Health Situation Analysis in the African Region. Atlas of Health Statistics, 2011

Transcription

1 Health Situation Analysis in the Atlas of Health Statistics, 20

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3 Health Situation Analysis in the Atlas of Health Statistics, 20

4 AFRO Library Cataloguing-in-Publication Data Atlas of Health Statistics of the 20. Health Systems 2. Health Information Systems. Health Policy. Health Services Coverage and Accessibility. Africa ISBN: (NLM Classification: W and W) World Health Organization. Regional Office for Africa, 20 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Publication and Language Services Unit, WHO Regional Office for Africa, P.O. Box, Brazzaville, Republic of (Tel: ; Fax: ; Requests for permission to reproduce or translate this publication whether for sale or for non-commercial distribution should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. This report was edited and produced by a team from the Royal Society of Medicine Press, London, UK. RSM Press would like to thank the following for use of photographs in this report: Tropical Health Education Trust (THET); The Butabika Link (Hannah Maule-ffinch); and The Jimma-Nottingham Link. Typeset by Phoenix Photosetting, Chatham, Kent Printed and bound in India by Replika Press Pvt. Ltd. More information about this publication can be obtained from: African Health Observatory (www.aho.afro.who.int) African Health Observatory and Knowledge Management Unit Office of the Assistant Regional Director WHO - Regional Office for Africa Brazzaville/Republic of

5 Contents List of Figures...v Message from the Regional Director...ix Overview of Profile of the...x Overview of Progress on the Health-related MDGs in the...xi Introduction... xii Health Status and Trends... Life expectancy... Mortality... Burden of disease The Health System... Health financing... Health workforce Medical products and equipment... 2 Health information Civil registration coverage Health research Specific Programmes and Services HIV/AIDS Tuberculosis... Malaria... Vaccine-preventable diseases... 8 Child and adolescent health... Maternal and newborn health... 2 Sexual and reproductive health... Neglected tropical diseases... 7 Non-communicable diseases and conditions... 8 Risk factors for health... 9 Food and nutrition... iii

6 Contents Key Determinants of Health... Demography... Resources and infrastructure... Poverty and income inequality... 8 Gender inequity... 0 Education... Environment... 2 partnerships and financial flows... 7 Science and technology... 9 Emergencies and disasters... 7 Progress on the Health-Related MDGs MDG- (Child health) MDG- (Maternal health)... 7 MDG- (AIDS, malaria and TB) MDG- (Malnourished children) MDG-7 (Water and sanitation)... 8 MDG-8 (Develop a global partnership for development)... 8 Explanatory Notes... 8 iv

7 List of Figures Figure A: The countries of the WHO and the Inter-Country Support Teams (ICST) xii Figure B: Population size (in thousands) of countries of the, 2008 xiii Figure : Life expectancy at birth in years in the African Region, 2008 Figure 2: Life expectancy at birth in years in WHO Regions, 2008 and 990 Figure : Life expectancy at birth in years in WHO Regions, by sex, 2008 Figure : Life expectancy at birth in years in the African Region, by country, 2008 and Figure : Life expectancy at birth in years in the African Region, by country and sex, Figure : Healthy life expectancy at birth in years in WHO Regions, by sex, 2007 Figure 7: Healthy life expectancy at birth in years in the, by country and sex, 2007 Figure 8: Adult mortality rate per 000 population in the, 2008 Figure 9: Adult mortality rate per 000 population in WHO Regions, 2008 and 990 Figure 0: Adult mortality rate per 000 population in WHO Regions, by sex, 2008 Figure : Adult mortality rate per 000 population in the, by country, 2008 and 990 Figure 2: Adult mortality rate per 000 population in the, by country and sex, 2008 Figure : Under- mortality rate per 000 live births in the, 2009 Figure : Under- mortality rate per 000 live births in WHO Regions, both sexes, 2009 and 990 Figure : Infant mortality rate per 000 live births in WHO Regions, 2009 and 990 Figure : Under- mortality rate per 000 live births in the, by country, 2009 and Figure : Infant mortality rate per 000 live births in the, by country, 2009 and Figure 8: Maternal mortality ratio per live births in WHO Regions, 2008 and Figure 9: Maternal mortality ratio per live births in the, by country, 2008 and Figure 20: Age-standardized death rates per population due to communicable diseases in the African Region, Figure 2: Age-standardized death rates per population due to non-communicable diseases in the, Figure 22: Age-standardized death rates per population due to injuries and violence in the African Region, Figure 2: Total burden of disease in DALYs per 000 population in WHO Regions, Figure 2: Leading causes of burden of diseases shown as percentage of total DALYs in the, Figure 2: Distribution of burden of diseases as percentage of total DALYs by group in the African Region, 200 Figure 2: Distribution of burden of diseases as percentage of total DALYs by broader causes in WHO Regions, 200 Figure 27: Distribution of burden of diseases as percentage of total DALYs by broader causes in the, by country, Figure 28: Distribution of years of life lost by broader causes in WHO Regions, 200 Figure 29: Distribution of years of life lost by broader causes in the, by country, 200 Figure 0: Per capita total expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000 Figure : Total expenditure on health as percentage of GDP in WHO Regions, 2007 and 2000 Figure 2: Per capita total expenditure on health (PPP int. $) in the, by country, 2007 and 2000 Figure : Total expenditure on health as percentage of GDP in the, by country, 2007 and 2000 Figure : General government expenditure on health as percentage of total expenditure on health in the, 2007 Figure : General government expenditure on health as percentage of total government expenditure, 2007 Figure : General government expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000 Figure 7: External resources for health as percentage of total expenditure on health in WHO Regions, 2007 and 2000 v

8 List of figures Figure 8: General government expenditure on health as percentage of total government expenditure in the, by country, 2007 and Figure 9: External resources for health as percentage of total expenditure on health in the, by country, 2007 and Figure 0: Private expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and Figure : Out-of-pocket expenditure as percentage of private expenditure on health in WHO Regions, 2007 and Figure 2: Private expenditure on health as percentage of total expenditure on health in the, by country, 2007 and Figure : Out-of-pocket expenditure as percentage of private expenditure on health in the, by country, 2007 and Figure : Per capita government expenditure on health (PPP int. $) in WHO Regions, 2007 and Figure : Per capita government expenditure on health (PPP int. $) in the, by country, 2007 and Figure : Physician-to-population ratio (per population) in the, Figure 7: Physician-to-population ratio (per population) in WHO Regions, Figure 8: Nursing and midwifery personnel-topopulation ratio (per population) in the African Region, Figure 9: Nursing and midwifery personnel-topopulation ratio (per population) in WHO Regions, Figure : Physician-to-population ratio (per population) in the, by country, Figure : Nursing and midwifery personnel-topopulation ratio (per population) in the African Region, by country, Figure 2: Median percentage availability of selected generic medicines in a sample of health facilities in the, countries with data, Figure : Median consumer price ratio of selected generic medicines (ratio of median local unit price to management sciences for health international reference price), countries with data, Figure : Hospital beds per population in WHO Regions, Figure : Hospital beds per population in the, by country, Figure : Percentage of civil registration coverage for births in the, by country, Figure 7: Percentage of civil registration coverage for deaths in the, Figure 8: Institutional level policies in research 28 Figure 9: Roles of Ministry of Health (MOH) and other central policy setting and implementing bodies in the as percentage, Figure 0: HIV/AIDS mortality rate (per population) in the, Figure : HIV/AIDS mortality rate (per population) in WHO Regions, Figure 2: Prevalence of HIV (per population) among people aged years or more in WHO Regions, Figure : Percentage of antiretroviral therapy among people with HIV/AIDS in need of treatment in WHO Regions, Figure : Percentage of people 9 years of age living with HIV in the, by country, 2007 and 200 Figure : Percentage of people receiving antiretroviral therapy in the, by country, 2009 and 2007 Figure : Percentage of men and women aged 2 years of age who used a condom at last high-risk sex,, Figure 7: Population aged 2 years of age with comprehensive knowledge of HIV/AIDS 2 Figure 8: Tuberculosis death rate per population per year in the, by country, 2007 and 2000 Figure 9: Tuberculosis incidence rate per population per year in the, by country, 2008 and 2000 Figure 70: Tuberculosis prevalence per population per year in the, by country, 2008 and 2000 Figure 7: Percentage of tuberculosis detection rate under DOTS in WHO Regions, 2007 and 2000 Figure 72: Percentage of tuberculosis detection rate under DOTS in the, by country, 2007 and 2000 Figure 7: Notified cases of malaria, in thousands, in the, by country, 2008 Figure 7: Percentage of children under years of age sleeping under insecticide-treated bed nets in the African Region, by country, and Figure 7: Malaria mortality rate per population in the, Figure 7: Proportion of children under years of age with fever being treated with antimalarial drugs in the, by country, and Figure 77: Percentage of neonates protected at birth against neonatal tetanus in WHO Regions, 2008 and Figure 78: Percentage immunization coverage among -year-olds for DTP in WHO Regions, 2008 and Figure 79: Percentage of neonates protected at birth against neonatal tetanus in the, by country, 2008 and Figure 80: Percentage immunization coverage among -year-olds for DTP in the, by country, 2008 and Figure 8: Immunization coverage among -year-olds for HepB in WHO Regions, vi

