the lack of mothers’ education. But
in some cases, even a single factor could become a
stumblingblock.Insomecountries,forexample,just
improvingamother’slevelof educationcouldonits
ownlifthouseholdhealthstandards.
For most indicators rural areas generally do worse
thanurbanareas.However,mostof thesedifferences
correspond to differences in household wealth.
Wealth is assessed in household surveys by noting
the ownership of  selected assets, suchas televisions
and bicycles, and other factors such as thematerials
used for housing construction. For access to water
andsanitation,forexample,almostalltherural-urban

differences reflect differences in household wealth.
Similarly, for mothers at similar wealth levels the
likelihoodofabirthbeingattendedbyaskilledhealth
professionalissimilarinbothurbanandruralareas.
3
Asia-Pacific Regional MDG Report 2011/12
OVERVIEW: Accelerating equitable achievement of the MDGs: closing the gaps in health and nutrition
Nevertheless,lowerhealthstandardsamongthepoor
and disadvantaged groups are not just the result of
lower incomes.They arise from a more general lack
of  material resources, including food, housing and
safewatersupplies.Poorerpeoplearealsomorelikely
to live in places with limited or low-quality health
services. And with less education, poor households
mayknowlittleof thebenefitsof medicaltreatments
andinterventions. Indeed,poorhealthcan alsobea
resultof agenerallackofempowerment.
Differencesinhouseholdwealthorlevelsof education
mayalsoaccountforsomeof thelarge,andsometimes
dramatic, disparities between provinces and districts.
Butthisisnotthewholestory.Aboveandbeyondthese
differencestherearefactorstiedtospecificregions–
perhaps reflecting the policies and programmes of 
localadministrations.
Closing the health gaps
If  governments are to reduce these disparities and
raisestandardsof healththeywillhavetofocusmuch
moresharplyontheneedsof thepoorandvulnerable.
This will also require a more integrated approach,
lookingbeyondhealthtoaddressotherissuessuchas

poverty, nutrition, watersuppliesandsanitation,and
women’sempowerment. Fortunately, the region now
hasawealthofknowledge andexpertiseonhowto
overcomehealthdeficits.Thissuggestseightpriorities.
1. Address the social determinants of health
Many countries that haveboosted economic growth
and household income have had less success in
assuring health for all. Clearly there are many other
factorsatplay–notablyarangeofsocialbarriersand
determinants. These can be related to gender, class,
ethnicity, caste,language,andreligion –arisingfrom
ingrainedsocialstructures,normsandprocessesthat
accept and even encourage unfair distributions of 
wealthandsocialresources.Forexample,peopleliving
withHIVandsomeotherchronicillnesses,facehigh
levelsofstigmaanddiscriminationthathindertheir
accesstomedicaltesting,treatment,careandsupport.
One of  the most significant social determinants is
gendernorms.Governmentsaimingtoimprovehealth
standardswillthereforewanttoimprovethestatusof 
women,provideeffectivereproductivehealthservices,
implementcomprehensivebreastfeedingprogrammes
in line with current recommendations and increase
community-based pressures against sex-selective
abortion.
Social determinants are also major drivers of 
non-communicable diseases (NCDs) – notably
diabetes, cardiovascular diseases, cancer and chronic
respiratory diseases. Poor people, lacking education
and information, or the funds for healthier options,

aremorevulnerabletotheimpactof NCDsthanthe
richandarelikelytodieearlier.Directlyandindirectly,
NCDs will have far-reaching impacts on progress
towardstheMDGs.
2. Expand access to primary health care
Anumberof countrieshaveputgreateremphasison
primarycarewithsupportingbasicinfrastructuresuch
asconnectivitytoroads,electricityandaccesstoclean
water and improved sanitation. But implementation
hasbeenuneven;indeedmanyhaveinsteadinvested
heavily in specialized curative care and relied more
on private provision. This leaves many poor people
behind who face severe financial hardships because
theyhavetopayforhealthcare.
Some countries have sought to implement primary
health care through an ‘Essential Service Package’
comprisingmaternalcare,childhealthcareandaction
against some communicable diseases. But funding
has been insufficient, leading to long waits and the
introductionof unofficialfees,andleavingsomeareas
underserved.
InthePacificWHOhaspromotedthe‘HealthyIslands’
approach.Thiscomprehensivepackageincludes:safe
waterandsanitation,foodsecurity,wastemanagement,
humanresourcedevelopment,preventionandcontrol
of  communicable and non-communicable diseases,
reproductive health services, and primary health
care.Recentlytherehavebeencallstorepositionthis
approach as a broader development initiative which
wouldincorporateotherelementssuchasfoodsecurity

