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

Health Situation Analysis in the Atlas of Health Statistics, 20

Health Situation Analysis in the Atlas of Health Statistics, 20

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: 978 929 02 9 (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: +7 2 900; Fax: +7 2 97; E-mail: afrobooks@afro.who.int). 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

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... 0 2 The Health System... Health financing... Health workforce... 22 Medical products and equipment... 2 Health information Civil registration coverage... 27 Health research... 28 Specific Programmes and Services... 29 HIV/AIDS... 29 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

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... 72 MDG- (Child health)... 72 MDG- (Maternal health)... 7 MDG- (AIDS, malaria and TB)... 77 MDG- (Malnourished children)... 82 MDG-7 (Water and sanitation)... 8 MDG-8 (Develop a global partnership for development)... 8 Explanatory Notes... 8 iv

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 990 2 Figure : Life expectancy at birth in years in the African Region, by country and sex, 2008 2 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 990 7 Figure : Infant mortality rate per 000 live births in the, by country, 2009 and 990 7 Figure 8: Maternal mortality ratio per 00000 live births in WHO Regions, 2008 and 990 8 Figure 9: Maternal mortality ratio per 00000 live births in the, by country, 2008 and 990 8 Figure 20: Age-standardized death rates per 00 000 population due to communicable diseases in the African Region, 200 9 Figure 2: Age-standardized death rates per 00 000 population due to non-communicable diseases in the, 200 9 Figure 22: Age-standardized death rates per 00 000 population due to injuries and violence in the African Region, 200 9 Figure 2: Total burden of disease in DALYs per 000 population in WHO Regions, 200 0 Figure 2: Leading causes of burden of diseases shown as percentage of total DALYs in the, 200 0 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, 200 2 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

List of figures Figure 8: General government expenditure on health as percentage of total government expenditure in the, by country, 2007 and 2000 8 Figure 9: External resources for health as percentage of total expenditure on health in the, by country, 2007 and 2000 8 Figure 0: Private expenditure on health as percentage of total expenditure on health in WHO Regions, 2007 and 2000 9 Figure : Out-of-pocket expenditure as percentage of private expenditure on health in WHO Regions, 2007 and 2000 9 Figure 2: Private expenditure on health as percentage of total expenditure on health in the, by country, 2007 and 2000 20 Figure : Out-of-pocket expenditure as percentage of private expenditure on health in the, by country, 2007 and 2000 20 Figure : Per capita government expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000 2 Figure : Per capita government expenditure on health (PPP int. $) in the, by country, 2007 and 2000 2 Figure : Physician-to-population ratio (per 0 000 population) in the, 2000 2009 22 Figure 7: Physician-to-population ratio (per 0 000 population) in WHO Regions, 2000 2009 22 Figure 8: Nursing and midwifery personnel-topopulation ratio (per 0 000 population) in the African Region, 2000 2009 2 Figure 9: Nursing and midwifery personnel-topopulation ratio (per 0 000 population) in WHO Regions, 2000 2009 2 Figure : Physician-to-population ratio (per 0 000 population) in the, by country, 2000 2009 2 Figure : Nursing and midwifery personnel-topopulation ratio (per 0 000 population) in the African Region, by country, 2000 2009 2 Figure 2: Median percentage availability of selected generic medicines in a sample of health facilities in the, countries with data, 200 2008 2 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, 200 2008 2 Figure : Hospital beds per 0 000 population in WHO Regions, 2000 2009 2 Figure : Hospital beds per 0 000 population in the, by country, 2000 2009 2 Figure : Percentage of civil registration coverage for births in the, by country, 2000 2008 27 Figure 7: Percentage of civil registration coverage for deaths in the, 2000 2008 27 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, 2007 28 Figure 0: HIV/AIDS mortality rate (per 00 000 population) in the, 2007 29 Figure : HIV/AIDS mortality rate (per 00 000 population) in WHO Regions, 2007 29 Figure 2: Prevalence of HIV (per 00 000 population) among people aged years or more in WHO Regions, 2007 0 Figure : Percentage of antiretroviral therapy among people with HIV/AIDS in need of treatment in WHO Regions, 2009 2 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,, 2002 200 2 Figure 7: Population aged 2 years of age with comprehensive knowledge of HIV/AIDS 2 Figure 8: Tuberculosis death rate per 00 000 population per year in the, by country, 2007 and 2000 Figure 9: Tuberculosis incidence rate per 00 000 population per year in the, by country, 2008 and 2000 Figure 70: Tuberculosis prevalence per 00 000 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, 200 2009 and 2000 200 Figure 7: Malaria mortality rate per 00 000 population in the, 2008 7 Figure 7: Proportion of children under years of age with fever being treated with antimalarial drugs in the, by country, 200 2009 and 2000 200 7 Figure 77: Percentage of neonates protected at birth against neonatal tetanus in WHO Regions, 2008 and 990 8 Figure 78: Percentage immunization coverage among -year-olds for DTP in WHO Regions, 2008 and 990 8 Figure 79: Percentage of neonates protected at birth against neonatal tetanus in the, by country, 2008 and 990 9 Figure 80: Percentage immunization coverage among -year-olds for DTP in the, by country, 2008 and 990 9 Figure 8: Immunization coverage among -year-olds for HepB in WHO Regions, 2008 0 vi

List of Figures Figure 82: Immunization coverage among -year-olds for HepB in the, by country, 2008 0 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, 2000 2009 Figure 8: Percentage of infants exclusively breastfed for the first months of life in the, by country, 2000 2009 Figure 8: Percentage of low-birthweight newborns in WHO Regions, 2000 2008 2 Figure 87: Percentage of low-birthweight newborns in the, by country, 2000 2008 2 Figure 88: Percentage of births attended by skilled health personnel in WHO Regions, 990 999 and 2000 2008 Figure 89: Percentage of births attended by skilled health personnel in the, 2000 2008 Figure 90: Percentage of births attended by skilled health personnel in the, by country, 2000 2008 and 990 999 Figure 9: Percentage of births by caesarean section in WHO Regions, 2000 2008 Figure 92: Percentage of births by caesarean section in the, by country, 2000 2008 Figure 9: Percentage of antenatal care coverage, at least one visit, in the, by country, 2000 2009 and 990 999 Figure 9: Percentage of antenatal care coverage, at least four visits, in the, by country, 2000 2009 and 990 999 Figure 9: Percentage of current contraceptive use (any method) among married women 9 years of age in the, by country, 2000 2008 and 990 999 Figure 9: Adolescent fertility rate (per 000 girls, 9 years of age) in the, 2000 2007 Figure 97: Total fertility rate per woman in WHO Regions, 2008 and 990 Figure 98: Number of reported cases of leprosy in WHO Regions, 2008 7 Figure 99: Number of reported cases of leprosy in the, by country, 2008 7 Figure 00: Distribution of causes of noncommunicable burden of diseases (percentage of total DALYs) in the, 200 8 Figure 0: Distribution of causes of intentional and non-intentional injuries (percentage of total DALYs) in the, 200 8 Figure 02: Distribution of causes of neuropsychiatric burden of diseases (percentage of total DALYs) in the, 200 8 Figure 0: Percentage of current tobacco use in persons years of age or older in WHO Regions, 200 9 Figure 0: Percentage of current tobacco use in persons years of age or older in the, by country, 200 9 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, 2000 2009 and 990 999 Figure 08: Percentage of stunted children under years of age in the, by country, 2000 2009 and 990 999 2 Figure 09: Percentage of overweight children under years of age in the, by country, 2000 2009 and 990 999 2 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, 998 2008 and 988 998 Figure : Annual growth rate (in %) of population in the, by country, 998 2008 and 988 998 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, 2000 200 7 Figure 8: Paved roads as percentage of all roads in the, by country, 2000 2007 7 Figure 9: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in WHO Region, 2000 2007 8 Figure 20: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in the, by country, 2000 2007 8 Figure 2: Share of incomes by poorest and richest section of the population in the, by country, 989 200 9 Figure 22: Percentage of female and male combined gross enrolment ratio for primary secondary tertiary education in the, by country, 200 0 Figure 2: Percentage of seats held by women in national parliaments in the, by country, 2009 and 200 0 Figure 2: Adult literacy rate (percentage aged and older) in the, by country and sex, 99 200 Figure 2: Percentage of the population aged 2 years who can both read and write (i.e. youth literacy rate) in the, by country, 2000 2007 and 990 999 vii

