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SPECIAL ARTICLE
Year : 2012  |  Volume : 56  |  Issue : 4  |  Page : 259-268  

Progress in health-related millennium development goals in the WHO South-East Asia Region


Deputy Regional Director, WHO Regional Office for South-East Asia

Date of Web Publication24-Jan-2013

Correspondence Address:
Poonam Khetrapal Singh
Deputy Regional Director, WHO Regional Office for South-East Asia, C217A, Defence Colony, New Delhi - 110024, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.106412

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   Abstract 

Home to 25% of the world's population and bearing 30% of the Global disease burden, the South-East Asia Region [1] of the World Health Organization has an important role in the progress of global health. Three of the eight million development goal (MDG) goals that relate to health are MDG 4, 5, and 6. There is progress in all three goals within the countries of the region, although the progress varies across countries and even within countries. With concerted and accelerated efforts in some countries and certain specific areas, the region will achieve the targets of the three health MDGs. The key challenges are in sustainable scaling up of evidence-based interventions to improve maternal and child health and controlling communicable diseases. This will require continued focus and investments in strengthening health systems that provide individual and family centered comprehensive package of interventions with equitable reach and that which is provided free at the point of service delivery. Important lessons that have been learnt in implementing the MDG agenda in the past two decades will inform setting up of the post MDG global health agenda. This article provides a snap shot of progress thus far, key challenges and opportunities in WHO South-East Asia Region and lays down the way forward for the global health agenda post 2015.

Keywords: Health, Goals, South-East Asia region


How to cite this article:
Singh PK. Progress in health-related millennium development goals in the WHO South-East Asia Region. Indian J Public Health 2012;56:259-68

How to cite this URL:
Singh PK. Progress in health-related millennium development goals in the WHO South-East Asia Region. Indian J Public Health [serial online] 2012 [cited 2019 Dec 7];56:259-68. Available from: http://www.ijph.in/text.asp?2012/56/4/259/106412

Heads of State from 189 countries adopted the UN Millennium Declaration in September 2000, endorsing a common global blueprint for development - the MDGs, for the first time in world history. Eight MDGs were established, encompassing issues that were considered fundamental for development: Poverty and hunger, ill health, lack of education, gender inequality, lack of access to clean water, and environmental degradation.What differentiated these from previous commitments was that they were specific and measurable. The MDGs had targets set for 2015, and measureable indicators agreed upon to monitor their progress.

Three MDGs relate directly to health: To reduce child mortality by two-thirds (MDG 4), to reduce maternal deaths by three-quarters and achieve universal access to reproductive health (MDG 5), and to halt and reverse the spread of human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS), achieve universal access to treatment for HIV/AIDS by 2010, and halt and reverse the incidence of malaria and other diseases (MDG 6). Inclusion of these health-related goals in the development goals underscores the inextricable connection between development and health.On one hand, economic development cannot be sustained without improvement in the health of the people - a healthy workforce is needed to drive the economy, and ill health places an enormous social and economic burden. On the other hand, poverty, hunger, and malnutrition (MDG1); lack of education (MDG2), gender inequality (MDG3); and unsafe water and poor sanitation (MDG7) are some of the underlying determinants of peoples' health. All these contribute to the three health-related MDGs and also indicate the interrelationship of these developmental goals. However, this paper presents the progress in the MDGs directly related to health in the South-East Asia Region of WHO.

The 11 countries of the WHO South-East Asia Region constitute approximately 25% of the world's population, as well as 25% of the world's poor, despite the fact that some of the countries are surging ahead with high economic growth. Progress in MDGs in the South-East Asia Region, therefore, is critical for achieving the MDG targets globally.Reporting on the progress of MDGs at country, regional, and global levels has underscored the importance of producing reliable and timely data in a standard manner that would also allow for global comparisons.