andclimatechange.
3. Integrate child and maternal health into a
continuum of care
A robust health system focuses on the needs of 
variousgroups alongthecontinuum of  care.Health
systemscan,forexample,reduceinequitiesinmaternal
andunder-5mortalitybyadoptingalifecycleapproach
–improvingaccessandaddressingthevulnerabilities
and risks that women,adolescentsand childrenface
throughout their lives. If  mothers face emergencies
during pregnancy and birth, for example, it is vital
thattheyhavetimelysupportfromskilledattendants,
andif necessaryfromdoctorswhocantreatobstetric
complications. Other simple and cost-effective
4
Asia-Pacific Regional MDG Report 2011/12
OVERVIEW: Accelerating equitable achievement of the MDGs: closing the gaps in health and nutrition
measures could reduce child deaths by around two-
thirds. These include implementing comprehensive
breastfeeding programmes (early initiation of 
breastfeedingandexclusivebreastfeedinginparticular),
controlling vector-borne diseases, and strengthening
immunizationprogrammes.
Governments also need to take a rights-based
approachtothelaws,policies,socialnorms,customs
andpracticesthatimpoverishanddisempowerwomen.
This should involve specific action against gender-
basedviolence.
4. Act on the health needs of the urban poor
Theurbanpoorareoftenunderservedbyhealthand

other services. People in slums often live in squalid
conditions that expose them to disease and to high
ratesof morbidityandmortality.
Betterurbanhealthservicesrequirestronginstitutional
frameworksthatcandelivercross-sectoral,inter-agency
services.Thisrequirescapableandinclusivegovernance
thatfocusesonbasicrights–tohealth,educationand
othersocialservices.Healthinterventionsareunlikely
tosucceediftheyarenotembeddedinbroaderefforts
torespecttherightsoftheircitizensandservetheir
basicneeds.
5. Devise sustainable financial strategies
Thoughmuchcanbeachievedatrelativelylowcost,
some healthinterventionsareexpensive. In the case
of accesstoaskilledprofessionalatbirth,forexample,
reaching the projected value for MDG 5 has been
estimated at $8 billion fortheregion, though if  the
off-trackcountriesaretoclosetheirgapstheywould
needafurther$13billion.Similarly,closingthegapfor
safewatersupplieswouldcostanadditional$2billion
andforsafesanitationanadditional$8billion.
Wherearethefundslikelytocomefrom?Asincomes
rise,morepeopleshouldbeinapositiontofinancetheir
ownhealthneeds.Infact,however,experiencesshow
thatascountriesdevelop,thebalanceof expenditure
tendstoshiftfromprivatetopublic.Thisishappening
becauseascountriesdeveloptheyalsocollectlotsof 
taxesfrom thepublicwhich enablethemtoprovide
public health services. Private health expenditure
also rises, but not always to the same extent.Richer

societiescanaffordtooffsetrisesinincomeinequality
byprovidingmorehealthservicesaspublicgoods.
Butincreasinghealthexpendituredoesnotnecessarily
demand high national income. This is clear from
cross-countryanalysiswhichshowsthatcountrieswith
similarpercapitaGDPsdemonstratedifferentlevels
of healthexpenditure.
Some countries should be able to spend more on
healthbymobilisingmoretaxesthroughtaxreforms
andimprovingtaxadministrationaswellasincreasing
fiscal deficits while keeping within accepted limits.
Anotheroptionistoreprioritizegovernmentbudgets
by switching resources from other government
expenditures. Governments can also gain resources
throughmoreefficientmanagementofhealthservices.
6. Improve the governance of health systems
In many developing countries health services are
poorly managed. Resources can also drain away
throughcorruptionandstaffabsenteeism.Alsolinked
tocorruption is the spreadoffake,counterfeit,and
substandardmedicines.
Actionisneededfromaboveandbelow.Governments
will need to ensure more transparent and better
managed services, while users will need to work
together to resistdemandsforbribes.Itisalso vital
toensuremoreeffectiveregulation.Whenthepublic
healthsectorfailstoperform,theprivatesectordoes
notperformeither.Thegovernmentthereforeneeds
to set the rules of  the game with regulations that
guarantee quality of  care and ensure fair pricing of 