List of figures Figure 2: Percentage of the population using improved drinking water sources in the, 2008 2 Figure 27: Percentage of the population using improved drinking water sources in WHO Regions, 2008 and 990 2 Figure 28: Percentage of the urban and rural population with access to improved drinking water sources in WHO Regions, 2008 2 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$) in the, by country, 200 7 Figure 9: Official development assistance received as percentage of GDP in the, by country, 200 and 990 7 Figure 0: Total debt service as percentage of GDP in the, by country, 990 and 200 8 Figure : Total external debt stocks (in millions of current US$) in the, by country, 2007 8 Figure 2: Percentage of population with telephone in the, by country, 200 and 2000 9 Figure : Percentage of population who are cellular or mobile subscribers in the, by country, 200 and 2000 9 Figure : Percentage of population who are telephone (fixed and mobile) subscribers in the African Region, by country, 2007 70 Figure : Percentage of the population who are Internet users in the, 2007 70 Figure : Total number of internally displaced people (thousands) in the, by country, 200 7 Figure : Total number of refugees (in thousands) in the, by country of origin, 200 7 Figure 8: Trend in under- mortality rate in the WHO, 990 2009 72 Figure 9: Under- mortality rate (per 000 live births) in WHO Regions, both sexes, 2008 and 990 72 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 00 000 live births) in WHO, 990 2008 7 Figure 2: Trend in maternal mortality ratio (per 00 000 live births) in WHO Regions in 2008 7 Figure : Maternal mortality ratio (per 00 000 live births) in the, by country, 2008 and the MDG target 7 Figure : Percentage of unmet need for family planning in the, by country, 2000 2007 and 990 999 7 Figure : Percentage of HIV-positive pregnant women 2 years of age for countries with trend data in the, 200 2007 and 2000 200 77 Figure : Percentage of population in need of treatment with access to antiretroviral drugs in the, by country, 2009 and 2007 78 Figure : Percentage of population living with advanced HIV infection who are receiving antiretroviral therapy, 2007 79 Figure 8: Percentage of pregnant women living with HIV infection who are receiving antiretroviral therapy for preventing mother-to-child transmission, 2008 79 Figure 9: Percentage of children under years of age sleeping under insecticide-treated bed nets in the African Region, 200 2009 and 2000 200 80 Figure 0: Percentage of children under years of age with fever being treated with antimalarial drugs in the, 200 2009 and 2000 200 80 Figure : Malaria mortality rate (per 00 000 population) in the, by country, 2008 and 200 8 Figure 2: Prevalence of tuberculosis (per 00 000 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, 2000 2009 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 990 8 viii

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

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. $) 2008 2008 2000 990 2008 990 2008 990 2007 2000 2008 2000 990 80,8 7 29 92 7 7 8 2,279,,9,77,80 7 8 80 20 8 8 0,290,90,82 All data sources are given in the African Health Observatory at www.aho.afro.who.int 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 (2000 2009) (as % of total government expenditure) Nursing and midwifery Physician density (per 2000 2007 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

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% 2 8 20 MDG Target : %... 20 MDG Target : 990 999 2000 2009 990 999 2000 2009 990 2000 200 2008 2009 20 MDG-: Trend in maternal mortality ratio (per 00,000 live births) MDG-: Percentage of unmet need for family planning 8 80 780 90 2.% 2.% 20 0.8%... 20 MDG Target : 2 990 99 2000 200 2008 20 990 999 2000 2007 990 999 2000 2007 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 220 290 20 0 220 9 2 2 0 220 80 70 2008 2000 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% % 990 2008 990 2008 990 2008 990 2008 xi

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

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 80 7 27 9 8 2 8 8 7 7 7 2 22 8 20 9 9 9 088 8 02 2 8 70 2 70 2 20 2 2 2 0 9 98 972 82 807 9 0 927 9 79 2 20 209 92 0 8 280 8 9 99 0 8 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

Life expectancy Health Status and Trends Figure : Life expectancy at birth in years in the African Region, 2008 2 7 + No data Outside WHO 2008 990 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 9 7 7 7 Western Pacific Region Region of the Americas 72 7 77 79 8 Figure 2: Life expectancy at birth in years in WHO Regions, 2008 and 990 70 Figure : Life expectancy at birth in years in WHO Regions, by sex, 2008

Health Status and Trends 2008 990 Male Female 2 Democratic Republic of the -Bissau Equatorial Seychelles 2 2 9 7 8 8 9 8 8 2 9 9 9 9 9 2 2 9 2 7 9 7 2 0 0 7 8 8 8 7 8 9 9 9 0 7 0 2 0 2 7 2 8 7 7 7 72 9 7 9 Figure : Life expectancy at birth in years in the African Region, by country, 2008 and 990 Democratic Republic of the -Bissau Equatorial Seychelles 2 2 9 8 7 7 7 7 9 8 8 8 8 9 9 8 9 9 2 2 2 2 9 9 7 8 7 0 8 2 8 2 8 8 8 0 2 0 0 2 7 7 8 7 9 77 70 72 Figure : Life expectancy at birth in years in the African Region, by country and sex, 2008 2

Life expectancy Male Female Male Female Eastern Mediterranean Region South-East Asia Region European Region Region of the Americas Western Pacific Region 7 7 8 Figure : Healthy life expectancy* at birth in years in WHO Regions, by sex, 2007 70 9 9 -Bissau Democratic Republic of the Equatorial Seychelles 7 8 9 0 0 0 0 0 8 2 2 2 2 2 2 2 2 2 7 8 8 7 8 7 9 7 8 8 9 9 8 9 9 9 2 9 2 2 2 2 8 9 0 2 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.

Health Statusand Trends Mortality Figure 8: Adult mortality rate per 000 population in the, 2008 2 8 8 07 08 9 9 20 2 772 No data Outside WHO South-East Asia Region Eastern Mediterranean Region European Region Region of the Americas Western Pacific Region 2008 990 92 7 28 27 20 22 9 2 2 Figure 9: Adult mortality rate per 000 population in WHO Regions, 2008 and 990 80 20 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 90 90 208 2 Western Pacific Region 8 2 2

Mortality 2008 990 Male Female Democratic Republic of the -Bissau Equatorial Seychelles 28 2 92 7 20 20 27 2 8 00 70 80 8 8 7 7 7 2 89 77 0 07 8 0 9 0 2 0 2 9 9 8 27 8 27 72 87 7 27 29 7 9 97 0 0 27 20 2 20 20 2 07 89 0 08 0 290 290 27 27 27 27 29 2 2 28 289 27 2 228 8 89 2 22 0 9 2 8 Figure : Adult mortality rate per 000 population in the, by country, 2008 and 990 772 8 20 Democratic Republic of the -Bissau 7 Equatorial 77 Seychelles 2 7 79 8 98 98 8 8 8 7 29 0 8 2 8 7 7 70 2 0 2 99 22 8 9 9 2 0 0 89 7 88 82 7 0 7 290 28 0 2 20 29 0 28 29 28 8 22 2 29 00 2 298 27 29 27 28 20 28 2 27 27 227 2 97 22 09 2 0 9 82 72 78 Figure 2: Adult mortality rate per 000 population in the, by country and sex, 2008

Health Statusand Trends Figure : Under- mortality rate per 000 live births in the, 2009* 2 2 8 8 28 29 2 20 No data Outside WHO Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region 2009 990 Figure : Under- mortality rate per 000 live births in 27 WHO Regions, both sexes, 9 2009 and 990* 72 0 9 2 8 0 89 Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region 2009 990 Figure : Infant mortality rate per 000 live births in 80 WHO Regions, 2009 and 09 990* 77 80 8 2 2 28 2 2 *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.