9 List of Figures Figure 82: Immunization coverage among -year-olds for HepB in the, by country, Figure 8: Distribution of causes of death among children aged under years, 2008 Figure 8: Percentage of infants exclusively breastfed for the first months of life in WHO Regions, Figure 8: Percentage of infants exclusively breastfed for the first months of life in the, by country, Figure 8: Percentage of low-birthweight newborns in WHO Regions, Figure 87: Percentage of low-birthweight newborns in the, by country, Figure 88: Percentage of births attended by skilled health personnel in WHO Regions, and Figure 89: Percentage of births attended by skilled health personnel in the, Figure 90: Percentage of births attended by skilled health personnel in the, by country, and Figure 9: Percentage of births by caesarean section in WHO Regions, Figure 92: Percentage of births by caesarean section in the, by country, Figure 9: Percentage of antenatal care coverage, at least one visit, in the, by country, and Figure 9: Percentage of antenatal care coverage, at least four visits, in the, by country, and Figure 9: Percentage of current contraceptive use (any method) among married women 9 years of age in the, by country, and Figure 9: Adolescent fertility rate (per 000 girls, 9 years of age) in the, Figure 97: Total fertility rate per woman in WHO Regions, 2008 and 990 Figure 98: Number of reported cases of leprosy in WHO Regions, Figure 99: Number of reported cases of leprosy in the, by country, Figure 00: Distribution of causes of noncommunicable burden of diseases (percentage of total DALYs) in the, Figure 0: Distribution of causes of intentional and non-intentional injuries (percentage of total DALYs) in the, Figure 02: Distribution of causes of neuropsychiatric burden of diseases (percentage of total DALYs) in the, Figure 0: Percentage of current tobacco use in persons years of age or older in WHO Regions, Figure 0: Percentage of current tobacco use in persons years of age or older in the, by country, Figure 0: Alcohol consumption (litres per person) among adults aged years of age or older in WHO Regions, 200 Figure 0: Alcohol consumption (litres per person) among adults aged years of age or older in the African Region, by country, 200 Figure 07: Percentage of underweight children under years of age in the, by country, and Figure 08: Percentage of stunted children under years of age in the, by country, and Figure 09: Percentage of overweight children under years of age in the, by country, and Figure 0: Age distribution of the population in WHO Regions, 2008 Figure : Age distribution of the population in the, by country, 2008 Figure 2: Total fertility rate per woman in the African Region, by country, 2008 and 990 Figure : Annual growth rate (in %) of population in WHO Regions, and Figure : Annual growth rate (in %) of population in the, by country, and Figure : Gross national income per capita (PPP int. $) in WHO Regions, 2008 and 990 Figure : Gross national income per capita (PPP int. $) in the, by country, 2008 and 990 Figure : Electrification rate in the, by country, Figure 8: Paved roads as percentage of all roads in the, by country, Figure 9: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in WHO Region, Figure 20: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in the, by country, Figure 2: Share of incomes by poorest and richest section of the population in the, by country, Figure 22: Percentage of female and male combined gross enrolment ratio for primary secondary tertiary education in the, by country, Figure 2: Percentage of seats held by women in national parliaments in the, by country, 2009 and Figure 2: Adult literacy rate (percentage aged and older) in the, by country and sex, Figure 2: Percentage of the population aged 2 years who can both read and write (i.e. youth literacy rate) in the, by country, and vii

10 List of figures Figure 2: Percentage of the population using improved drinking water sources in the, Figure 27: Percentage of the population using improved drinking water sources in WHO Regions, 2008 and Figure 28: Percentage of the urban and rural population with access to improved drinking water sources in WHO Regions, Figure 29: Percentage of population using improved drinking water sources in the, by country, 2008 and 990 Figure 0: Percentage of urban and rural population with access to improved drinking water sources in the, by country, 2008 Figure : Percentage of the population using improved sanitation facilities in the, 2008 Figure 2: Percentage of the population using improved sanitation facilities in WHO Regions, 2008 and 990 Figure : Percentage of the population using improved sanitation facilities in WHO Regions, urban and rural, 2008 Figure : Percentage of the population using improved sanitation facilities in the, by country, 2008 and 990 Figure : Percentage of the population using improved sanitation facilities in the, by country, urban and rural, 2008 Figure : Percentage of the population living in urban areas in the, by country, 2008 and 990 Figure 7: Percentage of urban population living in slums in the, by country, 200 and 990 Figure 8: Per capita official development assistance received (US$) in the, by country, Figure 9: Official development assistance received as percentage of GDP in the, by country, 200 and Figure 0: Total debt service as percentage of GDP in the, by country, 990 and Figure : Total external debt stocks (in millions of current US$) in the, by country, Figure 2: Percentage of population with telephone in the, by country, 200 and Figure : Percentage of population who are cellular or mobile subscribers in the, by country, 200 and Figure : Percentage of population who are telephone (fixed and mobile) subscribers in the African Region, by country, Figure : Percentage of the population who are Internet users in the, Figure : Total number of internally displaced people (thousands) in the, by country, Figure : Total number of refugees (in thousands) in the, by country of origin, Figure 8: Trend in under- mortality rate in the WHO, Figure 9: Under- mortality rate (per 000 live births) in WHO Regions, both sexes, 2008 and Figure : Under- mortality rate (per 000 live births) in the, by country, 2008 and the MDG target 7 Figure : Trend in maternal mortality ratio (per live births) in WHO, Figure 2: Trend in maternal mortality ratio (per live births) in WHO Regions in Figure : Maternal mortality ratio (per live births) in the, by country, 2008 and the MDG target 7 Figure : Percentage of unmet need for family planning in the, by country, and Figure : Percentage of HIV-positive pregnant women 2 years of age for countries with trend data in the, and Figure : Percentage of population in need of treatment with access to antiretroviral drugs in the, by country, 2009 and Figure : Percentage of population living with advanced HIV infection who are receiving antiretroviral therapy, Figure 8: Percentage of pregnant women living with HIV infection who are receiving antiretroviral therapy for preventing mother-to-child transmission, Figure 9: Percentage of children under years of age sleeping under insecticide-treated bed nets in the African Region, and Figure 0: Percentage of children under years of age with fever being treated with antimalarial drugs in the, and Figure : Malaria mortality rate (per population) in the, by country, 2008 and Figure 2: Prevalence of tuberculosis (per population) in the, by country, 2008 and the MDG target 8 Figure : Trend in children aged under years that are underweight 82 Figure : Percentage of underweight children under years of age in the, by country, and the MDG target 82 Figure : Percentage of the population using improved drinking water sources in the, by country, 2008 and the MDG target 8 Figure : Percentage of the population using improved sanitation facilities in the, by country, 2008 and the MDG target 8 Figure : Total debt service as percentage of exports of goods, services and income, 2007 and viii