healthservices.
7. Enhance the affordability of medicines through
generics
Ensuringaffordableaccesstomedicinesisanimportant
issue for the spread of medical care in developing
countries facing resource constraints. A number of
countries,includingIndia,MalaysiaandthePhilippines
havepursueddiversepolicyoptionssuchasfocussing
onproductionof  genericsandcompulsorylicensing
forimportationof antiretroviralmedicinestokeepthe
pricesofmedicineswithinthereachofthepoor.Use
of genericalternativestopatentedmedicineshad,for
example,reduced thecostof HIV/AIDStreatment,
from $10,000-$15,000 per year per patient to under
$80forcertainfirstlineregimensnow.
Theleastdevelopedcountriescanretaintheflexibility
on introduction of  product patents until 2016 and
seekfurtherextensionsof thetransitionperiod.These
flexibilities need to be retained and buttressed by
supportiveandharmonizedregionaltradeagreements.
Countries also need to cooperate on accelerating
researchanddevelopment(R&D)onaffordabledrugs
totreattheinfectiousdiseasesthatafflictlow-income
countriesinparticular.
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Asia-Pacific Regional MDG Report 2011/12
OVERVIEW: Accelerating equitable achievement of the MDGs: closing the gaps in health and nutrition
8. Strengthen international partnership and regional
cooperation 
There is considerable potential for greater regional

cooperation through the exchange of  information
and experience and, where appropriate, flows of 
development assistance. The Asia-Pacific already
hassomemechanisms.TheSouthAsian Association
for Regional Cooperation (SAARC) has a SAARC
DevelopmentFundwhichhas,forexample,initiateda
MaternalandChildHealthProject.Butthisisstillona
smallscaleandneedsgreatermomentumandpublicity.
Similarly,theAssociationofSouth-EastAsianNations
canfocusmoreof itsheathworkoneffectivehealth
policies and programmes among its least developed
members.
GovernmentsinLDCsshouldalsobeabletorelyon
someofficialdevelopmentassistancewhichcanbeused
tofinancenewinitiativesthatfitintowell-functioning
primary health care systems.  Official development
assistance can be supplemented by other, innovative
international financing mechanisms such as the
UNITAID andthesolidarityleviesonairlinetickets,
International Finance Facility for Immunization and
theAdvanceMarketCommitmentforpneumococcal
vaccines.In the context of  international partnership
for health related MDGs especially for the poorest
countriesamajornewinitiativeistheUnitedNations
Secretary-General’sGlobalStrategyforWomen’sand
Children’sHealth,2010.
Mutual inspiration
AcrossAsiaandthePacifictherearewidedisparitiesin
healthachievement.Buttheregionisalsoarichsource
of  positive experience. No single generic approach

will work everywhere. Every country has to address
itsownspecificcircumstances.Neverthelesscountries
canbeinspiredbytheirneighbourstodrivetheirown
experimentsandinnovations.

7
Asia-Pacific Regional MDG Report 2011/12
CHAPTER I
One of the region’s greatest successes has been in
propellingpeopleout of poverty.Between1990and
2009,AsiaandthePacificreducedtheproportionof 
peoplelivingonlessthan$1.25perdayfrom50to22
percent–orfrom1.57billionto871millionpeople.
1

The MDG objective over this period was to halve
the proportion of people living in extreme poverty;
the Asia-Pacific region as a whole has thus already
surpassedthepovertygoal.
Theregionhasalsoachievedthetargetsforanumber
ofothergoals.Ongender,forexample,ithassuccessfully
reduceddisparitiesinprimary,secondaryandtertiary
education. On health, it has begun to reduce the
prevalence of  HIV and has stopped the spread of 
tuberculosis.Andontheenvironment,ithasincreased
theproportionoflandareathatiscoveredbyforestsor
hasprotectedstatus,whilealsoreducingtheconsumption
of ozone-depletingsubstances.Andatthehousehold
level,ithasmorethanhalvedtheproportionof people
withoutaccesstosafedrinkingwater.