Mortality 2009 990 2009 990 27 9 80 09 Democratic Republic of the -Bissau Equatorial Seychelles 209 20 99 99 9 20 92 28 9 2 20 89 28 0 0 8 98 2 2 2 22 9 8 22 28 0 28 8 9 2 8 8 29 2 27 0 28 08 2 0 28 0 20 0 98 9 90 8 8 99 8 9 78 9 7 92 9 9 9 20 2 2 8 7 0 8 7 2 28 2 2 Democratic Republic of the -Bissau Equatorial Seychelles 2 2 2 20 2 2 2 0 0 9 98 9 9 9 9 0 88 20 88 7 8 2 8 08 8 0 8 7 80 79 78 0 7 7 7 90 7 8 70 0 9 29 8 99 7 2 89 7 2 8 2 2 2 7 7 7 7 8 02 9 92 9 29 2 9 2 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, 200. 7

Health Statusand Trends 2008 990 2008 990 20 8 20 8 Eastern Mediterranean Region South-East Asia Region Americas Region Western Pacific Region European Region 0 2 0 20 20 20 0 00 80 Figure 8: Maternal mortality ratio per 00 000 live births in WHO Regions, 2008 and 990* -Bissau Central African Republic United Republic of Tanzania Democratic Republic of the Equatorial 200 00 000 200 990 00 970 200 970 00 8 880 80 00 80 200 820 00 790 880 790 90 80 200 70 900 0 000 00 80 80 0 0 770 780 000 00 0 80 0 70 0 90 70 90 70 990 70 90 0 70 0 70 20 20 0 790 0 7 0 20 00 7 0 0 0 280 000 280 90 20 20 90 8 80 80 20 2 9 20 72 Figure 9: Maternal mortality ratio per 00 000 live births in the, by country, 2008 and 990* *Source: Trends in Maternal Mortality: 990 to 2008. Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: WHO, 200. 8

Mortality Figure 20: Age-standardized death rates* per 00 000 population due to communicable diseases in the, 200 2 0 78 79 8 02 0 298 No data Outside WHO Figure 2: Age-standardized death rates per 00 000 due to non-communicable diseases in the African Region, 200 9 9 7 72 88 89 97 98 07 No data Outside WHO Figure 22: Age-standardized death rates per 00 000 due to injuries and violence in the, 200 7 7 99 00 0 2 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: www.who.int/healthinfo/paper.pdf. 9

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 8..2 2. 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 2008. 0

Burden of disease Infectious and parasitic diseases Noncommunicable conditions Respiratory infections..9 2. 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% %

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, 200 80% % % 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

Burden of disease Communicable disease Non-communicable conditions Injuries Communicable disease Non-communicable conditions Injuries 80 7 80 7 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, 200 2 2 2 2 70 7 0 20 9 8 -Bissau Democratic Republic of the Equatorial Seychelles 0 87 8 8 8 8 8 8 8 8 8 8 8 82 82 82 82 82 8 8 8 8 80 80 79 79 78 78 78 78 78 77 7 7 7 7 7 7 72 7 9 8 78 2 8 0 0 9 8 0 7 9 7 2 0 7 0 7 2 2 2 8 8 0 9 2 7 9 0 0 8 8 7 9 7 7 7 2 9 8 8 8 20 7 8 9 2 8 8 9 2 2 2 9 9 2 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.

2 The Health System Health financing South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas 2007 2000 7 8 0 27 80 298 220 87 98 0 Figure 0: Per capita total expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000 8 8 South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas 2007 2000 Figure : Total expenditure on health as percentage of..7..2.2.9..8 8.8 8. 2.0. GDP in WHO Regions, 2007 and 2000 9.7 9.2

Health financing 2007 2000 2007 2000 7 8.2.9 Democratic Republic of the -Bissau Equatorial Seychelles 8 20 20 2 0 2 0 20 2 8 7 27 9 9 9 2 0 7 7 22 2 29 7 82 7 8 70 7 72 72 9 72 7 79 90 0 92 9 9 2 99 7 0 7 7 9 8 00 8 287 20 8 88 7 22 2 299 29 72 7 89 8 09 Equatorial Seychelles Democratic Republic of the -Bissau 2..9 2. 2. 2. 2.8 2. 2.. 2.8...8...8..7.2..2.8....9.....7..8..8..9..9.9......8..8...7..7..7..8.7.0.7....2..8.2.7.2.7.... 7.. 8. 7.2 8. 8. 8.9 0.0 9.9. 0..2 0. 9.2.2 0.2 7.2.9 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

2 The Health System Figure : General government expenditure on health as percentage of total expenditure on health in the, 2007.00.0. 2.0 2. 2.80 2.8.20.2 8.0 No data Outside WHO Figure : General government expenditure on health as percentage of total government expenditure, 2007.00.. 9.0 9. 2.0 2..99.00 9. No data Outside WHO

Health financing South-East Asia Region 2007 2000 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 7 8 7 7 7 0 8 Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region 2007 2000 Figure 7: External resources for health as percentage of.9 total expenditure on health. in WHO Regions, 2007 and.8 2000.0 0. 0. 0 0. 0 0. 0.9.7 0.2 0.

2 The Health System -Bissau Democratic Republic of the Equatorial Seychelles 2007 2000 9. 8.7.0 2..2.0.7.0.8 7.2..8..2... 0...2.9 7.8 7.7 8.0 7.8. 7.8 7. 7.9. 8.. 8. 9. 8.9 8. 8.9 0.7 9.. 9. 8.7 9.8 7. 0.2 8. 0. 9. 0.7. 0.7 9.0 0.7 0.8 0.8 0.9.0 0.... 8.8.8 9..9 8. 2. 8.8 2. 0. 2. 7.9 2..9.0.9.2 9.0. 8.9.8..0.0. 9..8.0. 9.0 8. 9. 9. 8.2 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 2007 2000.9. 0.2 9.9 2.9 7.8 2. 7.7. 2. 2.0 9.9 27.8 7.8.7. 2..9. 0.0..0...8. 28.. 9. 28..9 2.9 22.9 2. 22.2 2. 8. 2.7 28. 2..0 20.9 2. 9.8 7.8.8 20.... 2.... 2.9 0.8 9.0 0..8 0. 9. 0.. 8..2 7.9....2..0..8 9..0 0..7. 2.2.2 2.2..8... 0.8 0. 0.2. 0. 0. 7.9 Figure 9: External resources for health as percentage of total expenditure on health in the, by country, 2007 and 2000 8

Health financing South-East Asia Region Region of the Americas 2007 2000 7 9 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 2 2 0 2 South-East Asia Region 2007 2000 0 87 89 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 82 88 European Region 7 Region of the Americas 28 0 9

2 The Health System Democratic Republic of the -Bissau Seychelles Equatorial 2007 2000 7 89 88 79 99 7 7 7 70 7 7 7 79 7 8 7 8 7 7 9 7 9 2 2 9 0 8 2 8 7 2 8 9 7 8 9 8 2 7 0 8 2 9 2 2 9 0 8 2 29 7 0 2 0 2 28 28 2 9 2 27 20 2 20 8 27 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 2007 2000 0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 99 9 88 9 9 9 9 9 9 9 00 9 97 9 9 9 9 89 9 8 87 82 7 8 79 79 80 79 92 77 80 7 90 7 8 9 7 8 8 8 7 9 9 7 2 2 2 97 7 8 2 2 2 0 2 28 2 27 8 Figure : Out-of-pocket expenditure as percentage of private expenditure on health in the, by country, 2007 and 2000 20

Health financing 2007 2000 2007 2000 South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas 8 8 7 8 0 90 9 20 90 89 Figure : Per capita government expenditure on health (PPP int. $) in WHO Regions, 2007 and 2000 0 7 Democratic Republic of the -Bissau Equatorial Seychelles 8 7 8 9 9 0 0 0 8 20 8 9 9 9 20 2 2 27 27 20 28 9 0 2 0 2 20 9 2 0 0 2 2 0 2 2 8 28 8 0 0 7 80 9 9 2 27 8 0 22 9 9 7 28 8 78 Figure : Per capita government expenditure on health (PPP int. $) in the, by country, 2007 and 2000 2