   MDG 4: Reduce Child Mortality: Progress in South East Asian Region Top


MDG 4 on saving the lives of children can also be seen as saving and investing in the future of the country. The target for MDG 4 is to reduce the under-five mortality rate (U5MR) by two-thirds, between 1990 and 2015.According to the UN Inter-agency Group for Child Mortality Estimation 2012 Report, substantial progress has been made toward achieving MDG 4 overall in the region that accounts for 28% of the global under-five mortality. From a baseline of 12 million annual under-five child deaths reported in 1990, the region reported 42.5% decline at 6.9 million under-five deaths in 2011. The global reduction in U5MR in similar timeframe was 41%. [1]

Progress as measured in annual rate of decline more than 4% for U5MR is either achieved or on track in 8 of the 11 countries in the region [Table 1]. Government of Bangladesh has received the UN Secretary-General's award for progress in MDG4 at the special UN General Assembly Session on MDGs in 2010.
Table 1: MDG4 Status in South East Asian Region

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While there is much to cheer, there is need for caution. Three countries need to further accelerate progress in order to achieve MDG4 and as they are large countries, inability to do so may cost the region its achievement. There is also another aspect to reaching national goals - they mask the sub-national variations. Progress is uneven when it is disaggregated by income quintiles, socio-economic status, female literacy and education, rural-urban habitation, male-female ratios, etc. Thus the progress is not equitable. Overall economic growth, health expenditures, resource allocations governance, and accountability have differential impacts on final health outcomes for children. [2] For example, in India, children belonging to the poorest quintile are 3.5 times more likely to die before the age of five years compared with children belonging to the richest 20%. [3]

Neonatal mortality is responsible for 60-70% of infant mortality and above 50% of under-five mortality in the Region. [4] Progress in reduction of newborn mortality has been slower. The main causes of neonatal deaths include prematurity/low birth weight, birth asphyxia, and infections. Newborn survival and health are inextricably linked to mother's health and survival. Younger age and frequent childbirths at less than 24 months interval are known risk factors for high newborn mortality.

Under-nutrition among children that contributes to over a third of under-five deaths is also prevalent in the Region. Many children are born with low birth weight - as many as 28% in India and 22% in Bangladesh. [5] Stunting that denotes chronic under-nutrition in children ranges from 58% in Timor-Leste to 12% in Thailand. [6],[7]


   MDG 5: Reduce maternal deaths and achieve universal access to reproductive health Top


MDG 5 has two main targets: MDG5a, on reducing maternal mortality, with maternal mortality ratio and proportion of births attended by skilled health professionals as indicators; andMDG5b, on universal access to reproductive health, with four indicators,that is, contraceptive prevalence rate, adolescent birth rate, ante natal care (ANC) coverage rate, and unmet need for family planning.

MDG5a: Maternal Mortality in SEAR

Despite a significant reduction in the number of maternal deaths - from an estimated 543 000 in 1990 to 287 000 in 2010 the annual rate of decline is just over half that is needed to achieve the MDG target 5a (Reduce by three quarters the maternal mortality ratio, between 1990 and 2015). [5]

Recent maternal mortality ratio (MMR) estimates in SEAR countries and the status of progress for achieving MDG5, with the skilled birth attendance rates are shown in [Table 2]. While notable progress has been made in reduction of maternal mortality, disparities exist within and among countries.
Table 2: Current progress in achieving MDG 5 in South East Asian Region (WHS 2012)

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The region is well underway in achieving the MDG 5A target of reducing maternal mortality ratio. All member states have demonstrated increased political will and commitment to maternal and newborn health especially in their quest to achieve MDG5. Eight of the eleven countries in the region have either achieved or are on track for achieving MDG 5. The remaining three had already low levels of maternal mortality and the average annual rate of decrease may not be applicable to them [Table 2]. The Government of Nepal has received UN Secretary General's award for progress in MDG 5 in the special session of UN General Assembly on MDGs.

The main causes of maternal deaths in SEAR, quite similar to the global profile, are hemorrhage, eclampsia, hypertension, sepsis, and unsafe abortions. A majority of these deaths occur during or immediately following childbirth, underscoring the importance of skilled care at birth and immediate postpartum period. As discussed earlier, this has positive implications for newborn survival as well.

