|Year : 2014 | Volume
| Issue : 2 | Page : 65-69
WHO Millennium development goals and achievements so far
Gajanan S Gaude
Professor, Department of Pulmonary Medicine, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
|Date of Web Publication||7-Jan-2015|
Dr. Gajanan S Gaude
Professor, Department of Pulmonary Medicine, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gaude GS. WHO Millennium development goals and achievements so far. Indian J Health Sci Biomed Res 2014;7:65-9
Recently, the United Nations General Assembly concluded its 69 th Annual Session in new York with the President declaring that it would be a historic opportunity to formulate a post-2015 development agenda that is transformative, brings tangible results in fighting poverty, and leads in improving lives of all people. The theme of this year's general debate was "Delivering on and implementing a Transformative Post-2015 Development Agenda" and he said the framework must strive to eradicate poverty and hunger and promote sustained and inclusive economic growth. The opportunities that 2015 presents for bringing the countries and people of the world together to decide and embark on new pathways forward are historic and unprecedented. These decisions will determine the global course of action to end poverty, promote prosperity and well-being for all, protect the environment and address climate change. The actions made in 2015 are expected to result in new sustainable development goals to follow the eight Millennium Development Goals (MDGs). The UN is working with governments, civil society and other partners to build on the momentum generated by the MDGs and carry on with an ambitious post-2015 development agenda. 
The United Nations MDGs are eight goals that all 193 UN Member States have agreed to try to achieve by the year 2015. The United Nations Millennium Declaration, signed in September 2000 commits world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are derived from this Declaration, and all have specific targets and indicators. Each MDG has targets set for 2015 and indicators to monitor progress from 1990 levels. The MDGs place health at the heart of development and represent commitments by governments throughout the world to do more to reduce poverty and hunger and to tackle ill-health, gender inequality, lack of education, access to clean water and environmental degradation. Three of the eight goals are directly health-related; all of the others have important indirect effects on health. It warns that without significantly strengthened commitments from both wealthy and developing countries, the goals will not be met globally. Enormous progress has been made toward achieving the MDGs. Global poverty continues to decline, more children than ever are attending primary school, child deaths have dropped dramatically, access to safe drinking water has been greatly expanded, and targeted investments in fighting malaria, AIDS and tuberculosis have saved millions. Although some countries have made impressive gains in achieving health-related targets, others are falling behind. Often the countries making the least progress are those affected by high levels of HIV/AIDS, economic hardship or conflict. The MDGs are making a real difference in people's lives and with strong leadership and accountability, this progress can be expanded in most of the world's countries by the target date of 2015. After 2015, efforts to achieve a world of prosperity, equity, freedom, dignity and peace will continue unabated. The UN is working with governments, civil society and other partners to build on the momentum generated by the MDGs and carry on with an ambitious post-2015 development agenda.  As the 2015 target date for achieving the MDGs approaches, there is wide debate as to what development goals the global community should set for the next decade.
| Millennium Development Goal 1: Eradicate Extreme Poverty and Hunger|| |
Undernutrition which includes fetal growth restriction, stunting, wasting and deficiencies of vitamin A and zinc, along with suboptimal breastfeeding; is the underlying cause of death in an estimated 45% of all deaths among children under 5 years of age. The proportion of underweight children in developing countries has declined from 25% to 15% between 1990 and 2012. This rate of progress is close to the rate required to meet the MDGs target, however improvements have been unevenly distributed between and within different regions. Hence, utmost importance is given to eradicate the extreme poverty and under-nutrition, which has got direct bearing on the children mortality.
| Millennium Development Goal 2: Achieve Universal Primary School|| |
For a country to develop, the primary education of the children is very important. It is to be ensured that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling. Enrolment in primary education in developing regions has reached 90% in 2010, up from 82% in 1999, which means more kids than ever are attending primary school. In 2011, 57 million children of primary school age were out of school. Even as countries with the toughest challenges have made large strides, progress on primary school enrolment has slowed.  One in ten children of primary school age was still out of school in 2012. Gender gaps in youth literacy rates are also narrowing. Globally, 781 million adults and 126 million youth (aged 15-24) worldwide lack basic reading and writing skills, and > 60% of them are women.