2 The Health System Health workforce Figure : Physician-topopulation ratio (per 0 000 population) in the African Region, 2000 2009 0.9.00.0.00.0.00.0 8.00 8.0.0 No data Outside WHO South-East Asia Region 2 Figure 7: Physician-topopulation ratio (per 0 000 population) in WHO Regions, 2000 2009 Eastern Mediterranean Region 0 Western Pacific Region Region of the Americas 2 European Region 22

Health workforce Figure 8: Nursing and midwifery personnel-topopulation ratio (per 0 000 population) in the African Region, 2000 2009 0.9.00.0 0.00 0.0 2.00 2.0.00.0 79.00 No data Outside WHO South-East Asia Region Eastern Mediterranean Region Western Pacific Region 2 Figure 9: Nursing and midwifery personnelto-population ratio (per 0 000 population) in WHO Regions, 2000 2009 Region of the Americas European Region 8 28 2

2 The Health System 2 -Bissau Democratic Republic of the Equatorial Seychelles 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 2 2 2 2 2 8 2 Democratic Republic of the Equatorial -Bissau Seychelles 0. 2 2 2 2 2 7 7 7 7 7 8 8 0 2 9 9 2 7 79 Figure : Physician-to-population ratio (per 0 000 population) in the, by country, 2000 2009 Figure : Nursing and midwifery personnel-topopulation ratio (per 0 000 population) in the African Region, by country, 2000 2009 2

Medical products and equipment Medical products and equipment Public Private Public Private United Republic of Tanzania Sao Tome and Principe 8 20 2 2 22 2 Figure 2: Median percentage availability of selected generic medicines in a sample of health facilities in the, countries with data in 200 2008 8 8 8 70 72 72 80 8 88 Sao Tome and Principe United Republic of Tanzania.9.. 2..8 2. 2.2 2.0..8. 2.2 2.. 2.7 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, 200 2008.....8.. South-East Asia Region Eastern Mediterranean Region 9 2 Figure : Hospital beds per 0 000 population in WHO Regions, 2000 2009 Region of the Americas 2 Western Pacific Region 8 European Region 27 2

2 The Health System 2 9 Figure : Hospital beds per 0 000 population in the, by country, 2000 2009 7 7 8 Democratic Republic of the 8 8 9 9 9 9 -Bissau 0 0 2 2 8 9 Equatorial 9 9 2 2 22 27 28 0 2 Seychelles 9 2

Health information Civil registration coverage Health information Civil registration coverage 7 8 9 0 Democratic Republic of the Equatorial -Bissau 2 2 29 0 0 2 2 9 8 8 9 8 0 0 7 9 70 7 7 78 78 8 82 8 <2 2 9 9 7 7 89 90 00 No data Outside WHO Figure 7: Percentage of civil registration coverage for deaths in the, 2000 2008 Seychelles 89 90 90 90 90 Figure : Percentage of civil registration coverage for births in the, by country, 2000 2008 27

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) 28..2 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 2 70. 92.9 MOH carries out strategic planning 87. 00 Physicians are required to undertake continuing medical education (CME) to remain licensed. 2..2 Physicians are licensed by another body 2 2.9 8.8 MOH licenses physicians 29.. 2. National accrediation is carried out by another body 7. 8.8 MOH carries out national accreditation of medical schools/hospitals 7. 7. MOH maps knowledge sources and flows for policy making This is an explicit knowledge management framework in MOH 2. 7..7 29. 7.. 28

Specific Programmes and Services HIV/AIDS Figure 0: HIV/AIDS mortality rate (per 00 000 population) in the African Region, 2007 9 8 9 2 2 8 8 09 No data Outside WHO South-East Asia Region Region of the Americas 2 Figure : HIV/AIDS mortality rate (per 00 000 population) in WHO Regions, 2007 European Region Eastern Mediterranean Region Western Pacific Region 29

Specific Programmes and Services Americas Region European Region 8 700 Figure 2: Prevalence of HIV (per 00 000 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 9 2 9 Eastern Mediterranean Region 2 7 *Source: WHO/UNAIDS/UNICEF. Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector Progress Report 200. 0

2007 200 2009 2007.9.2 0 7 Cote d'ivoire Equatorial -Bissau Democratic Rep of the 8..9....2. 2. 0..9....2 7.0.9.. 7.9..0.9 7.7.9.0......7....2 2.8. 2.. 2.0. 2.0 2..9 2..8.8.7..7 0..7.. 2...2......2.2..0 0. 0.9 0.9 0.8 0.7 0.8 0.7 0. 0. 0. 0. 0. 0. 2. 2. 2.9 2. 2.2 2.9 2.0 Equatorial -Bissau Democratic Republic of the 2 8 8 8 8 20 9 2 9 2 2 2 22 22 22 0 2 2 2 2 2 20 2 2 2 28 2 28 28 29 9 0 20 0 2 0 7 7 28 9 0 27 7 2 8 8 8 2 9 9 2 2 29 7 7 8 79 88 88 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.

Specific Programmes and Services Male Female Male Female 2 2 0 -Bissau Figure : Percentage of men and women aged 2 years who used a condom at last high-risk sex, African Region, 2002 200* 2 8 20 2 2 2 2 2 2 29 28 28 7 7 8 0 9 9 2 7 2 2 7 2 0 0 7 8 2 70 Democratic Republic of the Equatorial -Bissau 9 9 Figure 7: Population aged 2 years with comprehensive correct knowledge of HIV/AIDS 7 9 27 2 2 8 22 8 2 2 2 2 27 28 8 20 2 20 27 2 2 7 8 2 0 7 2 2 8 8 28 0 7 9 2 *Source: United Nations Statistical Division, MDG Database, June 200. 2

Tuberculosis Tuberculosis 2007 2000 2008 2000 90 8 20 Equatorial Democratic Republic of the -Bissau Seychelles 2 8 2 7 20 8 9 8 9 97 8 22 28 2 28 8 27 2 02 87 02 87 02 2 00 9 8 9 0 92 79 90 90 8 90 7 87 82 7 78 89 7 8 7 78 70 9 2 2 8 9 8 7 2 27 0 8 9 2 2 Democratic Republic of the -Bissau Equatorial Seychelles 800 90 80 70 80 7 70 70 0 0 0 80 70 00 2 0 70 20 80 0 70 90 90 80 0 70 0 0 20 0 00 0 00 20 20 20 00 20 280 0 0 00 200 00 270 290 2 290 20 280 20 280 20 20 20 20 220 220 200 220 90 200 20 90 0 90 20 80 0 0 0 99 0 97 8 92 8 8 8 0 2 7 22 2 200 Figure 8: Tuberculosis death rate per 00 000 population per year in the, by country, 2007 and 2000* Figure 9: Tuberculosis incidence rate per 00 000 population per year in the, by country, 2008 and 2000* *Source: United Nations Statistical Division, MDG Database, June 200.

