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226 VOLUNTARY SUBNATIONAL REPORT
SDG 3
As a result of the Health Contingency generated by the Covid-19 pandemic, various strategic plans have been
developed that contribute to the safety of citizens; That is why, since the beginning of the contingency, 7 sanitary
flters were put into operation at the main entrances to the City of Motul, in which more than 500 people participated,
from the health, public safety and City Council departments.
Moreover, the paramedics who carry out the transfers of patients with suspected or positive COVID-19,
Personal Protective Equipment (PPE), were given medical supplies necessary to carry out their tasks safely, which
consisted of gown, overalls, nitrile cap, boots and gloves.
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[
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{
"country": "mex",
"file_id": "sdg-03/vlr-report-mex-yucatan-2020-en-14.pdf",
"language": "en",
"locality": "yucatan",
"size": "s",
"type": "vlr",
"year": 2020
}
|
106
3.3. SDG 3: Well-being and Health
3.3.1. Diagnosis
According to CONEVAL (2016), the State registered 14.4% of the population in a situation of
deprivation due to access to health services. The result represents a signifcant decrease of 12.5
percentage points in relation to the percentage obtained in 2008. Despite the decrease, the State
was ranked 15th among the States with the greatest lack of access to health services. At the
national level, 15.5% of the population needed access to health services.
Although the decrease is considerable, the State was ranked number 15 among the States with the greatest
deprivation for access to health services. At the national level, 15.5% of the population was in a situation of deprivation
due to access to these services. (The Boston Consulting Group, 2018)
The few prevention mechanisms with a focus on social inclusion and the insufcient coverage of the State
health service in the most vulnerable municipalities and communities of the State have caused a high incidence of
diseases and an inefcient system of public health for the social welfare of the population .
Membership/ Afliation
In 2016, Yucatan had coverage of 85.6% of the population afliated or assigned to receive medical services
from institutions such as Seguro Popular (45.3%), IMSS (38.5%), Instituto de Seguridad de Servicio Social de los
Trabajadores del Estado (ISSSTE for its initials in Spanish) ( 5.1%), State`s ISSSTE (0.4%), Pemex, Army, Navy (0.7%),
VOLUNTARY SUBNATIONAL REPORT 107
private insurance (0.8%), as well as any other medical service scheme (2.1%). The percentage of afliation achieved
positioned the State in 17th place among the States with the highest coverage to receive medical services.
Mortality
In 2017, Yucatan registered a mortality rate of 602.3 per 100 thousand inhabitants, representing an increase of 38.1
deaths per 100 thousand inhabitants compared to 2008. With this, Yucatan ranked sixth among the States with
the highest rate of General Mortality. Similarly, at the national level, there were 569.2 deaths per 100 thousand
inhabitants.
In the State of Yucatan, there is insufcient coverage of health services in the most lagging municipalities and
communities. This insufciency has made public health care inefcient for the social well-being of the Yucatecan
population, causing a high incidence of diseases.
Graph 13. General mortality rate by State, 2017
Source: Own elaboration with data from the General Directorate of Epidemiology (DGE for its initials in Spanish),
National Epidemiological Surveillance System (SINAVEfor its initials in Spanish), 2017.
In 2018, Yucatan registered 43.3 cases of death due to preventable causes related to pregnancy and childbirth
for every thousand live births, the national level rate was 30.2 deaths. The State result is 17.2 cases higher than in
2006. The cases registered in 2018 positioned the State in fourth place among the States with the highest Maternal
Mortality Rate.
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Graph 14. Maternal mortality rate by State, 2018.
Source: Own elaboration with data from the DGE, SINAVE, Epidemiological Surveillance Week 52, 2018
Regarding cancer mortality in women, the two main causes are breast and cervical cancer. In 2018, there
were 14.5 deaths from breast cancer per 100,000 women, 7.3 deaths (per 100,000 women) more than in the 2008
period. The deaths registered in 2017 placed the State in 23rd place among the States with the highest Mortality
Rate from Breast Cancer. At the national level, the rate was 18.1 deaths per 100,000 women.
Graph 15. Mortality rate from breast cancer by State, 2017.
Source: Own elaboration with data from the General Directorate of Health Information, Dynamic Cubes. National
Center for Gender Equity and Reproductive Health.
In this same area, the Cervical Cancer Mortality Rate was 14.4 deaths per 100 thousand women, this result
implies a decrease of four deaths (by the scale factor) concerning 2008. In a national comparison, Yucatan ranked
number fve among the States with the highest Cervical Cancer Mortality Rate since, in this area, the rate was 10.7
deaths per 100 thousand women.
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Graph 16. Cervical cancer mortality rate by State, 2017
Source: Own elaboration with data from the General Directorate of Health Information, Dynamic Cubes. National
Center for Gender Equity and Reproductive Health.
In 2016, 11.9 deaths of children under fve years of age were reported for every thousand births in Yucatan, in
contrast, 14.6 deaths were reported nationally. The State fgure represents a difference of -4.6 deaths in 2006. The
State was placed in the 24th position among the States with the highest Infant Mortality Rate.
Graph 17. Infant mortality rate (children under 5 years of age) by State, 2016
Source: Own elaboration with data from the Ministry of Health (SS for its initials in Spanish). National Health
Information System. Database of the Information Subsystem on Births, 2016. INEGI and SS. Vital Statistics: Mortality
Databases. CONAPO. Projections of the population of Mexico 2010-2050 and estimates 1990-2009.
Among the causes of death of children under fve years of age, the involvement of the intestine due to
increased evacuations stands out. In 2017, 13.9 deaths in children under fve for every thousand children were due to
Acute Diarrheal Diseases, ADDs, the result represents an increase of 12.1 cases for every thousand children under
fve years of age in the last 10 years. The indicator placed Yucatan as the second Federated State with the highest
Death Rate in Children under Five Years of Acute Diarrheal Diseases because, at the national level, the rate was 5.1
deaths.
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Likewise, another cause is Acute Respiratory Infections, ARIs, which are diseases that affect the ears, nose,
throat, and lungs. The State’s results placed it as the second State nationwide with the highest Mortality Rate in
Children under Five Years of Age by ARI.
Graph 18. Mortality rate in children under 5 years of age by ADDs by State, 2017.
Source: Own elaboration with data from the General Directorate of Health Information, Dynamic Cubes, 2017.
Graph 19. Mortality rate in children under 5 years of age due to ARIs by State, 2017
Source: Own elaboration with data from the General Directorate of Health Information, Dynamic Cubes, 2017.
Yucatan registered 5.4 cases of deaths from Acquired Immune Defciency Syndrome, AIDS, per 100,000
inhabitants in 2016, a fgure higher than the 4.3 deaths registered in 2006. At the national level, 3.8 deaths were
registered, making the State the seventh Federated State with the highest record of deaths from AIDS in the country.
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Graph 20. AIDS mortality rate by State, 2016.
Source: INEGI and SS. Mortality databases, 2016. CONAPO. Projections of the population of Mexico 2010-2050 and
estimates 1990-2009.
Graph 21. Suicide mortality rate, 2007-2017.
Sources: INEGI, Mortality Statistics, 2007-2017. CONAPO, Mexico Population Projections 2010-2050.
In 2017, 191 cases of suicides were registered in the State, a lower number than the 224 cases in 2016, but 51
cases higher than 10 years ago. The Suicide Rate is 8.8 per 100 thousand inhabitants, which placed the State as the
fourth with the highest rate in the country. At the national level, the rate was 5.3 cases per 100 thousand inhabitants.
Morbidity
In 2017 there were one million 175 thousand 626 incidences of diseases in Yucatan, which implied a Morbidity Rate of
538.7 per thousand inhabitants, a fgure far higher than the national average of 384.4 per thousand, which is why the
State occupied the fourth place among the States with the highest incidence of diseases.
The Secretariat of Health classifes the causes of diseases into 20 headings, four headings (diseases of the
digestive system; of the genitourinary system; pregnancy and puerperium; and trauma, poisoning and some other
consequences of external causes) cover 50% of the total incidences of diseases in the State, at the national level
112 VOLUNTARY SUBNATIONAL REPORT
the same groups covered 51.4%.
By State, Yucatan ranked frst with the highest incidence of diseases related to tumors (neoplasms),
third place in congenital malformations, deformities, and chromosomal abnormalities, and sixth place in trauma,
poisoning, and some other consequences of external causes. In contrast, it ranked 31st in endocrine, nutritional,
and metabolic diseases.
Specifcally, 52.7% are acute respiratory diseases, data similar to that of the national level since 55.3% of
the diseases are of the same category, that is, diseases that affect the ears, nose, throat, and lungs. The fgure
represented an increase of 2.2 percentage points in relation to the 2007 period. At the national level, 55.3% of
diseases fall under this concept.
In order of incidence, as a second item are intestinal infections by other organisms, 180 583 cases were due
to these infections, representing 15.4% of the total cases registered in the State. In 2007, 8.26% of the cases were
due to intestinal infections, showing an increase in the incidence of 7.1 percentage points. Nationwide, 12.1% of the
cases were due to intestinal infections by other organisms and poorly defned ones. The national epidemiological
panorama reports that 12.1% refer to this type of incidence.
Graph 22. Diseases with the highest incidence in the State, 2017
Source: SS, General Directorate of Epidemiology, National Epidemiological Surveillance System (Suive), 2017
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Graph 23. Obesity rate by State, 2017.
Source: Secretariat of Health, General Directorate of Epidemiology, National Epidemiological Surveillance System
(Suive), 2017
In 2017, 21 thousand 344 cases of people with obesity problems were reported, this represented a rate of
982.3 per 100 thousand inhabitants, a fgure higher than the 559.8 cases nationwide, and an increase in the incidence
of 613.3 cases for each 100,000 inhabitants compared to 2014. With the above, the State ranked frst in the country
with the highest Rate of Obesity Cases.
On the other hand, in Yucatan until 2017, 379 cases of people registered as seropositive to the Human
Immunodefciency Virus (HIV) were reported, the cases represent an incidence of 17.4 per 100 thousand inhabitants,
a higher fgure compared to the national rate of 6.7 cases. In relation to the 2012 period, the indicator has had an
increasing behavior, since a percentage variation of 67.7% has been registered in fve years. Yucatan was the third
State with the highest incidence of HIV in the country, the same position reached in 2012.
Graph 24. HIV incidence rate by State, 2017
Source: SS, General Directorate of Epidemiology, National Epidemiological Surveillance System (Suive), 2017.
Regarding vector-borne diseases, those with the highest incidence are dengue, chikungunya, and Zika,
which are transmitted by mosquitoes. Regarding dengue, 2018 registered the lowest rate in the last 10 years, with a
114 VOLUNTARY SUBNATIONAL REPORT
fgure of 0.86 cases per 100,000 inhabitants. The result contrasts with those of 2011 and 2012 where the rates were
319.1 and 296.9, respectively. Yucatan ranked 23rd among the States with the highest Dengue Incidence Rate in
2018.
In 2015, the frst cases of chikungunya were presented, that year the incidence rate was 78.8 positive cases
per 100,000 inhabitants, a fgure far higher than the national rate of 10.4 cases. In 2018, the cases were reduced to
0.13 cases per 100,000 inhabitants.
Similarly, in 2016 the frst cases of Zika were registered, for the aforementioned period, the incidence rate
was 59.8 cases per 100,000 inhabitants, a fgure higher than the national rate of 3.1 positive cases. At the end of
2018, a rate of 1.18 cases per 100,000 inhabitants was registered.
Graph 25. Time series of diseases transmitted by vector (mosquito), 2008-2018.
Source: Own elaboration with data from the SS, DGE, SINAVE, Epidemiological Surveillance Week 52, 2018.
Medical staff
The number of physicians (generals, specialists, interns and residents) in contact with patients in public health
institutions, in 2016, was 2.2 per thousand inhabitants, which implies greater coverage compared to 2006, when the
indicator was 1.6 doctors for every thousand inhabitants. The State was the fourth national among the States with
the highest availability of doctors per inhabitant. The result for the State is positive because the national rate is 1.8
doctors per thousand inhabitants, that is, a greater coverage and attention in the provision of health services.
VOLUNTARY SUBNATIONAL REPORT 115
In 2017, it was recorded that Yucatan had 876 nurses, 825 doctors and 384 beds as coverage in human and
material resources in private establishments. In the same year, a ratio of 2.3 nurses per bed was recorded, a fgure
0.7 units higher than the 2007 fgure. The result positioned Yucatan as the second State with the highest availability
of nurses per bed. There is one additional nurse per bed in the State than at the national level.
In the same context, the ratio of doctors per bed was 2.1, a result that has not changed in the last 10 years,
which is below the national ratio of 2.5 doctors per bed. The foregoing placed Yucatan as number 12 in the country
in the availability of doctors per census bed, falling six positions in relation to 2007.
In addition to the above, in the State, the average time to reach a hospital is 42 minutes, two minutes more
than the national average, 17 minutes more than the State of Colima and 27 minutes less than Oaxaca.
3.3.2. Theory of change
To contribute to the achievement of SDG 3, various studies of successful programs and/or actions were carried out
in different parts of the world, always taking into account the social, cultural, economic, and development conditions
presented by the State. In this sense, studies reveal that the extension of health coverage facilitates access and
improves health for vulnerable groups such as women, children, people with chronic diseases, etc. (Yu, S. W., Hill, C.,
Ricks, M. L., Bennet, J., & Oriol, N. E. 2017). Likewise, the evidence shows that mobile units have a positive impact on
the quality of life of the people they serve (Achla, B., Khanna, S., & Arora, N. 2016).
In the same way, evidence was found showing that reducing the distance to medical care and increasing
accessibility to primary health services reduces the death of children under 5 years of age (Rutherford, M.,
Mulholland, K. & Hill, P 2010) As a result of the above, different programs have been developed in the State that
directly contributes to the achievement of SDG 3: Health and Well-being.
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3.3.3. Government Actions
The Government of the State of Yucatan is committed to meet the goals of the 2030 Agenda. For this reason,
programs and actions were implemented to focus human and budgetary resources on the most vulnerable groups
in the areas with the greatest priority.
Based on the previous diagnosis and in joint work with the agencies in charge of the health sector, which is
causally related to SDG 3, programs and activities that had the focus of the 2030 Agenda were proposed. However,
derived from the contingency of the COVID-19, some of these activities were temporarily suspended to pay greater
attention to the actions of prevention and mitigation faced during the health contingency. The programs associated
with SDG 3 are presented below.
3.3.4. Flagship programs and their relationship with SDGs
The Government of Yucatan is convinced that a healthy population has a positive impact. Therefore, issues of special
relevance are addressed such as the elimination of poverty and the fght against inequality, with a focus on “Leaving
no one behind.”
In that sense, the fagship programs of the Government of the State of Yucatan were implemented. These
programs are:
• Médico 24/7
• Médico a Domicilio
• Medical equipment
• Infrastructure in medical units
• Caravanas DIFerentes
These programs have the objective of providing medical attention to vulnerable populations, which could
not exercise their right of access to health.
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Schematic description of the programs
The programs and actions are derived from the activities of the Budgetary Programs. In the following lines the
programs related to SDG 3. Health and Well-being are described, as well as the indicators with their goals and the
current progress.
Table 10. Programs and actions of the Government of the State of Yucatan, with their progress related to theSDG 3.
Health and Well-being
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Actions carried out before COVID-19 and relevant aspects
Within the Annual Work Plan, which considered all the activities to be carried out for this year, there are 48 activities
aligned to SDG 3. Health and Well-being. This represents 9.77% of the 491 total activities. Of the activities aligned to
SDG 3, the following stand out:
Table 11. Programs and actions of the Government of the State of Yucatan that were carried out before COVID-19
related to SDG3. Health and Well-being
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120 VOLUNTARY SUBNATIONAL REPORT
Actions carried out during COVID-19 and relevant aspects
Derived from the health contingency of COVID-19, an analysis was carried out using the structural analysis
methodology. This methodology made it possible to prioritize the activities that should be given greater resources,
both fnancial and human, so that the achievement of the Sustainable Development Goals could be advanced during
the situation of vulnerability generated by the COVID- 19 pandemic.
Graph 26. Prioritization matrix of the Secretariat of Social Development for activities related to SDG 3. Health and
Well-being.
Source: own elaboration with data from the Secretariat of Social Development
As a result of the structural analysis of the Secretariat of Social Development, the following strategies were
prioritized:
• Strategy 1; To strengthen hospital management and the development of human capital in the health sector
with a focus on inclusion and interculturality.
• Strategy 2; To promote equal opportunities for the social welfare of people in vulnerable situations.
• Strategy 8; To build inclusive and sustainable entrepreneurship capacities.
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Graph 27. Prioritization matrix of the Secretariat of Health of the State of Yucatan for activities related to SDG 3.
Health and Well-being.
Source: own elaboration with data from the Yucatan Secretariat of Health
As a result of the structural analysis of the Secretariat of Health of the State of Yucatan, the following
strategies were prioritized:
• Strategy 1; To encourage actions for the promotion and provision of health services among the population in
vulnerable situations.
• Strategy 2; To strengthen actions for the prevention and comprehensive care of diseases to reduce damage
to the health.
• Strategy 3; To strengthen hospital management and the development of human capital in the health sector
with a focus on inclusion and interculturality.
• Strategy 4; To strengthen the prevention and comprehensive care of mental disorders and suicide risk to
promote the biopsychosocial well-being of the individual and society.
• Strategy 5; To strengthen protection against health risks in establishments and points subject to health
control to prevent associated diseases.
• Strategy 6; To promote the participation of local and community authorities in the improvement of social
determinants in health to have a positive impact on public health.
• Strategy 7; To promote the continuous improvement of services and training of health personnel to guarantee
access to and exercise of the right to health for women in an inclusive manner.
• Strategy 8; To promote actions that increase the legal certainty of people in an inclusive and sustainable
way.
For SDG 3. Health and Well-being, the following activities were prioritized because of the structural analysis:
Vector-borne diseases prevention and control program
• Médico 24/7
• Child’s Health
• Fortalecimiento a la Atención Médica (FAM)
• Domestic violence
• International sanitary surveillance, regulation, and control
• Prevention and control of respiratory diseases (Epidemiological surveillance)
• Prevention and care of depression and anxiety
• Pediatric care services
• Community health services
• Maternal and perinatal health
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3.3.5. Emerging programs
As a result of the efforts to support the population of the State of Yucatan, with respect to the effects that the
health contingency represents for the citizens, the Plan Estatal para Impulsar la Economía, los Empleos y la Salud de
los Yucatecos was generated. The following activities are derived from this plan, which were proposed to contribute
to SDG 3. Health and Well-being.
• Acquisition of 190 new high-tech respirators, 15 transfer ventilators, as well as 314 vital sign monitors, as part
of the anticipated measures for the Coronavirus contingency.
• Implementation of the hospital reconversion with 234 beds allocated exclusively for the care of patients with
coronavirus and adding 68 new intensive care units.
• Temporary expansion of the Valladolid Hospital which allows for 100 additional beds for non-serious patients.
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• Acquisition of 20 high-tech insulating capsules for the transfer of patients with Coronavirus.
• Enabling the temporary hospital at the Centro de Convenciones y Exhibiciones Siglo XXI, where almost 500
beds were installed. In this place, 52 beds were set up with oxygen intakes for patients requiring critical care,
123 beds for intermediate care and 315 for minimal care.
• Increase in the capacity of laboratories to perform up to 350 daily tests within the State Coronavirus
surveillance system.
• Implementation of the Amigos de la Salud program that aims to strengthen hygiene and prevention measures
against Coronavirus, volunteers inform the population about the symptoms of this disease for a timely
detection and prevent its spread.
3.3.6. Progress report on the indicators of the 2030 Agenda
With an approach of the 2030 Agenda and the Sustainable Development Goals in the State, progress has been made
in the State’s situation. The progress in the indicators related to SDG 3 are presented below.
Annualized data as of fscal year 2019.
• The cases of diabetes decreased to 262.37 per 100,000 inhabitants; Yucatan occupies the seventh place
with the lowest rate in the country.
• Cases of depression decreased by 5.7% and the State improved fve positions, going from 17th to 22nd place
nationally.
124 VOLUNTARY SUBNATIONAL REPORT
Progress to 2020
• Percentage of the population with a lack of access to health services, the State has 14.1% of its population,
below the national level of 16.2% placing the State in 13th position nationally
• Mortality rate, in relation to the mortality rate, in Yucatan 589.48 deaths per 100,000 inhabitants are
registered, a number above the national value of 576.58 deaths per 100,000 inhabitants, which places the
State in the seventh position in the national ranking.
• Maternal mortality ratio, in relation to this indicator, there are 40.20 women for every 100 thousand live
births, a number below the national value of 41.10 women for every 100 thousand live births, which is why the
State is in the ffteenth place.
• Incidence of Obesity, the incidence rate of obesity in the State is 221.64 people per 100,000 inhabitants.
This value is lower than the national rate of 176.28 people per 100,000 inhabitants, which places the State in
twenty-frst place.
• Dengue Incidence, Yucatan had an incidence of 6.13 dengue cases per 100 thousand inhabitants. This value
is above the national level of 4.88 cases per 100,000 inhabitants, which is why Yucatan occupies the twentyfrst place.
3.3.7. Actions of Civil Society Organizations
Centro de Integración Juvenil
To prevent and treat addiction disorders and gambling disorders in outpatient clinics, the Atención Integral de las
adicciones program seeks to contribute in reducing the demand for drugs with community participation, through
prevention programs and treatment, based on evidence to improve the quality of life of the population. It seeks to
comply with SDG 3, through workshops on social skills and socio-emotional competencies, training courses, health
promotion activities; in addition to offering medical, psychological and social services in outpatient consultations
for addictive disorders to user and their families; supporting men and women from 10 to 65 years of age in the city
of Merida
In the reporting period:
• 2,497 informative sessions were held with an impact of 45,310 people served.
• 68 orientation workshops have been held with a coverage of 219 people.
• And 3,300 internal and external treatment consultations have been granted for the beneft of 968 people.
VOLUNTARY SUBNATIONAL REPORT 125
COVID-19 Actions
Within the framework of the contingency due to COVID-19, preventive and health promotion activities were continued
through the internet; The consultations that are part of the treatments for addiction abuse and dependence
disorders have been carried out remotely and in person, taking care of the necessary sanitary measures. In addition,
care services have been extended for emotional problems (depression, anxiety, stress) to all the public who may
have or present these disorders.
This program has an investment of 18,070,000.00 Mexican pesos to directly meet goal 3.5 that seeks to
strengthen the prevention and treatment of abuse of addictive substances: alcohol, tobacco, and other drugs, in
addition to pathological gambling.
Fundación por la Salud en Yucatán
Through its activities, Fundación por la Salud en Yucatán (FUNSAYUC for its acronym in Spanish) seeks to contribute
to the improvement of health through support to people and institutions lacking economic resources, making
available the necessary tools and resources that allow them to provide professional care of excellence and with
humane treatment. for the patient and his family.
In the reporting period, both patients and hospitals have been supported, paying for the expenses of
specialized drugs, imaging and laboratory studies, hospitalization, materials, and surgical supplies, among others.
COVID-19 Actions
During the contingency period due to COVID-19, the actions of this association intensifed, managing to collect and
donate more than 3,974 medical supplies in the months of contingency, benefting 3 hospitals, 1 health center and
1 nursing home.
Likewise, thanks to the Fundación MetLife, a donation was made through which equipment and supplies were
acquired to care for COVID-19 patients at the Regional Hospital of High Specialty. The supplies include a portable
electrocardiograph, portable ultrasound, 3 computers, and oxygen masks.
Organized Civil Society
COVID-19 Actions
Thanks to the effort and initiative of people from Civil Society committed with the health of the Yucatecans, 4,424
polyethylene masks, 2,565 face masks, 100 protective glasses, 1,000 shoe covers, 1,300 pairs of latex gloves, 110
126 VOLUNTARY SUBNATIONAL REPORT
overalls were purchased and donated. , 750 gowns and 1,450 caps for the beneft of the medical personnel of 7 public
hospitals in the State.
These efforts have added an investment of more than $ 600,000 Mexican pesos, in direct attention to goal
3.3 that seeks to combat communicable diseases.
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[
3
] |
{
"country": "mex",
"file_id": "sdg-03/vlr-report-mex-yucatan-2020-en-16.pdf",
"language": "en",
"locality": "yucatan",
"size": "l",
"type": "vlr",
"year": 2020
}
|
222 INFORME SUBNACIONAL VOLUNTARIO
ODS 3
Instalación de puestos de inspección sanitaria y desinfección vehicular.- fueron instalados 8 en la cabecera
municipal y 8 en las comisarías de mayor población: Ticum, Cepeda Peraza, Kantemó, Pencuyut, Xaya, Kinil y
Kancab, para proporcionar información importante a cerca de la prevención del COVID-19 por medio de volantes y
para la desinfección de vehículos. Se repartieron un total de 10,000 volantes y se desinfectaron un total de 145,000
vehículos, benefciando al total de la población de la cabecera municipal y sus comisarías. En estos fltros participo
el personal del Ayuntamiento Tekax, Salud municipal, Policía Municipal Tekax, departamento de prevención del
delito y monitores escolares, de igual forma se sumaron voluntarios de la Universidad Tecnológica Regional del Sur,
CNA y pobladores de comisarias, que recibieron una capacitación para informar y guiar a las personas que lleguen
del extranjero o viajes nacionales a llevar una cuarentena en casa y medidas de higiene.
INFORME SUBNACIONAL VOLUNTARIO 223
Instalación de lavamanos de desinfección.- estos fueron instalados en los accesos y salidas principales del
mercado municipal Con la fnalidad de proporcionar a la ciudadanía un medio para desinfectarse las manos y sus
artículos adquiridos, antes de partir a casa. Se logró la instalación de 4 lavamanos de desinfección funcionales,
benefciando al total de la población que acude al mercado municipal, así como a las pequeñas unidades económicas
que dependen del mercado tanto fjos como ambulantes.
|
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[
3
] |
{
"country": "mex",
"file_id": "sdg-03/vlr-report-mex-yucatan-2020-es-13.pdf",
"language": "es",
"locality": "yucatan",
"size": "s",
"type": "vlr",
"year": 2020
}
|
INFORME SUBNACIONAL VOLUNTARIO 225
4.14.3. IZAMAL
ODS 3
Saneamiento de espacios públicos. - con el fn de contribuir a la disminución de riesgos de contagios del COVID-19
y conscientes de la responsabilidad que representa como autoridades municipales y por ser Izamal uno de los
destinos turísticos más importantes del Estado, desde el inicio de la declaración de la pandemia en el Estado de
Yucatán realizo las siguientes acciones:
226 INFORME SUBNACIONAL VOLUNTARIO
• Puestos sanitarios en las entradas del municipio en los cuales se sanean vehículos, se exhorta el uso de
cubre boca y se proporciona información básica contra el COVID-19
• Se colocaron túneles de saneamiento en los principales puntos de afuencia de gente, así como en los sitios
de taxis de ascenso y descensos de gente que se traslada a los diversos puntos del Estado.
• Se implementó un programa de seguimiento para el cumplimiento de las normas sanitarias en comercios
indispensable y no indispensable para garantizar que empleados y clientes cumplan con estas y evitar riesgos
de contagio.
• Se sanean de manera constante: palacios municipales, consultorios, mercado municipal, edifcios públicos,
etc
• Saneamiento de unidades de transporte público.
• Dentro de las medidas preventivas se encuentra también el cierre de los espacios públicos de recreación.
Estos programas se implementan no solo en la cabecera municipal sino también en sus 5 comisarías por lo que
su cobertura es del 100% del municipio, acciones que quedaran como parte de la nueva realidad de nuestros
tiempos.
|
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[
3
] |
{
"country": "mex",
"file_id": "sdg-03/vlr-report-mex-yucatan-2020-es-14.pdf",
"language": "es",
"locality": "yucatan",
"size": "s",
"type": "vlr",
"year": 2020
}
|
253
6.5. Indicadores ODS 3 Salud y Bienestar
En cuanto a temas de salud, el gobierno seguirá la implementación de las medidas sanitarias en todos los sectores
para poder ejercer de manera adecuada las actividades diarias de la población, a su vez se prevé el seguimiento de
la implementación de los programas de atención a la salud mental y Médico 24/7, como parte del cual se realizaron
un total de 155,6870 consultas externas en benefcio de igual número de personas, por lo que en la mejora de los
semáforos de reactivación, se espera la continuidad de dicho programa.
Para el desarrollo óptimo de la primera infancia, la implementación de programas para el desarrollo de los
niños es de suma importancia para el Gobierno del Estado, por lo que se seguirán implementando programas de
alimentación (control nutricional), salud (combate de la obesidad, vacunación, asistencia médica, promoción de
lactancia materna) prevención de daño físico por violencia, apoyo asistencial para la salud mental (psicología), entre
otros que impulsen el cumplimento de los derechos de los niños y las niñas.
Sin embargo y, de manera evidente, los mayores efectos de la pandemia se resentirán en este ODS. En el
presente análisis se considera los efectos en la tasa de mortalidad general y la mortalidad infantil.
Es claro que la epidemia del COVID -19 tendrá un efecto en el incremento de la mortalidad que puede impactar
en otros padecimientos. Dicho efecto es esperable que se dé en años posteriores, principalmente derivado de otros
padecimientos.
254
Gráfca 5. Tasa Bruta de Mortalidad (Por cada mil habitantes)
Fuente: Elaborado por Seplan a partir de los datos de Indicadores demográfcos 1950-2050 Conapo
Por último, en términos de la mortalidad infantil, no se esperan efectos apreciables. Esto derivado de una
combinación de ser un grupo etario con baja incidencia de la mortalidad derivado de la Pandemia, y la aplicación
de un conjunto de políticas focalizadas que pueden mitigar los efectos indirectos del impacto económico de la
Pandemia y la tormenta tropical Cristóbal en los hogares (sobre todo hogares rurales).
Gráfca 3. Tasa de Mortalidad Infantil
Fuente: Elaborado por Seplan con datos de Indicadores demográfcos 1950-2050 Conapo, La desigualdad de la
mortalidad en México: tablas de mortalidad para la República Mexicana y sus entidades federativas 1990.
|
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[
3
] |
{
"country": "mex",
"file_id": "sdg-03/vlr-report-mex-yucatan-2020-es-16.pdf",
"language": "es",
"locality": "yucatan",
"size": "m",
"type": "vlr",
"year": 2020
}
|
ü Paving of 3 km of the road that gives access to the General Hospital.
ü Workshops on prevention of infectious diseases. This improved public
health indicators, with emphasis on the non-occurrence of cholera.
ü They monitor vaccination campaigns.
ü They give importance to psychiatric care and do follow up and support
families.
ü The municipality coordinates with the District that has 5 health units The
direct contributions are:
¡ It helps keep 2 hospitals clean;
¡ A health centre will be built this year and the maternity is being
extended.
¡ They also carry out hygiene inspections in markets and suppliers
have a medical card.
¡ They conduct training for young people about first aid and basic
health aspects.
¡ They work in liaison with community radios on Community
prevention in health.
ü Ahospital was built and a house for nurses is also being built. The challenge
is the equipment.
ü The main health problems are diarrhoea, cholera and malaria, diseases
linked to water scarcity and low quality of sanitation.
ü Ahealth centre is being built to decongest the only hospital they have.
ü Workshops on HIV/AIDS and early pregnancy.
ü They have built a health centre to provide primary health care, but it does
not have the necessary equipment and attention is limited.
ü They also bought an ambulance.
ü Training of women of all ages in the field of Sexual and Reproductive Health
and premature marriages.
Nampula
Chimoio
Dondo
Nhamatanda
Mandlakazi
Manhiça
Moatize
Massinga
ü Population that
assists this
hospital
ü 156500 People in
the last 5 years
ü No cholera cases
for more than 7
years
ü To support the
health sector with
practices that
prevent diseases
ü Primary attention
to health
ü To enhance
health attention
ü 5,200 Citizens
ü The municipality
population
ü 256 Women per
year
6.3. SDGs 3: GOOD HEALTH AND WELL-BEING
Access to health services is still limited due to infrastructure, equipment and insufficient staff, especially in rural
areas. Therefore, although municipalities do not have competences expressed in this sector, their initiatives to
expand access are helping reduce diseases.
ü To reduce epidemics such as AIDS, TB, malaria and neglected tropical diseases, and fight hepatitis,
waterborne diseases and other infectious diseases.
ü To achieve universal health coverage.
Municipalities Actions Results
24
VOLUNTARY LOCAL REVIEW: Progress and Challenges of 16 Municipalities of Mozambique
Municipalities Actions Results
Quissico
Maxixe
Chókwè
Matola
ü Construction of a Health Centre to reduce the distance of access to health
services.
ü Conduction of educational workshops on prevention of various diseases.
ü Refurbishment of health infrastructure and construction of a new health
centre.
ü Construction of a maternity ward because the only hospital is far.
ü To support construction and refurbishment of primary care health units and
their equipping with hospital furniture and transportation means.
ü To raise awareness of i) young people and women to adhere to family
planning; and, ii) pregnant women to adhere to delivery in health units.
ü To promote preventive health of preventable diseases and enhance the
contribution of traditional medicine and the use of medicinal plants in the
prevention and fight against diseases.
ü 5000
Beneficiaries
ü Whole population
ü Population of 3
neighbourhoods
ü 1 Maternity built
and equipped
ü Participation of
more than 100
people in
neighbourhood
workshops
25
VOLUNTARY LOCAL REVIEW: Progress and Challenges of 16 Municipalities of Mozambique
|
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Good Health and Wellbeing
Kuala Lumpur healthcare services continue to grow strength to
strength as the government invests and supports its advancement
for the overall public health as well as a global medical tourism
destination. Healthcare in Kuala Lumpur offers an advanced, efficient,
and easily accessible healthcare system for both its public and private
medical facilities. The facilities have gradually increased to meet the
rising patients’ demand for better healthcare and population growth.
The extension of power and responsibility of local government in
public health provides opportunities for Kuala Lumpur City Hall to
shift the focus from treating sickness to actively promoting health and
wellbeing.
Implementing the 2030 Agenda in Kuala Lumpur 54
Indicator 3.3
Ending Epidemics and Combating
Communicable Diseases in Kuala
Lumpur
Kuala Lumpur recorded a total of 362,576 COVID-19
cases up to 15 June 2022 since December 2021,
ranking the city, the fourth highest in Malaysia in
the coronavirus infection. The number of average
daily COVID-19 cases within the same period is ±287
cases daily.
To reduce the transmission of the virus the Federal
Government of Malaysia had implemented a
nationwide phased and periodic movement control
order (MCO). The order was enforced under the
prevention and Control of Infection Diseases Act
1988 and the Police Act 1967. Both State and Local
Governments including Kuala Lumpur City Hall are
mandated to adhere to the Order based on Article
81, and at the same time, are empowered under the
Local Government Act 1976 to regulate and support
crisis response and recovery implementation
on matters related to public health, diseases
transmission, and business and local economy.
Figure 4.7 KLCH’s efforts to control and reduce
communicable diseases in the city
55 Kuala Lumpur Voluntary Local Review
Hepatitis C: The Undiagnosed
Disease
In Kuala Lumpur, official records for Hepatitis
C cases account for a total of 84 cases with an
Incident Rate of 6.34. However, few studies were
done by the Ministry of Health Malaysia (MOH),
and WHO has shown that one-third of the
Hepatitis C infected individuals in many countries,
including Malaysia as well as Kuala Lumpur are
still unaware of their condition.
Lack of awareness of the disease and under
screening to identify patients with undiagnosed
Hepatitis C virus (HCV) infection is one of the
most prominent barriers to achieving HCV
elimination in the city. Before 2019, testing was
done via serology which takes a long time to be
diagnosed (approximately 4 weeks), resulting
in patients dropping out or getting lost in
between the waiting period. Another challenge
in diagnosing HCV is that many of those who are
infected are asymptomatic until decades later
develop symptoms of secondary or severe liver
damage.
In 2019, the MOH together with the Foundation
for Innovative New Diagnostics (FIND) and the
Drugs for Neglected Disease Initiatives (DNDi),
have brought in Rapid Test Kits (RTK) for Hepatitis
C in Malaysia. The innovative RTK allows medical
officers to conduct a larger screening pool within
a shorter period (within 5 minutes). Moreover,
the MOH has trained outreach workers from
Community-Based Organizations (CBO) on how
to conduct these RTKs in their communities and
the wider population.
These collaborative approaches have allowed
medical staff and CBO to reach the marginalized
people not only with Hepatitis C at the same
time, HIV and syphilis. Those who are positive
are encouraged to come to public clinics for
treatment.
Implementing the 2030 Agenda in Kuala Lumpur 56
Indicator 3.3
Reduce Pre-mature Mortality
from Non-Communicable Disease
Through Prevention and Treatment
In Malaysia, NCDs account for 71% of premature
mortality and over 70% of the diseased burden in
2014. The prevalence of NCDs in Kuala Lumpur is
higher in comparison with other states in Malaysia
as the city urbanizes, and the socio-economic
determinants in health also changes. Shifts in
socio-economic and demographic patterns such
as improved economic affordability, ease of travel,
transition to an unhealthy lifestyle, and higher food
consumption have led to a higher risk of behavioral
change and increased health risk factors of NCDs.
Findings from the NHMS 2019 shows that in Kuala
Lumpur prevalence in diabetes, hypertension , and
hypercholesterolemia and obesity among adults had
increase from the previous study conducted in 2015.
Results from the survey has a positive correlation
to health risk factors such as low awareness of
healthy plate concept among residents, the physical
inactivity and inadequate intake of vegetable and
fruit among residents in Kuala Lumpur.
57 Kuala Lumpur Voluntary Local Review
Preventive Measures for NonCommunicable Diseases in
Kuala Lumpur
Skim Peduli kesihatan B40 (PeKa B40)
PeKa B40, introduced by the Ministry of Health
offers all Malaysian citizens in the bottom 40
households various healthcare services focusing
on Non-Communicable Diseases. Among
the benefits of the programme is free health
screening at all public and private clinics which
includes the screening of mental health, physical
examination, breast examination, and blood
and urine test as well as health aid up to RM
20,000. In addition, recipients are also eligible for
transport incentives and cancer treatment upon
completing the programme’s health screening.
KL Car Free Morning
KL Car Free Morning is a green initiative to
promote a healthy lifestyle among both locals and
tourists in Kuala Lumpur through recreational
sports, arts, and cultural activities. The event was
initially held every first and third Sunday of each
month from 7 am to 9 am. Due to good responses
from participants, the City Hall extended the KL
Car Free Morning every Sunday of each month.
The road closures start from Dataran DBKL and
lead through a 7-kilometre stretch into major
streets of Kuala Lumpur’s Golden Triangle.
Public Health Awareness
KLCH collaborates with various agencies,
organizations and non-profit organizations to
conduct public health awareness campaigns in
the city.
Provision of Ample of Green Spaces in the City
The City Hall is responsible for the maintenance
and expansion of public parks and forests.
Through the City Hall’s Kuala Lumpur Landscape
Masterplan, KLCH intends to incorporate an
active mobility priority route, integrate canopy
cover monitoring as well as identify areas to create
new urban parks and forests. Not only do these
initiatives help to reduce the UHI effect, and
benefit both heat and flood risk mitigation, but
it also promotes a healthier lifestyle through the
promotion of physical activity and mobility as well
as mental health benefits.
Indicator 3.5
Prevention and Treatment of
Substance Abuse Including Drug
Abuse and Harmful Use of Alcohol
19.3%
Current Drinkers’ Prevalence in Kuala Lumpur -
Aged 18 Years and Older, 2019
Prevalence of Harmful Alcohol Consumption in
Kuala Lumpur
41.7%
Binge Drinkers
5.2%
Heavy Episodic Drinkers
Source: National Health and Morbidity Survey , 2019
Implementing the 2030 Agenda in Kuala Lumpur 58
National Action Plan: Prevention and Harmful Use of Alcohol
2013- 2020
The Malaysian Government has introduced a National Action Plan: Prevention and Harm Reduction of
Alcoholism (PeTA), 2013-2020 which aims to raise public awareness about the harm of alcohol, be responsible for
one’s health and prevent and reduce the harmful use of alcohol.
• The action plan empowers all stakeholders including local governments such as Kuala Lumpur City Hall to
implement initiatives according to the following public health principles:
• Strengthen health campaigns “ healthy without alcohol”
• Reduce the risk of harmful use of alcohol
• Reduce the impact of harmful use of alcohol
• Limit the availability of alcoholic beverages
• Sustainable preventive and treatment on harmful use of alcohol programmes.
Liquor Licensing Requirement
• Freezing of liquor licensing to groceries,
convenience shops, Chinese medicine
halls, and sundry shops business owners
• Alcohol premise to be 100 meters away
from housing areas and must not face any
house of worship, schools, and hospitals.
• Restriction of direct advertisements on
alcoholic drinks and liquor
• Wholesale and retail sales are restricted
up until 9.00 pm
ALCOHOL CONTROL
MEASURES
SUBSTANCE ABUSE
MEASURES
Collaborative Patrolling and
Enforcement
• Close collaboration with the Police
Force and National Anti-Drugs Agency
(AADK), Ministry of Internal Affairs
(KDN), and Housing Ministry in various
preventive substance abuse measures
such as the Federal Territory Integrated
Operations Against Illegal Activities
or Operasi Bersepadu Banteras Aktviti
Haram (Ops BAH) and Safe City
Programme, Bandar Selamat.
Liquor Sales Restrictions
Selling of alcohol is restricted to the following
groups:
• 21 years old and below
• Muslims
Public Awareness and Outreach
Programmes
• KLCH together with its partners
continuously conducts public awareness
and outreach programmes to targeted
communities and location in hopes to
give more exposure on the dangers
of drug abuse as well as giving out
information of preventive measures
Public Awareness
• Patrol in public places due to
drunkenness
• Intervention and screening at public and
private clinics
• Health programmes on the harmful
effects of alcohol abuse
59 Kuala Lumpur Voluntary Local Review
Indicator 3.6
Halve the number of deaths
and injuries from road traffic
accidents
The Federal Territories states comprising
Kuala Lumpur, Labuan and Putrajaya have
significantly reduced injuries and deaths
due to road traffic accidents between 2019
and 2020. Though the significant drop in
road traffic accidents between 2019 and
2020 was part of the positive impact of the
Movement Control Order (MCO) during
the height of the pandemic, road safety
initiatives have been ramped up over
the years by the City Hall in partnership
with the Federal Government, Ministry of
Transport and the Malaysian police force.
In efforts to strengthen the implementation
of traffic control within the city, KLCH has
tasked several departments to oversee
and implement the improvement and
enforcement of traffic management and
control. Among the departments involved
in enhancing road safety in Kuala Lumpur
are, Urban Transportation Department
Infrastructure Development Department,
Enforcement Department, and City
Planning Department.
Improving Road Safety & Traffic
Management
In Kuala Lumpur includes measures that bring drivers to a
safe speed, avoid injuries and deaths, and the promotion of
alternative transportation. It has also reduced the air and noise
pollution in the city.
Kuala Lumpur Command &
Control Centre (KLCCC) which
serves as a traffic management
hub to process and update
traffic data in Kuala Lumpur and
disseminate the information to
all city residents through various
communication medium
Establishing and enforcing speed
limits appropriate to the function
of road in the city
Enhance first and last mile
facilities at CBDs transit stations
Implementation of 5 traffic
calming schemes yearly
Install and continuously improve
street furniture and lighting
around the city
1
2
3
4
5
Implementing the 2030 Agenda in Kuala Lumpur 60
Indicator 3.8
Universal Health Coverage in Kuala
Lumpur
All Malaysian enjoy universal health coverage
through the public healthcare sector which is highly
subsidized by the Malaysian government. The
Ministry of Health (MOH) offers a comprehensive
range of services, including health promotion,
disease prevention, and curative and rehabilitative
care delivered through public clinics and hospitals.
The ability of the public healthcare sector to provide
health protection as part of a comprehensive
social protection system has produced significant
improvements in the health outcomes, such as
higher life expectancies, and low child and maternal
mortality rates.
The city’s healthcare system offers some of the
best healthcare in the country. Residents in Kuala
Lumpur have good physical access to healthcare
facilities, with an estimation of 92% of the population
living within 3 km of health facilities. In addition,
under the public healthcare system, residents
enjoy active vaccination programmes which have
significantly reduced the prevalence of preventable
diseases. People can choose between public and
private services where both services are equipped
with high-quality equipment, facilities, and
diagnostic and medical staff capabilities. However,
the healthcare system is not without its challenges.
Many public hospitals are in a severe shortage of
staff leading to longer waiting periods for patients
seeking treatment. Whilst private healthcare
provides an alternative to those who can’t manage
the long waiting period, opting for private healthcare
is not as affordable for those who are poor or not
financially stable.
The healthcare system in the city is also supported
by various government and non-governmental
agencies to reduce overcrowding in public hospitals.
These health-related services are either given
based on government hospital rates or even free
depending on the services provided. Among the
services delivered are healthcare awareness, free
screening for marginalized groups, and many more.
Implementing the 2030 Agenda in Kuala Lumpur 62
Health Expenditure 2019
1.3% (RM93)
Average Monthly Health Expenditure of
Total Household Expenditure
Indicator 3.a
Strengthening Tobacco
Control in Kuala Lumpur
It is estimated that some 20,000
Malaysians die annually due to smoking
and 22% of cancer deaths are caused
by tobacco intake. In line with the
World Health Organization Framework
Convention on Tobacco Control (WHO
FCTC), the Federal Government had
introduced the Control of Tobacco
Products Regulation (PPKHT) 2004
and then strengthen its prevention and
implementation of tobacco control
through the development of the National
Strategic Plan on Tobacco Control
(NSPTC) 2015-2020. The NSPTC has
a medium-term target to reduce the
smoking prevalence to below 15% by 2025,
and below 5 % by 2045.
As the capital city of Malaysia, Kuala
Lumpur also aspires to become a Cigarette
Smoke-Free City by 2040. The City Hall
has conducted various programmes
ranging from public awareness campaigns,
quit smoking clinics, fines, and smoke-free
areas to ensure that this aspiration is being
met. KLCH has also worked collaboratively
with various agencies and partners such
as majlis Kawalan Tembakau Malaysia,
Prasarana, MySihat, schools, traders, and
so forth to empower communities to adopt
a healthier lifestyle.
Kuala Lumpur Cigarette Smoke-Free
Initiative
The Kuala Lumpur City Hall aspires for the city to be
free from cigarette smoke by 2040. The Kuala Lumpur
Cigarette Smoke-Free Programme (Kuala Lumpur Bebas
Asap Rokok, KLBAR), spearheaded by local communities
with the facilitation from the Local Agenda 21 Unit and in
collaboration with the Health Department of Kuala Lumpur
and Putrajaya aims to promote the city towards a SmokeFree environment while encouraging inhabitants in Kuala
Lumpur to quit smoking and practice a healthy lifestyle.
Since the inception of the programme in 2014, the City
Hall has expanded its non-smoking zones from restaurants,
eateries, parks, public walkways, covered overhead bridges
and pedestrian walkways to markets and public swimming
pools. While enforcement against those caught smoking in
these areas is ongoing, the KLBAR initiatives aim to bring
attention to the prevalence and effects of smoking in society
through public awareness, digital and physical campaigns,
community engagement, and capacity building.
To further enhance the city’s smoke-free aspiration, the City
Hall plans to include “No Smoking” regulations as part of the
licensing conditions for business owners such as wholesale
markets.
63 Kuala Lumpur Voluntary Local Review
Indicator 3.d
Strengthen Capacity for Early
Warning, Risk Reduction and
Management of National and
Global Health Risk
The coronavirus pandemic had taken the world
by surprise , exposing existing gaps to nations
and cities healthcare and social protection
system. Kuala Lumpur is no exception, as the
initial preparedness towards the pandemic by
both federal and local government was generally
insufficient. However, the government had
quickly pivoted and making swift and massive
actions to respond to the crisis as the pandemic
continued.
In Kuala Lumpur, a concerted and joint effort
between the federal, local government and
non-profit organization was taken including
testing , contact tracing, public health screening,
vaccination and quarantine. Each stakeholder
had introduced individual stimuluses and social
protection schemes to help communities in the
city to weather the impact of COVID-19.
Implementing the 2030 Agenda in Kuala Lumpur 64
|
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[
3
] |
{
"country": "mys",
"file_id": "sdg-03/vlr-report-mys-kuala_lumpur-2022-en-3.pdf",
"language": "en",
"locality": "kuala_lumpur",
"size": "l",
"type": "vlr",
"year": 2022
}
|
Summary:
Melaka City has made remarkable strides in achieving SDG 3, focusing on good health and well-being.
Through community outreach programs and collaborations, infant and under-five mortality rates have
consistently decreased. However, the COVID-19 pandemic caused a surge in maternal mortality rates,
highlighting the need for improved access to quality maternal care. Proactive measures have been taken to
address communicable diseases and promote a healthy environment.
Efforts to combat non-communicable diseases include programs promoting physical activity and healthy
eating. The implementation of SPiKTRA - M has significantly reduced road traffic accidents. The city also
provides accessible healthcare services through hospitals, clinics, and meets WHO standards for healthcare
resources. Melaka City›s achievements in SDG 3 showcase its commitment to improving health and wellbeing for its residents.
È Target 3.1:
Reduce Maternal Mortality
Maternal Mortality Rate in Melaka
Tengah District, 2021
90.5
2021
12.2
2020
*Per 100,000 live births
Source: DOSM, 2022
The maternal mortality rate in the Melaka Tengah
District surged by 641.8% between 2020 and 2021,
reaching 90.5 deaths per 100,000 live births in
2021, a significant increase from 12.2 in 2020. This
rise during the COVID-19 pandemic reversed the
progress made in achieving Target 3.1 in Melaka City.
Factors contributing to this include lower
socioeconomic status, social inequality, and limited
access to quality and affordable healthcare for
pregnant women. The movement restrictions and
fear of contracting COVID-19 hindered access to
antenatal care, while delays in vaccinating pregnant
women and difficulties in reaching safe delivery
facilities added to the rise in maternal mortality.
Closure of family planning clinics also impacted
adequate family planning services. Moreover,
according to a report by UNFPA, the general
challenges for maternal mortality in Malaysian is
poor-quality maternal care including, long waiting
times, misdiagnoses, inefficient pregnancy checkups, and inadequate communication from healthcare
providers during delivery.
SDG 3:
Good Health & Wellbeing
42 2022 Melaka City Local Voluntary Review
È Target 3.2
End Preventable Death of Newborn and Children Below 5 Years
Old
Perinatal Neonatal
Neonatal Infant Under 5 y/o
Infant Under 5 y/o
Female Male
Mortality Rate of Children Below 5 Years
Old in Melaka Tengah District
Children Mortality Rate by Gender in
Melaka Tengah District, 2021
10
2019 2020 2021
8
6
4
1
0 0
5
10
Source: DOSM, 2022
There has been a consistent reduction in infant and below 5-year-old mortality rates over the years. This
achievement can be attributed to the implementation of various community outreach programs, particularly
the «Perkhidmatan Kesihatan Ibu dan Anak» (Mother and Child Health Services), focusing on vaccination
activities, including measles immunization, and overall health promotion. These initiatives are carried out by
the Melaka State Health Department in collaboration with other stakeholders.
Furthermore, additional programs and interventions are identified based on risk assessments conducted by
the District Health Office, taking into account reported cases, immunization coverage achievements, and
the presence of high-risk populations in specific locations. This comprehensive approach helps ensure that
effective measures are implemented to address the specific healthcare needs of infants and young children,
leading to a reduction in mortality rates in the district.
È Target 3.3
End Epidemics and Other Communicable Disease
Melaka City has faced various communicable diseases over the past three years, with pneumonia and
dengue being the most prominent aside from COVID-19. These diseases exhibit seasonal variations in
their transmission and prevalence patterns. Dengue cases tend to increase during the rainy season, while
pneumonia is influenced by factors such as poor air quality caused by haze and other pollutants.
To tackle these challenges, the Melaka Historic City Council (MBMB) has implemented proactive measures.
They have focused on public cleaning services and rigorous supervision to minimize breeding spaces for
vector-borne infections. Additionally, MBMB has introduced the Environment Sensor Station (ESS-15)
initiative to monitor and improve air quality in the city. This aligns with their vision of creating a healthy, smart,
and livable city by establishing Clean Air Zones and ensuring good air quality standards.
Table 3: Number of Communicable Diseases in Melaka City
Disease 2019 2020 2021
Dengue 1,487 1,948 478
COVID-19 0 267 44,512
Tubercolosis 400 328 300
Pneumonia 2,976 1,574 1,808
HIV 199 168 114
2022 Melaka City Local Voluntary Review 43
È Target 3.4
Reduce Premature Mortality
for Non-Communicable
Disease
440 people died due to Ischemic Heart
Disease in 2021 recording the No. 1 cause of
death in Merdeka City for 3 years consecutively
NCDs like heart disease, stroke, and diabetes remain
prevalent in Melaka City and are major causes
of death. While there has been some progress in
reducing NCD cases over the past three years, the
burden of these diseases remains significant.
Lifestyle factors, such as unhealthy eating habits
and limited knowledge about nutrition, contribute
to the high prevalence of NCDs. The community
also leads inactive lifestyles, lacking regular physical
activity. The city lacks facilities and infrastructure to
support an active lifestyle and adequately cater to
the aging population, potentially contributing to the
persistence of NCDs.
Disease Total Men Women
Cerebrovascular
Diseases
3,038 - -
Cancer 3,913 1,012 2,901
Cardiovascular 2,108 1,385 723
Diabetes 406 213 193
Depression 49 25 24
Source: JKNM, 2023
MBMB, working together with stakeholders such as
the Melaka Department of Health and Community
Groups, has launched a range of programs with the
goal of decreasing non-communicable diseases and
fostering a healthy lifestyle in the city.
\ Public Zumba Programs over the Weekend
\ Jogging and Cycling Activities
\ Healthy Eating Outreach Programs
\ Klinik Bergerak (e-Klinik) to encourage and
promote health screening especially cancers
among adults
È Target 3.6
Reduce Number of Death and
Injuries From Road Traffic
MBMB has made significant achievements to
reduce the number of road traffic accidents and
casualties. The city has witnessed a notable decrease
in cases, from 12,698 in 2019 to 7,900 cases in
2021. This achievement can be attributed to the
implementation of SPiKTRA - M, a pioneering
project in Malaysia that utilizes IR 4.0 technology.
Since its development in June 2019, SPiKTRA - M
has effectively contributed to traffic dispersal and
smooth flow by employing Artificial Intelligence (AI)
algorithms. It has successfully created an Integrated
Greenwave Linking system that optimizes traffic
signal timings, resulting in time savings of up to
300%.
SPiKTRA - M demonstrates its progress through
the SPiKTRA - M Control Room and user-friendly
applications accessible on mobile devices and
computers. Currently, 22 intersections in the
MBMB administrative area have been equipped
with this technology, and there are plans to install
it at an additional eleven intersections, with a total
investment of RM 4.36 million.
SPiKTRA - M optimizes traffic flow, synchronizes
signal timings, and employs real-time monitoring to
minimize accidents. It enables proactive congestion
management, remote signal adjustments, and
improved emergency response.
Road and Traffic Accidents and
Casualities in Melaka City
2019
2020
2021
12.698
9,348
7,900
44 2022 Melaka City Local Voluntary Review
È Target 3.8
Achieve Universal Health
Coverage
Public Hospital 2
Private Hospital 3
Community Clinic 17
Public Reproductive Health Clinic 2
Public Clinic 23
Private Clinic 195
District Clinic 13
Dentist 30
Source: JKNM , 2023
Melaka City has made significant strides in achieving
universal health coverage, as evidenced by the
following infrastructure and resources provided by
the Melaka Health Department (JKNM). The city
is equipped with a total of five hospitals, consisting
of two public hospitals and three private hospitals,
ensuring adequate healthcare facilities for the
population. In addition, there are 17 community
clinics, 13 district clinics, and two public reproductive
health clinics, further expanding access to healthcare
services across the city.
In terms of resources, Melaka City meets the
WHO standards for the ratio of hospital beds per
population. With a ratio of 1:5, there are sufficient
hospital beds available to cater to the healthcare
needs of the residents. Similarly, the city also meets
the WHO guidelines for the ratio of healthcare
workers per population, with a ratio of 1:2.
JKNM, in collaboration with various partners,
implements multiple initiatives to ensure public
health services in Melaka. These initiatives include:
\ Infectious disease surveillance
\ Strengthen the preparedness of Rapid Action
Teams (RAT) and Rapid Response Teams (RRT),
\ Coordinate the Emergency Operations Center
for emerging and newly emerging diseases,
\ Monitor and surveillance of vector-borne
diseases
\ Anonymous HIV screening programs at health
clinics
\ Health promotion activities related to TB and
Leprosy are carried out.
\ TB screening programs
\ Workplace Occupational Safety and Health
programs
\ Control of Non-communicable Diseases and
\ Family Health programs including maternal, child,
and disabled health,
\ Promotion of Healthy Eating programs
The Federal Government›s 2013 announcement
of RM 30 million allocations to the «Healthy
Community Builders of the Nation» (KOSPEN)
program has significant implications for Melaka
City. KOSPEN, a community-based initiative by
the Ministry of Health, aims to empower local
communities and combat the increasing prevalence
of Non-Communicable Diseases (NCDs) such as
diabetes, high blood pressure, high cholesterol,
smoking, and obesity. Melaka City, specifically
within the administrative area of MBMB has already
witnessed the positive effects of this program.
Communities in Tengkera, Peringgit, and Ayer
Molek have received assistance in health checkup equipment, enabling more accessible access
to health screenings and reducing congestion at
healthcare facilities.
Moreover, KOSPEN offers various engaging
activities in Melaka City, including health screenings,
mental health assessments, Pap smears, breast
examinations, medication awareness, dental care,
and nutrition education. With six targeted KOSPEN
localities in Melaka City, this program is crucial in
empowering the community and fostering a sense
of responsibility towards their health. Through
these initiatives, Melaka City is actively addressing
the challenges posed by NCDs and promoting a
healthier lifestyle among its residents.
2022 Melaka City Local Voluntary Review 45
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[
3
] |
{
"country": "mys",
"file_id": "sdg-03/vlr-report-mys-melaka-2022-en-1.pdf",
"language": "en",
"locality": "melaka",
"size": "l",
"type": "vlr",
"year": 2022
}
|
CITY COUNCIL OF PENANG ISLAND VOLUNTARY LOCAL REVIEW
SDG3
Ensure healthy lives and promote wellbeing
for all at all ages
The city council emphasises on the
concept of a cleaner, greener, safer
city for improved liveability. A healthy
community is one that is safe and
happy with policies to ensure their
health and wellbeing. Community
integrated care services, recreational
and sports programmes for healthier
lifestyles, health incentives, social
participation for vulnerable groups
and road traffic accident preventions
were among the comprehensive
measures taken in collaborative
efforts with the state and nongovernment resources.
3. 3 Control Infectious Disease 3.6 Continue to improve public
safety
3.8 Encourage Healthier
Lifestyle and Care System
Incidence Rate Of Water, Food And
Vector Borne Diseases
(Per 100,000 population rate)
Road Deaths and Accidents
in Penang
Dengue Cases in
George Town by Year
Source : Health Ministry of Malaysia Source: Penang Road Safety
Strategic Plan
Source : Health Ministry of
Malaysia
Targets 2030
0 fatality Drop 10% per year
for accidents & deaths
0 death
2014 2015 2016
Cholera 0.00 0.00 0.00
Typhoid 0.36 0.48 0.23
Food Poisoning 135.32 26.09 35.45
Hepatitis A 0.00 0.06 0.00
Dysentry 0.12 0.06 0.00
Dengue 190.86 350.57 156.30
Malaria 2.24 1.02 0.18
Typhus & Other
Richettsioses 0.06 0.06 0.00
Viral Enchephalitis 0.36 0.06 0.12
Filariasis 1.39 0.96 0.61
Water &
Food
Vector
DISEASE YEAR
32
CITY COUNCIL OF PENANG ISLAND VOLUNTARY LOCAL REVIEW
Promote Healthier Environment
With a plan to create an inclusive,
healthy and safe city, George Town city
establishes local health care systems to
control the spread of infectious diseases
and provides community integrated
medical care services such as centres for
dialysis, vaccination and first aid. The city
council emphasises on the concept of a
cleaner, greener, safer city for improved
liveability. A healthy community is one
that is safe and happy with policies to
ensure their health and wellbeing.
Community projects such as recreational
and sports programmes were introduced
to reinforce the importance of a healthy
lifestyle. Health incentives, social
participation for vulnerable groups and
road traffic accident preventions were
among the other comprehensive
measures taken in collaborative efforts
with the state and non-government
resources. Community Care Services
The city council has continued with its
integrated care services to enhance
healthcare services for vulnerable groups
and the general public. To-date, the city
council has set up and assisted in the setting
up of a total 38 of Automated External
Defibrillator (AED) at public spaces such as in
parks and within public buildings for
emergency use. AED devices can restore the
heart rhythm of victims of sudden cardiac
arrest. These devices are proven to be
important to allow people to respond to
medical emergencies that requires
defibrillation.
The city council will continue to provide and
facilitate community dialysis centres,
vaccination centres and first aid centres as
extra healthcare services for the public. The
city council is now in the midst of
constructing its first transit centre for the
homeless that is equipped with a medical
centre to protect the health of the
vulnerable groups.
33
CITY COUNCIL OF PENANG ISLAND VOLUNTARY LOCAL REVIEW
Control of Infectious Diseases
Dengue
The city council often collaborates with the
health ministry to control the number of
dengue cases in the state. The city council
conducts daily search and destroy activities
to get rid of potential mosquito breeding
ground. Reactive vector control measures
such as regular fogging at hotspots of
dengue outbreaks to destroy the mosquitoes
and its breeding grounds are implemented
to control and prevent the transmission of
the dengue virus. These measures have
reduced the number of dengue cases in
George Town city. The city also control the
spread of dengue through community
engagement.
Food Safety and Typhoid Vaccination
The city council provides typhoid
vaccinations at a minimal fee at its in-house
clinic for food handlers in Penang. Typhoid
vaccinations are effective in preventing
typhoid fever which is a life-threatening
infection caused by the bacterium,
Salmonella Typhi. This bacterium is usually
spread through contaminated food or
water.
Food handlers are also provided with a free
one-hour lecture on Food Safety by the city
council’s health inspector. All food handlers
who had received their typhoid vaccination
and attended the one-hour lecture will be
issued a Food Handler Card that they will
need to display at their business premises.
This is to ensure that the food handlers
comply with local by-laws on the
requirement to receive typhoid vaccination
and to attend food safety talks before they
can handle food in a food establishment.
34
CITY COUNCIL OF PENANG ISLAND VOLUNTARY LOCAL REVIEW
Promote Public Health
The city council continues to conduct
activities and workshops for the public
and in schools that cover topics on
health, food hygiene, dengue fever
awareness and in recent times,
COVID-19 prevention measures.
Nurses continue to visit kindergartens
and schools to conduct sessions within
classrooms to talk about topics such
as hand washing techniques, food
hygiene awareness, dengue fever
awareness and COVID-19 prevention
measures.
35
CITY COUNCIL OF PENANG ISLAND VOLUNTARY LOCAL REVIEW
Healthier Lifestyle Programmes
The city council often organizes and
facilitates activities and programmes to
promote a healthy lifestyle. These are events
and activities to encourage more people to
participate in health-building activities that
are fun and at the same time, rewarding.
The city council introduced its annual City
Walk programme on January 1 since 2012.
The event continued to be held annually but
had to be cancelled in 2021 due to the
COVID-19 pandemic. Previously, an
estimated 5 000 – 10 000 participants took
part in the City Walk each year.
The city council introduce Bike on Friday (BoF)
in April 2015 and have continued to organise
it every Friday. It recently celebrated its 300th
BoF but similarly, some of the sessions had to
be cancelled due to the pandemic.
In 2021, the city council jointly organised
a virtual run and cycling event with
Penang Chinese Chamber of Commerce
Young Entrepreneur Section (PCCC YES)
called Penang Steps Up. Events that
involved mass gatherings were still not
allowed but health-promoting events can
still continue on a virtual platform. In
Penang Steps Up, participants who sign
up can walk, run and cycle at their own
pace anywhere, anytime and any day
while still complying to the government’s
Covid-19 standard operating procedures
(SOPs). The virtual event was launched in
conjunction with the George Town World
Heritage Day celebrations on July 7.
Participants need only track their daily
steps or the distances cycled on their
health apps.
The objective of the event was to record
a collective 168 million steps and
28,000km rides from all participants within
14 days. By July 20, a total 201,651,263
collective steps were recorded.
36
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[
3
] |
{
"country": "mys",
"file_id": "sdg-03/vlr-report-mys-penang_island-2021-en-3.pdf",
"language": "en",
"locality": "penang_island",
"size": "m",
"type": "vlr",
"year": 2021
}
|
Ensure healthy lives and promote well-being for all at
all ages
The city council introduced measures and
enforced strict adherence to SOP. Contact
tracing systems for the community and the
affected economic sectors, construction
and manufacturing, were introduced. The
city also created multi-lingual versions of the
COVID-19 prevention SOP in various
formats, visual and audio, to disseminate to
the public through social media, official
websites and through public
announcements.
7
|
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"country": "mys",
"file_id": "sdg-03/vlr-report-mys-penang_island-2021-en-4.pdf",
"language": "en",
"locality": "penang_island",
"size": "s",
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}
|
Voluntary Local Review 2021
SUBANG JAYA
67
Implementing the 2030 Agenda in the City of Subang Jaya
SDG 3: Good Health and Well Being
The aim of goal three is to ensure healthy lives
and promote well-being for all at all ages.