Skilled attendance at birth that is critical to maternal and newborn survival remains low in some countries. Lack of access to skilled care has been tackled by the introduction of innovative mechanisms to improve physical access and transportation, as well as by using financial schemes to reduce financial barriers such as conditional cash transfer (JananiSurakshaYojna (JSY) in India) and demand side financing (DSF) in Bangladesh. These efforts have resulted in an appreciable increase in skilled attendance, although the quality of care remains to be further improved.Countries have also addressed accessibility and availability of emergency obstetrics services that have contributed in reducing maternal mortality.The coverage of these services has been variable across member countries especially related to the functionality of these facilities.

MDG5b: Universal access to RH in SEAR

To reduce number of maternal deaths women need access to good quality reproductive health services including family planning. The concept of "universal" is best taken to mean equity, which means the four indicators should be analyzed to detect any disparities or inequities within countries. According to World Health Statistics reports, the indicators were as shown in [Table 3].
Table 3: Status of South East Asian Region countries in achieving universal access to reproductive health

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While some progress has been made in family planning, the success has been modest. The CPR has been stagnant for several years in almost all countries.Continued advocacy for repositioning family planning services is warranted as use of modern methods of family planning will prevent more than a third of maternal deaths and 10% of child deaths.

The coverage of antenatal care for one and for four visits has shown improvement in all countries of the Region, yet there is need to improve the quality of services provided during of these visits.


   Progress in MDG 6: To combat HIV/AIDS, malaria, and other diseases Top


MDG 6 refers to prevention and treatment of communicable diseases, which can be halted or reduced through actions for effective detection and control. [8] The specific targets and indicators for MDG 6 are presented in [Table 4].
Table 4: MDG6 Targets and Indicators

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   HIV/AIDS Top


An estimated 3.5 million people are living with HIV/AIDS in the South-East Asia Region, according to 2010 data, of which 37% are women - this is less than the global average of 50%.Although overall HIV prevalence among the adult population is very low (0.3%), some population groups are disproportionately affected (e.g., sex workers, people who inject drugs, men who have sex with men, transgender people). Sub-regional variations in prevalence vary from <0.1% to >1.3%. Five countries: India, Indonesia, Myanmar, Nepal, and Thailand account for more than 99% of the HIV burden in this Region. [9]

Overall good progress has been reported on MDG targets for HIV in the region. The estimated number of new infections dropped by 34% from 320 000 in 2001 to 210 000 in 2010. The number of people on Anti Retroviral Therapy (ART) has increased 13-fold from 55000 in 2003 to 717000 in 2010. While this is commendable, it is lesser than the global increase of 17-fold in the same duration. [10]

However, the average ART coverage of 39% for the region is less than the global average of 49%. There are huge inter-country variations with ART coverage ranging from 67% in Thailand to less than 30% in Nepal and Indonesia. [11] The HIV epidemic in the region is driven by key affected populations - men who have sex with men, people who inject drugs, and sex workers. The condom use in these highly vulnerable groups is still low. More than 80% consistent condom use among sex workers was reported only from India, Myanmar, and Thailand.


   Malaria Top


The fight against malaria has also seen some progress in SEAR. An estimated 1322 million people or 76% of the total population are at risk of malaria. About 93% of the population of moderate to high risk of malaria in SEAR are living in Bangladesh, India, Indonesia, Myanmar, Thailand, and Timor Leste, and contributing more than 95% of confirmed malaria cases and deaths in the Region. Malaria disproportionately affected children under-five years of age and pregnant women. [12]

In 2010, 28,000,000 malaria cases were estimated in the South-East Asia Region of which 2,000,000 were reported cases. The reported cases thus constituted only 9% of the estimated cases - this was below the global average of 11%. [13] Fifty-four percent of the reported cases were Plasmodium falciparum.