Specific Programmes and Services 2008 2000 2007 2000 80 70 7 Democratic Republic of the -Bissau Seychelles Equatorial 820 90 80 790 70 770 0 7 70 20 720 00 700 70 20 0 0 00 0 70 80 0 0 00 0 0 0 80 90 0 90 220 70 0 20 0 20 80 0 20 00 20 90 270 90 00 0 80 0 0 0 0 290 2 280 00 20 220 280 90 0 80 0 270 0 0 0 80 82 7 99 0 0 8 200 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 2000 2 8 2 28 7 0 9 7 77 Figure 70: Tuberculosis prevalence per 00 000 population per year in the, by country, 2008 and 2000

Tuberculosis 2007 2000 7 98. 0.8 27. Figure 72: Percentage of tuberculosis detection under DOTS in the, by country, 2007 and 2000* 9. 2.7 8. 82 78. 2. 72. 2.9 9. 8.7 88..2.9 Democratic Republic of the 0.7.8 8. 7.2 7.2.7 90..7..7 2.8 0.7.9.2. 2. 9 7 8.. 2.2.7. 9..9..9 8... 28. 2.8 2..8 2. 2. 22.9. 22. 2. 8. 8..8... 77.8

Specific Programmes and Services Malaria 00 200 2009 2000 200 Democratic Republic of the -Bissau Equatorial 7 987 8 790 2 200 080 28 2 209 20 00 9 898 80 772 727 70 9 79 22 20 88 2 9 20 Democratic Republic of the Cote d'ivoire -Bissau 0. 0...2.8 0.7.9. 7..0 8.. 9.. 9.7 0.2.... 20. 7. 2.0 2.8 2.7.0 2.8. 28.2. 29.2.7.. 8. 2.0 9.0 7....7 22..8 0.2.7 2.9 8.9.2 9.0.7. 2..7. 8 2 0 8 2 0 Figure 7: Percentage of children under years of age sleeping under insecticide-treated bed nets in the, by country, 200 2009 and 2000 200* Figure 7: Notified cases of malaria, in thousands, in the, by country, 2008 *Source: World Malaria Report 2009. Geneva: WHO, 2009.

Malaria Figure 7: Malaria mortality rate per 00 000 population in the, 2008 0.8.8.9.0. 9.77 9.78 0.9 0.92 2.2 No data Outside WHO Democratic Republic of the Cote d'ivoire -Bissau 200 2009 2000 200. 9.2 9..2 9..0.. 9.7.2 20.. 2.0.9 2. 2. 2.9 28. 2.7.2 29.8 2.0 0.0. 0. 0.7.0 8..2.9.0 7..0 2.8..9.7 8. 7.7 0.0 8.0 9..0 0..7 8.2 7.0 8.8 7.8. 2..2 7.2 8.8 Figure 7: Proportion of children under years of age with fever being treated with antimalarial drugs in the, by country, 200 2009 and 2000 200 7

Specific Programmes and Services Vaccine-preventable diseases Western Pacific Region 2008 990 2 7 78 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 7 8 0 8 South-East Asia Region 2008 990 7 72 72 70 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 82 7 7 78 92 9 Western Pacific Region 9 9 7 82 8

Vaccine-preventable diseases Equatorial Democratic Republic of the -Bissau 2008 990 78 7 7 8 2 9 8 7 8 7 7 7 7 7 77 2 78 7 78 7 78 0 79 79 8 7 8 77 82 0 82 8 78 8 8 7 8 2 8 8 9 8 8 8 8 9 8 9 8 8 0 8 87 8 87 88 90 2 9 8 9 92 8 92 92 9 0 9 27 97 8 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 2008 990 7 72 20 20 77 8 78 82 0 2 88 22 7 7 7 72 8 2 9 72 7 7 79 80 9 8 2 8 9 8 9 82 8 82 8 8 8 8 78 8 8 87 8 88 89 79 89 77 9 87 92 8 9 89 9 89 9 92 9 92 97 97 8 98 88 99 8 99 92 99 99 Figure 80: Percentage immunization coverage among -year-olds for DTP in the, by country, 2008 and 990 9

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 88 89 9 0 2 8 7 Figure 82: Immunization coverage among -year-olds for HepB in the African Region, by country, 2008 0 2 7 7 8 8 Democratic Republic of the 9 7 72 7 7 79 80 8 8 82 8 8 8 8 8 87 88 89 9 9 9 92 9 9 97 97 99 99 99 Seychelles 99 0

Child and adolescent health Child and adolescent health Injuries 2% HIV/AIDS % Other diseases % Diarrhoea 8% 7 2 Congenital abnormalities 2% Neonatal sepsis % Measles % 7 7 0 Birth asphyxia 8% Malaria % 9 Prematurity 9% 9 2 Pneumonia % Figure 8: Distribution of causes of death among children aged under years, 2008 2 22 2 2 -Bissau 28 29 0 2 2 Democratic Republic of the 8 8 European Region 2 8 9 Region of the Americas Eastern Mediterranean Region 2 7 South-East Asia Region 0 0 88 Figure 8: Percentage of infants exclusively breastfed for the first months of life in WHO Regions, 2000 2009 Figure 8: Percentage of infants exclusively breastfed for the first months of life in the, by country, 2000 2009

Specific Programmes and Services Maternal and newborn health South-East Asia Region 2 Eastern Mediterranean Region 2 27 2 Region of the Americas 8 -Bissau 2 2 European Region 22 20 Western Pacific Region 20 9 9 Figure 8: Percentage of low-birthweight newborns in WHO Regions, 2000 2008 Equatorial 2 Democratic Republic of the 2 2 2 0 0 0 9 9 8 Figure 87: Percentage of low-birthweight newborns in the, by country, 2000 2008 2

Maternal and newborn health 2000 2008 990 999 2000 2008 990 999 South-East Asia Region Eastern Mediterranean Region Region of the Americas Western Pacific Region European Region 7 8 9 0 9 2 Figure 88: Percentage of births attended by skilled health personnel in WHO Regions, 990 999 and 2000 2008 28 29 9 8 82 99 No data Outside WHO 92 87 92 8 9 9 -Bissau Equatorial Democratic Republic of the 7 8 2 8 8 28 2 8 9 9 2 2 2 2 8 9 7 2 7 7 8 9 0 7 2 2 2 7 2 0 7 7 7 0 2 2 2 9 9 7 70 7 78 78 89 8 8 9 8 9 77 99 99 Figure 89: Percentage of births attended by skilled health personnel in the, 2000 2008 Figure 90: Percentage of births attended by skilled health personnel in the, by country, 2000 2008 and 990 999

Specific Programmes and Services.. South-East Asia Region 7. Eastern Mediterranean Region.8 0. European Region Western Pacific Region Region of the Americas 9.0 2.9 0.8 0.7..9.7 Figure 9: Percentage of births by caesarean section in WHO Regions, 2000 2008 Democratic Republic of the.8.9 2 2. 2.7 2.9...2.2.2....8....9 7.7 7.9 0.7 2.7 20. 7 Figure 92: Percentage of births by caesarean section in the, by country, 2000 2008

Maternal and newborn health 2000 2009 990 999 2000 2009 990 999 7 7 7 Equatorial 9 2. 0. 8. 9.9 70 8.9 70.9 7 8. 7 8 7 2.2 80 78.2 82 78.8 8 80. 8 82 8 8. 8 8.2 8 7 87 7. 88 7. 89 8 89 7. 90 8.7 90 90. 92 9.9 92 89.7 92 89 9 9.2 9 92. 9 9. 9 87.2 9 9. 8 2 8 Figure 9: Percentage of antenatal care coverage, at least four visits, in the, by country, 2000 2009 and 990 999 2 27 0 0 0 7 7 9 2 7. 0 2 2 70 7. 72.9 72 7 78 2 Figure 9: Percentage of antenatal care coverage, at least one visit, in the, by country, 2000 2009 and 990 999

Specific Programmes and Services Sexual and reproductive health 2000 2008 990 999 2 9 -Bissau 8 8 8 7 8 9 2 9 0 2 7 8 8 2 9 20 2 2 2 2 2 0 27 2 2 7 9 8 29 0 8 0 7 7.0.0. 0.0 0. 28.0 28. 9.0 9. 99.0 No data Outside WHO Figure 9: Adolescent fertility rate (per 000 girls, 9 years of age) in the, 2000 2007 Eastern Mediterranean Region South-East Asia Region Region of the Americas Western Pacific Region European Region 2. 2.2 2.7.8 2...9..8 2008 990.9..2 Figure 9: Percentage of current contraceptive use* (any method) among married women 9 years of age in the, by country, 2000 2008 and 990 999 2.. 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: http://who.int/reproductivehealth/ publications/rhindicators/guidelines.pdf) or the website http://www.un..org/esa/population/unpop.html.