11 Message from the Regional Director Basic data and statistics are at the core of all health systems. Without them, it would be impossible to analyse evidence and extract action-oriented knowledge for decision making. Clearly, the data should be of the highest quality possible. They should be timely, valid, accurate, derived and analysed by sound methods, consistent, comparable, and repeatable. This publication presents in numerical and graphical formats the best data available for key health indicators in the countries of WHO s. Although there have been considerable improvements in data collection and analysis and notable examples of success, this is not the case with all the data collected in the Region. Countries have worked long and hard, and with varying degrees of success, on strengthening their national health information systems. Nevertheless, there continue to be gaps in the system. One approach to strengthening health information systems that is currently underway is the development of an African Health Observatory and national health observations. The overall objective of the African Health Observatory is to contribute to regional and country efforts to narrow the knowledge gap and to strengthen health systems in the by providing easy access to high-quality information, evidence and knowledge, as well as facilitate their use for policy and decision making. The Observatory will monitor regional health status and trends and provide in-depth analysis by priority themes for attainment of the United Nations Millennium Development Goals and other global and regional commitments, and will identify inequities in health and use evidence-based information in the formulation of public health policies and programmes. The Observatory aims to facilitate the generation, sharing and application of information, evidence and knowledge. It will also serve as the focus for building networks, including communities of practice, around data collection and processing. Systematic reviews and evidence will be drawn from the Observatory s resources and packaged for, and disseminated to, key target audiences. It is essential to enhance and promote the use of evidence for policy and action. The Observatory will also link to national health observatories and all data collection activities in WHO country offices, Inter-Country Support Teams and the Regional Office in a two-way support system, as a way of strengthening national health information systems. With the continued input and collaboration of the countries, future editions of this publication will be produced as a significant information product of the Observatory. While thanking all Member States and those in charge of their health information systems for their cooperation in providing country data, I encourage all countries to continue collaborating with WHO to improve the availability and use of information through the African Health Observatory. Dr Luis Gomes Sambo Regional Director WHO Regional Office for Africa ix

12 Overview of Profile of the Selected indicators** Population size (in thousands) Population living in urban areas (%) Life expectancy at birth (years), both sexes Adult mortality rate (probability of dying between and 0 years per 000 population) Per capita total expenditure on health (PPP int. $) Gross national income per capita (PPP int. $) , ,279,,9,77, ,290,90,82 All data sources are given in the African Health Observatory at 9.7% Distribution of burden of diseases as % of total DALYs by broader causes (200) Communicable diseases 7.% 2.% Injuries 7.9% Non-communicable diseases 8.0% 2.0% Leading causes of burden of diseases (as % of total DALYs) (200) HIV/AIDS Lower respiratory infections Diarrhoeal diseases Malaria Neonatal infections and other conditions Birth asphyxia and birth trauma Prematurity and low birth weight Tuberculosis Burden of disease (% of total DALYs) by groups of disorders and conditions (200) 2.% Infectious and parasitic diseases 2.%.2% Noncommunicable.9% conditions 8.% Respiratory infections.% 8.2% Perinatal conditions 0.%.% Unintentional injuries.%.% Neuropsy chiatric.2%.0% disorders 2.9% Maternal conditions.0% African Region African Region African Region Road traffic accidents Protein-energy malnutrition.9%.9% Nutritional deficiencies Intentional injuries.% 2.% Distribution of causes of death among children aged < years (2008) HIV/AIDS % Neonatal % Asphyxia 8% Prematurity 9% Malaria % Injuries 2% Congenital 2% Other % Measles % Diarrhoea 8% Pneumonia % General government expenditure on health Health workforce ( ) (as % of total government expenditure) Nursing and midwifery Physician density (per personnel density (per 0,000 population) 0,000 population).% 28.% 8.7% African Region 9.% African Region African Region 2 African Region Antenatal care coverage (%) at least four visits Utilization of health services (2008) Contraceptive prevalance Immunization coverage among -year-olds, DTP Immunization coverage among -year-olds, measles Prevalence of smoking any tobacco product among adults aged years (200) Male Female 2% 82% 72% 8% 7%.% 8% % 2%.7% 8.9% 2.8% African Region African Region African Region African Region African Region African Region x

13 Overview of Progress on the Health-related MDGs in the MDG-: Children aged < years underweight MDG-: Trend in under- mortality rate (probability of dying by age ; per,000 live births) 2% 22% 22% MDG Target : % MDG Target : MDG-: Trend in maternal mortality ratio (per 00,000 live births) MDG-: Percentage of unmet need for family planning % 2.% % MDG Target : MDG-: Prevalence of HIV among adults aged 9 years, by region (2007) MDG-: Percentage of population living with advanced HIV infection who are receiving antiretroviral therapy, by region (2007) African.9% African % Americas 0.% Eastern Mediterranean % European 0.% Western Pacific 2% South-East Asia 0.% South-East Asia 28% Eastern Mediterranean 0.2% Americas % Western Pacific 0.% European 9% 0.8% % MDG-: Malaria mortality rate per 00,000 poplation, by region (200) African 0 Eastern Mediterranean 8 South-East Asia 2 Americas Western Pacific 0 European... MDG-: Prevalance of tuberculosis (per 00,000 population), by region African South-East Asia Eastern Mediterranean Western Pacific European Americas MDG-7: Population using improved drinking water sources MDG-7: Population using improved sanitation 20 MDG Target : 7% % % 20 MDG Target : 89% 77% 87% 20 MDG Target : % 20 MDG Target : 7% 0% 2% 0% % xi

14 Introduction The is one of the six regions in which the World Health Organization (WHO) collaborates with countries in public health. With over 70 million inhabitants in countries (see Figures A and B), it accounts for about one-seventh of the world s population. This statistical atlas describes the health status and trends in the countries of the, the various components of their health systems, coverage and access levels for specific programmes and services, and the key determinants of health in the Figure A: The countries of the WHO African Region and the subregions Cape Verde -Bissau Côte d Ivoire WHO and the subregions West Central South-East Outside WHO Equatorial Central African Republic Democratic Republic of the South Africa Seychelles xii

15 Introduction Region, and the progress made on reaching the United Nations Millennium Development Goals (MDGs). Each indicator is described, as appropriate, by place (WHO Regions and countries in the ), person (age and sex) and time (various years) using maps and graphs. The aim is to give a comprehensive overview of the health situation in the and its Member States. Democratic Republic of the -Bissau Equatorial Seychelles The main source for the data is WHO-AFRO s integrated database based on the World Health Statistics 200. Other UN agency databases have been used when necessary. All the data and figures in this atlas can be accessed through the African Health Observatory (www.aho.afro.who.int). 22 Figure B: Population size (in thousands) of countries of the African Region, 2008 xiii

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17 Life expectancy Health Status and Trends Figure : Life expectancy at birth in years in the African Region, No data Outside WHO Male Female 2 South-East Asia Region 8 South-East Asia Region Eastern Mediterranean Region Eastern Mediterranean Region European Region 72 7 European Region 7 79 Western Pacific Region Region of the Americas Western Pacific Region Region of the Americas Figure 2: Life expectancy at birth in years in WHO Regions, 2008 and Figure : Life expectancy at birth in years in WHO Regions, by sex, 2008

18 Health Status and Trends Male Female 2 Democratic Republic of the -Bissau Equatorial Seychelles Figure : Life expectancy at birth in years in the African Region, by country, 2008 and 990 Democratic Republic of the -Bissau Equatorial Seychelles Figure : Life expectancy at birth in years in the African Region, by country and sex,

19 Life expectancy Male Female Male Female Eastern Mediterranean Region South-East Asia Region European Region Region of the Americas Western Pacific Region Figure : Healthy life expectancy* at birth in years in WHO Regions, by sex, Bissau Democratic Republic of the Equatorial Seychelles Figure 7: Healthy life expectancy at birth in years in the, by country and sex, 2007 *Healthy life expectancy (HALE) at birth represents the average number of years that a person could expect to live in good health by taking into account years lived in less than full health due to disease and/or injury. As a result, it captures both fatal and nonfatal health outcomes and disabilities.