Some progress has been reported in malaria from the region - The percentage reduction from 2000 to 2010 is 15%, which is more than the global average of 3%. Maldives is the only country in the region that has eliminated malaria. According to the Global malaria Report 2011, DPR Korea and Sri Lanka are in preelimination phase while the rest of the countries are in control phase. Five countries in the region - Bhutan, DPRKorea, Nepal, Sri Lanka, and Thailand have reported more than 50% decrease in the number of malaria cases since 2000. Bangladesh and Myanmar have recently expanded diagnostic testing making trend analysis difficult.

The estimated deaths ascribed to malaria in the region are about 38,000, 31% of which are among children less than five years. The under-five mortality due to malaria in the region is much lower than the global average of 86%. This means that more adults in the region are dying of malaria. The percentage reduction in deaths since 2000 is 17% for the region, which is higher than the global average of 13%.

Bangladesh, Bhutan, Nepal, and Sri Lanka have not reported any major epidemic since past 3-5 years.Vector control through Indoor Residual Spray in all the countries and larvivorous fish in India, Indonesia, Myanmar, Sri Lanka, and Thailand is being implemented.Epidemic preparedness and surveillance are key control strategies in all countries.All countries have started using insecticide-treated bed nets (ITNs).Bangladesh and Bhutan have made good progress and have successfully reduced cases by up scaled ITN coverage. [12]


   Tuberculosis Top


The South-East Asia Region has almost half of all the world's tuberculosis (TB) cases, and 5 of the world's 22 TB high-burden countries. India alone accounts for a quarter of all new cases.

The Region registered an estimated 5 million prevalent and about 3.5 million incident TB cases in 2010. Although the death rates in the Region have declined due to successful implementation of the directly observed treatment, short course (DOTS), the disease still claims about half a million lives a year in the Region. [14]

The TB/HIV burden is also high. Approximately half of the estimated 3.5 million people living with HIV in the Region are likely to be coinfected with TB. Currently, approximately 600 million people have access to a comprehensive package of TB/HIV services in the Region.

A growing number of multidrug-resistant tuberculosis (MDR-TB) diagnosis and treatment sites are being established in the Region. In 2010, almost 4000 MDR-TB patients were put on treatment. There are currently 105,000 MDR-TB cases estimated in the Region.

Countries in the WHO South-East Asia Region have made significant progress toward achieving the TB-related MDGs. In some countries both the prevalence and TB mortality have reduced by more than 50% both of which are MDG targets. [15]

For the region overall, the TB prevalence and mortality rates have decreased by about 40% compared with the 1990 baseline.

The treatment success rate among new smear-positive pulmonary TB cases has remained above 85% since 2005 and was reported at 88% in 2010. The overall treatment success rate in the Region as a whole was 88%, close to the current target of 90%, and already five Member States have achieved the newly set target. The Challenges in achieving health related MDGs

Socio-cultural barriers

Poverty, gender inequity, lower literacy and education levels especially for girls, early marriage and child-bearing,limited access to sexual and reproductive health services continue to plague many parts of the region especially those that are hard to reach and who are most in need. Adopting innovative service delivery approaches to improve access to the marginalized and the needy is important in reducing health equity and improving health outcomes at population level. Addressing these issues is challenging as responses go much beyond the health sector to include education, human resources, nutrition, social protection, youth affairs, etc.

Health Systems Constraints

Achieving the health-related MDGs requires a well-functioning, integrated and fully operational health system. Primary health care services that include a comprehensive package of essential interventions delivered close to where people live and free at the point of care are critical to improving health and health outcomes for life course conditions like pregnancy and childbirth and disease conditions that affect children and adults. A preventive, promotive and curative package of continuum of care services from home to health care facility and from diagnosis to management that is responsive to the needs of people is needed. Insufficient resources both financial and human and dispersed health care service delivery and competing priorities in a resource constrained environment pose significant challenges. Reaching the vulnerable and marginalized sections of the population requires additional resources and innovative service delivery approaches that are frequently not possible unless there is additional financing. Stigma and discrimination especially for condition like HIV and TB require structural and behavioral interventions that are far beyond the health sector.