Neglected tropical diseases Neglected tropical diseases South-East Asia Region 29 8 Democratic Republic of the 0 899 Region of the Americas Western Pacific Region 8 89 27 Eastern Mediterranean Region 98 8 998 777 Figure 98: Number of reported cases of leprosy in WHO Regions, 2008 28 98 -Bissau Equatorial 7 9 8 2 0 298 27 27 2 78 27 2 7 0 0 0 Figure 99: Number of reported cases of leprosy in the, by country, 2008 7

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

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, 200 9 2 27 2 9 7 Seychelles 0 2 2 2 2 9 2 0 0 0 2 0 29 29 27 2 2 2 2 22 2 2 2 2 9 9 8 8 Democratic Republic of the 2 2 2 2 0 9 Figure 0: Percentage of current tobacco use in persons years of age or older in the, by country, 200 9

Specific Programmes and Services.. European Region 9. Seychelles.9 Region of the Americas.7 9.7.9 Western Pacific Region South-East Asia Region 0.7.7 7.9 7.0 7.0 Eastern Mediterranean Region 0....2. Figure 0: Alcohol consumption (litres per person) among adults aged years of age or older in WHO Regions, 200..2.0.7.7.7 Equatorial....8. -Bissau.2 2. 2. 2. 2. 2.0 Democratic Republic of the 2.0.9.9......0 0.8 0.8 0. 0. 0. 0. 0. 0.2 0.2 0. 0. Figure 0: Alcohol consumption (litres per person) among adults aged years or older in the African Region, by country, 200

Food and nutrition Democratic Republic of the -Bissau 2000 2009 990 999 22 2 Figure 07: Percentage of underweight* children under years of age in the, by country, 2000 2009 and 990 999 0 9 7 7 8 28 28 8 28 7 27 27 2 22 22 2 2 28 2 2 2 2 20 2 20 27 8 2 8 22 8 20 2 8 8 22 2 2 20 22 20 2 2 -Bissau Equatorial Democratic Republic of the Food and nutrition 2000 2009 990 999 2 20 2 2 27 0 28 28 29 29 29 0 0 7 7 7 9 9 9 0 0 2 0 8 0 8 7 7 2 2 7 7 Figure 08: Percentage of stunted* children under years of age in the, by country, 2000 2009 and 990 999 *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.

Specific Programmes and Services Equatorial Democratic Republic of the 2000 2009 990 999 0 0 0 0 0 8 9 9 9 8 2 8 8 2 7 7 7 8 2 2 2 2 22 Figure 09: Percentage of overweight* children under years of age in the African Region, by country, 2000 2009 and 990 999 *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

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 2 7 2 European Region 8 9 27 2

Key Determinants of Health Aged under (%) 2008 990 Aged 9 (%) Aged over 0 (%).9.2 Democratic Republic of the -Bissau Equatorial Seychelles 2 28 9 7 2 2 2 0 0 0 0 9 9 9 8 7 7 7 2 2 7 9 9 9 2 2 2 2 2 2 2 2 7 7 7 7 8 0 2 7 7 7 Democratic Republic of the -Bissau Equatorial Seychelles 7. 7.9. 7..2.7.0 7..9.8.8 7.2.8..7.9..2. 7.0....7..7..8..9. 7....2.......2.0.7.9.0.8.8.7.....9....2..9.......0..8...7..2..2..2..9 2.9.7 2.7. 2..7 2..7.9 2.7.8 2.2 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

Demography Eastern Mediterranean Region South-East Asia Region Region of the Americas Western Pacific Region European Region 998 2008 988 998 0.2 0...8.2. 2. 2.7 Figure : Annual growth rate (in %) of population in WHO Regions, 998 2008 and 988 998 0.8.2.. 2. 2. 0. Democratic Republic of the Equatorial -Bissau Seychelles 998 2008 988 998 2. 2.7. 0.9.7.2......2..2 2.8.2 0..2...8 2.9 2.9 2.9 2. 2.8. 2.8. 2.8.0 2.7 2.7 2.7 2.8 2.7. 2..2 2.. 2. 2. 2. 2.8 2.. 2. 2. 2. 2.9 2. 2.7 2.. 2. 2.7 2. 2. 2..9 2.2 2. 2. 2. 2..0 2.0. 2.0 2.9.9 2..7 2.0. 2.2. 2.7. 2.. 2..2..2 2. 0.9.2 0.. 0.2 2.2 Figure : Annual growth rate (in %) of population in the, by country, 998 2008 and 988 998

Key Determinants of Health Resources and infrastructure South-East Asia Region Eastern Mediterranean Region Western Pacific Region European Region Region of the Americas 2008 990 2279 9 0 99 80 298 898 282 82 8 0 290 22 89 2 00 Figure : Gross national income* per capita (PPP int. $) in WHO Regions, 2008 and 990 Democratic Republic of the -Bissau Seychelles Equatorial 2008 990 2279 9 20 290 00 00 80 0 0 90 0 80 80 70 70 7 0 770 270 820 00 80 0 870 90 00 0 00 720 090 0 00 0 20 0 90 0 880 90 20 20 90 20 820 280 70 0 0 0 790 80 0 80 990 0 80 90 9 2000 0 280 0 090 200 20 0 20 20 80 270 2920 790 0 9780 2 270 9700 2 80 0 00 80 90 0 9 770 2 700 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 www.unicef.org/infobycountry/stats_popup. html.

Resources and infrastructure Republic Democratic of the 2 Democratic Republic of the 7 7 9 8 8 8 9 0 0 0 0 0 2 9 20 20 22 8 8 9 9 9 9 9 20 22 7 8 9 -Bissau 22 2 27 28 29 70 9 98 0 2 Figure : Electrification rate in the, by country, 2000 200 8 9 70 7 Seychelles 9 00 Figure 8: Paved roads* as percentage of all roads in the, by country, 2000 2007 *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: http://data.worldbank.org/indicator/is.rod.pave.zs. 7

Key Determinants of Health Poverty and income inequality South-East Asia Region Western Pacific Region 8 89 Eastern Mediterranean Region Region of the Americas 7 2 77 7 8 European Region 70 7 8 Figure 9: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in WHO Region, 2000 2007 2 Democratic Republic of the -Bissau 2 2 9 7 2 9 7 9 9 0 2 2 2 2 20 Figure 20: Percentage of the population living under $ (PPP int. $) a day (i.e. in absolute poverty) in the, by country, 2000 2007 8

Poverty and income inequality African region 989 200 99 Poorest 0% Poorest 20% Richest 20% Richest 0% 2 2.. 78.7. Figure 2: Share of incomes by poorest and richest section of the population in the, by country, 989 200* 99. 99 2. 8. 99 2 7.7 2000 2.2.7 989.. 2000 200 2. 0.7 99 99 2.7 0. 2002 200 2. 9. -Bissau 99 2. 9. 200. 8.8 2000 2 8.2 2002 2 2. 7.7 998 2. 7 200 2.. 200 2.9. 99.. 2002 2.7 997 9..9 200 7 8.. 200 2 9.2.2 998 2 8 2.8 200 7 7.2 2.2 200 200 7..8 200 7. 0.7 200. 0.2 998 999 2. 0 2000.7 29. 200 7. 29 2000 0 7 2. 2.9 99 7 2. 2.8 999 2000 9 9. 2. *Source: World Bank, 200. 9

Key Determinants of Health Gender inequity Male Female 2009 200 African region African region.7 0. Central African Rep Democratic Republic of the -Bissau Equatorial Seychelles 2 9 28 2 2 2 9 28 29 2 2 2 7 29 7 28 7 2 7 8 2 9 2 8 2 8 2 9 8 8 8 8 9 2 8 2 9 2 8 8 2 2 2 7 7 8 7 9 70 72 8 7 7 7 7 77 77 8 8 Equatorial Democratic Republic of the Cote d'ivoire -Bissau Seychelles 7.7..2 2. 7. 7. 2 7. 9. 7.9 7.9 8 8. 8.9 9. 2 9.8. 0 7.8 0.2 2.2 0. 7. 0.8...9 2..2 2. 7.8 9..2 8.8.8..9..2 0..2 9.. 8..7 9.2..7 8.. 2.9 7.7 22.7 22 2. 22..8 2. 2. 2.8 2.9 2 0...8. 8.8 0. 0.7 29.8.8 0 7. 2.7. 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 www.milleniumindicators.un.org/unsd/mdgsmetadata 0

