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

1. Accelerating Equitable Achievement of the MDGsClosing Gaps in Health and Nutrition Outcomes ShiladityaChatterjee Regional Advisor on the MDGs Asian Development Bank

2. Accelerating Equitable Achievement of the MDGsClosing Gaps in Health and Nutrition Outcomes Chapter 1 : Progress and status Chapter 2 : Inequalities and disparities Chapter 3 : Health and nutrition Chapter 4 : Looking forward beyond 2015 Conclusions: Implications for public sector management

3. I. Status and Progress

4. Mixed progress since 1990

5. Regional and sub-regional performance Source: Staff calculations based on the United Nations MDG Database and World Population Prospects 2010; UNESCO Institute of Statistics for the education-related indicators under Goals 2 and 3, except ‘Reaching last grade’.

6. Asia-Pacific compares well with Africa but not Latin America

7. II. Inequalities and Disparities

8. Extent of Disparities Between Countries • The wide disparities in MDG outcomes between countries is evident from the figures below. Infant mortality Underweight children Income poverty

9. In many cases, such disparities are widening over time

10. Disparities within countries are also large Source: Demographic and Health Survey.

11. III. Health - the major lagging sector

12. Health spending is critical Cross-country variation in child mortality explained by differences in health spending Sources: United Nations MDG database for child mortality and World Bank, World Development Indicators online database for health expenditure per capita.

13. But many countries spend too little Total health expenditures as share of GDP (%)

14. Forcing large out of pocket expenses in many countries • Rich should pay for health care – but it must be subsidized for poor • Costs can be reduced if production of generics is expanded

15. Spending on more health personnel is critical • Lack of attendance of skilled health staff at births increases maternal deaths • Emphasis on primary health care needed

16. Public health services must be effective and corruption-free • Corruption harms health outcomes • Public health services less effective in preventing maternal and child deaths than private services

17. More basic infrastructure to support health services necessary Births attended by skilled health personnel and the extent of paved roads Sources : The World Bank, World Development Indicators online database for GDP per capita, electricity consumption, and percent of paved road networks; and the United Nations MDG database for skilled birth attendance, access to sanitation and safe drinking water. Better roads improve the proportion of births attended by skilled health staff as shown below. Better access to water and sanitation also improve health MDGs

18. Better health also depends on empowering women and targeting the socially discriminated • Women’s education and empowerment • Reduces maternal and child deaths • Improves family nutrition • Spreads awareness of breast feeding and birth spacing • Lower castes remain deprived in South Asia

19. IV. Looking Forward

20. Task ahead remains challenging

21. The Global Development Agenda beyond 2015 • Ending Asian deprivations will remain critical for Asia’s future • Rio +20 will shortly begin a process for developing a new set of development goals • UN Secretary General has called for defining a “new generation of sustainable development goals building on the MDGs”

22. Conclusions

23. Implications for public sector management • The task of achieving the MDGs (or SDGs in future) will fall mainly on the public sector • Improving PSM is therefore critical – as in health • Effectiveness of public health services key for health outcomes • Adoption of proper strategies and policies, backed by adequate provision of financial and human resources and infrastructure, is critical • Efficient implementation and monitoring are essential

24. Thank You