| Millennium Development Goal 3: Promote Gender Equality and Empower Women|| |
Girls' education is critically linked to self-determination, improved health, social and economic status as well as positive health outcomes for the mother and the child. Yet, girls still account for 55% of the out-of-school population. Maternal deaths and pregnancy-related conditions cannot be eliminated without the empowerment of women. Maternal mortality is the number one cause of death for adolescents 15-19 years old and in many countries, sexual and reproductive health services tend to focus exclusively on married women and ignore the needs of adolescents and unmarried women. Empowerment of women, including ensuring access to health information and control of resources such as money, is important for achieving gender equality and health equity. However, the ratio of female-to-male earned income is well below parity in all countries, including India for which data are available. Up to one in three women worldwide will experience violence at some point in her life, which can lead to unwanted pregnancy and abortion, among other things.  There are two forms of violence against women: violence by an intimate partner (intimate partner Violence) and sexual violence by someone other than a partner (nonpartner sexual violence). It shows, for the 1 st time, global and regional estimates of the prevalence of these two forms of violence, using data from around the world. Previous reporting on violence against women has not differentiated between partner and nonpartner violence. Hard decisions should be taken by the state as well as National Governments to control the violence against the women. Only then, the Nation can strive forward in health.
| Millennium Development Goal 4: Reduce Child Mortality|| |
Children mortality below the age of 5 years is highest in African and Asian countries. Globally, significant progress has been made in reducing mortality in children <5 years of age. The global rate of decline has also accelerated in recent years - from 1.2% per annum during 1990-1995 to 3.9% during 2005-2012. The number of under-five deaths worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. This translates into 17 000 fewer children dying every day in 2013 than in 1990. The risk of a child dying before their fifth birthday is 8 times higher in the WHO African Region than a child in the WHO European Region.  About half of the world's under-five deaths in 2013 still occurred in only five countries: India, Nigeria, Pakistan, Democratic Republic of the Congo, and China. India (21%) and Nigeria (13%) together account for more than a third of under-five deaths worldwide. Despite this improvement, the world is unlikely to achieve the MDGs target of a two-thirds reduction in 1990 mortality levels by the year 2015. More countries are now achieving high levels of immunization coverage; in 2012, 66% of Member States reached at least 90% coverage. In 2012, global measles immunization coverage was 84% among children aged 12-23 months. Between 2000 and 2012, measles deaths worldwide have been cut by almost 80% - from 562 000 to 122 000 deaths.
| Millennium Development Goal 5: Improve Maternal Health|| |
Despite a significant reduction in the number of maternal deaths - from an estimated 523000 in 1990 to 289000 in 2013 - the rate of decline is less than half of what is needed to achieve the MDGs target of a three-quarters reduction in the maternal mortality ratio between 1990 and 2015. Nearly 800 women die every day due to complications during pregnancy and childbirth. In order to reduce the number of maternal deaths, women need access to good-quality reproductive health care and effective interventions.  In 2011, 63% of women aged 15-49 years who were married or in a consensual union were using some form of contraception, while 12% wanted to stop or postpone childbearing but were not using contraception. The proportion of women receiving antenatal care at least once during pregnancy was about 81% for the period 2006-2013, but for the recommended minimum of 4 visits or more the corresponding figure drops to around 56%. The proportion of births attended by skilled personnel - crucial for reducing perinatal, neonatal and maternal deaths - is above 90% in 3 of the 6 WHO regions. However, increased coverage is needed in certain regions, such as the WHO African Region where the figure remains <50%. In India, lot of emphasis has to be focused on the deliveries conducted at sub-centers and Anganwadi trained workers.
| Millennium Development Goal 6: Combat HIV/AIDS, Malaria and Other Diseases|| |
In 2012, an estimated 2.3 million people were newly infected with HIV - 33% less than the 3.4 million people newly infected in 2001. Sub-Saharan Africa accounted for 70% of all the people who acquired HIV infection globally.  There were an estimated 35 million people living with HIV in 2012, an increase from previous years. As the access to antiretroviral therapy in low- and middle-income countries improves, the population living with HIV will continue to grow since fewer people are dying from AIDS-related causes.