20 Health Statusand Trends Mortality Figure 8: Adult mortality rate per 000 population in the, No data Outside WHO South-East Asia Region Eastern Mediterranean Region European Region Region of the Americas Western Pacific Region Figure 9: Adult mortality rate per 000 population in WHO Regions, 2008 and Male Female 2 7 Figure 0: Adult mortality rate per 000 population in WHO Regions, by sex, 2008 South-East Asia Region 8 22 Eastern Mediterranean Region 2 2 European Region Region of the Americas Western Pacific Region 8 2 2

21 Mortality Male Female Democratic Republic of the -Bissau Equatorial Seychelles Figure : Adult mortality rate per 000 population in the, by country, 2008 and Democratic Republic of the -Bissau 7 Equatorial 77 Seychelles Figure 2: Adult mortality rate per 000 population in the, by country and sex, 2008

22 Health Statusand Trends Figure : Under- mortality rate per 000 live births in the, 2009* No data Outside WHO Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region Figure : Under- mortality rate per 000 live births in 27 WHO Regions, both sexes, and 990* Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region Figure : Infant mortality rate per 000 live births in 80 WHO Regions, 2009 and * *Source: Levels and Trends in Child Mortality; Report 200. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. UNICEF, WHO, The World Bank and United Nations DESA/Population Division. New York: UNICEF, 200.

23 Mortality Democratic Republic of the -Bissau Equatorial Seychelles Democratic Republic of the -Bissau Equatorial Seychelles Figure : Under- mortality rate per 000 live births in the, by country, 2009 and 990* Figure : Infant mortality rate per 000 live births in the, by country, 2009 and 990* *Source: Levels and Trends in Child Mortality; Report 200. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. UNICEF, WHO, The World Bank and United Nations DESA/Population Division. New York: UNICEF,

24 Health Statusand Trends Eastern Mediterranean Region South-East Asia Region Americas Region Western Pacific Region European Region Figure 8: Maternal mortality ratio per live births in WHO Regions, 2008 and 990* -Bissau Central African Republic United Republic of Tanzania Democratic Republic of the Equatorial Figure 9: Maternal mortality ratio per live births in the, by country, 2008 and 990* *Source: Trends in Maternal Mortality: 990 to Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: WHO,

25 Mortality Figure 20: Age-standardized death rates* per population due to communicable diseases in the, No data Outside WHO Figure 2: Age-standardized death rates per due to non-communicable diseases in the African Region, No data Outside WHO Figure 22: Age-standardized death rates per due to injuries and violence in the, No data Outside WHO *Rates are age-standardized to WHO s world standard population. Ahmad OB, Boschi-Pinto C, Lopez AD et al. Age Standardization of Rates: A New WHO Standard. Geneva: WHO, 200. Available at: 9

26 Health Statusand Trends Burden of disease Eastern Mediterranean South-East Asia 27 2 Figure 2: Total burden of disease in DALYs* per 000 population in WHO Regions, 200 Europe Americas Western Pacific 2 HIV/AIDS Lower respiratory infections Diarrhoeal diseases Figure 2: Leading causes of burden of diseases shown as percentage of total DALYs in the, 200 Malaria 8.2 Neonatal infections and other Birth asphyxia and birth trauma.. Prematurity and low birth weight Tuberculosis 2.9 Road traffic accidents Protein energy malnutrition.9.9 *The disability-adjusted life-year (DALY) provides a consistent and comparative description of the burden of diseases and injuries needed to assess the comparative importance of diseases and injuries in causing premature death, loss of health and disability in different populations. The DALY extends the concept of potential years of life lost due to premature death to include equivalent years of healthy life lost by virtue of being in states of poor health or disability. One DALY can be thought of as one lost year of healthy life, and the burden of disease can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age, free of disease and disability. WHO. Burden of Diseases Update 200. Geneva, July

27 Burden of disease Infectious and parasitic diseases Noncommunicable conditions Respiratory infections Figure 2: Distribution of burden of diseases as percentage of total DALYs by group in the, 200 Perinatal conditions 0. Unintentional injuries. Neuropsychiatric disorders.2 Maternal conditions.0 Nutritional deficiencies. Intentional injuries 2. Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Non-communicable conditions Injuries 7% 2% 8% Figure 2: Distribution of burden of diseases as percentage of total DALYs by broader causes in WHO Regions, 200 Eastern Mediterranean % % % South-East Asia 2% % % Western Pacific 8% 9% % Americas % 9% % Europe 0% 77% %

28 Health Statusand Trends Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Non-communicable conditions Injuries 7% 2% 8% Figure 27: Distribution of burden of diseases as percentage of total DALYs by broader causes in the African Region, by country, % % % 79% % % 78% % % 78% % 7% 7% % 8% 7% % 7% 7% 8% % 7% % 7% 7% 20% % -Bissau 7% 9% % 7% 8% 7% 7% 8% 7% 7% 9% 7% 7% % 9% Democratic Republic of the 7% % 0% 7% 20% % 7% 20% 7% 7% 20% 7% 7% 8% 9% 72% % 0% 72% 2% 7% 72% 20% 8% 7% 2% 8% 7% 20% 9% Equatorial 70% 22% 8% 9% 2% % 9% 2% 7% 9% 2% 7% 8% 2% 8% 8% 2% 7% 8% 2% 8% % 2% % % 27% 8% % 29% 8% % 28% 9% 2% 0% 8% 2% % 7% % 29% 0% 0% 28% % 8% 2% 0% % % 8% % % % % % 2% Seychelles % 7% % % 77% 8% 2

29 Burden of disease Communicable disease Non-communicable conditions Injuries Communicable disease Non-communicable conditions Injuries Eastern Mediterranean Region South-East Asia Region Region of the Americas Western Pacific Region European Region Figure 28: Distribution of years of life lost* by broader causes in WHO Regions, Bissau Democratic Republic of the Equatorial Seychelles Figure 29: Distribution of years of life lost by broader causes in the, by country, 200 *Years of life lost (YLL) take into account the age at which deaths occur by assigning greater statistical weight to deaths occurring at younger ages and lower statistical weight to deaths occurring at older ages.

30 2 The Health System Health financing South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas Figure 0: Per capita total expenditure on health (PPP int. $) in WHO Regions, 2007 and South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas Figure : Total expenditure on health as percentage of GDP in WHO Regions, 2007 and

31 Health financing Democratic Republic of the -Bissau Equatorial Seychelles Equatorial Seychelles Democratic Republic of the -Bissau Figure 2: Per capita total expenditure on health (PPP int. $) in the, by country, 2007 and 2000 Figure : Total expenditure on health as percentage of GDP in the, by country, 2007 and 2000

32 2 The Health System Figure : General government expenditure on health as percentage of total expenditure on health in the, No data Outside WHO Figure : General government expenditure on health as percentage of total government expenditure, No data Outside WHO

33 Health financing South-East Asia Region Figure : General 7 government expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000 Region of the Americas Eastern Mediterranean Region Western Pacific Region European Region Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region Figure 7: External resources for health as percentage of.9 total expenditure on health. in WHO Regions, 2007 and

34 2 The Health System -Bissau Democratic Republic of the Equatorial Seychelles Figure 8: General government expenditure on health as percentage of total government expenditure in the, by country, 2007 and 2000 Democratic Republic of the -Bissau Equatorial Seychelles Figure 9: External resources for health as percentage of total expenditure on health in the, by country, 2007 and