Ontheotherhand,theregionisstilllagginginsome
major areas. Indeed itisbehindschedule for ten of 
the 22 indicators assessed in this report. It has, for
example, yet to ensure that all children complete
primary school.Norhasit managed toextendbasic
sanitationsufficientlyrapidly,orreduceCO
2
emissions.
Most disturbing of all however, it hasbeen slow to
prevent people going hungry, stop children dying
beforetheirfifthbirthday,orextendmaternalhealth
careservicesandpreventmothersdyingfromcauses
related to childbirth. Moreover, on most indicators,
becauseof theregion’slargepopulationitisalsohome
toahighproportionof theworld’sdeprivedpeople.
Toassessprogress,thisreportusestheUnitedNations
internationallycomparabledataset,whichmayinsome
cases showdatathatdifferfrom those published by
nationalstatisticaloffices(BoxI-1).
Thetrendsupto2010aresummarizedinTableI-1–
fortheregionasawhole,forsomesubregions,andfor
theleast-developedcountries.Forselectedindicators,
based on trends of progress since 1990, the report
placeseachcountryorcountrygroupintooneoffour
categories:
 Earlyachiever–Alreadyachievedthe2015target
 Ontrack–Expectedtomeetthetargetby2015
 Off track:Slow–Expectedtomeetthe target,but after
 2015
 Off track:Regressing/Noprogress–Slippingbackwards

 orstagnating
MDGs in Asia and the Pacific:
where we stand
The Asia-Pacific region has registered impressive progress on many
MDG indicators, especially in reducing poverty and achieving
gender parity in education. But the region is lagging on some
important targets, particularly those related to health, which is the
main focus of this report. Many Asia-Pacific countries will need to
step up their efforts to reduce hunger, prevent the deaths of millions
of women and children, and ensure that all households benefit from
basic sanitation.
8
Asia-Pacific Regional MDG Report 2011/12
CHAPTER I: MDGs in Asia and the Pacific: where we stand
Tooffermorepreciseprofiles,somerowsinthistable
excludethelargestcountries.Thisisbecausetheoverall
regionalandsub-regionalachievementwillbeheavily
influenced bytheirperformance.TableI-1therefore
also shows the performance of  the regionand sub-
regionswithouttheselargecountries.Ascanbeseen,
‘Asia and the Pacificexcluding China andIndia’ has
insomecasesperformedworsethanthe regionasa
whole–onforestcover,forexample,itisregressing,
andonextendingaccesstosafedrinkingwateritisonly
on-track.Ontheotherhandthisgroupofcountries
hasfaredbetteronchildnutrition,asmeasuredbythe
proportionof under-5childrenunderweight.
Table I-1alsotracks the progress of  theregion’s13
least developed countries (LDCs). On 15 indicators
the LDCs have had slow progress or none at all –

performing well only on gender equality in primary
andsecondary,stoppingthespreadof HIVandTB,
increasingtheproportionof protectedlandareasand
reducingconsumptionof ozone-depletingsubstances.
The table also highlights significant differences
betweensubregions.Thegreatestprogresshasbeenin
South-EastAsia,whichhasalreadyachievedtenof the
22assessedindicatorsandisontrackforanotherfour.
The North and Central-Asian countries as a group
havealreadyachieved11of theindicators,andif the
RussianFederationisexcludedtheyhaveachieved13
– though even then they are progressing slowly on
anothersixandmakingnoprogressonCO
2
emissions,
theconsumptionof ozone-depletingsubstances,and
ensuringthatallchildrengotoprimaryschool.
SouthAsiastartedfromalowbaseonmanyindicators.
Althoughithasmadegoodprogressonnineofthem
Box I-1 – Ensuring comparable data
Foraglobaloraregionalreport,cross-countrydatashouldbestrictlycomparable.Theprogressassessments
ascontainedinthisreportrelyonthelatestavailabledatafromtheglobaldatabaseonofficialMDGIndicators
—theUnitedNationsMDGIndicatorsdatabase(see />TheUnitedNationsMDGIndicatorsdatabaseistheproductof theInter-AgencyExpertGrouponMDG
Indicators(IAEG),coordinatedandmaintainedbytheUnitedNationsStatisticsDivision.TheIAEGincludes
variousDepartmentswithintheUnitedNationsSecretariat,anumberof UNagenciesfromwithintheUnited
Nationssystemandoutside,variousgovernmentagenciesandnationalstatisticians,andotherorganizations
concernedwiththedevelopmentof MDGdataatthenationalandinternationallevelsincludingdonorsand
expertadvisers.
TheIAEGisresponsibleforthepreparationof dataandanalysistomonitorprogresstowardstheMDGs
atthe globallevel.TheGroupalsoreviewsanddefinesmethodologiesandtechnicalissuesinrelation to