About half the world's population is at risk of malaria, and an estimated 207 million cases in 2012 led to approximately 627 000 deaths - most of these in children under the age of 5 living in Africa. During the period 2000-2012, malaria incidence and mortality rates of population at risk have both fallen globally, 29% and 42% respectively. An estimated 3.3 million lives were saved as a result of scaling-up malaria interventions during the same period. The coverage of interventions such as the distribution of insecticide-treated nets and indoor residual spraying has greatly increased and will need to be sustained in order to prevent a resurgence of disease and deaths caused by malaria.
The annual global number of new cases of tuberculosis has been slowly falling for a decade thus achieving MDGs target to reverse the spread of the disease by 2015. In 2012, there were an estimated 8.6 million new cases and 1.3 million deaths (including 320 000 deaths among HIV-positive people). Globally, treatment success rates have been sustained at high levels since 2007, at or above the target of 85%. Between 1995 and 2012, 56 million people were successfully treated for tuberculosis and 22 million lives were saved. However, multi-drug resistant tuberculosis (MDR-TB), which emerged primarily as a result of inadequate treatment, continues to pose problems. Now in many countries including India, the treatment for MDR-TB has also been taken up to a large scale, and it has been integrated into national control program as DOTS PLUS.
Neglected tropical diseases (NTDs) are a medically diverse group of infections caused by a variety of pathogens such as viruses, bacteria, protozoa and helminths. The 17 diseases prioritized by WHO are found in 149 countries and can cause multiple infections in one person and are almost always associated with poverty. Leprosy has now been eliminated as a public health problem in 119 out of the 122 countries where it was previously endemic. Dracunculiasis (also known as the guinea-worm) is a crippling parasitic disease on verge of eradication, with only 148 cases reported in 2013. However, NTDs still affect more than 1 billion people worldwide. Despite renewed momentum characterized by unprecedented progress, some NTDs (like dengue) remain a significant obstacle to health, making it harder to achieve the MDGs, and pose an ongoing impediment to poverty reduction and overall socioeconomic development in tropical country like India.
| Millennium Development Goal 7: Ensure Environmental Sustainability|| |
World has now met the MDGs target relating to access to safe drinking-water. In 2012, 90% of the population used an improved source of drinking-water compared with 76% in 1990. Progress has however been uneven across different regions, between urban and rural areas, and between rich and poor. About basic sanitation, current rates of progress are too slow for the MDG target to be met globally. In 2012, 2.5 billion people did not have access to improved sanitation facilities; with 1 billion these people still practicing open defecation. The number of people living in urban areas without access to improved sanitation is increasing because of rapid growth in the size of urban populations.  The set target by 2015 is that too, halve the proportion of people without sustainable access to safe drinking water and basic sanitation. In this regard, the Prime Minister of India has recently launched an ambitious campaign of "Shhach Bharat" (clean India) all across villages, and cities. To prove good sanitation efforts are also being made to provide at least one clean toilet in all the schools in India under Prime Ministers Project. Furthermore, he has launched the Ganga river clean project and hence that the livelihood of nearly 40 crore people can be improved. In this way, we can attain the sustainability of the environment to a great extent.