Financial barriers to access and utilization of services remain a formidable challenge in many countries in the Region. Out of pocket or direct payments for services can be catastrophic for families, which pushes them further into poverty.

Scaling up Interventions

We know the technical interventions that are evidence-based and will deliver the results. They need to be scaled up to reach critical coverage levels and include the marginalized and vulnerable groups to have equitable progress. Sustainable scaling up is constrained by lack of resources, ill-equipped, and poorly functioning health systems, poor functional and referral linkages across programs. This results in loss to follow up and poor retention in care programs especially for long-term and lifelong treatment programs like TB and HIV. It also adversely affects the continuum from pregnancy, childbirth, postnatal, family planning, and child-care services. The coverage for children receiving oral rehydration solution (ORS) for diarrhea is quite low (50% or less) in India, [3] Indonesia, [16] Myanmar, [17] Nepal, [18] and Thailand [7] . Coverage for children receiving antibiotics for pneumonia is quite low for India (13%), Bangladesh [19] (22%), and Nepal (25%). In Thailand, Nepal, Indonesia, and Bangladesh, only about half of the infants are breastfed within one hour of birth while it is much better in Maldives [20] (64%), Myanmar (76%), and Sri Lanka [21] (80%).


   Weak monitoring systems Top


Availability of reliable data still remains a challenge and there is still reliance on estimations using modeled data. There is need to put in place or to improve the civil registration system (CRS), routing reporting, recording and monitoring systems.

National averages tend to mask sub-national variations and variations between rich-poor, rural-urban, etc. Very few data are reported that have age and sex disaggregation. These averages thus mask the vulnerabilities facing populations in the poorer sections, in rural areas, in lower age groups and women. Maternal mortality is the clearest indication of inequity, especially in terms of the rich-poor and urban-rural divide. The MMR in developing regions (240) was 15 times higher than in developed regions. [5]

Increased attention and investments are needed to get reliable information at country level for meaningful analysis, comparisons, and most importantly use for local decision-making.


   Structural Barriers Top


Ensuring equitable access and providing services that reach the most affected and vulnerable populations are key bottlenecks. Stigma and discrimination and punitive legal frameworks continue to haunt progress in expansion of HIV prevention and care services among the at risk population groups.


   Sustainable Financing Top


To sustain and maintain the gains will need focus on planning, implementation, and identifying sustainable financial resources. Donor dependence and reduced international funding for development aid threaten to reverse the gains. National ownership and increased domestic funding is critical for attainment and maintenance of health-related population goals.


   Future Directions Top


MDG 4 and 5

High commitment and accountability: Continued political commitment at the highest level for MDG 4 and 5 would be extremely important. UN Secretary General's Strategy for Women's and Children's Health [22] is a great opportunity.Global community and National Governments (including SEAR Member States) have collectively committed about 40 billion USD to accelerate the progress in achievement of MDGs 4 and 5.

The United Nations has convened a high-level Commission to propose ways to make countries and their partners more accountable for women's and children's health. The Commission on Information and Accountability (COIA) for Women's and Children's Health [23] has proposed a framework for global reporting, oversight, and accountability of women's and children's health. The Commission has enunciated the principles of accountability that recognizes that the accountabilitybegins with national sovereignty and the responsibility of a government to its people and to the global community [Box 1].



The Commission has further described 10 recommendations and a set of eleven indicators for maternal, newborn, and child health. Improving quality of information and data especially maternal and under-5 mortality data is essential for tracking progress of MDG 4 and 5 [Box 2].



Access to good quality services and equity remains a major priority in reproductive, maternal, newborn, and child health.Improving the quality of health services, decreasing barriers to access of health services and monitoring progress at national and local levels would be important in rapidly increasing access to healthcare services. Working in partnerships with civil society and NGOs for would be important for effectively address some of the challenges. One way is to develop/strengthen community-based approaches, by strengthening capacity of community health workers in home-based newborn care and management of sick child and promoting care of health child at home as well as community-level community empowerment and mobilization.