theindicators,producesguidelines,and helpsdefine prioritiesandstrategies tosupportcountriesin data
collection,analysisandreportingonMDGs.
ThedatacontainedintheUnitedNationsMDGIndicatorsdatabasearetypicallydrawnfromofficialstatistics
providedbyministriesandnationalstatisticalofficestotherespectiveinternationalagencies.Insomecases,
nationallyreportedfiguresareadjustedbyinternationalagenciestoensurecomparabilityacrosscountries.For
datanotproducedbythenationalstatisticalsystem,theresponsibleinternationalagencyoftenseekstofillthe
gapbyusingdatacollectedthroughsurveyssponsoredorcarriedoutbyinternationalagencies.Inaddition,
countriessometimeshavemorerecentdatathathavenotyetbecomeavailableintheglobaldatabase.
Duetosuchtimelagsandthenecessaryadjustmentsorestimationmadebyinternationalagencies,discrepancies
mayoccurbetweennationalandinternationaldataseriesforagivenMDGindicator.Suchdiscrepanciescould
resultindifferencesintheassessmentofacountry’sprogressinreachingcertainMDGtargets.
Anotherissueis thatinternationalagenciescontinuously refinetheir methodsandextend thesourcesof 
thedatatheycollect.Thishasresultedinbetterqualitydata,butithasthedisadvantagethattheresultsin
this2011/12Asia-PacificMDGReportarenotcomparabletothoseinpreviouseditions.Fordetailsof the
classificationmethod,see />Source: Most of this box is based on E/ESCAP/CST(2)/INF/5, available at paragraphs
4-8. Annex I of E/ESCAP/CST(2)/INF/5 lists the international agencies responsible for the compilation of international data on the
official MDG indicators.
9
Asia-Pacific Regional MDG Report 2011/12
CHAPTER I: MDGs in Asia and the Pacific: where we stand
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’.
butisprogressingonlyslowlyonmanyothers.Given
thepopulationweightofIndiaitisalsousefultoconsider
‘SouthAsiawithoutIndia’.Ascanbeseen,thisgrouping
isontrackforpovertyandforTBincidenceisanearly
achiever,butisprogressingslowlyontheprovisionof 
cleanwater,andisregressingonforestcover.
Table I-1 also summarizes the achievement of  the
Pacific Island countries. As a group they have been

successful in indicators related to gender parity in
tertiary education, HIV prevalence, TB incidence,
protectedareas,CO
2
emissionsandtheconsumption
of ozone-depletingsubstances.Butonsix indicators
theyhavebeenregressingormakingnoprogressand
inanotherfivehavebeenadvancingtooslowly.
The Pacific Islands also have their own ‘regional
giant’:PapuaNewGuinea ishometoalmost 70per
centof thePacificIslandcountries’population,soits
performanceinevitablyswayssubregionalachievement.
TableI-1thereforepresentsestimatesforthePacific
Island countries excluding Papua New Guinea. This
grouphasmadebetterprogressongenderequalityin
education,TBprevalenceandforestcover.Ithasalso
been advancing, albeit slowly, onsanitation and safe
drinkingwater.
Just as there are significant differences between
Asia-Pacific subregions, there can be even greater
disparities within subregions. This is clear from
TableI-2.Forexample,whereasSouth-EastAsiaasa
wholeisontrackorisanearlyachieverfor14of these
22indicators,Cambodiamanagesthisforonly11and
LaoPDRforonlyeight–thelatterhavingmadeslow
progressinprimarycompletion,forexample,andon
genderparityatsecondaryeducation.Attheotherend
of thespectrum, SriLankanotablyoutperforms the
subregionalaverage:SouthAsiaasawholeisontrack
orisanearlyachieverforonlynineindicators,while