Subang Jaya Healthcare System and Facilities
Malaysia has an advanced, efficient, and easily
accessible healthcare system due to the government’s
extensive support and investment in promoting overall
public health. Healthcare services in the country
consist of tax-funded and government-run primary
healthcare centers as well as private services which are
mostly located in urban areas. Both public and private
healthcare facilities are gradually increasing to meet
the rising patients’ demand for better healthcare and
population growth.
According to Selangor Health Department (Jabatan
Kesihatan Negeri Selangor), there are a total of 16
health facilities in Subang Jaya. This includes Health
Clinics, Dental Clinics, Community Clinics, Mobile
Clinics, and Hospitals. There are 5 hospitals servicing
Subang Jaya, namely Columbia Asia Puchong, KPMC
Medical Centre, QHC Medical Centre, Sime Darby
Medical Centre Subang Jaya, and Sunway Medical
Centre which are all privately run. There are no public
hospitals in the area, community members in need of
a more affordable treatment would have to consider
adjacent government hospitals such as Hospital Shah
Alam or Hospital Serdang.
It is estimated that Subang Jaya will be needing
38 health clinics by 2035 to cater to its projected
population growth of 1.56 mil. Currently, only 4 health
clinics are available scattered in the area and 12 more in
planning according to the Subang Jaya Local Plans.
Low income communities in Subang Jaya is also able to
access affordable healthcare services through SelCare
, a holistic healthcare assistance program under the
Selangor State Government. Among the assistance
provided under this program are :
• Healthcare Insurance Scheme (Skim Insuran
Peduli Sihat) :
Free basic treatment as well as funeral assistance,
critical illness coverage, life insurance and personal
accident protection to household income below
RM 2,000 per month
• Selangor Heart Treatment Scheme (Skim
Rawatan Jantung Selangor):
Free heart treatment to low-income people
• Healthcare for Civil Servant Scheme (Skim
Peduli Sihat Penjawat Awam):
Private healthcare subsidies up to RM 10,000
annually for Grade 44 civil servants and below
• Skim Kasih Ibu Smart Selangor:
Special welfare program for mothers (including
single mothers) of low income group
Total Number of Hospital Beds in Subang Jaya
Hospitals Locality No. of Beds
Columbia Asia Hospital Puchong 78
KPMC Medical Centre Puchong 29
QHC Medical Centre Subang Jaya 11
Sime Darby Medical
Centre
Subang Jaya 444
Sunway Medical Centre Subang Jaya 617
Total Number of Beds 1,179
24 Health Facilities in
Subang Jaya ,
2021
Hospitals*
5
Public Dental
Clinic
2
Public Health
Clinic
4
Mobile Clinic
1
Community
Clinic
4
Source :
1. Selangor Health Department
2. Subang Jaya City Council
Note: Hospitals includes both government and private hospitals
Voluntary Local Review 2021
SUBANG JAYA
Implementing the 2030 Agenda in the City of Subang Jaya
68
Peduli Sihat Medical
Card by Selangor State
Government
Subang Jaya Mortality and
Diseases (Communicable and NonCommunicable)
According to the DOSM’s statistics on Cause of Death
in Malaysia, 2019, Ischaemic heart diseases was the
leading cause of death contributing 15.9% to the
nation’s urban cause of death, followed by pneumonia
(12%), cerebrovascular diseases (7.6%), transport
accidents (3.6%) and malignant neoplasm of trachea,
bronchus, and lung (2.5%). The Petaling District
(Subang Jaya) recorded 835 deaths due to Ischaemic
heart diseases in 2019, making the district one of the
highest recorded cases nationwide.
Dengue remains endemic in Malaysia since its outbreak
in the 1980s. Selangor has the highest concentration of
cases annually, with 7,132 out of 12,473 recorded cases
nationwide as of June 16, 2021. The dengue fever in
the country is seasonal, with variable transmission and
prevalence patterns occurring from June to September
and September to March following the Southwest
monsoon season and Northeast monsoon season
respectively, creating the perfect breeding condition
for the Aedes mosquitoes.
According to Selangor Health Department, Subang
Jaya has among the highest dengue active and
hotspot areas in the Petaling District. SJCC has taken
a proactive approach through its public cleaning
services and supervision to ensure breeding spaces
of vector-borne infection diseases are reduced or
completely eliminated.
The average number of dengue cases in Subang Jaya
is 7,574 cases between 2015 to 2020. The highest
recorded number of cases in the city was in 2015 with
a total of 10,499 cases. The city saw a 32.1% drop in
cases in 2020 in comparison to the previous year.
Aside from SJCC’s continuous efforts to prevent Aedes
breeding, dengue incidences were probably indirectly
inhibited by the periodic COVID-19 Movement Control
Order (MCO) by the Malaysian government that
resulted in people staying at home and being more
attentive to their living environments
Source: Department of Statistics
Principal Causes of Death in Subang Jaya , 2019
Source:
Health Department, SJCC
Health Department Ofce Petaling District, 2021
Dengue Cases in Subang Jaya
15.9%
11.5%
7.3%
3.5% 2.6%
15.2%
12.0%
7.6%
3.6% 2.5%
0.0%
5.0%
10.0%
15.0%
20.0%
Ischaemic
Heart Disease
Pneumonia
Cerebrovascula
r Diseases
Transport
Accidents
Malignant
neoplasm of
trachea,
bronchus and
lungs
Principal Causes of Death in Subang Jaya , 2019
2018 2019
Source: Department of Statistics
10,499
8,609
5,041 5,450
9,441
6,408
0
2,000
4,000
6,000
8,000
10,000
12,000
2015 2016 2017 2018 2019 2020
Dengue Cases in Subang Jaya
Voluntary Local Review 2021
SUBANG JAYA
69
Implementing the 2030 Agenda in the City of Subang Jaya
As part of the municipality’s role in the prevention of
substance abuse,SJCC’s Licensing Department was
selected as the pioneer program of the Anti-Drug
at Entertainment Premises Campaign (Kempen Anti
Dadah di Premis Hiburan) by the National Anti-Drug
Agency (Agensi Anti Dadah Kebangsaan, AADK). A total
of 147 entertainment license holder has participated
and implemented the drug-prevention promotion and
program on their respective premises. In 2020, SJCC
had declared Subang Jaya as a Drug-free City.
Dengue Active and Hotspot Areas in the Petaling District (January – March, 2021)
Water (River) Quality in Subang Jaya
There are 10 rivers within the administration area of
SJCC, namely Sungai Kuyoh, Sungai Rasau, Sungai
Damansara, Sungai Biring, Sungai Bohol, Sungai
Penaga,Sunagi Kuala Bharu, Sungai Kemuning and
Sungai Klang. The water quality of Sungai Klang,
Sungai Damasara and Sungai Rasau remains in Class III
(Slightly Polluted) from 2012 to 2015. The main reason
to the low water quality are the prevalent discharge
of untreated sewage into the rivers as well as illegal
dumping of garbage into the river
Source: Selangor Health Department
Sungai Klang
Sungai Kuyoh
City
Council Sub-district (Mukim)
No of Cases Cumulative
Cases January February March
Subang
Jaya
Damansara 165 117 27 309
Petaling 92 5 52 147
Petaling
Jaya
Damansara 29 18 0 47
Petaling 19 20 32 71
Sungai Buloh 23 5 0 28
Shah Alam
Damansara 119 19 59 197
Sungai Buloh 0 0 75 75
Bukit Raja 28 49 137 214
0 10 20 30 40 50 60 70 80
Sg. Kuyoh
Sg. Rasau
Sg. Damansara
Sg. Klang
River Water Quality Status in SJCC area for 2014 & 2015
2015 2014
Voluntary Local Review 2021
SUBANG JAYA
Implementing the 2030 Agenda in the City of Subang Jaya
70
Eradicating Dengue Through Surveillance and Public Cleanliness
Subang Jaya Dengue Eradicating Activities, ME 52, 2019
Prevention of and response to dengue cases falls under
the Health Department of Subang Jaya City Council.
Among the activities taken-up by the department to
eradicate dengue breeding spots are Surveillance,
Abating, Larva-siding, Fogging and the Enforcement
of the Eradicating Disease –Carrying Insect Act. In
Source : SJCC Annual
Report, 2019
Highlight Project
2019, up to epidemiological week (ME) 52, a total of
440,120 premises had undergone fogging and 25,254
premises was monitored to detect and implement early
intervention in Subang Jaya. Community responses and
complaints have also contributed to the city council’s
preparedness and planning in its dengue eradicating
activities
Premise Surveillance Abating Larva-ciding Fogging Notis Sek 8 Ntk Close Community
Complaints
Shop lots 20,925 20,923 225,553 434,332 235 14 - 188
Construction Site 24 24 - 1 2 8 2
Factories 57 60 928 1,514 2 4 -
Schools 90 83 11 22 28 1 -
Religious Centres 50 48 65 122 1 - -
Govt. Buildings 14 14 8 12 - - -
Graveyards 1 1 1 - - - -
Empty Lots 22 19 23 18 - - -
Recreational Parks /
Playground
677 674 542 640 - - -
Others (e.g. Parking
areas, drains, back
alley, etc.)
3,394 3,387 2,519 3,549 2 2 -
Total number of
premises
25,254 25,233 229,611 440,120 270 29 2
Voluntary Local Review 2021
SUBANG JAYA
71
Implementing the 2030 Agenda in the City of Subang Jaya
Premise Surveillance Abating Larva-ciding Fogging Notis Sek 8 Ntk Close Community
Complaints
Shop lots 20,925 20,923 225,553 434,332 235 14 - 188
Construction Site 24 24 - 1 2 8 2
Factories 57 60 928 1,514 2 4 -
Schools 90 83 11 22 28 1 -
Religious Centres 50 48 65 122 1 - -
Govt. Buildings 14 14 8 12 - - -
Graveyards 1 1 1 - - - -
Empty Lots 22 19 23 18 - - -
Recreational Parks /
Playground
677 674 542 640 - - -
Others (e.g. Parking
areas, drains, back
alley, etc.)
3,394 3,387 2,519 3,549 2 2 -
Total number of
premises
25,254 25,233 229,611 440,120 270 29 2
COVID-19 Operations Room
The city council had turned its Subang Jaya Vibrant
Command Centre (SJVCC) into SJCC’s COVID-19 Operations
during the national lockdown. As the name suggest,
the room will become the central hub for any COVID-19
updates in Subang Jaya including updating current
COVID-19 cases data in Malaysia, Selangor and the Petaling
district, close contact and management of positive cases
in the district as well as conveying any information and
answering queries from the public with relation to the
pandemic and its standard operation procedures (SOPs).
The public are able to access the operations room daily
from 8am to 8pm.
Monthly “Gotong Royong” Campaigns
SJCC conducts Gotong-Royong campaigns at targeted
areas as part of its community engagement and dengue
eradicating eforts. Gotong royong is a form of collectivism
in the Malay / Asian culture. The idea behind gotongroyong is to share the burden or overcome difculties
Highlight Project
among members of the community for mutual beneft.
The idea has been integrated into the formal institution in
Malaysia during social activities partly to encourage public
awareness on health and cleanliness and subsequently
build social cohesion.
In 2020, SJCC had conducted 7 gotong royong within
the Subang Jaya area. The campaigns are usually in
collaboration between the city council, community
groups, the Ministry of Housing and Local Government
(KPKT) Ministry of Health COMBI Squad, Selangor State
health department (JKNS), Petaling District Health Ofce
(PKD), Fire and Rescue Department and the private
sectors.
Aside from the gotong-royong activity, activities such
as robotic exercises, children coloring contests, health
exhibitions, fogging, and individual housing inspections
are conducted during the campaign.
“Gotong-royong” activities by communities in Subang Jaya
|
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[
3
] |
{
"country": "mys",
"file_id": "sdg-03/vlr-report-mys-subang_jaya-2021-en-1.pdf",
"language": "en",
"locality": "subang_jaya",
"size": "l",
"type": "vlr",
"year": 2021
}
|
3
Good health is vital for people. SDG
3 includes a number of subgoals
and indicators focused on specifc
contributions to good health. The
importance of this SDG has been
demonstrated in full force during the
COVID-19 pandemic. Although Amsterdam generally ofers high-quality
essential healthcare services, these
have been under enormous pressure
since the start of the pandemic.
Healthy lifestyle
Amsterdam shows signs of a slightly
healthier lifestyle compared to the
Netherlands as a whole (Figure 7).
Almost four out of fve Amsterdam
residents perceived their own health
as good or very good in 2020. The
amount of people with one or more
long-term illnesses is slightly lower
than in the Netherlands as a whole.
This might be because Amsterdam
has a relatively young population.16
The number of people who are overweight17 has slightly decreased in the
period 2016-2020 and is just under
40%. This is considerably less than
the Netherlands as a whole, where
the percentage slightly increased in
the same period and is now almost
50%. The city has launched diferent
policy initiatives to address the issue
of obesity, especially in young people. The city has committed itself to
the goal to have all Amsterdam children at a healthy weight by 2033.18
The COVID-19 pandemic and
access to health care
Beginning in March 2020, Amsterdam was hit by COVID-19. This has
led to serious health problems, as
well as problems in health care provision. The impact of the pandemic
is still difcult to quantify.
However, 2020 fgures show that
the COVID-19 crisis has negatively
afected mental and social well-being, especially among young adults.19
Around 7% of Amsterdam residents
indicate that they or someone in
their household have not received
necessary medical and/or dental
treatment in the past year. The main
reason treatment did not take place
was the COVID-19 crisis. The lack
of coverage from the health insurance and the deductible or personal
contribution were other important
reasons.20
Smoking, alcohol and drug use
Amsterdam shows relatively high
levels of smoking and alcohol and
drug use. About 22% of Amsterdam
adults are smokers; half of them
smoke daily. Smoking is more common in Amsterdam than elsewhere
in the Netherlands and in the other
major cities. The trend is downward:
in 2016, 27% of Amsterdam adults
were smokers.21
Only four out of ten adult Amsterdam residents (40.5%) meet the
standard for responsible alcohol use
(one glass or less per day on average). This is lower than the national
average of 43.4%.22 Of adults, 14% can
be counted as heavy and/or excessive
drinkers.
Regarding drug use, 22.3% of adults
in the Amsterdam region indicated
having used drugs in the last year
compared to 9.2% for the Netherlands as a whole.23
With regard to policy on smoking,
alcohol and drugs, the following
goals are set for 2030:
● Less than 5% of Amsterdam
residents smoke
● Less than 5% of Amsterdam
residents have heavy or excessive
alcohol consumption
● Drug use has declined
16 The average age of the
Amsterdam population was
38.7 in 2021; compared to
42.3 for the Netherlands
on average (Waar staat je
gemeente; based on CBS
Bevolkingsstatistiek 2021).
17 Defned as percentage of
persons over 19 years with
a Body Mass Index (BMI) of
25.0 kg/m2 and over.
18 Amsterdamse Aanpak
Gezond Gewicht, 2017.
19 Amsterdamse
Gezondheidsmonitor 2020,
p. 10-12.
20 Amsterdamse
Gezondheidsmonitor 2020,
p. 16.
21 Amsterdamse
Gezondheidsmonitor 2020,
p. 18.
22 RIVM 2021 (data for 2020).
23 CBS, 2020, Gezondheid,
zorggebruik en Leefstijl.
These numbers are for
the 2017-2019 period and
only available at regional
level (GGD regions;
for Amsterdam this
includes the city and fve
surrounding municipalities)
Ensure healthy lives and promote well-being
for all at all ages
Good health and
well-being
39
Fig. 7 Health indicators the Netherlands and Amsterdam, 2020 (in % adult population)
perceived health
(good/very good)
one or more
long-term illnesses
overweight
(BMI > 25)
smokers
79.3 32.2 49.4 21.8
79.1 28.7 39.3 16.7
Source: CBS, Health Monitor 2020.
Amsterdam The Netherlands
SDGS IN BRIEF | CONTENTS
→
|
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|
36 | Utrecht and the Global Goals Utrecht and the Global Goals | 37
3 Good health
and well-being
Ensure healthy lives
and promote well-being
for all at all ages.
Online
dashboard
Good health is vital for people.
SDG 3 includes a number of
sub-goals aimed at making
specifc contributions to overall
good health. The Public Health
Monitor Utrecht permanently
monitors the health of all Utrecht
residents – from young to old and
those in vulnerable situations.
It also maps out the factors that
infuence health.
Health inequalities in Utrecht remain signifcant
(Figure 3.1). The healthy life expectancy at
birth is ffteen years shorter for residents of
Overvecht than it is for residents of Northeast
Utrecht. Similarly, it is twelve years shorter than
the expectancy in Northwest and eleven years
shorter than the expectancy for Southwest.
This pattern is also evident in the perceived
health across districts. Health inequalities are
hardly reduced. Mortality around birth from 24
weeks of pregnancy in Utrecht is slightly higher
than the national average but lower than that of
Rotterdam and The Hague. In Overvecht and
Zuidwest, the number of infants who die around
birth is 1.5 to 2 times higher than the Utrecht
average
The segmentation of districts is related to the
average income of individuals and households.
Overvecht, in particular, has a higher
concentration of households living at or below
the social minimum. Due to limited afordable
housing options, vulnerable groups tend to be
concentrated in Overvecht, whereas they are
less prevalent in the Inner City or East districts.
More than 80% of Utrecht’s youth and
adults feel healthy which aligns with the
city’s demographics of a large population in
their twenties and thirties, and a signifcant
percentage of residents with a college or
university education. However, nearly 20%
(46,000) of adults in Utrecht feel unhealthy,
often encompassing multiple health issues.
In Utrecht, certain groups are more prone to
health problems or an unhealthy lifestyle. These
include people with primary education, junior
or senior secondary vocational education (LBO
or VMBO), and hose facing fnancial difculties
(SDG1). Over the past ten to ffteen years,
health disparities between these groups and
others have grown. What’s more, they also
face additional challenges related to underlying
factors contributing to poor health, such as
unfavourable living conditions or limited (health)
skills. The health gap is also widening for
children in single-parent families. While these
groups are distributed throughout the city, they
are overrepresented in neighbourhoods like
Northwest, Overvecht, South and Southwest.
Through the Public Health policy 2019-2023
‘Health for everyone’, the municipality aims to
ensure that a healthy urban life is accessible
to everyone. This policy approach revolves
around the concept of ‘positive health’, which
focuses on how well residents can cope with
their circumstances. In doing so, the municipality
acknowledges the impact of factors like fnancial
concerns on people’s ability to maintain their health.
Mental health (3.4)
The fgures on mental health and sleep highlight
the need for a frm commitment. The mental
well-being of children, young people and young
adults is particularly concerning. Between
2019 and 2021, there was a decline in mental
health among some children and young people.
In 2022, 22% of young adults experienced
moderate to severe mental health problems.
They faced various health issues that can be
indicative of compromised mental well-being,
such as difculty concentrating and symptoms
of depression. More than half of all young adults
frequently feel stressed, while 46% of young
people often experience stress.
Sleep problems and fatigue occur across all age
groups. Children are increasingly experiencing
poor sleep and feeling tired more frequently.
Among young people, 39% sufer from fatigue.
Among adults, 43% have difculty sleeping, and
the fgure rises to 46% among the elderly.
Drug use (3.5)
Furthermore, drug use seems to be normalised
among young adults, with one in three
38 | Utrecht and the Global Goals Utrecht and the Global Goals | 39
considering drug use at home as normal. In the survey
19% of young adults indicated that they had used hard
drugs in the past four weeks. Other substance use also
demands attention. 30% of fourth-grade youth have
consumed alcohol in the past four weeks, an increase
from 25% in 2019. Among young adults, 29% are
heavy drinkers, which is defned as drinking four (for
women) or six (for men) glasses of alcohol in a day at
least once a week. While the percentage of smokers
in Utrecht is falling, 18% of adults still smoke. This
percentage is higher among Utrecht residents with
only primary or prevocational education.
Spatial policy (3.9)
Healthy air is crucial for the well-being of residents.
That is why Utrecht is implementing measures to make
the air in the city healthier. New facilities for vulnerable
groups that are particularly sensitive to air pollution
are not being constructed near busy roads. Our Public
Health department’s experts play a role in city planning
to guarantee appropriate considerations. For example,
they ensure that there is sufcient distance between
busy roads and homes, schools, childcare locations,
retirement homes, nursing homes and hospitals. They
look at whether cyclists and pedestrians are given
enough space. They also emphasise the importance
of green spaces and play areas in neighbourhoods
and the preservation of peaceful areas. These health
considerations are integrated into initial planning notes,
urban development programmes, and zoning plans.
Good
practices
GeluksCafés
GeluksBV is a social
entrepreneur with the
mission: ‘Working on Gross
National Happiness’, which
entails promoting balanced
growth that serves people’s
health and well-being. Their
approach is guided by insights
from positive psychology
(happiness research) and
positive health.
‘GeluksCafés’ have been
established in collaboration
with local young people,
aiming to equip with insights
and skills to enhance their
resilience and happiness and
thus their overall well-being.
The goal is to empower young
people in Utrecht, enabling
them to make choices that
support their health and
experience greater freedom
in their behaviours.
Utrecht Health pact
The Utrecht Health Pact is a collaborative
network of parties dedicated to the wellbeing of Utrecht residents. It serves
as the local prevention agreement for
Utrecht. The network welcomes all
organisations and individuals who want
to contribute to city’s health initiatives,
providing an opportunity to inspire,
collaborate and learn from each other
in the feld of health. There is a lot of
knowledge available in the city, and
by connecting this knowledge, a large
team is created that works towards a
pleasant and healthy life for every Utrecht
resident. The Health Pact encourages
and supports activities and cooperations
in the feld of health, resulting in great
initiatives that reach many people in
the city. This empowers people to take
control of their own well-being.
Lunch together to break loneliness
The ‘lunch together to break loneliness’ initiative aims to address social isolation and provide
opportunities for everyone who feels lonely to connect with others. These lunches are open
to everyone, ofering lonely Utrecht residents the chance to come together and alleviate
their sense of loneliness. Through the voluntary eforts of the companies, social partners
and volunteers, Utrecht residents can enjoy a healthy meal accompanied by meaningful
social interaction, connecting them with others in a place where they would normally never
go. Additionally, these gatherings provide an opportunity to inform attendees about other
initiatives in the district and city.
Indekerngezond
Indekerngezond is a neighbourhood
platform and community hub in the
heart of Leidsche Rijn. It was created by
residents, for residents, and operates
based on the principles of Positive
Health. The core values of resilience, selfdirection, participation and a meaningful
life are at the heart of all activities. At
Indekerngezond, residents take the lead.
Instead of receiving advice, they explore
what works best for them and determine
the steps they want to take. By fostering
intrinsic motivation, the initiatives
undertaken are more likely to be efective
and suitable for the individuals involved.
Indekerngezond draws inspiration from
Blue Zones, which are areas around
the world where people live longer and
healthier lives, often without chronic
diseases, medicines or mental decline.
40 | Utrecht and the Global Goals Utrecht and the Global Goals | 41
|
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[
3
] |
{
"country": "nld",
"file_id": "sdg-03/vlr-report-nld-utrecht-2023-en-5.pdf",
"language": "en",
"locality": "utrecht",
"size": "m",
"type": "vlr",
"year": 2023
}
|
12 | Utrecht and the Global Goals Utrecht and the Global Goals | 13
The average life expectancy at
birth in Utrecht is 81.3 years,
but there are clear diferences
in health between Utrecht
residents. Residents who have
difculties making ends meet
and Utrecht residents who
have only completed primary
or a secondary vocational
education are increasingly
disadvantaged in terms of
health. The municipality
employs targeted measures in
lifestyle and living environment
to address these disparities.
|
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16 • Sustainability Report (VLR) ▪ City of Oslo ▪
SDG3: Good Health and Well-Being
Sustainable Development Goal 3 is about ensuring healthy lives
and promoting well-being for all at all ages. Good health is
fundamental to enable people to achieve their full potential and
contribute to social development. For Oslo, this goal relates to
areas such as reducing social inequality in health, creating an agefriendly city, providing activities and access to clean air and green
areas, and promoting good quality of life. Preventing the spread of
infectious diseases is also an important municipal task, and one
which became particularly relevant in 2020 and 2021.
Health is impacted by the environment, economy and
social conditions. As a large city and Norway’s capital,
Oslo differs in many ways from the rest of the country,
not least in terms of the serious health inequality that
exists between different areas of the city. Social inequality in health is an ongoing public health challenge in
Oslo and the disparities are systematic. Social inequality in health refers to the fact that social factors such
as education, occupation and income, impact living
conditions and quality of life, which in turn impact on
the individual’s health. Socioeconomic resources
include financial resources, education and occupation.
One result of social inequality in health outcomes is a
difference in life expectancy between those with different levels of educational attainment. The population of
Oslo has historically had lower life expectancy than the
rest of the country, however it is now at the national
average. In Oslo, the life expectancy at birth is 80 years
of age for men and 84 years of age for women. There
are also differences in life expectancy between districts, however these have decreased since the 1990s.
The difference in life expectancy between different
educational groups is also declining. Quality of life is
about how we feel and our perception of how meaningful life is. This field is being assigned increasingly
greater attention in social planning and administration,
and Oslo has poorer results than the rest of the country
in national quality of life surveys. This may be due to
younger people generally reporting a lower quality of
life than older people, and the fact that Oslo has a
young population. However, there may also be issues
and challenges that are specific to a large city.
Children and young people in the capital are about as
physically active and participate in outdoor activities to
the same extent as the rest of the country. However,
there are significant differences within Oslo. Children
n Figure 3 Life expectancy
from birth in Oslo for 2001–
2020, by gender.
70
75
80
85
2001 to
2015
2002 to
2016
2003 to
2017
2004 to
2018
2005 to
2019
2006 to
2020
Oslo
Norway
District with highest life expectancy
District with lowest life expectancy
Source: Statistics Norway (SSB) and Oslo Statistics (Oslostatistikken)
Social inequality in health is an
ongoing public health challenge
in Oslo and the disparities are
systematic.
Sustainability Report (VLR) ▪ City of Oslo • 17
from the outer west of the city are the most active, and
the same applies to children from households in which
the parents have a high level of income and education. It
is an important task for the City of Oslo to reduce social,
economic or cultural barriers to participation in cultural
and organisational life, because art and cultural activities
have a positive impact on health and quality of life.
Despite Oslo’s population being younger than the
national average, the city is facing a period in which
the elderly population will increase. The challenges
associated with an ageing population include promoting health and preventing illness in order to minimise
the strain on the health and care services, and ensure
the best possible qualify of life for the individual.
Social inequality is also reflected in the area of mental
health, and the living conditions of citizens are important for general health and quality of life. For example,
the risk of anxiety disorders is greater for people who
left school at the end of their compulsory education
(Year 10) than those with a university or college degree.
Health is created in a number of arenas and areas of life
which are, in various ways, of importance to people’s
health and living conditions. Examples are school, work,
home and local environment. Social support and participation in different arenas are particularly important
factors in the effort to promote public health.
What are we doing?
An important goal for the City of Oslo is to contribute
towards reducing social inequality and improve public
health. Public health is an important focus area for the
City of Oslo, and a new public health strategy for Oslo
is currently being prepared. The strategy will apply for
all of the City of Oslo’s activities and will focus on systematic public health endeavours and sustainable social
development. The public health perspective and how
the City of Oslo can contribute to solving important
public health challenges will also be assessed in all of
the municipal plans that are formulated.
Much of the basis for good health and well-being
among the population is created in arenas other than
the health sector. Urban development through
attractive urban and residential areas is important
for good public health. The same applies to the work
on reducing harmful air pollution by becoming a zeroemissions city. Oslo also has an Action Plan for an
Age-Friendly City which aims to facilitate an inclusive
and accessible urban environment that promotes
active ageing and contributes to elderly people feeling
a sense of belonging, achievement and safety, and
which enables them to live free and meaningful lives.
The Health Guide (Helseveiviseren) is a digital guide
that helps citizens to easily locate the services they
need in their district. Such needs may, for example,
relate to physical and mental health, transport or
social activities. The Health Guide will contribute
towards preventive healthcare being initiated as early
as possible, and standardise the health services in the
different districts. Active participation in the local
community is a primary goal in the local community
programme in the area-based initiatives, and
culture and volunteering play a key role in this. The
City of Oslo also has a number of grant schemes that
support cultural experiences and promote active
participation at every stage in life.
Despite Oslo’s population being
younger than the national average,
the city is facing a period in which the
elderly population will increase.
Quality of life is about how we feel
and our perception of how meaningful
life is.
Photo: Kobets Freund / City of Oslo
|
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[
3
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{
"country": "nor",
"file_id": "sdg-03/vlr-report-nor-oslo-2023-en-3.pdf",
"language": "en",
"locality": "oslo",
"size": "m",
"type": "vlr",
"year": 2023
}
|
Informe Local Voluntario - Lima 2021
Garantizar una vida sana y promover el bienestar de las personas de
todas las edades.
ODS 3
Meta 3.1
Meta 3.2
Meta 3.3
Meta 3.4
Meta 3.5
Meta 3.6
Meta 3.7
Meta 3.8
Meta 3.a
Meta 3.c
Meta 3.1
Meta 3.3
Meta 3.2
Mortalidad materna.
Muertes evitables de recién nacidos y de niños menores de 5 años.
VIH, TBC, malaria y otras enfermedades transmisibles.
Mortalidad prematura por enfermedades no transmisibles.
Abuso de sustancias adictivas.
Muertes y lesiones por accidentes de tráfico.
Acceso a salud sexual y reproductiva.
Cobertura sanitaria universal.
Control del tabaco.
Financiación de la salud y personal sanitario.
El proyecto Ciudades solidarias y
comprometidas contra el estigma y la
discriminación trabaja a favor de la población
con VIH, mediante actividades de capacitación
y sensibilización para la promoción de
derechos de dicha población vulnerable. Esta
iniciativa ha sido implementada en alianza
con ONUSIDA y la asociación Ccefro, a partir
de la frma de la Declaración de París por
parte de la MML en diciembre del 20202
.
En Lima, al 2020, el número de muertes maternas
directas fue de 19 (en comparación con las 24 en
el 2019) y el de indirectas, 41 (16 en el 2019).
Al 2019, hubo 3,658 nuevas detecciones de VIH; el
84% de estas se dio en varones.
El 99.7% de los partos vienen siendo atendidos
por personal de salud califcado, mientras que el
95% de los partos son institucionales.
La tasa urbana de mortalidad neonatal en el
2020 ha sido de 8 por cada 1,000 nacidos vivos,
mientras que la de niños menores de 5 años de
edad fue de 16 para el periodo 2017-20181
.
En el 2019, por cada 100 mil habitantes, hubo 117
casos de tuberculosis y 6 de hepatitis B, estadísticas
25
20 21
28
17
14
25 24
19
32
18 18
21 22
18
16 16
41
2012 2013 2014 2015 2016 2017 2018 2019 2020
Número de muertes maternas directas e indirectas
Número de muertes maternas directas Número de muertes maternas indirectas
Fuente: Dirección General de Epidemiología - Minsa
Datos a nivel de Lima provincia
99.00 99.3 99.5 99.6 99.5 99.7
97.7 98.2 98.5 98.8
97.7
95.0
2014 2015 2016 2017 2018 2019
Porcentaje de partos con personal de salud calificado,
institucionales
Porcentaje de partos con personal de salud calificada
Porcentaje de partos institucionales
Fuente: Endes - INEI
Datos a nivel de Lima Metropolitana
2,666
2,913
2,653
3,234
2,228
3,542
2,368
3,658
848 932 775 916
495 721 496 616 597
1,799 2,02 6 1,864
2,291
1,629
2,820
1,872
3,06 1
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Casos de infección por VIH notificados, según sexo y año
de diagnóstico
Total Mujer Hombre
Fuente: Dirección General de Epidemiología - Minsa
Datos a nivel de provincia de Lima
39 Firmado digitalmente por LAURA
RIOS Christian Alberto FAU
20131380951 hard
Motivo: Doy V° B°
Fecha: 07.10.2021 12:09:24 -05:00
Informe Local Voluntario - Lima 2021
Meta 3.4
Meta 3.5 - 3.a
Meta 3.7
Meta 3.6
Meta 3.8
A nivel nacional, la tasa de mortalidad atribuida a
las enfermedades cardiovasculares, el cáncer, la
diabetes o las enfermedades respiratorias crónicas
(porcentaje del total de defunciones) es de 52%.
Acerca de la prevención y el tratamiento del
abuso de sustancias adictivas, en el 2019, el 75%
de personas de 15 años a más había consumido
bebidas alcohólicas en los últimos doce meses6 y
el 4,2% tenía un trastorno por consumo de alcohol7
.
La prevalencia de consumo diario de tabaco para
dichas edades es de 2,4%8. En relación con las
sustancias ilegales, la prevalencia es de 1,4% (1,2%
marihuana y 0,2% clorhidrato de cocaína)9
.
Con relación al acceso a servicios de salud sexual
y reproductiva, se tiene que el 60% de las mujeres
limeñas entre 15 y 49 años de edad practican
la planifcación familiar con métodos modernos11.
Cabe resaltar que, en el contexto de la pandemia,
el acceso a estos servicios se vio seriamente
restringido.
Los accidentes de tránsito y las muertes
relacionadas con ellos son uno de los más graves
problemas estructurales de salud pública en el
Perú. En Lima, la tasa de fallecidos por accidentes
de tránsito por cada 100 000 habitantes fue de 3,8
en el 201710.
Para el año 2019, el número de estos accidentes
fue de casi 95 mil a nivel nacional, el 52% de
ellos registrados en Lima. La cantidad nacional
de fallecidos se estimaba en 250 personas por
mes. Entre enero y febrero del 2020, en Lima, se
registraron 4% más accidentes que en los mismos
meses del año anterior, aunque luego las cifras
descendieron en 70%, debido al confnamiento y
a la prohibición del uso de autos particulares.
En Lima, las personas que cuentan con algún
seguro de salud representan el 73%. Esto incluye
el seguro social de salud contributivo (EsSalud)
y el Seguro Integral de Salud no contributivo y
universal (SIS).
relativamente estables a lo largo de los años.
Finalmente, se notifcaron 2 casos de malaria (en
el 2018, hubo 3)3
.
En relación con el COVID-19, el Perú ha sido uno
de los países más afectados. A junio del 2021
registraba casi dos millones de casos y más de 180
mil muertes, una de las peores tasas de mortalidad
en el mundo4. Tanto en contagios como en
fallecimientos, Lima representa aproximadamente
el 50% del total histórico nacional5
. Los datos
actualizados sobre casos y muertes se encuentran
en la sala situacional en línea para Lima.
de la MML proporciona atención integral
gratuita a la población en situación de mayor
vulnerabilidad víctimas de accidentes de
tránsito, con lesiones graves o, en caso de
muerte, a sus familiares.
Viene atendiendo a más de 3,100 personas
en aspectos legales (1,685), sociales (1,336) y
psicológicos (30 varones y 43 mujeres). Asimismo,
brinda capacitaciones sobre seguridad vial
y charlas de concientización para reducir el
número de fallecimientos por accidentes viales,
llegando con ellas a miles de personas.
El Programa de Defensa Municipal de
Víctimas de Accidentes de Tránsito (PDMVAT) El gasto mensual real promedio per cápita en salud
en el 2020 fue de S/5.68, menor al de otros años.
51.1
51.8 51.3
52.2
53.3
54.3
59.9
58.5
60 .1
2011 2012 2013 2014 2015 2016 2017 2018 2019
Mujeres de 15 a 49 años de edad que practican la planificación
familiar con métodos modernos
Fuente: Endes - INEI
Datos para Lima Metropolitana
45.1 48.7 52.4 53.7 56 58.6 62.3 66.7 69.8 72.7 73.7 72.8 74.4 72.99
27.8 29.5 29.7 30.6 33.5 33.3 34.5 35.0 34.1 34.8 32.8 33.1 33.8
8.8 10.9 12.3 12.5 11.2
16.3 19.5 23.7 27.1 27.8
28.8 30.8
34.6
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Porcentaje de población afiliada a algún seguro de salud,
a EsSalud y al Seguro Integral de Salud
Con seguro de Salud Con Seguro de Salud en EsSalud Afiliado al SIS
Fuente: Enaho - INEI
Datos para Lima Metropolitana
40 Firmado digitalmente por LAURA
RIOS Christian Alberto FAU
20131380951 hard
Motivo: Doy V° B°
Fecha: 07.10.2021 12:09:51 -05:00
Informe Local Voluntario - Lima 2021
Lima cuenta con el Sistema Metropolitano de
la Solidaridad (Sisol)12. Creado ofcialmente
en el 2004 por la MML, se trata de la mayor red
municipal de servicios de atención de salud
ambulatoria del Perú. Este sistema se encuentra
bajo la gestión y la administración de la MML, pero
las consultas están a cargo de microempresas
médicas.
Gracias a su organización mixta, novedosa para
la experiencia peruana de servicios de salud,
Sisol se ha convertido en uno de los sistemas
con mayor demanda, brindando en Lima casi la
misma cantidad de atenciones por año que el
Minsa y EsSalud. Así, para el 2020, Sisol realizó un 1
millón 842 mil atenciones, de las cuales más de un
millón fueron a mujeres. Ese mismo año, realizó
3,399 atenciones solidarias para la contención del
COVID-19. Entre los aspectos positivos, según los
usuarios, se encuentran la cercanía de los locales y
la rapidez con que les atienden13.
Las Brigadas Comunitarias de Salud forman
parte de la estrategia territorial Lima Te Cuida,
y consisten en capacitar a las personas para
fortalecer la participación vecinal en situaciones
de emergencia, brindando primeros auxilios
y, en el actual contexto sanitario, atendiendo
urgencias relacionadas con el COVID-19. Los
brigadistas provienen de algunas de las zonas
económicamente más vulnerables de Lima.
Meta 3.c
En cuanto al personal sanitario, Lima cuenta con
un médico o médica por cada 219 habitantes y una
enfermera o enfermero por cada 296 habitantes;
esto no ha tenido cambios importantes en los cinco
años previos a la pandemia. Aún no se cuenta con
información de cómo esto ha variado con la emergencia
sanitaria.
4
5
6
7
8
9
10
11
12
13
Referencias:
Es necesario fortalecer el aún precario sistema de
salud limeño para atender los casos de COVID-19 y, a
la vez, mantener la atención de otras enfermedades,
epidemias y situaciones que requieren
atención. Es preciso focalizarse en aquellos
distritos y zonas en que el acceso a los servicios
de salud es limitado y la calidad es defciente.
Aún es signifcativo el porcentaje de población que
no cuenta con seguro de salud. Se deben redoblar
esfuerzos para lograr el aseguramiento en salud,
en especial de la población más vulnerable.
Problemáticas como los accidentes de tránsito
y pandemias como el VIH y la tuberculosis
requieren intervenciones decididas orientadas
a reducir drásticamente los nuevos casos.
Es necesario insistir en los servicios de parto
institucional y con personal capacitado,
para asegurar que la mortalidad materna
y neonatal se mantengan a la baja.
Es importante garantizar la participación
protagónica de grupos de riesgo y poblaciones
vulnerables en la toma de decisiones sobre
políticas de salud.
Conclusiones y desafíos
Información brindada por la Presidencia del Consejo de Ministros
(PCM). Ver la noticia aquí.
Ver la Sala situacional del Covid-19 en Perú.
Sistema ODS-INEI.
INEI (2021): Endes.
INEI (2021): Endes.
Comisión Nacional para el Desarrollo y Vida sin Drogas (Devida 2014).
Disponible aquí.
Sistema ODS-INEI.
INEI (2021): Endes.
Página web de Sisol.
Con información de Arroyo J, Pastor-Goyzueta A.: La innovación en la
organización de servicios con el Sistema Metropolitano de la Solidaridad
en Perú. 2013;33(6):391–7, así como de la página web de SISOL.
Con información de INEI (2021): Encuesta Demográfca y de
Salud Familiar – Endes 2020, y del Sistema ODS-INEI.
Página web de ONUSIDA.
Fuentes: Dirección General de Epidemiología – Minsa, y Sistema
ODS-INEI.
1
2
3
8.3
9.0 8.9 9.0 8.98 .9
7.9
7.6 7.5
7.9
8.1
8.3
8.1
5.7
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Proporción asignado en salud del gasto real promedio
per cápita mensual
Fuente: Endes - INEI
Datos para Lima Metropolitana
270 263 255 249 241 237 232 228 224 219
368
355
344
334
323
314 308 302 300 296
20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 20 18 20 19
Número de habitantes por cada médico/a y enfermero/a
Médicos/as Enfermeros/as
Fuente: Minsa
Datos a nivel de Lima Metropolitana
Firmado digitalmente por LAURA 41 RIOS Christian Alberto FAU
20131380951 hard
Motivo: Doy V° B°
Fecha: 07.10.2021 12:10:55 -05:00
Informe Local Voluntario - Lima 2021
42
Firmado digitalmente por LAURA
RIOS Christian Alberto FAU
20131380951 hard
Motivo: Doy V° B°
Fecha: 07.10.2021 12:18:14 -05:00
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] |
[
3
] |
{
"country": "per",
"file_id": "sdg-03/vlr-report-per-de_lima-2021-es-3.pdf",
"language": "es",
"locality": "de_lima",
"size": "l",
"type": "vlr",
"year": 2021
}
|
22 MAFRA MORE SUSTAINABLE - VOLUNTARY LOCAL REVIEW 23
Municipal Sustainability Index 202 2
3 8
Target 3.4 | By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental
. . .
100,000 inhabitants, by Sex
Source: INE (2011/2015-2016/2020), calculated by CESOP
9.5
10.5 10.5 10.5 10.4 9.9 9.6
13.5 13.6 13.7 14.0
12.3 12.4
0
2015 2016 2017 2018 2019 2020 2030
Five-year mortality rate due to intentional self-harm
(suicide) per 100,000 inhabitants
Path to the objective Portugal Mafra
Projection 2030 Objective
21.3
15.3
4.1 4.4
12.4
9.6
Mafra Portugal
Five-year mortality rate due to intentional
self-harm (suicide) per 100,000 inhabitants,
by Sex
Men
Women
Total
Progressão para
o objetivo 2030
Progression toward
the 2030 objective
Municipal Sustainability Index 202 2
4 3
Target 3.c | Substantially increase health financing and the recruitment,
development, training and retention of the health workforce in developing
countries, especially in least developed countries and small island developing
|
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[
3
] |
{
"country": "prt",
"file_id": "sdg-03/vlr-report-prt-mafra-2023-en-3.pdf",
"language": "en",
"locality": "mafra",
"size": "s",
"type": "vlr",
"year": 2023
}
|
17
SDG 3– Good Health and Well-being
The 3rd SDG, with its focus on ensuring healthy lives and promoting wellbeing for all at all ages, covers goals related to access to health care, mortality,
substance abuse, chemicals and pollution, as well as research and disease
eradication (ODSLocal, 2022a).
Regarding the goals of this SDG, the following can be identified as being
associated with access to health care: ensuring universal access to sexual and
reproductive health care (Target 3.7), achieving universal health coverage
(Target 3.8) and increasing health financing, as well as support for professionals
(Target 3.C) (Idem). In relation to mortality, the targets that stand out are to
minimise the maternal mortality rate (Target 3.1), to end all preventable deaths
of new-borns and children under 5 years (Target 3.2), reducing mortality from
non-communicable diseases and promoting mental health (Target 3.4), and also
reducing the number of people killed or injured in road accidents (Target 3.6)
(Idem). In the context of substance abuse, the targets highlighted are to
strengthen prevention and treatment of substance abuse (Target 3.5) and to
implement the Framework Convention on Tobacco Control of World Health
Organization (WHO) (Target 3.A) (Idem). Regarding chemicals and pollution, the
presented target seeks to reduce the number of deaths and illnesses due to
harmful chemicals, contamination and pollution of air, water and soil (Target 3.9)
(Idem). The last target consists of eradicating communicable diseases and is
aligned with the research and disease eradication aspect (Target 3.3) (Idem).
To better understand this SDG, figure 8 helps to understand the SDG and
its targets.
18
Figure 8. SDG 3: Good Health and Well-being. ODSLocal, 2022b. Own translation.
With this in mind, we can list some projects and good practices
implemented by the Matosinhos Municipality in this context.
Examples of projects include:
Centro GIS
PISS (Private Institution of Social
Solidarity) with the purpose of responding to
the existing problems of discrimination and
violence and the lack of services for lesbian,
gay, bisexual, trans and intersex (LGBTI)
victims. The “Gis Centre” is the only structure
in the north of the country to guarantee free and specialised support to LGBTI
people.
19
MATOSINHOS, + Movimento + VIDA 2021
The project (“MATOSINHOS, + Movement + LIFE 2021”) is free of charges
for the population of Perafita, Matosinhos, in a socio-economically disadvantaged
area, and provides weekly physical activity classes for different age groups in
order to combat sedentary lifestyles, social and affective isolation, and contribute
to a better quality of life.
Eu, Tu, Nós... Somos Seixo
A project (“I, You, We… are Seixo”) designed as a response to the
vulnerabilities identified among the population living in the Seixo Housing Estate.
The focus is placed on the residents as agents of change, on the work in building
their capacity and strengthening their image as community leaders in the
neighbourhood are fundamental factors for the maintenance and sustainability of
the project.
In the case of good practice, we listed:
Matosinhos Ativo
“Matosinhos Active” is a free
programme of physical activity, addressed to
senior citizens living in the Matosinhos
Municipality. In addition to being free,
includes insurance and the modalities Cardio
+65 and Aqua +65. Cardio +65 consists of a
set of mobility, flexibility and coordination activities. Aqua +65 is a circuit of
exercises in the aquatic environment.
20
Matosinhos a Cuidar
“Matosinhos Caring” is a programme that involves two interconnected
actions: the Carers' Support Office, which provides an individualised face-to-face
service and promotes integrated support measures to promote the biopsychosocial well-being of informal carers; and the Carers' Stock Exchange
service, as social support, which consists of providing care free of charge, by
people with the appropriate profile and qualifications, to enable informal carers to
take breaks from their caring duties so that they can dedicate themselves to any
other activity that is of personal benefit or merely for rest.
abem: Rede Solidária do Medicamento (“Medicines Solidarity Network”)
Solidarity programme by the Dignitude
Association, which hopes to guarantee
access to out-patient medication for any
citizen in Portugal who is in a situation of
economic need that makes it impossible for
them to purchase the medication prescribed
by a doctor.
21
In the case of health, we show as an example the indicator Deaths from
respiratory system diseases, per 100,000 inhabitants (no.), referring to target 3.9.
By analysing the values in the graphic, it can be seen that the most recent value
has not yet reached the target value (78.6) but is more than 50% of the way to
reaching the 2030 target value.
Figure 9. Deaths from respiratory system diseases, per 100,000 inhabitants (nº). ODSLocal, 2022c.
|
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64 INFORME VOLUNTARIO LOCAL 2022 FILADELFIA - PARAGUAY 65 D
el análisis de las acciones vinculadas del PMD de Filadelfia con respecto al ODS 3 se destaca la mayor presencia del Ministerio de Salud Pública
y Bienestar Social en el municipio de Filadelfia, así como una amplia contribución del sector privado en garantizar el acceso a servicios de salud
esenciales de calidad, acceso a medicamentos básicos y vacunas eficaces, asequibles y de calidad para todos.
El municipio de Filadelfia cuenta con cobertura de salud pública principalmente a través de las Unidades de Salud Familiar USF y el Policlínico Munici
-
pal Amistad. Las poblaciones asistidas provienen no solamente del municipio, sino de varias localidades alejadas de los Departamentos Alto Paraguay
y Presidente Hayes. La atención a los pueblos indígenas se realiza mediante USF habilitadas en las mismas comunidades indígenas. Los trabajadores
indígenas cuentan con un seguro privado conocido como Sistema de Ayuda Mutual Hospitalaria (AMH).
Entre las acciones de la gestión del gobierno municipal, en el área de salud, se destacan las campañas ciudadanas permanentes por la lucha contra el
dengue, la Chikunguña, a través de mingas ambientales, recolección de basuras y pulverización con productos químicos . Realiza intervenciones admi
-
nistrativas ante las denuncias de la ciudadanía por acumulación de basuras y chatarras, letrinas que despiden mal olor, gallineros en zonas urbanas.
Durante la pandemia del COVID 19 ha dispuesto protocolos y medidas sanitarias para la prevención de los contagios, como el lavado de manos con
agua y jabón, el uso correcto de tapabocas y el distanciamiento físico.En lo que respecta a la prevención y el tratamiento de abuso de sustancias adic
-
tivas, incluido el uso indebido de estupefacientes y el consumo de alcohol, como la exposición a productos peligrosos por la polución y contaminación
del aire, agua y suelo el gobierno municipal con trabajos del Departamento de seguridad ha avanzado en las siguientes acciones: z Mejorar en la señalización de las vías, precaución de los transeúntes y la concientización de los conductores. z Promover el registro del conductor y desarrollar espacios de educación vial. z Realizar pruebas de alcotest.
ACCIONES DEL PLAN
DE DESARROLLO MUNICIPAL
2016-2025 z Consolidación de redes de
salud regionales
z Incidencia para el mejor
funcionamiento del sis
-
tema nacional de salud,
y con énfasis en la de
-
finitiva implementación
de las Políticas de Salud
Indígena
Campañas ciudadanas
permanentes por la lucha
contra el dengue,
la chikunguña.
Intervenciones
administrativas ante
las denuncias de la
ciudadanía.
Protocolos y medidas sanitarias
para la prevención de
los contagios
del COVID 19.
Minga
Ambiental
66 INFORME VOLUNTARIO LOCAL 2022 FILADELFIA - PARAGUAY 67 Consejo Local de Salud
El Ministerio de Salud Pública y Bienestar Social con la Municipalidad de Filadelfia conforman el Consejo Local de Salud del distrito de Filadelfia,
representado en este acto por el Intendente Municipal, en su carácter de Presidente.
Esto responde a los requerimientos de la Ley N O 1032/96 crea el Sistema Nacional de Salud, cuyo objetivo es distribuir de manera equitativa y justa
los recursos nacionales en el Sector Salud, con la organización de dicho sistema requiere de una descentralización administrativa, financiera y operacional eficiente y conveniente para el país, tendiente a lograr el desarrollo y fortalecimiento de los servicios locales de salud. Así mismo, esto se
contempla en la Ley Orgánica Municipal NO 3966/10, que determina el compromiso formal del Municipio con la salud de la población local.
El trabajo de este Consejo se relaciona directamente al proceso de descentralización administrativa local en salud de los servicios y programas de
salud, entiéndase como descentralización administrativa local en salud, la delegación de funciones y recursos que compete a la administración
central y departamental en cuanto a la fiscalización del proceso de gestión, planificación local y priorización programática de las actividades de
promoción, prevención y recuperación de la salud, el gerenciamiento de los servicios, control del personal, ejecución presupuestaria, coordinación
interinstitucional, y promoción de la participación social.
El aporte anual del gobierno municipal al Consejo Local de Salud, como base mínima, es el equivalente al 5% de sus ingresos ejecutados para complementar el financiamiento y mejoramiento de los servicios asistenciales. En el año 2021, la transferencia al Consejo de Salud ha sido de Gs. 862.471.075.
En el presupuesto municipal, el financiamiento al Consejo Local de Salud, ocupa el mayor porcentaje de transferencia realizada, por encima de la
transferencia realizada al Gobierno Departamental y al Ministerio de Hacienda.
Policlínico Municipal de Salud “Amistad”
Al Policlínico Municipal de Salud Amistad acuden pacientes que provienen de distintas partes del Chaco, incluso de comunidades alejadas de los
Departamentos de Alto Paraguay y Presidente Hayes, todos los pacientes, especialmente de escasos recursos, acuden en búsqueda de soluciones que
deben ser respondidas por el Centro de Salud. Anualmente el actual Policlínico Municipal de Salud atiende a unas 10.000 personas.
Unidad de Salud Familiar USF
Paraguay, adopta y organiza el modelo de atención basado en redes integradas e integrales de servicios de salud. En este contexto, la unidad efectora
es la Unidad de Salud de la Familia en sus diferentes modalidades (USF satélite, USF móvil, USF estándar, USF ampliada), operacionalizada por un equipo de Salud de la Familia (ESF), mediante una cartera de servicios y capacidad instalada definida para el primer nivel de atención, constituyéndose
en el inicio de un proceso continuo de asistencia sanitaria, abarcando actividades de promoción, prevención, curación, cuidados paliativos y rehabilitación. La vigilancia de la salud a lo largo del curso de vida, en sus diferentes ámbitos (domicilio, escuela, trabajo) y en cualquier circunstancia buscando satisfacer de manera coordinada, integral y continua las necesidades de salud en el territorio social asignado, para
una población estimada en 2.800 a 4.000 habitantes, considerando especificidades para comunidades rurales y pueblos indígenas.
Unidad de Salud Familiar (USF) en la comunidad indígena Uj’e Lhavos
El municipio ha construido con el Ministerio de Salud y la Gobernación de Boquerón la USF en la comunidad indígena Uj’e Lhavos
para la atención primaria de la salud, atención odontológica. Además, la USF cuenta con una farmacia social y programas de
atención a la salud extra muro.
En el año 2020 la USF fue reacondicionada a través del Consejo Local de Salud, por un monto de Gs. 160.000.000, con fondos
provenientes de la Municipalidad de Filadelfia. La USF fue fortalecida para afrontar la pandemia del COVID 19. Además, las obras
fueron realizadas con mano de obra de la propia comunidad. Esta unidad asistencial funciona desde el año 2012. La población de
Uj’e Lhavos es de aproximadamente unas 3.000 personas. La USF atiende a pacientes de la comunidad y además a personas de otros
barrios de la ciudad.
Unidad de Salud Familiar (USF) en la comunidad indígena Cacique Mayeto
La Unidad de Salud de la Familia (USF) de la comunidad indígena Cacique Mayeto, ofrece servicio de atención a la salud pública no
solo para los miembros de la comunidad sino también a la población fuera de la comunidad. Cuenta con un Médico General, una
Obstetra, una Técnica en Enfermería y dos Agentes Comunitarios, que brindan el servicio de lunes a viernes de 07:00 a 13:00 horas.
La USF cuenta con todos los programas y servicios de prevención y asistencia ofrecidos por el Ministerio de Salud Pública en
lo que respecta a Atención Primaria a la Salud. Realiza campañas de vacunación para toda la población de prevención de Influenza, contra el COVID-19 y las que forman parte del esquema regular de vacunación. Además de brindar charlas educativas
y de prevención para la comunidad.
La comunidad indígena Cacique Mayeto está asentada sobre un predio que pertenece a la Cooperativa Fernheim utilizando 15 ha de
las 70 ha que dispone en el sitio la cooperativa, dentro de las 15 has hay entre 128 y 130 lotes, donde habitan 298 familias.
La USF la comunidad indígena
Uj’e Lhavos fue fortalecida para afrontar
la pandemia del COVID 19. Además, las
obras fueron realizadas con mano de
obra de la propia comunidad.
La población de Uj’e Lhavos es de
aproximadamente unas 3.000 personas.
La comunidad Cacique Mayeto,
del pueblo Enlhet, está situada dentro
de la ciudad de Filadelfia. Ocupa un
predio de 15 has donde están asentadas
en unos 128 y 130 lotes, donde habitan
298 familias.
El Pueblo Enlhet es el quinto pueblo
indígena más urbanizado de Paraguay.
68 INFORME VOLUNTARIO LOCAL 2022 FILADELFIA - PARAGUAY 69 La comunidad indígena del pueblo Enlhet, está situada dentro de la ciudad de Filadelfia. El Pueblo Enlhet es el quinto pueblo indígena más urbanizado
de Paraguay. A nivel país están distribuidos en cinco comunidades rurales y cinco urbanas situadas entre los departamentos de Boquerón y Presidente
Hayes. Cacique Mayeto, es una de ellas, también llamada “Barrio Obrero Lengua” o “Misión Enlhet”. La mayor parte de los hombres trabaja en actividades económicas relacionadas a la lechería, la quesería, procesamiento de carne, de maní, que les permite acceder a un sistema de salud privado de
la Cooperativa Fernheim que es la Asistencia Mutual Hospitalaria (AMH). Mientras que las mujeres trabajan como empleadas domésticas.
En el municipio de Filadelfia, además, se encuentran otra USF que asiste a la población rural de Tte. Martínez y la USF Arco Iris. La USF de Arco Iris está
ubicada a unos 70 kilómetros del casco urbano de Filadelfia y brinda sus servicios principalmente a las comunidades indígenas angaité como San
Martín, Santo Domingo y algunas comunidades indígenas cercanas, de la parcialidad ayorea. La municipalidad colabora con la USF, principalmente en
el traslado del personal de blanco para consultas y campañas de vacunación en las comunidades indígenas.
El Hospital Privado Filadelfia
La Asociación Fernheim fue la primera forma de organización de la Colonia Fernheim. La extrema necesidad en los tiempos difíciles de la colonización
impulsó a buscar esta forma solidaria de unión. Esta asociación tiene el fin de garantizar una asistencia frente a las necesidades sociales y culturales
de sus socios. El Hospital Filadelfia vela por la salud integral de los socios de la Asociación Fernheim y atiende a todas las personas que acuden a
sus servicios.
El Hospital Filadelfia funciona desde los inicios de la fundación de la Colonia Fernheim. Los servicios que brinda son: consultas médicas familiares y
de especialistas, cirugías, internaciones, primeros auxilios, exámenes de laboratorio, diagnósticos con ultrasonido, EKG, rayos X y tomografía, colonoscopía. Además, ofrece servicios fisioterapéuticos, fisioterapia y traslados con ambulancias.
Una escuela de enfermería, INFORTES Filial Escuela de Enfermería Filadelfia, funciona en su seno desde hace 50 años. Es una carrera académica, reconocida por la Universidad Evangélica del Paraguay.
El Sistema de Ayuda Mutual Hospitalaria (AMH)
Para la atención médica integral y especializada de la población indígena del Chaco. (Vía Decreto reglamentario fueron designados la ASCIM, la Colonia Menno, la Colonia Neuland y la Colonia Fernheim como grupos patronales de la AMH). Son 13 las comunidades indígenas asistidas por el seguro
médico privado AMH.
En el 2022, se ha concretado la Conformación del Consejo Municipal de Prevención y Tratamiento de Adicciones sustentada en la Ley Nº . 6.800 del
Poder Legislativo y estará conformado por representantes de instituciones públicas y privadas.
Brecha del ODS 3
En materia de salud, la brecha del ODS 3 a nivel local es desarrollar una Hospital Distrital de segundo nivel de atención y complejidad media con
70 camas y 2 camas de terapia intermedia. Los servicios que debe brindar son: atención ambulatoria, urgencias, internación, rehabilitación, estudios
diagnósticos, cobertura de componentes sanguíneos en especialidades básicas: pediatría, ginecoobstetricia, clínica médica y cirugía hasta mediano
riesgo. La infraestructura hospitalaria pública más cercana es el Hospital Materno Infantil de Villa Choferes del Chaco a 16 km, fuera del distrito; el
Hospital Regional del MSPBS a 77 km; el Hospital Indígena en la ciudad de Limpio a 450 km y; el Hospital Central del IPS Central a 455 km.
En base al Manual de Organización de los Servicios de Salud en el marco de las RIISS Paraguay del MSPBS, la categoría sería la de un Hospital Distrital,
la cobertura iría más allá de los limites distritales, tomando en cuenta la peor situación sanitaria en los distritos aledaños. La población beneficiada
directa sería la distrital (23.000 hab. estimados) e indirectamente la población de los distritos de Carlos Casado, Loma Plata, Boquerón, Mcal. Estigarribia y Bahía Negra.
En base a un programa establecido en conjunto con el Consejo Local de Salud y su traducción en una estimación de áreas, se llegó al resultado de
mínimamente 4.700 m² cubiertos. Traducido a un costo mínimo de 1.000US/ m² equivale al cambio actual a 32.900.000.000 Gs. o 4,7 millones de dólares norteamericanos. Esto no incluye equipamiento.
El municipio cuenta con un terreno de 36.000 m² (3,6 ha) con un valor mínimo de 4.320.000.000 Gs. o 615.000 US$. Cuenta con equipamiento de consultorios, ecografía, odontología, laboratorio y farmacia que trasladaría y un valor estimado de 600.000.000 Gs. o 85.000 US$. A esto se suma el aporte
anual municipal al Consejo Local de Salud que es de 750.000.000 Gs. o 107.000 US$. Desarrollo de Anteproyecto Arquitectónico por valor estimado de
90.000.000 Gs. o 13.000 US$ .
|
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[
3
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{
"country": "pry",
"file_id": "sdg-03/vlr-report-pry-filadelfia-2022-es-1.pdf",
"language": "es",
"locality": "filadelfia",
"size": "l",
"type": "vlr",
"year": 2022
}
|
Voluntary local review of Helsingborg Voluntary local review of Helsingborg
THE PANDEMIC’S
PROBABLE IMPACT ON
THE GOALS
Goal 3:
The pandemic year has had an impact on people’s everyday exercising. Travelling to work has
decreased, including the small journeys made by foot or bike between, for example, the home
and station, which reduces the amount of everyday physical activity. Fewer visit restaurants
which could affect eating habits both to the better and for the worse, depending on the type of
food and the individual’s ability to prepare healthy meals at home. The production of fruit and
vegetables from both Sweden and the rest of Europe will decrease as a result of a shortage of
seasonal labour in agriculture, as noted by grocery stores. This entails a risk of price increases
for fruit and vegetables which could hit hardest on low-income groups and unemployed that
even before the crisis had the lowest intake of fruit and vegetables.
71
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[
3
] |
{
"country": "swe",
"file_id": "sdg-03/vlr-report-swe-helsingborg-2021-en-5.pdf",
"language": "en",
"locality": "helsingborg",
"size": "s",
"type": "vlr",
"year": 2021
}
|
Voluntary local review of Helsingborg Voluntary local review of Helsingborg
GOAL 3.
GOOD HEALTH AND
WELL-BEING FOR ALL
Public health in Sweden is generally good compared to most countries. The average life expectancy is high. The healthcare provided in Sweden is considered good and there is public
access to tax-funded healthcare for those who need it. The regions are responsible for providing healthcare, and the municipalities oversee many of the welfare services that greatly affect
people’s health throughout their lives – school, care and social services, as well as leisure and
cultural activities and urban planning. By way of their core assignments and activities, municipalities have an opportunity to work in ways that prevent disease and promote health. Many
of the SDG´s targets are related to challenges facing Sweden and Helsingborg. However, not
all targets are relevant in a Swedish context. We need to work more with the growing health
divides between different social groups, preventing disease, promoting good mental health,
preventing suicide and substance-abuse problems, and engaging more people in physical
activity. 15
Voluntary local review of Helsingborg Voluntary local review of Helsingborg
ANALYSIS
Goal 3 is largely dependent on the progress made in other areas. Combatting poverty, creating good education opportunities for all, good working conditions, and fnancial growth – in
addition to making cities and communities sustainable – strongly infuence the opportunities for ensuring good health among the population. Also, the environment impacts people’s
health both in the short and long term.
Health is not only infuenced by one’s genes and lifestyle, but also (and especially) underlying factors that are impacted by our immediate surroundings, opportunities, and access to
a good education, recreation, relationships and social interactions, and employment. How
people perceive their life situation, their surroundings, and their faith in the future also play a
part. Therefore, the goals concerning equal opportunities, gender equality, and peaceful and
inclusive communities also factor in.
The goal and its targets have largely been fulflled in Helsingborg. However, there are some
challenges pertaining to the growing difference in health between men and women, between
groups with varying educational backgrounds, and between individuals born in Sweden and
those of foreign origin. Among young women, non-binary and LGBTQ individuals, as well as
people with disabilities, mental ill-health is more prevalent compared to other groups. There
are multiple consequences of mental ill-health, the most serious of which lead to increased
violence in society, various forms of substance abuse, and in some cases, suicide.
Preventative and health-promoting efforts start with,
among other things, more physical activity
Children and young people who are physically active are more likely to perceive their health
as good compared to children who are not as active. They also perform better academically
compared to those who are physically inactive. We know from health surveys that a large
proportion of the adults in Helsingborg remains motionless for most of the day. The majority
also use their car for travelling shorter distances between 1–3 km rather than going by foot
or bicycle. Low physical activity, as well as social inactivity and sense of loneliness has a
negative effect on health perception. In Helsingborg 19 per cent of the men report that they
have no close friend to rely on for emotional support. Sense of loneliness is frst and foremost a growing problem among the elderly. That is why we need to invest more in engaging
people in physical and social activity, and work to promote health and prevent illness at as
early a stage as possible in our children’s and young people’s lives and prevent loneliness
among the elderly. Increased physical activity also reduces the risk of mental ill-health.
Physical and mental health are two priority areas in upcoming strategic steering documents
for sustainable development - the Quality-of-Life Programme, where we place particular emphasis on closing health gaps to ensure we leave no one behind.
Voluntary local review of Helsingborg Voluntary local review of Helsingborg
A GLIMPSE OF WHAT WE
ARE TESTING IN HELSINGBORG
There are several examples of initiatives aimed at improving people’s quality of life in Helsingborg. The city is using innovative approaches so that the physical environment promotes
health and equality through thoughtful design, the participation of children and young people,
environments adapted for individuals with dementia, and equality-based certifcation for inclusive public spaces. We are looking into innovative methods for creating conditions for good
health among children and young people, such as prescribed physical activity, health-promoting schools, and methods for existential health.