Much progress has been made in advocating for and assisting in better integration of services, notably for prevention of mother-to-child transmission of pediatric HIV and congenital syphilis, and this should continue.

In contrast, the countries that are close to achieving the MDG 4 target would need to prepare for new challenges like prevention and management of birth defects that account for significant proportion of newborns and child deaths once mortality due to infections, under-nutrition, etc., decreases. Countries also need to move beyond mortality and invest in improving child growth and development to achieve full life potential, besides maintaining the decline of child mortality. Investing in early childhood development is an effective strategy to contribute to child survival as well as health, nutrition, and development outcomes.

World Leaders have recently committed to repositioning of family planning services in a recent global summit where WHO reemphasized its commitments to working with Member States toward attaining universal health coverage and achieving universal access to reproductive health.

A strong statement for committing to child survival 'A Promise Renewed' has been issued during the Child Survival Call to Action Forum organized jointly by Governments of India, Ethiopia, and USA in June 2012.

The Governments would lead the effort by sharpening their national action plans, with costed strategies, and by monitoring five-year milestones. Development partners wouldsupport the national targets by pledging to align their support with government-led action plans; private sector partners would spur innovation and identify new resources for child survival; and, through action and advocacy, civil society would support the communities, and families whose decisions profoundly influence prospects for maternal and child survival.


   MDG 6: HIV/AIDS Top


The region is committed to achieving the three zeroes - zero new infections, zero deaths, and zero discrimination. It is also committed in eliminating mother-to-child transmission of HIV by 2015. Achieving these tall targets will require designing structural interventions to reduce stigma and discrimination in community and health-care settings, especially for key populations at higher risk; and address legal barriers by repealing discriminative laws that hinder access to prevention interventions. We will also need innovations in planning, programming, and service delivery approaches to ensure access and utilization by the marginalized and the most vulnerable including women and children. Other priorities include enabling people to know their status through decentralization of HIV testing and counseling services; improving access to and quality of HIV treatment through implementation of the five pillars of Treatment 2.0; providing support for treatment adherence and ensure close monitoring to "slow" the development of HIV drug resistance; continued advocacy to reduce the prices of antiretroviral drugs through the use of international treaties and instruments, such as flexibilities in the trade-related aspects of international property rights (TRIPs); ensuring commitment to, and active collaboration with TB programs to reduce the burden of TB/HIV and increase the survival of people living with HIV. Finally, strengthening the collection and use of strategic information on HIV at country level is crucial.


   MDG 6: Malaria Top


There are two major priorities for the future in malaria.First, to further reduce malaria cases and deaths in high burden countries, and move towardpreelimination/elimination of the disease wherever feasible, and second, to do everything possible to contain artemisinin-resistance.Achieving these would involve strengthening surveillance, monitoring, and evaluation;improving quality of microscopy and rapid diagnostic tests; strengthening regulatory capacity to ensure quality of drugs, address fake/counterfeit drugs and ban mono-therapy; strengthening managerial and technical capacities for malaria control and elimination; and focused research to supportintensive malaria control toward elimination.


   MDG 6: Tuberculosis Top


The immediate priority is to prevent and treat MDR-TB and limit its spread.In order to prevent MDR TB basic DOTS needs to be further strengthened, with all sectors being involved.There should be an uninterrupted supply of quality first line drugs.Prompt detection and treatment of MDR-TB is very important.Achieving this needs the introduction of rapid diagnostics and an ensured supply of quality drugs for drug-resistant tuberculosis.Most importantly, it needs resources to be invested by national and international stakeholders.