35 Health financing South-East Asia Region Region of the Americas Figure 0: Private expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000 Eastern Mediterranean Region 7 Western Pacific Region 2 27 European Region South-East Asia Region Figure : Out-of-pocket expenditure as percentage of private expenditure on health in WHO Regions, 2007 and 2000 Eastern Mediterranean Region 8 8 Western Pacific Region European Region 7 Region of the Americas

36 2 The Health System Democratic Republic of the -Bissau Seychelles Equatorial Figure 2: Private expenditure on health as percentage of total expenditure on health in the, by country, 2007 and 2000 Equatorial Seychelles -Bissau Democratic Republic of the Figure : Out-of-pocket expenditure as percentage of private expenditure on health in the, by country, 2007 and

37 Health financing South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas Figure : Per capita government expenditure on health (PPP int. $) in WHO Regions, 2007 and Democratic Republic of the -Bissau Equatorial Seychelles Figure : Per capita government expenditure on health (PPP int. $) in the, by country, 2007 and

38 2 The Health System Health workforce Figure : Physician-topopulation ratio (per population) in the African Region, No data Outside WHO South-East Asia Region 2 Figure 7: Physician-topopulation ratio (per population) in WHO Regions, Eastern Mediterranean Region 0 Western Pacific Region Region of the Americas 2 European Region 22

39 Health workforce Figure 8: Nursing and midwifery personnel-topopulation ratio (per population) in the African Region, No data Outside WHO South-East Asia Region Eastern Mediterranean Region Western Pacific Region 2 Figure 9: Nursing and midwifery personnelto-population ratio (per population) in WHO Regions, Region of the Americas European Region

40 2 The Health System 2 -Bissau Democratic Republic of the Equatorial Seychelles Democratic Republic of the Equatorial -Bissau Seychelles Figure : Physician-to-population ratio (per population) in the, by country, Figure : Nursing and midwifery personnel-topopulation ratio (per population) in the African Region, by country,

41 Medical products and equipment Medical products and equipment Public Private Public Private United Republic of Tanzania Sao Tome and Principe Figure 2: Median percentage availability of selected generic medicines in a sample of health facilities in the, countries with data in Sao Tome and Principe United Republic of Tanzania Figure : Median consumer price ratio of selected generic medicines (ratio of median local unit price to management sciences for health international reference price), countries with data, South-East Asia Region Eastern Mediterranean Region 9 2 Figure : Hospital beds per population in WHO Regions, Region of the Americas 2 Western Pacific Region 8 European Region 27 2

42 2 The Health System 2 9 Figure : Hospital beds per population in the, by country, Democratic Republic of the Bissau Equatorial Seychelles 9 2

43 Health information Civil registration coverage Health information Civil registration coverage Democratic Republic of the Equatorial -Bissau < No data Outside WHO Figure 7: Percentage of civil registration coverage for deaths in the, Seychelles Figure : Percentage of civil registration coverage for births in the, by country,

44 2 The Health System Health research High research activity (n=279) Medium research activity (n=9) Low research activity (n=) Figure 8: Institutional level policies on research Requirement of ethical review for all research involving human subjects conducted anywhere in which researchers of institution participate 27% 7% % Availability of a written policy on ethical review for all research involving human subjects within institution by staff (faculty, researchers, or others) 2% % % Availability of written policies requiring that researchers obtain the informed consent of participants 29% 9% 9% National guidelines issued by professional associations Western Subregion ( countries) Southern/Eastern Subregion ( countries) Central Subregion (8 countries) Figure 9: Roles of Ministry of Health (MOH) and other central policy setting and implementing bodies in the as percentage, 2007 MOH carries out benchmarking MOH carries out strategic planning Physicians are required to undertake continuing medical education (CME) to remain licensed Physicians are licensed by another body MOH licenses physicians National accrediation is carried out by another body MOH carries out national accreditation of medical schools/hospitals MOH maps knowledge sources and flows for policy making This is an explicit knowledge management framework in MOH

45 Specific Programmes and Services HIV/AIDS Figure 0: HIV/AIDS mortality rate (per population) in the African Region, No data Outside WHO South-East Asia Region Region of the Americas 2 Figure : HIV/AIDS mortality rate (per population) in WHO Regions, 2007 European Region Eastern Mediterranean Region Western Pacific Region 29

46 Specific Programmes and Services Americas Region European Region Figure 2: Prevalence of HIV (per population) among people aged years or more in WHO Regions, 2007 South-East Asia Region 29 Eastern Mediterranean Region 202 Western Pacific Region 89 Americas Region All Pregnant women 7 Figure : Percentage of antiretroviral therapy among people with HIV/AIDS in need of treatment in WHO Regions, 2009* Western Pacific Region 2 South-East Asia Region European Region Eastern Mediterranean Region 2 7 *Source: WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector Progress Report

47 Cote d'ivoire Equatorial -Bissau Democratic Rep of the Equatorial -Bissau Democratic Republic of the Figure : Percentage of people 9 years of age living with HIV in the, by country, 2007 and 200 Figure : Percentage of people receiving antiretroviral therapy in the, by country, 2009 and 2007* *Source: WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector Progress Report 200.

48 Specific Programmes and Services Male Female Male Female Bissau Figure : Percentage of men and women aged 2 years who used a condom at last high-risk sex, African Region, * Democratic Republic of the Equatorial -Bissau 9 9 Figure 7: Population aged 2 years with comprehensive correct knowledge of HIV/AIDS *Source: United Nations Statistical Division, MDG Database, June

49 Tuberculosis Tuberculosis Equatorial Democratic Republic of the -Bissau Seychelles Democratic Republic of the -Bissau Equatorial Seychelles Figure 8: Tuberculosis death rate per population per year in the, by country, 2007 and 2000* Figure 9: Tuberculosis incidence rate per population per year in the, by country, 2008 and 2000* *Source: United Nations Statistical Division, MDG Database, June 200.

50 Specific Programmes and Services Democratic Republic of the -Bissau Seychelles Equatorial Western Pacific Region Americas Region South-East Asia Region Eastern Mediterranean Region European Region Figure 7: Percentage of tuberculosis detection rate under DOTS in WHO Regions, 2007 and Figure 70: Tuberculosis prevalence per population per year in the, by country, 2008 and 2000

51 Tuberculosis Figure 72: Percentage of tuberculosis detection under DOTS in the, by country, 2007 and 2000* Democratic Republic of the

52 Specific Programmes and Services Malaria Democratic Republic of the -Bissau Equatorial Democratic Republic of the Cote d'ivoire -Bissau Figure 7: Percentage of children under years of age sleeping under insecticide-treated bed nets in the, by country, and * Figure 7: Notified cases of malaria, in thousands, in the, by country, 2008 *Source: World Malaria Report Geneva: WHO, 2009.