SriLankamanagesthisfor15.
It should also be noted that even the country-
level achievements profiled in Table I-2 mask many
subnational disparities, between regions or between
social groups. This issue is explored in detail in
ChapterII.
Table I-1 – Country groups on and off track for the MDGs
10
Asia-Pacific Regional MDG Report 2011/12
CHAPTER I: MDGs in Asia and the Pacific: where we stand
Box I-2 – Data on HIV
Toassesscommitmentstoreducebothsexualandinjection-drugtransmissionofHIV,UNmemberstates,
through the 2011 Political Declaration on HIV/AIDS, now place even more emphasis on tracking new
infections.Suchdatarespondmorerapidlytochangesinprotectivebehaviourthandodataonprevalence
whichlargelyreflectpastbehaviour.PeoplelivingwithHIVwhohavebetteraccesstoantiretroviraltreatment
arelivinglonger,soevenwhennewinfectionsdecreaseprevalencemaynotdecline.
Between1990and 2009 somecountriesmanaged toreducethe numberof new HIVinfections, despite
populationgrowth.Elsewhere,however,thenumberofnewHIVinfectionsremainsunacceptable.
AnumberofcountrieshaveseenincreasesinbothnumberofpeoplelivingwithHIVandthenumberof
newinfections–asinBangladesh,Bhutan,China,Fiji,Indonesia,LaoPDR,Malaysia,Maldives,Mongolia,
Pakistan,PapuaNewGuinea,Philippines,RepublicofKorea,Singapore,SriLanka,andVietNam.
Othercountriesdidnotshowsuchclearpatterns.InThailandandCambodia,thenumberof peopleliving
withHIVincreasedbetween1990and2000.Theyhaddecreasedby2009,butwerestillhigherthanin1990.
Duringthesametimeperiod,thenumberofnewinfectionsdecreased.
InMyanmarandIndia,thenumberof peoplelivingwithHIVincreasedbetween1990and2000,butremained
thesamein2009.InNepal,thenumberof peoplelivingwithHIVincreasedfrom1990to2009.Inallthree
countries,thenumberofnewinfectionsincreasedfrom1990to2000butdecreasedby2009.Completedata
onallAsiaandPacificcountriescanfoundat />Source: AIDSinfo Database accessed on 24th August 2011.
Burden of HIV 1990-2009, selected Asia-Pacific countries
India

Cambodia
Myanmar
Nepal
Thailand
low bound
estimate
high bound
low bound
estimate
high bound
low bound
estimate
high bound
low bound
estimate
high bound
low bound
estimate
high bound
1990
190,000
250,000
320,000
13,000
23,000
51,000
44,000
58,000
70,000
15,000

20,000
27,000
250,000
320,000
400,000
2000
2,200,000
2,400,000
2,700,000
65,000
95,000
130,000
190,000
240,000
300,000
48,000
58,000
70,000
500,000
660,000
850,000
2009
2,100,000
2,400,000
2,800,000
42,000
63,000
90,000
200,000
240,000

290,000
51,000
64,000
80,000
420,000
530,000
660,000
1990
75,000
92,000
110,000
9,200
17,000
36,000
12,000
20,000
24,000
4,000
4,900
6,700
110,000
150,000
200,000
2000
260,000
290,000
330,000
3,500
6,200
10,000

21,000
25,000
30,000
5,000
6,900
8,600
22,000
28,000
36,000
2009
110,000
140,000
160,000

<1000
1,700
4,200
14,000
17,000
20,000
2,700
4,800
7,800
9,800
12,000
15,000
Number of people living with HIV Number of new HIV infections
11
Asia-Pacific Regional MDG Report 2011/12
CHAPTER I: MDGs in Asia and the Pacific: where we stand