GETTING MYSELF
TO SCHOOL
– A PROJECT TO PROMOTE
WALKING AND BIKING TO SCHOOL
17
Voluntary local review of Helsingborg Voluntary local review of Helsingborg
– A PROJECT TO PROMOTE
WALKING AND BIKING TO SCHOOL
LEARN TO BIKE
FOR ADULT WOMEN
BORN ABROAD
GYMS AT ELDERLY
CARE HOMES
|
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[
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{
"country": "swe",
"file_id": "sdg-03/vlr-report-swe-helsingborg-2021-en-6.pdf",
"language": "en",
"locality": "helsingborg",
"size": "m",
"type": "vlr",
"year": 2021
}
|
CITY OF MALMÖ • VOLUNTARY LOCAL REVIEW • APPENDIX 1 | SDG 3 10
SDG 3. Good Health and Well-being
15 The indicator has not been followed up in this VLR.
16 The indicator has not been followed up in this VLR.
17 Kolada uses four-year averages (T-4 to year T) to calculate average life expectancy at municipal level (Kolada N00925; N00923).
18 WSP conducted an evaluation of the Malmö Commission in 2020 on behalf of the City of Malmö. WSP is of the opinion that the health of Malmö
residents has improved over time, although they fnd it difcult to link this positive development directly to the work of the Malmö Commission.
WSP’s analyses of health and health determinants and their development over time indicate overall positive development for most of the variables
analysed. The improvement applies both to Malmö as a whole and in relation to Skåne and Sweden as a whole. Further, there was a reduction in
inequality within Malmö in 2011–2016, between both men and women, people born in Sweden and people born abroad, and between diferent
districts. WSP points to the increasing average life expectancy of the population in general in Malmö, for example, and in all levels of education
since the 1990s. The rate of increase is diferent, however. WSP also highlights the fact that many of the social health determinants have improved in
Malmö. Child poverty has decreased, for example, the percentage of students in Malmö who meet the knowledge requirements has increased and
the percentage of children in preschool has increased between 2013 and 2018 (WSP 2020).
SDG 3 (Good Health and Well-being) aims to create
social conditions to promote good, equal health for
all. From a global perspective, it can be concluded that
public health in Sweden is generally good. Maternal
and infant mortality is low in Sweden, and the number
of people injured and killed in road trafc incidents
and the number of deaths from certain non-communicable diseases has decreased steadily over time (SCB
2019, page 31). Health is also developing positively in
several other respects: average life expectancy is increasing, more people consider their overall health to be
good, and premature death (deaths between the ages of
15 and 64) are decreasing. However, this development
difers between diferent groups in society. To improve
public health still further, health needs to be improved
in the group of people with the worst health, who are
otherwise at risk of being left behind. Health inequalities arise when diferent groups systematically have
diferent living conditions and lifestyle habits. Te
diferences in health can eventually become so great
that they result in diferences in average life expectancy
between diferent groups (Folkhälsomyndigheten
2020), which is a pattern that is echoed in Malmö.
Tere are fve indicators for the goal:
• Life expectancy for men/women
• Residents who consider themselves to be in good
health
• People on long-term sick leave with mental
problems
• Fall injuries among people over the age of 6515
• Antibiotic sales on prescription/1,000 res.16
Life expectancy is increasing at a faster
pace for men compared with women, and
difers between diferent groups of Malmö
residents
Life expectancy is an indicator for measuring the
outcome in relation to SDG 3. In the latest sustainability follow-up from 2020, the analysis showed that
the average life expectancy of Malmö residents has
increased from 82.7 years for women and 77.9 years
for men in 2010, to 83.9 years for women and 80.0
years for men in 2019.17 Tus this means that average life expectancy is higher for women, but that it
is increasing at a faster pace for men. Te average life
expectancy of men and women in Malmö is slightly
below the national average, which in 2019 was 84.2
years for women and 80.8 years for men (Kolada
N00925; N00923).18 One pattern that has persisted
over time indicates that average life expectancy is also
continuing to difer depending on the level of education, the highest average life expectancy being seen in
the group of individuals with the highest level of education. Te diference in remaining average life expectancy at the age of 30 in Malmö between men with
only primary and secondary education and women
with post-secondary education is approximately nine
years (SCB, Skåne database, own calculations).
11
Most Malmö residents are of the
opinion that they feel well, but this
varies depending on gender, age
and level of education
Te personal perception of health provides an
overall picture of how people perceive their own
health, both physically and mentally. Studies have
shown a link between people’s own perceptions
and their future health, care-seeking and mortality
(Folkhälsomyndigheten 2018). In total, 70 per cent
of adult Malmö residents rated their health as very
good or good in 2019, which is on par with Skåne and
the national average. A slightly lower percentage of
women than men reported a good personal perception
of health in 2019. Tis percentage increased between
2004 and 2012, but the latest survey bucked the positive trend.
Age afects the personal perception of health: that is a
fact. Tat is why it is not surprising to see that the
oldest age group contains the lowest percentage of
individuals who would rate their own health as good.
It is also among the oldest Malmö residents that the
diferences between the genders are the greatest (see
Figure 3).
As research has established on many occasions, the
level of education is of signifcance to how people
perceive their health. Te city’s sustainability follow-up
from 2020 shows that among Malmö residents with
post-secondary education, 75 per cent rated their
health as good compared with 63 per cent of Malmö
residents with primary and secondary education.
19 Region Skåne’s 2019 public health survey examined impaired mental well-being with an abbreviated version (GHQ-5) of the established General
Health Questionnaire (GHQ) GHQ5 is made up of fve questions about how you have felt in recent weeks. The respondent is deemed to have impaired mental well-being if answering at least two questions in the afrmative.
Mental illness, stress and long-term sick
leave more common among women and
younger Malmö residents
Among adult Malmö residents, slightly more than one
in fve reported impaired mental well-being19 in 2019,
which is a slightly higher percentage than in Skåne as
a whole (19 per cent) and Sweden as a whole (17 per
cent). An analysis of developments over time showed
that the percentage of people with impaired mental
well-being increased slightly from 2004 onwards
(Region Skåne 2000–2019). Te city’s younger residents (aged 18–34) account for the highest percentage
of people with impaired mental well-being, while
the lowest percentage is in the 65–69 age range. Te
analyses also show that the percentage of people with
impaired mental well-being is higher among women
than among men in all age categories.
Te follow-ups from 2019 and 2020 have been unable
to show any major diference in impaired mental
well-being linked with educational achievement.
However, there is some diference depending on the
region of birth, one in fve Malmö residents born in
Sweden having impaired mental well-being compared
with one in four Malmö residents with an overseas
background (outside Europe).
As regards long-term sick leave with mental illnesses,
comparisons over the 2005–2018 period show that
Malmö is above the national average, but slightly
below Stockholm and Gothenburg. More women than
men are on long-term sick leave with a psychiatric
diagnosis (Kolada N74811).
Major diferences between girls and boys
as regards mental well-being
Given the current methods for measuring mental
well-being, the analysis shows a signifcant diference between how girls and boys in Malmö feel on
a mental level; which is the same pattern that can be
seen nationally. Te analyses in Sustainability Report
2019, based on data from Region Skåne’s public health
report on children and young people from 2016,
showed that among children and young people, the
percentage who rated their health as good was higher
100%
80%
60%
40%
20%
0%
Women
Men
Total
18–34 35–44 45–54 55–64 65–69 70–74 75–84
Figure 3. Percentage of Malmö residents with a good
personal perception of health per age group and gender in
2019 (%). Source: Region Skåne 2000–2019.
CITY OF MALMÖ • VOLUNTARY LOCAL REVIEW • APPENDIX 1 | SDG 3
CITY OF MALMÖ • VOLUNTARY LOCAL REVIEW • APPENDIX 1 | SDG 3 12
among boys compared with girls. It was also found
that the percentage of young people who reported
good health fell between 2012 and 2016. Tis trend
was independent of gender, country of birth and age.
Te same declining trend could be perceived for the
percentages of children and young people who were
looking forward to the future. A decrease was also
apparent as children grew older, and fewer girls than
boys reported looking forward to the future. Girls also
reported higher incidences of mental problems and felt
that their quality of life was signifcantly lower than for
boys (Region Skåne 2016).
Tis view was confrmed in the latest follow-up. In
health surveys conducted within the student health
service in Malmö, the vast majority of children state
that they mostly feel fne and are happy in themselves.
However, older girls generally feel worse than others
(see Figure 4). Similar diferences in terms of age and
gender are seen both in Skåne and nationally (Region
Skåne 2016). One in fve girls in Years 7–8 felt down
every day or frequently in the 2019/2020 academic
year, compared with just under one in ten boys. Tere
is also a slight increase over time among girls in Years
7–8 since the 2016/2017 academic year, from 18 per
cent to 21 per cent. No corresponding increase is seen
among boys, or for Year 4 children (medicinska elevhälsan 2016–2020).20
20 It is important to problematise how mental illness is measured so as to capture the experiences of both boys/girls and men/women. The poor wellbeing of boys and men can take on forms other than the one normally used to measure mental illness. Norms related to gender, for example, can
be used to understand why mental illness among boys and men can manifest itself in more extroverted behaviour, which can include violence in
various forms (Folkhälsomyndigheten 2019, page 11). In a recently published literature review, the Swedish Gender Equality Agency has highlighted how norms linked with masculinity can have a negative impact on both physical and mental health, and that certain masculinity norms are
interlinked with more extroverted behaviour, but also a reduced inclination to seek support for mental problems (Jämställdhetsmyndigheten 2021,
page 80 f ). The report also criticises the fact that there is limited research in Sweden to highlight the link between masculinity norms and health
outcomes: most of the research available is based on Australia and the US (ibid, page 79).
In 2018, Region Skåne (2018–1) published a supplement to Folkhälsorapport Barn och Unga i Skåne 2016
[Public health report, children and young people in
Skåne 2016] which focused on young people’s health
on the basis of gender identity. In this survey, 1.7
per cent reported diferences between their biological
gender and their gender identity and were categorised
as transgender. Tese children more often considered
their health to be poor, were more likely to report
that they did no sleep enough and were unhappy
with themselves to the same extent as other children. A similar pattern emerges from health surveys
conducted in the feld of student health in the City
of Malmö, where students questioning their gender
identity generally report poorer health. Tese children
belong to a particularly vulnerable group in society
who are not always given the same rights as people
whose gender identity matches the gender assigned at
birth, even though they are protected by the Swedish
Discrimination Act.
Region Skåne’s (2018–2) supplement to Folkhälsorapport Barn och Unga i Skåne 2016 [Public health
report, children and young people in Skåne 2016] on
the health of children and young people with disabilities shows that students with some form of disability
are more likely to consider their health to be poor
compared with other students. Tis group of young
people report more physical and mental problems,
everyday stress, the fact that they feel less happy with
life and that they are more frequently less happy with
their relationships with their families. Moreover, they
are less likely to have close friends and experience
loneliness more frequently than students without disabilities. Tere is a diference between the genders here,
too, with girls having poorer health and higher levels
of perceived loneliness (Myndigheten för delaktighet
2020).
60%
50%
40%
30%
20%
10%
0%
Girls
Boys
Total
Year 6 Upper secondary school Year 1
Figure 4. Percentage of people who felt depressed or sad
most of the time in the last year, even if they sometimes
feel fne: by gender, 2017 and 2019 (%). Source: Stadskontoret, Malmö stad 2017, 2019.
|
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[
3
] |
{
"country": "swe",
"file_id": "sdg-03/vlr-report-swe-malmo-2021-en-8.pdf",
"language": "en",
"locality": "malmo",
"size": "l",
"type": "vlr",
"year": 2021
}
|
This goal aims to create social conditions to promote good, equal health for all. From a
global perspective, it can be concluded that public health in Sweden is generally good;
and this is also true of Malmö. The inequality in health between diferent groups poses
the biggest challenge for Malmö.
Most Malmö residents are of the opinion that they feel well, but this varies depending
on gender, age and level of education. The oldest age group contains the lowest
percentage of individuals who would rate their own health as good. Mental illness
continues to present a major health challenge, and we are seeing deterioration over
time. The city’s younger residents (aged 18–34) account for the highest percentage of
people with impaired mental well-being, and girls generally feel worse than boys.
In Malmö, average life expectancy for men is increasing at a faster pace than for
women. One pattern that has persisted over time indicates that average life expectancy difers depending on the level of education, the highest average life expectancy
being seen in the group of individuals with the highest level of education. The difference in remaining average life expectancy at the age of 30 in Malmö between men
with only primary and secondary education and women with post-secondary education is approximately nine years.
|
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] |
[
3
] |
{
"country": "swe",
"file_id": "sdg-03/vlr-report-swe-malmo-2021-en-9.pdf",
"language": "en",
"locality": "malmo",
"size": "s",
"type": "vlr",
"year": 2021
}
|
SDG3
Mwanza City faces challenges in achieving
SDG 3, including a high maternal mortality
ratio (386/100,000 live births), which
exceeds both the local target and the SDG
threshold. Although progress has been made
in reducing under-five mortality and
maintaining a high proportion of vaccinated
children, the city is at risk of not achieving
the SDG target for neonatal mortality and is
witnessing an increase in deaths due to
noncommunicable diseases, primarily
cardiovascular and respiratory conditions.
However, the city has achieved a significantly
lower adolescent birth rate compared to the
national average.
Recommendations:
● Enhance healthcare accessibility and
affordability, by improving the availability
and distribution of medical
infrastructure and providers,
considering the population's needs.
● Stimulate prevention initiatives through
educational activities, focusing on
promoting healthy lifestyles and disease
prevention.
● Strengthen health systems and
workforce, by training and increasing the
number of healthcare workers to
address the shortage and improve
service quality; and ensuring the
availability of essential medicines and
sexual and reproductive health services
● Reduce maternal mortality, by (1)
promoting antenatal care, including early
identification and treatment of
pregnancy complications; (2) increasing
coverage of IPT2 vaccinations, postnatal
care, and reproductive health services;
(3) ensuring timely access to quality
emergency obstetric care for women
with pregnancy complications; and (4)
improving health insurance coverage to
remove barriers to necessary medical
treatments.
67
● Address non-communicable diseases
(NCDs), by implementing awareness
campaigns and population screenings to
identify NCDs at an early stage and
increasing public knowledge about
modifiable risk factors like tobacco use,
harmful alcohol consumption, unhealthy
diets, and physical inactivity.
68
|
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[
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{
"country": "tza",
"file_id": "sdg-03/vlr-report-tza-mwanza-2022-en-3.pdf",
"language": "en",
"locality": "mwanza",
"size": "s",
"type": "vlr",
"year": 2022
}
|
3.2 SDG 3 - Ensure healthy lives
and promote well-being for all at
all ages
The Sustainable Development Goal 3 focuses
on ensuring healthy lives and promoting wellbeing for all at all ages. The goal encompasses
a broad range of health-related targets and
indicators that aim to address various
aspects of global health challenges. It seeks
to improve access to quality healthcare
services, reduce maternal and child
mortality, combat major diseases, promote
mental health, and address substance abuse,
among other key areas. SDG 3 recognizes
the fundamental importance of good health
and well-being as essential foundations for
sustainable development.
Due to data availability, the city of Mwanza is
reporting targets 3.1, 3.2, 3.4, and 3.7, as well
as UMF indicator 14 which falls under SDG
3.
3.2.1 Highlights
● In 2022, the Maternal Mortality Ratio
sits at 386/100,000 live births, far
above the local target of 172/100,000
and SDG threshold of 70/100,000.
● Mwanza City has managed to reduce
the under-five mortality rate from 9.5
per 1000 live births in 2020 to 6.6 per
1000 live births in 2022.
● The proportion of vaccinated
children under 1 year old sits at a high
● level with an average of 98%
throughout 2020-2022.
● The neonatal mortality rate sits at
33.7/1000 in 2022, increasing slightly
from 2021.
● Deaths by noncommunicable
diseases are on the rise, with 149
cases in 2021.
● In 2022, the adolescent birth rate of
8.6 in 1000 teenagers in Mwanza City
is significantly lower than the entire
country's adolescent birth rate of 132
in 1000 girls.
19
3.2.2 Target review
Target 3.1 Reduce the global maternal
mortality ratio to less than 70 per 100,000
live births by 2030
Target 3.1 underscores the urgent need to
improve maternal healthcare, enhance
access to quality services, and prevent
complications during pregnancy and
childbirth. Maternal mortality remains a
public health problem in developing
countries, including in Tanzania. Achieving
this goal will contribute to the well-being and
survival of mothers in the city, promoting a
healthier future for all.
The local target of reducing maternal
mortality to 172/100,000 by 2023 has not
been achieved, with a current Maternal
Mortality Ratio of 386/ 100,000. Several
factors may contribute to this high rate.
For instance, in the previous year, only
6.4% of women received postnatal care
services, despite the target being set at 50%
for 2023 (MTEF, 2022). Additionally,
although 80% of pregnant women were
scheduled for IPT2 vaccination by 2022, only
10.2% received it. Similarly, reproductive
health services were received by only 9% of
the targeted 80% in 2022 (MTEF, 2022). The
lack of healthcare infrastructure in the city
may contribute to these figures, and thus the
high maternal mortality rate.
Target 3:1 Reduce the global maternal mortality ratio to less than 70 per 100,000 live births by
2030
Indicator 2020 2021 2022 Local target SDG status
SDG 3.1.1
Maternal mortality ratio per
100,000 263 261 386
172/100,000
(by 2023) At risk
Source: Mwanza City Council (2023)
Image: Vice president Dr. Mpango visiting a
mother and her newborn child at the newly built
Sekou Toure Hospital.
20
Target 3.2: End preventable deaths of
newborns and children under 5 years of
age
SDG Target 3.2 is dedicated to ending
preventable deaths among newborns and
children under the age of five. It specifically
aims to reduce neonatal mortality to at least
12 deaths per 1,000 live births and maintain
under-five mortality below 25 deaths per
1,000 live births by 2030. This target
emphasizes the importance of addressing the
underlying causes of child mortality to
ensure a healthier and brighter future for our
youngest generation.
Significant progress has been made in
reducing mortality rates among children
under the age of five which dropped to
6.6/1000 live births in 2022. This
development has likely been supported by a
substantial increase in Insecticide-Treated
Nets coverage from 26% in 2019 to 80% in
2022; a rise in Vitamin A supplementation to
90% in 2022; and 100% of diagnosed
uncomplicated malaria cases receiving
adequate treatment in 2022. Additionally,
the proportion of vaccinated children under
the age of 1 sits at a high level with an average
of 98% throughout 2020-2022.
In contrast, the neonatal mortality rate sits
at 33.7/1000 in 2022, increasing slightly from
2021. While still representing a reduction
from 43.8/1000 live births in 2020 the SDG
target is at risk of not being achieved by
2030.
Target 3.2 End preventable deaths of newborns and children under 5 years of age, reduce
neonatal mortality at least at 12/1000 live births, keep under-five mortality less than 25/1000
live births by 2030
Indicator 2020 2021 2022 Local target SDG status
SDG 3.2.1 / 1.1.1 (UMF-01)
Under-5 mortality rate per 1000
live births 9.5 9.3 6.6
Reduce
under-five
mortality to
10/1000 by
2023
Achieved
SDG 3.2.2
Neonatal mortality rate per live
1000 births 43.8 32.5 33.7
Reduce
neonates
mortality to
15/1000 by
2023
At risk
1.2.6 (UMF-14)
Proportion of vaccinated
children under year 1
(DPT3/HB3/Measles)
100% 96% 98% >90% Achieved
Source: Mwanza City Council (2023) 21
Target 3.4 Reduce 1/3 mortality from
non-communicable diseases through
prevention and treatment and promote
mental health and well-being
SDG Target 3.4 aims to reduce mortality
from non-communicable diseases (NCDs) by
one-third through prevention, treatment,
and the promotion of mental health and wellbeing. This target recognizes the growing
impact of NCDs on global health and
emphasizes the need for comprehensive
strategies to address their prevention,
treatment, and management. Additionally, it
highlights the importance of prioritizing
mental health and well-being as integral
components of achieving sustainable
development and ensuring healthy lives for
all.
SDG Indicator 3.4.1 and UMF indicator 1.3.2
(UMF-18) measure the mortality rate
attributed to NCDs. In 2016, Mwanza’s
population recorded 60 deaths from NCDs.
This number increased to 149 cases in 2021
(Mwanza Profile, 2022). Among the reported
causes of death, cardiovascular diseases such
as heart failure and hypertensive heart
conditions were the primary contributors,
followed by respiratory diseases. It is
important to note that the impact of the
COVID-19 pandemic is likely reflected in the
increased mortality rates in 2020 and 2021.
The number of deaths attributed to
attributed to cardiovascular disease, cancer,
diabetes shows an increase between 2020
and 2021 that far exceeds the local target of
under 50 cases.
Target 3.4 Reduce 1/3 mortality from non-communicable diseases through prevention and
treatment and promote mental health and well-being
Indicator 2020 2021 2022 Local target SDG status
SDG 3.4.1 / 1.3.2 (UMF-18)
Mortality rate attributed to
cardiovascular disease, cancer,
diabetes diseases (no. of cases)
133 149 ...... <50 cases
At risk
Source: Mwanza City Council (2023)
22
Target 3.7 Ensure universal access to
sexual and reproductive health-care
services, including for family planning,
information and education by 2030
SDG Target 3.7 focuses on ensuring
universal access to sexual and reproductive
health-care services by 2030. This includes
comprehensive provision of family planning,
information, education, and other
reproductive health services. By prioritizing
access to these essential services, this target
aims to promote reproductive rights, reduce
maternal mortality, empower individuals
with informed choices, and enhance overall
sexual and reproductive health for all,
contributing to sustainable development and
well-being.
Pregnancy and childbirth during adolescence
can affect a girl's healthy growth into
adulthood and have adverse effects on her
education, lifestyle, and health also leading to
increased health risks of the child as well as
increased risk of the same adverse socioeconomic risks that their mothers face. The
adolescent birth rate is thus an important
indicator that is captured as SDG 3.7.2. as
well as UMF indicator 1.1.7 (UMF-07). In
2022, 8.6 in 1000 teenagers in Mwanza City
gave birth. Notably, this birth rate is
significantly lower than the entire country's
adolescent birth rate of 132 per 1000 girls
(Tanzania Demographic Health Survey,
2016). Reasons for teenage girls falling
pregnant are complex but can include a lack
of adequate parenting, poor sex education,
low educational attainment and poverty
which lead to early marriage.
Target 3.7 Ensure universal access to sexual and reproductive health-care services, including for
family planning, information and education by 2030
Indicator 2020 2021 2022 Local target SDG status
SDG 3.7.2 / 1.1.7 (UMF-07)
Adolescent birth rate (aged 10-
19 years) per 1000 women in
that age group
10.2 9.5 8.6 < 20
Achieved
Source: Mwanza City Council (2023)
23
3.2.3 Implications for policy and practices
Mwanza City has a total of 73 healthcare
facilities, including 11 hospitals, 12 health
centers and 50 dispensaries (Mwanza City
Profile, 2022). Goal 3 specifically focuses on
the promotion of good health for everyone
by providing quality healthcare services to
people across different age groups without
discrimination or prejudice. In order for this
goal to be achieved, policymakers need to
consider improving accessibility and
affordability of medical infrastructure and
providers, as well as stimulating prevention
initiatives such as educational activities.
It is important that the government trains
health workers, improves the availability of
essential medicines, sexual and reproductive
health services, and strengthens health
systems in Mwanza City. Accordingly,
Mwanza City is committed to enhancing
population health by addressing the shortage
of healthcare professionals and reducing it
from 43% in 2020 to 20% by June 2025
(MTEF, 2022).
In addition, the city should promote
antenatal care to prevent complications
where possible and to ensure that pregnancy
complications are identified early and treated
appropriately. There is a need to ensure
women receive more IPT2 vaccinations,
attend postnatal care and use reproductive
health services education to reduce maternal
mortality. Women with pregnancy
complications also need timely access to
quality emergency obstetric care.
Furthermore, it has been identified that
many women in the community lack health
insurance, which hinders their access to
necessary medical treatments (see Box 2
‘Community perception on health issues’ for
examples). The parliament is currently
finalizing approval for a national health
insurance program that aims to provide
coverage for all people in Tanzania.
To address the issue of maternal mortality in
Mwanza City, several projects can be
proposed. These should focus on
strengthening the health system
infrastructure, increasing the presence of
skilled birth attendants, providing training for
healthcare workers, and improving maternal
health education campaigns. Additionally, it is
essential for the government to improve
infrastructure and increase quality human
resources for health care.
To reduce non-communicable diseases
(NCDs), Mwanza has developed a
comprehensive plan to implement an
awareness campaign and conduct population
screenings. The primary goal of these
initiatives are (1) to identify individuals with
24
diabetes, cardiovascular risks, and cancer at
an early stage, allowing for immediate
treatment, and (2) increase awareness about
the main modifiable risk factors associated
with these diseases, which are tobacco use,
harmful alcohol consumption, unhealthy
diets, and physical inactivity, Mwanza city
aims to increase public knowledge about
these risk factors from 21% to 50% by June
2025 (Reference). Furthermore, there are
plans to enhance the capacity for diabetes
management, aiming to increase it from 49%
in 2020 to 75% by June 2025 (MTEF, 2022).
Box 2: Community perception on health issues
1.
2
3.
4.
5.
"When I became sick in February of this year, I was rushed to the hospital, but I
went nearly three hours without receiving medical attention. There were many
patients queuing up when we arrived. In reality, there are very few medical
doctors in relation to the total number of patients in hospitals". Woman (36 -yearold) quoted.
“Hospital medical expenses have recently risen significantly, making unaffordable
for those of us who do not have health insurance." “I don't go to the hospital if I'm
sick since I can't afford to pay for medical diagnosis and treatment”.Woman (25-
year-old) quoted.
"Many health centers and dispensaries lack the health infrastructure tools and
medical supplies needed to provide healthcare services". Health care lacks
sufficient human resources, like physicians and nurses. The government must
keep hiring healthcare workers."Woman (32-year-old) quoted.
“When we are pregnant, many women visit the hospital or a health center to seek
reproductive advice. However, there are moments when we get distracted with
home tasks. We experience challenges during birth and delivery. Sometimes it's
our fault, not the midwives”. Woman (41-year-old) quoted.
"We request the government to provide more maternal and child health education
campaigns to prevent maternal death during childbirth." Woman (41-year-old)
quoted.
25
|
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"file_id": "sdg-03/vlr-report-tza-mwanza-2022-en-4.pdf",
"language": "en",
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|
HLPF - 2017
45
Goal 3: Ensure Healthy Lives and Promote Well-being for
All at the All Ages
SDG 3 relates to healthy lives and well-being and is composed of 13 global targets
and 26 global indicators. In the context of the nationalization of the SDGs, and
considering the available data and achievability of the SDGs’ targets and
indicators, the Ministry of Public Health (MoPH), as leading entity for SDG 3,
together with the Central Statistics Office (CSO) and MoEc, has identified 10
national targets and 17 national indicators, out of which four are to be finalized, for
A-SDG 3.
Many key health indicators improved more rapidly in Afghanistan than in most
other countries that had started at a similar level of development.14 In particular,
“the under-5 mortality rate dropped 60 percent from 137 per 1,000 live births in
2002 to 55 in 2016 whereas births attended by skilled health personnel increased
to 58 percent from 14.3 percent over the same period.
The number of functioning health facilities increased five-fold over while the
proportion of facilities with female staff increased from 22 percent to 87 percent.”15
However, challenges remain, especially with respect to malnutrition, maternal
mortality ratio and high fertility rates, that would require adjustments to policies
implemented to achieve sustainable development.
Such indicators can be used to measure the progress made towards Afghanistan’s
achievements towards the MDGs, and further to the achievements towards the
SDGs.
Three of the eight MDGs directly related to the health sector (MFGs 4, 5 and 6)..
(a) MDG 4: “Reduce Child Mortality”.
According to the World Health Organization (WHO), under-five mortality has
declined from 181 in 1990 to 91 in 2015 per 1000 births. The main causes of deaths
for the under-five were acute respiratory diseases (20%), diarrhea (14%),
prematurity (13%) and (11%) intrapartum related complication (World Health
Organization, 2016). However, there are huge reduction in the number of underfive mortality rate, it is still very high and also Afghanistan could not get the two
14 The World Bank, Strong Progress but Challenges Remain in Health Sector in Afghanistan, 1 June 2017, available at:
http://www.worldbank.org/en/news/press-release/2017/06/01/strong-progress-but-challenges-remain-in-health-sector-in-afghanistan
(accessed on 14 June 2017) (Strong Progress but Challenges Remain in Health Sector in Afghanistan) 15 Strong Progress but Challenges Remain in Health Sector in Afghanistan
HLPF - 2017
46
thirds targets. Neonatal mortality rate is another main factor that has been
diminished from 53 in 1990 to 36 in 2015.
(b) MDG 5: “Improve Maternal Health”.
Based on the data of DHS 2015, the maternal mortality is very high compare to the
neighboring countries. MMR was above 1200 per 100,000 live births in 2015..
According to this report the main leading causes for maternal mortality ratio are
postpartum hemorrhage, eclampsia and sepsis (World Health Organization, 2016).
Under coverage of this goal is another target 5.B, “achieve, by 2015, universal
access to reproductive health services”, which beside the maternal and child
mortality rate reduction following services are improved and provided. Antenatal
care, quality maternal, newborn and child health services, family planning services
and contraceptive distribution have been provided; target evidence-based, costeffective and community training conducted to improve the managerial skills and
ensure lifesaving medicines, commodities and equipment and ensure equitable
distribution of human resources with community outreach (World Health
Organization, 2016).
(c) MDG 6: “Combat HIV/AIDS, Malaria and Other Diseases”,
According to the WHO, the number of HIV positive or prevalence is low in
Afghanistan. Most of the infected population are who inject drugs, which it is
prevalence is 7%, however, 94% report using sterilized injecting kits. The
prevalence of women sex workers is 0 and among guy is only 1%. The
antiretroviral therapy is providing only for 200 women to prevent the transmission
of the HIV from infected mother to child which 1%. Routine test of collected blood
is done on 52% and the expected antiretroviral therapy coverage is for 3% (World
Health Organization, 2016).
Tuberculosis is the other infectious diseases that have approximate mortality rate
of 43 people in 100,000. According to the WHO report, 31,622 cases of
tuberculosis reported in 2013, of which 14,277 cases were new positive sputum
cases. Success rate of treatment, in 2012, were 88%. Drug resistance cases is
3.7% among new cases, while it is 20% among previously treated cases.
Tuberculosis is still major health problem despite availability of medicines and
advanced diagnostic tools (World Health Organization, 2016).
Malaria is considered the high burden and high risk for Afghanistan. From 2003 to
2012, the total confirmed cases decreased by 85% from 360,940 to 54,840 cases.
Afghanistan has been certified neglected tropical diseases free since 2007.
However, cases of cutaneous and visceral leshmaniasis and blinding trachoma
were reported: respectively, 33,894 and 24 in 2012.
HLPF - 2017
47
Coverage of immunization among one-year old has improved from 1990 to 2013
for BCG from 30% to 75%, DTP3 from 25% to 71%, Polio from 25 to 71% and
Measles from 20% to 75%. Coverage of neonatal tetanus during the same period
as also increased from 13% to 65%. Hepatitis B vaccine coverage was 71% in
2013.
Contribution of non-communicable diseases burden has been rising and account
for 36.6% all deaths; cardiovascular diseases account for 18.6%, cancer for 6.2%,
respiratory diseases for 2.7% and diabetes mellitus 1.4% for all deaths. 31.7% of
all deaths between ages 30 to 70 years are occurred due to one of the four abovementioned communicable diseases. More than 8.6% of young people aged 13 to
15 years (boy 8.7% and girl 8.8%) have ever smoked cigarettes, while passive
smokers reported 23.7%. Consumption of alcohol per capita is 0.7 liter of pure
alcohol. High blood pressure affects 22.5% of the population above 18 years old
(22.8% male and 22.1 female), whereas, obesity affects 2.2% of the population
(1.4% male and 3.0% female). From the 11 essential medicines for treatment of
non-communicable, only eights are available in the public health sector (World
Health Organization, 2016).
According to the WHO report, prevalence annual rate of cannabis use is estimated
at 4.3%, opiates 2.7%, cocaine 0.1%, and amphetamines 0.1% , and the estimated
prevalence of substance use disorders among adults (15 years and over) is 0.9%
for men and 0.1% for women (World Health Organization, 2016).
Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per
100,000 live births. This target has two indicators, maternal mortality ratio and births
attended by skilled health personal, accordingly.
The maternity mortality ratio in Afghanistan is 1200 per 100,000 live births according to
Afghanistan Demographic and Health Survey (ADHS 2015). 2015 Constitutes in this
instance the baseline year, and by 2030, considering the future plans in the provision of
health services, the MoPH has planned to bring it down it to 160.
The percentage of live births occurred in presence of doctor, midwife or any skilled health
personal with provision of health care services during a year currently stands at 51%
according to the MoPH. By 2030, it planned to be increased to 79%.
Target 3.2: By 2030 end preventable deaths of newborns and children under five years
of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per
1,000 live births and under five mortality to at least as low as 25 per 1,000 live births.
The number of child deaths under five years of age per 1000 live births is 55 In 2015
based on MoPH data. By 2030 the MoPH, with the assistance of other stakeholders and
thanks to past experiences is planning to decrease it to 20.
HLPF - 2017
48
Based on the given data from MoPH, the rate of the number of neonatal deaths in a
specific year per 1000 live births in 2015 is 36 which is the baseline data. By 2030, the
MoPH, with the assistance of other stakeholders and thanks to past experiences is
planning to decrease it to 23.
Target 3.3: by 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected
tropical diseases and combat hepatitis, water-borne diseases and other communicable
diseases.
According to the given data from MoPH, the number of TB positive in 2017 is 143 per
100000, which is baseline. This number is supposed to increase until 2023, after which
it will start decreasing into 10 per 100000 by 2030.
The current number of malaria cases per 1000 persons in a year, is at a current rate of
11 people in 1000. This is accepted as a baseline. According to the MoPH this rate has
been planned to decrease to 1 person in 2030.
The number of new hepatitis B positive cases per 100,000 population is currently 4.5.
This is the accepted baseline. According to MoPH, thanks to preventive planned
precautions it will be decreased to 1 in 2030.
Target 3.4: by 2030, reduce by one third premature mortality from non-communicable
diseases through prevention and treatment and promote mental health and well-being.
Unconditional probability of dying between the exact ages of 30 and 70 years from
cardiovascular diseases, cancer, diabetes or chronic respiratory diseases. According to
the MoPH, the mentioned diseases contributed to 35% deaths in Afghanistan that
accepted as a baseline, any by 2030, it will be decreased to 10% of deaths in Afghanistan.
Target 3.5: Strengthen the prevention and treatment of substance abuse, including
narcotic drug abuse and harmful use of alcohol in Afghanistan.
Percentage of the drug abusers (People dependence to a stimulant, nevertheless of its
side effects, having good effects on its mood and his/her affiliation is increasing by each
time of use), who are provided treatment services. According to MoPH, 2.7% of these
people are provided such services, which is the baseline and by 2030, it will be increased
by 10%.
Target 3.7: by 2030, ensure universal access to sexual and reproductive health-care
services, including for family planning, information and education, and the integration of
reproductive health into national strategies and programs.
Proportion of women of reproductive age (aged 15-49 years) who have their need for
family planning satisfied with modern methods.
HLPF - 2017
49
According to the given data of MoPH, these services are provided to 20% of this
category of people, which is the baseline. By 2030, the services will be provided to 45%
of the population
Number of adolescent birth rate aged 13 to 19 years per 1000 women, according to the
given data of MoPH, is 12.1, which is baseline that by 2030, it is planned to decrease
the number to 7.3.
Target 3.8: Achieve universal health coverage, including financial risk protection, access
to quality essential health-care services and access to safe, effective, quality and
affordable essential medicines and vaccines for all in Afghanistan.
Access to basic and essential package of health services including family planning,
reproductive health services (at least four times during the pregnancy), provision and
implementation of vaccines and other health package services within two hours of walking
or 10 km distance. According to the given data of MoPH, 88% of people have access to
such services, which is the baseline, and by 2030, it will be increased to 97%.
Percentage of the health sector services (budget) financed by international community.
According to the data of MoPH, the dependency or budget financed by donors is 75%,
which is the baseline and by 2030, it has been planned to decrease to 34%.
Target 3.9: by 2030, substantially reduce the number of deaths and illnesses from
hazardous chemicals and air, water and soil pollution and contamination.
Percentage of people who are having access to potable water or access of people to
clean drinkable water in which do not cause any health problems. According to the MoPH,
65 % of all population have access to such water, which is the baseline and by 2030, it
will be increased to 100%.
Target 3.a: Strengthen the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries, as appropriate.
According to the given data, 48% of males and 6 % females are tobacco users, which
are the baselines, and by 2030, this figure will be decreased to a substantial level.
Target 3.c: substantially increase health financing and the recruitment, development,
training and retention of the health workforce in Afghanistan.
Government contribution in funding of the health services provision that includes basic
and essential health services. According to the given data, the government pay for 4.2 of
total health expenditure which is the baseline and by 2030, it will be increased to 20 %.
Number of health workers who providing the health services throughout the country.
According to the data from MoPH, there are 24413 persons, which is the baseline and by
2030 it will be increased by 31710.
|
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[
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{
"country": "afg",
"file_id": "sdg-03/vnr-report-afg-2017-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2017
}
|
AFGHANISTAN VNR 2021
SUSTAINABLE DEVELOPMENT GOALS
GOAL 3. GOOD HEALTH AND
WELL-BEING
Ensure healthy lives and promote well-being for all at all
ages
COVID-19 has imposed additional health and socioeconomic hardships especially on vulnerable populations.
The Government quickly recognized the seriousness of the
pandemic. A whole-of-government response was
executed, and unprecedented authority was delegated to
the Ministry of Public Health (MoPH) and provincial
governors to quickly respond to COVID-19.
These quick measures resulted in a lower level of deaths
compared to other countries. The government established
an emergency relief fund to provide all Afghans with inkind support for two months as part of the short-term
response. In the longer term, the government will support
the Afghan people by building resilience among poorer
households in rural areas, through increasing investment
in water management, seeds, and other livestock practices
to improve agricultural productivity.
The Government of Afghanistan, together with its
development partners and the private sector, has been
able to provide basic health services to 85 percent of
Afghans. This shows a significant increase compared to
2013 when these services were available only to 60
percent of the population across the country. The results
compared to just a few years back are impressive.
However, COVID-19 could slow down the progress of
reducing maternal and child mortality rate, as it hampers
essential health service delivery.
SOURCE: SDR DATASET, 2020
Maternal mortality rates have dropped from 1,450 deaths
per 100,000 live births to 638 maternal deaths in 201830.
To meet the zero-mortality target, on average 8 percent
annual reduction in maternal mortality is required. The
proportion of births attended by skilled healthcare
30 Online Database for Sustainable Development Report 2020
personnel has also increased from just 39.9 percent in
2012 to 58.8 percent in 2018. This is reflective of the fact
that that the government has made impressive strides to
improve service delivery in the health sector. The
percentage of pregnant women who had at least one
antenatal check-up in 2018 increased to 70 percent, while
in 2005 it was just 23 percent. Afghanistan has developed
a National Reproductive, Maternal, Newborn, Child, and
Adolescent Health (RMNCAH) Strategy and has been
implementing the strategy over the past two years.
SOURCE: INCOME EXPENDITURE AND LABOR FORCES SURVEY 2020, NSIA
SOURCE: SDR DATA, 2020
Routine health care would not be sufficient to meet the
planned A-SDG Goal 3 targets
The Ministry of Public Health has also made remarkable
efforts in reducing neonatal and under-five child morality.
Neonatal mortality per 1,000 live births has been reduced
to 37.1 percent in 2018 and likewise, the under-five
mortality rate per 1,000 live births fell from 129.4 in 2000
to 62.3 in 2018. Globally, the under-five mortality rate fell
from 76 deaths per 1,000 live births in 2000 to 39 in 2018,
1450
1390
1300
1240
1180114011201090
1030993 954 905858 810 786
701 673 638
0
200
400
600
800
1000
1200
1400
1600
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
MATERNAL MORTALITY RATE(PER 100,000 LIVE BIRTHS)
17.2
23.9
39 39.9
45.2
51 53.4
61.8
0
10
20
30
40
50
60
70
SKILL BIRTH ATTENDANCE (IN %)
61
37.1
129.4
62.3
0
20
40
60
80
100
120
140
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
NEONATAL AND UNDER-5 MORTALITY RATE (PER 1000
LIVE BIRTHS)
sdg3_neonat sdg3_u5mort
18
AFGHANISTAN VNR 2021
SUSTAINABLE DEVELOPMENT GOALS
and the neonatal mortality rate fell from 31 deaths per
1,000 live births in 2000 to 18 deaths in 2018.
As the COVID-19 pandemic continues to impact essential
health services and systems, disrupt routine health
services, and further constrain access to essential
nutrition services, hundreds of additional under-5 deaths
are expected in future years. According to the SDGs Report
2020, if routine health care is disrupted and access to food
is decreased, the increase in child and maternal deaths
could be devastating as 118 low and middle-income
countries could see an increase of between 9.8 and 44.8
percent in under-5 deaths per month and an 8.3 to 38.6
percent rise in maternal deaths per month over a period of
six months.
SOURCE: SDR DATA, 2020
The percentage of surviving infants who received two
WHO-recommended vaccines increased from 24 percent
in 2000 to 64 percent in 2018.
COVID-19 related disruption could also cause a spike in
illness and deaths from both communicable and noncommunicable diseases
The number of adults (15+) and children (0-14) newlyinfected with HIV increased from 1,300 in 2017 to 1,500
cases in 2019. Tuberculosis incidences per 100,000
persons per year was 189 in 2017 and remained at the
same number of cases in 2019. Malaria incidences per
1,000 persons per year slightly increased from 27.2 in 2017
to 29 in 201831.
The mortality rate attributed to cardiovascular disease
(CVD), cancer, diabetes, and chronic respiratory disease
dropped from 31 percent in 2017 to 27 percent in 2020.
The death rate due to road traffic injuries per 100,000
persons in a year reached 15.1 in 2017.
Current health expenditure per capita in current USD was
$81, of which $61 was out-of-pocket expenditure in 2018.
31 Global Hunger Index, 2020
32 AFGHANISTAN COVID-19 Socio-Economic Impact Assessment
Fiscal Options in Response to Coronavirus Crisis, UNDP, 2020
But it likely increased in 2020, and 2021, due to COVID-19
repercussions. Meanwhile, out-of-pocket health
expenditure as a percentage of current health expense
was 75 percent in 2018. Increasing the number and the
amount of out-of-pocket health expenditure will push more
people into extreme poverty. Income loss due to COVID-19
lockdown measures will likely exacerbate the situation.
The COVID-19 pandemic has revealed serious challenges
in the capacity to diagnose COVID-1932, the procurement
of medical supplies and services, to properly manage
cases, and to make available sufficient human resources.
The availability of Intensive Care Facilities (ICU) is also a
key challenge. There are only 1,000 ICU facilities across
the country of which only 520 are equipped with
ventilators33.
As outlined above, before the emergence of COVID-19,
there was some progress against the SDG-3 targets. The
COVID-19 negatively impacted the rate of progress.
Mainly due to the lockdown, fewer people have sought
healthcare services outside emergency care. Routine
services were severely affected with significant impacts
on the capacity to treat communicable and noncommunicable diseases.
24
64
0
10
20
30
40
50
60
70
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
INFANTS RECIEVED 2 WHO RECOMMENDED VACCINES
(%)
sdg3_vac
19
|
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|
21
PROGRESS IN IM P LEMENTING TH E SD G S
3.3. SDG 3 GOOD HEALTH
AND WELL-BEING
SDG 3 aims to ensure healthy lives and
promote well-being for all at all ages. The
Declaration of the 2030 Agenda for Sustainable Development recognizes that improving health indicators is a global challenge
and an indispensable requirement for sustainable development.
3.3.1. Context of Angola
Health and social well-being are priorities
of the Angolan government highlighted in
the Human Development Pillar of the National Development Plan (NDP 2018-2022).
The gradual increase in public investment
in health has allowed an expansion of access to services, until the frst quarter of
2021, 60% of the population had access
to health services, according to the Ministry of Health (MINSA). Another important
area that translates the effect of resource availability has been the increase in
health professionals in the sector, in order
to mitigate the insufciency in quantity
and quality, especially in peripheral areas
30 DNSP/MINSA (2020) Programa de Saúde Sexual Reprodutiva. Luanda: MINSA.
(between 2015 and 2019, it went from one
doctor or nurse to 1.34 doctors and 10.62
nurses per 10,000 population). In 2020, the
entry process for new professionals was
continued to fll 7,000 vacancies, of which
1,242 doctors, 2,757 nurses, 1,691 diagnostic and therapeutic technicians, 779
hospital support and 531 from the general
regime. Currently, the sector has 77,419
professionals, of which 4,133 are doctors,
of which 1,623 are specialists, 32,980 are
nurses, 7,534 are diagnostic and therapeutic technicians, and 32,772 are general and
hospital support technicians.
Regarding health data, the maternal mortality ratio measured in the 2015-2016 IIMS
was 239 maternal deaths per 100,000 live
births, and until the frst quarter of 2021,
administrative data obtained by registering births performed in health facilities
record 248 maternal deaths per 100,000
live births. According to MINSA data, the
maternal mortality ratio increased from
291.97 per 100,000 live births in 2018 to
287.89 per 100,000 in 201930. Despite the
methodological difference for the measurement of this indicator, the increase
in maternal mortality may be linked to the
difculties still existing in access to quality health services, the persistence of
high rates of teenage pregnancy, low education of women, gender inequalities, in
addition to the limited coverage of family
planning and the poor availability of health
professionals.
Until the frst quarter of 2021, there was
also a reduction in the number of institutional deliveries compared to previous
years, attributable to the effects of the
COVID-19 pandemic, which caused the
closure of routine services in several heal-
22
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT
th units during the State of Emergency,
combined with the users’ fear of attending
health units during the pandemic. As for
the proportion of deliveries assisted by
qualifed health personnel, until this period and according to information provided
by the Health Information System, only
14% of expected deliveries were performed in health facilities, falling far short of
the recommended target of 55% programmed for the year31. The poor performance
of this indicator is, in part, justifed by the
situation of the COVID-19 pandemic, highlighted earlier. Regular data collection from
the provinces has been a challenge that
may be contributing to the underestimation of information on institutional deliveries. Cultural factors, such as resistance to
delivery and postpartum care by men, may
also underlie the very low uptake of deliveries attended by skilled health personnel32.
An aspect also of concern has been the observed decline in pregnant women’s access
to prenatal care, as measured by adherence to the frst appointment. According to
administrative data available for the period
2016-2018, pregnant women’s access to the
frst consultation has dropped from 81% in
2016 to 57% in 2017 and to 45% in 2018. The
same was true for the proportion of pregnant women expected to complete four
consultations, which reduced from 44% in
2016 to 31% in 2017 and 24% in 2018.
For the calculation of birth coverage, considering as denominator the pregnant women who had access to health services,
measured by the frst consultation, these
represented 66.65% of pregnant women
who had an institutional delivery, the same
percentage in the year 2018 which was
31 Ditto.
32 MINSA (2020) Programa de Saúde Sexual Reprodutiva, 2020. Luanda: MINSA.
66% of pregnant women who went to the
frst consultation and returned for institutional delivery.
Regarding vaccination, Angola has been
extending the number of health units offering vaccination, highlighting that in the
period from 2015 to 2019, vaccination posts
increased from 1,347 to 1,643. From 2017 to
2019, the inactivated polio vaccine (injectable) was introduced as part of the commitment to eradicate polio in the region and
the world. In terms of infrastructure improvements, 58 solar cold chain equipment
were installed in 15 provinces, the central
cold chain was expanded to three chambers, and temperature recording (multi-log)
systems for remote monitoring of vaccine
storage were installed in three provinces.
The management capacity of the Expanded Vaccination Program (EPI) was strengthened with the provision of 34 computers
and 40 tablets to improve the working conditions of provincial and municipal supervisors and improve the program’s information
system. Regarding vaccination coverage of
BCG, administered at birth, these increased
from 58% in 2016 to 90% in 2017 and 96% in
2018. The triple-dose vaccines, which are
good indicators for assessing vaccination
coverage, went, for example, from 74% coverage to 73% and 82% in 2016, 2017, and
2018, respectively (Pentavalent and pneumonia vaccine, three doses). In the same
period, routine vaccination intensifcation
activities were carried out in municipalities
with low coverage, as well as polio vaccination campaigns in provinces with emergence of vaccine-derived cases. To improve
program performance, municipal teams
were formed and trained in three provin-
23
PROGRESS IN IM P LEMENTING TH E SD G S
ces where polio environmental surveillance
monitoring was implemented.
The Child Health Program monitors three
communicable diseases in under-fves,
namely, severe pneumonia, acute diarrheal diseases with severe dehydration,
and severe malnutrition. The selected
proxy indicators of average incidence of
these diseases for the period 2014-2018
are described in the table below:
Table 4. Average incidence of communicable diseases in children under fve (2014-2018)
A decline in the incidence of pneumonia
and diarrhea with severe dehydration is
observed between 2014 and 2017, which
coincides with the introduction of the
pneumo 13 and rotavirus vaccines. To minimize the situation of the mentioned diseases, the health sector in its under-fve
strategy has as main pillars the promotion
of early and exclusive breastfeeding until
six months of age and continued until two
years of age, with the gradual introduction of a balanced diet. Vitamin A is also
administered during routine vaccination
starting at six months of age and in polio
vaccination campaigns. In 2020, 2,867,852
doses of vitamin A were administered to
children between the ages of six months
and fve years.
Regarding HIV-AIDS surveillance, it is being implemented but there is not yet an
effective system of individual notifcation of HIV-AIDS cases, implemented in
all health facilities in the country, which
would allow new cases to be counted (without duplicates). Estimates of new HIVAIDS cases in 2020, calculated by the Joint
United Nations Programme on HIV-AIDS
(UNAIDS) Spectrum program, are still preliminary: in the year 2019, it corresponded
to 0.9/1,000 population. The trend in HIVAIDS incidence, by the same estimates,
is one of stability over the last ten years.
Regarding routine data, to assess the coverage of testing, treatment and viral suppression, there has been great progress
in the last three years in the information
system, with the adoption of integrated
instruments for registration and data collection (HIV-AIDS, TB, SSR) and the use
of the DHIS2 platform. However, constraints related to the quality of records and
reports persist, in addition to defcient
means for sending data (equipment, trained human resources and internet), which
impact the results of the indicators.
During the year 2020 the malaria Incidence rate was 250/1,000 population, higher
compared to the year 2019, which recorded
234/1,000 population. According to the National Malaria Control Program (2020), the
rise in cases, is due to the reduction in integrated preventive interventions, namely
24
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT
Integrated Vector Control and the distribution of Long-Lasting Insecticide Treated
Mosquito nets, partly due to the situation
imposed by the COVID-19 pandemic, which
also had an effect on the reduction in the
number of consultations for all causes, including malaria.
Administrative coverage of contraceptive
use remains low at around 9%.
Through the National Institute for Anti-Drug Fight (INALUD), 10,529 drug users
were controlled in Angola in 2019, of which
6,782 use cannabis sativa and alcohol, while 3,747 use multi-drugs. Although it is no33 DNSP/MINSA (2018) Mental Health Program. Luanda: MINSA.
34 MINSA (2020) Programa de Saúde Sexual Reprodutiva, 2020. Luanda: MINSA.
table that there are several difculties in
collecting and sending statistical data in
certain provinces, the effort made by the
Local Intervention Units (UIL) to make them
available is visible. The data of the mental
health program for 2018 still records 8.4
suicides per 100,000 population33.
Regarding the overall status of non-communicable diseases, Angola has selected three causes for monitoring, namely
hypertension, diabetes and trafc accident trauma. In the table below you can
see the distribution of these diseases in
the years 2018-2019.
Table 5. Non-communicable diseases (2018-2019)
Of the three non-communicable diseases,
hypertension is the main cause of morbidity, with an incidence of 997.96 per 100
thousand population. However, trafc accidents, despite having a lower incidence,
have a mortality rate of 8.27 per 100 thousand population.
Among other reasons for the increase in
the maternal mortality rate in 2020 is the
weak fnancing of health facilities at the
municipal level, insufcient to cover operating costs for campaigns to mobilize
women to adhere to institutional delivery
and increase access to delivery rooms for
pregnant women. Also, the low coverage
of specialized nurses in delivery rooms in
the most remote areas34.
The proportion of women with their family
planning needs met also showed a drastic
reduction considering the available admi-
25
PROGRESS IN IM P LEMENTING TH E SD G S
nistrative data, from 24% according to the
2015-2016 IIMS to 7.8% in 2020 according
to MINSA data35.
Access to health insurance is relatively
low in Angola, averaging 0.9%, of which
1.4% refers to the proportion of population
residing in urban areas and 0.1% for population residing in rural areas36.
WHO has identifed 20 Neglected Communicable Diseases (NTDs), 16 of which
are prevalent in Angola. The most frequent
in the country are Onchocerciasis (River
Blindness), Schistosomiasis (Bilharzia),
Soil-transmitted Helminths (Geohelminthiasis), Lymphatic Filariasis (African Human Elephantiasis), Leprosy, Trypanosomiasis (Sleeping sickness), and Rabies. The
35 Ditto.
36 INE (2019) Inequality and Poverty Quick Fact Sheet. IDR/IDREA – 2018/2019. Luanda: National Institute of
Statistics.
least frequent are Dengue, Trachoma, Brucellosis, Cystocercosis, Leishmaniasis,
Buruli ulcer, Bouba, Scabies, Dracuncolosis, and Snakebite Poisoning. Five of the
most frequent, namely Schistosomiasis,
Lymphatic Filariasis/Loasis, Onchocerciasis, Trachoma, and Geohelminthiasis, are
amenable to preventive chemotherapy.
The country carries out a mapping of neglected diseases every fve years, and the
last mapping was carried out in 2018. Some
of the neglected diseases are included in
the National Epidemiological Surveillance
System of mandatory notifcation, such as
schistosomiasis, leprosy, trypanosomiasis, onchocerciasis, dengue, and rabies.
Table 6. Evolution of NTDs (2017-2019)
Regarding Trachoma, a pre-assessment of
the records of surgical interventions was
performed in the period 2009 to 2016, and a
total of 863 cases were diagnosed, of which
189 (22%) were intervened. For the diseases
amenable to prophylactic treatment, the following campaigns were developed during
2020: for Lymphatic Filariasis, prophylactic
treatment with Ivermectin and Albendazole
was administered to 1,977,831 people (28%
therapeutic coverage). For Onchocerciasis,
administration of Ivermectin to 3,509,327
26
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT
people (39.15% coverage of endemic areas).
For Schistosomiasis and Helminthiasis,
Praziquantel was administered to 437,818
(3.62%) and the second dose for Helminthiasis with only Albendazole to 2,404,442
individuals) (7.11% therapeutic coverage.
The improvements in the control of these
diseases are due primarily to government
efforts and funding from the World Health
Organization.
Respiratory diseases and in over-fves has
a high incidence, 2,366.22/100,000 population. However, mortality from this cause
was 3/100,000 in 2018 and 3.17/100,000 in
2019. Regarding waterborne diseases,
there was an outbreak of small intensity
in 2018 with 1,416 cases and 18 deaths and
only 19 cases and no deaths the following
year. With regard to typhoid fever, which
has the same transmission mechanism,
there was an incidence of 1,577.25/100,000
population in 2018 and a low mortality
rate (0.78/100,000); in 2019 the incidence
is down slightly (1,450.72/100,000) and a
mortality rate of 0.86/100,000.
In the area of zoonoses, human rabies
stands out, since in the period 2018-2019
it increased from 216 cases to 257 (an incidence of 0.74/100,000 to 0.52/100,000), all
ending in death. Of note, efforts have been
made by the government, both in relation
to animal control and vaccination of humans after exposure. Dengue fever in the
2018-2019 period went from 2,502 cases
(incidence of 855/100,000 population) to
489 cases (incidence of 1.62/100,000).
3.3.2. Plans, Actions and Perspectives
The Government of Angola through the
NDP 2018-2022 implements different programs to promote quality health, highlighting the following:
27
PROGRESS IN IM P LEMENTING TH E SD G S
28
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT
In the period 2015-2019, the Ministry of
Health, with the support of several partners, has developed several national strategies, which follow international parameters, focused on reproductive, maternal,
neonatal, child, adolescent, and food and
nutrition health, which provide the basic
guidelines to improve the health and well-being levels of the Angolan population.
The Ministry of Health has been able to
mobilize domestic resources, international cooperation, in addition to loans, to
improve health interventions. As of 2017,
for example, the procurement of vaccines
with GBS resources stands at about USD
20 million per year.
The involvement of the First Lady of the
Republic, in the scope of the Born Free to
Shine campaign, aimed at reducing the
transmission of HIV-AIDS from mother to
child, has been remarkable for the sector in order to mobilize society in general
about the need for testing for the human
immunodefciency virus.
Also, the creation of mental health nuclei
in several provinces has improved the reporting of mental forum illnesses/events.
In response to the pandemic of COVID-19,
the Government of Angola increased and
strengthened the capacity of the national public health system by increasing
the number of molecular biology laboratories, a total of six for the entire country, equipping hospital units and building
feld hospitals, in addition to acquiring
cutting-edge materials and equipment.
In 2020, 5,581 beds were acquired, above
the annual target (500 beds). This performance resulted from the increase in
inpatient capacity in health units, especially in units undergoing rehabilitation
and expansion, namely, in the emergency room of the Children’s Hospital, in the
quarantine and treatment areas of COVID-19 (Special Economic Zone, Barra do
Kwanza, Calumbo 1 and 2), in response to
the improvement in the health services.
Additionally, the Bié General Hospital and
Photo by Francisco Venâncio on Unsplash
29
PROGRESS IN IM P LEMENTING TH E SD G S
the Maternal-Child and Provincial Hospitals of Lunda Sul were inaugurated.
The decision to increase the number of
health professionals, with a focus on a
more balanced distribution of them throughout the country, came in response to a
need to improve health services.
The Presidential Decree establishing the
new organizational chart of MINSA, with
emphasis on the creation of the Department of Primary Health Care to replace
the former department of reproductive
health, expands the scope of the work of
the National Directorate of Public Health
with regard to addressing universal health
coverage.
Comparing 2020 with 2018, especially in
relation to the Prevention of Mother-toChild Transmission of HIV-AIDS Program
and driven by the Born Free to Shine campaign support, there is an increase in HIVAIDS testing coverage in pregnant women
from 46% (2018) to 62% (2020). Coverage
for HIV-AIDS testing in pregnant women in
antenatal care increased from 56% (2018)
to 93% (2020). Over the same period, antiretroviral treatment coverage relative
to the estimated number of pregnant women living with HIV-AIDS increased from
36% (2018) to 71% (2020). This progress has
reduced the estimated Mother-to-Child
HIV-AIDS Transmission Rate from 28% in
2018 to 19% in 2020 (preliminary Spectrum
data). The biggest barriers lie in attracting
pregnant women for prenatal care and institutional delivery, in addition to follow-up
of the HIV-exposed child. In the last two
years, the country has invested in expanding the supply of viral load molecular virology tests for treatment monitoring and
37 INE (2017) Survey of Multiple Indicators and Health 2015-2016. Luanda: National Institute of Statistics.
for early infant diagnosis, with acquisition
of equipment and supplies.
There was also a reduction in mortality due
to road trafc injuries in the 2018-2020
period following investments made by the
government in road prevention campaigns
and the creation of the Integrated Center
for Public Safety.
One of the major challenges to achieve SDG
3 is multisectoral articulation, with special
emphasis on the Ministries of Youth and
Sports, Education and Social Action, Family and Promotion of Women, which act on
the determinants that directly refect on
the health of the population, with emphasis on maternal, neonatal, child and adolescent health and nutrition. Since Angola
is an eminently young country, with a majority female population, the emphasis of
the mentioned sectors should naturally be
on the application of the Demographic Dividend approach, the social mobilization of
girls in the communities for the dissemination of qualifed information on sexual and
reproductive health; the inclusion of Sexual
Education themes in the curricula of primary and secondary schools, creating mechanisms for the retention of girls in school;
and the intensifcation of actions for gender equality and equity and the prevention
of gender-based violence. Another challenge is the repositioning of people-centered
Family Planning and a strong involvement
of men in this perspective.
The main SDG 3 indicators37 for this VNR
were based on the 2015-2016 Multiple Indicator Cluster and Health Survey as baseline.
Due to the emergence of the COVID-19 pandemic, the IIMS 2020 was not conducted and
for the purpose of monitoring the progress
30
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT
of the indicators, the report considered the
Statistical Yearbooks and Epidemiological
Bulletins of the Ministry of Health, data generated by specifc programs such as Spectrum, as well as proxy indicators. Another
important aspect to note is that the Health
Information System in Angola is in a transitional phase, relying on both a manual system and digital data production. The two
systems are not harmonized, and there is
information that appears in one that does
not appear in the other. Additionally, it is observed that a large part of the health units
have not been able to report the information,
whether manual or digital.
Despite the progress made in terms of the
existence of favorable and current national plans and strategies, increased public
health sector capacity in managing COVID-19 and improved government capacity
in establishing partnerships and mobilizing domestic and external resources, the
reduction of maternal, child and adolescent mortality rates in particular and the
integrated package of women’s, newborn,
child and adolescent health services remain a major challenge to meeting the SDG
3 targets. Another major challenge in the
sector lies in a functional and harmonized
health information system, especially at
the level of data production units, including the operationalization of the various
strategies defned at the national level.
For the operationalization of the deconcentration/decentralization of health services,
it is important to allocate human, fnancial,
and material resources for the implementation of programs prioritized by the government at the municipal level, with emphasis on improving maternal and child health.
There are already all the guiding instruments
that standardize the quality of care to be
provided to the prioritized groups. On the
other hand, there is an expansion of several
health structures under construction in the
different municipalities included in the PIIM.
The timeliness of investment in family
planning in order to achieve 52% coverage,
as described in the Demographic Dividend
study, will have a benefcial spillover effect,
ranging from slowing population growth,
with falling maternal and infant mortality, to
preventing teenage pregnancy, causing girls to be retained in school, and increasing
the opportunities for more than half of the
population to contribute concretely to the
harmonious economic and social growth
of the country. Joining the Family Planning
2030 initiative, reafrming commitments
to allocate fnancial and programmatic resources for interventions to provide information and modern methods of contraception, including for adolescents and young
women, should be a priority for the sector.
The restructuring of the mother, child and
adolescent health programs, based on
primary health care, including community
health, aiming to achieve universal health coverage is another desirable option,
along with the continuity of external funding and support from other national and
international stakeholders and donors.
The COVID-19 prevention measures, which
are universal, have benefted the prevention of other communicable diseases, such
as respiratory infections, the fecal-oral
transmission diseases, also benefting
from the massive training of Infection Control and Prevention technicians and the
use of personal protective equipment in
the country. The pandemic showed the government’s capacity to organize itself and
respond to adverse situations with quality,
relying on the support of various partners.
|
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3
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82 ALBANIA - VOLUNTARY NATIONAL REVIEW ON SDGs
Goal 3. Ensure healthy lives and promote well-being for all at all ages
The Strategic Document of Sexual and Reproductive Health and the National Strategy on Health identify this goal
as a top priority in Albania. Preventable deaths in children are also priorities discussed in depth in the national
policies.
The second indicator selected for this goal—death from chronic disease—measures one dimension of the overall
health situation that is particularly relevant in European countries.
SDG Target 3.2 By 2030, end preventable deaths of newborns and children under 5 years of
age, with all countries aiming to reduce neonatal mortality to at least as low as
12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000
live births
Indicator 3.2.1 Under-five mortality rate
Chart 6: Under-five mortality rate (per 1,000 live births), 2012–2017
Definition:
Under-five mortality is the probability of a child born in a
specific year or period dying before reaching the age of 5
years, if subject to age specific mortality rates of that period,
expressed per 1000 live births
Alignment with SDG Target:
Totally aligned
Objective:
To be consistent with Target 3.2 this indicator should
decrease
Definition:
Under-five mortality is the probability of a child born in a
specific year or period dying before reaching the age of 5
years, if subject to age specific mortality rates of that period,
expressed per 1000 live births
Disaggregation:
Region, sex and age
Source:
Civil registration, census survey, DHS
Periodicity:
Annually
Available time series: 2011–2017
Tier II
ALBANIA - VOLUNTARY NATIONAL REVIEW ON SDGs 83
SDG Target 3.4 By 2030, reduce by one-third premature mortality from non-communicable
diseases through prevention and treatment and promote mental health and
well-being
Indicator 3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic
respiratory disease
Chart 7: Mortality rate attributed to cardiovascular disease, cancer,
diabetes or chronic respiratory disease, 2012–2017
Definition:
Mortality rate attributed to cardiovascular disease, cancer,
diabetes or chronic respiratory disease. Probability of dying
between the ages of 30 and 70 years from cardiovascular
diseases, cancer, diabetes or chronic respiratory diseases
Alignment with SDG Target:
Aligned 80%
Objective:
To be consistent with Target 3.4 this indicator should
decrease
Disaggregation:
Sex, age
Source:
INSTAT
Periodicity:
Annually
Available time series:
2011–2017
Tier II
|
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|
61
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62
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ODD 3 : Bonne santé et bien-être
L’Andorre a réalisé des progrès substantiels dans le maintien de l’excellence de la
qualité des soins dans les services de santé du pays. Au cours des dernières années,
un travail important a été fait pour attirer le talent des professionnels de la santé
travaillant dans le pays, ainsi que des avancées importantes ont été faites dans
les domaines de la recherche médicale et de l’innovation. En outre, différentes
mesures ont été prises pour favoriser la rationalisation des dépenses publiques
tout en garantissant une meilleure qualité de soins aux citoyens. Cependant, la
pérennité du système de fnancement public des soins de santé devient un déf
qui nécessite l’action consensuelle de toutes les forces politiques du pays. En ce
sens, ces dernières années, diverses réunions se sont tenues, dans le cadre du
pacte d’État de santé, pour convenir à des mesures nécessaires pour faire face à
ce défcit croissant.