53 Malaria Figure 7: Malaria mortality rate per population in the, No data Outside WHO Democratic Republic of the Cote d'ivoire -Bissau Figure 7: Proportion of children under years of age with fever being treated with antimalarial drugs in the, by country, and

54 Specific Programmes and Services Vaccine-preventable diseases Western Pacific Region Figure 77: Percentage of neonates protected at birth against neonatal tetanus in WHO Regions, 2008 and 990 European Region 2 72 Eastern Mediterranean Region 7 79 Region of the Americas 8 South-East Asia Region South-East Asia Region Figure 78: Percentage immunization coverage among -year-olds for DTP in WHO Regions, 2008 and 990 Eastern Mediterranean Region Region of the Americas European Region Western Pacific Region

55 Vaccine-preventable diseases Equatorial Democratic Republic of the -Bissau Figure 79: Percentage of neonates protected at birth against neonatal tetanus in the, by country, 2008 and 990 Equatorial -Bissau Democratic Republic of the Seychelles Figure 80: Percentage immunization coverage among -year-olds for DTP in the, by country, 2008 and 990 9

56 Specific Programmes and Services South-East Asia Region European Region 7 7 Figure 8: Immunization coverage among -year-olds for HepB in WHO Regions, 2008 Eastern Mediterranean Region 8 Region of the Americas Western Pacific Region Figure 82: Immunization coverage among -year-olds for HepB in the African Region, by country, Democratic Republic of the Seychelles 99 0

57 Child and adolescent health Child and adolescent health Injuries 2% HIV/AIDS % Other diseases % Diarrhoea 8% 7 2 Congenital abnormalities 2% Neonatal sepsis % Measles % Birth asphyxia 8% Malaria % 9 Prematurity 9% 9 2 Pneumonia % Figure 8: Distribution of causes of death among children aged under years, Bissau Democratic Republic of the 8 8 European Region Region of the Americas Eastern Mediterranean Region 2 7 South-East Asia Region Figure 8: Percentage of infants exclusively breastfed for the first months of life in WHO Regions, Figure 8: Percentage of infants exclusively breastfed for the first months of life in the, by country,

58 Specific Programmes and Services Maternal and newborn health South-East Asia Region 2 Eastern Mediterranean Region Region of the Americas 8 -Bissau 2 2 European Region Western Pacific Region Figure 8: Percentage of low-birthweight newborns in WHO Regions, Equatorial 2 Democratic Republic of the Figure 87: Percentage of low-birthweight newborns in the, by country,

59 Maternal and newborn health South-East Asia Region Eastern Mediterranean Region Region of the Americas Western Pacific Region European Region Figure 88: Percentage of births attended by skilled health personnel in WHO Regions, and No data Outside WHO Bissau Equatorial Democratic Republic of the Figure 89: Percentage of births attended by skilled health personnel in the, Figure 90: Percentage of births attended by skilled health personnel in the, by country, and

60 Specific Programmes and Services.. South-East Asia Region 7. Eastern Mediterranean Region.8 0. European Region Western Pacific Region Region of the Americas Figure 9: Percentage of births by caesarean section in WHO Regions, Democratic Republic of the Figure 92: Percentage of births by caesarean section in the, by country,

61 Maternal and newborn health Equatorial Figure 9: Percentage of antenatal care coverage, at least four visits, in the, by country, and Figure 9: Percentage of antenatal care coverage, at least one visit, in the, by country, and

62 Specific Programmes and Services Sexual and reproductive health Bissau No data Outside WHO Figure 9: Adolescent fertility rate (per 000 girls, 9 years of age) in the, Eastern Mediterranean Region South-East Asia Region Region of the Americas Western Pacific Region European Region Figure 9: Percentage of current contraceptive use* (any method) among married women 9 years of age in the, by country, and Figure 97: Total fertility rate per woman in WHO Regions, 2008 and 990 *Percentage of women aged 9 married or in union who are currently using, or whose sexual partner is using, at least one method of contraception, regardless of the method used. For details, see Reproductive Health Indicators: Guidelines for their Generation, Interpretation and Analysis for Monitoring. Geneva: WHO, 200 (available at: publications/rhindicators/guidelines.pdf) or the website

63 Neglected tropical diseases Neglected tropical diseases South-East Asia Region 29 8 Democratic Republic of the Region of the Americas Western Pacific Region Eastern Mediterranean Region Figure 98: Number of reported cases of leprosy in WHO Regions, Bissau Equatorial Figure 99: Number of reported cases of leprosy in the, by country,

64 Specific Programmes and Services Non-communicable diseases and conditions Cardiovascular diseases.8 Sense organ disorders 2. Respiratory diseases.9 gnant neoplasms. Congenital abnormalities. Unintentional. Digestive diseases. Road traffic accidents.9 Endocrine disorders 0.8 Poisoning, fires, drownings, falls. Musculoskeletal diseases 0.7 Others.9 Diseases of the genitourinary system 0. Diabetes mellitus 0. Intentional 2. Skin diseases 0.2 Violence.7 Oral diseases 0.2 War and conflict 0. Other neoplasms 0. Self-inflicted injuries 0. Others 0.0 Others 0.0 Figure 00: Distribution of causes of noncommunicable burden of diseases (percentage of total DALYs) in the, 200 Figure 0: Distribution of causes of intentional and non-intentional injuries (percentage of total DALYs) in the, 200 Psychiatric disorders. Neurological disorders 0.9 Unipolar depressive disorders.2 Epilepsy 0. PTSD, OCD and panic disorders 0. Multiple sclerosis 0.2 Bipolar affective disorder 0. Insomnia (primary) 0. Schizophrenia 0. Migraine 0. Alcohol use disorders 0.2 Parkinson s disease 0.0 Drug-use disorders 0.2 Dementias 0. Other neuropsychiatric conditions 0.8 Figure 02: Distribution of causes of neuropsychiatric burden of diseases (percentage of total DALYs) in the, 200 8

65 Risk factors for health Risk factors for health Male Female Male Female 8 8 Western Pacific Region European Region South-East Asia Region Eastern Mediterranean Region Region of the Americas Figure 0: Percentage of current tobacco use in persons years of age or older in WHO Regions, Seychelles Democratic Republic of the Figure 0: Percentage of current tobacco use in persons years of age or older in the, by country, 200 9

66 Specific Programmes and Services.. European Region 9. Seychelles.9 Region of the Americas Western Pacific Region South-East Asia Region Eastern Mediterranean Region Figure 0: Alcohol consumption (litres per person) among adults aged years of age or older in WHO Regions, Equatorial Bissau Democratic Republic of the Figure 0: Alcohol consumption (litres per person) among adults aged years or older in the African Region, by country, 200

67 Food and nutrition Democratic Republic of the -Bissau Figure 07: Percentage of underweight* children under years of age in the, by country, and Bissau Equatorial Democratic Republic of the Food and nutrition Figure 08: Percentage of stunted* children under years of age in the, by country, and *Percentage of children underweight describes how many children under years of age have a weight-for-age below minus two standard deviations of the National Center for Health Statistics (NCHS)/WHO reference median. Percentage of children stunted describes how many children under years of age have a height-for-age below minus two standard deviations of the NCHS/WHO reference median.

68 Specific Programmes and Services Equatorial Democratic Republic of the Figure 09: Percentage of overweight* children under years of age in the African Region, by country, and *Percentage of children overweight describes how many children under years of age have a weight-for-height above two standard deviations of the NCHS/WHO reference median. 2

69 Key Determinants of Health Demography Aged under (%) Aged 9 (%) Aged over 0 (%) 2 Figure 0: Age distribution of the population in WHO Regions, 2008 Eastern Mediterranean Region 9 South-East Asia Region 8 Region of the Americas 2 2 Western Pacific Region European Region

70 Key Determinants of Health Aged under (%) Aged 9 (%) Aged over 0 (%).9.2 Democratic Republic of the -Bissau Equatorial Seychelles Democratic Republic of the -Bissau Equatorial Seychelles Figure : Age distribution of the population in the, by country, 2008 Figure 2: Total fertility rate per woman in the African Region, by country, 2008 and 990

71 Demography Eastern Mediterranean Region South-East Asia Region Region of the Americas Western Pacific Region European Region Figure : Annual growth rate (in %) of population in WHO Regions, and Democratic Republic of the Equatorial -Bissau Seychelles Figure : Annual growth rate (in %) of population in the, by country, and

72 Key Determinants of Health Resources and infrastructure South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas Figure : Gross national income* per capita (PPP int. $) in WHO Regions, 2008 and 990 Democratic Republic of the -Bissau Seychelles Equatorial Figure : Gross national income per capita (PPP int. $) in the, by country, 2008 and 990 *Gross national income (GNI) is the sum of value added by all resident producers plus any product taxes (less subsidies) not included in the valuation of output plus net receipts of primary income (compensation of employees and property income) from abroad. GNI per capita is GNI divided by mid-year population For further details, see html.