Table I-2 – Countries on and off track for the MDGs
Source: Staff calculations based on the United Nations MDG Database.
12
Asia-Pacific Regional MDG Report 2011/12
CHAPTER I: MDGs in Asia and the Pacific: where we stand
Asia and the Pacific on the global
stage
Using the global MDG Database also makes it
possible to compare Asia and the Pacific with two
other developing regions: Sub-Saharan Africa and
LatinAmericaandtheCaribbean.FigureI-1illustrates
thiscomparisonforsixindicators.Inthesecharts,the
sizeofthebubblesisinproportiontothenumberof 
peoplecurrentlyaffected.Theslopinglinedivideseach
chartintotwoparts:ifthebubbleis abovetheline,
since1990thevaluesonthatindicatorhaveincreased;
if itisbelowthelinetheyhavedecreased.Thecolours
correspondto theon-oroff-trackprogresssymbols
introducedearlier.AsFigureI-1indicates,Asiaandthe
Pacificisgenerallymakingbetterprogresstowardsthe
MDGtargetsthanSub-SaharanAfrica,butislagging
behindLatinAmericaandtheCaribbean.Butbecause
of itslargerpopulationsize, onmostindicators,the
Asia-Pacificregionhasthegreatestnumbersofpeople
affected.
Thetotalnumberof Asia-Pacificpeoplewhoremain
deprived is detailed for 10 indicators in Figure I-2.
For safe drinking water, for example, the region has
maderemarkableprogress:between1990and2008the
numberof peoplewithoutaccesstosafedrinkingwater

fellfrom856millionto466million.Neverthelessthe
regionisstillhometomorethanhalf thedeveloping
world’stotaldeprivedpopulation.Andinthecaseof 
sanitation, the region in2008 had almost 1.9billion
peoplewithoutaccess–morethan70percentof the
developingworld’sdeprivedpopulation.
Health – diagnosing the deficits
It is rather surprising that a region as economically
dynamicasAsiaandthePacificshouldstillfallshort
whenitcomestoensuringthatitspeoplearehealthy.
Theremainderof thischapterwillthereforefocuson
critical health deficits, identifying the indicators for
whichprogresshasbeentooslow,indicatingthespeed
of changerequiredtohitthetargetsandpointingout
howmanypeoplewouldbenefit.
Feeding our children
A key failure has been to ensure that children in
Asia and the Pacific are well-nourished. Figure I-3
illustratesthetaskaheadbyshowingforaselectionof 
countrieswhatproportionof under-fivechildrenare
underweight–weighinglessthantheyshouldfortheir
age. For each country progress is represented byan
arrow.Thetailof thearrowisatthestartingpoint–
1990orthefirst subsequentyearforwhichdataare
available.Thetipof thearrowshowstheproportion
of  childrenunderweight in thelatestyearforwhich
dataareavailable.Thecolourof thearrowcorresponds
to this report’s on- or off-track colour coding. The
verticallineshowsthe2015MDGtarget–whichfor
eachcountryishalf therateof thestartingpoint.

Insomecases,thearrowspointtohearteningprogress.
Bangladesh,Afghanistan,CambodiaandVietNam,for
example,startedatveryhighlevels,andareontrack
to meet their targets. However four other countries
in which more than 30 per cent of  children were
underweightin1990remainoff track.Onthecurrent
trend,by2015theAsia-Pacificoff-trackcountriesstill
havemorethan60millionchildrenunderweight.
Nevertheless,manyof theoff-trackcountriesshould
stillbeabletoturnthingsaround.Thisisindicatedin
TableI-3whichshowsthatanumberof countriesin
Central and West Asia couldstillmeetthetarget by
reducingtheirproportionof underweightchildrenby
lessthanonepercentagepointperyear.Butalltheoff-
trackcountries,includingIndia,couldmeetthetarget
byreducingtheprevalenceofunderweightchildrenby
2percentagepointsperyear.
Preventing child deaths
A very disturbing consequence of  MDG shortfalls
in Asia and the Pacific is that more than 3 million
childrenacrossthe regiondiedbeforereaching their
fifthbirthdayin2010.Thecurrentpictureisshownin
FigureI-4.
Somecountrieshadveryhighmortalityratesin1990
–around100per1,000 livebirths –buthavemade
striking progress. These include Timor-Leste, Lao
PDR,Bangladesh,NepalandMaldives.Buttheoverall
outcome is clearly unacceptable of 48 countries for
whichdataareavailable,32areofftrack.Nevertheless,
asindicatedinTableI-4,halftheoff-trackcountries

couldstillmeetthetargetiftheymanagedtoreduce
furthertheirunder-5mortalitybyaround2deathsper
1,000livebirthsperyear.
13
Asia-Pacific Regional MDG Report 2011/12
CHAPTER I: MDGs in Asia and the Pacific: where we stand
Source: Staff calculations based on the United Nations MDG Database and World Population Prospects 2010.
Figure I-1 – Asia and the Pacific compared with Sub-Saharan Africa and Latin America and the
Caribbean