Progrès des indicateurs de santé (3.1, 3.2, et 3.3)
Les principaux indicateurs de santé en Andorre sont satisfaisants. En témoigne,
par exemple, l’espérance de vie élevée dans le pays, qui a atteint en 2020 l’âge de
83,4 ans en moyenne (2016-2020), même s’il faut tenir compte du retour dans les
pays d’origine de certains résidents. En ce qui concerne la mortalité maternelle,
elle est de 0 % et il faut noter que les accouchements sont assistés par du personnel
de santé spécialisé.
Ces dernières années, le Ministère de la Santé a mis à jour les protocoles de
détection et d’action sur les maladies transmissibles. Il a également publié
récemment un arrêté ministériel sur les maladies à déclaration obligatoire.
63
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Le Ministère de la Santé consacre par ailleurs une part importante de ses efforts
à la promotion d’habitudes saines pour réduire l’incidence des maladies non
transmissibles, ainsi qu’à des campagnes de sensibilisation sur la prévention
des maladies. Le programme de détection précoce du cancer du sein auprès des
femmes âgées de 50 à 69 ans en est un exemple. En 2020, cette fourchette a été
étendue à 74 ans.
64
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« À partir de 50 ans, une mammographie tous les 2 ans »
Soins de santé mentale et conduites addictives (3.4 et 3.5)
L’Andorre a fait des progrès dans la prise en charge de la santé mentale de la
population. En février 2022, le Plan global de santé mentale et des dépendances
(PISMA) a été présenté. Il vise à transformer le
système actuel vers un nouveau modèle de soins
global, interdisciplinaire, centré sur l’individu et
communautaire. Parmi les mesures de ce Plan fgurent,
entre autres, la lutte contre la stigmatisation sociale en
rapport avec la santé mentale, qui prévoit des campagnes
de sensibilisation à destination de la population,
l’élaboration d’un plan national de lutte contre le
suicide, ou la défnition du rôle des psychologues au sein
du portefeuille de services de santé.
65
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Dans le cadre des différentes initiatives sur la santé mentale et les dépendances,
en 2021, la Commission nationale de la santé mentale et des dépendances a
été mise en place en tant qu’organe consultatif ayant pour objectif de conseiller
le Gouvernement sur la promotion des soins complets de santé mentale et
d’améliorer la coordination de tous les acteurs concernés. Cet organe, qui inclut
des représentants de la société civile et de la jeunesse, est également chargé de
superviser la mise en œuvre du PISMA. Récemment, la Commission de la santé
mentale a mis sur pied un groupe de travail pour les jeunes adolescents présentant
des troubles de conduites et des dépendances, afn d’évaluer leurs besoins.
Les conséquences de la pandémie de la Covid-19 ont également eu un impact
évident sur la santé mentale de la population. Conscient de cet enjeu, le Ministère
de la Santé a lancé en avril 2021 un Programme de prise en charge psychologique
dans le cadre de l’urgence sanitaire provoquée par la Covid-19, destiné à toutes
les personnes de plus de 6 ans qui en éprouvent le besoin.
Enfn, un nouveau portefeuille de services et de produits de santé a récemment
été approuvé, défnissant les services pris en charge par l’État et la manière dont
les services sont fournis, intégrant, entre autres, les consultations auprès de
psychologues. Un décret doit encore entériner ces décisions.
Couverture sanitaire universelle (3.8)
Le système de santé publique du pays est basé sur un système de sécurité
sociale dans lequel la Caisse andorrane de Sécurité sociale (CASS) collecte les
cotisations des travailleurs et des employeurs par le biais des retenues salariales
correspondantes. La couverture santé en Andorre a tendance à être universelle.
Il s’agit d’un système public de sécurité sociale avec un système de copaiement,
tout en parvenant à être solidaire. Il existe de multiples mécanismes de prise en
charge complémentaire pour cause de maladie ou de ressources insuffsantes.
66
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Ces dernières années, la CASS a mené diverses initiatives pour améliorer la gestion
publique du service. Concrètement, en 2017-2018, le nouveau portail web a été
lancé, ce qui a permis la numérisation progressive du service, l’accès aux informations
personnelles des usagers et la gestion des démarches en ligne. Par ailleurs, un système
de rendez-vous à l’avance a été mis en place afn d’améliorer la gestion et le temps
d’attente des citoyens. Aussi, en 2018-2019, une campagne de communication a été
réalisée, à l’occasion du 50e anniversaire de la CASS, permettant d’en expliquer le
fonctionnement et les services qu’elle offre aux citoyens.
Ces évolutions progressives de la gestion de l’entité sont suivies depuis 2017 au
travers de l’enquête annuelle de satisfaction des usagers de la CASS, qui recueille
l’avis des citoyens sur les services prodigués par l’établissement public et permet
de déterminer les actions nécessaires à l’amélioration du service. Les résultats de
la dernière enquête (2020) indiquent que la satisfaction globale à l’égard du service
est très bonne et que la perception du service rendu par la CASS aux usagers s’est
améliorée ces dernières années.
En réponse aux avancées internationales concernant la protection des droits et des
devoirs en matière de santé, le Conseil Général a approuvé en 2017 la Loi 20/2017
sur les droits et les devoirs des usagers et des professionnels du système de
santé et sur le dossier médical partagé. Cette Loi a permis de disposer d’une norme
spécifque qui rassemble la formulation des droits et des devoirs de l’usager du
système de santé et qui assure la sécurité juridique des citoyens et des professionnels.
La Loi réglemente également les droits et les devoirs des professionnels de la santé et
introduit un régime disciplinaire pour ces derniers. Enfn, le texte prévoit la création
du dossier médical partagé, devenu incontournable pour la promotion de soins de
santé de qualité.
67
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En effet, le dossier médical partagé est un outil essentiel, auquel ont accès tous
les professionnels de la santé exerçant en Andorre, à condition qu’ils aient
une motivation justifée, et permet une utilisation partagée des informations
disponibles sur la situation et l’évolution d’un patient tout au long de la continuité
des soins. Son objectif est d’évoluer vers un système intégré qui permet une
plus grande coordination entre les professionnels et les prestataires de santé
et, en fn de compte, conduit à une plus grande qualité et sécurité des services
de santé destinés à l’usager. Ainsi, il convient de noter l’approbation, en mars
dernier, du Portefeuille de services et de produits de santé (CSPS), qui défnit
les prestations de santé fnancées publiquement par la CASS et le Gouvernement
et fxe les conditions de prestation des services inclus.
La mise en place du dossier médical partagé, ainsi que la prescription électronique
et le déploiement du modèle de la voie préférentielle, qui renforce la coordination
entre les niveaux de soins et la fgure du médecin des soins de santé primaires, ont
clairement contribué à renforcer la prévention et la promotion de la santé tout en
garantissant une rationalisation des dépenses publiques.
« Le médecin référent vous connaît, vous écoute et vous accompagne »
68
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Formation des professionnels de la santé (3.c)
L’Andorre est pleinement engagée pour la formation des professionnels de la
santé et leur perfectionnement. Il existe divers accords de coopération avec
les pays voisins, l’Espagne et la France, qui incluent l’échange de professionnels
et la formation partagée. Dans le cadre de la planifcation des professionnels
de la santé, en octobre 2019, le règlement d’accréditation des professionnels
préalable à la signature de la Convention avec la CASS a été approuvé dans le but
de mettre en valeur la formation continue et d’établir des mécanismes favorisant
la rétention des talents. Ainsi, les nouvelles accréditations des professionnels de
la santé doivent répondre aux besoins sectoriels ou aux accords de coopération
avec les pays voisins. L’objectif est de promouvoir l’exercice et le retour en Andorre
des professionnels qui ont passé une partie de leur vie dans le pays et connaissent
les structures et le fonctionnement du système de santé andorran.
Soins aux personnes âgées
Le vieillissement progressif de la population du pays a rendu nécessaire la révision
des polítiques destinées à cette tranche d’âge. Dans le domaine de la santé, le
Service andorran des soins de santé (SAAS) a lancé le Service de vieillissement
en bonne santé, qui, entre autres mesures, prévoit des actions pour évaluer
les capacités intrinsèques des personnes âgées et établir des interventions,
généralement diététiques et physiques, pour retarder la dépendance. La stratégie
du Projet APTITUDE est également complémentaire des actions de ce service. Le
Projet APTITUDE fait partie des projets POCTEFA et vise à mettre en place des
mesures de prévention du handicap afn de prévenir la perte d’autonomie chez
les personnes âgées. L‘objectif est d’inverser la fragilité des plus de 65 ans afn
de retarder leur dépendance par diverses interventions liées à l’exercice, aux
habitudes alimentaires, ainsi qu’à la formation, ou la recherche et l’innovation
dans le domaine de la gériatrie.
69
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Réduction des victimes des accidents de la route (3.6)
Le Gouvernement d’Andorre s’est engagé à atteindre les objectifs mondiaux de
réduction des accidents de la route et de promotion de la sécurité routière dans
le but global d’atteindre 0 victime d’ici 2050. Le pays dispose du Plan national
de sécurité routière (2021-2030), qui comprend un ensemble de mesures
pour avancer vers cet objectif. Concrètement, le Plan prévoit diverses mesures,
notamment des campagnes de sensibilisation à la conduite responsable, la révision
des limitations de vitesse sur les routes du pays, ou la promotion des transports
en commun dans des conditions météorologiques défavorables.
De même, depuis 2020, le programme d’éducation routière dans les écoles est
devenu un outil très important à la fois pour éduquer les nouvelles générations,
et sensibiliser la population à une mobilité plus sûre et plus responsable. En ce
sens, le groupe de personnes qui subit le moins d’accidents de la route est celui
des jeunes entre 20 et 30 ans.
Soulignons que la Mairie d’Encamp a pris différentes initiatives conjointes avec
le Ministère de l’Éducation et de l’Enseignement supérieur, l’Automobile Club
d’Andorre et le Département de la Mobilité pour sensibiliser les élèves des écoles
aux mesures de sensibilisation et de prévention des accidents de la route. Cela a
également favorisé la création d’espaces urbains paisibles pour donner la priorité
aux piétons et réduire la circulation automobile.
70
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Promotion des droits sexuels et reproductifs (3.7)
La promotion et le respect des droits sexuels et reproductifs est une action
décisive du Gouvernement. Le Ministère de la Santé, en collaboration avec le
Ministère de l’Éducation et de l’Enseignement supérieur, organise divers ateliers
pédagogiques dans les écoles sur la santé sexuelle et reproductive, conformément
aux engagements internationaux existants. En outre, plusieurs campagnes de
sensibilisation ont été menées sur l’utilisation des méthodes contraceptives
destinées à la population jeune, dans le but de garantir une santé reproductive
effcace.
Plus récemment, en mars 2020, le Ministère de la Santé a lancé le Service de prise
en charge globale de la femme (SIAD). Ce service vise à devenir un espace public
d’information et de conseil pour celles et ceux qui ont besoin d’orientation sur
la santé sexuelle et reproductive, y compris la planifcation familiale, assurant
une assistance individualisée, gratuite et sur tout le territoire. Le SIAD, les
Urgences et la Consultation Jeunes du SAAS proposent la pilule du lendemain
gratuitement. Les jeunes femmes de plus de 16 ans recevront la pilule sans avoir
besoin d’être accompagnées, tandis que les jeunes de moins de 16 ans doivent
être accompagnées de leurs parents ou tuteurs légaux pour la recevoir.
Concernant l’interruption volontaire de grossesse, le SIAD a défni un protocole
d’action pour les personnes qui souhaitent bénéfcier de conseils liés à cet aspect.
Le SIAD prévoit également la possibilité d’une prise en charge de la patiente à un
stade postérieur de l’interruption de grossesse.
Inauguration du SIAD. Source: Gouvernement d’Andorre
71
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Sans aucun doute, la question de la dépénalisation de l’avortement est objet de
débat dans la société andorrane. C’est aussi l’une des principales revendications
des mouvements féministes du pays, qui ont plaidé ces dernières années pour
aller de l’avant sur cette question.
Le développement des techniques de procréation humaine assistée a été l’une
des avancées majeures de la science et a résolu de nombreux problèmes liés à
la stérilité et à l’infertilité. Cette avancée contient des implications éthiques
qui nécessitent une réglementation spécifque. En réponse à cette question, le
Conseil Général a approuvé, en 2019, la Loi 12/2019 qualifée de techniques
de procréation assistée. L’objet de cette Loi est de réglementer l’application des
techniques de procréation assistée, scientifquement et cliniquement indiquées,
de réglementer la même application dans la prévention et le traitement des
maladies d’origine génétique et de réglementer les hypothèses et les exigences
d’utilisation des gamètes humains cryoconservés et embryons in vitro, ainsi que
les conditions de leur traitement et de leur éventuel rejet.
Enfn, le portefeuille de services et de produits de santé a été récemment approuvé,
défnissant ce qui est fnancé par l’État et comment les prestations sont fournies,
y compris, entre autres, la FIV (Fécondation in Vitro), qui sera développée par
décret.
Incidence de la Covid-19
Le pays a été durement touché par la pandémie de la Covid-19. Au niveau
sanitaire, les débuts de la pandémie ont été particulièrement diffciles en
raison de l’augmentation de la pression hospitalière provoquée par l’affux de
patients. Cependant, les mesures de prévention et de confnement et surtout
la collaboration citoyenne ont permis d’alléger signifcativement la pression
hospitalière lors de la première et de la deuxième vague d’infections. Les données
au 30 mars 2022 sont : 40 024 personnes touchées et un total de 39 283 fns
d’hospitalisation. Le nombre total de décès est de 153. Depuis le début du Plan de
vaccination, 156 427 doses, 58 053 premières doses, 57 359 deuxièmes doses et
41 015 troisièmes doses de vaccin ont été administrées.
À noter également l’augmentation ces dernières années des dépenses publiques
de santé pour renforcer les actions de confnement, de prévention et de soins.
72
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matières Le Gouvernement d’Andorre s’est clairement engagé dans la détection précoce
de la maladie, grâce à une campagne de tests intensifs de la population, qui a
permis d’obtenir des données importantes sur l’incidence de la maladie dans la
population. De plus, avec l’assouplissement des restrictions et la volonté d’assurer
un retour à la normalité en toute sécurité, le Gouvernement d’Andorre a fourni
des tests de diagnostic gratuits pour la maladie à des moments précis de forte
affuence, ainsi qu’un accès garanti à ceux-ci à des prix abordables. Cette stratégie
planifée centrée sur la détection de la maladie a fait de l’Andorre l’un des pays avec
l’un des ratios les plus élevés de tests de diagnostic. Ainsi, par exemple, fn janvier
2022, le chiffre de 20 116 tests de diagnostic pour 100 000 habitants a été atteint.
L’Observatoire COVID a également été récemment mis en place dans le but
d’accompagner l’exécutif dans le suivi et le contrôle des effets de la crise du
coronavirus. Ses fonctions spécifques comprennent la promotion d’études
scientifques d’intérêt liées à la pandémie, la défnition d’indicateurs et de
sources d’information pour connaître l’état de la situation, l’analyse des données
pertinentes avec leur évolution et leur impact, la promotion de protocoles d’action
de soins spécialisés ou la diffusion de résultats et d’informations pertinents.
Actuellement, une étude sur la Covid persistante et son incidence dans la
population est en cours. Les résultats préliminaires, présentés en février dernier,
ont fourni des données précieuses sur le comportement de la Covid persistante
et ont été utiles pour sensibiliser les personnes présentant des symptômes
compatibles avec la maladie à rechercher des soins de santé appropriés.
73
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Défs, prochaines actions
Les mesures de con!nement qui ont dû être appliquées dans le pays pour
freiner la propagation du virus ont posé un dé! en termes de gestion
publique de l’urgence sanitaire. Dans ce sens, des travaux sont actuellement
menés sur l’élaboration du Plan National de contingence en situation de
crise sanitaire. Un groupe de travail a été mis en place composé de membres
du Ministère de la Santé, du SAAS et de la Protection Civile. Le document
devrait être !nalisé au premier trimestre 2023.
Le 11 mai 2020, l’Andorre a adhéré à la Convention-cadre de l’Organisation
Mondiale de la Santé pour la lutte antitabac (Genève, 2003). Le Ministère
de la Santé travaille actuellement sur des amendements législatifs pour
adapter le cadre réglementaire. Le projet de loi devrait être déposé au cours
de l’année 2022.
Les 12 et 13 mai 2022, le ministère de la Santé, le SAAS, l’Université d’Andorre
et l’agence Andorra Recerca + Innovació ont organisé conjointement la
Conférence sur la santé planétaire. Cette conférence internationale a
permis de donner de la visibilité à un nouveau domaine transdisciplinaire
qui se concentre sur l’analyse et le traitement des impacts des perturbations
humaines sur les systèmes naturels de la Terre sur la santé humaine. La
Conférence a été l’occasion de ré"échir sur l’impact du changement
climatique et de la perte de biodiversité sur la santé humaine.
En ce qui concerne la promotion de la recherche, le Projet de loi sur la
recherche dans le domaine de la santé et de la biomédecine est actuellement
en cours d’examen au Parlement. Le texte repose sur des principes éthiques
fondamentaux et applique comme critère la primauté de la personne sur
l’intérêt de la société ou de la science, sauf dans le cas où cette prééminence
pourrait mettre en danger la santé publique. Dans le même temps, la Loi
élargira considérablement les opportunités de développement du secteur
et contribuera à attirer et à retenir le talent de nouveaux professionnels.
74
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L’Andorre a pris des mesures décisives pour garantir une meilleure
qualité des services de santé à ses citoyens. Cependant, la question de la
pérennité du système de !nancement public reste un dé!. Alors que les
rapports soulignent l’urgence de remédier au dé!cit croissant du système
de !nancement, il n’y a pas d’accord général parmi les forces politiques
représentées dans le Pacte national de santé sur la manière de réformer le
système public de !nancement pour maintenir des services de santé de
qualité et durables.
Bonne pratique
Sant Julià de Lòria, une ville cardio-protégée. Signature en 2020 d’un
accord de collaboration entre la Mairie de Sant Julià de Lòria et la CroixRouge andorrane pour l’installation de dé!brillateurs dans di#érents
points stratégiques de la ville, ainsi que des formations destinées à tout le
personnel de l’administration locale et des agents sociaux.
Progrès: Voie préférentielle entièrement déployée et Dossier médical
partagé d’Andorre entièrement mis en place.
Défs: Développement de la prescription électronique.
|
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ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
ALIGNMENT OF THE SDG TARGETS TO THE NATIONAL AGENDA 2021
Implementation efforts for health-related SDGs are aligned with the ongoing work towards the pillar of “World-Class Healthcare”
in UAE’s Vision 2021 which emphasizes the importance of disease prevention and a strong healthcare system, capable of
responding efficiently to epidemics or health risks.
The UAE aspires to create one of the best healthcare systems in the world and the National Agenda specifies a set of ambitious
targets and indicators (KPIs) to achieve this. Many of these targets are closely related to the health-related targets in the SDGs.
SDGs have been incorporated in the following multi-sectoral plans: National Non-Communicable diseases (NCD) plan, National
Nutrition plan, National Maternal and Child health (MCH) plan and the Childhood Obesity Framework. In 2018, further
integration of the SDGs with the local development plans of the seven Emirates will be undertaken.
1 WHO’s 2017 report is the source for all figures used in this chapter: http://apps.who.int/iris/bitstream/10665/255336/1/9789241565486-eng.pdf?ua=1
COORDINATING AGENCY:
MINISTRY OF HEALTH & PREVENTION
GOOD HEALTH 03 AND WELL-BEING
& PREVENTION
MINISTRY OF HEALTH
56 57
UAE’s Ministry of Health and Prevention (MOHAP) leads the implementation of health-related targets in the SDGs.
While MOHAP’s primary focus is on SDG 3 (Good Health and Well-being), there are several targets in SDG 1 (No Poverty),
SDG 2 (Zero Hunger), SDG 5 (Gender Equality), SDG 6 (Clean Water and Sanitation), SDG 7 (Affordable and Clean Energy),
SDG 11 (Sustainable Cities and Communities), SDG 13 (Climate Action), and SDG 16 (Peace, Justice and Strong Institutions)
for which it is the lead or supporting agency.1
58 59
INSTITUTIONAL MECHANISMS
In 2017, MOHAP established a taskforce for health related-SDGs which reports to UAE’s National Committee on SDGs. The taskforce
is responsible for developing a framework and governance mechanism to integrate health-related SDG targets and indicators within
the strategic plans of federal and local level government agencies. The taskforce also provides guidance on policy and service delivery
and engages with the national statistics system to develop and enhance systems for data capture, monitoring and reporting.
UPDATES ON SELECTED HEALTH-RELATED SDG TARGETS
Target (3.1) & Target (3.2)
The current rate of maternal mortality in UAE is 6 per 100,000 live births and the target is to reduce it to 3 per 100,000 by 2030.
The current under-five mortality rate is 6.8 per 1,000 live births and the target for 2030 is 4 per 1,000 live births. In the UAE,
births attended by skilled health personnel is 100%.
In order to strengthen maternal and child health, MOHAP developed the 2017-2021 National Maternal and Child Health (MCH)
plan in partnership with national stakeholders and the WHOs. One way to ensure good health for newborn babies is to encourage
breastfeeding; MOHAP has adopted a baby-friendly concept at both public and private hospitals and increased the number of
lactation consultants. In addition, MOHAP has undertaken efforts to expand screening for possible instances of congenital heart
disease and hearing disabilities.
Target (3.3): End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis,
water-borne diseases and other communicable diseases.
According to the World Economic Forum, UAE has the lowest HIV prevalence in the world (<0.2%) and the lowest tuberculosis
rate (1.8/100,000). The WHO reports that UAE is completely free of malaria.
‘Infants receiving three doses of hepatitis B vaccine’ is used as a proxy indicator to track the prevalence of hepatitis. The UAE is
at 94% hepatitis vaccine coverage with an aim to reach 100% by 2030.
Target (3.4): Reduce by one-third premature mortality from non-communicable diseases through prevention and
treatment and promote mental health and well-being.
Non-communicable diseases represent a major health burden for UAE. Mortality results from the four main NCDs (cardiovascular
diseases, cancer, diabetes and chronic respiratory diseases) accounts for 65% of all deaths in UAE. Moreover, the four main
diseases account for 17.4% of premature mortality (30-70yrs) in UAE. There is a strong national commitment to address
NCDs as part of an integrated multi-sectoral approach. UAE’s National Agenda, includes a set of national targets for reducing
NCD mortality and burden. These targets are aligned with WHO global targets for 2025 and the targets for the SDGs.
To achieve the national targets and to be aligned with global commitments, MOHAP has developed a multi-sectoral national
action plan for NCD prevention and control for (2017- 2021). In addition, a national high-level multi-sectoral NCD Committee
was established in 2016 with membership of all relevant sectors to oversee the progress in the implementation of the NCD
action plan and its KPIs. Recently implemented excise taxes on tobacco (100%) and sugary drinks (50%) reinforce government
commitments to NCD prevention and obesity reduction. A national framework to combat childhood (ages 5-17 years) obesity
and mass media campaigns targeting adult obesity (18+) has been developed by MOHAP in collaboration with stakeholders
across the federal and local governments and the private-sector.
NCD screening and management: The national agenda was a turning point to scale up screening programs in Primary Health Care (PHC).
MOHAP, in collaboration with the WHO launched an initiative to integrate CVDs & diabetes screening programs in PHC.
The “integrated NCD program” focused on estimating the cardiovascular risk among population aged 40+, increasing early
detection of NCDs and sensitizing healthcare providers in these settings on the importance of health promotion and screening.
An initial assessment of this initiative showed improved access to NCD screening. Higher patient satisfaction and trust in PHC
was also observed. MOHAP will continue expanding this initiative to cover all PHC, encouraging patients to self-manage NCDs
and will build capacity of staff for counseling activities.
To enhance mental health services “The National Policy for The Promotion of Mental Health in the United Arab Emirates” was
developed in 2017.
In addition, the UAE established a national cancer registry to monitor cancer programs and enhance strategies to reduce mortality
rates from cancer.
Target (3.a): Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate.
Currently, the prevalence of tobacco use among male adults (18+) is 21.6% and the aim is to reduce it to 15.7% by 2021.
(See graphs below).
To protect the population from tobacco exposure, UAE endorsed the MPOWER tobacco control measures by participating in the
Global Youth Tobacco Survey in 2002, 2006, 2013.
MOHAP has launched annual tobacco awareness campaigns and all tobacco products include a pictorial warning. Direct tobacco
advertisement is banned in the country. In October 2017, a 100% tax on all tobacco products was levied.
The 2021 National Agenda Target for Tobacco Consumption in Relation to The Current Rate (%)2
Targeted Percentage
Actual Percentage
2 Source: Ministry of Health and Prevention
2014
2015
2016
2017
2018
2019
2020
2021
20
15
10
5
0
17.6 17.4 17.1 16.8 16.6 16.3 16 15.7
21.6
2
1
0
2014
2015
2016
2017
2018
2019
2020
2021
1.9
1.86 1.83 1.8 1.77 1.74 1.71 1.69 1.66
Target (3.6): Halve the number of global deaths and injuries from road traffic accidents.
Ministry of Interior is the lead agency responsible for targets pertaining to road traffic. See chapter on SDG 16 for further details.
Target (3.7): Ensure universal access to sexual and reproductive health-care services, including for family planning,
information and education, and the integration of reproductive health into national strategies and programs.
The satisfaction rate with family planning services in the UAE is approximately 70% with an aim to increase this
figure to 75%.
According to the WHO, the adolescent birth rate for UAE is 34.2/1,000 women aged 15-19 years.
60 61
The Women and Childbirth Monitoring System has been established to improve reproductive health services. The system tracks
each step in a patients’ pregnancy and captures key information (fetus development, mother’s health, pregnancy progress, etc.) in
electronic medical records. These records are updated in real-time and are provided to care givers to increase efficiency. The system
has many benefits of which the main ones are improving patient care by creating a single portal for all clinical data and increasing
the efficiency of healthcare providers by providing immediate access to information needed for planning and decision-making.
Target (3.8): Achieve universal health coverage, including financial risk protection, access to quality essential health-care
services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
MOHAP has undertaken a number of initiatives to improve access to health care, expand health care facilities and integrate
health information systems across all levels of care.
To improve the quality of health-care, the Medical Reference Key / Clinical Key program has been implemented. This program
provides decision-making support to physicians and nurses regarding a patient’s condition and treatment by relaying relevant
medical and surgical information based on health updates and clinical research.
In order to meet the universal health coverage requirement, the UAE is continually expanding insurance schemes with an aim to
provide all UAE citizens and residents with universal health coverage.
Vaccination services are also central to the National Agenda. Currently, vaccination coverage in the UAE is 94% with an aim to
achieve 100% coverage by 2030.
Target (3.9): Reduce the number of deaths and illnesses from hazardous chemicals air, water and soil pollution
and contamination.
The Ministry of Climate Change and Environment (MOCCAE) is a member of the high-level NCD Committee. MOCCAE, in
collaboration with MOHAP, has been working on water clean-up campaigns, and more generally, population education and
awareness raising campaigns. The UAE has also built several energy- efficient residential communities and commercial areas. The
initiative to ‘go green’ has begun with the aim to have as many “Nearly Zero Energy Buildings (nZEBs)” as possible.
According to WHO, in the UAE current mortality rate attributed to household and ambient air pollution is 7.5/100,000 population.
The mortality rate attributable to unsafe water is lower than 0.1. Likewise the mortality rate attributed to unintentional poisoning
is 0.3/100,000 population.
Target (3.c): Substantially increase health financing and the recruitment, development, training and retention of the
health workforce
The National Agenda also aims to ensure that health-care providers are present in sufficient numbers to facilitate the well-being of
patients. Target 3.c aligns with an important National Agenda KPI which aims to increase the number of doctors and nurses per 1,000
population by year 2021. Health worker population density is currently 46.2/10,000 population. A number of initiatives have been
launched in support of this target. However more recently, a comprehensive training program for nurses has been inaugurated to
ensure that nurses are trained to the highest healthcare standards and that they are also familiar with the cultural context of the UAE.
Target (3.d): Strengthening national capacity for early warning, risk reduction and management of national and global health risks
UAE current score for International Health Regulation (IHR) and emergency preparedness is 91 out of a maximum of 100, and
the target is to reach a score of 95 by 2030.
OTHER KEY INTERVENTIONS TO IMPLEMENT HEALTH-RELATED SDG TARGETS
In addition to the aforementioned initiatives, there are many cross-cutting programs that were developed to support
implementation, monitoring and reporting of health-related SDG goals, targets and indicators:
1. Open data
UAE has introduced a national open data platform to help decision-makers, researchers, biostatisticians and other users to
benefit from information and statistics.
2. Nationwide Health Survey
The World Health Survey (WHS) was developed by the World Health Organization (WHO) as a means to compile comprehensive
baseline information on the health of populations.
The UAE is conducting a nationwide health survey to collect data for health indicators. The survey is conducted under the
supervision and management of the Ministry of Health and Prevention in cooperation with the World Health Organization, and
other strategic partners. The recent survey started in late 2017 and will be completed in 2018.
3. National Unified Medical Record Program
The UAE Cabinet has approved the National Unified Medical Record (NUMR) project the objective of which is to build a nationwide
integrated platform for sharing data to ensure improved care through interoperability among all health care authorities and
medical practitioners. Each patient in the UAE will have one electronic health record that can be accessed by both public and
private healthcare entities. The initiative aims to facilitate the timely sharing of vital patient information that will ensure better
decision making. Consequently, quality and care would be improved, safety ensured, efficiency increased and health disparities
would be reduced. NUMR is expected to be finalized within the next five years.
4. Implementing Advanced Technology
Advanced technologies are being deployed to assist the advancement of medicine, improve the accessibility of health services,
reduce the workload of health workers, and reduce human error. For instance, pharmacies in some hospitals are benefiting from
robotic technology that dispenses prescribed medication with a click of a button based on a bar code. This minimizes human error
and improves the accuracy of data collection on the dispensing and usage of prescription medicines. An added advantage is that
the dispensing process is paper free. In addition, the UAE currently houses a cutting-edge surgical technology called “Da Vinci”
which is used to perform minimally invasive heart surgeries and ensure short recovery periods for patients.
5. Smart Patient Portal
The Smart Patient portal provides citizens and residents easy access to their own health profiles including details such as
appointment records, laboratory reports, medication, history of health problems, allergies and treatments including diagnostic
procedures (e.g. radiology) surgical histories. In addition the Smart Room project in hospitals aims to connect medical devices
in a patient’s room with their electronic file to improve real-time treatment and medical care, and to raise the efficiency of work
flow among the medical staff.
6. Supporting Policies and Laws and Regulations
There are many policies and laws that are in place to govern the provision of healthcare services in the UAE. Some recent ones
(2013 onwards) are mapped to the relevant SDGs and presented in the following table.
UAE Ranked # 1
(Lowest) Tuberculosis cases/100,000 population - Global Competitiveness Report by World
Economic Forum 2017/18
(Lowest) HIV prevalence, % adult population - Travel and Tourism Competitiveness Report
by World Economic Forum 2017
(Lowest) Malaria cases/100,000 population - Travel and Tourism Competitiveness Report by
World Economic Forum 2017
|
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[
3
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{
"country": "are",
"file_id": "sdg-03/vnr-report-are-2018-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
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|
SDG 3 – CASE STUDY
Malaffi
Problem statement
The introduction of mandatory health insurance
in Abu Dhabi in 2006 brought tremendous change
to the sector. The increasing number of private
healthcare providers posed a challenge with
coordination of care, overutilization of services and
increased financial burden for the payors. The cost
of healthcare continued to rise globally, and within
the GCC, the UAE became the most expensive63,64
also due to the ageing population and increased
incidence of chronic diseases. The Department of
Health (DOH), the healthcare regulator in Abu Dhabi,
needed mechanisms to control the quality of care
and access to centralised population health data to
manage the healthcare sector better.
Idea and description
As a result, in 2016, the DOH decided to digitally
transform the healthcare sector in Abu Dhabi, aiming
to enhance the wellbeing of the Emirate’s residents
through enhanced prevention and access to
integrated, innovative, high-quality and cost-effective
healthcare, in line with UAE’s National Agenda.
As a key component of the digital transformation,
in 2019, the DOH launched Malaffi (Arabic for ‘my
file’), as a Public-Private Partnership65 with Injazat,
a regional leader in digital transformation. Malaffi,
the first Health Information Exchange (HIE) in the
Middle East and North Africa, will safely and securely
connect public and private healthcare providers
in the Emirate, creating a centralised repository of
unified patient records.
Results and impact
In only three years, Malaffi safely and securely
connected almost the entire sector in Abu Dhabi
and has been noted as one of the fastest HIE
implementations worldwide. All hospitals, 96% of
medical centres and clinics, over 70% of pharmacies
and 99% of the patient encounters are already
connected, providing secure access to a total of 770
m unique clinical records, to over 45,500 doctors,
nurses and other members of staff.
Malaffi collates information about encounters,
allergies, laboratory results and radiology reports,
medication, vital signs, vaccination records,
clinical documents, problems and diagnosis and
procedures. The team is working on expanding the
scope to more data points to increase the clinical
value of the system, including radiology images, and
to also provide patients with access to their medical
history through a health portal to motivate patients
to be more engaged in the management of their
health.
Consistently, around 30% of users with access
are using the platform monthly, which compares
favourably to averages of other global HIEs. Through
user surveys and testimonials, there is strong
evidence that Malaffi already yields numerous
benefits to patients and providers, such as improving
coordination of care and reducing the number of
unnecessary and duplicate diagnostic interventions
and medical errors. It also supports preventative
care and better-informed decision making, improving
patient safety and experience, healthcare quality,
and outcomes.
96%
70% 770M
45,500
Medical centres
and clinics
Pharmacies
99%
Patient encounters
Unique clinical
records
Doctors, nurses and
other members of staff
63 Department of Health Abu Dhabi 2017
64 2017 CAQH INDEX
65 A special project company called Abu Dhabi Health Data Services was established to build, operate and transfer the HIE to the DOH after a
A key player in Abu Dhabi’s COVID-19 response
When COVID-19 emerged in 2020, Malaffi proved
critical to the globally recognised successful
pandemic response of the Emirate. To date, Malaffi
has collated a total of 95 million PCR Tests and 11
million vaccination records available to the frontline
clinicians and enabled them to provide better patient
care.
Furthermore, the Government had access to realtime pandemic insights and was better prepared
to allocate resources efficiently and implement
measures such as mass testing, isolation, and
vaccination, safeguarding the population’s health
and wellbeing.
Improving interoperability and data quality
Analysing the vast database of clinical data, the
Malaffi team identified specific gaps and issues that
affected data quality. As a result, in November 2021,
the DOH issued guidance on coding standards to
healthcare providers in Abu Dhabi (such as SNOMED
CT66 and LOINC67). The adoption of these standards
will significantly improve interoperability, increase
the clinical value of the data, and the accuracy and
scope of population health insights.
Better population health insights
Malaffi provided the DOH for the first time access to
population health insights in near real-time based on
the analysis of the consolidated clinical data of the
entire population
Using AI technology, predictive analytics and
machine learning, Malaffi will increasingly be used
to prevent and reduce disease progression, promote
improved health outcomes and, ultimately, prolong
life.
Malaffi will contribute to creating advanced systems
tailored for syndromic and pandemic surveillance
and response, along with other solutions which will
ensure Abu Dhabi remains at the forefront of public
health and safety.
In 2021, Malaffi premiered a
demonstration of a population risk
management platform that uses
advanced artificial intelligence
(AI) analytic technologies, such as
machine learning and predictive
models that will empower the
healthcare sector to support
care management, and improve
population health and assist in
ensuring continuity of care.
95M
Frontline
clinicians
PCR
|
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|
Garantizar una vida sana y
promover el bienestar para
todos en todas las edades
Hasta el mes de diciembre de 2019, las metas adoptadas por la Argentina
correspondientes al ODS 3 y los organismos responsables de las mismas
fueron:
Metas
→ Meta 3.1. Para 2030, reducir la tasa mundial de mortalidad materna a menos de 70 por cada
100.000 nacidos vivos.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.2. Para 2030, poner fn a las muertes evitables de recién nacidos y de niños menores
de 5 años, logrando que todos los países intenten reducir la mortalidad neonatal al menos
hasta 12 por cada 1.000 nacidos vivos, y la mortalidad de niños menores de 5 años al menos
hasta 25 por cada 1.000 nacidos vivos.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.3. Para 2030, poner fn a las epidemias del Sida, la Tuberculosis, la Malaria y
las enfermedades tropicales desatendidas y combatir la Hepatitis, las enfermedades
transmitidas por el agua y otras enfermedades transmisibles.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.4. Para 2030, reducir en un tercio la mortalidad prematura por enfermedades
no transmisibles mediante la prevención y el tratamiento y promover la salud mental y el
bienestar.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.5. Fortalecer la prevención y el tratamiento del abuso de sustancias adictivas,
incluido el uso indebido de estupefacientes y el consumo nocivo de alcohol.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.6. De aquí a 2020, reducir a la mitad el número de muertes y lesiones causadas por
accidentes de tráfco en el mundo.
Organismo responsable: Ministerio de Transporte.
→ Meta 3.7. Para 2030, garantizar el acceso universal a los servicios de salud sexual y
reproductiva, incluidos los de planifcación de la familia, información y educación, y la
integración de la salud reproductiva en las estrategias y los programas nacionales.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.8. Lograr la cobertura sanitaria universal, incluida la protección contra los riesgos
fnancieros, el acceso a servicios de salud esenciales de calidad y el acceso a medicamentos
y vacunas inocuos, efcaces, asequibles y de calidad para todos.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.9. Para 2030, reducir sustancialmente el número de muertes y enfermedades
producidas por productos químicos peligrosos y la contaminación del aire, el agua y el suelo.
Organismo responsable: Secretaría de Gobierno de Salud.
117
→ Meta 3.a. Fortalecer la aplicación del Convenio Marco de la Organización Mundial de la
Salud para el Control del Tabaco en todos los países, según proceda.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.b. Apoyar las actividades de investigación y desarrollo de vacunas y medicamentos
contra las enfermedades transmisibles y no transmisibles que afectan primordialmente a los
países en desarrollo y facilitar el acceso a medicamentos y vacunas esenciales asequibles de
conformidad con la Declaración relativa al Acuerdo sobre los Aspectos de los Derechos de
Propiedad Intelectual Relacionados con el Comercio y la Salud Pública, en la que se afrma
el derecho de los países en desarrollo a utilizar al máximo las disposiciones del Acuerdo
sobre los Aspectos de los Derechos de Propiedad Intelectual Relacionados con el Comercio
respecto a la fexibilidad para proteger la salud pública y, en particular, proporcionar acceso
a los medicamentos para todos.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.c. Aumentar considerablemente la fnanciación de la salud y la contratación, el
perfeccionamiento, la capacitación y la retención del personal sanitario en los países en
desarrollo, especialmente en los países menos adelantados y los pequeños Estados insulares
en desarrollo.
Organismo responsable: Secretaría de Gobierno de Salud.
→ Meta 3.d. Reforzar la capacidad de todos los países, en particular los países en desarrollo,
en materia de alerta temprana, reducción de riesgos y gestión de los riesgos para la salud
nacional y mundial.
Organismo responsable: Secretaría de Gobierno de Salud.
ODS 3 Salud y Bienestar
118
Seguimiento de los progresos
Situación inicial y análisis de la evolución: metas e indicadores
→ Meta 3.1. Para 2030, reducir la tasa mundial de mortalidad materna a menos de 70 por cada
100.000 nacidos vivos.
Indicador 3.1.1. Razón de mortalidad materna por 100.000 nacidos vivos.
Indicador 3.1.2. Porcentaje de nacidos vivos atendidos por personal especializado.
El Indicador 3.1.1. ha mantenido una tendencia descendente desde el año de la línea de base.
Mientras que el porcentaje de nacidos vivos atendidos por personal especializado se mantiene
desde 2014 sobre el 99,5%.
→ Meta 3.2. Para 2030, poner fn a las muertes evitables de recién nacidos y de niños menores
de 5 años, logrando que todos los países intenten reducir la mortalidad neonatal al menos
hasta 12 por cada 1.000 nacidos vivos, y la mortalidad de niños menores de 5 años al menos
hasta 25 por cada 1.000 nacidos vivos.
Indicador 3.2.1. Número de muertes de menores de 5 años cada 1.000 nacidos vivos.
Indicador 3.2.2. Tasa de mortalidad neonatal cada 1.000 nacidos vivos.
Las muertes de menores de 5 años y neonatales descendieron entre 2014 y 2017.
→ Meta 3.3. Para 2030, poner fn a las epidemias del Sida, la Tuberculosis, la Malaria y
las enfermedades tropicales desatendidas y combatir la Hepatitis, las enfermedades
transmitidas por el agua y otras enfermedades transmisibles.
Indicador 3.3.1. Número de nuevos diagnósticos de VIH por 100.000 habitantes
Indicador 3.3.1.* Tasa de mortalidad por Sida por 100.000 habitantes.
Indicador 3.3.2. Casos nuevos notifcados de Tuberculosis por 100.000 habitantes.
Indicador 3.3.3. Casos notifcados de Malaria por 100.000 habitantes.
Indicador 3.3.4.* Tasa de notifcaciones de Hepatitis B en personas de 15 a 24 años por
100.000 habitantes.
Indicador 3.3.5.* Tasa de notifcación de Rabia Humana por 100.000 habitantes.
Indicador 3.3.5.2
* Cantidad de provincias con casos notifcados de Rabia Canina.
Indicador 3.3.5.3* Cantidad de departamentos con casos notifcados de Rabia Canina.
Indicador 3.3.5.4* Tasa de notifcación de Echinococcosis/Hidatidosis en menores de 15
años por 100.000 habitantes.
Indicador 3.3.5.5* Tasa de notifcación de Leishmaniasis Tegumentaria por 100.000
habitantes.
Indicador 3.3.5.6* Tasa de notifcación de Leishmaniasis Visceral por 100.000 habitantes
Indicador 3.3.5.7
* Porcentaje de provincias endémicas certifcadas con interrupción de la
transmisión vectorial de Chagas.
Indicador 3.3.5.8* Cantidad de provincias con tasa de prevalencia de Lepra superior a 1 por
10.000 habitantes.
El número de nuevos diagnósticos de VIH descendió entre 2013 y 2016. Aunque el valor
de 2013 es el que se adjudicó a la meta intermedia 2020. La mortalidad por Sida se mantuvo
aproximadamente entre 2014 y 2017.
Los casos nuevos notifcados de Tuberculosis aumentaron levemente.
No ha habido casos notifcados de Malaria desde 2015.
La tasa de notifcaciones de Hepatitis B en personas de 15 a 24 años se ha mantenido en una
tendencia descendente.
No se han notifcado casos de rabia humana desde 2015. La cantidad de provincias con casos
de rabia canina ha descendido desde 2015, habiéndose alcanzado en 2017 la meta intermedia
planteada para 2015. Continúa descendiendo en 2018.
121
Salud y Bienestar ODS 3
Los casos de Hidatidosis en menores de 15 años descendieron notablemente hacia 2018
superándose ampliamente el valor esperado para la meta 2025 y el de 2030.
Los casos de Leishmaniasis Tegumentaria descendieron entre 2015 y 2017. Mientras que los de
Leishmaniasis visceral aumentaron entre 2014 y 2016, retomando el valor de 2015 en 2017.
En 2018 una provincia endémica de Chagas certifcó la interrupción de la transmisión vectorial,
siendo entonces 10 las provincias certifcadas de las 19 endémicas de la enfermedad.
En ese año, solo una provincia tenía una tasa de prevalencia de Lepra superior a 1.
→ Meta 3.4. Para 2030, reducir en un tercio la mortalidad prematura por enfermedades no
transmisibles mediante la prevención y el tratamiento y promover la salud mental y el
bienestar.
Indicador 3.4.1.* Tasa de mortalidad específca por enfermedades cardiovasculares por
cada 100.000 habitantes de 30 a 69 años.
Indicador 3.4.1.2
* Tasa de mortalidad por Tumores Malignos por cada 100.000 habitantes
de 30 a 69 años.
Indicador 3.4.1.3* Tasa de mortalidad específca por Diabetes Mellitus por cada 100.000
habitantes de 30 a 69 años.
Indicador 3.4.1.4* Tasa de mortalidad específca por enfermedades crónicas del sistema
respiratorio por cada 100.000 habitantes de 40 a 74 años
Indicador 3.4.2. Tasa de mortalidad por suicidio por 100.000 habitantes.
La tasa de mortalidad por enfermedades cardiovasculares aumentó en 2016 con respecto a la
línea de base (2014) bajando a aproximadamente el valor de dicho año en 2017.
La tasa de mortalidad por tumores maligno se mantuvo descendiendo desde 2014.
La tasa de mortalidad por Diabetes Mellitus bajó en 2016 en relación con el valor de la línea de
base (2014) volviendo a subir en 2017 superando el valor del año de base.
La tasa de mortalidad específca por enfermedades crónicas del sistema respiratorio ascendió
entre 2014 y 2016 y descendió en 2017.
La tasa de mortalidad por suicidio se mantuvo con una tendencia levemente descendente.
→ Meta 3.5. Fortalecer la prevención y el tratamiento del abuso de sustancias adictivas,
incluido el uso indebido de estupefacientes y el consumo nocivo de alcohol.
Indicador 3.5.2.* Consumo total anual de alcohol per cápita (en litros de alcohol puro).
Indicador 3.5.2.2
* Prevalencia de consumo de alcohol regular de riesgo.
Indicador 3.5.2.3* Prevalencia de consumo de alcohol episódico excesivo.
El consumo de alcohol está en aumento. Tanto el consumo regular de riesgo como el consumo
episódico aumentaron desde la anterior Encuesta de Factores de Riesgo (pasó de 7,8% a 8,4%
en 2018 y de 10,4% a 13,3% en 2013 y 2018 respectivamente).
→ Meta 3.6. De aquí a 2020, reducir a la mitad el número de muertes y lesiones causadas por
accidentes de tráfco en el mundo.
Indicador 3.6.1. Tasa de mortalidad por lesiones debidas a accidentes de tránsito.
La mortalidad por accidentes de tránsito se mantuvo estable entre 2016 y 2018.
→ Meta 3.7. Para 2030, garantizar el acceso universal a los servicios de salud sexual y
reproductiva, incluidos los de planifcación de la familia, información y educación, y la
integración de la salud reproductiva en las estrategias y los programas nacionales.
Indicador 3.7.1.* Tasa de embarazo no planifcado.
Indicador 3.7.1.2
* Tasa de embarazo no planifcado entre adolescentes de 15 a 19 años.
Indicador 3.7.1.3* Tasa de uso de métodos anticonceptivos en mujeres en edad reproductiva.
Indicador 3.7.2.* Tasa de fecundidad adolescente temprana por cada 1.000 mujeres.
Indicador 3.7.2.2
* Tasa de fecundidad adolescente tardía por cada 1.000 mujeres.
ODS 3 Salud y Bienestar
122
El embarazo no planifcado aumentó 5,2 p.p. entre 2014 y 2018 (pasó de 58,4% a 63,6%). Entre
las adolescente aumentó también en 4,1 p.p. para el mismo periodo (pasó de 69% a 73,1%).
Las tasas de fecundidad adolescente (temprana y tardía descendieron entre 2014 y 2018. De
acuerdo a datos de la Secretaría de Gobierno de Salud, en 2018, los valores para la tasa de
fecundidad adolescente temprana y tardía fueron 1,4 y 49,2 por mil mujeres respectivamente70.
→ Meta 3.8. Lograr la cobertura sanitaria universal, incluida la protección contra los riesgos
fnancieros, el acceso a servicios de salud esenciales de calidad y el acceso a medicamentos
y vacunas inocuos, efcaces, asequibles y de calidad para todos.
Indicador 3.8.1.* Porcentaje de personas con cobertura pública exclusiva con acceso a
servicios básicos de salud.
La cobertura pública de servicios básicos de salud aumentó aproximadamente 9 p.p. en 2018 en
relación con 2016.
→ Meta 3.9. Para 2030, reducir sustancialmente el número de muertes y enfermedades
producidas por productos químicos peligrosos y la contaminación del aire, el agua y el
suelo.
Indicador 3.9.2.* Tasa de diarreas en menores de 5 años por 100 mil habitantes.
La tasa de diarreas en menores de cinco años mostró un continuo descenso.
→ Meta 3.a. Fortalecer la aplicación del Convenio Marco de la Organización Mundial de la
Salud para el Control del Tabaco en todos los países, según proceda.
Indicador 3.a.1.* Prevalencia de consumo de tabaco en población de 18 y más años.
La prevalencia de consumo de tabaco (cigarrillos) fue de 22,2%, lo que muestra un sostenido
descenso en relación con los valores de las Encuestas de Factores de Riesgo anteriores.
→ Meta 3.b. Apoyar las actividades de investigación y desarrollo de vacunas y medicamentos
contra las enfermedades transmisibles y no transmisibles que afectan primordialmente a los
países en desarrollo y facilitar el acceso a medicamentos y vacunas esenciales asequibles de
conformidad con la Declaración relativa al Acuerdo sobre los Aspectos de los Derechos de
Propiedad Intelectual Relacionados con el Comercio y la Salud Pública, en la que se afrma
el derecho de los países en desarrollo a utilizar al máximo las disposiciones del Acuerdo
sobre los Aspectos de los Derechos de Propiedad Intelectual Relacionados con el Comercio
respecto a la fexibilidad para proteger la salud pública y, en particular, proporcionar acceso
a los medicamentos para todos.
Indicador 3.b.2.* Montos presupuestarios para áreas de investigación en salud.
La inversión en investigación en salud tuvo un continuo aumento entre 2015 y 2018. La meta
intermedia propuesta para 2020 fue superada en 2017.
→ Meta 3.c. Aumentar considerablemente la fnanciación de la salud y la contratación, el
perfeccionamiento, la capacitación y la retención del personal sanitario en los países en
desarrollo, especialmente en los países menos adelantados y los pequeños Estados insulares
en desarrollo.
Indicador 3.c.1.* Composición del equipo de salud. Médicos/as cada 10 mil habitantes.
Indicador 3.c.1.2
* Composición del equipo de salud. Enfermeros/as cada 10 mil habitantes.
Indicador 3.c.1.3* Composición del equipo de salud. Obstétricos/as cada 10 mil habitantes.
Tanto en médicos/as como en enfermeros/as se observa un aumento entre 2013 y 2016. Mientras
que en obstétricas/os se nota un descenso importante.
→ Meta 3.d. Reforzar la capacidad de todos los países, en particular los países en desarrollo,
en materia de alerta temprana, reducción de riesgos y gestión de los riesgos para la salud
nacional y mundial.
123
Salud y Bienestar ODS 3
70 Secretaría de Gobierno de Salud (2019) Argentina. Indicadores básicos. Ministerio de Salud y Desarrollo Social, OPS/OMS.
Se ha considerado trabajar el indicador 3.d.1.* Porcentaje de implementación de las capacidades
básicas del Reglamento Sanitario Internacional sobre la base del Cuestionario elaborado por la
OMS.
Intervenciones orientadas a las metas
→ Meta 3.1. Para 2030, reducir la tasa mundial de mortalidad materna a menos de 70 por cada
100.000 nacidos vivos.
→ Meta 3.2. Para 2030, poner fn a las muertes evitables de recién nacidos y de niños menores
de 5 años, logrando que todos los países intenten reducir la mortalidad neonatal al menos
hasta 12 por cada 1.000 nacidos vivos, y la mortalidad de niños menores de 5 años al menos
hasta 25 por cada 1.000 nacidos vivos.
A través de la asistencia técnica y fnanciera, la redacción de normativas para la atención, la
distribución de insumos y la realización de actividades de capacitación dirigidas al sector salud de
las distintas jurisdicciones del país, la Dirección Nacional de Maternidad, Infancia y Adolescencia
persigue los siguientes objetivos: reducir las probabilidades de enfermar o morir de la población
objetivo; mejorar la cobertura y calidad de los servicios de salud, así como las posibilidades de
acceso a ellos de toda la población, en especial la más vulnerable; conocer el estado de salud de
los niños, a fn de detectar patologías y derivar en forma oportuna su resolución; promover la
regionalización de la atención perinatal en las jurisdicciones; reducir las desigualdades entre los
indicadores de salud correspondientes a cada uno de los géneros, las distintas áreas geográfcas,
los niveles socio-económicos, etnias, etc.
→ Meta 3.3. Para 2030, poner fn a las epidemias del Sida, la Tuberculosis, la Malaria y
las enfermedades tropicales desatendidas y combatir la Hepatitis, las enfermedades
transmitidas por el agua y otras enfermedades transmisibles.
Para la lucha contra dichas enfermedades se identifcaron los siguientes programas:
→ Programa de Lucha contra el Paludismo.
→ Programa Nacional de Chagas. Proyecto FONPLATA de Interrupción de la Transmisión
Vectorial de la Enfermedad de Chagas.
→ Programa Nacional de Control de Enfermedades Zoonóticas.
→ Programa Nacional de Control de la Tuberculosis y de la Lepra.
→ Programa Nacional de Control de las Hepatitis Virales.
Asimismo, se consideró la actuación del Instituto de Medicina Tropical que realiza investigaciones
en el tema, de la Dirección de Sida, Enfermedades de Transmisión Sexual, Hepatitis y Tuberculosis
y de la Dirección de Control de Enfermedades Inmunoprevenibles.
→ Meta 3.4. Para 2030, reducir en un tercio la mortalidad prematura por enfermedades
no transmisibles mediante la prevención y el tratamiento y promover la salud mental y el
bienestar.
Se identifcaron los siguientes programas:
→ Programa Nacional de Prevención de las Enfermedades Cardiovasculares.
→ Programa Nacional de Prevención y Control de las Enfermedades Respiratorias Crónicas.
→ Programa Nacional de Prevención y Control de Personas con Diabetes Mellitus.
También, las actuaciones de Dirección Nacional de Salud Mental y Adicciones y del Instituto
Nacional del Cáncer.
→ Meta 3.5. Fortalecer la prevención y el tratamiento del abuso de sustancias adictivas,
incluido el uso indebido de estupefacientes y el consumo nocivo de alcohol.
Para avanzar en esta meta, se consideran especialmente las actuaciones de Dirección Nacional
de Salud Mental y Adicciones.
ODS 3 Salud y Bienestar
124
→ Meta 3.6. De aquí a 2020, reducir a la mitad el número de muertes y lesiones causadas por
accidentes de tráfco en el mundo.
Se identifca el Plan Estratégico de Seguridad Vial para reducir la tasa de siniestros en la Argentina
mediante la promoción, coordinación, control y seguimiento de las políticas de seguridad vial
nacional.
→ Meta 3.7. Para 2030, garantizar el acceso universal a los servicios de salud sexual y
reproductiva, incluidos los de planifcación de la familia, información y educación, y la
integración de la salud reproductiva en las estrategias y los programas nacionales.
Se asocia a esta meta, el Plan Nacional de Prevención y reducción del Embarazo No Intencional
en la Adolescencia y el Programa Nacional de Salud Sexual y Reproductiva.
→ Meta 3.8. Lograr la cobertura sanitaria universal, incluida la protección contra los riesgos
fnancieros, el acceso a servicios de salud esenciales de calidad y el acceso a medicamentos
y vacunas inocuos, efcaces, asequibles y de calidad para todos.
Entre los esfuerzos implicados para el alcance de la meta, se encuentra la Cobertura Nacional de
Salud que prevé el otorgamiento de prestaciones de salud igualitarias, integrales y humanizadas
tendientes a la promoción, protección, recuperación y rehabilitación de la salud.
→ Meta 3.9. Para 2030, reducir sustancialmente el número de muertes y enfermedades
producidas por productos químicos peligrosos y la contaminación del aire, el agua y el suelo.
Se realiza vacunación nacional contra rotavirus a través del Calendario Nacional de Vacunación
con el objeto de disminuir la morbimortalidad por diarrea aguda por dicho virus.
→ Meta 3.a. Fortalecer la aplicación del Convenio Marco de la Organización Mundial de la
Salud para el Control del Tabaco en todos los países, según proceda.
Se implementa el Programa Nacional de Control de Tabaco cuyo objetivo es prevenir el inicio,
disminuir el consumo de tabaco y proteger a la población de la exposición al humo.
→ Meta 3.b. Apoyar las actividades de investigación y desarrollo de vacunas y medicamentos
contra las enfermedades transmisibles y no transmisibles que afectan primordialmente a los
países en desarrollo y facilitar el acceso a medicamentos y vacunas esenciales asequibles de
conformidad con la Declaración relativa al Acuerdo sobre los Aspectos de los Derechos de
Propiedad Intelectual Relacionados con el Comercio y la Salud Pública, en la que se afrma
el derecho de los países en desarrollo a utilizar al máximo las disposiciones del Acuerdo
sobre los Aspectos de los Derechos de Propiedad Intelectual Relacionados con el Comercio
respecto a la fexibilidad para proteger la salud pública y, en particular, proporcionar acceso
a los medicamentos para todos.
Con el objeto de promover investigaciones éticas y de calidad en salud pública se implementan
proyectos de investigación y otorgan becas (en el marco de Salud Investiga).
→ Meta 3.c. Aumentar considerablemente la fnanciación de la salud y la contratación, el
perfeccionamiento, la capacitación y la retención del personal sanitario en los países en
desarrollo, especialmente en los países menos adelantados y los pequeños Estados insulares
en desarrollo.
La Dirección Nacional de Capital Humano, de la Secretaría de Gobierno de Salud, desarrolla los
criterios de formación y capacitación del capital humano en salud.
→ Meta 3.d. Reforzar la capacidad de todos los países, en particular los países en desarrollo,
en materia de alerta temprana, reducción de riesgos y gestión de los riesgos para la salud
nacional y mundial.
125
Salud y Bienestar ODS 3
Se implementa el Reglamento Sanitario Internacional (2005) que aporta a prevenir la
propagación internacional de enfermedades, proteger contra esa propagación, controlarla
y darle una respuesta de salud pública proporcionada y restringida a los riesgos para la salud
pública y evitando al mismo tiempo las interferencias innecesarias con el tráfco y el comercio
internacionales. Según lo previsto en el mismo, cada Estado Parte desarrolla, refuerza y mantiene
las capacidades básicas necesarias para las tareas de vigilancia y respuesta y las capacidades
básicas necesarias en los aeropuertos, puertos y pasos fronterizos terrestres designados.
Recursos presupuestarios movilizados para el ODS 371
El análisis del gasto en el ODS 3 – Salud y Bienestar muestra un incremento del 51,4% en el año
2019 con respecto a 2018 (esto es, $9.383 millones adicionales). La participación en el Gasto
Primario Total se mantiene para todo el período analizado entorno al 0,7%, con excepción del año
2017 que es del 0,6%. Por su parte, la participación del presupuesto vinculado a este objetivo en
función Producto Bruto Interno se mantiene en el 0,1% para todo el período analizado.
En el análisis por meta se observa que el gasto primario vinculado al ODS 3 estuvo orientado,
principalmente, al cumplimiento de la Meta 3.3 Poner fn a las epidemias del SIDA, la tuberculosis,
la malaria y las enfermedades tropicales desatendidas y combatir la hepatitis, las enfermedades
transmitidas por el agua y otras enfermedades transmisibles y la meta 3.9 Reducir sustancialmente
el número de muertes y enfermedades producidas por productos químicos peligrosos y la
contaminación del aire, el agua y el suelo, al considerar ambas metas de forma conjunta72. Para el
año 2019 el gasto dirigido a atender estas metas representa el 65,5% del gasto vinculado a este
objetivo y presenta un incremento interanual del 86% respecto a 2018 ($ 8.362 millones).
En el marco de estas metas se fnancian las acciones de vacunación, convirtiéndose en la
intervención de mayor impacto en términos de control, erradicación y eliminación de aquellas
infecciones que conllevan graves consecuencias para la salud individual y comunitaria.
ODS 3 Salud y Bienestar
126
71 Sección elaborada sobre la base de la publicación conjunta del CNCPS y la Jefatura de Gabinete de Ministros (2019) Implementación de la Agenda 2030.
Vinculación de los Objetivos de Desarrollo Sostenible y el Presupuesto de la Administración Pública Nacional (Disponible en: www.odsargentina.gob.ar) y de
actualizaciones de la Jefatura de Gabinete de Ministros, Dirección Nacional de Coordinación del Presupuesto Nacional en base a datos del E-Sidif.
72 La Meta 3.9. contempla las acciones vinculadas a la prevención del Rotavirus. La provisión de esta vacuna se fnancia a través del mismo programa que
fnancia un importante conjunto de vacunas (programa 20– Prevención de enfermedades inmunoprevenibles) que también asisten a la Meta 3.3. Debido
a que no fue posible desagregar presupuestariamente la porción que corresponde a cada tipo de vacuna dentro de dicho programa, se analizan en forma
conjunta ambas metas.
|
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{
"country": "arg",
"file_id": "sdg-03/vnr-report-arg-2020-es-3.pdf",
"language": "es",
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|
40
Healthy Lives and Well-being for all
at all Ages
Progress
Armenia made good progress in ensuring healthy
lives and promoting well-being. National programs in
immunization, maternal and child healthcare have helped
to reduce mother and child and infant mortality rates.
86.4 percent of the target population covered by all
vaccines included in their national program. The coverage
was higher among children of up to 7 years of age. Since
2010, Armenia achieved and maintained 97% of MMR
(Measles, Mumps, and Rubella) vaccination among
children10.
Infant mortality rate was reduced to 8.67 per 1,000
live births, and under-five mortality rate – to 10.1 per
1,000 live births (figure 16).
Nearly all births in Armenia are attended by skilled
health personnel and antenatal healthcare coverage.
Overall, maternal mortality rate has reduced in the last
decade, though varied notably across years (figure
17)11. The maternal mortality in Armenia is lower than in
other countries of CIS, but significantly higher than in the
EU.
Starting from August 2018, anyone infected with HIV
is offered to initiate antiretroviral treatment after diagnosis, according to the National ART Guidelines, developed
in line with the WHO “Treat all” policy and all tuberculosis
cases were detected and cured under directly observed
10 Source: Ministry of Health.
11 Since the population number is less than 5 million, the maternal mortality rate is recommended to report by three-year average numbers.
Figure 16: Child mortality rate. Source: RA SCA
Figure 17: Maternal mortality. Ministry of Health
41
Healthy Lives and Well-being for all
at all Ages
Challenges
treatment. In 2016, Armenia became one of the first four
countries in the world to eliminate mother-to-child transmission (EMTCT) of HIV. In 2017, the National AIDS
Center of the Ministry of Healthcare was awarded with
Certificate for winning the UN Public Service Awards, First
Place, in the category of Innovation and Excellence in
Delivering Health Services in recognition of the contribution for supporting the implementation of the 2030
Agenda for Sustainable Development. This success was
part of the larger progress in its national HIV response in
the last ten years. The UN in Armenia through WHO,
UNAIDS and UNICEF supported the country in its tightly
integrated system of services on HIV/AIDS, tuberculosis,
maternal and child health, which ensures early diagnostics, provision of quality health care, effective treatment.
The number of tuberculosis cases has been steadily
decreasing in the last decade and was 27 people per
100,000 population (figure 18). The level of acute Hepatitis B incidence per 100,000 population was 2.3 and 1.2
in 2015 and 2016, respectively.
Armenia is a WHO-certified malaria and polio free country, and there have not been registered new local malaria
cases since 2006, and no polio cases.
In Armenia, noncommunicable diseases (NCDs) are
estimated to account for 92 percent of deaths, with cardiovascular diseases as the main killer with 54 percent,
followed by cancer with 22 percent (Global Health Observatory, WHO, 2012).
In 2016, the mortality burden due to most prevalent
NCDs comprised 80%, with CSD being the lead cause
(48%), followed by malignancies (20.5%), diabetes
(4.2%), injuries, poisonings and external causes (4.5%),
chronic obstructive pulmonary diseases, including bronchitis, asthma, other chronic pulmonary and bronchoectonic diseases (4%)12. Alarmingly, premature mortality
from all causes accounted for 32 percent, with those
main NCDs representing 77 percent of these premature
deaths (European Detailed Mortality Database, WHO
Regional Office for Europe, 2016). See figure 19.
This challenge is related to accessibility of healthcare
in the country as well and to education and awareness
among the population. Access to healthcare needs significant improvement. Less than half of people who have
health problems visit doctors. This attendance ration
differs depending on poverty level. Only 42.3 percent of
non-poor and 27.3 percent of the poor visit a doctor when
having health problems. More than 90 percent of population households consider that healthcare expenditures are
large as a share of total household expenditure or income.
12 Source: National Health Information Analytical Center (NHIAC) and SCA, http://nih.am/assets/pdf/atvk/14c0b8ed94657718a8658fb0f8ae2ff6.pdf
Figure 18: HIV and Tuberculosis. Source: Ministry of Health
42
Healthy Lives and Well-being for all
at all Ages
while 45 percent are overweight or obese. The proportion
of women who are thin has remained essentially
unchanged since 2000, while the proportion of women
who are overweight or obese has increased slightly, from
42 percent in 2000 to 45 percent in 2015-1615. Every
second respondent (48%) was overweight. One-fifth of
respondents (19.5%) were obese (body mass index ≥ 30
kg/m2). The proportion of obese women (25%) was 1.6
times higher than that of men (14%). According to urinalysis results individuals consume on average 9.8 grams of
salt per day (11 grams for men and 8.4 grams for women).
The target population of the survey consumed almost
twice the recommended amount of salt. [Source: ARM
STEPS survey 2016-201716.