73 Resources and infrastructure Republic Democratic of the 2 Democratic Republic of the Bissau Figure : Electrification rate in the, by country, Seychelles 9 00 Figure 8: Paved roads* as percentage of all roads in the, by country, *Paved roads are those surfaced with crushed stone (macadam) and hydrocarbon binder or bituminized agents, with concrete, or with cobblestones, as a percentage of all the country s roads, measured in length. Source: 7

74 Key Determinants of Health Poverty and income inequality South-East Asia Region Western Pacific Region 8 89 Eastern Mediterranean Region Region of the Americas European Region Figure 9: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in WHO Region, Democratic Republic of the -Bissau Figure 20: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in the, by country,

75 Poverty and income inequality African region Poorest 0% Poorest 20% Richest 20% Richest 0% Figure 2: Share of incomes by poorest and richest section of the population in the, by country, * Bissau *Source: World Bank,

76 Key Determinants of Health Gender inequity Male Female African region African region.7 0. Central African Rep Democratic Republic of the -Bissau Equatorial Seychelles Equatorial Democratic Republic of the Cote d'ivoire -Bissau Seychelles Figure 22: Percentage of female and male combined gross enrolment ratio* for primary secondary tertiary education in the, by country, 200 Figure 2: Percentage of seats held by women in national parliaments in the, by country, 2009 and 200 *Number of students enrolled in primary, secondary and tertiary levels of education, regardless of age, as percentage of the population of official school age for the three levels. The gross enrolment ratio can be greater than 00% as a result of grade repetition and entry at ages younger or older than the typical age at that grade level (UNDP definition). Source: United Nations Statistical Division, MDG Database, June 200. Number of seats held by women expressed as a percentage of all occupied seats. Women s representation in parliaments is one aspect of women s opportunities in political and public life, and it is therefore linked to women s empowerment. For additional information, see the website 0

77 Education Education Male Female Bissau Central African Rep Democratic Republic of the Seychelles Equatorial Figure 2: Adult literacy rate (percentage aged and older) in the, by country and sex, Arican Region Cote d'ivoire Democratic Republic of the -Bissau Equatorial Seychelles Figure 2: Percentage of the population aged 2 years who can both read and write (i.e. youth literacy rate*) in the, by country, and *The youth literacy rate reflects the outcomes of primary education over the previous 0 years or so. As a measure of the effectiveness of the primary education system, it is often seen as a proxy measure of social progress and economic achievement. The literacy rate for this analysis is simply the complement of the illiteracy rate. For details, see the websites and unesco.org. Source: UNESCO Institute for Statistics, Source: United Nations Statistical Division, MDG Database, June 200.

78 Key Determinants of Health Environment Figure 2: Percentage of the population using improved drinking water sources in the, No data Outside WHO Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region Figure 27: Percentage of the population using improved drinking water sources* in WHO Regions, 2008 and South-East Asia Region Eastern Mediterranean Region Region of the Americas Western Pacific Region European Region Urban Rural Figure 28: Percentage of the urban and rural population with access to improved drinking water sources in WHO Regions, *An improved drinking water source, by nature of its construction and design, is likely to protect the source from outside contamination, in particular from faecal matter. Improved drinking water sources include piped water into dwelling, plot or yard; a public tap or stand pipe; a tube well or borehole; a protected dug well; and protected spring and rainwater collection. For additional information, see the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation website: 2

79 Environment Urban Rural 8 8 Democratic Republic of the -Bissau Democratic Republic of the -Bissau Seychelles Figure 29: Percentage of population using improved drinking water sources in the, by country, 2008 and 990 Figure 0: Percentage of urban and rural population with access to improved drinking water sources in the, by country, 2008

80 Key Determinants of Health Figure : Percentage of the population using improved sanitation facilities in the, No data Outside WHO South-East Asia Region Figure 2: Percentage of the population using improved sanitation facilities in WHO Regions, 2008 and 990 Eastern Mediterranean Region Western Pacific Region 9 2 Region of the Americas 87 8 European Region 9 9 South-East Asia Region Urban 2 Rural 7 0 Figure : Percentage of the population using improved sanitation facilities in WHO Regions, urban and rural, 2008 Western Pacific Region 9 Eastern Mediterranean Region 8 Region of the Americas European Region 97 87

81 Environment Urban Rural Bissau Democratic Republic of the Democratic Republic of the -Bissau Seychelles Figure : Percentage of the population using improved sanitation facilities in the, by country, 2008 and 990 Figure : Percentage of the population using improved sanitation facilities in the, by country, urban and rural, 2008

82 Key Determinants of Health -Bissau Democratic Republic of the Equatorial Seychelles Figure : Percentage of the population living in urban areas in the, by country, 2008 and Bissau Democratic Rep of the Equatorial Cote d'ivoire Figure 7: Percentage of urban population living in slums* in the, by country, 200 and *A slum household is defined as a group of individuals living under the same roof lacking one or more of the following conditions: access to improved water, access to improved sanitation, sufficient living area, durability of housing, and security of tenure. However, since information on secure tenure is not available for most of the countries, only the first four indicators are used to define a slum household, and then to estimate the proportion of urban population living in slums. The indicator is intended to provide an overview of the share of the urban population living in conditions of poverty and physical and environmental deprivation. For details, see the United Nations Human Settlements Programme (UN-HABITAT) Urban Observatory, Nairobi (available at the website: Source: United Nations Statistical Division, MDG database, June 200.

83 partnerships and financial flows partnerships and financial flows African region Seychelles Equatorial -Bissau Tanzania (United Republic of) (Democratic Republic of the) African region -Bissau Democratic Republic of the Seychelles Equatorial Figure 8: Per capita official development assistance* received (US$) in the, by country, 200 Figure 9: Official development assistance received as percentage of GDP in the, by country, 200 and 990 *Official Development Assistance (ODA) is defined as those flows to countries and territories on the DAC List of ODA Recipients (available at and to multilateral development institutions () that are provided by official agencies, including state and local governments, or by their executive agencies; and (2) each transaction of which is (a) administered with the promotion of the economic development and welfare of developing countries as its main objective and (b) concessional in character and conveys a grant element of at least 2% (calculated at a rate of discount of 0%). Source: OECD DAC 2007; World Bank,

84 Key Determinants of Health African region -Bissau Seychelles Democratic Republic of the Equatorial Democratic Republic of the Seychelles -Bissau Figure 0: Total debt service as percentage of GDP in the, by country, 990 and 200* Figure : Total external debt stocks (in millions of current US$) in the, by country, 2007 *Source: World Bank, 200. Total external debt is debt owed to non-residents repayable in foreign currency, goods or services. Total external debt is the sum of public, publicly guaranteed and private non-guaranteed long-term debt, use of IMF credit and short-term debt. Short-term debt includes all debt having an original maturity of year or less and interest in arrears on long-term debt. Source: World Bank, Development Finance 8

85 Science and technology Science and technology Democratic Republic of the -Bissau Equatorial Seychelles Democratic Rep of the -Bissau Cote d'ivoire Equatorial Seychelles Figure 2: Percentage of population with telephone in the, by country, 200 and 2000* Figure : Percentage of population who are cellular or mobile subscribers in the, by country, 200 and 2000* *Source: International Telecommunication Union, September

86 Key Determinants of Health Seychelles Democratic Republic of the Tanzania Equatorial Bissau 2.2 -Bissau Equatorial Democratic Republic of the Seychelles Figure : Percentage of population who are telephone (fixed and mobile) subscribers in the African Region, by country, 2007* Figure : Percentage of the population who are Internet users in the, 2007 *Source: International Telecommunication Union, September Source: United Nations Statistical Division, MDG database, June

87 Emergencies and disasters Emergencies and disasters 8 Democratic Rep of the Democratic Republic of the -Bissau Figure : Total number of internally displaced* people (thousands) in the, by country, 200 Figure : Total number of refugees (in thousands) in the, by country of origin, *Internally displaced people (IDP) are persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized State border. For more information, see Source: UNHCR,