| Millennium Development Goal 8: Develop a Global Partnership for Development|| |
Many people continue to face a scarcity of medicines in the public sector, forcing them to the private sector where prices can be substantially higher. Surveys undertook from 2007 to 2012 show the average availability of selected generic medicines in low- and middle-income countries was only 57% in the public sector. Patient prices of lowest priced generics in the private sector averaged 5 times international reference prices, ranging up to about 16 times higher in some countries. Even the lowest-priced generics can put common treatments beyond the reach of low-income households in developing countries. The greatest price is paid by patients suffering chronic diseases. Effective treatments for the majority of the global chronic disease burden exist, yet universal access remains out-of-reach. Hence, the target of MDGs is to seek the cooperation of the pharmaceutical companies, and to provide access of affordable essential medicines in developing countries.
| Obstacles and Solutions|| |
Seizing the opportunity offered by the MDGs will not be easy. Wealthy countries have so far failed to live up to all of their responsibilities under the compact, which include establishing fairer international trade policies, increasing official development assistance, delivering debt relief and accelerating technology transfer. Despite progress in some cases, many developing countries are not currently on track to achieve their health-related MDG objectives. Without significantly strengthened commitments from both developed and developing countries, the MDGs will not be met globally, and outcomes in some of the poorest countries will remain far below the hoped-for achievements.  WHO and international health partners must intensify their cooperation with Member States to speed up progress towards the MDGs and ensure that gains are made by those most in need.
WHO works with partners to support national efforts to achieve the health-related MDGs. WHO's activities include: Setting prevention and treatment guidelines and other global norms and standards; providing technical support to countries to implement guidelines; analyzing social and economic factors and highlighting the broader risks and opportunities for health. WHO assists national authorities as they develop health policies and plans, and helps governments work with development partners to align external assistance with domestic priorities. WHO also collects and disseminates data on health so that countries can plan health spending and track progress.
WHO has proposed 20 ways to help the countries reach the MDGs: 
- Increase access to safe, effective, quality medicines and diagnostics
- Prevent people from falling into poverty because they have to pay for health care themselves. WHO recommends replacing user fees with pooled, prepayment financing systems such as taxation and/or insurance
- Develop strategies to address critical shortages of health workers. These include finding ways to improve training, manage migration, and enhance geographical distribution
- Improve the availability, quality and analysis of health information. Regular updates will be given regarding MDGs
- Ensure that sick children get quality health care within 24 h of becoming ill, and provide safe, effective medicines for children
- Continue to immunize children against measles and other vaccine-preventable diseases, and introduce new, life-saving vaccines such as those against pneumonia and rotavirus diarrhea
- Reduce deaths from pneumonia and diarrhoea, which together kill almost 3 million children under 5-year-old each year
- Assess children's growth according to a global standard to identify cases of malnutrition in time to intervene effectively, and develop national nutrition plans and policies for infants and children
- Improve essential antenatal and postnatal care for all mothers and babies, providing integrated services to address all maternity needs, and supporting care in the home
- Increase access to sexual and reproductive health services, including family planning, infertility services, prevention and treatment of sexually transmitted infections, and skilled care before, during and after pregnancy and childbirth
- Address gender inequalities that limit the ability of women and girls to protect their health, and provide a full range of health services for women of all ages
- Reduce AIDS deaths, improve quality of life for people living with HIV, and reduce the number of new infections by providing comprehensive prevention, treatment and care service
- Promote a comprehensive approach to preventing mother-to-child transmission of HIV that integrates a full range of antenatal and postnatal services
- Reach national targets improving TB control, surveillance, and care. But MDR-TB remains a serious concern, and efforts should be done to prevent the same
- Increase survival rates of people with both TB and HIV.
- Improve local availability of effective antimalarial medicines (artemisinin-based combination therapy) and rapid diagnostic tests.
- Curb the spread of malaria by promoting the use of insecticide-treated nets and integrated vector management - better water, sanitation, and irrigation management.
- Monitor AIDS, TB and malaria prevention, treatment and care coverage via WHO's annual status reports and maternal and child health with the Countdown to 2015 reports that track progress on MDGs 4 and 5.
- Prevent, eliminate or eradicate NTD.
- Improve the availability of safe drinking water and sanitation. In 2008, 87% of the world's population could access safe drinking water.
| References|| |
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