HIV prevalence among adult population in Armenia
remains low making up 0.2 percent, which is in 4.5 times
lower than HIV prevalence in the Eastern Europe and
Central Asia region. The number of registered HIV cases
Alcohol per capita consumption (aged 15 years and
older) is low compared to most European countries and
was 4.1 of liters of pure alcohol per year in 2015, though
has been increasing (in 2000, the indicator was 3 liters of
pure alcohol)13.
Refugees, stateless persons and other displaced population have limited access to healthcare due to lack of
knowledge about their rights and state programs, and
language barriers. In addition, the cost of medicines is not
always affordable due to limited state assistance, lack of
decent employment, and other socio-economic
constraints.
Many health indicators can be improved not only
through increasing public or private spending on health,
but also learning about healthy lifestyles, effective treatment methods, causes and/or reasons of health problems.
For instance, Armenia has a relatively high share of its
population with cardiovascular diseases and cancer
(figure 19). According to the 2016-2017 STEPS survey,
27.9 percent of the total number of respondents were
current smokers and 26.9% daily smokers. Men smoked
more than women: 51.7 percent% vs. 1.8 percent14.
Broader anti-tobacco campaigns and more effective
enforcement of anti-tobacco legislation could help reducing the number of smoking people. Armenia has ratified
the WHO Framework convention on Tobacco control
(WHO-FCTC). However, many interventions are still not
enforced, e.g. ban of smoking in public places.
Additional examples are related to child malnutrition
(figure 14), and obesity among women and men. Thus,
among women age 15–49, just 4% of women are thin,
13 Source: WHO European Health for All Database: https://gateway.euro.who.int/en/hfa-explorer/
14 Source: ARM STEPS survey 2016-2017 http://www.who.int/chp/steps/Armenia_2016_STEPS_FS.pdf?ua=1 The 2016-2017STEPS survey on the prevalence of NCD risk
factors in 19-69 years old population of Armenia, showed that every third person (35.7%) had three or more risk factors for NCDs, and every second men had three and
more risk factors. Three quarters (73.2%) of respondents with raised blood pressure were not taking any medication (their systolic blood pressure was ≥ 140 and diastolic
blood pressure was ≥ 90 mmHg). According to Armenia STEPS survey, 27.9% were current smokers and 26.9% daily smokers. Men smoked more (51.7%) than women
(1.8%), and every second person is a passive smoker
152015-16 Armenia Demographic and Health Survey (DHS).
Figure 19: Non-communicable diseases: Ministry of Health
43
Healthy Lives and Well-being for all
at all Ages
increased till 2014, though started a decline since then
(figure 18). The majority of HIV patients had a history of
unsafe behavior abroad and most probably were infected
there (in 2016 - 51.5 percent). The factor of outbound
labor migration is significant (out of the 1,397 HIV cases
registered in 2012-2016, 68.1 percent were outbound
labor migrants and their partners). HIV prevalence among
male migrants aged 18-49 originating from rural areas is
0.6 percent17, and among male migrants aged 18-49
originating from urban areas - 1.2 percent, which exceeds
3 and 6 times respectively HIV prevalence among general
population18.
The knowledge about HIV/AIDS in the age group
15-24 still remains low19. Less than half (48 percent) of
women and 44 percent of men know that HIV can be
transmitted during pregnancy, delivery, and by breastfeeding. About 1 in 4 women and 1 in 5 men know that
the risk of HIV transmission from mother to child can be
reduced by the mother taking drugs during pregnancy.
Less than half of Armenian women and men know where
to get an HIV test. Even fewer have ever been tested and
received their results; 12 percent of women and 1 percent
of men have ever been tested for HIV and received their
results20. HIV Treatment Cascade 2017 shows that the
gap between the estimated number of PLHIV and those
PLHIV know their HIV status is the largest one and need
to be addressed.
Armenia’s epidemiological context in regards to Tuberculosis (TB) continues to improve with the disease
incidence being on decrease. Timely and effective access
to TB diagnosis and effective treatment of people with
multidrug-resistant TB (MDR TB) is yet a challenge in
Armenia. The treatment success rate of new and relapse
TB patients is 79-83 % within the last years (2013-2016),
which is below the WHO global target of 85%. With
improved access to new TB drugs it is expected that treatment outcomes for 2016 and later cohorts will show
higher success rates.
Development and implementation of effective viral
hepatitis control measures remains a major issue for the
healthcare system in Armenia. The prevalence of hepatitis
B infection in the general population is about 2 percent.
Hepatitis C, too, is still a major issue, and the prevalence of
hepatitis C infection in estimated at 3-5 percent. In light of
the global goal of elimination of viral hepatitis as a public
health threat by 2030, to country developed a national
strategy to reduce morbidity and mortality due to chronic
hepatitis B and C in Armenia.
Armenia is graduating from GAVI Alliance support in
2019 and will graduate from GF support in 2020. Government midterm expenditures projections indicate decrease
in health budget and MoH will face serious challenge of
competing priorities like non-communicable diseases
versus immunization, HIV/AIDS and TB.
The use of modern family planning methods is not
widespread among women of reproductive age (aged
15-49 years). 57 percent of women use any contraception
methods. The use of modern contraceptives has increased
during last decade (from 20 in 2005 to 28 in 2015-2016),
however it still remains very low. The use of family planning methods is related not only to their availability and
accessibility, but also and, may be more importantly, be
attributed to culture, and lack of education and awareness.
The situation may be improved through well designed
awareness and educational activities about family planning among both women and men.
16 Source: ARM STEPS survey 2016-2017. http://www.who.int/chp/steps/Armenia_2016_STEPS_FS.pdf?ua=1
17 Biological and Behavioral Surveillance Surveys on Armenian, Male, Seasonal Labor Migrants in Rural Communities in Armenia, 2016, Grigoryan
S.R., et al., Yerevan, National Center for AIDS Prevention, 2017.
18 Biological and Behavioral Surveillance Surveys on Armenian, Male, Seasonal Labor Migrants in Urban Communities in Armenia, 2018, Grigoryan
S.R., et al., Yerevan, National Center for AIDS Prevention, 2018.
19 Source: HIV Behavioural Surveillance Survey among Youth in the Republic of Armenia, 2016, Grigoryan S.R., et al., Yerevan, National Center for
AIDS Prevention, 2017.
20 2015-16 Armenia Demographic and Health Survey (DHS).
|
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[
3
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{
"country": "arm",
"file_id": "sdg-03/vnr-report-arm-2018-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2018
}
|
Healthy life and well-being
According to the statistical data, cases of maternal
mortality in 2017-2019 did not exceed 12, ranging
between 3 and 12, while the maternal mortality rate
for a three-year period (2016-2018) did not exceed
20 per 100.000 live births. IN 2015, the maternal
mortality rate made 11.9/100000. This is lower than
the CIS states index but higher than average figures
in Europe (The recent available data shows the following maternal mortality rates in 2015: CIS: 16.8
per 100.000 live births, Europe: 10 per 100.000 live
births, EU: 4 per 100.000 live births).
Ensure healthy lives and promote
well-being for all at all ages
19.7
2015 2016 2017 2018
22.3 18.3 21.9
Maternal mortality ratio (average three-year indicator)(per 100000 live births)
18
Though indirect reasons for maternal death are prevailing in the maternal death structure (for instance,
severe extragenital pathologies), there remain maternal death cases that could have been prevented.
These cases identified inadequate preparedness to
organize and deliver medical aid, drawbacks related
to early diagnosis and referral, other organizational
and procedural flaws.
In order to address the above-mentioned problems,
the following activities have been carried out within
current programmes in 2018-2019:
• Modernization of maternity services, increased
cost-efficiency of allotments within the state
order and quality of medical aid, optimization of
the number of maternity hospitals.
• Increased financial flows and improved quality
of services due to structural and staff reforms
and resource redistribution.
• Assessment of the infrastructures, staff and
equipment, as well as capacities of maternity
hospital medical organizations which caused
review of levels of maternity organizations, with
specified functions and criteria.
• Reviewed mandatory conditions and requirements for delivery of maternity services, defined
criteria for maternity medical organizations in
terms of preparedness to deliver emergency
medical aid, as a mandatory requirement for reducing maternity mortality.
• Defined monitoring for application of adopted
guidelines and practices.
• In order to prevent maternal mortality and improve the quality of managing hard obstetric
cases, the Minister of Healthcare ordered to
assign regional maternity medical organizations to the 3rd tier maternal organizations of
Yerevan city, to provide them with organizational and methodolocial assistance, clinical guidelines, and enable visits to discuss the “hanging
by a thread” cases.
• Improved knowledge and testing for medical
workers, obstetrician-gynecologists in regional in-patient maternity departments; medical
workers who scored less than 75 per cent took
a second test.
• In March 2020, the Government approved the
2020-2023 programme for improving the birth
rate stipulated by healthcare factors and actions ensuring its implementation aimed at prenatal care, reproductive health of adolescents
and youth, improved medical aid in maternity
in-patient departments, as well as reduction of
maternal death and perinatal losses, infertility
treatment, including the expansion of the scope
of medical aid and beneficiaries through use of
assisted reproductive technologies.
2018-2019 saw steady decline in neonatal mortality
rates and mortality rates of children under five.
2015 2016 2017 2018
6.3 10.4 6.1 10.1 6.2 9.6 5.0 8.7
Mortality rate
Neonatal
mortality rate
Under-five mortality rate (per
1000 live births)
19
So, according to the data published by the Statistical Committee, the mortality rate of children under five
made 8.7% in 2018 as compared to 9.6% in 2017; in January-December 2019 it made 7.6% (absolute number
of 276) as compared to 8.7% of the same period in 2018 (absolute number of 317). The same trend is maintained with regard to neonatal mortality rate: in 2015-2017 it has decreased as well, though at a lower rate
(6.3% in 2015, 6.1% in 2016, 6,1% in 2017). This index has declined for over one point per mile in 2018 (5%).
In order to improve children’s health and reduce the mortality rates a number of programme activities have
been implemented, in particular:
• Expansion of medical aid delivered within the
state order framework. In particular, previously,
free hospital treatment was available to children
under 7 years of age; instead, now it covers all
children under 18 thus significantly improving
the accessibility and quality of hospital medical
care for children;
• Several medical services involving up-to-date
and expensive technologies have been added to
the list of state-funded free medical care, which
were previously provided on paid basis;
• In addition to the “urgent” emergency service
that transported infants and kids from regional medical facilities by reanimobiles, an emergency aviation service was launched in 2019
to transport children from remote regions for
emergency medical care;
• Several other programmes focused on the improvement of neonatal care, including practices
and guidelines developed in cooperation with
the Armenian Association of Neonatal Medicine, training of staff of almost all maternity
hospitals, purchase of equipment, introduction
of 24/7 quick response and consultation system.
• With support of UNICEF, five maternity facilities
of the republic have been equipped with necessary units for intensive neonatal care. These actions allowed to ensure beneficial treatment for
sick and premature babies, in particular, those
born with brain pathologies, very low birthweight babies, and reduce neonatal mortality.
• At least 90% vaccination coverage of children
was ensured due to the National Programme of
Immunization.
• The legal framework of the sphere was improved, in particular, the order of organization
of free neonatal medical aid and care, the order
of free in-patient medical aid and service for
children, characteristics and assessment criteria for children’s in-patient services, by tiers,
were approved and reviewed.
Other spheres of the healthcare system also saw certain achievements, in particular:
• The scope of beneficiaries eligible for receiving medical care and service free of charge and
under privileged conditions guaranteed by the
state, as well as the list of delivered services
have been expanded;
• Professional development trainings have been
conducted for medical workers;
• A programme for emergency surgeries for
acute myocardial infarction (coronary stenting)
is introduced, provided to the whole population
free of charge; also, a programme for treatment
of acute or subacute ischemic stroke (including intravenous thrombolysis therapy with Alteplase) is introduced and provided to population free of charge as well;
• Surgery, radiation therapy and service for treatment of malignant diseases is now free of
charge for the whole population, replacing the
previous co-payment principle;
• In 2019 the delivery of out-of-hospital palliative
care service was launched within the stateplaced order;
• The number of emergency teams was increased, and sanitary aviation service was introduced in 2019 in order to improve the preparedness of the emergency care system and
boost the emergency response, availability and
quality of medical aid services;
• Heading towards the Healthy Life ideology, huge
progress is recorded in terms of curbing the
20 harmful impact of the secondhand smoke
through regulation of the legislative framework. Cultural revolution towards smoking
behavior is occurring, and this will help cut
the number of smokers, thus reducing the
NCD morbidity and mortality rates as well;
• With the IOM and UNAIDS support public
health campaign to improve prevention and
detection of HIV/AIDS among Armenian urban labour migrants and mobile populations
in all phases of the migration cycle through
behavioral changes was launched.
One of the challenges identified in the 2018 report still remains the low number of people applying to the primary health care facilities for
disease treatment. In 2018, 32.7% of patients
applied for the primary health care (PHC) services for medical consultation or treatment; this
figure made 30.7% among residents of other cities, 39.4% in case of rural population, while Yerevan residents amounted to 29.1%. In comparison to the previous year, fewer patients in other
cities and Yerevan have applied for medical consultation or treatment, while the figure increased
among the rural residents (in 2017 the figures
were 33.5%, 35.7% and 34.3%, respectively)
|
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38 | Page
SDG 3: Good Health and Well-Being
Ensure healthy lives and promote well -being for all at all ages
Antigua and Barbuda continues to make many positive strides in health particularly around
mortality indicators such as life expectancy at birth for females and males (2017), survival to age
65 for females and males (2017) and under age 5 mortality rate (2017). The death rate in Antigua
and Barbuda is one of the lowest among CARICOM Member States, The country’s immunization
coverage against preventable childhood illnesses has achieved a near perfect score, maternal
deaths are very low, environmental health risks have been reduced, and credible gains have been
recorded in building core capacities to implement international health regulations.
Indicator 2017 Close to, Better than or
Worse that LAC
Countries Average
Life Expectancy at Birth (Female) 78.9 years Close to LAC
Life Expectancy at Birth (Male) 74 years Better than LAC
Survival to Age 65 % (Female) 85.1 Close to LAC
Survival to Age 65 % (Male) 78.6 Better than LAC
Under Age 5 Mortality Rate (per
1,000 live births)
7.0 Better than LAC
Source: Health at a Glance: Latin America and the Caribbean 2020
Health services are delivered at the primary, secondary, and tertiary levels within the public and
private sectors. Free health care is provided by the Government. At the primary level, Antigua is
divided into six medical districts with a network of 25 public health clinics plus one clinic in
Barbuda. Clinics are located within 3.2 km of every major community. The health team at the
primary level provides services such as medical clinics, maternal and child health, community
mental health, dental care, screening for noncommunicable diseases (NCDs), and prevention and
control of communicable diseases.
Government expenditure on health in 2018 was estimated at 5.23 per cent of GDP which is
consistent with other Caribbean countries but below the average of developed countries. The
Life Expectancy at Birth
77
Under Age 5 Mortality
7/1,000
Government
Expenditure on Health
5.23%
NCDs
85%
of all deaths
39 | Page
health system is financed primarily through public taxation and levies in support of the Medical
Benefits Scheme. The Scheme is funded by a payroll tax of 7 per cent that provides a dedicated
revenue source for primary and secondary care. This programme affords citizens free health care.
The government has taken preparatory steps to transition the Medical Benefits Scheme into a
national health insurance program. Approximately 15,000 residents have private health insurance,
largely provided through their employers.
Secondary and tertiary health services are provided at the Mount St. John’s Medical Centre, a 187-
bed facility in Antigua, and an 8-bed facility in Barbuda. All citizens have access to care in Antigua
and Barbuda. Adequate access to health care is a function of a number of indicators including
medical infrastructure availability (number of hospital beds per 1,000 population), human
resources availability (doctors per 1,000 population, nurses per 1,000 population, psychiatrists per
100,000 population and coverage for maternal and child health services (mothers receiving at
least four antenatal visits during pregnancy). Antigua and Barbuda’s progress under these
indicators is highlighted in the table below.
Indicator 2017 Close to, Better than or
Worse that LAC
Countries Average
Hospital beds per 1,000 population 3.8 Better than LAC
Doctors per 1,000 population 3.0 Better than LAC
Nurses per 1,000 population 4.5 Better than LAC
Psychiatrists per 100,000 population 1.0 Worse than LAC
Mothers receiving at least four
antenatal visits during pregnancy (%)
83 Close to LAC
Source: Health at a Glance: Latin America and the Caribbean 2020
Whilst there has been notable progress, there however remains challenges that need to be
addressed such as the increasing incidence of chronic non-communicable diseases, HIV infections
pharmaceutical supplies management, policy and legislation, human resources for health and
infrastructural and plant maintenance. The sector also suffers from critical staff shortages in
relation to nursing, laboratory personnel, radiology as well as environmental health personnel.
The overall strategic direction of the health sector is guided by the National Strategic Plan for
Health (2016-2020) which is the instrument creating a world-class health care system in Antigua
and Barbuda, towards achieving a healthy population. The core principles underlying the Plan are
equity, shared responsibility, and good governance. The Plan is geared towards ensuring higher
levels of national investment in health and wellness that will empower individuals and families to
manage their own health, strengthening the health system and community mechanisms, and
expanding strategic partnerships to advance the nation’s health care system.
40 | Page
The nation’s main health challenges are in relation to NCDs as well as vector-borne diseases such
as dengue and leptospirosis. The Government is particularly concerned about the morbidity and
mortality associated with chronic NCDs attributed to tobacco use, limited physical inactivity,
unhealthy diets, and the harmful use of alcohol as some of the main lifestyle factors that are
driving the upsurge of NCDs. The consumption of alcohol is about 7 litres per capita and similar to
the consumption pattern of countries in the Latin America and Caribbean region but above the
world average of 5.8 litres per capita9
.
Non-communicable Diseases (NCDs) account for more than 85 per cent of all deaths. The highestranking causes of years lost due to premature deaths are ischemic heart disease, diabetes mellitus
and cerebrovascular disease. It is estimated that 37 per cent of persons suffer from diabetes
mellitus and 69 per cent from hypertension. Diabetes continues to be the leading cause of
disability-adjusted life years (DALY) in Antigua and Barbuda. To address the increasing incidence
of NCDs, in 2016 the Government launched the National Policy and Action Plan for Prevention and
Control of NCDs. This Plan defines a multi-sectoral approach to reduce preventable morbidity and
premature mortality due to NCDs, as well as to control the risk factors attributed to these diseases.
The Plan targets five areas: reinforcing the coordination and management of NCD prevention and
control, strengthening the approach to NCDs and risk factors throughout the health system,
identifying NCD risk factors and protective factors, building healthy and active communities
through multi-sectoral policies and partnerships, and increasing surveillance, research,
information availability, and education. A Wellness Committee has been established to coordinate
the implementation of the Plan.
NCDs and disabilities present the most pressing challenge to health and social wellbeing of the
elderly. In 2016, the Government promulgated the National Policy and Plan of Action on Healthy
Ageing 2017- 2027 which has as its policy goal to allow more people to live longer in good health,
to remain active for longer, and to counteract growing inequalities in old age.
Infectious diseases, including HIV and AIDS, and accidental and intentional injuries are among the
ten leading causes of mortality in Antigua and Barbuda. The National Strategic Plan for HIV/AIDS
was developed by the Ministry of Health, in collaboration with the AIDS Secretariat, and civil
society organizations. In Antigua & Barbuda, the transmission of HIV is linked to gender inequality
in relations including heterosexual sex, unprotected tourism sex, commercial and transactional
sex. Women and girls are often at an economic disadvantage, which leads them to enter
transactional relationships to enhance their incomes, thus increasing their risk of becoming
infected with HIV.
9
https://www.who.int/data/gho/data/indicators/indicator-details/GHO
41 | Page
The Government continues to focus on adolescent pregnancy, which is showing signs of
decreasing. The adolescent birth rate is 27.7 per 1,000 women aged 15–19 as of 2018, down from
28.8 per 1,000 in 201710.
Antigua and Barbuda remains one of the few countries in the world with a low rate of death, a low
rate of infections, a high rate of recovery, and no known community spread from COVID-19. Issues
however remain with respect to access to vaccines to support herd immunity and getting the
country back to a state of normalcy.
Bright Spots, Success Stories and Opportunities
“Antigua and Barbuda Moves”
In 2020, the Government launched the programme “Antigua and Barbuda Moves”, geared
towards reducing the number of persons with non-communicable diseases such as heart disease,
diabetes, and hypertension. Using the key pillars of physical activity, nutrition and early detection
(screenings) citizens are being encouraged to make positive lifestyle changes to secure “BETTER
LIVING, BETTER LIFE!”
Tax on Sugary Beverages
In 2019, the government introduced a tax on sugary beverages to reduce childhood obesity and
issues related to overweight.
Strategies and Actions that will Accelerate the Achievement of Goal 3
Adequate financing of the health sector within the guidelines of the international
benchmark of 5 to 6 percent of GDP to enable them to better address current and future
needs.
Improve health literacy as a key tool for reducing the incidence of both communicable and
NCDs.
Strengthen legislation to prevent discrimination against people living with HIV and AIDS
Integrate human resources management of the health sector.
Provide resources and capacity to adequately implement key policies and strategies such
as the National Policy and Action Plan for Prevention and Control of NCDs.
Develop and implement a national health insurance scheme.
Rehabilitate existing health infrastructure and accelerate a health infrastructure
modernization programme.
Greater emphasis to be placed on mental health services.
Development and roll out of a standardized and effective national health information
system capable of providing comprehensive and consistent data for planning and
programming in the sector.
10 https://data.unwomen.org/country/antigua-and-barbuda
42 | Page
Build strategic partnerships – between the public and private sector, public and civil society
organizations, and the public sector and development partners to deliver health care and
advance the performance of the health sector.
Development and roll out of reporting, monitoring and evaluation systems for the health
sector.
Prioritize the national health research agenda towards strengthening national capacity for
surveillance and research on NCDs and other diseases.
Strengthen the governance, management and operations for pharmaceuticals.
Develop a National Sport and Physical Activity Policy and action plan to support the healthy
lifestyles towards reducing the incidence of NCDs.
|
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AUSTRALIA’S VOLUNTARY NATIONAL REVIEW ON THE SUSTAINABLE DEVELOPMENT GOALS 33
03 ENSURE HEALTHY LIVES
AND PROMOTE WELL-BEING
AT ALL AGES
“While there are positive signs
and progress on many fronts,
it is clear that Australia is not
healthy in every way, and some
patterns and trends give cause for
concern. Chronic diseases… are
becoming increasingly common in
Australia due to a population that
is increasing and ageing, as well
as to social and lifestyle changes.
… Presenting a broad picture of
health status can mask the fact
that some groups in our community
are not faring as well, including
people living in rural and remote
areas, the lowest socioeconomic
groups, Indigenous Australians and
people living with disability.”
Australian Institute of Health and Welfare,
Australia’s Health 2016
The Australian Government is committed to
ensuring access to a world-class health system
built on the foundation of universal health
coverage, support for hospitals, a priority
on preventive health and mental health, and
investments in medical research. The system
also enables quick and effective response to
emerging threats, potential outbreaks
and disasters.
Australia’s health system centres on the principle
of universal health coverage, providing access
to timely, high-quality health services delivered
without discrimination and addressing the
differing needs which people have throughout
their life. The universal public health insurance
scheme, Medicare, provides free access to public
hospitals and subsidised access to medical
services. The Pharmaceutical Benefits Scheme
supports affordable access to a wide range of
medicines, with higher subsidies for frequent
users and those on low incomes. For example, a
new listing of the PrEP preventive drug for people
at medium to high risk of HIV will put Australia in
reach of being one of the first countries to end
the transmission of HIV.
As a member of the World Health Organization
(WHO), Australia supports the WHO’s right to
health objectives and respects the right of our
population to achieve the highest attainable
standard of physical and mental health. Overall,
Australia’s population is relatively healthy, with
among the highest life expectancy globally,
however, more needs to be done to address poor
health outcomes for some groups. Australian
governments collaborate with civil society
organisations and health providers to work
towards addressing these gaps.
AUSTRALIA’S VOLUNTARY NATIONAL REVIEW ON THE SUSTAINABLE DEVELOPMENT GOALS 34
AUSTRALIAN ACTION
Governments in Australia recognise the
importance of healthy ecosystems and socioeconomic factors to human health, with an
interlinked, holistic approach that focuses on the
underlying determinants of health, consistent with
linkages between SDG3 and many of the other
SDGs.
For example, the Victorian Government,
particularly Parks Victoria, has worked closely
with the International Union for the Conservation
of Nature and its member organisations to
develop an integrated approach recognising the
contribution of nature and parks to overall health
and wellbeing, building on a message of “Healthy
Parks, Healthy People”. New South Wales Health
is working with the NSW Office of Environment
and Heritage, the University of Sydney and local
health districts to consider possible effects
of climate change such as hot weather and
heatwaves, natural disasters and extreme weather
events, air pollutants, food-borne diseases and
drinking water quality.
Australia is a global leader in many areas
of public health and medical research. In
2012, we were the first country to introduce
plain packaging for tobacco products. A
comprehensive range of measures has seen the
age-standardised daily smoking prevalence drop
from 22.3 per cent in 2001 to 14.7 per cent in
2014-1519, one of the lowest rates in the world.
Research at the University of Queensland led
to development of the Human Papillomavirus
vaccine, a vital step forward in women’s health.
Innovation and technology may assist with
addressing the needs of those in rural and
remote areas, with a transition towards the
greater integration of digital technology,
including mobile health, online health records
and telehealth systems. Access to primary
health care will remain critical and people rely
on crucial services like the Royal Flying Doctor
Service, which services an area of 7.69 million
square kilometres. In 2017, Australia appointed
its first National Rural Health Commissioner,
an independent and high profile champion for
regional, rural and remote health, who will seek
to address, among other issues, the unequal
distribution of health professionals between innermetropolitan and rural and remote areas.
ADDRESSING HEALTH CHALLENGES
AND LEAVING NO ONE BEHIND
Aboriginal and Torres Strait Islander
peoples’ health care
The gap in health outcomes between Aboriginal
and Torres Strait Islander and non-Aboriginal
and Torres Strait Islander people is caused
by a mix of social factors, risk factors and
differences in access to appropriate health
care. In collaboration across jurisdictions
and with Aboriginal and Torres Strait Islander
organisations, Australia is working to improve
the health of Aboriginal and Torres Strait Islander
Australians. The Government recognises the
importance of a holistic concept of health for
Aboriginal and Torres Strait Islander peoples
and consulted widely in 2017 on the social and
cultural determinants of health, in order to inform
the implementation of the National Aboriginal and
Torres Strait Islander Health Plan.
Further, communities and researchers have
developed an Australian Model of First 1000
Days20, which focuses on reducing under-nutrition
for the period from conception to a child’s
second birthday, for application to Aboriginal
and Torres Strait Islander families. It includes
improving nutrition and maternal and child
health as well as an Aboriginal and Torres Strait
Islander-led holistic and ecological framework
focusing on comprehensive primary health
care with a case management style approach.
It includes strong community governance
processes and interventions that focus on the
family environment.
19 Australian Bureau of Statistics 4364.0.55.001 National Health Survey: First Results, 2014-15, Table 1: Summary health Characteristics,
2001 to 2014-15 – Australia. Note: These rates are for Persons 18 years and over
20 http://www.first1000daysaustralia.org.au/
AUSTRALIA’S VOLUNTARY NATIONAL REVIEW ON THE SUSTAINABLE DEVELOPMENT GOALS 35
Obesity is a major risk factor for noncommunicable diseases, along with tobacco
use, poor diet and nutrition, harmful consumption
of alcohol and physical inactivity. As heart
disease, cancer and mental illness account for
almost half the burden of disease in Australia,
the Government has committed significant
funding to initiatives to support healthy lifestyles,
mental health, preventive health and sport. The
Australian Chronic Disease Prevention Alliance
manages programs and campaigns aimed at
preventing non-communicable diseases through
lifestyle changes, such as improved nutrition and
increased physical activity.
Government mental health programs are
complemented by broad-based community
initiatives and organisations such as beyondblue
and Lifeline Australia. Mental Health First Aid
(MHFA) Australia has development courses
training more than half a million Australians in
mental health first aid. More than 25 countries
have adopted the MHFA Australia program since
its inception in 2001.21
LGBTIQA+ people are more likely to
experience and be diagnosed with a mental
health disorder, and are more likely to attempt
suicide in their lifetime, compared to the general
population. 22, 23 The Australian Government
recognises the particular impact of mental health
issues and suicide in the LGBTIQA+ community
and funds a number of programs specific to the
community’s needs. For example, QLife is a
peer-supported telephone and web-based
counselling and referral service for LGBTI people.
REGIONAL AND GLOBAL ACTION
Australia’s 2017 Foreign Policy White Paper
highlights our commitment to guarding against
regional and global health risks, in particular
preventing and responding to the introduction
and spread of infectious disease. We support
countries in our region to build health systems
and services that are responsive to people’s
needs, for example, partnering with the World
Bank across the Indo-Pacific region to help
countries strengthen and finance essential
disease and immunisation programs and improve
health security.
We are a long-standing, major donor to global
health funds and organisations, including the
Global Fund to fight AIDS, Tuberculosis and
Malaria, Gavi the Vaccine Alliance, UNAIDS and
the United Nations Population Fund (UNFPA),
as well as multilateral banks that work in the
health sector. Our contributions have helped
mobilise financing for health interventions in our
region; supported the establishment of innovative
partnerships, including with the private sector to
reduce the cost of essential health commodities
and stimulate investment in new technologies;
and supported developing countries to lower
rates of infectious diseases.
We work with international institutions to prevent,
detect and respond to health emergencies and
tackle antimicrobial resistance. We are members
of the End Malaria Council and supported the
establishment of the Asia-Pacific Leaders Malaria
Alliance. Through the Indo-Pacific Centre for
Health Security, we are investing in research,
partnerships and efforts to improve the capacity
and resilience of health systems in the region.
Australia has supported Monash University’s
World Mosquito Program to test the use of
Wolbachia, an innovative mosquito control
21 https://mhfa.com.au/our-impact/our-global-impact
22 Robinson, K.H., Bansel, P., Denson, N., Ovenden, G. & Davies, C. (2014) Growing Up Queer: Issues Facing Young Australians Who Are
Gender Variant and Sexuality Diverse, Young and Well Cooperative Research Centre, Melbourne, 23 Hillier, L., Jones, T., Monagle, M., Overton,
N., Gahan, L., Blackman, J. & Mitchell, A. (2010) Writing Themselves in 3: The third national study on the health and wellbeing of same sex
attracted and gender questioning young people, Australian Research in Sex, Health and Society, La Trobe University, Melbourne.
AUSTRALIA’S VOLUNTARY NATIONAL REVIEW ON THE SUSTAINABLE DEVELOPMENT GOALS 36
Students in Queensland use do-it-yourself ‘Mozzie Boxes’ to grow and release the World Mosquito Program’s
Wolbachia-carrying mosquitos. Photo: Thom Cookes/Eliminate Dengue.
method endorsed by WHO in 2017. Australia is
supporting partner governments in Fiji, Kiribati,
Vanuatu and Sri Lanka test the approach, which
could help to protect an estimated half a million
people in the region from viruses like dengue,
Zika and chikungunya over the three year test
period.
Health challenges in the Pacific
Our neighbours in Pacific small island states face
specific health care challenges, including high
rates of non-communicable diseases (NCDs),
geographic barriers, constrained health spending
and health sector workforce shortages and health
risks posed by climate change. Many Pacific
countries have made good progress in areas
such as communicable disease control and
maternal and child mortality, however, rates of
NCDs are increasing dramatically due to factors
such as smoking, alcohol consumption, physical
inactivity and poor diet.
In Tonga, Australia is supporting the Ministry
of Health to improve health service systems,
delivery and to address NCDs. The program’s
focus on primary and preventive approaches
includes supporting Tonga to introduce legislation
and fiscal measures, strengthening primary health
care, improving community health centres and
expanding diabetes outreach to outer islands and
remote communities. Future work will focus on
strengthening the workforce, health financing and
leadership to improve primary care and disabilityinclusive health services at the community level.
|
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[
3
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{
"country": "aus",
"file_id": "sdg-03/vnr-report-aus-2018-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2018
}
|
Target National indicators (selected) Trend
3.1 TARGET: Low maternal mortality
3.3 New HIV infections
Hepatitis B incidence
3.4 Premature mortality
Suicide rate
3.5 Alcohol-related deaths and suicides
3.6 Deaths from road traffic accidents
3.8 TARGET: Access to essential health care
3.a Average daily consumption of cigarettes
in persons aged 15+ years
Deaths due to lung cancer / bronchial
carcinoma
Source: Statistics Austria. 8-year trend 2010–2018 (if figures missing,
at least 7-year trend) in 4 categories ( ) if there is a clear target
(quantitative/normative); (part of the) indicator target achieved;
calculation of trend not possible. More information about methodological questions can be found in the National Indicator Report 2020.
Good health care
According to a meta-analysis conducted by the Austrian
National Public Health Institute on SDG 3, Austria scores
well overall in the health-care sector (Austrian National
Public Health Institute 2019)*. In addition to universal
health coverage and the density of medical, nursing and
midwifery staff, Austria also has a relatively low rate of
neonatal and maternal mortality. During the observation
period, maternal mortality ranges from 1.3 to 8.6 women
per 100,000 live births – well below the global UN target
of less than 70 per 100,000 live births. The neonatal
mortality rate (2.0 per 1,000 live births in 2018) and
under-5 mortality rate (3.2 per 1,000 live births in 2018)
are both well below the global UN targets of 12 and 25
per 1,000 live births respectively. According to the Austrian National Public Health Institute, there is potential
* Griebler, Robert; Delcour, Jennifer; Antony, Gabriele (2019):
Meta-analysis based on established SDG indices and rankings
on the challenges of SDG implementation in Austria –
focusing on the health sector. Updated 2019. Vienna, Austrian
National Public Health Institute
Goal 3
Ensure healthy lives and
promote well-being for all
at all ages
Maternal, neonatal and under-5 mortality is
extremely low in Austria.
Austria reduced premature mortality from
non-communicable diseases by 15 % between
2010 and 2018.
There is a downward trend in the
suicide rate.
Deaths from lung cancer have decreased
slightly.
There is a high level of alcohol-related
deaths and suicides (3,030 in 2018).
61
for improvement in the mortality of children under five
compared to other EU countries. The nationwide expansion of the Early Childhood Interventions Programme
(Frühe Hilfen) makes a particularly significant difference
to the health of children in families experiencing stressful
situations (see ‘Expansion of the Early Childhood Interventions Programme in Austria’). According to the most
recent figures, the percentage of the population covered
by social health insurance was 99.9 %.
With regard to the incidence of communicable diseases (target 3.4: HIV, malaria, hepatitis B and neglected
tropical diseases), Austria also scores highly for achieving
the targets in the meta-analysis referred to above.
However, it should also be mentioned that the incidence
of hepatitis B increased from 8.2 cases (2010) per 1,000
uninfected persons to 12.8 cases in 2018, with a peak of
16.6 cases in 2014.
Expansion of the Early Childhood
Interventions Programme in Austria
To promote healthy lives and well-being from the
outset, the implementation partners have been
setting up and expanding regional networks for
early childhood interventions since 2015. These
networks are based on a standardised Austrian
model. The early childhood interventions are
part of the measures of the Austrian Health
Targets and serve as an overall health promotion
and intervention concept for families in difficult
situations. At the end of 2019, networks for
early childhood interventions existed in 64 of
Austria’s 116 political districts and there is a
national early childhood intervention centre for
coordination and quality assurance at national
level. The number of families supported by the
regional networks for early childhood interventions is increasing considerably. In line with the
principle of ‘leaving no one behind’, the support is
particularly aimed at disadvantaged families and
families experiencing stressful situations.
Multi-professional care provided by
primary health care units
The Federal Ministry of Social Affairs, Health,
Care and Consumer Protection is strengthening
multi-professional and interdisciplinary primary health care in Austria to achieve the goal
of ensuring health for all at all ages. The new
team-based primary care units provide a broad
range of health care close to patients’ homes,
with longer opening hours. General practitioners work in a team with other health and social
care providers, enabling patients to benefit from
health and social care providers being concentrated in one place. The aim is to establish 75
primary care units in Austria by 2021. To support
the implementation and ensure successful results,
the Federal Ministry of Social Affairs, Health,
Care and Consumer Protection has launched a
comprehensive start-up initiative and has started
a collaboration with the European Investment
Bank. Strengthening primary care is a key priority
under the target of universal health coverage.
In keeping with the approach of ‘leaving no one
behind’, the initiative also prevents inequalities in
access to health care.
Action plan for women’s health
The Federal Government is addressing the WHO
goals set out in the ‘Strategy on women’s health
and well-being in the WHO European Region’
with its action plan for women’s health. As the
first European country to develop an action plan
in this area, Austria is particularly committed
to achieving the goals of women’s health and
well-being and gender equality. The plan comprises 40 measures to improve equal health
opportunities for women, and the implementation
of these measures has been promoted at federal
and state level since 2017. The multi-stakeholder
approach influences not just the development of
the action plan, but also its implementation: The
Women’s Health Dialogue (FrauenGesundheitsDialog) brings together stakeholders and NGOs to
discuss the implementation of measures and the
priorities.
62
Lower premature mortality from
non-communicable diseases
A key international indicator for the health of the population is premature mortality from non-communicable
diseases (cancer, cardiovascular disease, diabetes and
chronic respiratory disease) among 30- to 69-year-olds.
The figure has fallen by 15 % – a considerable amount –
since 2010: In 2018, there were 250 mortalities from
non-communicable diseases per 100,000 people aged
between 30 and 69; the comparable figure in 2010 was
293.1 per 100,000 population. Mortality has decreased
more in men than in women. In the case of disease, especially among older persons, the question arises as to the
best care options that also fulfil the patient’s health requirements. Austria has developed a new service to meet
this need: the ‘care hub’ (Pflegedrehscheibe) (see ‘Styrian
Care Hub’).
Styrian ‘Care Hub’ (Pflegedrehscheibe)
The Federal State of Styria is helping to achieve
the SDG of promoting the well-being and health
of people of all ages with its ‘care hub’. Implemented as a pilot project from 2018 and rolled
out throughout Styria from 2020, the care hub is
a contact centre and service point that enables
those in need of care to receive the help they
require at the right time. In line with the one-stop
shop principle, the care hub offices are located
in rooms at district administration offices (Bezirkshauptmannschaften). The effectiveness of the
care hub can be attributed to its comprehensive
multi-stakeholder approach. It links a large number of organisations and state institutions for the
benefit of those in need of care. With its services
for people who need care, the care hub helps to
fulfil the commitment to ‘leave no one behind’.
Suicides, alcohol-related deaths and
lung cancer
The Austrian National Public Health Institute
sees potential for improvement in the reduction of
suicides and in the consumption of tobacco and alcohol (meta-analysis, Austrian National Public Health
Institute 2019). The suicide rate decreased from
15.3 deaths per 100,000 population to 13.5 deaths
(−12 %) between 2010 and 2018 but remains slightly
higher than the European average.
In 2010, the number of alcohol-related deaths
was estimated to be 3,162. The figure was 3,030 in
2018. This represents a fall of 4%, although the level is
generally high (Handbuch Alkohol [Alcohol Handbook],
Austrian National Public Health Institute 2019). Average alcohol consumption among 15- to 99-year-olds
remained relatively constant between 2010 and 2018,
at around 12 litres of pure alcohol per person per year.
The number of people killed in road traffic accidents decreased significantly, from 66 deaths per
million population in 2010 to 46.3 deaths in 2018.
Live births to mothers under 15 years old and
mothers aged between 15 and 19 (known as teenage
births) declined considerably between 2010 and 2018.
From 2010 to 2018, the death rate due to lung
cancer (including bronchial carcinoma) decreased just
slightly from 47.1 deaths per 100,000 population to
46.2 deaths (−2 %). While the death rate among men
dropped sharply (−11 %), it rose significantly among
women (+12 %). Trends in smoking prevalence are
(partly) responsible: The number of men who smoke
every day has declined, whereas the number of female
daily smokers has increased. In addition, it should be
noted that the impact of changes in smoking prevalence figures on cause-of-death statistics will only
become apparent in the very long term. From 2010
to 2018, the number of cigarettes consumed daily
in the population (over 15 years of age) fell from 5.3
to 4.3. The proportion of 15-year-old school pupils
who smoked daily actually fell from 19 % (2010) to
7.0 % (2018).
Austria reduced premature
mortality from non-communicable
diseases by 15 % between 2010
and 2018.
63
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VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
45
GOAL 3. Ensure
healthy lives and
promote wellbeing for all at
all ages
State care for
maternal and child
health is steadily growing. In Azerbaijan, as
elsewhere, a healthy life is considered one of the
main conditions for sustainable development. To
this end, provision of quality and affordable
medical services to the population of the country
occupies a special place in the country's social and
economic development strategy. There is state
care for improving overall public health, including
maternal and child health, and further growth of
this care is observed as the country's capabilities
have been expanding since early 2000s. Thus, the
amount of funds allocated from the state budget for
healthcare has increased by more than 17.3 times
in 2000-2015, and substantial financial resources
have been allocated for the construction, repair,
restoration and reconstruction of healthcare
facilities. In 2016, 702.5 million AZN was
allocated from the state budget for healthcare,
which accounts for 3.96% of budget expenditures.
In addition, compulsory medical insurance has
started to be applied as one of the most important
measures in the direction of increasing public
access to medical services in Azerbaijan,
stimulating provision of high-quality medical
services and establishing sustainable financial
sources in the field of healthcare. To this end, in
2016, the statue and structure of the State Agency
for Compulsory Medical Insurance under the
Cabinet of Ministers of the Republic of Azerbaijan
was approved, and work was started in two pilot
regions.
By Decision No.211, dated September 15, 2006,
of the Cabinet of Ministers of the Republic of
Azerbaijan, "Program of Measures on Protection of
Maternal and Child Health" was approved. The
main goal of the program is to strengthen maternal
and child health, protect reproductive health, create
the necessary conditions for the birth of healthy
and desired children, and reduce morbidity and
mortality among mothers and children.
As a follow-up to this program, the "State
Program on improvement of maternal and child
health for 2014-2020" was approved by the Decree
of June 13, 2014 of the President of the Republic
of Azerbaijan. The main goal of this program is to
improve the quality of treatment and preventive
care provided to women and children in the
country and further improves their health status.
Table 6.10 shows the maternal mortality situation
in the country.
As can be seen from Table 6.10, although
maternal mortality increased significantly during
the transition period reaching 37.6 per 100,000 live
births, the steps taken to improve maternal health
in subsequent years have led to improvements in
this area. Thus, this figure decreased to 14.4 in
2000-2015 and to 13.8 in 2016.
The increase in the share of births attended by
skilled medical staff also had a positive impact on
the improvement of the situation in this area during
this period (Table 6.11).
VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
46
During the period under review, the situation
with the mortality rate among children under the
age of 5 in the country has also improved
significantly. Thus, the mortality rate among
children under the age of 5 declined from 30.5 to
13.3 per 1,000 live births in 2000-2015 (Table
6.12).
The analyses show that a slight quantitative
increase in this indicator in 2015 and 2016 is
associated with the negative processes occurring
all over the world in these years and is temporary
in nature.
Neonatal mortality. During 2011-2015, the
number of infants who died in the neonatal period
dropped from 1152 to 981 or from 6.5 to 5.9 per
1,000 live births. In 2016 neonatal mortality rate
dropped to 5.5 per 1,000 live births.
In addition to the above-mentioned State
Programs on the protection of maternal and child
health, the Law of the Republic of Azerbaijan "On
compulsory dispanserization of children" has been
adopted. According to the Ministry of Health, more
than 92% of children were examined in 2015 as
part of the Program on compulsory dispanserization of children. 6% of children who underwent the
medical examination were registered with the
dispensary, and 1% were hospitalized in
specialized medical institutions.
Adopted in 1999, first ever in the region of
Eastern Europe and CIS, the "Concept of the
demographic development of the Republic of
Azerbaijan" and, developed on its basis and
approved by the Decree of November 11, 2004 of
the President of the Republic of Azerbaijan, the
"State Program on the development of demography
and population occupancy in the Republic of
Azerbaijan" have also played a special role. The
measures envisaged by these political documents
are aimed at optimal reproduction of the
population, prolongation of life expectancy,
strengthening of the protection of mothers and
children, creation of a socio-economic basis that
promotes the development of families, and
improving the effectiveness of the regulation of
migration processes.
Combating HIV. Important measures are carried
out in the Republic of Azerbaijan in the field of
detection and prevention of HIV and treatment of
HIV-infected people, as part of efforts to combat
this infection. The adoption of Law No.1001-IIIQ,
dated May 11, 2010, of the Republic of Azerbaijan
"On combating disease caused by human
immunodeficiency virus" has laid the groundwork
for the implementation of comprehensive measures
against this infection.
Azerbaijan is among the countries with a low rate
of HIV infection. In total, at the end of 2015, the
number of people registered as infected with
HIV/AIDS in the country was 5,629. Table 6.13
shows the number of people newly infected with
HIV per 1000 healthy people in the period 2010-
2015. As can be seen from the table, this indicator
has seen a rise from 0.05 to 0.07. An upward trend
has been observed in both men and women. In
2015, the figure for men increased by 66.7%
compared to 2010 or from 0.06 to 0.1, and for
women it increased by 2.5 times or from 0.02 to
0.05.
VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
47
On February 17, 2016, the Cabinet of Ministers
of the Republic of Azerbaijan adopted Decision
No.63 on approval of the "Program of Measures to
Combat HIV/AIDS for 2016-2020". The Program
of Measures has been developed in accordance
with “Azerbaijan 2020: Outlook for the Future”
Development Concept and will cover a number of
measures in the field of combating HIV in the
mentioned period.
Other infectious diseases. Analyses show that as
a result of consistent and sustained measures, the
spread of infectious diseases such as tuberculosis,
malaria, hepatitis B and tropical diseases has been
prevented, and the incidence of these diseases has
decreased (Table 6.14).
A number of normative documents have been
prepared and the strategies recommended by WHO
have been adopted to meet the requirements arising
from the Law of the Republic of Azerbaijan “On
Combating Tuberculosis in the Republic of
Azerbaijan”. In addition, the "Action program to
combat tuberculosis for 2011-2015", approved by
the Decision No.226 of November 26, 2010 of the
Cabinet of Ministers of the Republic of Azerbaijan,
has been adopted. After the adoption of the
program, a number of medical institutions involved
in the fight against tuberculosis were built or
repaired in the country and their material and
technical base was strengthened. As can be seen
from Table 6.14, during the implementation of this
program, the number of people infected with
tuberculosis per 100,000 population decreased
from 53.7 in 2010 to 41.9 in 2015.
Following this program, the "Action Program on
fight against tuberculosis for 2016-2020" was
approved by Decision No.16 of January 28, 2016
of the Cabinet of Ministers of the Republic of
Azerbaijan. The main objective of the Action
Program is to reduce the spread of tuberculosis and
the rate of disability and mortality from this disease
in the Republic of Azerbaijan. Below are the
expected results of this program:
- early detection of cases of the disease;
- increased recovery rate through timely treatment
of identified patients;
- prevention of nosocomial infection by
strengthening anti-epidemic measures in health
facilities;
- improved registration of TB patients;
- reduced incidence of disability and mortality
from tuberculosis;;
- raising public awareness of tuberculosis
prevention.
Judging from Table 6.14, as a result of the
measures carried out, the epidemiological situation
with malaria in our country has improved, and in
fact, no case of malaria has been registered since
2013, and similarly no cases of tropical diseases
have been detected. As for the hepatitis B virus,
Decision No.18 made by the WHO Assembly in
2010 has been adopted with a view to
strengthening efforts to combat hepatitis viruses in
the country. According to this Decision, July 28
was declared as World Hepatitis Day.
According to the Ministry of Health, as part of
the ongoing fight against hepatitis B and C in the
country in 2016, a commission set up in the
Ministry of Health examined 2,648 patients, of
which 1,766 are receiving long-term treatment and
provided free medicines. Overall, the ratio of
VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
48
people infected with hepatitis B virus, which
constituted 4.1 per 100,000 populations in 2010,
dropped 1.5 per 100,000 people in 2015.
At present, the main task in these areas is to
maintain the downward trend.
The fight against cardiovascular disease,
cancer, diabetes and chronic respiratory
diseases also takes center stage in the country.
Studies have shown that over the past 10 years the
incidence of circulatory system in the country has
increased by 5%, respiratory diseases by 11%,
endocrine system diseases by 2.5 times, including
diabetes mellitus by 3.7 times, nervous system
disorders by 15%, and malignant neoplasms by
30%. During this period, the global incidence of
non-infectious diseases (NIDs) increased by about
14%. In Azerbaijan, as in most countries, NIDs are
the main causes of morbidity and mortality. In the
structure of morbidity, NIDs constitute more than
50%, of which 17.6% are circulatory system
diseases, 15% respiratory diseases, 15% endocrine
system diseases, and 2.7% malignant neoplasms
[Strategy for Combating Non-Infectious Diseases for 2015-
2020 in the Republic of Azerbaijan].
If we look at the data in Table 6.15, the
proportion of deaths from NIDs in total mortality
in Azerbaijan has increased over the past 5 years.
As part of the fight against NIDs, the country has
developed the "Strategy for combating noninfectious diseases in the Republic of Azerbaijan
for 2015-2020" (here in after referred to as the
Strategy) on the basis of the Development Concept
"Azerbaijan 2020: Outlook for the Future" with the
aim of improving the health of the population,
achieving the greatest possible reduction in the rate
of premature deaths from NIDs and increasing
public awareness in the fight against disease. This
strategy was approved by Order dated December
23, 2015 of the President of the Republic of
Azerbaijan.
The strategy document approved in respect of
NIDs is aimed at combating NIDs in general.
However, separate important state documents have
also been adopted on the diseases belonging to
NIDs. The "State Program on Diabetes Mellitus"
covering the period 2006-2010 in accordance with
Decision No.101 dated June 7, 2005 of the Cabinet
of Ministers of the Republic of Azerbaijan
pursuant to Decree No.32 dated February 12, 2004
of the President of the Republic of Azerbaijan "On
the implementation of the Law of the Republic of
Azerbaijan on state care for people with diabetes
mellitus" can be shown as an example. During the
period after the adoption of the state program, the
provision of patients suffering from diabetes
mellitus with medicines has significantly
improved, and most patients have been provided
with self-monitoring devices, blood glucose
meters. In addition, as a logical extension of this
State Program, the "Action Program on diabetes
mellitus for 2011-2015" was approved by Decision
No.222 dated November 26, 2010 of the Cabinet of
Ministers of the Republic of Azerbaijan. As a
result of the action program, diabetes education
schools have been created in medical facilities and
this network has been expanded for prevention of
complications of diabetes mellitus. Currently, such
schools operate in Nakhchivan Autonomous
Republic, Baku, Ganja, Sumgait and Mingachevir
cities, Salyan, Shirvan, Lankaran, Shaki, Barda and
Balakan regions. At the same time, as a result of
improving the work to identify patients with
diabetes, the number of registered patients over the
past 10 years has increased more than 3 times, and
the death rate from this disease has decreased by
VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
49
more than 2 times.
Besides, the "State Program on diabetes mellitus
disease for 2016-2020" has been approved by
Decision No.15 dated January 28, 2016 of the
Cabinet of Ministers of the Republic of Azerbaijan.
As a continuation of previous programs, this State
Program was also aimed at prevention of diabetes
mellitus, improvement of patient care and
prevention of complications caused by this disease.
High rates of morbidity and mortality from
malignant tumors give grounds for treating the
fight against these diseases as one of the priority
areas of the state. In recent years, the mortality rate
from neoplasms has increased among the
population of the country (Table 6.15). In this
regard, the "Action Program on the provision of
oncological patients with basic anti-tumor
medicines" was approved by Decision No.178
dated July 19, 2006 of the Cabinet of Ministers of
the Republic of Azerbaijan with a view to
improving the quality of treatment of oncological
patients in the country and providing them with
medicines. After the adoption of the program,
significant progress has been made in the fight
against malignant tumors. The material and
technical base of health facilities providing
oncological care has been improved. The National
Oncology Center is equipped with the most
modern medical equipment, including a mobile
diagnostic complex.
The number of chemotherapy drugs purchased for
oncological patients, which was 14, 27 and 37 in
the period 2006-2008, reached 46 in 2012 [25].
Deaths by suicide (self-murder). In 2015, 240
suicides were registered in the country, and in
2016, 295 suicides were registered, which was
about 2.5 cases per 100 000 population in 2015 and
constituted 3.1 case in 2016. In 2010-2015, the
ratio of deaths from suicide to the total number of
deaths by country decreased from 0.6% to 0.4%. In
2016 this indicator constituted 0.5%.
Carrying out the necessary investigative actions
in connection with each case of suicide and
obtaining expert conclusions of forensic
psychiatric and psychological examinations related
to each case, the prosecutor's offices have
determined the causes and circumstances of
occurrence of these cases.
As is seen from the table 6.16, the population
morbidity due to alcohol abuse, drug abuse and
toxicomania are inclined to increase. This is mainly
related to increase in drug abuse. Specifically, the
number of drug abusers per 100,000 populations
registered with primary care units reached 297.9
persons in 2015 after an increase of 21.2 persons
since 2010. The figure rose even more in 2016
before it reached 303.9 persons. The period under
review saw an increase in the number of
toxicomania patients as well.
Taking into account the importance of helping
people suffering from drug addiction return to
normal life and society, the President of the
Republic of Azerbaijan approved by Decree
No.371 dated July 15, 2000 and Order No.2271
dated June 28, 2007 the "Program on combating
illicit trafficking in drugs, psychotropic substances
and their precursors and spread of drug addiction"
VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
50
and the "Program on combating illicit trafficking in
drugs, psychotropic substances and their precursors
and spread of drug addiction (for 2007-2012)" have
been successfully implemented.
The "State Program (for 2013-2018) on combating illicit trafficking in drugs, psychotropic substances and their precursors and spread of drug
addiction for the next 5-year period" has been
approved by Order No. 2966 dated June 24, 2013
of the President. To ensure compliance with subitem 4.2.7 of the Action Plan for the implementation of this Program, the "Program on treatment,
rehabilitation and re-socialization of persons
suffering from drug addiction" has been approved
by Decision No.276 dated August 13, 2014 of the
Cabinet of Ministers of the Republic of Azerbaijan.
The number of deaths caused by road
accidents. In 2010-2016, the highest rate of deaths
from road traffic accidents was in 2013 (1293
people), and the lowest was in 2016 (829 people)
(Table 6.17).
Taking into account the fact that fatal traffic
accidents happen mainly at night, strengthening the
operational mode of road patrol officers during
night hours, warning drivers about hazardous areas
(bad road, dangerous bend, etc.) by using flashing
light of a road patrol car in areas with a regular
incidence of road accidents, and other serious
measures have been taken to prevent road
accidents.
Ensuring reproductive health. According to
available data (from 2011), the share of women in
the country being of reproductive age (15-49 years
old) and meeting their family planning needs via
modern methods constituted 8%. This figure has
been taken from the Demographic and Health
Survey conducted by the Ministry of Health in
2011. A measure concerning the next survey has
been included in the draft "State Program of the
Republic of Azerbaijan on population occupancy
and demographic development (for 2017-2030)".
The share of children born to women aged 15-19
in the total number of live births dropped from
11.9% in 2011 to 11.6% in 2015, and the number
of live births per 1,000 women in this age group
decreased from 56.7 to 52.4. In 2016 this figure has
been 52.8 (Table 6.18).
Developed first ever in the European and CIS
region by Azerbaijani experts and approved by the
Ministry of Health, the "National strategy on reproductive health" (2008-2015) has been of great
importance.
The Human Rights Commissioner (Ombudsman)
of the Republic of Azerbaijan has called on the
National Parliament to speed up the adoption of the
bill "On reproductive health" in order to organize
issues related to the protection of reproductive
health of the country's population at the level of
modern standards.
Besides, work is currently underway in this
sphere to prepare the "Reproductive Health Strategy in Azerbaijan" with a view to implementing the
tasks being assigned for 2017-2025.
Coverage of main healthcare - sanitation
services. Table 6.19 shows the number of live births and the share of persons treated for infectious
and parasitic diseases in the hospital. In 2015, the
number of live births increased by 0.3% compared
to 2010 and amounted to 166210 people. In the
same period, the share of people treated for infectious and parasitic diseases declined from 4.4% to
4%. In 2016 this figure rose to 4.5%.
VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
51
Health insurance. Mandatory health insurance is
implemented as a pilot project in administrative
areas of Mingachevir city and Yevlakh district. In
the framework of mandatory health insurance,
228.1 thousand people (100% of the population)
registered in the pilot areas are covered by the
benefit package of healthcare services. Insurance
coverage of the entire population has been set as a
goal for the future, when mandatory health
insurance will be applied throughout the country.
Use of tobacco. As a result of studies conducted by
the Ministry of Health of the Republic of
Azerbaijan in connection with NIDs, it has been
found that the vast majority of the occurrence of
NIDs is associated with tobacco use, overweight
and unhealthy diets. Although in 2013 and 2014,
the level of use of tobacco products among people
above 15 years of age increased amounting to
18.4% and 18.2%, in 2015 this figure dropped to
17% and in 2016 to 16.2% (Table 6.20).
It is expected that the widespread use of effective
measures recommended by WHO in combating
NIDs will contribute to progress in this direction in
the country. Besides, achieving a 10% reduction in
tobacco use in the country in 2020 than in 2014 is
among the goals of the "Strategy on combating
non-infectious diseases in the Republic of
Azerbaijan for 2015-2020".
Number of health workers. At present, the
reforms in the medical education and personnel
training system in the country serve the
development of healthcare on the basis of
international standards. In recent years, extremely
important measures have been taken in the country
in this area. In this respect, one of the most
necessary and important issues is to bring the
physician specialties used in the country into
conformity with the register adopted in developed
countries of the world and to the Law on
Education. To this end, the Ministry of Health has
prepared a new list of doctor’s specialties for use in
institutions. The new list includes 40 different
specialties and the nomenclature of positions of the
specialists working in healthcare facilities has been
approved in accordance with these specialties. In
addition, the threshold numbers for providing the
population with medical personnel and beds have
been determined.
At present, there are 3.39 physicians and 5.73
mid-level health workers per 1,000 population in
the health sector (Figure 6.1). As of January 2011,
universally accepted certification of medical
workers is being implemented.
Azerbaijan Medical University, Azerbaijan State
Advanced Training Institute for Doctors, and 11
scientific research institutes and centers are
functioning in the country.
VOLUNTARY NATIONAL REVIEW - AZERBAIJAN
52
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74 Third Voluntary National Review of the Republic of Azerbaijan
The goal is aimed at reducing the maternal mortality ratio to less than 70 per
100,000 live births, the neonatal mortality to at least as low as 12 per 1,000
live births, and the under-5 mortality
to at least as low as 25 per 1,000 live
births. It also aims to end the epidemics of AIDS, tuberculosis, malaria and
neglected tropical diseases and combating infections and non-communicable diseases. It further aims to prevent
narcotic drug abuse and the harmful
use of alcohol, halve the number of
global deaths and injuries from road
trafc accidents, and substantially reduce the number of deaths and illnesses resulting from hazardous chemicals
and air, water and soil pollution and
contamination.
3.1. By 2030, reduce the global maternal mortality ratio to less than 70 per
100,000 live births.
3.1.1 Maternal mortality ratio.
Although the maternal mortality ratio
in Azerbaijan increased by 0.5 points
between 2015 and 2019, stabilizing at
14.9, the overall number of mothers who
Goal 3
Ensure healthy
lives and promote
well-being for
all at all ages.
PROGRESS IN 5 THEMATIC GOALS
Figure 10. Maternal mortality ratio, per 100,000 live birth
Source: SSC
14,4
13,8
14,6
12,2
14,9
10
11
12
13
14
15
16
2015 2016 2017 2018 2019
Third Voluntary National Review of the Republic of Azerbaijan 75
PROGRESS IN
THEMATIC GOALS 5
died during pregnancy, childbirth and
pastpartum period fell from 24 in 2015
to 21 in 2019. The number of maternal deaths in 2019, disaggregated by
economic regions, was one in the Nakhchivan Autonomous Republic, eight
in Baku, one in Absheron economic
region, two in Ganja-Gazakh economic
region, four in Lankaran economic region, one in Guba-Khachmaz economic region, and four in Aran economic
region. No maternal deaths were reported in Sheki-Zagatala, Upper Karabakh, Kalbajar-Lachin, and Mountainous
Shirvan economic regions. Compared
to 2015, the maternal mortality ratio decreased from 23.5 to 15.2 in rural areas,
and increased from 4.9 to 14.6 in urban
areas in 2019. Overall, the maternal
mortality rate was higher in rural areas
than in urban areas. In 2019, the number of maternal deaths was 10 in urban
areas and 11 in rural areas.
3.1.2 Proportion of births attended by
skilled health personnel.
Almost all births in Azerbaijan in recent
years are performed under medical
supervision. Specifically, the share of
births attended by skilled health personnel to undertake the necessary
control, provision of services and counseling during pregnancy, as well as
during childbirth and the postpartum
period, independent delivery and care
of newborns, increased from 99.8% in
2015 to 99.9% in 2019.
3.2. By 2030, end preventable deaths
of newborns and children under 5
years of age, with all countries aiming
to reduce neonatal mortality to at least
as low as 12 per 1,000 live births and
under-5 mortality to at least as low as
25 per 1,000 live births.
The Child and Family Support Centers in
Aghdam, Shuvalan, Sabirabad, Ismayilli,
Goygol, Hajigabul, Zardab and Saatli,
which form part of the State Committee for Family, Women and Children’s
Afairs, conducted a series of activities
in order to raise awareness on health
and disease issues, in order to ensure
the coverage of children in dispanserFigure 11. The share of births attended by skilled health personnel, %
Source: SSC
99,8 99,8 99,8
99,9 99,9
99,7
99,8
99,9
100,0
2015 2016 2017 2018 2019
76 Third Voluntary National Review of the Republic of Azerbaijan
ization (health screening) services. The
activities, which involved a total of 457
people, included the distribution of 120
leaflets and the provision of education
information (via WhatsApp) to 66 people.
3.2.1 Under-five mortality rate.
In the last five years, the under-five
mortality rate has decreased, falling
from 13.3 per 1,000 live births in 2015
to 13.0 in 2019. While the mortality rate
increased slightly among boys (from
14.7 to 14.8 per 1,000 live births), it
showed a decrease among girls (from
11.8 to 10.9) in the same period. The total number of deaths of children under
five increased by 10 in 2019 compared
to 2018 to reach 1,835, (1,113 boys and
722 girls). Thus, the yearly number of
deaths among children under five is
35.1% lower for girls than for boys. The
number of deaths of children under five
was 7.6 per 1,000 in rural areas and 18.7
per 1,000 in urban areas. The majority
of children (84.9%) died before reaching their first birthday, while 15.1% died
between the ages of one and five.
Under-5 mortality rate, per 1.000 live births, disaggregated by sex
Source: SSC
13,3 13,8 13,7 13,1 13,0
14,7 15,4 15,3
14,3 14,8
11,8 11,9 11,9 11,7
10,9
0
2
4
6
8
10
12
14
16
18
2015 2016 2017 2018 2019
Total Boys Girls
PROGRESS IN 5 THEMATIC GOALS
Neonatal mortality rate, per 1000 live births
Source: SSC
5,9
5,5
6,6 6,5
6,9
5,3
4,5
5,3 5,2 5,4
0,6
1,0 1,3 1,3 1,5
0
1
2
3
4
5
6
7
8
2015 2016 2017 2018 2019
Total neonatal deaths Early neonatal death Late neonatal death
Third Voluntary National Review of the Republic of Azerbaijan 77
3.2.2 Neonataal mortality rate.
Although the neonatal mortality rate in
Azerbaijan fluctuated between 2015
and 2019, the overall indicator increase
was 1.0 points (between 2015-2019)
to reach 6.9. Early neonatal mortality
during the first seven days of life was
higher than late neonatal mortality
during the first 7-28 days of life. In the
same period, the neonatal mortality rate
for boys increased from 7.0 to 8.3, for
girls from 4.6 to 5.2, and for all years
the neonatal mortality rate for boys was
higher than for girls.
3.3 By 2030, end the epidemics of
AIDS, tuberculosis, malaria and neglected tropical diseases and combat
hepatitis, water-borne diseases and
other communicable diseases.
3.3.1 Number of new HIV infections per
1,000 uninfected population, by sex,
age and key populations.
In 2019, 686 new HIV infections were
registered (447 male and 239 female).
Compared to 2015, the number of new
HIV infections per 1,000 population fell
during 2015-2018 to 0.06, but increased
to 0.07 again in 2019. Although the
number of new HIV infections per 1,000
population did not change in 2019 compared to 2015 for women, there was a
slight decrease for men.
While there was no significant change in
the overall number of new HIV infections
per 1,000 population, there was still an
increase in the absolute number of new
HIV infections. By the end of 2019, the
total number of people with HIV registered in the treatment and prevention
facilities increased by 2,407 people
compared to 2015 to reach 7,846 people. The number of registered people
with AIDS increased by 695 to reach
2,377. Seven new HIV infections were
PROGRESS IN
THEMATIC GOALS 5
78 Third Voluntary National Review of the Republic of Azerbaijan
registered in the 0-14 age group, 176 in
the 15-29 age group, 560 in the 15-49
age group, and 119 in the 50+ age group.
3.3.2 Tuberculosis incidence per 1,000
population.