88 Progress on the Health-Related MDGs MDG- (Child health) Target.A: Reduce by two-thirds, between 990 and 20, the under- mortality rate 200 Figure 8: Trend in under- mortality rate in the WHO, MDG target MDG target 2 Figure 9: Under- mortality rate (per 000 live births) in WHO Regions, both sexes, 2008 and 990 South-East Asia Region 29 2 European Region

89 Democratic Republic of the -Bissau Equatorial Seychelles 2009 MDG target MDG- (Child health) Figure : Under- mortality rate (per 000 live births) in the, by country, 2008 and the MDG target* *Source: Levels and Trends in Child Mortality; Report 200. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. UNICEF, WHO, The World Bank and United Nations DESA/Population Division. New York: UNICEF,

90 Progress on the Health-Related MDGs MDG- (Maternal health) Target.A: Reduce by three-quarters, between 990 and 20, the maternal mortality ratio Figure : Trend in maternal mortality ratio (per 00,000 live births) in WHO, MDG target MDG target 2 20 Figure 2: Trend in maternal mortality ratio (per 00,000 live births) in WHO Regions in 2008 Eastern Mediterranean Region South-East Asia Region 20 Americas Region 28 Western Pacific Region European Region

91 MDG- (Maternal health) -Bissau 2008 MDG target Figure : Maternal mortality ratio (per live births) in the African Region, by country, 2008 and the MDG target* Democratic Republic of the Equatorial *Source: Trends in Maternal Mortality: 990 to Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: WHO,

92 Progress on the Health-Related MDGs Target.B: Achieve, by 20, universal access to reproductive health Figure : Percentage of unmet need for family planning* in the African Region, by country, and *The proportion of women of reproductive age ( 9 years) who are married or in union and who have an unmet need for family planning, i.e. who do not want any more children or want to wait at least 2 years before having a baby, and yet are not using contraception. Further details can be found on the websites and html. 7

93 MDG- (AIDS, malaria and TB) MDG- (AIDS, malaria and TB) Target.A: Have halted by 20 and begun to reverse the spread of HIV/AIDS Figure : Percentage of HIV-positive pregnant women 2 years of age for countries with trend data in the, and For these two countries, the prevalence has increased between 2000 and

94 Progress on the Health-Related MDGs Target.B: Achieve, by 20, universal access to treatment for HIV/AIDS for all those who need it Countries with coverage rate of 20% or less Countries with coverage rate of 2 0% Equatorial Côte d Ivoire -Bissau Countries with coverage rate of % or more. and have reached in 2009 the Universal Access target of 80% Burkina Fasi Figure : Percentage of population in need of treatment with access to antiretroviral drugs in the, by country, 2009 and

95 MDG- (AIDS, malaria and TB) Eastern Mediterranean Region Western Pacific Region South-East Asia Region 2 28 Figure : Percentage of population living with advanced HIV infection who are receiving antiretroviral therapy in 2007 Americas Region European Region 9 Eastern Mediterranean Region European Region Western Pacific Region South-East Asia Region 2 0 Figure 8: Percentage of pregnant women living with HIV infection who are receiving antiretroviral therapy for preventing mother-to-child transmission, 2008 Americas Region 2 79

96 Progress on the Health-Related MDGs Target.C: Have halted by 20 and begun to reverse the incidence of malaria and other major diseases Democratic Republic of the Cote d'ivoire -Bissau These six countries have shown an increasing trend in coverage between 2000 and 2009 Democratic Republic of the -Bissau Figure 0: Percentage of children under years of age with fever being treated with antimalarial drugs in the, and Figure 9: Percentage of children under years of age sleeping under insecticide-treated bed nets in the, and

97 MDG- (AIDS, malaria and TB) MDG target Bissau Democratic Republic of the Equatorial Democratic Republic of the -Bissau Seychelles Equatorial Figure : Malaria mortality rate (per population) in the, by country, 2008 and 200* Figure 2: Prevalence of tuberculosis (per population) in the, by country, 2008 and the MDG target *Source: World Malaria Report Geneva: WHO,

98 Progress on the Health-Related MDGs MDG- (Malnourished children) Target.C: Halve, between 990 and 20, the proportion of people who suffer from hunger 0% MDG target 2% 22 20% 22% % 0% % 20 MDG target 20 Figure : Trend in children aged under years that are underweight Democratic Republic of the -Bissau Figure : Percentage of underweight children under years of age in the, by country, and the MDG target 82

99 MDG-7 (Water and sanitation) MDG-7 (Water and sanitation) Target 7.C: Halve, by 20, the proportion of people without sustainable access to safe drinking water and basic sanitation 2008 MDG target 2008 MDG target 7 Democratic Republic of the United Republic of Tanzania -Bissau Central African Republic Sao Tome and Principe Bissau Democratic Republic of the United Republic of Tanzania Central African Republic Figure : Percentage of the population using improved drinking water sources in the, by country, 2008 and the MDG target Figure : Percentage of the population using improved sanitation facilities in the, by country, 2008 and the MDG target 8

100 Progress on the Health-Related MDGs MDG-8 (Develop a global partnership for development) Target 8.D: Deal comprehensively with debt problems of developing countries for national and international measures in order to make debt sustainable in the long term Figure : Total debt service as percentage of exports of goods, services and income Seychelles Tanzania -Bissau

101 Explanatory Notes The following provides the definition of the health statistics categories included in this volume, as well as the rationale for their inclusion and the estimation methods used in their production. HEALTH STATUS. Life expectancy at birth Rationale for use: Life expectancy at birth reflects the overall mortality level of a population. It summarizes the mortality pattern that prevails across all age groups, children and adolescents, adults and the elderly. Definition: Average number of years that a newborn is expected to live if current mortality rates continue to apply. Methods of estimation: WHO has developed a model life table based on about 800 life tables from vital registration judged to be of good quality. For countries with vital registration, the level of completeness of recorded mortality data in the population is assessed and mortality rates are adjusted accordingly. Where vital registration data for 200 were available, these were used directly to construct the life table. For countries where the information system provided a time series of annual life tables, parameters from the life table were projected using a weighted regression model, giving more weight to recent years. Projected values of the two life table parameters were then applied to the modified logit life table model, where the most recent national data provided an age pattern, to predict the full life table for 200. In case of inadequate sources of age-specific mortality rates, the life table is derived from estimated under- mortality rates and adult mortality rates that are applied to a global standard (defined as the average of all the 800 life tables using a modified logit model). Source: Life Tables for WHO Member States. Geneva, WHO, 200. Available at: whosis/database/life_tables/life_tables.cfm. 2. Healthy life expectancy (HALE) Rationale for use: Substantial resources are devoted to reducing the incidence, duration and severity of major diseases that cause morbidity but not mortality and to reducing their impact on people s lives. It is important to capture both fatal and nonfatal health outcomes in a summary measure of average levels of population health. Healthy life expectancy (HALE) at birth adds up expectation of life for different health states, adjusted for severity distribution, making it sensitive to changes over time or differences between countries in the severity distribution of health states. Definition: Average number of years that a person can expect to live in full health by taking into account years lived in less than full health due to disease and/or injury. Methods of estimation: Since comparable health state prevalence data are not available for all countries, a four-stage strategy is used. Data from the WHOGBD study are used to estimate severityadjusted prevalence by age and sex for all countries. Data from the WHOMCSS and WHS are used to make independent estimates of severity-adjusted prevalence by age and sex for survey countries. Prevalence for all countries is calculated based on GBD, MCSS and WHS estimates. Life tables constructed by WHO are used with Sullivan s method to compute HALE for countries. HALE estimates use methods described in the statistical annex to the World Health Report 200. Estimates for 2007 have been revised to take into account the Burden of Disease estimates for Member States for the year 200 and may not be entirely comparable with those for 2002 published 8