   Beyond MDGs - What after 2015 Top


The MDGs provided the framework for galvanizing attention and support from policy makers, global leaders, national governments, and development partners. As the deadline comes to a close it is imperative to plan beyond and work with various stakeholders move in a concerted manner so that the gains are consolidated and we are able to enhance our achievements thus far. Debates and discussions have already started on the shape, content and structure of the development agenda beyond 2015. The lessons learnt from implementing the MDG framework will provide important guidance and direction. As newer challenges emerge it will be important to adjust the development framework to address them in the context of the old unfinished agenda. What shape the global development framework will take beyond 2015 is as yet unknown - will it be more of the same, some changes or a major overhaul - only time will tell. But it is important to factor in the lessons from the current MDG framework. The MDGs provided time bound goals, which were critical for speeding up the response to human development; however, the measures were all aimed toward the end and not means. At the start there was no baseline and 1990 was taken as a baseline where perhaps data for most of the indicators was available. This should rectify with the new goals. Another major drawback was that the global goals were taken as proxy measures for national goals. While the two are inter-dependent they are not the same and this distinction is important as the collective achievement of global goals does not necessarily mean that countries have done all that needs to be done - identification of gaps gives the impetus for continued enhancement and improvement to achieve the universal health goal. For some targets, it was proportional decline, which depend on the starting point that was not the same for all countries and this may have put the low income countries at a disadvantage.

The United Nations Secretary General's 2012 annual report, "Accelerating progress towards the Millennium Development Goals: Options for sustained and inclusive growth and issues for advancing the UN Development Agenda beyond 2015", summarizes the progress made toward the MDGs and looks at the post 2015 development agenda. The report emphasizes the need of consistency with the decisions of the 2012 Conference for Sustainable Development (Rio+20) emphasizing the sustainable development goals (SDGs). A total of 190 countries in Rio+20 Conference adopted a paper "The future we Want", which recognized the role that regional bodies can play in the integration of economic social and environmental dimensions into the sustainable development agenda. The Secretary-General has appointed a High-level Panel to advice on the global development agenda beyond 2015. In support of this process, the United Nations Development Group is leading efforts to catalyze a "global conversation" on the post 2015 agenda through a series of eleven global thematic consultations and more than 50 national consultations. The outcomes of the health and other thematic consultations will feed into the report that the high-level panel will present to the General Assembly in September 2013.

Several regional consultations have been held around the post 2015 development agenda in the region culminating in the publication of the "Regional MDG Report (2012-2013 - Post 2015 development agenda in the Asia Pacific". Sub-regional consultations from South-East Asian Member States were held from November 21-23, 2012 in Bangkok where priorities, strategies, and interventions from South-East Asian countries were identified.

An informal consultation with Member States is slated for December 14, 2012 by WHO co-facilitated by the Governments of Botswana, Sweden, and UNICEFin Geneva, which will be an important input into the global health thematic consultation.The consultation will be aroundlessons learnt from the health MDGs and the health priorities post 2015, which would shape the broader development agenda.

It is too early to say what will or will not be included and what will finally make its way to the post 2015 development framework.[24]

 
   References Top

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2.UNESCAP, Asian Development Bank (ADB), United Nations Development Programme (UNDP). Accelerating Equitable Achievement of the MDGs: Closing Gaps in Health and Nutrition Outcomes Asia-Pacific Regional MDG Report 2011/12. Bangkok: United Nations and ADB; 2012.  Back to cited text no. 2
    
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12.World health Organization, Regional Office for South East Asia. Available from: http://intranet.searo.who.int/EN/Section10/Section21/Section340_4018.htmnone . [Last accessed 2012 Oct 30].  Back to cited text no. 12
    
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23.The Commission on information and accountability for Women′s and Children′s Health. Keeping promises, measuring results: Geneva: WHO; 2011. Available from: http://www.everywomaneverychild.org/images/content/files/accountability_commission/final_report/Final_EN_Web.pdf. [Last accessed on 2012 Nov 7].  Back to cited text no. 23
    
24.World Health Organization. World Health Statistics 2011. Geneva: WHO; 2011.  Back to cited text no. 24
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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