In 2015-2019, the incidence of tuberculosis per 1,000 population decreased
by 5.4 points to 36.5. In 2019, the
incidence of tuberculosis per 1,000
population was twice as high for men
(48.8) than for women (24.2). Overall,
the incidence of tuberculosis per 1,000
population decreased by 9.4 points for
men and 1.4 points for women between
2015 and 2019.
In 2019, the number of new tuberculosis
cases was 3,613, (66.8% male, 33.2% female), with 27.8% of these cases registered in urban areas and 72.2% in rural
areas. In 2019, 179 of new tuberculosis
cases were found in children aged 0-14.
3.3.3 Malaria incidence per 1,000 population.
PROGRESS IN 5 THEMATIC GOALS
Figure 14. Number of new HIV infections per 1,000 uninfected population, by sex, age
Source: SSC
Figure 15. Tuberculosis incidence per 1,000 population, by sex
Source: SSC
41,9 39,4 39,8 38,3 36,5
58,2
53,7 52,1 50,9 48,8
25,6 25,1 27,5 25,7 24,2
0
10
20
30
40
50
60
70
2015 2016 2017 2018 2019
total men women
0,07
0,06 0,06 0,06
0,07
0,10
0,07 0,07
0,09 0,09
0,05
0,04 0,04 0,04
0,05
0
0,02
0,04
0,06
0,08
0,1
0,12
2015 2016 2017 2018 2019
total men women
Third Voluntary National Review of the Republic of Azerbaijan 79
No cases of malaria have been registered in Azerbaijan since 2013. The last
time a case was registered was 2012,
when three people (two men and one
woman) were found to be infected.
3.3.4 Hepatitis B incidence per 100,000
population.
In 2015-2019, the incidence of Hepatitis
B per 100,000 population increased by
0.1 points to 1.6 (increasing by 0.4 points
for men, but decreasing by 0.3 points
for women); the 2019 figure in urban
areas was 1.9 and in rural areas 1.2.
Compared to the preceding year, in
2019, the number of new Hepatitis B
infections in absolute terms increased
by 49.4% for men (115 people) and decreased by 32.8% for women (41 people), with an overall increase of 13.0%
(156 people).
3.4. By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and
treatment and promote mental health
and well-being.
In cooperation with public unions and
charitable foundations operating at
the international and local level in the
provision of medical and social support
to families of children with disabilities,
the Child and Family Support Centers
(under the State Committee for Family,
Women and Children Afairs) provided assistance to 15 people working in
children’s institutions; provided medical and social support for the families
of eight children with disabilities; and
referred six children with disabilities
to the Medical Rehabilitation Center of
Mardakan settlement, through the cooperation agreement with the Azerbaijan Service and Assessment Network
(ASAN) and UNICEF.
In accordance with the Persons with Disabilities Social Protection and Rehabilitation Programme, the Ministry of Labour
and Social Protection of Population provided financial assistance to 69 people
in 2019 and 50 people in 2020 to cover
treatment in Azerbaijan, and covered
the travel expenses of 19 people in 2019
PROGRESS IN
THEMATIC GOALS 5
Figure 16. Hepatitis B incidence per 100,000 population, by sex
Source: SSC
1,5
1,3
1,6
1,4
1,6
1,9 1,9
2,3
1,6
2,3
1,1
0,7
1,0
1,2
0,8
0
0,5
1
1,5
2
2,5
2015 2016 2017 2018 2019
total men women
80 Third Voluntary National Review of the Republic of Azerbaijan
and 17 people in 2020, enabling them to
receive treatment abroad.
In accordance with resolution No. 128 of
the Cabinet of Ministers, dated August
12, 2002, 4,708 persons with disabilities in 2019 and 2,274 persons in 2020
were provided with sanatorium-resort
vouchers.
Youth Houses, the social service institutions under the Ministry of Youth and
Sports, regularly provide socio-psychological and rehabilitation services
for children with disabilities and their
parents. Training sessions were organised in 2019 (56 sessions), 2020 (34
sessions) and 2021 (11 sessions to date)
for families of children with disabilities.
In 2019, 524 children with disabilities
benefitted from socio-psychological
and legal services, 196 in 2020 and
three, currently, in 2021. Furthermore,
25 children with disabilities were provided with rehabilitation services in
2019 and seven in 2020.
3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or
chronic respiratory disease.
Compared to 2015, the death rate from
cardiovascular disease, cancer, diabetes and chronic respiratory disease decreased by 3.0 points, from 452.1 to 449.1
per 100,000 population in 2019. In the
same period, this figure decreased by 5.6
points from 442.0 to 436.4 for women, but
remained unchanged for men (462.0).
The highest number of deaths occurred
in cardiovascular disease and the
lowest in diabetes. When categorised
by type of disease, in 2019 the number
of deaths from cardiovascular disease
per 100,000 population was 327.8, from
cancer 89.0, from chronic respiratory
disease 18.7, and from diabetes 13.6.
During the period under review, mortality rates decreased relatively for cardiovascular disease, and increased relatively for chronic respiratory disease,
cancer, and diabetes.
Figure 17. Mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease,
per 100,000 population, by sex
Source: SSC
452,1
472,8 470,1
466,3
449,1
462,0
482,1 482,0 479,0
462,0
442,0
463,8
458,4
453,6
436,4
410
420
430
440
450
460
470
480
490
2015 2016 2017 2018 2019
total men women
PROGRESS IN 5 THEMATIC GOALS
Third Voluntary National Review of the Republic of Azerbaijan 81
In 2019, 8,819 people died of cancer,
1,346 from diabetes, 32,471 from cardiovascular disease and 1,854 from chronic
respiratory disease in the country.
3.4.2 Suicide mortality rate.
Although the number of suicides in the
country increased in 2016 compared
to 2015, in subsequent years this figure was lower than in 2016. Overall, in
2015-2019, the suicide mortality rate in
the country decreased by 0.4 points,
from 2.5 to 2.1 per 100,000 population.
At every level of the dynamics, the
suicide rate for boys was higher than
for girls. During this period, the suicide
mortality rate decreased by 0.4 points
from 3.7 to 3.3 per 100,000 population,
decreasing by 0.5 points for women
from 1.4 to 0.9 per 100,000 population.
In 2015-2019, the suicide mortality rate
in urban and rural areas decreased by
0.4 and 0.5 points, respectively, and
amounted to 2.1.
3.5. Strengthen the prevention and
treatment of substance abuse, including narcotic drug abuse and harmful
use of alcohol.
In 2019-2020, the Internal Afairs agencies held more than 2,500 meetings,
gatherings and conferences in specialized secondary and higher education
institutions on the prevention of drug
use among children and youth, the
prevention of ofenses and other harmful habits, legal awareness, and the
promotion of healthy lifestyles. In total,
95 addiction care providers and 200
psychologists from health facilities were
involved in the events, which were
attended by about 90,000 students and
their legal representatives. Articles and
reports were published in various media outlets on “Illicit trafcking in drugs
and psychotropic substances”, “Drug
addiction as an important problem
of humanity”, “Legal and socio-moral
consequences of drug use”, “What do
we know about drugs”, “Drugs destroy
youth” and others topics; eight videos
and four presentations were prepared
and disseminated on the ofcial websites of the Ministry and its subordinate
PROGRESS IN
THEMATIC GOALS 5
Figure 18. Suicide mortality rate, per 100,000 population, by sex
Source: SSC
2,5
3,1
1,9 1,9 2,1
3,7
4,5
2,9 3,0
3,3
1,4
1,7
0,9 0,9 0,9
0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
5
2015 2016 2017 2018 2019
total men women
82 Third Voluntary National Review of the Republic of Azerbaijan
structures, and social networks. Workshops were held for 716 ofcers of the
national police agencies on “The role
of the state in the healthy upbringing
of minors, youth, and implementation
of anti-drug measures”, “New types of
drugs and psychotropic substances,
their transportation characteristics” and
“Organization and conduct of preventive work among drug and substance
abusers”.
In addition, Child and Family Support
Centers in Goygol, Aghdam, Hajigabul,
Goranboy, Saatli, Zardab, Zagatala and
Shuvalan, part of the State Committee
for Family, Women and Children Afairs,
held events, webinars and online meetings to discuss healthy lifestyles among
youth, and the prevention of infectious
and non-infectious diseases. The activities were organised to raise awareness
among youth on the negative efects
of drug addiction, tobacco, alcohol and
other psychoactive substances, the
importance of food nutrition, and to
increase their knowledge and improve
their behaviour, increase their level of
physical activity, and educate them,
together with their parents and teachers on the importance and benefits of
adopting a health lifestyle. Overall, a
total of 719 people participated in the
collection of events.
As part of the implementation of the
relevant activities of the “Azerbaijani
Youth in 2017-2021 State Program” and
the “State Program on Combating Illicit
Trafcking in Narcotic Drugs, Psychotropic Substances and their Precursors
and Drug Addiction for 2019-2024”, the
Ministry of Youth and Sports organized
a number of events. Overall, more than
1,000 youths participated in online
workshops during the pandemic.
3.6. By 2020, halve the number of
global deaths and injuries from road
trafc accidents.
The Ministry of Internal Afairs put a
number of measures in place to promote road safety among adolescents
and young people. As part of the safety weeks, organised to prevent vehicle-pedestrian collisions in Azerbaijan,
events were held on educational topics
such as “Learn, abide, teach and demand”; a “Trafc rules” textbook was
distributed to minors, and many of
these events were aired on TV stations,
websites and social networks.
3.6.1 Death rate due to road trafc injuries.
Although the death rate due to road
trafc accidents per 100,000 people
has been decreasing each year since
2015, it showed an increase again in
2019. The overall death rate due to
road trafc injuries between 2015-2019,
decreased from 9.4 to 8.3 per 100,000
population. Despite the fact that the
number of deaths due to road traffic accidents decreased for men and
increased for women over these years,
the mortality rate for men is much higher than for women. During 2015-2019,
the indicator decreased by 2.4 points
for men and increased by 0.3 points
for women. Overall, the number of men
killed in road trafc accidents in 2019
was 637, and the number of women
was 184.
PROGRESS IN 5 THEMATIC GOALS
Third Voluntary National Review of the Republic of Azerbaijan 83
3.7. By 2030, ensure universal access
to sexual and reproductive health-care
services, including for family planning,
information and education, and the
integration of reproductive health into
national strategies and programmes.
3.7.2 Adolescent birth rate (aged 10–14
years; aged 15–19 years) per 1,000
women in that age group.
The birth rate among women aged 15-
19 has been in decline in recent years
and, while this figure showed an increase in 2019, when compared to the
2015 rate, the 2019 birth rate among
women aged 15-19 had still decreased
by 4.3 points, from 52.4 to 48.1 births
per 1,000 women in that age group.
The birth rate among women aged 15-
19 continues to be significantly higher
in rural areas than in urban areas, with
2019 rates indicating 66.9 births per
1,000 in rural areas and 28.9 in urban
areas.
PROGRESS IN
THEMATIC GOALS 5
Figure 19. Death rate due to road trafc injuries, per 100,000 population, by sex
Source: SSC
9,4
7,9 7,7 7,4
8,3
15,3
12,1 11,7 11,3
12,9
3,4 3,6 3,7 3,5 3,7
0
2
4
6
8
10
12
14
16
18
2015 2016 2017 2018 2019
total men women
Figure 20. Adolescent birth rate (aged 15–19 years) per 1,000 women in that age group, by location
Source: SSC
52,4 52,8
45,7 44,2
48,1
35,1 33,9
28,4 26,8 28,9
69,0 71,1
62,6 61,1
66,9
0
10
20
30
40
50
60
70
80
2015 2016 2017 2018 2019
total urban rural
84 Third Voluntary National Review of the Republic of Azerbaijan
3.8. Achieve universal health coverage, including financial risk protection,
access to quality essential health-care
services and access to safe, efective,
quality and afordable essential medicines and vaccines for all.
From January, 2020, the State Agency
for Mandatory Health Insurance began
introducing mandatory health insurance
throughout the country. The health
insurance currently covers 59 administrative-territorial units, and from April
2021, the mandatory health insurance
coverage will be expanded to include
the cities of Baku, Sumgayit, Khankendi,
and the districts of Absheron, Gubadli,
Zangilan and Shusha. In this regard,
software and new registration systems
are being installed in hospitals, and the
supply of medicines and medical consumables is being digitized through the
provision of computer equipment and
internet access for hospitals and the
development of a hospital information
system. A register of medical services
is also being compiled and hospital staf
are being trained on the principles and
rules of mandatory health insurance.
The Agency also organizes regular educational training sessions on non-communicable diseases, maternal and child
health, health management, etc.
3.a Strengthen the implementation of
the World Health Organization Framework Convention on Tobacco Control
in all countries, as appropriate.
3.a.1. Age-standardized prevalence of
current tobacco use among persons
aged 15 years and older.
In recent years, the prevalence of tobacco use in the country has decreased
with the use among those aged 15
and above decreasing from 17.0% to
15.2% between 2015-2019. In 2019, the
highest number of tobacco users was
registered among people aged 45-64.
The tobacco use rate among these individuals was 21.5%, while 0.2% of people
aged 15-19, 13.6% of people aged 20-
44 and 13.2% of people aged 65 and
above used tobacco.
PROGRESS IN 5 THEMATIC GOALS
Figure 21. Prevalence of current tobacco use among persons aged 15 years and older, %
Source: SSC
17
16,2
15,9
15,3 15,2
14
14,5
15
15,5
16
16,5
17
17,5
2015 2016 2017 2018 2019
3.a.1 Prevalence of current tobacco use among persons aged
15 years and older, by age (%)
Third Voluntary National Review of the Republic of Azerbaijan 85
3.c. Substantially increase health
financing and the recruitment, development, training and retention of the
health workforce in developing countries, especially in least developed
countries and small island developing
States.
3.c.1 Health worker density and distribution (per 10,000 population).
Compared to 2015, the number of
health workers in all categories per
10,000 population showed a decline in
2019, decreasing from 91.1 to 87.9. The
number of medical doctors decreased
from 33.9 to 32.0, and the number of
nursing personnel from 57.3 to 55.9.
This shortage of health workers was
more prevalent in the regions.
The number of health workers increased from 874,000 in 2015 to
875,000 in 2019, while the number
of medical doctors decreased from
325,000 to 318,000. The 2019 distribution of medical doctors by specialty
indicated 7,801 physicians (24.5% of the
total number of doctors) and only 71
addiction care providers (0.22% of the
total number of doctors). The number
of nursing personnel also decreased
by 8,000 people compared to 2015
and amounted to 557,000 people by
the end of 2019; the majority being
(383,000 thousand) nurses.
PROGRESS IN
THEMATIC GOALS 5
Figure 22. Health worker density and distribution (per 10,000 population)
Source: SSC
91,14 89,42 86,6 87,75 87,94
33,9 33,2 32,6 32,9 32,0
57,3 56,2 54,0 54,8 55,9
0
10
20
30
40
50
60
70
80
90
100
2015 2016 2017 2018 2019
Total health workers Medical doctors Nursery personnel
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[
3
] |
{
"country": "aze",
"file_id": "sdg-03/vnr-report-aze-2021-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2021
}
|
79
SDG 3: Ensure healthy lives and promote well-being
for all at all ages
The first indicator selected for this goal, death from chronic diseases, measures one dimension of the overall health situation that is
particularly relevant in European countries. The second indicator, about daily smokers, measures a behaviour that is a determinant
of the health situation.
UN-Target: 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention
and treatment and promote mental health and well-being.
UNSTAT-Indicator: 3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.
NVR-Indicator Deaths due to chronic diseases: crude death rate by 100 000 inhabitants.
400
450
500
550
600
650
00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 2016
Chart 5. Deaths due to chronic diseases
Crude death rate by 100 000 inhabitants
Belgium
Source: Statistics Belgium, Eurostat
EU-28
Definition: number of death per 100.000 inhabitants due to
chronic diseases: malignant neoplasms (C00-C97), diabetes
mellitus (E10-E14), ischaemic heart diseases (I20-I25), cerebrovascular diseases (I60-I69), chronic lower respiratory diseases
(J40-J47) and chronic liver disease (K70, K73-K74). Codes in
parenthesises are from the International Statistical Classification of Diseases and Related Health Problems (ICD).
Objective: to be consistent with Target 3.4, this indicator should
decrease.
Disaggregations: sex, age.
Source: Statistics Belgium; Eurostat (2017), Causes of death,
codes hlth_cd_acdr, hlth_cd_acdr2 (last consulted 2/5/2017).
UN-Target: 3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco
Control in all countries, as appropriate.
UNSTAT-Indicator: 3.a.1 Age-standardized prevalence of current tobacco use among persons aged 15 years and older.
NVR-Indicator Daily smokers: Percentage of the population aged 15 and over.
17
18
19
20
21
22
23
24
25
26
00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 2016
Chart 6. Daily smokers
Percentage of the population aged 15 and over
Belgium
Source: WHO
Germany France Netherlands
Definition: percentage of the population (15 years and over)
that reports smoking daily.
Objective: this indicator should decrease as it measures the
implementation of Target 3.a. Tobacco use is also a well-known
cause of chronic diseases. A decrease of this indicator would thus
contribute to reduce the incidence of those diseases.
Disaggregations: sex, education, income.
Source: WHO (2016), WHO global report on trends in prevalence of tobacco smoking 2015. WHO.int (last consulted
2/5/2017); Disaggregations: Scientific Institute of Public Health
(2014), Gisle L. La consommation de tabac. In: Gisle L, Demarest
S (éd.). Enquête de santé 2013. Rapport 2: Comportements de santé
et style de vie. WIV-ISP, Bruxelles; Scientific Institute of Public
Health (2016), Belgian Health Interview Survey – Interactive
Analysis, https://hisia.wiv-isp.be.
|
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|
14
According to the OECD
Better Life index, Belgium
ranks above average in worklife balance as well as in
subjective well-being and
health status. The 2017
World Happiness Report
ranked Belgium 17th, one place up compared to the previous
edition. When asked to rate their general satisfaction with life
on a scale from 0 to 10, Belgians gave it a 6.9 grade, higher
than the OECD average of 6.5. In terms of health, life
expectancy at birth in Belgium is 81 years (for women it is
83 years, compared to 78 for men). A large part (78%) of the
Belgian population reports to be in good health, which is a
better result than the EU-15 average. Belgians also report to
be satisfied with the health care system. Infants receiving the
8 WHO vaccines rate at 96%. In Belgium, over one in four
people over the age of 15 indicate that they suffer from at least
one chronic illness. Compared to other EU member states, the
country has a relatively high depression rate. The figures
concerning suicide are decreasing, but remain high.
The combination of chronic care, ageing and the up-take in
new technologies challenges the guaranteed sustainable
financing base of the welfare and health care system, where
clear arrangements on basic financing mechanisms and
solidarity exist.
Government priorities relate to addressing non-communicable diseases (NCDs) such as cardiovascular diseases, cancer,
chronic respiratory diseases, diabetes and mental illness –
which are the leading causes of mortality. Efforts to prevent
these focus on tackling four major risk behaviors – smoking
(18.1% daily smokers 10, indicator 6 in the annex), alcohol
abuse (9% of the adult population consumes too much alcohol) 11, unhealthy diets and sedentary lifestyles – and are based
on an integrated horizontal approach targeted at health promotion, prevention and early detection, involving all relevant
policy makers and stakeholders.
Reducing deaths and injuries from road traffic accidents is a
focus area of specific importance. In 2015, Belgium registered
65 such deaths per 1 million. This is already a significant improvement compared with the 1994 figure of 167. According
to the latest assessment in 2016, there were 13% less traffic
related deaths in comparison to 2015. The number of injuries
dropped with 1.4%. These figures have never been better, but
work remains to be done in order to achieve the objective of
an absolute number of maximum 420 deaths from traffic
accidents by 2020. As 70% of all traffic victims are male,
specific attention also needs to go to this category.
When it comes to addressing the health related issues in the
Belgian international development efforts 12, a rights-based approach is the point of departure. Preference is given to strengthening health systems and to integrating health services within
an effective system that enhances the quality and the resilience
of these services. Major policy priorities in this context are the
fight against communicable and non-communicable diseases
as well as the promotion of sexual and reproductive health
and rights.
A joint plan concluded between all Belgian governments
aims at improving chronically ill persons’ quality of life 13
in their own environments (family, school, workplace) and
in their communities, so they can actively manage their
care trajectory. Further tweaks to the health care system
are foreseen and indeed necessary in order to improve
the general population’s state of health and the chronically ill’s specifically. They are also needed to improve
the quality of the care provided, in terms of accessibility
SDG 3: Ensure healthy lives and promote
well-being for all at all ages
10 A steady and firm decrease from 23,5 in 2000 to 18,1 % in 2015, with significant difference between men (22%) and women (16%). 11 Significant gender differences exist, with about 15% of the male population consuming too much alcohol against 6% of the female population. 12 The sector represented 146.7 million EUR, or over 7% of our ODA commitments in 2016 (est.). 13 Integrated Care for Better Health.
15
and evidence base, and to obtain efficiency gains within
the assigned means (better care and its financial sustainability). In addition, several other plans focus on specific
diseases such as Alzheimer and autism 14.The Walloon
Health Observatory, through the analysis of socio-sanitary
data, currently studies (2015-2019) mental and primary
health care, population ageing, the quality of hospital care
and health promotion. Gender and social health-related inequalities are cross-cutting points of attention in
these efforts. Wallonia also works on a future Health and
Prevention 2030 Plan 15 with five priority areas: promotion of safety measures and of healthy life styles (inter alia
through food, physical exercise and combating excessive
alcohol and tobacco consumption), promotion of mental
health and general well-being, and prevention of chronical
illnesses, of infectious diseases and of non-intentional
traumas (3.4). Measures against HIV and aids, Hepatitis C
or TB are furthermore coordinated within specific plans.
The one on HIV (2014-2019) contains 58 actions to curb
the number of new HIV infections, to further improve
access to HIV-specialized prevention, detection, care and
quality assistance services and programs, and to bring
down all forms of stigma and discrimination, especially
when they are based on serological or health status (3.3).
In the field of mental health care Belgium has shifted from
traditional, large psychiatric institutions to a modern, inclusive care system with increased focus on the community,
establishing inter alia multidisciplinary outreach teams
that provide to people with mental health conditions, who
traditionally would have been hospitalized, the opportunity to choose where they wish to receive treatment and
care. The treatment and care provided by these teams
have shown to prevent long-term hospitalization. Through
the recently approved Federal Masterplan on internment
(2016) Belgium is also stepping up its action on forensic
psychiatric treatment and care, increasing the capacity of
specialized centers as well as facilitating access for internees to conventional and regular care in view of optimizing
re-integration into society (3.4).
As sports have a beneficial effect on physical and mental
health alike, Flemish policies attach importance to this
notion 16 through a series of sports after school and sports
at work related actions. A campaign 17 inciting less active
citizens to develop more active life styles is part and parcel
of the same effort. By integrating sport as a tool in the
fight against obesity and inactivity, the French-speaking
Community promotes health enhancing physical activity
(HEPA) policies across sectors and as a partner in regional
health promotion plans (3.4).
In terms of alcohol policies, measures taken by the various
Belgian governments include stricter oversight on advertisements for alcohol containing products, higher fines for
trampling with advertising rules, awareness-raising campaigns and training programs for care deliverers regarding
alcohol use by pregnant women, and an excise increase on
alcoholic drinks. Meanwhile, a pilot project focuses on detection of and intervention upon alcohol problems among
emergency warden patients in eight hospitals. A series of
initiatives particularly targets young persons (16-18 age
range), including clarifying legal provisions, strengthening
and intensifying control measures on vending machines
with alcoholic beverages, and launching discussions between alcohol producers and retail sellers in order to
obtain an agreement on voluntary labelling of minimum
age. When it comes to smoking, governments are taking
several steps: awareness raising, labels and warnings, regulating the sale and advertising of tobacco products, and a
smoking ban in publicly accessible places. New measures to
discourage and decrease tobacco use as from 2016 include
a ban on internet sales, a legal framework on e-cigarettes
and even more visible health warnings (3.5).
Road traffic safety policies are being developed among various actors and stakeholders. At the federal level, the socalled States General on Road Traffic Safety in 2015 spelled
out 20 recommendations, which were an inspiration for
many actions taken since then, such as efforts to simplify
traffic rules, to better execute traffic fines, to make an
14 Plan Autisme 2016. 15 Plan Prévention Santé Horizon 2030. 16 “Bewegen op Verwijzing” (“Exercise per Medical Certificate”). 17 #sportersbelevenmeer.
16
alcolock mandatory in passenger vehicles and for repeat
offenders, to increase objective and subjective probability
of detection through the use of a reliable and continuously
updated database, and to improve the quality of alcohol
and drugs screenings. At the Flemish level 18, policy recommendations are centered around the 4E’s: Education &
Awareness, Engineering, Enforcement, Evaluation. These
recommendations have been taken on board when a road
safety plan (2015) 19 and a cycling policy plan (2016) 20
were developed, with a focus on awareness-raising, information and sensitization on safe traffic behavior. A specific
program21 confronts 17 year olds with the testimonies
by road traffic victims on their lives before and after the
accident. The Walloon Government promotes safe road
behavior through awareness-raising campaigns for the
wider audience as well as specific categories of road users.
Parents associations of children who were victims of traffic
accidents lobby the political world in order to impact both
road safety and the environment through imposing certain
basic limits in terms of motor vehicle features (3.6).
Access to quality health care services in Flanders is being
ensured through a wide range of measures such as making
primary care services more accessible 22, enlarging the
scope of the Flemish Social Protection in order to better insure people against long-term care needs, paying
special attention to persons with disabilities, adopting
an action plan on youth assistance, and creating ‘Houses
of the Child’. Flanders Care acts as a catalyzer for system
innovation in the organization of care services, putting the
patient central stage and adapting the services offered to
society’s needs. This also answers to the (youth, elderly)
population’s changing needs in terms of care. Accessibility is also one of the principal objectives of a Patients’
Future Pact 23 agreed between the federal government
and the pharmaceutical industry. Other measures aim to
improve access to care for a series of particularly vulnerable groups (such as detainees, low income households,
homeless people, newly-arrived immigrants, sex workers,
drug users, people with mental disorders) which tend to
have only weak links with standard medical care, guided
by the operational recommendations which were formulated by the National Institute for Health and Disability
Insurance 24. Focusing specifically on high quality child
care and well-being, the Office for Birth and Childhood 25
of the French-speaking Community provides prenatal
and childhood consultations, mobile clinics, vaccination
programs, free medical consultations and home visits, thus
supporting both children and their parents, medically as
well as socially (3.8).
Regarding the health and environment nexus, a coherent
approach is ensured through the Joint Inter-Ministerial
Conference on Environment and Health (JICEH), bringing
together the responsible ministers from the three levels of
government. The National Health and Environment Action
Plan (2009-2017) focuses inter alia on human biomonitoring (in the context of EU research on actual exposure
of citizens to chemicals and the possible health effects),
training for environmental health professionals, ozone
and particulate matter, presence of exotic mosquitos, and
persistent organic pollutants (POPs) in human milk. A new
Flemish air quality plan is being prepared, based on the
evaluation of the previous one (2012-2015). Wallonia
has set up its own environment and health policy cell that
has been working out several plans that should improve
the Walloons’ environment and hence their health and
well-being – on air, climate and energy 26, radon 27, on decreasing the use of pesticides 28, POPs 29, heat waves and
18 Vlaams Huis van de Verkeersveiligheid (Flemish House for Road Safety).
19 Verkeersveiligheidsplan.
20 Vlaams Fietsbeleidsplan.
21 Verkeersgetuigen/Getuigen onderweg.
22 “Breed Onthaal”.
23 Pacte d’Avenir pour le Patient.
24 RIZIV/INAMI White paper on Access to Care in Belgium (2014). 25 Office de la Naissance et de l’Enfance.
26 Plan Air Climat Energie 2016-2022. 27 Plan d’actions régional en matière de Radon (2013). 28 Programme wallon de réduction des pesticides (2013-2017). 29 Plan POP.
17
ozone peaks 30, and on regional actions that link health and
environment 31 (3.9).
Belgium has been at the very cutting-edge of pharmaceutical innovation for over 150 years. It has developed five
of the global top-100 drugs, the world’s highest number
per capita, and its pharmaceutical companies also tend to
perform well in their efforts to improve access to medicines for people living in low- and middle-income countries.
With medicines taking up around a tenth in its total exports, Belgium is also the largest provider of vaccines and
medicines to the UN system. More generally speaking,
within the 14% of funds allocated by the Belgian development cooperation to the health sector, 22% are constituted by the provision of medicines, which is an especially
interesting figure given that Belgium also has one of the
most stringent legislations on the quality of vaccines and
medicines destined for exports. A new initiative, rolled out
in 2017, seeks to ensure the quality of all pharmaceutical
products purchased, stored and/or distributed by Belgian
actors, governmental and non-governmental alike, through
Belgian ODA financing. Moreover, Belgium has acceded to
the recently created Coalition for Epidemic Preparedness
Innovations (CEPI), a global alliance which intends to step
up the fight against fatal infectious diseases in the coming
years by making vaccines for emerging infectious diseases
available more quickly (3.b).
Belgium is strongly committed to strengthening health
systems through its international cooperation, following
a rights-based, sector-wide approach that ensures
integration within local systems. The World Health
Organization (WHO), UNAIDS, the Global Fund to fight
Aids, Tuberculosis and Malaria (GFATM) and the UN
Population Fund (UNFPA) are institutional partners of
our development cooperation. When it comes to capacity
building (3.c, 3.d), the internationally renowned Institute
of Tropical Medicine (ITM) is a partner of choice for
federal and subnational authorities alike: it twins with
southern counterparts in order to introduce evidencebased medicine models, it applies a Switching the Poles
demand-driven assistance methodology in its training
programs for southern physicians, and it organizes crash
courses for southern medical experts preparing them for
multilateral negotiations in their field.
On early warning (3.d), Belgian development actors are
working with various research partners on dynamic predictive mapping in the field of communicable diseases,
notably through a demonstration project for the malaria
vector habitat in South East Asia, and through efforts to
adapt this approach to other vector-borne diseases than
malaria (such as dengue fever). Belgian health experts participate in countries’ external evaluations in the framework
of the 2005 International Health Regulation, and our own
Belgian system and procedures in that regard will be critically assessed in the course of 2017. Belgium recently awarded new state-to-state loans, soft loans, mixed
credits and grants to projects in Kenya (bacteriological
decontamination of hospital waste, and clinical laboratory
and radiology services improvement), Vietnam and Egypt
(supplying nuclear medicine machinery), Ghana (supplying diagnostic radiology related material) and Mongolia
(medical equipment to a diagnostic and medical center).
In terms of management of global health risks, our country
- through development cooperation as well as initiatives
by civil society, the ITM and the private sector - took a
forefront role in helping to contain the most recent global ebola outbreaks and in assisting the directly affected
countries 32, putting emphasis on innovation and on the
association of strategies strenghtening mutual trust between communities and health services.
Belgium is equally dedicated to the promotion of sexual
and reproductive health and rights (3.7), inter alia in the
context of the relevant UN fora such as the Human Rights
Council, the Commission on the Status of Women or the
Commission on Population and Development. We hosted a highly successful international conference for the
Global Fundraising Initiative She Decides in March 2017
30 Plan vagues de chaleur et pics d’ozone (2008). 31 Programme d’actions régionales environnement santé (PARES) (2008). 32 Guinea, for example, became a new partner country for our bilateral development cooperation in 2015.
18
(see SDG 5 for discussion in more detail). The Belgian
multi-stakeholder platform for international health
(Be-cause Health) 33 and the ITM developed a freely
accessible e-tutorial covering a wide range of topics in
the field of sexual and reproductive health and rights
such as safe motherhood, sexual violence, child marriage, female genital mutilation, HIV, sexually transmitted infections, family planning and sexual rights.
The Flemish government is dedicating a large part of its
development cooperation in Mozambique to this particular subsector and provides support to the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme
for Research, Development and Research Training in
Human Reproduction (HRP) 34.
The Belgian commitment in terms of fighting maternal
mortality (3.1) plays out mainly in sub-Saharan African
partner countries of our bilateral development cooperation. Focal areas include the skilling of medical personnel
in emergency obstetric care, decentralization of blood
transfusion, and capacity building for rural health centers
both in terms of surgery competences (including caesarian
section skills) as well as in upgrading ambulance services.
In countries such as Senegal, there has been a significant
uptake in the 2012-2015 period in the intervention areas
of Belgian projects, in terms of coverage (new ailments
treated, +49%) and of professionally assisted deliveries
(+37%).
Ending communicable and neglected tropical diseases
(NTDs) (3.3) was and is high on Belgium’s priority list.
Belgium joined the international coalition to control, eliminate and eradicate 10 NTDs. Building on its widely recognized expertise in fighting sleeping disease in the DRC,
through a decentralized approach integrating sleeping
disease surveillance activities within our support to local
health systems Belgium will allocate 25,3 million EUR over
the next nine years, in a decisive push to eliminate sleeping
sickness by 2025. The Bill & Melinda Gates Foundation
has committed to match Belgium’s contribution. Other
Initiatives range from general support for UNAIDS (its first
executive director was Belgian) and CSOs that are assisting in setting up HIV positive patient groups in Southern
African countries, to sustained action campaigns against
tuberculosis and leprosy.
At the multilateral level, Belgium supports the mandate
and work of the UN Special Rapporteur on the right of
everyone to the enjoyment of the highest attainable standard of physical and mental health (3.4, 3.5). Mental health
is a special focus area of HM Queen Mathilde, one of the
17 SDG Advocates, and is also taken at heart in our efforts
abroad. In Rwanda, Belgium has been the principal donor
to fight mental health problems including substance abuse
nationwide for nearly a decade and we helped establishing
a national policy on the matter.
Belgian development actors consider mutual health
insurance schemes as a key component of achieving
universal health coverage (3.8) given their role as
important mechanisms to improve governance issues
in the health sector, access and quality care as well as
patients’ rights and equity. Facilitating better sharing of
expertise and experiences in order to overcome purely
sectoral approaches, actions in this area are supported
in Uganda, Benin, Burundi, Rwanda, Senegal and Niger.
33 http://www.be-causehealth.be/en/who-are-we/ 34 Currently, the Flemish representative is also Chair of HRP’s Executive Board.
|
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|
SDG 3/
GOOD HEALTH
AND WELL-BEING
SDG 3/ GOOD HEALTH AND WELL-BEING - 36 -
SDG3 GOOD HEALTH
AND WELL-BEING
Ensure healthy lives and
promote well-being for all at all ages
SDG Indicator Unit Objectve Assessment
i12. Healthy life years Years at birth o
i15. Premature deaths due to chronic diseases Rate/100,000<65 70.1
i22. Daily smokers % 13.2
The various governments in Belgium have been
actve for many years in the areas of disease preventon, the promoton of health and well-being,
research and road safety.
DISEASE PREVENTION AND
PROMOTING HEALTH
Wallonia unveiled its Walloon Preventon and
Health Promoton Plan for 2030 in 2018. In the
context of the plan to end poverty, the ‘Impulseo’
scheme of the Walloon Region ofers fnancial
support for helping family doctors set up in areas
with a shortage of doctors. Based on an evaluaton,
the criteria for grantng the Impulseo support will
be redefned to prioritse areas with partcularly
acute shortages.
The Brussels Region has a new Health Promoton Plan 2023-2027. This plan sets out a common
roadmap and specifc health promoton actons to
improve the well-being of Brussels residents and
tackle social inequalites in health.
The German-speaking Community is strengthening
its health network with its Guaranteeing Health
Care project. One of the objectves is to improve
front-line support, including the development of
a front-line concept and a register of health
professions.
Belgium has launched NAPED, a natonal plan to
counter endocrine disruptors based on preventon,
regulaton and scientfc research. These three
strands complement each other and follow a One
World One Health approach, that takes into account
the connecton between human, animal and environmental health.
Flanders contnues to invest in mental health care
and specifcally in the residental and quality of
life of the elderly in residental care centres. It also
strives to promote healthier lifestyles, protect
people from infectous diseases and envisage the
detecton of diseases in tme. Within the Flemish
Acton Plan for Suicide Preventon, there is a focus
on the specifc needs and target groups. For example, there is an ongoing campaign to make mental
health problems less taboo, specifcally targetng
men (komuitjekop.be). Over 4.5 million people pay
the health care premium each year for Flemish social protecton. Flemish Social Protecton uses these
funds to strengthen more than 300,000 people in
need of care each month, with a care budget.
SDG 3/ GOOD HEALTH AND WELL-BEING - 37 -
RESEARCH
Belgium is very actve in the fght against musculoskeletal disorders, which are among the most
common occupatonal diseases, including RSI.
The MEMO+ project, launched in 2021 as part of the
Natonal Acton Plan on Environment and Health,
monitors exotc tger mosquitoes in Belgium.
The Flemish Impulse Programme Care strengthens
cooperaton in innovaton, aspires to beter care
for everyone in Flanders, and has consciously opted
for personalised and digital medicine and care
technology. Through innovaton, the Flanders’ Care
program aims to improve the supply of quality care
and encourage responsible entrepreneurship in the
healthcare economy. Through cross-cutng collaboraton between care and industry, Flanders’ Care
4.0 facilitates the development of collaboraton
and business models to forge more efcient collaboraton between the care sector and the business
world.
FIRST-LINE CARE AND PSYCHO-SOCIAL
The ‘Care in the City’ partnership in the BrusselsCapital Region brings together actors from the
health, social and spatal planning sectors to identfy
their needs and see how they can further improve
the customer experience.
Projects for the reform of mental health for children
and youth, adults and the elderly are ongoing, and
are optmised where possible. During the COVID-19
crisis, frst-line care psychologists became more
accessible for vulnerable groups. Evaluaton and
optmisaton also enhance this operaton.
Flanders has been investng in a partner organisaton for promotng mental health since 2020 and,
via geluksdriehoek.be, among others, brings existng
knowledge and practcal tools on resilience and
mental well-being to the general populaton. With
the Youth and Children’s Rights Policy Plan, Flanders
is targetng the well-being and positve identty
development of children and young people, the
development of pleasant and healthy neighbourhoods with quality housing, adequate social meeting space, and access to recreaton. In additon, the
plan also focuses on an integrated leisure policy and
media literacy.
Following COVID-19, in the context of the Walloon
Resilience recovery plan, the Region initated a
project to facilitate the further development of a
contnuum of care, by promotng mental health
services in the city within all age groups and living
environments.
In REK III, the German-speaking Community
launched the Guaranteeing Health Care project,and
is drafing a decree and implementng decrees that
will help bolster the mental health of the public.
ROAD SAFETY
The federal government has taken the necessary
measures to prevent dangerous conduct by road
users (tackling recidivism, automatc detecton of
violatons, optmising cross-border enforcement,
studying the introducton of a points-based driving
licence, revising trafc regulatons, etc.). The federal
government drafed a federal road safety plan
for 2021, with specifc, quantfed goals, including
reducing annual trafc fatalites from 650 today, to
zero by 2050.
The Flanders Road Safety Plan 2021-2025 makes
cyclists and pedestrians the priority. The main
objectve of the plan is to reduce trafc fatalites.
There is also a focus on driving under the infuence,
excessive and/or inappropriate speed and
distractons.
INTERNATIONAL ACTIONS
As part of short-term emergency solutons to the
COVID-19 pandemic, Belgium supported COVAX, for
equitable access to vaccines for low- and middleincome countries. The Belgian government decided
to forward vaccine doses to countries with vaccine
shortages, and supported eforts in logistcs and
medical facilites. Flanders is a partner for vaccine
donatons to Mozambique: the donaton of Astra
Zeneca vaccines to this country is part of the commitment agreed between Belgium and its federated
enttes to redistribute at least 4 million vaccines
SDG 3/ GOOD HEALTH AND WELL-BEING - 38 -
to middle- and low-income countries through the
multlateral distributon mechanism COVAX by the
end of 2021.
In additon, our country contributes to the response
of the internatonal fnancial insttutons to
COVID-19, and is a key player in various Team
Europe Initatves of the EU in the health sector.
To this end, Belgium, together with its European
partners (Germany, France and the European
Union), is strengthening the insttutonal capacity of
African countries for local producton by improving
the regional regulatory framework via the World
Health Organizaton, and by developing the expertse of relevant natonal (public health insttutes,
ministries of health) and regional actors.
The federal government is putng universal access
to basic health care at the heart of its cooperaton with partner countries in this regard, the ‘She
Decides’ movement remains an important partner
for exchange. Furthermore, the right to health,
including sexual and reproductve health and rights,
and the strengthening of health systems remain a
priority for our non-governmental partners, civil
society and academic actors. The federal government supports humanitarian partners in strengthening protecton mechanisms to ensure access to
sexual and reproductve health care for populaton
groups in vulnerable situatons.
An important goal of Flemish Development Cooperaton is to further strengthen the health system
in Mozambique and expand basic health care in this
country. Moreover, Flanders aims to help realise
the right to (sexual) health and healthy, self-chosen
pregnancies of women, adolescents and other vulnerable groups such as sexual and gender minorites
(LGBTQIA+), displaced persons and persons with
disabilites, both in Mozambique and around the
world.
CHALLENGES
In general, Belgium can present good fgures for
SDG 3, but as is the case in other sectors, the search
for sufcient workers and strong profles in the
healthcare sector remains a challenge.
Other risk factors for health also remain a major
concern. About 74 000 new cases of cancer and
about 30 000 deaths from cancer were expected
in Belgium in 2020. Cancer incidence in Belgium
is greater than the EU average both for men and
women. Preventng and detectng chronic diseases
such as cancer, diabetes or cerebrovascular diseases
early therefore remains a challenge.
In 2019, among the under 65s in Belgium, there
were 87.7 deaths from chronic conditons per
100,000 inhabitants of that age group. To achieve
SDG3 by 2030, this fgure must fall to 69.5. There
has been a decline, but this target will not be
achieved if the trend since 2003 contnues (data
available November 2022). The number of premature deaths from chronic conditons is therefore
evolving unfavourably.
Overweight and obesity rates have increased, driven by poor nutriton and low physical actvity. The
number of avoidable hospitalisatons also needs to
fall, in partcular for asthma and chronic obstructve
pulmonary disease.
Finally, as in other countries, the COVID-19 pandemic has impacted the mental health of Belgians
and has caused more mental health problems. For
example, the prevalence of anxiety and depression
symptoms among adults more than doubled during
the frst wave. When lockdown measures were subsequently relaxed during the summer of 2020, prevalence fell again (but not to pre-COVID-19 levels),
only to rise again to similar levels during the second
wave. By March 2021, the prevalence had declined
slightly but stll remained nearly twice as high as
in 2018. Specifc focus on mental resilience among
the younger generaton is essental. The pandemic
highlighted the need for investment in health care
(infrastructure and human resources).
|
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[
3
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{
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|
ODD 3 « Bonne santé et bien-être »
74. Le diagnostic de la mortalité des mères et des enfants montre un contraste
entre l’évolution du taux de mortalité maternelle (passant 347 en 2014 à 391 pour
100.000 naissances vivantes en 2017-2018) et celle des taux de mortalité néonatale
(38 en 2014 et 30 en 2017-2018 pour 1000 naissances vivantes) et des enfants de moins
de cinq ans (115 en 2014 et 96 en 2017-2018 pour 1000 naissances vivantes).
L’incidence de la tuberculose est passée de 36,3 en 2015 à 34,3 pour 100.000 habitants
en 2018.L’incidence du paludisme a diminué de 3 points sur la même période passant
de 155 à 152 pour 1000 habitants. Par ailleurs, la proportion de femmes en âge de
procréer (15 à 49 ans) qui utilisent des méthodes modernes de planification familiale
a stagné autour de 12% de 2014 à 2018.
75. Les efforts consentis par le Gouvernement s’inscrivent dans l’amélioration du
plateau technique en vue d’offrir des soins de qualité à la population. Dans ce cadre,
3,23% et 87,55% des formations sanitaires ciblées ont disposé du plateau technique
pour offrir les services de qualité respectivement en Soins Obstétricaux et Néonataux
d’Urgence (SONU) et en Planification Familiale en 2019 contre respectivement 0% et
83% en 2018.
76. Dans le souci de garantir une bonne santé et promouvoir le bien-être pour
tous, le Gouvernement béninois a pris de nombreuses mesures et procédé à des
réformes pour accélérer la marche du Bénin vers l’atteinte de l’ODD 3. Au nombre
desdites mesures, on note : la suppression de la double pratique « Clientèle privée et
publique du personnel médical» le 25 juillet 2018 et la mise en œuvre des mesures
d'accompagnement notamment pour renforcer la motivation du personnel dans le
secteur ; la mise en place de la commission de contrôle de la qualité des prestations
de soins par décret 2018-472 du 10 octobre 2018 pour assurer le contrôle physique et
le respect des normes de prestations de soins de santé par les établissements publics
et privés . La mise en œuvre de cette mesure a permis de réduire de façon
substantielle le nombre de structures sanitaires clandestines et d’améliorer la qualité
des soins dans les formations sanitaires publiques. Aussi, convient-il de noter la
création de l’Agence Nationale de gestion de la gratuité de la césarienne et le Conseil
National de Lutte contre le VIH/Sida, la Tuberculose, le Paludisme, les Hépatites, les
Infections Sexuellement Transmissibles et les Epidémies.
77. Par ailleurs, d’autres interventions relatives à l’atteinte de l’ODD 3 ont été
enregistrées. Il s’agit de :
- la campagne de dépistage de 4300 femmes et la prise en charge de 533 cas
de lésions précancéreuses du col de l'utérus ;
- l’acquisition d’antirétroviraux et réactifs pour la prise en charge de 47.001
PVVIH ;
- la vaccination contre la rougeole et la rubéole de 777.969 enfants entre 9 mois
et 14 ans ;
- le dépistage de 139 cas de fistules dont 126 réparés et la réinsertion de 87
femmes guéries ayant bénéficié d'une réinsertion psycho-socio-économique ;
- la finalisation des études de faisabilité du projet de construction du Centre
Hospitalier de Référence dans la commune d’Abomey-Calavi ;
- l’acquisition de 8 ambulances médicalisées modernes au profit des zones
sanitaires ;
- le renforcement des compétences de 56 nouveaux prestataires sur les SONU
et une meilleure prise en charge des gestantes.
78. Enfin, le Gouvernement a enclenché une série de réhabilitations des
formations sanitaires au niveau d’Abomey-Calavi, de Parakou et de Porto-Novo.
|
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|
50
Rapport national volontaire (2016-2022)
Burkina Faso
Le Burkina Faso, qui ambitionne d’assurer un mieux-être de la population
à travers une offre de santé pour tous, en a fait une priorité dans les
différents référentiels nationaux de développement.
Faire passer le taux mondial de mortalité maternelle au-dessous
de 70 pour 100 000 naissances vivantes
Le pays enregistre une baisse de la mortalité maternelle. En effet, le taux de mortalité maternelle
pour 100 000 naissances vivantes est passé de 440 en 1998 à 232 en 202131. En dépit de la baisse
constatée, la situation de la mortalité maternelle demeure préoccupante au regard de la tendance
de l’évolution de certains indicateurs de routine d’appréciation des soins maternels que sont
la mortalité maternelle intra-hospitalière, les consultations prénatales et les accouchements
assistés.
La mortalité maternelle intra-hospitalière pour 100 000 parturientes reste toujours élevée (135
en 2015 et 134 en 2021). Les consultations prénatales notamment en CPN4 demeurent toujours
faibles (54% en 2021 contre 34,1% en 2016).
Graphique 9 : Évolution des décès liés à la grossesse pour 100 000 naissances vivantes
Source : EDSBF 2003, 2010 et 2021
Des difficultés subsistent mettant à mal les efforts dans le domaine. Il s’agit, entre autres,
des barrières géographiques, financières et socioculturelles (le recours tardif des femmes aux
soins…), l’inégale répartition spatiale de l’offre de Services de soins prénataux (SPN), la faible
capacité opérationnelle des services de SPN due à l’insuffisance de personnels qualifiés, les
ruptures et les difficultés d’approvisionnement en intrants et l’insécurité.
ODD 3:
Permettre à tous de vivre
en bonne santé et promouvoir
le bien-être de tous à tout âge
Cible 3.1.
1991-1998
(7 ans avant EDSBF-II
1998-1999)
2003-2010
(7 ans avant EDSBF-IV
2010)
2004-2021
(7 ans avant EDSBF-V
2021)
440
341
232
31 Enquêtes démographiques et de santé (EDS)
51
Eliminer les décès évitables de nouveau-nés et d’enfants
de moins de 5 ans
La mortalité infanto-juvénile connaît une baisse significative mais demeure toujours élevée.
En effet, selon les Enquêtes démographiques et de santé (EDS) du Burkina Faso, le quotient
de mortalité infanto-juvénile32 pour 1 000 naissances vivantes est passé de 184 en 2003 à 48 en
2021. Cette baisse est imputable à la réduction de la mortalité infantile33 (de 81 en 2003 à 30 pour
100 000 en 2021) et à celle de la mortalité néonatale34 (de 31 en 2003 à 18 pour 100 000 en 2021).
Graphique 10 : Mortalité des enfants de moins de 5 ans (décès pour 1 000 naissances vivantes)
Source : Construit à partir des données du Rapport EDS 2021
L’amélioration de ces indicateurs s’explique en partie par la mise en œuvre d’actions visant à
faciliter l’accès des populations particulièrement les femmes et les enfants aux services de
santé. Parmi ces actions, figure notamment la mesure de gratuité des soins au profit de la femme
enceinte et des enfants de moins de cinq (05) ans qui a permis d’améliorer la fréquentation
des services de santé ; l’institutionnalisation de la santé communautaire et l’offre de services
préventifs, curatifs, promotionnels et de soutien de proximité par un réseau de plus de 17 000
ASBC dans les communautés et les ménages ; la poursuite de la gratuité de la vaccination sur
toute l’étendue du territoire et l’introduction de nouveaux vaccins comme le vaccin contre la
méningite A (MenAfriVac) en 2017, le Vaccin poliomyélite inactivé (VPI) et le vaccin Rougeole
rubéole (RR) en 2018 (cf. Tableau des couvertures vaccinales en annexe).
Nonobstant ces efforts consentis, des difficultés subsistent et sont liées à la fermeture de
certaines formations sanitaires ou leur fonctionnement à minima dû à l’insécurité, à la rupture
en intrants au niveau de certains points de prestation, à l’insuffisance de plateau technique, la
faible capacité opérationnelle des services de soins prénatals (seulement 32% des structures
de soins disposent de directives de soins prénatals et moins de 1% des formations sanitaires
disposent de l’ensemble des éléments traceurs).
Mettre fin à l’épidémie de sida, la tuberculose, le paludisme, les
maladies tropicales négligées et autres maladies transmissibles
Le paludisme demeure un problème majeur de santé publique et représente le principal motif
de consultation, d’hospitalisation et de décès dans les formations sanitaires au Burkina Faso.
L’incidence du paludisme pour 1 000 habitants dans la population générale est passée de 449 cas
en 2015 à 568,9 cas en 2021. Chez les enfants de moins de 5 ans, elle était de 1 237,6 cas en 2021
contre 1 090 en 2015. Les principales difficultés qui pourraient expliquer cette persistance de
l’incidence sont, entre autres, le problème d’assainissement du cadre de vie, la faible utilisation
des moustiquaires (MILDA35).
La létalité du paludisme chez les enfants de moins de cinq ans est restée quasi-stationnaire
se situant à 1,3% en 2021 après un taux de 1,5% en 2015, pour des cibles visées de 1,1 en 2023 et
0,5 en 2025. Ce taux est largement supérieur à celui de la population générale qui se situe entre
Cible 3.2.
Cible 3.3.
EDSBF 2003 EDSBF 2010 EDSBF 2021
31
81
184
23
65
129
18
48
30
Mortalité infanto-juvénile
Mortalité infantile
Mortalité néonatale
32 La mortalité infanto-juvénile est une statistique correspondant à la mortalité des enfants de moins de cinq ans
33 La mortalité infantile désigne les décès d'enfants âgés de moins d'un an
34 La mortalité néonatale représente le nombre de décès survenue au cours des 28 premiers jours de vie rapporté au nombre de
naissances vivantes enregistrées au cours de la même période
35 Moustiquaire imprégnée à longue durée d'action
52
Rapport national volontaire (2016-2022)
Burkina Faso
1,2% en 2015 à 0,7% en 2021. Si cette tendance se maintient, le pays ne serait pas en mesure
d’atteindre les objectifs fixés en 2025. Des disparités existent d’une région à l’autre. Les régions
du Sahel, de la Boucle du Mouhoun, de l’Est, du Sud-Ouest et du Centre-Nord présentent des
taux de létalité chez les moins de 5 ans supérieurs à la moyenne nationale.
Les principales raisons de cette létalité pourraient être les retards à la consultation et la faible
disponibilité des Produits sanguins labiles (PSL) avec un taux de satisfaction en PSL de 78,09%
en 2021.
Graphique 11 : Létalité (en %) du paludisme chez les enfants de moins de 5 ans et dans la
population générale de 2016 à 2021
Source : Construit à partir des données des annuaires statistiques du MSHP de 2016 à 2021
Pour pallier ces insuffisances, des actions pour le renforcement de la prise en charge du
paludisme ont été mises en œuvre. Il s’agit notamment de l’approvisionnement en Produit
sanguin labile, la mise en œuvre du traitement pré-transfert à l’artésunate rectal chez les enfants
de moins de 5 ans. En plus de ces actions curatives, des mesures de prévention ont concerné
la mise en œuvre de la Chimio prévention du paludisme saisonnier (CPS) dans tous les districts
du pays, des séances de sensibilisation en milieu scolaire sur le paludisme et la campagne de
distribution gratuite de MILDA en faveur des femmes enceintes et des enfants de moins de
1 an, le développement de la santé communautaire (ASBC),, la stratégie d’interventions intégrées
à base communautaire (PEC du paludisme au niveau communautaire, TPIg-communautaire,
traitement pré-transfert des cas de paludisme grave).
Des progrès ont également été enregistrés dans la lutte contre le VIH. La séroprévalence de
l’infection à VIH dans la population générale est à la baisse. Elle est estimée à 0,7%36 en 2021
contre 1,3%37 en 2015. Il en est de même chez les femmes enceintes vues en CPN et testées
positives pour le VIH avec une prévalence qui est passée de 1,3% en 2015 à 0,8% en 2020.
Malgré la réduction des cas d’infection, le nombre de décès (de 3 600 décès pour 100 000 habitants
en 2015 à 2 000 en 2021) interpelle sur les efforts à fournir pour améliorer davantage la survie des
PVVIH avec un accent particulier sur les femmes qui sont les plus concernées. Cette situation
s’expliquerait en grande partie par l’insuffisance du dépistage et de la prise en charge des femmes
enceintes due à la non-disponibilité des intrants et/ou l’insuffisance dans la gestion des intrants
pour le dépistage et la prise en charge des cas, la fermeture de certaines FS due à l’insécurité.
En outre, les violences exercées par un partenaire intime augmenteraient de 50% le risque de
contamination chez les femmes. Les femmes vivant avec le VIH signalent régulièrement des
violences de la part de leur partenaire intime, de membres de leur famille ou de leur communauté,
ainsi qu’au sein de services de santé.
2016 2018 2019
1,6
1,4
1,2
1,0
0,8
0,6
0,4
0,2
0,0
2017 2020 2021
1,5
0,9
0,8 0,8 0,8 0,7 0,7
1,5 1,4
1,3
1,4 1,4
y = -0,0314x + 1,5267
R2
=0,6101
y = -0,0314x + 0,8933
R2
=0,6101
36 Annuaire statistique de la santé 2021
37 Annuaire statistique de la santé 2016 LÉTALITÉ EN %
National moins de 5 ans Linéaire (National) Linéaire (moins de 5 ans)
53
Graphique 12 : Évolution de la prévalence
du VIH au Burkina Faso de 2016 à 2021
Graphique 13 : Évolution des décès au VIH
pour 100 000 habitants
Source : Programme sectoriel santé de lutte contre le VIH/SIDA et les IST PSSLS-IST 2015-2019, rapport de la
séro-surveillance de 2016 à 2020
Afin de renforcer la lutte contre le VIH/SIDA et de réduire de 70% la mortalité liée au VIH à
l’horizon 2025, le Burkina Faso a souscrit à l’atteinte des 3 fois 9538. Ainsi en 2021, ce sont 61 213
personnes atteintes du VIH/SIDA qui sont sous ARV sur 61 274 PVVIH dans la file active globale
(FA), soit 99,9% avec une charge virale indétectable à 12 mois à 76,1%.
La lutte contre la tuberculose a connu des avancées. Le taux d’incidence de la tuberculose
est dans une tendance globale à la baisse entre 2015 et 2021 passant de 30,3 à 15,2 pour 100 000
habitants. Le taux de décès liés à la tuberculose est passé de 9,9% en 2015 à 8,7% en 202139.
Graphique 14 : Évolution de l’incidence de la tuberculose pour 100 000 habitants de 2016 à 2021
Source : Annuaires statistiques du Ministère en charge de la Santé, 2016 à 2021
Les progrès et réalisations dans la lutte contre la tuberculose ont été possibles grâce à la
politique de gratuité du dépistage et le traitement dans tous les centres de santé publics et
conventionnés du pays. Toutes ces actions sont soutenues par une participation de la société
civile dans les domaines du dépistage, du traitement et de la veille communautaire.
Les principales difficultés qui ont entravé la lutte contre la tuberculose sont la couverture
insuffisante et l’inégale répartition des FS offrant des services de lutte contre la tuberculose, le
recours tardif de la population aux Centres de santé pour une meilleure prise en charge des cas,
la faible disponibilité des intrants, la faible capacité opérationnelle des formations sanitaires, la
faible mise en œuvre des prestations de soins communautaires et l’insécurité.
Dans le cadre de la lutte contre les Maladies tropicales négligées (MTN), le Burkina Faso s’est
inscrit dans les recommandations de l’Organisation mondiale de la santé (OMS) préconisant
cinq stratégies d’action face à la prise en charge de ces maladies. Ces stratégies ont permis,
2016
2015 2016
2019
2019
2018
2018
1,60%
1,40%
1,20%
1,00%
0,80%
0,60%
0,40%
0,20%
0,00%
35
30
25
20
15
10
2017
2017
2020
2020
2021
2021
0
1500
1300
1800
30,3 29,8 29,5 28,3 27,6
15,2
28,5
3100
3300
2900
3100
1000 2000 3000 4000
2019
2017
2018
2016
2015
National Femmes
3600
1800
1600
38 À l’horizon 2025, 95% des personnes vivant avec le VIH connaissent leur statut sérologique
• À l’horizon 2025, 95% de toutes les personnes infectées par le VIH dépistées reçoivent un traitement antirétroviral durable
• À l’horizon 2025, 95% des personnes recevant un traitement antirétroviral ont une charge virale durablement indétectable
39 Annuaires statistiques de la santé
54
Rapport national volontaire (2016-2022)
Burkina Faso
au cours de la période 2015-2021, de produire un certain nombre de résultats conformément
aux cibles attendues. Les seuils d’interruption de la transmission ciblés par l’OMS ont été
relativement atteints, traduisant l’évolution de notre pays vers l’objectif de contrôle à l’horizon
2020. En effet, les enquêtes d’évaluation de la transmission réalisées révèlent les prévalences
suivantes : (i) inférieure à 2% pour le trachome contre un seuil de 5% ; (ii) inférieure à 1% pour
la filariose lymphatique dans 60 districts contre un seuil de 1% ; (iii) inférieure à 5% dans 10
régions sanitaires pour la schistosomiase ; (iv) nulle pour les géohelminthiases dans la plupart
des sites évalués. Ainsi, le nombre de personnes ayant besoin d’intervention de lutte contre la
filariose lymphatique a connu une baisse considérable au niveau national, passant de 6 924 392
en 2016 à 2 186 506 en 2020.
Graphique 15 : Évolution du nombre de personnes ayant besoin d’interventions de lutte contre
la Filariose lymphatique contre le nombre de personnes traitées de 2016 à 2020
Sources : Construit à partir des données des annuaires statistiques du Ministère en charge de la santé, 2016 à 2020
Ces résultats importants ont été obtenus grâce à la chimiothérapie préventive à travers des
campagnes de traitement de masse visant ainsi l’interruption de la transmission, aux évaluations
de couverture thérapeutique associées aux enquêtes de Connaissances, attitudes et pratiques
(CAP), aux études entomologiques et sociologiques, à la distribution des MILDA et au renforcement
de l’information, éducation et communication (IEC), la prise en charge des cas, la prévention
des incapacités et handicaps, c’est-à-dire le contrôle de la morbidité et la mise en œuvre des
activités de surveillance active et passive par le programme MTN.
Assurer l’accès de tous à des services de soins de santé sexuelle et
procréative
Le Burkina Faso a adhéré aux engagements internationaux en faveur de la planification familiale à
travers des cadres de politiques de développement, notamment la Conférence internationale sur
la population et le développement (CIPD) tenue en 1994 au Caire, le Partenariat de Ouagadougou
(2011) et l’Action mondiale accélérée en faveur de la santé des adolescents en Ouganda (2020).
À cet effet, il a engagé des mesures de politiques en vue d’améliorer l’accès des populations,
notamment celles vulnérables, aux services de soin de santé sexuelle. Les interventions majeures
sont (i) la mise en œuvre de la gratuité de la Planification familiale (PF) ; (ii) l’implication des
hommes pour la promotion de la PF (« école des maris et futurs époux », Approche IFC, « père
Burkimbila », …) ; (iii) le renforcement de l’offre de services de la PF en post-partum et postabortum et aussi son intégration à tous les points de contact de la mère et du nouveau-né dans
les formations sanitaires et (iv) la Délégation des tâches (DT) en matière de planification familiale
concerne aussi bien le niveau communautaire que les formations sanitaires et les officines.
Les différents efforts se sont traduits par une amélioration du taux de prévalence contraceptive
des femmes en âge de procréer (15 à 49 ans) qui est passé de 24,20% en 2016 à 31,20% en
2021 en dépit de la baisse. L’augmentation de la prévalence contraceptive cache néanmoins
des disparités importantes selon le milieu de résidence. En effet, en 2021, elle est de 29,1% en
Cible 3.7.
2016 2018 2019
8 000 000
7 000 000
6 000 000
5 000 000
4 000 000
3 000 000
2 000 000
1 000 000
0
2017 2020
6 924 392
5 530 123
2 152 616
2 114 837 2 186 506
1 749 542 1 696 528 1 727 545
2 857 415
Population totale
nécessitant TDM
Population
traitée
3 577 833
Nombre de personnes
55
milieu rural contre 41,5% en milieu urbain. Il existe également des disparités régionales dues
essentiellement à la persistance des ruptures de stocks de produits contraceptifs dans les
formations sanitaires, la crise sécuritaire avec la fermeture de certaines formations sanitaires
ou leur fonctionnement à minima, des services de PF de faible qualité et non adaptés surtout
pour les Populations déplacées internes.
Graphique 16 : Évolution du taux de prévalence contraceptive chez les femmes de 15 à 49 ans
entre 2016 et 2021
Source : Construit à partir des données des annuaires statistiques du MSHP de 2016 à 2021
La proportion de demande satisfaite en planification familiale moderne chez les femmes de
15-49 ans a connu une augmentation tout au long de la période. Elle est passée de 45,3% en
2016 à 56,6% en 2021, soit une moyenne annuelle de 52,95% de demandes satisfaites. Quant aux
besoins non satisfaits pour la contraception, la proportion est passée de 28,8% en 2016 à 15,5%
en 2021, soit une moyenne annuelle de 22,09% de demandes non satisfaites.
A) Politiques publiques mises en œuvre
Les politiques publiques mises en œuvre sur la période sont essentiellement la Politique
sectorielle santé et le Plan national de développement sanitaire (PNDS 2016-2020). À cela
s’ajoutent des stratégies thématiques dont la politique pharmaceutique, le Plan stratégique de
lutte contre le paludisme, le Plan stratégique de lutte contre la tuberculose, la Stratégie de la
prise en charge intégrée des maladies de l’enfant, le Cadre stratégique national de lutte contre
le SIDA et le Plan national de planification familiale.
En plus, plusieurs autres mesures ont été mises en œuvre pour améliorer l’accès des femmes
enceintes aux services d’accouchement au nombre desquelles la subvention pour les Soins
obstétricaux néonatals d’urgence (SONU), la gratuité des soins ciblant les femmes et les enfants
de moins de 5 ans, les actions de communication pour le changement de comportement sur les
pratiques familiales essentielles (le mentorat, « l’école des maris ») ; la stratégie « Collaborer
avec les Individus, les Familles et les communautés pour améliorer la santé maternelle et
néonatale » (IFC).
Pour améliorer l’offre de services PF, le Gouvernement a mis en œuvre la gratuité de la planification
familiale.
Dans le domaine du paludisme, certaines mesures ciblées sont mises en œuvre en vue d’améliorer
l’accès à la prévention et à la prise en charge pour les groupes spécifiques : il s’agit, entre autres,
de la gratuité de la distribution en routine des MILDA en faveur des femmes enceintes et des
enfants de moins de 1 an, le développement de la santé communautaire (ASBC) ; la stratégie
d’interventions intégrées à base communautaire. Aussi, l’opérationnalisation de la Fonction
publique hospitalière (FPH) apparaît comme un élément important de motivation du personnel
à rester dans les postes en zones difficiles.
2016 2018 2019
35
30
25
20
15
2017 2020 2021
24,2 24,6
30,1 30,7
28,1
31,2
Taux de prévalence
contraceptive chez les
femmes de 15-49 ans
Linéaire (Taux de prévalence
contraceptive chez les
femmes de 15-49 ans)
56
Rapport national volontaire (2016-2022)
Burkina Faso
B) Effets de la COVID-19 et de la crise sécuritaire sur l’ODD 3
La crise sécuritaire et la crise de la pandémie de COVID-19 ont entraîné une perturbation dans
la mise en œuvre des activités du secteur de la santé avec un impact négatif sur les indicateurs
de santé.