Education Education Male Female 2000 2007 990 999 -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, 99 200 9 7 8 7 2 8 2 2 29 2 0 0 0 9 7 2 9 9 7 0 72 72 7 90 7 7 0 77 77 8 77 0 78 2 78 70 78 0 80 0 80 82 8 8 78 8 8 8 87 8 88 7 88 8 89 80 9 79 9 92 92 78 9 8 9 8 Arican Region Cote d'ivoire Democratic Republic of the -Bissau Equatorial Seychelles 7 9 29 2 8 9 9 20 2 0 7 9 70 70 72 72 7 7 78 78 7 78 80 8 7 8 70 87 7 88 90 77 9 7 9 9 88 9 89 9 9 9 9 9 9 9 97 9 97 88 98 9 98 9 99 99 Figure 2: Percentage of the population aged 2 years who can both read and write (i.e. youth literacy rate*) in the, by country, 2000 2007 and 990 999 *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 www.unescobkk.org/infores/efa2000/tech.html and www.uis. unesco.org. Source: UNESCO Institute for Statistics, 2007. Source: United Nations Statistical Division, MDG Database, June 200.

Key Determinants of Health Environment Figure 2: Percentage of the population using improved drinking water sources in the, 2008 8.. 7 7. 87 87. 99 No data Outside WHO Eastern Mediterranean Region South-East Asia Region Western Pacific Region Region of the Americas European Region 2008 990 7 7 8 8 8 90 9 9 98 9 Figure 27: Percentage of the population using improved drinking water sources* in WHO Regions, 2008 and 990 77 87 South-East Asia Region Eastern Mediterranean Region Region of the Americas Western Pacific Region European Region Urban Rural 8 7 8 8 8 8 9 9 98 98 99 9 Figure 28: Percentage of the urban and rural population with access to improved drinking water sources in WHO Regions, 2008 78 9 *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: www.wssinfo.org/en/welcome.html. 2

Environment 2008 990 Urban Rural 8 8 Democratic Republic of the -Bissau 8 7 8 9 0 9 8 29 8 7 9 0 9 0 9 8 7 8 7 8 8 9 9 7 7 2 72 70 7 7 7 80 7 80 0 82 82 78 8 9 8 8 87 89 9 8 92 7 92 9 9 9 87 99 Democratic Republic of the -Bissau Seychelles 2 7 0 8 7 7 29 7 7 7 2 77 29 77 2 79 80 28 80 8 8 7 8 8 2 8 9 8 79 8 82 8 2 87 87 89 89 88 90 7 9 97 9 92 92 92 2 92 9 8 9 72 9 9 9 77 9 8 9 9 97 8 98 2 99 90 99 88 99 78 99 72 00 99 00 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

Key Determinants of Health Figure : Percentage of the population using improved sanitation facilities in the, 2008 9. 2 2.. 7 7. 9 No data Outside WHO South-East Asia Region 2008 990 0 0 2 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 70 92 European Region 97 87

Environment 2008 990 Urban Rural 0 2 7 -Bissau Democratic Republic of the 9 9 8 2 2 2 7 9 9 9 2 2 20 2 9 2 2 2 2 29 2 0 2 2 7 2 2 7 7 8 9 9 8 2 2 2 7 0 7 77 9 9 9 9 88 Democratic Republic of the -Bissau Seychelles 0 8 7 2 2 2 2 2 2 2 27 2 29 8 0 9 29 2 2 0 28 8 8 9 0 2 28 2 9 9 9 0 9 7 2 7 9 0 8 8 9 8 7 9 8 8 8 9 90 97 98 88 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

Key Determinants of Health -Bissau Democratic Republic of the Equatorial Seychelles 2008 990 7 29 0 8 9 2 20 2 22 8 2 2 2 2 9 27 2 28 28 29 2 0 28 2 2 28 28 9 7 2 7 28 7 29 8 9 7 9 0 2 2 9 2 0 8 9 0 9 7 7 7 7 8 0 2 0 0 2 2 9 Figure : Percentage of the population living in urban areas in the, by country, 2008 and 990 8 -Bissau Democratic Rep of the Equatorial Cote d'ivoire 200 990 Figure 7: Percentage of urban population living in slums* in the, by country, 200 and 990 2 77 97 9 9 9 9 99 87 8 8 9 8 9 82 99 8 9 80 9 7 2 72 80 72 82 9 2 7 9 9 99 89 9 80 8 2 8 0 8 7 72 70 8 7 2 80 7 80 9 8 78 2 29 8 *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: www.unhabitat.org/programmes/guo). Source: United Nations Statistical Division, MDG database, June 200.

partnerships and financial flows partnerships and financial flows African region 200 990 Seychelles Equatorial -Bissau Tanzania (United Republic of) (Democratic Republic of the) 8 8 78 2 2 9 9 8 2 2 0 9 9 9 8 8 7 2 28 28 27 2 2 2 22 9 7 22 20 2 African region -Bissau Democratic Republic of the Seychelles Equatorial 2 7 29 9 29 8 28 27 27 2 2 2 0 9 8 8 20 2 27 0 0 0 2 8 8 7 7 8 7 8 7 0 2 0 2 2 2 0 0 0 0 9 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 www.oecd.org/dac/stats/daclist) 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, 2007. 7

Key Determinants of Health African region -Bissau Seychelles Democratic Republic of the Equatorial 200 990 80 9 8 7 7 7 7 2 2 2 2 2 2 2 2 2 2 2 2 7 9 0 2 0 2 0 2 2 2 9 Democratic Republic of the Seychelles -Bissau 98 2 78 2 28 89 7 7 29 79 2 28 2 0 2789 2 288 27 208 98 97 0 08 97 972 87 870 87 7 7 80 99 9 02 9 8 29 9 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

Science and technology 200 2000 Science and technology 200 2000..0 2.8 20.9 Democratic Republic of the -Bissau Equatorial Seychelles 0.0 0.2 0.0 0. 0.0 0.0 0. 0. 0.2 0.2 0. 0. 0. 0.2 0. 0. 0. 0. 0. 0. 0. 0.8 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0.7 0. 0.7 0. 0.7 0.9 0.8 0. 0.8 0. 0.8 0.8 0.8.0 0.9 0.8 0.9 0..0 0.8.2 0.9. 0.7..8.. 2.0. 2..0 2. 2.2 2.7.2 2.8 2.2 2.8.2 2.9 2.7..2...8.2 7.7 8. 7.8.8 0.0 0.9.0 2. 2. 2.7 28.7 2. Democratic Rep of the -Bissau Cote d'ivoire Equatorial Seychelles 0.0 0. 0.0 0.. 0.0. 0.0 2. 0.2 2.7 0.. 0.0. 0.. 0.0.7 0.. 0.. 0.. 2..7 0. 7. 0.0 7. 0.2 8. 0. 9. 0.0 0.9 0..2.. 0.0. 0. 2. 0.9.0 0.9. 0.2.8 0. 8.9 0.7 9. 2. 20.0.2 20.9 0. 2.0. 22.0.2 2. 0.7 2. 0.0 2.. 2.0 2. 2.0 0. 27.2. 29.7.. 0... 0. 9.8 8...8..0.9 8. 8. 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 2009. 9

Key Determinants of Health.8 2 2 0.22 0.28 Seychelles 7 7 7 8 9 2 2 2 8 20 Democratic Republic of the Tanzania Equatorial 0.2 0. 0.7 0.2 0. 0.8 0.9 0.0 0.77 0.8 0.9 0.9 0.99.00.08....70 2 2.2 22 -Bissau 2.2 -Bissau 22 2.7 22 2. 2 2. Equatorial Democratic Republic of the 2 2 2 28 29 0 2 2 9 8 72 88 90 90 97 Seychelles 2.9.9.7.08.87.0.07..87..2.7 7.8 7.99 8. 0.2 0..9 2.9.9 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 2009. Source: United Nations Statistical Division, MDG database, June 200. 70