L’insécurité grandissante a limité l’accès des populations aux services de santé avec la destruction
des infrastructures et des équipements, la fuite ou la limitation de déplacement du personnel
soignant. En effet, il est dénombré 1 781 formations sanitaires fermées et 75 saccagées, 37
ambulances retirées au 30 mars 2023. Par ailleurs, la prise en charge des populations déplacées
augmente la charge de travail des personnels soignants et la pression sur la capacité d’accueil
des formations sanitaires ouvertes, nécessitant un renforcement des équipements sanitaires
et du personnel de santé.
Le secteur de la santé a été durement affecté par la COVID-19, qui a conduit à une réorganisation
du système sanitaire. Cette situation a induit une réduction de l’offre en services spécialisés,
l’arrêt des activités de prévention au profit de la mère et de l’enfant, la suspension de certains
services aux malades avec pour conséquence des complications et des décès, la réduction de
l’accès physique, financier et sécurisé aux produits de santé, notamment pour les patients avec
des maladies chroniques, la baisse de l’utilisation des services de contraception et de planning
familial durant les deux (02) premiers mois de la survenue de la COVID-19 au Burkina Faso.
Pour faire face au défi sécuritaire et à la pandémie de COVID-19, des stratégies de résilience pour
la continuité des soins ont été développées. Il s’agit principalement de la stratégie de résilience
du système de santé en zone de sécurité précaire, du plan national d’approvisionnement en
produits de santé dans les situations d’urgence et de catastrophe, de la stratégie de santé
communautaire qui vise le développement de l’offre de soins au niveau communautaire, du plan
de prévention et de riposte à la pandémie de COVID-19, du guide d’orientation de la continuité
des soins et services dans le contexte de la pandémie de COVID-19.
Conclusion partielle
La situation sanitaire au Burkina Faso s’est améliorée ces dernières années avec la baisse
de la mortalité maternelle, de la mortalité infanto-juvénile et de l’amélioration de la prise en
charge de la malnutrition et l’accès aux services de santé. Toutefois, des efforts restent à
consentir en raison du niveau élevé de certains indicateurs tels que la mortalité maternelle
intra-hospitalière et la faible disponibilité en produits sanguins labiles.
Pour assurer le développement du secteur de la santé, de nombreux défis restent à
relever dont les principaux sont l’amélioration de l’accès aux services de santé et aux
soins de qualité ; la lutte pour la baisse significative des morbidités liées aux maladies
transmissibles et non transmissibles et la réduction de la mortalité maternelle et infantile,
et la disponibilité et la gestion efficiente des ressources en santé pour répondre aux
différents besoins du secteur.
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[
3
] |
{
"country": "bfa",
"file_id": "sdg-03/vnr-report-bfa-2023-fr-5.pdf",
"language": "fr",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
17
Au titre de la santé, le pays enregistre une baisse de la mortalité maternelle. En effet, le taux
de mortalité maternelle pour 100 000 naissances vivantes est passé de 440 en 1998 à 232 en
20214
. Nonobstant ce qui précède, la situation de la mortalité maternelle demeure toujours
préoccupante. La mortalité infanto-juvénile connaît une baisse significative. En effet, selon les
Enquêtes démographiques et de santé (EDS) du Burkina Faso, le quotient de mortalité infantojuvénile5 pour 1 000 naissances vivantes est passé de 184 en 2003 à 48 en 2021. Cette baisse est
imputable à la réduction de la mortalité infantile6 (de 81 en 2003 à 30 pour 100 000 en 2021) et à
celle de la mortalité néonatale7 (de 31 en 2003 à 18 pour 100 000 en 2021).
Pour assurer le mieux-être de la population à travers une offre de santé de qualité pour tous et à
moindre coût, plusieurs efforts ont été consentis et renforcés à travers le programme de gratuité
des Soins obstétricaux et néonatals d’urgence (SONU) ainsi que la gratuité des soins aux femmes
enceintes et aux enfants de moins de 5 ans, le renforcement de la disponibilité du personnel
qualifié en particulier celle des sages-femmes dans les formations sanitaires, le renforcement
de la couverture vaccinale chez les enfants, la lutte contre les carences nutritionnelles et
l’amélioration de la santé de la population de façon générale par la lutte contre l’épidémie du
sida, la tuberculose, le paludisme, les maladies tropicales négligées, les hépatites, les maladies
transmises par l’eau et les autres maladies transmissibles et l’amélioration de l’accès au service
de santé par une meilleure couverture du pays en infrastructures sanitaires.
48
décès infantojuvénile sur 1 000
naissances vivantes enregistrés
en 2021, contre 184
en 2003
|
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3.3. SDG # 3: Ensure healthy lives and promote well-being for all at all ages
3.3.1. Introduction
Bangladesh has remarkable achievements in health related MDGs. Prime Minister Sheikh
Hasina received the UN MDG Award in 2010 for government’s success in reduction of
under-five mortality. In 2011, Bangladesh received 'Digital Health for Digital Development’,
a South-South Award for successful attainment of MDG- 4 & MDG-5.
18
The Government of Bangladesh recognizes health as an integral part of development.
Improvements in health would translate into higher incomes, higher economic growth, and
accelerated poverty reduction. Bangladesh has achieved remarkable progress in improving
the life expectancy at birth (72 years). The status of mean years of schooling and expected
years of schooling has also improved significantly (Fig 3.2; Source: Calculated from micro
data of Sample Vital Registration System, BBS 2016). The gross national income (per capita
3,341 PPP$) has also increased elevating the country in the group of medium-ranking
Human Development Index (HDI) countries.
Four of the seven targets of the Sendai Framework for Disaster Risk Reduction are directly
linked to health. These focus on reducing mortality and injuries, improving people’s wellbeing and promoting the safety of health facilities and hospitals. Accordingly, the
government has prioritized design, construction and retrofit hospitals, storage for
emergency medicine, preservation of doctor and nurses’ database to ensure healthy lives
and wellbeing of its citizens.
3.3.2. Status of Health and Population
Health Status: Since independence, Bangladesh has made significant progress in health
outcomes. Infant and child mortality rates, under-five mortality rate and maternal mortality
rate have reduced significantly in 2015 (Fig 3.3). The neonatal mortality rate (NMR) also
reduced from 81/1,000 (1981) to 20 (2015). Expanded programme on immunization (EPI)
coverage evaluation survey 2015 reveals that 82.5% children were fully vaccinated.
Deliveries attended by skilled health personnel (SHPs) increased from 5% (1991) to 42%
(2014). Proportion of birth in health facilities by wealth quintile from 4.4:43.4 in 2007 to
15.0:69.5 in 2014 (BDHS) indicates a sharp reduction in inequity in Bangladesh.
The prevalence of malaria dropped from 456 (2005)
to 300 (2015) per 100,000 persons; the death rate
has also reduced to 0.07 per 100,000 populations in
2015. According to the National Tuberculosis (TB)
Prevalence Survey (2007-2009) Report of
Bangladesh, the overall prevalence of new smear
positive cases among adults aged 15 and older was
estimated at 79.4 people over a population of
100,000. The overall case notification rate was 119
per 100,000 populations which have come down to
53 (2014). Polio and leprosy are virtually
eliminated. HIV prevalence is still very low, but there is a high risk of infection. Regarding
tobacco control, legislation was first enacted in Bangladesh in 2005 and was strengthened in
2013 to increase compliance with the WHO Framework Convention on Tobacco Control
(FCTC). Most significant recent achievements include: (a) Introduction of pictorial health
warnings covering 50% of tobacco packaging since March 2016; (b) Implementation of a
4.04 4.11 4.19 4.69 4.84 4.85 4.94
9.58 9.9 10.05 10.82
11.61 11.75 11.83
Y-2010Y-2011Y-2012Y-2013Y-2014Y-2015Y-2016
Fig 3..2: Human Development Index
Mean Years of Schooling
Expected Years of Schooling
19
strong taxation policy by raising tobacco taxes to 79% of the retail price of the most popular
brand of cigarettes.
Development of a countrywide network of healthcare infrastructure in the public sector is
remarkable. Community based primary health care service through community clinics (CCs)
is a flagship initiative of the government of Prime Minister Sheikh Hasina. This initiative has
been highly appreciated by the international community as a means to bring the services
closer to the people. CC is the lowest tier health facility in the rural areas all over
Bangladesh including the remote and very hard-to-reach areas. Each CC has a defined
catchment area with 7,000-10,000 population. CC promotes health and provides preventive
and basic curative care. Currently, 13,136 CCs are functioning with adequate health workers
and medicines. Among these 1,008 CCs are providing delivery facilities. On an average 40
patients/day attend each CC, 95% of whom are women and children.
Population Status: Bangladesh is now Asia’s fifth and world’s eighth populous country with
an estimated population of about 160 million. Strong policy interventions led to continuous
reduction in the annual growth rate of population from the level of 2.52% (1974) to 1.37
(2011). The total fertility rate (TFR) also went down from 6.3 (1975) to 2.1 (2015). The
contraceptive prevalence rate (CPR) increased from 7.7% (1975) to 62.1% (2015).
Cross-Cutting Issues: World Health Organization (WHO) has recently drawn attention of the
world community to the inevitable effect of climate change on the basic requirements for
maintaining health: clean air and fresh water, sufficient food and adequate shelter.
Bangladesh has demonstrated remarkable achievements in natural disaster/ emergency
response through better preparedness and proper management. Health risks from natural
disasters are minimized through the supply of emergency drugs and laboratory reagents in
patient management.
Bangladesh also considers the healthcare waste management a critical issue in the context
of environment pollution. To effectively address
this issue, the Government developed a Health
Care Waste Management Plan (HCWMP). The
country’s commitment to and support for women’s
development programmes over the past two
decades have resulted in positive gains in female
life expectancy, MMR, IMR and child mortality
rates, and empowerment.
3.3.3. Strategies for ensuring healthy lives and
promote well-being for all
The Government of Bangladesh recently (March 21,
2017) approved a mega programme for the HNP sector development. The US $ 14.71 billion
mega programme called 4th Health, Population and Nutrition Sector Program (4th HPNSP) -
2017/2022, is guided by Bangladesh’s Vision 2021, and is in line with the SDGs. The 4th
212
36 111
29
648
176
Y-1981 Y-2015
Fig 3.3: Under five and infant mortality rate
Under five mortality rate
Infant mortality rate
Maternal mortality rate
20
HPNSP incorporates appropriate strategies and activities for focused improvements in
increasing access to and utilization of
health care. It also aims at improving
equity along with financial protection
in order to meaningfully realize the
objectives of universal health coverage
(UHC) by 2030.
Achieving sustainable levels of
financing for the sector will depend on
a combination of managing demand
for health care. The 4th HPNSP will be
translated into actions through implementation of a number of strategies (Box-3.1).
Road Safety
The Government addresses road safety issues with 3E approaches, i.e. Engineering,
Education, and Enforcement. We have taken up various engineering measures to make the
roads and highways safe. We have also introduced various enforcement measures i.e. digital
motor vehicle management system and put adequate emphasis on enforcing traffic laws. In
addition, massive mass awareness campaigns on road safety issues are going on.
3.3.4. Challenges
• Ensuring skilled attendance at birth;
• Addressing the communicable and non-communicable diseases;
• The prevalence of road accidents, drowning, aging and geriatric diseases;
• The spread of infectious diseases such as Hepatitis B and C;
• The health effects of geo-climatic disasters and arsenicosis;
• Sustainable health financing and promotion of equity in the context of achieving
UHC.
There is a high level of commitment from the GOB
in bringing health care as close to the communities
as possible. National commitment and policy
support are reflected in different key strategies
and policies (Box-3.2).
3.3.5. Data Availability to Monitor the Implementation of SDGs-3
There are 13 targets to be implemented under SDGs-3, which will be monitored by 27
indicators. Out of the 27 indicators, 5 indicators (3.5.1, 3.8.1, 3.8.2, 3.b.1, 3.b.3) are still in
Box-3.2: Key Strategies and Policies
• 7th Five Year Plan (2016-2020)
• National Health Policy-2011
• Bangladesh Population Policy 2012
• 4th Health, Population and Nutrition Sector
Programme (2017-2022)
Box-3.1 HPNSP Implementation Strategies
• Building capacities in leadership, management and regulation
• Restructuring the MOHFW
• Rolling out an upgraded essential services package (ESP)
• Developing new approaches and partnerships
• Focusing on the improvement of the quality of care
• Promoting the importance of public health
• Tackling the rising burden of NCDs
• Tackling the burden of established and new communicable diseases
• Adopting new technologies to strengthen surveillance, data quality
and information systems for evidence based decision making
• Increasing investment in health
21
the Tier III category meaning metadata is yet to be finalized by the UNSC. The available
baseline figures and their milestone targets against the SDG indicators are provided in
Annex-3.
22
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47
4.3 Goal 3: Ensure healthy lives and promote well-being for all at all ages
Introduction
Sustainable Development Goal 3 aspires to ensure health and well-being for all at all ages by
improving maternal and child health, ending the epidemics of major communicable diseases,
48
reducing non-communicable and mental diseases and ensuring access to reproductive healthcare services. It also intends to reduce behavioural and environmental health risk factors. These
objectives will be achieved through realizing other objectives such as providing universal
health coverage, ensuring access to safe, affordable and effective medicines and vaccines for
all, supporting research and development of vaccines and medicines for communicable and
non-communicable, substantially increasing health financing and developing health
workforces in developing countries. In addition, the capacity of developing countries for early
warning, risk reduction and management of national and global risks will need to be enhanced.
Context
Global study reveals that Bangladesh’s public health investment is comparatively lower (with
respect to GDP) than its comparable countries, but the country’s health outcomes are better.
Credits are given to low-cost intervention, particularly the innovation of Oral Rehydration
Saline (ORS) invented in Bangladesh that has drastically reduced diarrhoea-related mortality.
This reduction in mortality was attained by the aggressive distribution of rehydration materials
along with the expanded programme on immunization though the partnership between
government and NGOs. The next-door services provided by the Community Clinics, one for
every 6000 rural people, with free medicines, one of the ten priority initiatives of Hon’ble
Prime Minister Sheikh Hasina, has spearheaded this achievement. The use of ICT in health
services also gave a positive impact in the last decade. The Hon’ble Prime Minister of
Bangladesh was awarded UN MDG Award in 2010 for a radical reduction of the under-five
mortality rate. In 2011, Bangladesh received the South-South Award 'Digital Health for Digital
Development' for success on the attainment of MDG- 4 & 5.
In 1990, Bangladesh’s life expectancy at birth was 56.1 years; in 2018 it is 72.3 years (SVRS,
2018). An article in ‘The Economist,’ titled “Bangladesh shows how to keep children alive,”
pointed out “in 1990 the under-five death rate in Bangladesh was 54 per cent higher than the
world average. Now (2016) it’s 16 per cent lower.”
There is a high level of commitment from the Government of Bangladesh to bringing healthcare
as close to the communities as possible. National commitment and policy support are reflected
in the 7th Five Year Plan, National Health Policy-2011, Bangladesh Population Policy 2012,
National Nutrition Policy 2015, National Drug Policy 2016 and Health, Population and
Nutrition Sector Programme. However, there are unfinished agenda of MDGs, particularly in
the health sector. Incremental public financing in the health sector in a sustainable way is a
daunting challenge.
Progress against targets
3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
The Maternal Mortality Ratio (MMR) decreased from 181 per 100,000 live births in 2015 to
169 in 2018 (SVRS, 2018). The reduction in maternal mortality is attributed to multiple factors,
including increased access and utilization of health facilities, improvements in female
education and per capita income. Fertility reductions have also contributed substantially to the
lowering of MMR by lowering the number of high risk, high parity births.
49
The number of births attended by skilled health personnel was 42.1 per cent in 2014 (BDHS,
2014), which increased to 53 per cent in 2017 (BDHS, 2017). According to the Multiple
Indicator Cluster Survey (MICS, 2019), the proportion is 59 per cent. With a view to speeding
up the reduction of MMR, MoHFW has been pursuing to increase availability and utilization
of quality maternal health services at different levels, including implementation of different
strategies in alignment with the standard Essential Services Packages of the health sector
programme. These essential services include: (i) ANC, PNC, and counselling, (ii) 24/7 delivery
services at the UH&FWCs, UHCs and MCWCs, (iii) comprehensive referral system from
community to different facilities, (iv) 24/7 BEmONC and CEmONC services, (v) deliveries by
the CSBAs, (vi) capacity building of service providers, and (vii) advocacy with NGOs, local
government institutions to mobilize resources and collaborative MNCH activities at remote
areas.
Table 3.1 Maternal Health
2013 2014 2015 2016 2017 2018 2019
Maternal mortality ratio per
100000 live births (SVRS,
BBS)
197 193 181 178 172 169 -
Proportion of births attended
by skilled health personnel
(%)
43.5
(MICS)
42.1
(BDHS)
- - 53
(BDHS)
- 59
(MICS)
3.2 By 2030, end preventable deaths of new-borns and children under 5 years of age, with all
countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per 1,000 live births
The under-five mortality rate has persistently declined from 36 per 1,000 live births in 2015 to
29 in 2018 (SVRS, 2018), which already achieved the SDG target of 2025 set by the
government. On the other hand, the neonatal mortality rate (NMR) decreased to 16 per 1,000
live births in 2018 from 20 in 2015 (SVRS, 2018); which also achieved the SDG target of 2025,
set by the government. Several programmes/activities like essential service package, expanded
programme on immunization, establishment of Special Care Newborn Unit at public hospitals,
incremental provision of antenatal care services for pregnant women, control of diarrhoeal
diseases, kangaroo mother care practice, practicing IMCI protocol, etc. are playing key role in
decreasing under five mortality rate and neonatal mortality rate.
Table 3.2 Child Health
2015 2016 2017 2018
Under five mortality rate per 1000 live births 36 35 31 29
Neonatal mortality rate per 1000 live births 20 19 17 16
Source: SVRS, BBS, various years
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases
and combat hepatitis, water-borne diseases and other communicable diseases
The prevalence of HIV/AIDS (all ages) has been very low in Bangladesh [<0.01 (all ages) and
0.015 (adults 15-49 years) per 1,000 uninfected population, UNAIDS, 2018]. However, it
50
remains vulnerable to an HIV epidemic because of its high prevalence in neighbouring
countries and the high mobility of Bangladeshis within and beyond the country. For this reason,
the government has continuously been monitoring the incidence and detection rates and
addressing AIDS patients with adequate importance. Currently, free medicines and other
services to HIV patients are being provided from seven government hospitals and HIV
detection activities have been continuing through 23 hospitals.
The incidence rate of tuberculosis (TB) has been reduced to 221 in 2018 from 225 per 100,000
in 2015 (National Tuberculosis Programme, 2018). Malaria incidence per 1000 population was
2.29 in 2015 (National Malaria Elimination Programme-NMEP, 2015), which has also been
declining. The incidence rate is now 0.92 (NMEP, 2018). The government interventions in
collaboration with the Development Partners and NGOs for malaria eradication resulted in a
decline in incidence nationally.
Hepatitis B incidence (per 100,000 population) among under-five children was 1.38 in 2015
(GHO, WHO). World Health Organization announced in July 2019 that Bangladesh is among
the first four countries (Bangladesh, Bhutan, Nepal, and Thailand) in the WHO South-East
Asia region to achieve Hepatitis B control, with the disease dropping to less than one per cent
among five-year-old children. Government interventions including the establishment of a
multi-sectoral approach for activities related to prevention and control, the introduction of the
vaccine to high-risk groups and the establishment of a surveillance system for Hepatitis virusinfected cases are continuing.
There is a huge burden of the Neglected Tropical diseases (NTDs) in Bangladesh, particularly
for Kala-azar, Lymphatic Filariasis, and Dengue, etc. The number of people requiring
interventions against NTD has been increased from about 50 million (WHO, 2016) to about
56.33 million (WHO, 2019). By 2030 it needs to be reduced to 35.0 million and efforts are on
through various interventions such as integrated vector management, promotion of clinical
management, and active engagement of the communities, etc. for reducing NTDs.
3.4 By 2030, reduce by one-third premature mortality from non-communicable diseases
through prevention and treatment and promote mental health and well-being
Non-communicable diseases (NCDs) have now formed a major share of the overall disease
burden and mortality. The mortality rate attributed to cardiovascular disease, cancer, diabetes
or chronic respiratory disease was 21.6 in 2016 (WHO, 2019) and the situation is unchanged
since then. Awareness programmes on helpful behavioural patterns, changing dietary habits,
lifestyle change, etc. activities are being implemented for preventing NCDs. Facility readiness
including training of doctors are going on for better treatment of NCD patients. As a matter of
policy direction, more emphasis has been given to prevention and lifestyle change in the
national health programme of MoHFW.
Suicide is the most common cause of unnatural death in Bangladesh with a higher proportion
of women having the tendency to commit suicide. While mental disorders in the form of
depression and anxiety are common causes of suicide in many societies, there are some
proximate causes of suicide for women in Bangladesh such as physical and domestic violence.
According to the Ministry of Home Affairs (MoHA), the suicide mortality rate has been
declining from 7.68 per 100,000 population in 2015 to 5.19 in 2019.
51
3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse
and harmful use of alcohol
According to the Department of Narcotics Control (DNC) of the Security Services Division
coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and
aftercare services) for substance use disorders was 16, 416 in 2015, which has increased to
38,035 in 2018. Per capita alcohol consumption remains same as 0.083 litres in 2016 and 2018.
3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents
Bangladesh Road Transport Authority (BRTA) being the leading organization has been taking
various measures for road safety according to National Road Safety Action Plan (NRSAP).
The 8th NRSAP (2017-2020) has been prepared in line with achieving the target of SDGs. Other
than BRTA, different government organizations are involved to implement the 8th NRSAP
including Bangladesh Police, R&H Department, LGED, Dhaka Transport Coordination
Authority, Dhaka City Corporation (North and South), Accident Research Institute, National
Curriculum and Textbook Board, Non-Formal Education Department, District
Administrations, etc. and NGOs like BRAC. The plan is organized in accordance with nine key
safety themes matching the five road safety pillars of UN Decade of Road Safety (2011-2020):
(i) planning, management, and coordination of road safety, (ii) road traffic accident data
system, (iii) road safety engineering, (iv) road and traffic legislation, (v) traffic enforcement,
(vi) driver training and testing, (vii) vehicle safety, (viii) road safety education and publicity,
and (ix) medical services for road traffic accident victims. National Road Safety Council has
given 111 recommendations to improve the road safety condition in Bangladesh. Furthermore,
the new Road Transport Act 2018 has been approved in October 2018, which has introduced
tougher punishments for traffic rule violations compared to the existing one, aiming to ensure
safe movement on the roads of Bangladesh.
As part of making enforcement activities effective, BRTA introduced a digital motor vehicle
management system including a Retro-reflective number plate, Radio Frequency Identification
tag, Digital Registration Certificate, Digital Smart Card Driving License. Twelve RFID stations
have been established to track the movement of the motor vehicle in Dhaka City. Automatic
Vehicle Inspection Centre (VIC) at Mirpur has been introduced. All the above-mentioned
activities and actions have reduced the death rate due to road traffic injuries to 1.65 per 100,000
population in 2018 from 2.48 in 2015.
Table 3.3 Death rate due to road traffic injuries (per 100,000 population)
Year Total Male Female
2015 2.48 4.03 0.93
2016 2.65 4.30 1.00
2017 1.37 2.23 0.51
2018 1.65 2.66 0.63
Source: Bangladesh Police, Public Security Division, Ministry of Home Affairs
3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including
for family planning, information and education, and the integration of reproductive health into
national strategies and programmes
52
The proportion of women of reproductive age who have their need for family planning satisfied
with modern methods is targeted to reach 75 per cent by 2020 against the baseline of 72.6 per
cent in 2014 (BDHS, 2014). According to BDHS 2017, the proportion is now 70.3 per cent.
However, according to MICS 2019, the proportion is 77.4 per cent. The Government has been
pursuing to progress through certain activities for the overall improvement of the reproductive
health status of women, awareness about access to contraceptive methods, antenatal care,
promotion of safe delivery practices, post-natal care, etc.
The SVRS, 2018 shows that the adolescent birth rate (aged 15-19 years) per 1,000 women in
that age group is 74 against the baseline figure of 75 (SVRS, 2015). However, the MICS of
BBS found the figure as static at 83 from 2012-13 to 2019. The MoHFW has been
strengthening family planning services through expanding mother, child, reproductive and
adolescent healthcare services in the city corporations. Various programmes focusing on safe
sexual behaviour, health risks, proper nutrition and hygiene of the adolescents and puberty are
under implementation through the adolescent friendly service centres.
3.8 Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential
medicines and vaccines for all
The Ministry of Health and Family Welfare has been implementing different activities
including the Essential Service Packages through the 4th Health, Population and Nutrition
Sector Programme (HPNSP), which represents government’s commitment to ensure the right
to health and access to the most essential health services for the entire population. The Service
Coverage Index of WB-WHO (2019) assessed that Bangladesh achieved a score of 54 per cent
on a UHC index of essential Health Services.
The grassroots level Community Clinics (CCs) based PHC service provision by the
Government has created increased access of the poor, particularly women and children, and the
CCs have taken off as the first-contact facility serving as a platform of community participation
for achieving UHC and for ensuring equity and social justice. Besides, the social health
protection scheme in the name of “Shasthyo Shuroksha Karmasuchi (SSK) is providing free
hospital services to the poor- below poverty level cardholders. The Maternal Health Voucher
Scheme (MHVS), in operation in 55 Upazilas, is another health protection scheme for ensuring
the safe delivery of poor pregnant mothers. Various indicators as evident from the BDHS 2017-
18 indicate a sharp reduction in health inequity in Bangladesh e.g., the proportion of births in
health facilities by wealth quintile from 1:5 in 2014 to 1:3 in 2018.
In case of catastrophic expenditure on health, 24.7 per cent of people spent more than 10 per
cent of their household's total expenditure on healthcare (Health SDG Profile, Bangladesh,
WHO, 2019, estimated from HIES, 2016). For the sustenance of health financing, the
government has been providing incremental budget to MoHFW every year at an average rate
of about 15 per cent. Besides, many good examples exist in Bangladesh, e.g., the Community
Clinic Model. Considering that only about 23 per cent of people in Bangladesh seek care from
the public healthcare providers, public private partnership (PPP) models are now being pursued
by the government, which would help improve coverage and access as well as improve quality
of services.
53
3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals
and air, water and soil pollution and contamination
The mortality resulting from exposure to ambient (outdoor) and indoor (household) air
pollution from polluting fuels use for cooking is rising in Bangladesh. Mortality rates are
calculated by dividing the number of deaths by the total population multiplied by 100,000
which stood at 68.2 in 2012 (WHO, 2012), which has increased to 149 in 2016 (WHO 2016).
Inadequate water, sanitation, and hygiene cause death, which can be prevented by improving
those services and practices. Bangladesh has made considerable progress in coverage of water
and sanitation services. However, hygiene services warrant much more attention. The mortality
rate attributed to exposure to unsafe WASH services per 100,000 population is estimated at
11.9 in 2016 (WHO, 2016).
Deaths from unintentional poisoning give an indication of the lack of proper management of
hazardous chemicals and pollution in the country. In an ideal health system, these deaths can
be prevented with adequate management. The mortality rate attributed to unintentional
poisoning per 100,000 populations was estimated at 0.30 in 2015 and the situation is unchanged
since then (WHO, 2019). MoHFW has been implementing various activities including creation
of community awareness about health hazards of air, water, soil related pollution, enforcement
of law for prevention of pollution, supporting role in the implementation of relevant policies
by other Ministries, coordination with non-health interventions of other Ministries, educating
family members and school students on risk of poisonous substances, and decreasing access to
poisonous substances through restriction on selling and storage of deadly chemicals with a
view to reducing the mortality rate.
3.a Strengthen the implementation of the World Health Organization Framework Convention
on Tobacco Control in all countries, as appropriate
The Global Adult Tobacco Survey (GATS), 2017 found that prevalence of tobacco uses among
persons aged 15 years and older had decreased from 43.3 per cent in 2009 to 35.3 per cent in
2017, among whom 46.0 per cent are men and 25.2 per cent are women. The MoHFW has been
implementing anti-tobacco programme based on WHO-FCTC (Framework Convention on
Tobacco Control) and Tobacco Control Law of Bangladesh. Besides, awareness-raising
activities among common people on potential harm of tobacco, anti-tobacco campaign among
high school children, mass media campaign against smoking in public etc. are going on.
3.b Support the research and development of vaccines and medicines for the communicable
and non-communicable diseases that primarily affect developing countries, provide access to
affordable essential medicines and vaccines, in accordance with the Doha Declaration on the
TRIPS Agreement and Public Health, which affirms the right of developing countries to use to
the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property
Rights regarding flexibilities to protect public health, and, in particular, provide access to
medicines for all
The proportion of the target population (≤12-month-old children) covered by all vaccines
increased from 78 per cent in 2014 to 86 per cent in 2017 (BDHS, 2017). Bangladesh has been
implementing an effective national immunization programme entitled “Expanded Programme
on Immunization (EPI)” since 1979. Strengthening the EPI activities with special focus on hard
to reach and low performing areas, conducting sero-survey for all antigen specially Oral Polio
54
Vaccine, maintaining Maternal and Neonatal Tetanus Elimination validation status, ensuring
Effective Vaccine Management (EVM), and monitoring and supportive supervision at all levels
are being pursued routinely for achieving immunization target.
Total net official development assistance to medical research and basic health sectors was US$
177.4 million in FY 2014-15 which has increased to US$ 248.7 million in FY 2017-18, and
further increased to US$ 402.02 million in FY 2018-19.
Table 3.4 Net ODA to medical research and basic healthcare, 2015-19 (Million US$)
2014-15 2015-16 2016-17 2017-18 2018-19
177.4 206.2 252.5 248.7 402.02
Source: Flow of External Resources into Bangladesh, ERD
3.c Substantially increase health financing and the recruitment, development, training and
retention of the health workforce in developing countries, especially in least developed
countries and small island developing States
There has been considerable recruitment of doctors, nurses, midwives, field-level health and
family planning workers with the gradual decline in vacancies. Health worker density was 7.4
per 10,000 populations and the distribution of physician: nurse: health technologist was
1:0.5:0.2 in Bangladesh (HRH Datasheet, 2014, MoHFW). The density has now increased to
8.3 per 10,000 populations and the distribution is 1:0.6:0.3 (HRH Data Sheet, 2019, MoHFW),
which needs to be raised to 44.5 and 1:3:5 respectively by 2030.
Apart from increasing the number of health and family planning professionals/workers,
MoHFW has been concentrating on improving quality of public and private pre-service health
workforce education system, capacity development to ensure better management at all levels
of service delivery, review and updating of the Health Workforce Strategy addressing private
and informal sector, operationalization of the Human Resources Information System (HRIS)
for the evidence-based decision, and strengthening quality assurance of medical education at
both private and public sector institutions through licensing and accreditation.
3.d Strengthen the capacity of all countries, in particular developing countries, for early
warning, risk reduction and management of national and global health risks
Bangladesh has made considerable progress in national health regulations capacity building
based on the gaps identified through Joint External Evaluation. The country reached nearer to
global average score (60 per cent) on National Health Regulations capacity as assessed by the
‘State Party Self-Assessment Annual Reporting Tool’ and the values of the indicator stood at
58 per cent in 2018 (WHO, 2019). However, Bangladesh wants to have all the core
requirements to be in place by 2030.
Challenges
Demographic transition includes population shift to the urban area where primary
healthcare services are not as well organized as in the rural areas of Bangladesh.
Expansion of city areas up to Upazila level, rural-urban migration, and a rising urban
population poses a new challenge for effective urban PHC service delivery. Absence or
paucity of PHC service facilities in urban areas means that the disadvantaged are the
55
worst sufferers, which is evident from the health status of urban people living in the
slums.
Society is now facing a double disease burden because of the epidemiological
transition. Non-communicable diseases as the major cause of death jointly with
urbanization and increasing population with old age. The epidemiological transition has
a huge direct impact on the financial vulnerability of the patients, especially the poor
and has long-term implications on the health budget.
The expanding and dominating role of the private sector (generally covering 86 per cent
of health service provision) along with mushroom growth of clinics and diagnostic
centres has made the health sector unregulated with limited supervision from the
government. Quality of service provided by the private sector raises questions though
they charge high prices for services.
Out of pocket expenditure as a percentage of total health expenditure is 67 per cent.
Reducing this high out of pocket expenditure with a view to achieving universal health
coverage is a huge challenge.
Improving service quality, standardization and accreditation for the quality of care with
the full potential of skill-mix human resources through the implementation of health
workforce strategy is a daunting task.
Since disease pattern is changing, prevention and control of NCDs such as road
accidents, drowning, ageing, and geriatric diseases need more attention.
Health-poverty nexus has dual implications: poverty impedes for getting appropriate
health services, on the other hand, huge health expenditure, particularly on NCDs,
eventually pushes families to go beneath the poverty line.
There are many cross-cutting issues with regard to delivering health services. Linkage
with local government institutions (management of medical waste), with the
Department of Environment (controlling air pollution), with Road Transport Division
(reducing road traffic accident), etc. are very badly needed. Hence, lack of coordination
and collaboration with other Ministries/Divisions/Agencies, NGOs, CSOs, the Private
Sector, and Communities can be treated as a huge challenge.
Way forward
The Ministry of Health and Family Welfare has been implementing various healthrelated programmes/projects/activities to overcome the challenges. In this respect, the
4th HPNSP serves as the first, and the foundation stone, of three subsequent programmes
for realizing the targets of SDGs including the overarching goal of achieving UHC by
2030. Implementation of various health-related programmes towards achieving the
SDGs is an ongoing process. As part of this process, MoHFW has identified certain
actions in key areas to speed up efforts towards the implementation of SDGs. The
identified areas are: (a) increasing yearly budget allocation for health programmes, (b)
increasing capacity of professionals and improving service quality, (c) gaining
efficiency in resource use and reducing wastage, (d) increasing coverage under
financial risk protection, (e) increasing number of health and family planning
professionals, (f) strengthening health system institutions, and (g) strengthening
56
mechanism to routinely collect SDGs data along with data management capacity
building.
The government has already recruited doctors, nurses, Community Health Care
Providers, and midwives to improve Maternal and Neonatal Health. Quite a few
numbers of personnel including Family Welfare Assistant and Family Welfare Visitors
will be recruited to support family welfare services. To improve family planning
services in hard to reach areas and low performing areas, adequate staff will be
provided.
National Strategy for Adolescent Health (2017-30) has been approved and the National
Plan of Action is being prepared. Measures are being taken to create demand for family
planning services among adolescent girls and newlywed couples, to bring RMG
workers under these services and to increase access to family planning services in
general.
Best practices/ best cases
Community Clinic based PHC Services: The
establishment of community clinics (CCs) nationwide is
a flagship programme of the government and is
recognized globally as a model for providing low-cost
primary healthcare services to the grassroots
community population. At present more than 13,743
CCs are functioning all over the country, each for about
6,000 population. It is an excellent example of
community engagement through the Community Group
and Community Support Groups.
Posting of Community Health Care Providers (CHCPs) –
the key human resources of a community clinic-with proper skill development training, and
distribution of adequate medicines and contraceptives have made each CC a single service delivery
point to deliver preventive, screening, promotional referral care services to the community.
It is estimated that an average of 45 patients/day, receive service from each CC and almost 95 per
cent of them are women and children. For ensuring community engagement, each CC has one
Community Group and three Community Support Groups with having 13 - 17 members including one
elected local government representative. The CC based service provision has led to increasing access
of the poor to public health services and community participation. The government has also passed
the ‘Community Clinic Health Assistance Trust Act, 2018' for ensuring the participation of rural people
in healthcare services and for collecting donations for the Trust.
ICT – HIS and e-Health Programme: The success of Bangladesh in the use of information and
communication technology for health is also recognized widely and has drawn global attention.
Laptops and Android Tablets have been provided at community clinics and other field level workers.
Programmes are active in enrolling information related to each pregnant mother and under-five
children. A uniform 'Health Identifier Code' is being provided to every citizen which will be used in
making the permanent health record software design linking with the national ID card database.
A full-fledged call centre named "Sasthyo Batayan" meaning “Health Window” has been functioning.
"Skype Based Tele-consultation" has been introduced alongside the telemedicine service. Besides,
paperless management information system in the health sector has also been taken. On 1st March
57
2020, Tangail district has been declared as paperless e-MIS in health in terms of information
management regarding family planning, maternal and child health, adolescent and reproductive
health services.
Intelligent Dengue Tracking and Management System (IDTAMS): Directorate General of Health
Services (DGHS) together with a2i Programme and with technical support from IDARE Bangladesh, has
taken the initiative to devise a complex and complete digital framework to enable the healthcare
delivery system to respond in real time and consistently support the stakeholders in data-driven
decision making. The digital framework (https://dengue.gov.bd/) is the first comprehensive disease
management system in Bangladesh. It will monitor, track, visualize and predict the incidence of
dengue, which in turn will aid in the early public health mitigations to minimize morbidity and
mortality related to the disease.
The IDTAMS operation starts from the data collection through a2I’s advanced data ingestion system
(ADIS) integrating the surveillance systems of DGHS, Institute of Epidemiology, Disease Control and
Research (IEDCR), MIS, City Corporation, Bangladesh Meteorological Department, hospitals for
historical case numbers and additional entomological survey data from communicable disease control.
Such big and raw data then utilized to create disease outbreak prediction ahead of time using
intelligent predictive analytics computation systems (iPACS) and create actionable intelligence that
optimizes resources of hospitals for patient management and of City Corporation for mosquito
termination programme. Such actionable intelligence is sent in a form of early warning, alerts for
decision support, and visualizes through a visual analytics engine, which is also an enabler for datadriven decision making by the high-level policy makers.
Community Vision Centre (CVC): In Bangladesh, 1.5 per cent of adults are blind and 21.6 per cent have
low vision. National Eye Care (NEC) is an operational plan under the Health Services Division of the
Ministry of Health and Family Welfare to ensure that comprehensive eye care is available in every
corner of the country. Primarily, NEC is working to prevent and eliminate avoidable blindness from
the community. It was a great challenge for the NEC to provide comprehensive eye care to the
marginalized and rural people with the existing set-up. As a result, all the indices of blindness
eradication are very low in our country. To overcome this scenario, NEC has introduced the
'Community Vision Centre-CVC' set-up, a proven community eye care service delivery system to reach
the marginalized people. The government has a plan to establish 200 CVC throughout the country by
the year 2022. The Hon’ble Prime Minister, Sheikh Hasina inaugurated 20 CVCs on 29th August 2018.
Sheikh Fazilatunnesa Mujib Eye Hospital & Training Centre, a highly specialized tertiary level eye
hospital serves as Base Centre for these 20 CVCs. Later, 30 more CVCs have been established on 1st
March 2019 with base centres at Rangpur Medical College Hospital and Rajshahi Medical College
Hospital. Presently, 50 CVCs are spread over in 18 districts under 50 UHCs.
Leave No One Behind (LNOB): Significant progress has been made in ensuring the rights of persons
with a disability so that no one is left behind. Several initiatives have been undertaken on a priority
basis such as health services to persons with disabilities in the community clinics; child development
centres in government medical hospitals; etc. The Gender Equity Strategy (GES), 2014 along with a
Comprehensive Gender Equity Action Plan for 10 years (2014-2024) and the Women Friendly Hospital
Initiative programme are being implemented by MoHFW for addressing women’s rights and
discriminations suffered by women/girls. Under the on-going Women Friendly Hospital Initiative
Programme, 28 women-friendly hospitals render specialized psychosocial counselling to women
survivors of violence and link them with legal aid agencies. The implementation of community clinicsbased services, provision of separate toilets, the establishment of breastfeeding corners, nutrition
58
corners, and other facilities in public hospitals have contributed to increasing access of poor women
to health services. Social health protection schemes mentioned above are also aimed at leaving no
one behind.
However, there are still other equity issues involving geographical, ethnic, gender, and different forms
of marginalization. Gradual expansion of service coverage in the hard-to-reach areas, effective
implementation of tribal health plan and health workforce management, etc. activities programme
under the 4th HPNSP for addressing inequity issues are continuing.
|
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[
3
] |
{
"country": "bgd",
"file_id": "sdg-03/vnr-report-bgd-2020-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
03_10. Life expectancy at birth (in years)
73.8
74.2
74.4
74.9
74.5
74.7
74.9 74.8
73.0
73.5
74.0
74.5
75.0
75.5
76.0
2010 2011 2012 2013 2014 2015 2016 2017
years
Life expectancy at birth indicates the average life expectancy of the new-born under the hypothesis for a constant
intensity of the age specific mortality observed for the respective year
03_20. Share of people at the age of 16 and over with good or very good perceived health by sex
67.3 67.2
66.7
66.4
66
65.6
65.8
66.7
66.5
64.5
65.0
65.5
66.0
66.5
67.0
67.5
2010 2011 2012 2013 2014 2015 2016 2017 2018
%
years
Relative share of the population aged 16 and over who assessed their health as good or very good
03_60. Self-reported unmet need for medical examination and care (% of the population at the age of 16 and over)
10.5 9.8
8.3 8.9
5.6
4.7
2.8 2.1 1.9
0
2
4
6
8
10
12
2010 2011 2012 2013 2014 2015 2016 2017 2018
%
years
Self-reported unmet needs concern a person’s own assessment of whether he or she needed medical examination or treatment (dental care excluded), but did not have
it or did not seek it. The data stem from the EU Statistics on
Income and Living Conditions (EU SILC)
ENSURE HEALTHY LIVES AND PROMOTE
WELL-BEING FOR ALL AT ALL AGES
104
|
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|
The protection of citizens' health is a national priority
and is guaranteed by the state through the implementation of the principles of equality, provision of accessible and quality health care, health promotion and disease prevention, reduction of the risk of adverse impact
of environmental factors. Efforts are aimed at improving
the quality of health care, optimizing outpatient and
hospital networks according to the needs of the population, introducing mechanisms to improve access to
quality and safe medicines, implementing national preventive programs to promote healthy lifestyles with a
special focus on the socially significant diseases that are
the most common cause of death and disability, as well
as at the effective and transparent spending of public
health funds.
Work is underway to improve the efficiency of the
health insurance system, including real-time information sharing.
For this purpose, a National Health Information System is being created, in which 95 health information
standards, 35 standard information systems and 74
electronic administrative services have been integrated and electronic health records have been introduced. It will reduce the time needed to provide
health care to patients, improve the quality of health
care, diagnosis and treatment through the use of
new technologies in e-Health.
A cooperation agreement is concluded every two
years between the Ministry of Health of the Republic
of Bulgaria and the Regional Office for Europe of the
World Health Organization (WHO). The purpose of
the agreements is to increase the capacity of our
country to promote the health of the population
and reduce inequalities in health care.
The objectives of the European Health Policy
Framework 2020 are in line with the spirit of the
2030 Agenda by promoting inclusive and participatory governance, adopting a holistic approach at
both society and government level, as well as by the
strategic mobilization and use of resources.
As a result of efforts, a large share of the population
at the age of 16 and over perceive their health as
good or very good
2008 2010 2018
62.6 67.3 66.5
%/Eurostat
There is a continuing trend of increasing life expectancy, albeit at a slow pace
2010-2012 2012-2014 2016-2018
74.02 74.89 74.83
number of years
Challenges
Although tending to decrease, mortality from
chronic diseases in people under the age of 65 remains high, thus more prevention and measures are
necessary.
2010 2015 2016
202.4 206.3 193.9
number per 100,000 people/Eurostat
The problem is compounded by additional risk factors, including smoking, alcohol use and increased
obesity, as well as inefficiently used health care expenditure.
The rate of premature mortality is alarming, especially in men (relative share of deaths below 65 years
of the total number of deaths).
2017 2018
20.9 21.0
%/NSI
The incidence of newly registered cases of HIV infection per 100,000 population in Bulgaria is 3.4 in 2017
and 4.4 in 2018, which is below the EU average, according to the Ministry of Health.
2017
241 registered
cases
2018
300 registered
>>>>
cases
The problem of active tuberculosis incidence remains – 18.4 per 100,000 in 2018. Vulnerable groups
are drug users, prostitutes, the elderly, children at
risk, Roma, prisoners, migrants and asylum seekers.
More and more cases of measles are reported.
2017
165 diseased
April 2019
246 diseased
>>>>
in 11 regions
ENSURE HEALTHY LIVES AND PROMOTE
WELL-BEING FOR ALL AT ALL AGES
45
Ambient air quality is another significant health risk factor. According to estimates by the European Environment Agency, about 14,200 premature deaths in 2015
were due to fine particulate matter concentrations.
2015
14,200 cases of premature
death due to high fine
particular matter concentration
Serious health challenges remain among the Roma
community, such as the lack of self-awareness about
health and the lack of health insurance.34
Measures taken
The National Health Strategy 2014-2020 is the main
Bulgarian strategic document that specifies the goals
for the development of the health care system by
2020. Measures are being taken to reduce the mortality rate and to increase the average life expectancy.
A priority area for health policies is maternal and child
health. The implementation of the National Program
for Improvement of Maternal and Child Health 2014-
2020 started in 2015. The Program finances over 100
medical establishments for activities outside the scope
of health insurance, for which there are no other
sources of funding, but which have significant health
effect associated with early diagnosis and comprehensive treatment of certain diseases.
The National Health Insurance Fund implements the
Maternal Health Care Programme for early detection of
diseases and complications of the pregnant woman
and fetus. The compulsory payment of health insurance contributions provides access to a package of
health services, which includes preventive examinations and examinations during pregnancy. It covers
prophylactic examinations for the period from pregnancy diagnosis to the 42nd day after birth.
It includes examinations and pregnancy monitoring
studies paid by the NHIF. In case of a risk pregnancy,
the Maternal Health Care Programme is obligatory implemented by a specialist obstetrician-gynecologist.
In Bulgaria, all children under 18 are health insured and
have guaranteed access to health care within the
scope of compulsory health insurance, with health insurance contributions being paid by the state budget.
Apart from the scope of compulsory health insurance for Bulgarian citizens, there is also an opportunity for financial support for treatment abroad when
the respective type of treatment cannot be provided
in Bulgaria in a timely manner.
34 Report on the implementation of national Roma integration
strategies – 2019. COM (2019) 406 final, p. 9.
The Ministry of Health also provides annual subsidies
to more than 65 hospitals established by municipalities in hard to reach and/or remote areas. Funds are
provided for the maintenance of the capacity of the
medical establishments and for the provision of diagnostics and treatment of patients, including the continuous treatment of patients with cardiovascular, neurological and pulmonary diseases.
The NHIF provides additional funding annually for
general practitioners working in hard-to-reach and
disadvantaged areas, thus stimulating primary care
in places that are unattractive to physicians and
other medical staff to provide primary care for the
population of these areas.
Preventive health care activities in certain areas are
preceded or accompanied by awareness campaigns
about the importance of preventive care among vulnerable groups, including the Roma population,
through the involvement of health mediators. Activities to support them improve access to health care and
disease prevention services for vulnerable populations.
Immunoprophylaxis is a priority. Immunization calendars, policies and programs have been developed
in accordance with the recommendations of the
WHO. The guidelines for future national immunoprophylaxis actions coincide with those of the WHO
– maintaining a sufficiently high immunization coverage to prevent the spread of vaccine-preventable
infectious diseases on the territory of the country
upon import of the relevant agents, in particular
diphtheria, poliomyelitis, etc.
Measures are taken to reduce diseases or premature
mortality associated with risk factors such as smoking, alcohol abuse, unhealthy eating habits and low
physical activity (National Program for Prevention of
Chronic Non-communicable Diseases 2014-2020).
Healthy lifestyle campaigns are conducted on a regular
basis. In 2018, the Ministry of Health in partnership
with the Ministry of Education and Science, the Ministry of Youth and Sports, the Ministry of Culture and the
Representation of the European Commission to Bulgaria celebrated the tenth anniversary of the National
Student Competition “Ambassadors of Health” for the
2017/2018 school year. To increase physical activity in
the country, thematic days and campaigns are marked
– World Movement Day, European School Sport Day,
World Day dedicated to the WHO initiative “Move for
health!”
Prevention and early diagnosis of major chronic
non-communicable diseases is being carried out.
Screening for three types of cancer is performed –
cervical cancer, breast cancer and colon cancer.
Drug policy, as a sectoral health policy, aims to provide access to safe, effective and quality vital medicines for all at affordable prices.
46
A National Programme for the Prevention and Control of HIV and Sexually Transmitted Diseases for the
period 2017-2020 is implemented in Bulgaria. The
main interventions are aimed at the prevention of HIV
among the groups at the highest risk.
The aim of the National Program for Prevention and
Control of Tuberculosis 2017-2020 is to reduce the
incidence and mortality of tuberculosis by 40% in
2025 compared to 2015. The main interventions are
aimed at timely diagnosis and control, successful
treatment, raising public awareness of the risks and
symptoms of the disease.
Several interlinked national programs have been
developed to address the issue of ambient air quality – National Program for the Improvement of Ambient Air Quality 2018-2024; National Programme for
Restricting Overall Annual National Emissions of
Sulphur Dioxide, Nitrous Oxide, Volatile Organic
Compounds and Ammonia 2007-2019; National Air
Pollution Control Program 2020-2030.
Mental health and wellbeing are regulated by the
Law on Health. A National Strategy for Mental
Health until 2030 is under development.
Municipal Councils for Drugs have been set up for the
fight against drugs. They provide effective interaction
between institutions, NGOs, youth associations and
the media at the local level in their efforts to limit the
distribution and use of psychoactive substances.
A new Anti-Drug Strategy is under preparation for
the period 2019-2023.
The National Strategy for the Improvement of Road
Safety (2011-2020) has set a specific goal – to reduce
the number of deceased by 50% and of wounded by
20%, compared to 2010. A new Law on Roads is being developed.
The Road Infrastructure Agency is responsible for
maintaining the transport network through the Regional Road Departments, according to the Law on
Roads.. Based on the 2013 Road Infrastructure Safety
Management Guidelines (2011), road safety inspections are regularly carried out to prevent road defects.
Achieved results
NSI data for 2018 indicate that there is a long-term
trend of reduction of infant mortality, with the lowest level in the demographic history of Bulgaria – 5.8
under one year old per 1,000 live births. The mortality rate for children aged 1-9 is one of the indicators
on which Bulgaria has made great progress.
As a result of the extensive implementation of highcoverage immunoprophylaxis over the last 50 years,
no serious infectious diseases have occurred in the
country35 (rabies – since 1974, poliomyelitis – since
2002, diphtheria – since 1993, tetanus – isolated
cases in unvaccinated people). Mandatory immunizations and reimmunizations relate to 11 infectious
diseases, according to data from the National Center
for Public Health and Analyzes (NCPHA).
1980
2018
0.7 per
1,000
people of
the same
0.2 per
1,000
people of
the same
GOAL 3.2.
Death rate
of children
aged 1–9
14
age group age group
When purchasing vaccines for children up to 2 years
of age, a reserve is set at the national level, which
guarantees the stability and continuity of the immunization process. The risks of unforeseen circumstances decline and the measures envisage a rapid
response to an adverse epidemic threatening public
health.
Diagnosis and treatment of all tuberculosis patients
and people with latent tuberculosis infection is
completely free of charge, regardless of their health
insurance status. In 2018, over 34,500 individuals
were screened for tuberculosis risk – 6,384 drug users, refugees, migrants, children at risk, youth at risk
and 24,501 Roma community representatives. >>>> 2007
37.1 newly
registered
per 100,000
2018
18.4 newly
registered
per 100,000
Successful treatment
outcome: more than
85% of the cases
Access to treatment for drug addicts has been improved. Nine state programs were developed with
1,350 patients, 14 private programs subsidized by
the Ministry of Health with 1,900 patients, and 13
private programs with 694 places funded otherwise.
Nine to 10 AIDS-related deaths occur per year in the
last three years. The number of newly reported cases
of HIV infection is 241 in 2017 and 311 in 2018.
35 Data relevant as of Jan. 31, 2020.
47
Improved Eurostat results:
Share of people aged 16 or over reporting unmet
need for medical examination and care – 15.3% in
2008 and 1.9% in 2018
The share of fatal accidents at work per 100,000 employees decreased from 5.34 in 2008 to 3.4 in 2017.
The share of people living in households considering that they suffer from noise decreased from
16.9% in 2008 to 9.4% in 2018.
Road accident fatalities
2018
611 deceased
8,466 wounded
2010 2015 2017
10.5 9.9 9.6
per 100,000 population/Eurostat
International Development Cooperation
ODA contributed to the construction of health infrastructure in Moldova, the Republic of North Macedonia and Georgia. A project aimed at improving
the sexual and reproductive health of adolescents
and young people in the region of Eastern Europe
and Central Asia has been implemented. Significant
social initiatives include a project to provide equipment for the “New Clinic for Children” in Tbilisi, as
well as a center for children with disabilities in Borjomi, Georgia.
48
|
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[
3
] |
{
"country": "bgr",
"file_id": "sdg-03/vnr-report-bgr-2020-en-6.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
36
4.4.3 Healthy lifestyles
Ensure that everyone enjoys healthy lifestyles at all ages.
Sustainable Development Goal 3 calls to: "ensure healthy lives and promote wellbeing for all at all ages", thereby shifting the focus of attention from disease to
universal health as a key component in the promotion of well-being throughout the
course of a person’s life. This does not mean that disease, its prevention, or its
treatment, are neglected. Rather, health policy focuses on areas such as noncommunicable diseases and mental health (Target 4 of Goal 3), as well as health
nutrition and obesity issues (Target 1 and 2 of Goal 2). Addressing child and
maternal mortality and non-communicable diseases (which are linked to healthy
lifestyles), reproductive health, access to medicines and treatment, and
comprehensive health coverage are all priorities for Bahrain. Access to good quality
health services remain at the heart of the Government Action Plan and, in particular,
through the work of the Ministry of Health.
The Government of Bahrain has adopted the policy of "providing comprehensive
healthcare to all citizens and residents" through preventive and curative programs,
and through a network of health services at all levels, including primary and
secondary healthcare, as well as clinical care. The government has assumed
responsibility for implementing this policy in its relevant technical and financial
10 July 2018
37
fields in cooperation with the private sector, which has led to a significant
improvement in many of the health indicators for the Kingdom. For example, the
maternal mortality rate of 14 deaths per 100,000 live births (Indicator 3.1.1) is low
and surpasses the 2030 target of 70 deaths per 100,000 live births. In addition, 99.8%
of births are supervised by health professionals (Indicator 3.1.2), which has led to a
decline in maternal mortality. Healthcare programs are provided during pregnancy
and involves prenatal and neonatal care and includes the areas of vaccinations
(Indicator 3.8.1), and family planning services (Indicator 3.7.1). The Kingdom of
Bahrain seeks to decrease the number of deaths of infants by 2030, which stood at
6.4 deaths per 1,000 live births in 2014 (Indicator 3.2.2). In this regard, the launch
of the National Strategy for Children (2013-2017) has contributed to the reduction
in the under-five mortality rate to 12 deaths per 1,000 live births (Indicator 3.2.3),
which is about 50% lower than the global target values for this indicator of 24 deaths
per 1,000 live births by 2030.
With regards to HIV infection and tuberculosis, generally there is a low prevalence
in Bahrain, with a new infection rate of 0.04 AIDS per 1,000 non-infected people
(Indicator 3.3.1) and 0.17 TB per 1,000 people (Indicator 3.3.2). This is due to
increased community awareness on prevention and the early detection of cases,
particularly through the introduction of a pre-employment medical check-up system,
as well as access to treatment for patients, which in turn has reduced the risk of
transmission. For malaria and other vector-borne diseases such as Hepatitis B
(Indicator 3.3.4), the incidence rate decreased from 4.9 per 100,000 in 2004 to 0.6
per 100,000 in 2014.
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65 Bahrain Voluntary National Review 2023
CHAPTER 5: PROGRESS IN ACHIEVING THE SDGS
As stipulated in the Constitution “Every citizen is entitled to health care. The State cares for public
health and the State ensures the means of prevention and treatment by establishing a variety of
hospitals and healthcare institutions.” Furthermore, Bahrain’s Vision 2030 sees Bahrain becoming
DOHDGLQJFHQWHUIRUPRGHUQPHGLFLQHRIIHULQJKLJKTXDOLW\DQG¿QDQFLDOO\VXVWDLQDEOHKHDOWK
care in the region.
Bahrain’s sustained commitment towards disease elimination, improving healthcare
infrastructure, and promoting health awareness campaigns continues to enhance the health
and well-being of its citizens and residents, positioning the country as a model for public health
DQGVXVWDLQDEOHGHYHORSPHQW%DKUDLQKDVVKRZQH[HPSODU\UHVLOLHQFHGXULQJWKH&29,'
pandemic, mobilizing resources and introducing innovative solutions, in a record time.
The Supreme Council of Health (SCH) and the Ministry of Health work relentlessly to update health
SURJUDPVDQGVWUDWHJLHVLQOLQHZLWKWKHWDUJHWVRI6'* *RRG+HDOWK :HOO%HLQJ
SDG 3
The Supreme Council of Health’s National
+HDOWK3ODQ LVD\HDUYLVLRQ
for a healthy and safe society, ensuring
health services are delivered with fairness,
HI¿FLHQF\DQGKLJKTXDOLW\7KH3ODQLQFOXGHV
launching the Social Health Insurance
law and the launch of the National Health
Insurance program (SEHATI) – due to be
rolled-out in 2024 – which entitles Bahraini
citizens to receive free treatment at all
government medical facilities. Citizens
NATIONAL EFFORTS
Universal Healthcare
can choose from a number of packages,
with compulsory services including
comprehensive primary health care,
inpatient-outpatient services and accidents
and emergency services in Bahrain; and
conditional in-vitro fertilization, medicines,
all types of medical tests and treatment
abroad, if required. The SCH set up the
Health Insurance Fund (SHIFA) which will
cover the cost of treatment for citizens in
government hospitals.
66 Bahrain Voluntary National Review 2023
CHAPTER 5: PROGRESS IN ACHIEVING THE SDGS
Preventative Measures
Packages will also be offered to expatriates
which will be funded by employers and
will be made available in government and
private facilities. Visitors to the Kingdom will
be offered a mandatory package – available
in all government facilities – which will be
funded by the visitor and insured by SHIFA.
Technology was part of the designing of the
new SEHATI program, with every citizen
and resident in Bahrain due to receive
a chip-enabled card containing their
medical history, test results, diagnoses and
prescription details.
The new health insurance program is
expected to enhance competitiveness
and boost the private healthcare sector,
providing investment opportunities for
businesses.
Preventative measures in the form of
immunizations are critical to protecting the
population from communicable diseases
that can easily spread in the community. The
Kingdom of Bahrain offers immunizations
free of charge for citizens as per a set
schedule. Immunizations are a pre-requisite
IRU VFKRRO HQWU\ VLQFH ZLWK VRPH
vaccines, including booster doses, given
to students at their schools to ensure full
accessibility. As such, Bahrain maintained
high rates of coverage for routine childhood
SDG 3
LPPXQL]DWLRQH[FHHGLQJ SHUFHQWHYHU\
\HDUVLQFH ZLWKVRPHLPPXQL]DWLRQV
DFKLHYLQJ SHUFHQW FRYHUDJH
The Kingdom’s long-term experience in
immunizations has led to advanced levels
of health awareness which contributed
WR WKH KLJK WDNHXS UDWH RI WKH &29,'
vaccinations. Bahrainis displayed high
sense of responsibility during the pandemic,
setting an example of effective partnerships
to ensure the success of the plans to combat
the virus. The availability of free vaccinations
for every citizen and resident stressed
Bahrain’s humanitarian approach.
Other Services
• Mother and child health services are
provided to all citizens and residents in
the Kingdom of Bahrain and continue to
be prioritized by the Ministry of Health.
These services include reproductive
health – the ability and the freedom for
family planning –, postnatal care, school
health and child screening.
• 7KH¿UVWQXWULWLRQFOLQLFZDVHVWDEOLVKHG
E\WKH0LQLVWU\RI+HDOWKLQGXHWR
the high number of patients with obesity
in the Kingdom and the subsequent
health complications it caused. The clinic
DFKLHYHGVLJQL¿FDQWVXFFHVVLQUHGXFLQJ
obesity and limiting its risks. Nutrition
clinics are now open in all health regions
in the Kingdom.
67 Bahrain Voluntary National Review 2023
CHAPTER 5: PROGRESS IN ACHIEVING THE SDGS
Bahrain plans to establish a specialized
genetic analysis center using the latest
VFLHQWL¿F LQQRYDWLRQV LQ SDUWQHUVKLS
with Harvard Medical School, as part of
its National Genome Program, to further
its efforts in improving the quality of
health services and preventing diseases
– particularly genetic, intractable and
deadly diseases. The center will have a
database of the Bahraini population’s
'1$ WKDW ZLOO EH DQDO\]HG DQG VWXGLHG
National Genome Program
SDG 3
• ,QWHQVL¿HG PHQWDO KHDOWK SURJUDPV
awareness campaigns, the introduction
RIWKHQHZWUDI¿FODZRIDQGVPDUW
systems for monitoring violations and
red-light crossings have contributed to
WKHUHGXFWLRQLQURDGWUDI¿FLQMXULHV
• The Ministry of Interior launched the
µ7D¶DIHH¶SURJUDPZKLFKDLPVWRDVVLVW
drug users and treat their addictions. The
SURJUDPZDVLQDXJXUDWHGLQDVSDUW
of the national plan to combat drugs and
psychotropic substances, where it offers
the necessary psychological and social
services to treat those who have joined
from addiction, and provides health
services if needed, in cooperation with
the relevant institutions. To break the
fear barrier for drug users, the program
has placed a strong emphasis on
respecting the privacy of those enrolled.
As of 2022, the program facilitated the
HQUROOPHQW RI LQGLYLGXDOV DQG WKH
VXFFHVVIXOUHFRYHU\RI SDUWLFLSDQWV Pharmaceuticals
As part of Bahrain’s broader health sector
efforts, the NHRA granted the Bahrain
International Medicine Manufacturing
Company a manufacturing license in 2020
DQGFHUWL¿HGLW DV D ³*RRG0DQXIDFWXULQJ
Practice facility” in 2022. In 2023, the
company started producing Omega-3 Soft
*HO &DSVXOHV DQG FRXJK V\UXS WKH ¿UVW
domestically produced pharmaceuticals,
which will be marketed to the rest of the
*&&,UDTDQG<HPHQ7KHSODQWDOVRIHDWXUHV
a research and development laboratory,
contributing to Bahrain’s aforementioned
efforts at boosting innovation.
to identify opportunities that contribute
to improvements in disease diagnosis,
early detection, as well as lowering the
population’s risk of contracting diseases.
The program’s approach differs from
other genome projects in that it integrates
research, clinical and comprehensive
capacity building and technology transfer
efforts; the Program involved training 60
genomics technicians in advanced genetic
decoding techniques.
%DKUDLQ DFKLHYHG VLJQL¿FDQW SURJUHVV
LQ WKH SURJUDP E\ UHFRUGLQJ WKH ¿UVW
complete sequence of the human genome
in the country. The program, led by Bahraini
researchers, included three human genome
VDPSOHV ZLWK D KLJK FRYHUDJH UDWH RI
percent. The researchers also successfully
PRQLWRUHGWKHJHQHWLFVHTXHQFHRI&29,'
through integrated genetic sequencing,
DQDO\]LQJ RYHU YLUDO VDPSOHV
68 Bahrain Voluntary National Review 2023
CHAPTER 5: PROGRESS IN ACHIEVING THE SDGS SDG 3
a national health survey in 2023 – the last
VXUYH\ ZDV FRQGXFWHG LQ ± ZKLFK
will cover 4,000 Bahraini and non-Bahraini
families and will provide an updated
database for the well- being of citizens and
residents.
Bahrain integrated mental health in primary
KHDOWKFDUHKHQFHLQFUHDVLQJWKHHI¿FLHQF\
of services and reducing the stigma by
attending a psychiatric hospital. Going
forward, the Government will continue to
work on updating the Mental Health Law,
which aims to regulate the relationship
between patients and stakeholders in their
circle, protecting the patient’s rights, and
promoting the integration of the mental
patient into society. The Government is
currently studying the plans to also establish
WKH ¿UVW SV\FKLDWULF KRVSLWDO IRU FKLOGUHQ
which will help with early diagnostics.
Furthermore, the Government plans to utilize
DUWL¿FLDOLQWHOOLJHQFHWRVXSSRUWWKHGLJLWDO
transformation of the sector, focusing on
modern practices in the use of information
and modern technologies to reduce effort
and cost, and simplify procedures.
CHALLENGES AND WAY FORWARD
The Government is committed to creating
opportunities for investments by the
private sector in healthcare, such is the
case with the new health insurance plan.
Two recent examples of private sector led
investments are the King Hamad American
0LVVLRQ+RVSLWDODQG WKH'LOPXQLD+HDOWK
Services Complex. The Government plans
to strengthen the integration between the
Ministry of Health and private health care
SURYLGHUV HQFRXUDJLQJ D XQL¿HG V\VWHP
with standardized guidelines and protocols
to ensure consistent and high-quality care
across all healthcare facilities.
Bahrain will continue to provide support
IRU VFLHQWL¿F UHVHDUFK IRFXVHG RQ
addressing health-related challenges and
the continuous training of specialists. The
Government plans to utilize recent projects;
including the King Abdullah Medical City,
which includes academic and medical
facilities as well as research centers to
study diseases prevalent in the region such
as cancer, diabetes and obesity.