Emergencies and disasters Emergencies and disasters 8 Democratic Rep of the 00 000 7 70 22 90 00 2 9 8 2 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, 200 9 8 72 27 2 22 2 0 0 8 7 2 207 87 02 97 *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 www.internal-displaced.org. Source: UNHCR, 2007. 7

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, 990 2009 2 2 8 00 20 MDG target 0 990 2000 200 2007 2008 2009 20 2008 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 2 0 2 72

Democratic Republic of the -Bissau Equatorial Seychelles 2009 MDG target 27 0 209 7 99 9 80 92 9 9 8 8 7 8 0 02 9 2 77 2 77 0 8 7 28 28 9 8 2 82 7 0 7 08 0 0 70 0 98 9 90 27 8 8 78 2 7 9 9 0 2 2 8 7 20 8 2 2 20 28 2 8 2 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, 200. 7

Progress on the Health-Related MDGs MDG- (Maternal health) Target.A: Reduce by three-quarters, between 990 and 20, the maternal mortality ratio 200 00 8 80 780 90 20 Figure : Trend in maternal mortality ratio (per 00,000 live births) in WHO, 990 2008 00 2 20 MDG target 0 990 99 2000 200 2008 200 20 2008 MDG target 2 20 Figure 2: Trend in maternal mortality ratio (per 00,000 live births) in WHO Regions in 2008 Eastern Mediterranean Region 08 20 South-East Asia Region 20 Americas Region 28 Western Pacific Region European Region 2 00 20 7

MDG- (Maternal health) -Bissau 2008 MDG target 2 2 00 27 00 2 220 27 00 220 20 8 80 80 820 790 790 000 990 970 970 200 Figure : Maternal mortality ratio (per 00 000 live births) in the African Region, by country, 2008 and the MDG target* Democratic Republic of the 00 22 2 0 9 9 2 27 9 9 228 28 80 70 0 00 80 0 0 0 0 70 70 70 Equatorial 0 8 0 8 20 0 98 0 88 0 8 00 88 8 0 280 2 280 2 20 90 2 80 20 9 8 8 *Source: Trends in Maternal Mortality: 990 to 2008. Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. Geneva: WHO, 200. 7

Progress on the Health-Related MDGs Target.B: Achieve, by 20, universal access to reproductive health 2000 2007 990 999 2 2 29 8 0 9 2 28 2 0 2 29 29 28 27 28 27 2 2 2 9 22 0 2 2 20 22 2 9 7 2 Figure : Percentage of unmet need for family planning* in the African Region, by country, 2000 2007 and 990 999 *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 http://www.unfpa.org and http://www.un.org/esa/population/unpop. html. 7

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 200 2007 2000 200.8 27. 2.9 2.2.2. Figure : Percentage of HIV-positive pregnant women 2 years of age for countries with trend data in the, 200 2007 and 2000 200. 2.2.9.2.7.9. 0..0. 2..0.8 2..7.7.... For these two countries, the prevalence has increased between 2000 and 2007 77

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% 2009 2007 2009 2007 2 8 8 8 8 20 9 2 9 2 Equatorial Côte d Ivoire -Bissau 0 2 2 22 22 22 2 2 2 2 2 20 2 2 2 28 2 28 28 29 9 0 2 0 20 0 Countries with coverage rate of % or more. and have reached in 2009 the Universal Access target of 80% 2009 2007 7 Burkina Fasi 7 7 28 9 0 27 7 2 8 8 8 2 9 9 2 7 7 8 79 88 88 Figure : Percentage of population in need of treatment with access to antiretroviral drugs in the, by country, 2009 and 2007 78

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

Progress on the Health-Related MDGs Target.C: Have halted by 20 and begun to reverse the incidence of malaria and other major diseases 200 2009 2000 200 200 2009 2000 200 Democratic Republic of the Cote d'ivoire -Bissau 0. 0...2.8 0.7.9. 7..0 8.. 9.. 9.7 0.2.... 20. 7. 2.0 2.8 2.7.0 2.8. 28.2. 29.2.7.. 8. 2.0 9.0 7....7 22..8 0.2.7 2.9 8.9.2 9.0.7. 2..7. These six countries have shown an increasing trend in coverage between 2000 and 2009 Democratic Republic of the -Bissau 9..0.. 9.2 9.7 2. 2. 2.9 28. 2.7 29.8 0.0. 0..0.2.9.0.0..9.7 8..0 0..7 8.2 7.0 7.8. Figure 0: Percentage of children under years of age with fever being treated with antimalarial drugs in the, 200 2009 and 2000 200 9.. 20.. 2.0.9.2.2 8. 2..2 2.0 7.2 8.8 0.7 7..2 2.8 7.7 0.0 8.0 9. 8.8 Figure 9: Percentage of children under years of age sleeping under insecticide-treated bed nets in the, 200 2009 and 2000 200 80

MDG- (AIDS, malaria and TB) 2008 200 2008 MDG target.9 0 9 80 -Bissau Democratic Republic of the Equatorial 2. 28. 8. 9.2 0.2 0.9 80 0.0 2 29. 8 29. 98 2. 0 2. 9 9.8 92.7 229.7 09.7. 7 0.8 9 0. 0. 00 0.0 9 9.7 20 9. 9. 7. 7.. 80. 0.8 9.7.. 0 2..9 0. 2. 0.2 0 0.8 0 0. 220 0. 0 Democratic Republic of the -Bissau Seychelles Equatorial 22 90 790 20 770 7 20 70 720 9 700 292 70 0 8 0 0 8 80 2 0 2 0 0 90 2 90 90 90 2 70 0 8 20 9 20 28 0 9 00 2 90 0 90 0 0 0 9 0 90 290 2 280 22 20 28 220 202 90 27 80 9 0 70 0 07 82 2 7 7 9 8 0 27 22 200 Figure : Malaria mortality rate (per 00 000 population) in the, by country, 2008 and 200* Figure 2: Prevalence of tuberculosis (per 00 000 population) in the, by country, 2008 and the MDG target *Source: World Malaria Report 2009. Geneva: WHO, 2009. 8

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% 2000 2009 MDG target 2% 22 20% 22% 2 0 9 0% 0% 990 999 2000 2009 % 20 MDG target 20 Figure : Trend in children aged under years that are underweight Democratic Republic of the -Bissau 8 9 28 28 9 28 9 27 2 22 2 2 2 2 2 20 20 8 2 8 7 7 9 0 9 7 9 2 2 0 0 8 Figure : Percentage of underweight children under years of age in the, by country, 2000 2009 and the MDG target 82

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 8 9 7 7 8 8 8 9 9 8 9 78 8 7 9 72 0 7 0 7 72 8 7 79 7 72 8 79 9 8 9 7 7 7 72 8 7 7 7 78 7 7 80 88 80 70 82 77 82 89 8 97 8 8 8 87 89 9 92 92 87 92 82 9 97 9 9 99 00 -Bissau Democratic Republic of the United Republic of Tanzania Central African Republic 9 9 2 2 2 9 2 2 2 2 2 29 2 2 7 0 2 8 9 9 72 72 7 7 8 70 9 7 9 2 7 7 0 8 7 77 8 9 9 9 9 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

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 2007 990..7 Figure : Total debt service as percentage of exports of goods, services and income 0.8 2.9 20.0 0.0. 9.2. 2.7 22.2 Seychelles 2. 8.9 0.0 20. 9.8 8..9.2.7......2 8.2 9.9. 9.0.0..0.8. 2.9 2.. 2.9 2.9 8. 8. 2. 2..9..7 8..9 0.0 Tanzania -Bissau...2..0 0... 2..8..9.2 22. 2.2 2. 2.9. 29.8 29.... 8

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: www.who.int/ 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