The monitoring and studying of the causes
of illness and deaths will continue, with
the aim of enhancing and developing data
driven plans for their reduction, alongside
collaborating with relevant entities to
identify vulnerable groups at higher risks of
diseases. The Ministry of Health is preparing
|
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52
SDG3: Ensure Healthy Lives & Promote Well-Being for all at all
Ages
Good health is a cornerstone of human capital
development. The Bahamas has a functioning
health care system with public and private
hospitals and an extensive network of clinics
throughout the Family Islands. Funding for the
public system is largely derived from the national
budget with contributions by the National
Insurance Board and some private and external
sources.31 The Ministry of Health has a budget
of $293.9 million, of which $216 is allocated to the Public Hospitals Authority, the body that
oversees the major hospitals in the country, among other responsibilities.
With respect to maternal and reproductive health, deaths among infants and newborns remain
significant contributors to mortality with 8.6 deaths per 1,000 live births recorded in 2016 and a
mortality rate of 10.6 deaths per 1,000 live births for children under five years old. The main cause
of infant mortality is respiratory disorders. Approximately 6% of mothers-to-be do not seek
medical care during their pregnancies 32.
There is a high prevalence of non-communicable diseases in The Bahamas. WHO estimates that
diabetes, cancer, and heart disease account for 72% of the deaths in the country. Some of these
diseases are simply a result of a longer life expectancy, but others are reflective of lifestyle
31 Sanigest International, 2014 32 Working Paper, State of the Nation on Human Capital 2016 p.85
Picture 22: Doctors at the Princess Margaret Hospital in
Nassau, Bahamas (Photo credit: PHA)
53
changes. Obesity has also been cited as the main risk factor influencing the rise of noncommunicable diseases. The 2014 WHO report indicates that as high as 43.2% females and 29.8%
males were obese and that 56.5% of females and 38.5% of males do not get sufficient levels of
exercise. Other lifestyle risk factors included smoking and alcohol consumption.
Although there has been a reduction in newly diagnosed cases of AIDS and in AIDS-related deaths
because of the use of anti-retroviral drugs, the fight against HIV/AIDS continues. The national
adult HIV prevalence rate is 3.3%, which is among the highest in the Caribbean region, and there
is a challenge with under-reporting of HIV transmission through injected drug use33. Rates of HIV
infection among pregnant women have remained relatively stable. Between 2003 and 2013, there
were no reports of any child being born infected with HIV when the mothers received and adhered
to appropriate Prevention of Mother-To-Child Transmission (PMTCT) ARV treatment34.
The incidence of tuberculosis (TB) has shown a steady downward trend since the 1990s. This is
due to contact tracing and the introduction of directly-observed therapy35. The notification rate of
new cases has decreased from 28.4 per 100,000 population in 1997 to 9.1 per 100,000 population
in 2010, the lowest rate in more than 20 years36.
With respect to mental health, the Sandilands Rehabilitation Centre in New Providence and the
Rand Memorial Hospital in Grand Bahama are the two main government facilities that offer mental
health services for substance abuse and psychiatric disorders37. The resources at these institutions
are strained. The negative stigma attached to mental health issues also prevents persons from
seeking care.
The prevalence of road accidents requires urgent action. Ninety percent of road traffic fatalities
were caused by human error such as drunk driving, speeding, overtaking in dangerous
circumstances, texting, and cell phone use38.
33 Working Paper, State of the Nation on Human Capital 2016 p. 82 34 Working Paper, State of the Nation on Human Capital 2016, page 87 35 Working Paper, State of the Nation on Human Capital 2016, page 87 36 World Health Organization. 37 PAHO, “Health in the Americas 2012: Bahamas Chapter” referenced in Working Paper, State of the Nation on Human Capital p.89 38 The Bahama Journal, 5 November 2013. 46 People Killed In Car Crashes http://jonesbahamas.com/46-people-killed-in-car-crashes/
54
Picture 23: School children engaging in sporting activities in New Providence
Key Interventions for Implementing SDG3
National Health Insurance
In January 2016, the Government launched the National Health Insurance Plan for universal access
to primary care to improve coverage and promote greater efficiency, equity, performance and
accountability within the healthcare system. During the fiscal period beginning July 2018, the
Government will extend the critical healthcare component under the NHI and introduce the first
phase of the Catastrophic Care Insurance Plan.
Healthcare Capital Works
The Government invested $60 million to renovate the Princess Margaret Hospital (New
Providence) and the Rand Memorial Hospital (Grand Bahama). The Critical Care Block has been
improved through a $45 million refurbishment project in 201539.
39Stronger Bahamas. 2015. A Stronger Bahamas. [ONLINE] Available at: http://strongerbahamas.com/modern/social-programmes/. [Accessed 21
September 2017].
55
Road Safety
In April 2014, The Ministry of Transport and Aviation acquired the expertise of an independent
transportation, planning and management consultant to spearhead the revision of the Road Traffic
Act with a view to modernising the country's transportation system40. The Government also
continues to receive support from the Inter-American Development Bank (IDB) for the New
Providence Transport Programme. This programme aims to improve the public road system. More
efficient traffic flows will reduce the harm caused to the environment by congestion, increase
productivity and improve the attractiveness of the island.
To reduce the number of deaths and injuries from road traffic accidents, in 2014 the Ministry of
Transport developed a National Road Safety Strategy which provides a strategic framework to
address road safety over a six-year period (2006-2012) 41 . Some of the initiatives include
accelerating driver education in the schools and public awareness campaigns on road safety42.
Additionally, announced during its 2015/2016 Budget communication, the Government banned
the importation of wrecked vehicles and cars more than ten years old43.
Non-Communicable Diseases
In 2016, the Ministry of Health in collaboration with the Pan American Health Organization
(PAHO/WHO) developed a roadmap, the National Multi-sectoral Non-Communicable Disease
Strategy and Plan of Action, 2017-2022, embodying the social determinants of health to halt and
reverse the climbing non-communicable disease statistics. This roadmap is geared towards
accomplishing the Government’s goal of reducing the prevalence of such diseases. The next step
is the development of an implementation plan for the roadmap.
Additionally, through the Ministry of Health, the Healthy Bahamas Coalition has been established
to propose and revise policies to assist in the reduction of the incidence, complications, and deaths
related to non-communicable diseases. The Coalition comprises representatives from the
40 Bahamas Local 8 April 2014. Ministry of Transport undertakes comprehensive review of Road Traffic Act.
https://www.bahamaslocal.com/newsitem/96668/Ministry_of_Transport_undertakes_comprehensive_review_of_Road_Traffic_Act.html 41 The Nassau Guardian, 23 June 2012, Policy and Planning Unit was created to address various road user issues, says minister
https://thenassauguardian.com/2012/06/23/policy-and-planning-unit-was-created-to-address-various-road-user-issues-says-minister/ 42 Rose, Eric 2012 43 Virgill, Khrisna 28 May 2015
56
Government, private sector, faith-based, and civil society organizations with a view to improving
the general health of persons living in The Bahamas.
Upcoming Minister of Health Initiatives
The Ministry in its 2018/2019 budget has proposed the following:
Sponsorship of several studies to look at the potential role of mental and psychological
challenges as well as the impact of nutrition (specifically micronutrient deficiency) and the
impact of sugar, fat, preservatives, chemicals steroids and antibiotics in the diet on the
expression of violence;
A national campaign which will be geared towards equipping Bahamians with practical
tips to turn forgotten foods such as beans, pumpkin and cassava into viable delicious meal
options; and to reinvent some of our familiar staples; and
An aggressive public sensitization campaign to improve the nation’s understanding of
what’s healthy and what’s not. There will be Breadbasket Town Halls to raise health
literacy and education;
A proposed tax on sugar sweetened beverages to decrease consumption and improve
revenue to support healthy lifestyle initiatives.
The implementation of “Cyclovias” i.e. closing certain streets for set periods to all vehicles
for cyclists, skate boarders, runners, and walkers to move freely and be active;
New funding to conduct a population-based research study to define the current health
status and risk factor profile;
The launch of the “Treat All” people living with HIV strategy which makes life-saving
antiretroviral medication available to all who need it, regardless of CD4 count or clinical
stage;
Strengthening of Emergency & Urgent Care: Expansion of A&E and other clinics to
prevent the unnecessary use of urgent hospital services as well as the early detection and
management of Secondary Complications;
Commencement of Telemedicine Services in a phased approach, with particular emphasis
on the Family Islands;
Strengthening Community Education and Participation;
Restructuring and improving Home Care Services; and
57
Upgrading health Information Management Clinical Data systems utilized within the
hospitals.
Training: the PHA successfully completed its first Psychiatric Mental Health Diploma
Program, where thirty–one Registered Nurses were trained in this specialty area, the
Ministry plans to sponsor another eighteen-month Trained Clinical Nurse Certificate
Programme at The University of The Bahamas. Additionally, discussions are underway to
sponsor an eighteen-month Midwifery Diploma Programme in January 2018, also, at The
University of The Bahamas.
Disaster Preparedness to ensure a resilient health system.
Strengthening of funding to primary health care.
Challenges Faced Implementing SDG3 Programmes
Particular challenges faced by The Bahamas in the implementation of SDG3 include:
Sustainable funding of the health care system.
The high cost of healthy foods particularly vegetables and cultural changes to encourage
the consumption of a healthier food mix.
A predominantly sedentary lifestyle for some residents resulting from the absence of
appropriate infrastructure to encourage physical activity, coupled with concerns about
safety.
The prevalence of social stigmas around mental health challenges and addiction.
Social norms which discourage condom use.
|
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[
3
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{
"country": "bhs",
"file_id": "sdg-03/vnr-report-bhs-2018-en-5.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2018
}
|
25
c. SDG3 Good Health and Well-being: Seven priority targets out of the thirteen indicators
matched to the associated NDP goals (see Table 3).
The associated NDP Goals 2, 5 and 7 are aligned to SDG3. Only by strengthening the management
and operations of public health facilities, can this service be affordable to the population at large. A
modern, sustainable and universal accessible health care system is the associated NDP Goal 5. This
goal focuses on: providing universal access to health, funding for National Health Insurance, wellness
and the social determinants of health and the rationalising of health care governance. The associated
Goal 7.3 and 7.7 will create a level playing field for the population and the marginalised community
ensuring that they get equal health care treatment and are not discriminated.
|
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[
3
] |
{
"country": "bhs",
"file_id": "sdg-03/vnr-report-bhs-2018-en-6.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2018
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|
Voluntary Review / Implementation of Agenda 2030 and the Sustainable Development Goals in Bosnia and Herzegovina
42
SDG 3
Ensure healthy lives and
promote well-being for all
and at all ages
Ensuring healthy lives and promoting
well-being for all at all ages and
the enjoyment of a high health
standard is important in Bosnia and
Herzegovina.
Life expectancy is increasing:
estimated life expectancy for
women is 78.78 years and for men
74.04 years in 2016.12 Regarding
mortality, cardiovascular diseases
are the leading cause of death
(51.8% of all deaths13). The next
leading causes of death are malign,
endocrine and metabolic diseases
(predominantly diabetes) and
eating disorders. The most common
causes of cardiovascular disease are
unhealthy lifestyle habits, cigarette
smoking and in particular alcohol
consumption. According to the 2011
Household Budget Survey, only 22
from 7.5 for every 1,000 live births in
2006 to 5.9 permille in 2016, while in
the Republika Srpska it was reduced
to 4.8 per-mille (2006) to 2.4 per-mille
in 2016.15, and in the Federation of
BiH in 2016, this rate was 4.8 permille, while in 2017 it amounted to
4.2 per-mille16. MICS IV from 2011
estimates that the infant mortality
rate for Roma children in Bosnia and
Herzegovina at 24 for every 1,000 live
births, which is nearly 8 times the
average in the country.
The 2011 household budget survey
shows 95 % public health insurance
coverage and 1 % private insurance
coverage in Bosnia and Herzegovina.
On the other hand, of the total
health care spending in BiH for 2016
(most recent data), 71% is public
consumption and 29% is private
% of adults said that they had not
consumed alcohol over the past
seven days.
According to the findings of the 2015
Household Budget Survey, 5.1 % of
people needed but did not receive
medical treatment. The main reason
for not receiving medical treatment
was unafordability (41%). However,
an improvement in patient waiting
lists was noticeable: down from 31.5
% to 23.5 %. According to their own
opinion, five in seven persons felt
‘very well’ or ‘well’, while 10.3 % felt
‘bad’ or ‘very bad’.
Infant deaths are one of the
best indicators of the health of a
population and primarily of children.
The infant mortality rate14 in Bosnia
and Herzegovina is decreasing, down
life expectancy
at birth
78.78 74.04
Voluntary Review / Implementation of Agenda 2030 and the Sustainable Development Goals in Bosnia and Herzegovina
43
12 An estimate by the World Health
Organization.
13 The Agency for Statistics of Bosnia and
Herzegovina, 2016 Demography.
14 The infant mortality rate shows the ratio
between the deaths of children under oneyear age per every 1,000 live births over a
one-year period.
15 The Agency for Statistics of Bosnia and
Herzegovina, 2016 Demography; RS data
Institute for Statistics of Republika Srpska,
Statistical Bulletin, 5 demography, 2016.
16 http://fzs.ba/index.php/publikacije/
godisnji-bilteni/stanovnistvo-i-registar/
17 Agency for statistics BiH, Ministry of Health
Republika Srpska, for FBiH: http://fzs.ba/
wp-content/uploads/2018/04/12.7.pdf
18 The latest data from the HFA database.
consumption. In the Republika
Srpska in the same year, 73.9% of
total consumption is spent on public
and 26.1% on private consumption
and in the Federation of BiH in the
same period, 70% was public and
30% was private consumption17. The
size of medical staf compared with
the overall size of the population is
significantly smaller than the EU-28
average, which makes the adequate
provision and timely access to
healthcare services dificult.
Long-term care services, preventive
healthcare services and health
administration are covered almost
entirely through public funding, while
medical devices for outpatients are
financed largely by household out-of
pocket payments. Most of the health
funding in Bosnia and Herzegovina
51.8 %
5.9 ‰
mortality
connected to
cardiovascular
diseases
infant mortality
rate
is allocated for inpatient hospital
treatment and medical devices for
outpatients. Around 3.7 % is spent on
the administration and management
of the health systems in BiH, which
is an increase over the previous year
when the share was 3 % and overall
expenses were smaller. Bosnia and
Herzegovina needs to find a way to
reduce the cost of inpatient hospital
care. One of the ways to do this is
through preventive healthcare,
which accounts for just 1.8 % of total
healthcare expenses (in Republika
Srpska 2.6%, and in the Federation
BiH 1.1%). The average length of
inpatient stay in 201518 was 7.2 days,
which represents a decrease from 8.3
days in 2009.
|
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{
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"file_id": "sdg-03/vnr-report-bih-2019-en-3.pdf",
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!"
SDG 3. ENSURE HEALTHY
LIVES AND PROMOTE
WELL-BEING FOR ALL AT
ALL AGES
The enjoyment of the highest
possible standard of health is one
of the fundamental rights of every
human being. The issue of health
goes largely beyond the health sector
because its main determinants (age,
sex, and inheritance) are related to
living conditions, environmental
factors, lifestyles, socio-economic
factors, factors related to upbringing,
education, and culture, as well as the
functioning of the health and social
protection systems.
Promotion of a healthy life and
well-being of people of all ages,
while enjoying high standards of
health, are important in BiH. Life
expectancy at birth was 79 years
for women and 74 years for men in
2019, and an increasing trend has
12 Source: WHO database
13 Household Budget Survey, 2015
14 Source: National Health Accounts, BiH Agency for Statistics
been recorded12. According to the
latest available data on household
budget, 98% of individuals were
covered by public and 1% by private
insurance. 13 According to the same
survey, it is estimated that 1% of the
population does not have health
insurance. However, during the
state of emergency/natural disaster,
all levels of government adopted
temporary universal health care
measures related to COVID-19.
Regarding health expenditure, the
costs are increasing year by year, and
according to the latest data, they
make up 9% of GDP.14 The continuous
increase in expenditures can be
partly explained by population
aging, and the fact that treatment
is becoming “more expensive” with
the introduction of new technologies
and a broader range of laboratory
findings. The services of longterm care, preventive healthcare
and health administration are
almost exclusively financed
from public expenditures, while
medical resources for outpatients
are financed largely from private
expenditures, that is, from direct
household expenditures. In BiH, the
largest portion of funds is allocated
for the inpatient treatment and
outpatient care devices.
In BiH, the under-five mortality rate
and the infant mortality rate are
at the level of the European Union
average. The most common causes
of infant mortality and the under-five
mortality are related to the perinatal
period, which speaks of the necessity
of improving perinatal care. In this
regard, it is expected that the infant
mortality rate will decrease in the
coming period, given that the RS
Government introduced in 2022 the
legal right for all pregnant women
to free non-invasive prenatal testing,
which can detect in the early stages
of pregnancy a predisposition to
genetic diseases manifested afer the
birth of a child, which means better
and timely prevention and treatment
of genetic diseases.
Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age,
Indicator Trend Description of trend
SDG indicator 3.2.1: Under-five
mortality rate per 1,000 live
births
The under-five mortality rate is one of the basic indicators when
it comes to children’s well-being. In BiH, this rate is decreasing,
and was 5.7 in 2020. However, if the 2018-2020 downward trend
continues, the target value (5.1) for 2023 will not be achieved
without additional interventions.
SDG indicator 3.2.2: Infant
mortality rate per 1,000 live
births (under one year of age)
The infant mortality rate is one of the indicators of the
population’s health. According to the latest indicator, the infant
mortality rate is 4.6 per 1,000 live births, which is very close to the
target value for 2023, which is 4.5.
!"#$"%&&'()'*+,(%-()$'.,%'&/&.*()*01%'2%-%1#!3%).'$#*1& !#
In terms of mortality caused by
non-communicable diseases, the
situation has shown a deterioration
compared to the baseline value,
indicating a deviation from the target
value set for 2023. Several significant
risk factors contribute to the
occurrence and mortality from noncommunicable diseases, including
tobacco consumption, excessive
alcohol consumption, pollution, and
obesity, among others. It is crucial
to make substantial investments
in preventive healthcare measures
and enhance both physical and
financial access to health services.
In 2021, the majority of deaths were
attributed to cardiovascular diseases
(39%), followed by COVID-19, and
malignant neoplastic diseases
(15%). Other significant causes of
mortality included endocrine and
metabolic diseases with nutritional
disorders, as well as diseases of
the respiratory system. According
to the World Health Organization
(WHO), approximately 38% of the
population in BiH are smokers,
43.2% have high blood pressure,
and 26.5% are obese. In recent years,
various levels of government have
implemented significant measures
to reduce risk factors, such as the
implementation of the Law on the
Prohibition of Smoking in Enclosed
Spaces in FBiH starting from 2023.
Additionally, preventive programs
have been established, including
free HPV vaccination, early screening
programs, and campaigns to raise
awareness about healthy lifestyle
habits.
Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through
prevention and treatment and promote mental health and well-being
Indicator Trend Description of trend
Adjusted SDG indicator 3.4.1:
Non-communicable disease
mortality rate (per 1,000
population) – total
Based on the latest estimates, the mortality rate from noncommunicable diseases in BiH is showing a concerning deterioration,
indicating that the target for 2023 is unlikely to be achieved. The
estimated mortality rate for non-communicable diseases in 2020 is
18.7 deaths per 1000 people (24 for males and 13.6 for females), while
the target value is set at 16.7 (19.8 for males and 11.1 for females).
Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse
and harmful use of alcohol
Indicator Trend Description of trend
SDG indicator 3.5.2: Alcohol
abuse, defined in the national
context as consumption of
alcohol per capita (at the
age of 15 and older) during a
calendar year in liters of pure
alcohol
The data available suggests a concerning trend of increasing per
capita alcohol abuse. It is important to note a gender disparity in
this regard, with men consuming 12.9 liters of alcohol per capita in
2019, compared to 3.0 liters for women. Based on the observed trend
between 2016 and 2019, it is unlikely that the target value of 5.3 liters
for 2023 will be achieved.
In addition to non-communicable
diseases, deaths caused by trafic
accidents can also be reduced by
preventive action, since a large
number of trafic accidents on
our roads are the result of noncompliance with trafic rules and
regulations and a low level of trafic
culture and an increasing number
of trafic participants. Irregular
speed, which is not adapted to
road conditions, is one of the most
common causes of trafic accidents,
followed by those caused under
the influence of alcohol and other
intoxicants. The highest number of
trafic accidents was recorded on the
streets in settlements, and the lowest
on the motorways, so improving the
quality of the road infrastructure
reduces the number of accidents.
In the period 2015-2020, the trend
of improving road infrastructure
is visible, and many projects are
planned that could contribute to
approaching the 2023 target of 11.5.
"#$%&'()*!)+",+-
,./01.12343562!67!481294!:;<;!429!3=1!
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!$
Target 3.6: By 2030, halve the number of global deaths and injuries from road trafic accidents
Indicator Trend Description of trend
SDG indicator 3.6.1: Mortality
rate due to trafic injuries per
100,000 population
One of the major challenges is the persistently high mortality
rate caused by trafic injuries. Based on the latest data provided
by the WHO in 2019, the annual death rate due to trafic injuries
is 13.5 per 100,000 population. To achieve the target value of
11.5 by 2023, further eforts and interventions are required to
efectively address this issue.
An example of good
practice: Droplet
Droplet is the first mobile application
in BiH which, among other things,
enables easier registration and
identification of the necessary
blood donors when needed. The
development of the pilot mobile
application is supported through a
project implemented by the nongovernmental organization PRONI,
with the support of the BD BiH
Government.
This idea was selected as one of the
best at the RISE (Regional Incubator
for Social Entrepreneurs) regional
INCUBATION program. RISE is built
and monitored by a Consortium
that includes PULSE Group, Regional
Youth Cooperation Ofice – RYCO,
SEEYN, Institut Français, OFAJ
DFJW, AFD - Agence Française de
Développement.
An example of good
practice: HPV vaccine
There is a strong emphasis on
raising public awareness about the
significance of HPV vaccination at
all levels of government. A pilot HPV
vaccination project was successfully
conducted in the Sarajevo Canton,
ofering free vaccination to girls
and women aged 11-26 throughout
2022. Subsequently, the ministries of
health at the entity level developed
their own HPV vaccination programs,
and the vaccination process
commenced in selected areas of both
entities in 2023. Various initiatives
are underway in BiH to inform the
public about HPV infection, provide
ongoing education to parents and
children regarding the HPV vaccine,
and ensure the accessibility and
voluntary nature of vaccination
services.
Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, efective, quality and afordable essential medicines
and vaccines for all
Indicator Trend Description of trend
SDG indicator 3.8.1: Coverage of essential health care
services
N/A
SDG indicator 3.8.2: Proportion of households with large
expenditure on health as a share of total household
expenditure, %
N/A
- 3.8.1.a Proportion of population with household
expenditures on health greater than 10% of total
household expenditure or income
N/A
- 3.8.1.b Proportion of population with household
expenditures on health greater than 25% of total
household expenditure or income
N/A
!"#$"%&&'()'*+,(%-()$'.,%'&/&.*()*01%'2%-%1#!3%).'$#*1& !!
The goal of ensuring both physical
and financial access to healthcare
has not been fully realized, and there
is also a deviation from the target,
particularly in terms of the number
of nurses per 10,000 population
(adjusted SDG indicator 3.c.1).
Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on
Tobacco Control in all countries, as appropriate
Indicator Trend Description of trend
SDG indicator 3.a.1:
Prevalence of current tobacco
use among persons (aged 15
and over)
WHO estimates the consumption of tobacco products to be at
a very high level, and the reduction in its use is occurring at a
slower pace. Between 2011 and 2018, there was only a one
percentage point diference, with the prevalence decreasing
from 39.3% to 38.3%. If this slow downward trend continues, it
is unlikely that the target value of 31% for 2023 will be achieved.
The most recent surveys on tobacco
consumption were carried out in
2018 in the FBiH and in 2019 in the
RS. The findings from these surveys
indicate a notable prevalence of
tobacco use among school children
in both entities, with a higher
rate observed in the FBiH. The
upcoming implementation of the
Law on Prohibition of Smoking in
Closed Spaces in the FBiH, starting
in May 2023, is expected to play a
significant role in reducing cigarette
consumption and ultimately help
achieve the target of 31% by 2023.
Target 3.c: Substantially increase health financing and the recruitment, development, training and
retention of the health workers
Indicator Trend Description of trend
Adjusted SDG 3.c.1:
Health worker density and
distribution per 10,000
population
Regarding the availability of pharmacists, improvements were
observed compared to the baseline value (1.2 in 2014 compared
to 1.5 in 2020). However, considering the pace of improvement,
further eforts are required to reach the target value for 2023 (2.1).
Regarding the number of doctors per 10,000 population, there is
a noticeable improvement compared to the baseline value (20
in 2013, compared to 23.3 in 2020), and the target value for 2023
has already been reached (22.5).
On the other hand, the number of dentists in the period 2014-
2020 per 10,000 population did not change (2.3), and therefore,
the target value for 2023 (5.3) will not be reached.
The number of nurses has significantly decreased (63 in 2014
compared to 41.1 in 2020), and it is evident that the target value
for 2023 will not be reached (69.1).
While there is a lack of consistent
monitoring of the emigration
of medical personnel to more
developed Western countries, the
impact of this phenomenon on the
inadequate number of healthcare
professionals in our country is highly
evident.
"#$%&'()*!)+",+-
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>?>34524@01!91A106/.123!8640>!52!B6>254!429!C1DE186A524
!%
An example of good practice: Healthy Aging Centers
The Partnership for Public Health Association has established 18 Healthy Aging Centers in 10 local communities
throughout BiH which provide day care, professional involvement, recreational and educational activities, health
advice and care services for users. The survey conducted by the Association, UNFPA in BiH and UCL researchers
revealed three key areas for improvement for the center members: physical activity, eating habits and relationships
with friends and family. Institutions support these centers by providing space for their work, such as the Center for
Healthy Ageing in Novo Sarajevo, which receives financial support and rents space from the municipality. Since
2019, these centers have provided support to over 1,000 beneficiaries.
|
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3
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"file_id": "sdg-03/vnr-report-bih-2023-en-3.pdf",
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|
19
SDG 3 “Good Health and Well-Being”.
Belarus is making significant efforts to achieve the Sustainable
Development Goal in the field of healthcare.
The concept of safe motherhood formulated by the World Health
Organisation has been included in the safe motherhood programme in Belarus.
In the Republic of Belarus, there is a multi-tiered system providing medical
care to women and children which as of 2021 included a perinatal centre of the
4th technological level (the Republican Scientific and Practical Centre "Mother
and Child"), 17 perinatal centres of the 3rd level in the regions and the city of
Minsk; 27 inter-district and urban perinatal centres of the 2nd level, and 64
healthcare organisations of the 1 st district level.
Pregnant women are guaranteed medical care in public health
organisations during and after childbirth. 100% of women have access to prenatal
and postnatal medical care, and 99.9% of births are attended by qualified medical
personnel.
Thanks to the favourable conditions for the birth of healthy children,
reduction of child disability, and reduction of infant, child, and maternal
mortality in the period 2000-2019, the maternal mortality rate in Belarus
decreased by 21 times: from 21 to 1 per 100,000 live births. In 2019, the infant
mortality rate reached the level of 1 per 1,000 live births, taking into account
children with a birth weight of 500 grams or more. According to this indicator,
the Republic of Belarus is at the level of developed countries.
There is a decrease in the mortality rate of children under the age of 5,
which by 2019 decreased to 3 per 1,000 live births compared to 12.3 in 2000.
The Republic of Belarus is making every effort to provide high-quality
medical care to people living with HIV and high coverage of key and vulnerable
groups of the population with HIV prevention, treatment, care, and support
services. Belarus has consistently pursued an active policy to fight the spread of
HIV/AIDS and the implement the commitments undertaken under the 2016 UN
General Assembly Political Declaration on the Global Response to the
HIV/AIDS Epidemic and its Cessation by 2030.
Thanks to the implementation of the State Programme "Health of the
People and Demographic Security of the Republic of Belarus" for 2016-2020 and
HIV prevention programmes in partnership with international organisations
(UNAIDS, UNDP, UNICEF) and non-governmental associations with the
support of the Global Fund, the country has managed to significantly limit the
spread of HIV infection.
In 2021, the incidence of HIV infection in the Republic of Belarus was 16
cases per 100,000 population and presently it remains in a concentrated phase:
HIV infection is prevalent in the groups that are most vulnerable to HIV, such as
injecting drug users (22.7%), women involved in sex work (9.7%), and men
practising sex with men (5.8 %).
20
Despite the epidemiological situation related to the COVID-19 pandemic,
the country has ensured progress towards all the targets of the UNAIDS 95-95-
95 strategic goal: by the end of 2021, 85.3 per cent of the estimated number of
people living with HIV in Belarus had been identified and were aware of their
diagnosis; 85 per cent of them were receiving antiretroviral treatment; 82.1 per
cent had achieved undetectable viral load.
The Republic of Belarus supports and develops the Global Health Sector
Strategy on Viral Hepatitis for 2016-2021 adopted in May 2016 by the World
Health Assembly, which in the period 2017-2021 resulted in a more than twofold
reduction in the incidence of viral hepatitis В in the country: from 11.2 to 4.8 per
100,000 population.
In order to stop the spread of tuberculosis in the territory of the Republic
of Belarus, in 2016-2017, the country implemented the grant of the Global Fund
"Ensuring universal access to rapid laboratory diagnostics of drug- resistant
tuberculosis (DR-ТВ) and universal coverage of patients with DR-TB with
quality treatment".
Since 2019, the Republic of Belarus has been implementing the next grant
of the Global Fund “Strengthening of HIV and ТВ national systems of
prevention, treatment, care and support in the Republic of Belarus". Measures to
prevent the spread of tuberculosis envisioned in the State Programme "People's
Health and Demographic Security of the Republic of Belarus" implemented in
2016-2020 and a similar state programme adopted for 2021-2025 allowed to
achieve a more than twofold reduction in the incidence of tuberculosis in the
country in the period 2016-2021: from 28.3 to 21.7 per 100,000 people.
The healthcare system has ensured universal coverage of health services,
access to safe, effective and high-quality medicines and vaccines.
In the Republic of Belarus, all adults and children with ophthalmological
diseases (cataract, glaucoma, diseases of the retina and vitreous, optic nerve,
cornea, pathologies of the lacrimal tract and orbit, refractive disorders, etc.) and
ocular lesions receive modem specialised ophthalmological care.
Several unique microsurgical and laser operations on the eye are performed
in the Republic of Belarus, including comeal transplantation using a femtosecond
laser; surgical treatment of glaucoma involving stenting of the canal of Schlemm;
combined surgical interventions (comeal transplantation, cataract
phacoemulsification, vitreal surgery; glaucoma surgery, including with
implantation of drainage devices).
Measures have been taken to strengthen the material and technical base of
sanatorium-and-spa and health-improving organisations, which has allowed to
increase the number of consumers of services, including rehabilitation from
disorders caused by the coronavirus infection. In 2021, 749,600 Belarusian
citizens were accommodated in sanatorium-and-spa and health-improving
organisations, as well as in other specialised institutions (the growth rate is 135.2
21
per cent compared to 2020).
Improvement and implementation of the National Calendar of Preventive
Vaccinations in the last 10 years have resulted in achievement and maintenance
at a high level (97 per cent and above) of the coverage of preventive vaccination
and specific protection of the population of the Republic of Belarus from viral
hepatitis B, tuberculosis, diphtheria, tetanus, whooping cough, polio, measles,
mumps, and rubella.
Targeted efforts to implement evidence-based measures for reclamation
and cultivation of wetlands, landscaping in settlements and countryside
recreation places, sanitary anti-epidemic measures, including the improvement
of sanitary and epidemiological legislation, continuous surveillance, active
identification and treatment of patients with malaria, entomological monitoring
of specific vectors of invasion, and disinsection allowed to prevent local cases of
malaria in the territory of the Republic of Belarus.
Since 2000, isolated cases of malaria have been registered in the territory
of Belarus, all of which are imported cases or relapses of previous acute disease.
Implementation of the Subprogramme "Prevention and Treatment of
Alcohol Abuse and Alcoholism, Mental Health protection" of the State
Programme "People's Health and Demographic Security of the Republic of
Belarus" for 2016-2020, comprehensive plans, outreach strategies providing for
awareness-raising, legal, organisational, as well as educational measures aimed
at reduction of alcohol consumption by the population and rejection of the use of
narcotic drugs and psychotropic substances allowed to reduce the total number
of people seeking medical help from healthcare organisations due to the use of
psychoactive substances in 2021 by 27 per cent compared to 2016.
To reduce the harm caused by excessive tobacco consumption, systematic
work is being carried out in the Republic of Belarus to implement the main
strategies of the WHO Framework Convention on Tobacco Control: smoking,
tobacco products consumption, use of electronic smoking systems and systems
for consumption of tobacco in public places are restricted; the list of public places
where smoking is prohibited has been expanded; prices for tobacco products are
regularly increased. The requirements for packaging and labelling of tobacco
products in accordance with international standards have been defined;
advertising of tobacco products, liquids for electronic smoking systems, and their
sale to persons under 18 years of age are prohibited.
A comparative analysis of the results of STEPS studies on the prevalence
of risk factors for non-communicable diseases conducted in the Republic of
Belarus in 2016 and 2020 showed a 3 per cent decrease in the prevalence of
tobacco use among people aged 18 to 69 years.
In the Republic of Belarus, continuous outreach work is underway to
promote healthy lifestyles and raise awareness of the issues related to the
22
development of responsible behaviour skills and the prevention of diseases and
addictions.
Special attention is paid to the reproductive health of students: educational
institutions are taking active measures to create a healthy environment; students
are trained to use their time for work and rest rationally and with health benefits,
awareness-raising campaigns on combatting bad habits are conducted,
sensitisation on the issues of early initiation of sexual activity and sexually
transmitted diseases is conducted both as part of extracurricular activities and
within the framework of academic subjects.
In 2019, the preventive project "Healthy Cities and Towns" was approved
at the state level with the aim of minimizing the impact of risk factors such as
consumption of tobacco and alcohol, irrational and unbalanced nutrition, and
physical inactivity, and, as a result, reducing the risk of disease and mortality
from non-communicable diseases. In 2021, the project was implemented in 147
settlements of Belarus.
Belarus is carrying out targeted work to prevent road accidents, which
resulted in a 21.1 per cent reduction in the level of deaths and injuries on the
roads in 2021.
|
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[
3
] |
{
"country": "blr",
"file_id": "sdg-03/vnr-report-blr-2022-en-5.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2022
}
|
8
SDG 3. Belarus is one of the world leaders in terms of access of the
population to medical services.
Maternal mortality has decreased 21 times; the mortality of children under
the age of 5 and in the neonatal period has significantly decreased (1 per 1000
live births). According to this indicator, the Republic of Belarus is at the level of
developed countries.
Within the framework of the National Calendar of Preventive
Vaccinations, almost 100% of the country’s population have been vaccinated (the
coverage” of children with preventive vaccinations against all infections included
in the immunisation programme is 98-99 per cent, while the coverage of adult
population is more than 97 per cent).
In 2021, the incidence of HIV infection in the Republic of Belarus was 16
cases per 100,000 population.
Belarus has launched the preventive project "Healthy Cities and Towns",
which aims to minimise the risks associated with consumption of tobacco and
alcohol, irrational and unbalanced nutrition, and physical inactivity.
In the Republic of Belarus, all adults and children with ophthalmological
diseases (cataract, glaucoma, diseases of the retina and vitreous, optic nerve,
cornea, pathologies of the lacrimal tract and orbit, refractive disorders, etc.) and
ocular lesions receive modem specialised ophthalmological care.
|
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Goal #3 Good Health and Well Being
While Goal 3 outlines good health and wellbeing as desirable outcomes, health issues are embedded within all other goals. The SDGs health goal includes new indicators and refined targets to
follow up on MDGs advancements and gaps. The MDGs ended with accomplishments such as
1 00% of public sector hospital certified as Baby Friendly Hospitals, Exclusive Breastfeeding Rate
Up to six months of Age increasing from 10.0 to 33.0%, maintenance of the high vaccination coverage and reduction in child mortality rate from 1 0.0 to 14.0%, growth in vaccination coverage and the
successful and effective implementation of the Integrated Management of Childhood Illnesses
(IMCI). Belize met the Toronto Call to Action target of 39.7 health care professionals per 10,000
population. HIV/AIDS prevalence shows trends of stabilization, access to antiretroviral drugs increased, and mother-to-child HIV transmission rates reduced. Belize was placed at the pre-elimination stage for malaria.
The SDGs met a number of challenges regarding good health and continued investment in health
is necessary to contribute to reducing inequality, sustainable and inclusive economic growth, social
development, environmental protection, and to the eradication of poverty and hunger, and that
gains in health require actions across other Sustainable Development Goals. Neonatal care continues to be a challenge. Human Resources in Health (HRH) needed a boost to ensure that they can
respond to emerging health issues. Dependence on health care workers [doctors] through international cooperation coupled with the migration of Belizean health care workers contributed to greater
human resources challenges. Barriers to accessing health services such as geographical inaccessibility, economical barrier, limited transportation and lack of confidence in the health system are not
easily eliminated. The Ministry of Health re-introduced the provision of contraceptive commodities
and increased access to definitive contraception methods through routine and non-routine services.
The knowledge on HIV/AIDs transmission among the 15-24 age group was low. Tuberculosis and
Dengue remains a concern.
3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000
live births
The Belize Health Sector Strategy 2014-2024 reports a decline in the maternal mortality ratio between the years 2000 to 2012, from 82 to 41.5 per one hundred thousand live births and twice
achieved zero maternal deaths in 2011 and 2013. In 2015 the maternal mortality rate increased to
94 maternal deaths per one hundred thousand live births. Output indicators such as prenatal care,
childbirth attendance, postnatal care and immediate new-born care among others have improved.
Primary health care services are delivered at health facilities in both urban and rural communities
or through mobile clinics. The MOH has increased its capacity to better diagnose, care and treat
through training amongst doctors and nurses. Clinical standards are monitored and evaluated regularly. Gaps identified are addressed in an implementation plan and monitored on a quarterly basis.
3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with
all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births
and under-5 mortality to at least as low as 25 per 1,000 live births
The MOH (2015) reported an infant mortality rate of 16.8 per 1000 live births increasing by 36%
compared to 2014. The MOH view this with concern, and makes it a top priority in the Health Sector
Strategy, "While great strides have been made in reduction of infant mortality, there remains an extremely high burden of the perinatal/neonatal mortality component, indicating an issue with quality
and coverage of prenatal care (p.25)" among other causes outside of MOH control.
The under-5 mortality rate was measured at 16.5 per 1 ,000 live births in 2015, so we are already
below the target. Earlier, the under-five mortality rate was reduced from 21/1000 live births in the
period 2003-2007 to 18.3/1 000 in 2008-2012. However, the causes of mortality among children less
than one year, as well as those under five have been primarily as a result of hypoxia, birth asphyxia,
respiratory conditions, other perinatal conditions, as well as, congenital anomalies.
The child immunization rate, however, fell below the 95.0% mark in 2016. Previously, it maintained
an average of 95.0% from 2010-2015. The main causes of the reduction of the vaccination coverage is the insufficient number of health professionals at primary care facilities combined with insufficient transportation means; approximately 60% of the children receive their vaccines through outreach sessions.
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne diseases and other communicable diseases
2016 statistics suggests that communicable diseases were directly linked to 20% of deaths in
Belize, with a third of those deaths being among HIV/AIDS patients. The country has responded
with a national policy for Communicable Disease surveillance and investments in improving the national communicable Disease surveillance system. Major modification to the communicable disease
surveillance system for Belize involves the expansion of syndromic surveillance to include additional syndromes. The expanded surveillance of syndromes also allows for inclusion of data collected
by nursing staff in health centres improving the coverage, timeliness and representativeness of the
surveillance system. This modification also aims to improve early outbreak detection capabilities for
timelier public health intervention. As a result of the health sector reform, the electronic medical
record system called the Belize Health Information System (BHIS) was implemented in 2008 which
included an HIV-specific module.
Advanced HIV infection is one of the leading causes of death among the rate of infection is high
among females 20-24 years and females 60-64 years in 2015. By the end of 2016, the HIV prevalence rate was at 1.5%. The 2016 figure reflects a 0.1% increase from the previously recorded 1.4%
recorded in the previous 3 consecutive years (2013-2015). For 2016 there was a greater volume of
HIV testing done among persons 15 to 39 years. Though there is an increase of HIV testing in both
sexes, there is a continued short fall in established target of increasing HIV testing in the male population. Patterns have shown greater HIV testing in the female population, at a ratio of 0.5 to 0.6
M:1 F. There is an also a similar pattern showing higher rates of men dying from AIDS related complications among the affected. The 2011 Sexual Behaviour Survey reported 13.85% prevalence
rate within the men having sex with men (MSM) population. Intervention in the mother to child transmission program and other preventative programs led to improvement in reducing HIV prevalence.
The Government of Belize with the support of social partners currently implement a preventative
public health HIV/AIDS programme aimed at decreasing the risk and impact of STI/HIV/AIDS
through the delivery of efficient and effective HIV/AIDS services in Belize. The programme promotes voluntary counselling and testing, access to ARV Therapy and medications for Opportunistic
Infections for Belizeans Living with HIV/AIDS and monitoring and evaluation for sustainability and
quality of care.
Tuberculosis and Malaria are highly endemic in Belize. Malaria incidence was 0.01 per 1 ,000 population in 2016. Reporting only 22 local cases of Malaria in 2013, Belize is making remarkable progress toward national malaria elimination in advance of the 2020 goal set for the region. No deaths
due to malaria have been reported since 2006. Such improvement can be attributed to active surveillance and community based interventions (elimination of breeding sites, increased distribution
of bed nets, and improved detection through clinical finding and laboratory testing at health facilities
and by community volunteers), intersectoral cooperation, and cross-border collaboration with Guatemala and Mexico. Priority is given to preventive interventions, early detection, care and treatment.
Belize is at the pre-elimination stage for malaria.
In 2016, Tuberculosis incidence was 0.32 per 1,000 population. In place is a National Tuberculosis
which includes a strategy for public education, improved diagnosis; dual phase treatment regimens
(initial (intensive) phase lasting 2 months/ continuation phase usually lasting 4-6 months improved
surveillance tied to the National Health Information and Surveillance Unit and Contact Tracing.
Target: 3.4 by 2030 reduce by one third premature mortality from non-communicable
diseases through prevention and treatment and promote mental health and well-being
Belize continues to undergo an epidemiological transition in which NCDs have become increasingly
prominent in the disease profile and have been increasing in their share of the disease burden for
well over a decade. Since 2007 the leading cause of mortality are heart disease and diabetes and
its complications. In response, the Ministry of Health in partnership with the Pan American Health
organization launched the Belize National Plan of Action for the Prevention and Control of
Non-Communicable Diseases (NCDs) 2013-2023 in 2014.
In line with the Plan of Action, the MOH has increased its interventions to address community prevention programs for non communicable diseases. Government has invested in increased recruitment and coverage of Community Health Workers and Health Education Officer who conduct
health education messages and intervention in homes and schools in the rural and urban communities. Additionally, the National Health Insurance Scheme provides for the routine screening for
non-communication diseases such as diabetes hypertension, heart related conditions, and asthma.
There have been improved primary and secondary care services for those diagnosed with related
conditions to assist and ensure patients are guided and managed from becoming a tertiary level
case. Clinical standards are developed to better assist clinical staff with the management of patients
suffering with these conditions. Annual audits of selected patient charts are conducted to ensure
quality care are given to patient according to protocol.
It is estimated that approximately 8% of adults in Belize are likely to be affected by mental disorders,
including psychotic disorders, depression, anxiety disorders, and substance abuse (World Mental
Health Survey, 2004). In 2004 the Government of Belize adopted a national Mental Health Policy.
Belize Mental Health Program provides services to mental health patients with limited coordination
and collaboration with other agencies such as the National Drug Abuse and Control Council, government ministries including the Ministries of Human Development; however mental health service
in Belize continues to be equated with institutional psychiatric care and care for the severely mentally disabled. The presence of psychiatric institution seems to be the only important service, for the
treatment of mental disorders. While this kind of care is important and attention is given to it, mental
health services also include the treatment of less severe mental health problems, the prevention of
psychological problems, and promotion of mental health through public mental health services and
education.
The national system has been supported by installation of psychiatric nurses, as part of a community-based psychiatric program; provide ongoing counselling to survivors of gender-based violence
and child abuse, as well as pre- and post-test counselling for HIV as well as through the works of a
Mental Health Association and a Mental Health Consumer Association. The consumer association
in 2005 advocated successfully for new psychotropic drugs to be added to the national drug formulary.
It should be noted that the Government of Belize, Ministry of health has elaborated a Mental Health
Program Strategic Plan which is expected to direct further improvement to the system of care.
3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug
abuse and harmful use of alcohol
The National Drug Abuse Control Council (NDACC), the Ministry of Health and the Ministry of Education have been conducting drug use prevention programs in schools and local communities. The
MOH also makes note of patient family history and substance abuse through BHIS. Quality clinical
audits are conducted on patient records to ensure clinicians are documenting and gathering critical
information on drug use. Surveillance on the use of tobacco and alcohol is being done among
school aged children to better monitor intervention measures in schools and communities. The
MOH has developed draft tobacco legislation and has strengthened the monitoring of narcotics
abuse in collaboration with the Police Department.
However, the country lacks adequate treatment centers and programs for those requiring addiction
rehabilitation. Standards are yet to be developed for operating centers. There is also the need for
better community policing to effectively eliminate the sale of alcohol to minors. Packaging and labelling of tobacco products requires effective monitoring by the competent authority.
3. 6 By 2020, halve the number of global deaths and injuries from road traffic accidents
In collaboration with the Ministry of Transport and Works, MOH has developed a committee to look
at issues surrounding road transport accidents. This body has been focusing on improved traffic
standards and safety measures to reduce fatalities from road transport accident. In 2013, the Government implemented the Road Safety Project, which looks at standards and safety measures as it
relates drivers on highways and roads. Highway patrols are stationed on the highways to better
monitor road safety practices amongst drivers. Road rehabilitation are currently being done and
supported by the Government of Belize to improve the road conditions. Death rate due to road traffic injuries over the last five years average 23.1 deaths per 1 00,000 population, with the highest rate
reported in 2016 (28.0 per 100,000 population). Most fatality occurs from reckless driving due to alcohol drinking and cell phone use being a major suspected reason. Medical response services are
available through BERT and the MOH, to quickly respond to road transport accidents. The ministry
improved trauma rooms at KHMH and equipped ICU and specialist doctor to respond to critical patients suffering from road transport accidents.
3. 7 By 2030, ensure universal access to sexual and reproductive health-care services,
including for family planning, information and education, and the integration of reproductive
health into national strategies and programmes
While basic sexual and reproductive health care is free in Belize and available in all public hospitals
countrywide, it is only accessible to those above the age of 16. The maternal and child health care
program of the Ministry of Health supports community intervention programs aiding families with
voluntary family planning and preventative measures.
The adolescent birth rate (aged 10-14 years) over the last five years has been slowly declining.
Belize now averages 7 4 per 1000 adolescent 15-19 years (M ICS5, 2015). None state actors are
also very active in the targeting young people in sexual and reproductive health. School-based programs exist in Belize, which highlight prevention and curative measures as it relates to safe sexual
practices within the context of a Health and Family Life Education curriculum at the primary school
level and Positive Youth Development (PYD) curriculum at secondary school level. There are however, barriers to implementation of these curricula in schools managed by faith based organisations.
3.8 Achieve universal health coverage, including financial risk protection, access to
quality essential health-care services and access to safe, effective, quality and affordable
essential medicines and vaccines for all
The introduction of the National Health Insurance scheme in 2001 was intended to make universal
health care available to the population without any financial barriers. This model was implemented
in a limited geographic and population area. At present the scheme services a population of
120,000 (33% of the total population). A key challenge, limiting programme coverage is that the plan
is that the NHI continues to be funded by general revenue and sustainability and financing mechanisms have not been finalized.
Social Security Board (SSB) administers the National Health Insurance Fund (NHIF) on Behalf of
the Government of Belize. It instructs the NHIF to purchase services agreed upon by the ministry
underscoring performance principles of productivity, efficiency, and effectiveness. 90% of the NHIF
is utilized in the purchasing of primary healthcare contractual services. The National Health Insurance pilot did not include service fees ; however, the roll-out introduced co-payments were in Southside Belize City and Northern Belize, but not in the Southern Health Region where the highest
levels of poverty is recorded. Nominal fees are applied in hospitals and clinics for imaging and laboratory tests and similar fees are charged for inpatient services, including deliveries. However, essential medicines and vaccines are free. Vaccinations are facilitated through regional hospitals and
community health centres. In 2015 the percentage of children age 24-35 months who received all
vaccinations recommended in the national immunization schedule by their first birthday (measles
by second birthday) stood at 77.5%. 5% of children ages 24-35 months are not vaccinated.
There exists a growing private health insurance and private investment in health.
3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and contamination
The Government of Belize has established a robust national framework for the management of hazardous chemical and the control of the release of pollution substances into the environment. Belize's Environmental Protection Act of 2002 established the Department of Environment whose primary roles include the prevention and control pollution by co-ordinating all activities relating to the
discharge of wastes into the environment. Belize has managed to preserve its natural environment
more effectively than many of its neighbours in Latin America and the Caribbean. However, the
country does face pollution challenges, most of which are consequences of development projects
and a growing population. Pollution data in Belize is currently inadequate.
For this target to be met, data collection systems will need to track these indicators. Also, multi sectorial collaboration will need to establish guidelines so that illnesses and deaths resulting from
chemicals and contaminants could be identified.
3.A Support the research and development of vaccines and medicines for the
communicable and non-communicable diseases that primarily affect developing countries,
provide access to affordable essential medicines and vaccines, in accordance with the
Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of
developing countries to use to the full the provisions in the Agreement on Trade-Related
Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and,
in particular, provide access to medicines for all.
This is an area that requires better implementation and collaboration between local and international partners. However, the Ministry of Health through PAHO has specific suppliers of vaccine and related products. The Ministry of Health also recently developed a Drug Inspectorate Unit to monitor
pharmaceutical and manufacturing activities in Belize. Through the Licensing and Accreditation
Unit, standards and practices are monitored in all pharmacies nationwide. Importers are now required to obtain a license from the Ministry of Health. This process requests that all suppliers in
Belize provide the MOH with Good Manufacturing Practices Certificate for each pharmaceutical to
be imported. Through BELIPO, patent rights for pharmaceuticals are being monitored. This is an
area which requires stronger partnership and support at the highest levels.
3. C Substantially increase health financing and the recruitment, development, training and
retention of the health workforce in developing countries, especially in least developed
countries and Small Island developing States
The Government of Belize is committed to the health and wellbeing of the people of Belize. The
MOH's budget in 2015 has increased to approximately 6.0% of GOP. Personnel emoluments and
medical supplies consume a large share of the budgetary allocation. It has been mandated that the
funds be utilized as follows : 5.0% for staff performance incentives, to be granted at the discretion of
regional management teams; 10.0% for staff development (training, workshops, conferences, and
seminars); and 85.0% for capital investments.
Belize supports a Primary Health Care-based health system, composed of a core set of functional
and structural elements that guarantee universal coverage and access to services that are acceptable to the population and that are equity-enhancing. There is continuous investment in improving
health facilities. However, human resource availability remains a major concern although there has
been some recruitment of relevant specialist doctors at the secondary and primary care levels there
exist a serious shortage of certain specialties such as (physiotherapist, biomedical technicians,
X-Ray technician, and ultrasound -no- graphers etc.) that severely restrict the quality and quantity
of services being provided.
3. 0 Strengthen the capacity of all countries, in particular developing countries, for early
warning, risk reduction and management of national and global health risks
The Epidemiology Unit, Ministry of Health, is responsible for Epidemiological Surveillance which
corresponds to a process of continuous evaluation of the health situation. The Epidemiology Unit
monitors emerging and re-emerging conditions and spearheads the national response mechanism.
Belize currently conducts regional reporting to PAHO. The MOH implements ongoing Field Epidemiological Training Programs to equipped first line responders to manage outbreak response. Supporting the surveillance work of the Epidemiology Unit is the Central Medical Laboratory who receives and processes samples 24/7 in the event of an outbreak. Belize Agriculture Health Authority
and the MOH have signed a collaborative agreement confirm lab samples. These two entities share
epidemiological data especially for zoonotic and food borne conditions. PAHO and the Caribbean
Region Public Health Agency (CARPHA) conduct training on infection control, preventative measures and monitoring of communicable diseases. They also ensure that personal protective gears
are used. The MOH recently revised its International Health Regulation (IHR) Strategic Plan for
Belize 2017.
|
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INFORME NACIONAL VOLUNTARIO DE BOLIVIA 2021
- 27 -
ODS3. Salud y bienestar
En el marco de la Constitución Política del Estado, el nivel
central del Estado tiene como mandato constitucional la
generación de la política nacional de salud y gestión del
Sistema Nacional de Salud, así como la de construir un
Sistema Único de Salud universal, gratuito, equitativo,
intracultural, intercultural, participativo, con calidad,
calidez y control social.
A fn de garantizar el derecho a la salud y el acceso
a la salud de todas las personas, sin exclusión ni
discriminación alguna y de manera gratuita, en la gestión
2019 se ha implementado el Sistema Único de Salud,
Universal y Gratuito (SUS) a través de la promulgación
de la Ley N° 11528 de 20 de febrero de 2019, el cual
se constituye como una de las principales políticas del
Sector Salud que tiene como objetivo principal, brindar
atenciones en salud de manera gratuita a todas las
bolivianas y bolivianos que no se encuentran cubiertas
por la Seguridad Social de Corto Plazo.
Meta 3.2 De aquí a 2030, poner fn a las muertes
evitables de recién nacidos y de niños menores
8 La Ley N° 475 de 30 de diciembre de 2013, de Prestaciones de Servicios de Salud Integral del Estado Plurinacional de Bolivia, modifcada por la Ley N° 1069 de 28 de mayo de 2018 y por la
Ley N° 1152 de 20 de febrero de 2019, permitió dar un importante paso en la atención gratuita en salud, benefciando a las mujeres embarazadas, niñas(os) menores a 5 años, personas de 60
años o más, mujeres en edad fértil en atenciones de salud sexual y reproductiva y personas con discapacidad) que no cuentan con un seguro de la Seguridad Social de Corto Plazo.
de 5 años, logrando que todos los países
intenten reducir la mortalidad neonatal al menos
a 12 por cada 1.000 nacidos vivos y la mortalidad
de los niños menores de 5 años al menos a 25
por cada 1.000 nacidos vivos.
A objeto de mejorar la salud infantil y disminuir
las tasas de mortalidad, el gobierno ha venido
implementando el Programa Bono Juana Azurduy,
el Programa Ampliado de Inmunización (PAI),
el Subsidio Universal Prenatal por la Vida9
y acciones dirigidas a fomentar la lactancia materna10
y nutrición de las niñas y niños, que aportaron a la
disminución de la mortalidad infantil y neonatal en el
país.
Entre el 2003 y 2016, la Tasa de Mortalidad
Infantil disminuyó de 54 a 24 por mil nacidos
vivos, y de acuerdo a las proyecciones11
del Instituto Nacional de Estadística, en el año 2020
la tasa de mortalidad infantil habría alcanzado 22,4 x
1.000 nacidos vivos.
9 Decreto Supremo Nº 2480, de 06/08/2015 que instituye el Subsidio Universal Prenatal por la Vida y el Decreto Supremo Nº
10 Ley N° 3460, de 15 de agosto de 2006, de Fomento a la Lactancia Materna y Comercialización de sus Sucedáneos.
11 Proyecciones de la Tasa de Mortalidad Infantil (2012-2022). https://www.ine.gob.bo/index.php/censos-y-proyecciones-de-poblacion-sociales/
Gráfco 12: Tasa de Mortalidad Infantil, 2003 - 2020
(Por mil nacidos vivos)
Fuente: Instituto Nacional de Estadística - Ministerio de Salud
Nota: Encuesta Nacional de Demografía y Salud (2003 y 2008), Encuesta Nacional de Demografía y Salud (2016), Proyecciones de la Tasa de
Mortalidad Infantil (2017-2020).
INFORME NACIONAL VOLUNTARIO DE BOLIVIA 2021
- 28 -
Las acciones implementadas se vieron fortalecidas por
la implementación del Sistema Único de Salud que,
entre sus prestaciones, brinda atención gratuita para
controles prenatales, partos y consultas de crecimiento
y desarrollo a niños menores de cinco años.
Meta 3.3 De aquí a 2030, poner fn a las
epidemias del SIDA, la tuberculosis, la malaria
y las enfermedades tropicales desatendidas
y combatir la hepatitis, las enfermedades
transmitidas por el agua y otras enfermedades
transmisibles.
El Síndrome de Inmunodefciencia Adquirida (SIDA) es
una enfermedad crónica que pone en riesgo la vida de las
personas que presentan el Virus de Inmunodefciencia
Humana (VIH) que ataca el sistema inmunológico.
En Bolivia, entre 1984 y 2020 se reportaron 29.223
personas que viven con VIH/SIDA, de las cuales 24.644
tienen VIH y 4.579 SIDA. Asimismo, las personas que
reciben tratamiento antirretroviral al 2020 alcanzaron a
11.758 personas.
El tratamiento antirretroviral ha mejorado
considerablemente la calidad de vida de las personas
que viven con VIH, asimismo, con el seguimiento clínico
y de laboratorio se ha logrado suprimir la carga viral de
la persona lo que ha permitido disminuir la transmisión
del virus.
El nivel central del Estado coordina acciones con los
Centros Departamentales y Regionales de Vigilancia,
que permitieron una detección más temprana del VIH
para su tratamiento oportuno, evitando que las personas
enfermas desarrollen la fase SIDA.
Estas acciones, permitieron que, en los últimos 5 años
la incidencia de VIH descienda de 0,124 casos nuevos
por mil habitantes a 0,112 en 2020, esta disminución
se acentúa cuando se analiza el indicador por sexo,
presentando una baja mayor en el indicador de los
hombres con relación al de las mujeres; sin embargo, la
mayor incidencia de VIH se da en varones.
Gráfco 13: Incidencia de VIH, 2015 - 2020
(Por 1.000 habitantes)
Fuente: Ministerio de Salud y Deportes
Una enfermedad endémica de Bolivia es la malaria,
que en la anterior agenda global de los Objetivos de
Desarrollo del Milenio logró alcanzar la meta de reducir
la incidencia de la malaria a un Índice Parasitario Anual
(IPA) de 2,0 por mil habitantes. Actualmente, se han
venido ejecutando acciones para el fortalecimiento
del diagnóstico, tratamiento y control vectorial, entre
otros, que han permitido controlar y disminuir el
número de casos de malaria en el país.
El Programa Nacional y los 11 Programas Regionales
de Malaria se han fortalecido institucionalmente
INFORME NACIONAL VOLUNTARIO DE BOLIVIA 2021
- 29 -
para realizar diferentes acciones a fn de controlar la
enfermedad y eliminar la malaria, entre las principales
acciones que se ha venido implementando destacan:
i) los puntos de diagnóstico y tratamiento de
base comunitaria; ii) distribución de mosquiteros
impregnados con insecticida; y iii) visitas domiciliarias
para enseñar cómo combatir la enfermedad en el
domicilio.
Estas acciones, si bien permitieron mantener el IPA
por debajo de 2,0 por mil habitantes entre 2015 y
2018, han sido insufcientes para evitar el incremento
constante que este índice reportó al año 2020 con un
IPA de 2,68 por mil habitantes, incremento explicado
principalmente por la pandemia de la COVID-19 y la
restricción de actividades en este periodo.
Gráfco 14: Índice Parasitario Anual, 2015 - 2020
(Por 1.000 habitantes)
Fuente: Ministerio de Salud y Deportes
MDS= Meta de Desarrollo Sostenible
A objeto de alcanzar la meta de desarrollo sostenible
en el año 2030, los actores involucrados de los
diferentes niveles de gobierno reforzarán las acciones
de prevención, diagnóstico y tratamiento de esta
enfermedad, especialmente en los departamentos
de Beni y Pando que presentan los niveles más altos
de IPA en el país, 18,1 y 51,9 por mil habitantes
respectivamente.
MDS<2
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{
"country": "bol",
"file_id": "sdg-03/vnr-report-bol-2021-es-3.pdf",
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|
Voluntary national review on the sustainable development goals
Voluntary national review on the sustainable development goals
56 57 ERADICATING POVERTY AND PROMOTING PROSPERITY IN A CHANGING WORLD ERADICATING POVERTY AND PROMOTING PROSPERITY IN A CHANGING WORLD
BACK TO THE TABLE OF CONTENTS BACK TO THE TABLE OF CONTENTS
ENSURE HEALTHY LIVES
AND PROMOTE WELLBEING FOR ALL AT ALL AGES
The Unifed Health System (SUS) is essential to provide health care
and promote the well-being of all Brazilians. Currently, over 70% of
the population depends almost exclusively on the public health service
to receive medical care. This structure has contributed to the achieve
-
ment of the target of reducing child mortality and combating HIV/
AIDS, malaria and other diseases under the MDGs.
The Unifed Health System provides access to health goods and ser
-
vices at all levels of care: provides approximately 95% of basic health
-
care; funds almost 70% of hospitalizations in the country; is the pri
-
mary responsible for urgent and emergency care; is in charge of almost
all public health services (e.g. vaccination); provides coverage for
high-complexity, high-cost treatments, such as antiretroviral therapy
for HIV and transplants, among others.
The Family Health Strategy (ESF) integrates actions of basic health
prevention and promotion through multiprofessional teams (physi
-
cians, nurses, nursing auxiliaries or technicians, and community health
agents), who work in defned geographical areas and their populations.
The Family Health Strategy covers more than 60% of the population
and is present mainly in less affuent locations (more than 85% of regis
-
tered households have monthly household per capita incomes of up to 2
minimum salaries). The prospect is to expand Family Health Teams to
as many as 43 thousand in 2017, and 46 thousand in 2019.
In order to expand access to basic services and allocate physicians in
the outskirts of major cities, inland and in isolated regions, the More
Doctors Program allocated 18,240 physicians in 4,058 Municipalities
and 34 Special Indigenous Health Districts, providing health coverage
to 63 million Brazilians by 2016. The Government’s priority is to make
the country self-suffcient in the supply of physicians, expanding the
participation of Brazilian professionals in the Program. The target is
to replace 4 thousand physicians from partner countries by Brazilians
in three years.
Voluntary national review on the sustainable development goals
Voluntary national review on the sustainable development goals
58 59 ERADICATING POVERTY AND PROMOTING PROSPERITY IN A CHANGING WORLD ERADICATING POVERTY AND PROMOTING PROSPERITY IN A CHANGING WORLD
BACK TO THE TABLE OF CONTENTS BACK TO THE TABLE OF CONTENTS
In the Brazilian population, some groups and regions still present high
incidence of infectious diseases. Thus, Brazilian public health works
to fght such diseases, especially through: i) the National Tuberculo
-
sis Control Program; ii) the National Malaria Prevention and Control
Program and the National Surveillance Policy; and iii) the actions for
Prevention and Control of HIV, AIDS and other Sexually Transmit
-
ted Infections and Viral Hepatitis.
These initiatives provide standardized diagnoses and treatments
through the public health network and some localities are innovat
-
ing by introducing active outreach of cases for the treatment of peo
-
ple with tuberculosis and malaria. In the fght against HIV/AIDS,
the Unifed Health System (SUS) works with prevention through edu
-
cation and awareness-raising campaigns and massive distribution of
condoms, in addition to offering comprehensive medical care, empha
-
sizing on guaranteed access to antiretroviral therapy (ART).
Throughout 2016, there has been an intensifcation of actions of mobi
-
lization and fght against the mosquito Aedes aegypti by means of the
National Plan to Combat the Aedes. This Plan has three axes: i) mobi
-
lization and mosquito control; ii) care and assistance to people; and iii)
technological development, education and research.
Also noteworthy was the investment of R$ 119 million (US$ 37.35 mil
-
lion) for the purchase of 3.5 million rapid tests for the Zika virus in
2016, aimed at supplying the health network for 12 months. Produced
by a Brazilian laboratory, the tests are targeted to pregnant women,
children under one year of age, and people with symptoms of the dis
-
ease. The tests allow to identify if the patient is or has ever been infect
-
ed by the Zika virus.
The promotion of well-being and healthy lives cannot be dissociat
-
ed from the demands that arise from increased life expectancy of the
population, and from risk factors such as obesity, sedentary lifestyles,
and stress, which contribute to continuous increase in the incidence
of diseases such as hypertension and diabetes. Under SUS, the Fitness
Gymnasium program provides infrastructure, equipment and quali
-
fed professionals for physical activities, promotion of healthy eating,
education in health and healthy lifestyles. In 2016, the Federal Gov
-
ernment supported 635 Fitness Gymnasium hubs.
Other issues that require cross-sectoral interventions are those
resulting from traffc violence. In addition to providing assistance
to accident victims, the Life in Traffc Program aims to reduce acci
-
dents through educational campaigns, intervention in risk factors,
and improvement of information systems on accidents, injuries and
fatalities. In a complementary way, the Urban Mobility and Traffc
Program contributes by supporting urban public transportation sys
-
tems and promoting education campaigns for road safety and acci
-
dent prevention.
|
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[
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{
"country": "bra",
"file_id": "sdg-03/vnr-report-bra-2017-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
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}
|
Barbados Voluntary National Review 2023
65
SDG 3: Good health and well-being
‘Ensure healthy lives and promote well-being for all at all ages’
Overview of SDG 3
The GOB has undertaken major steps over the years to institute comprehensive, equitable,
efficient and quality health care service. Good health and well-being is the cornerstone of a
productive society. Our health care system comprises both public (accounting for 65 percent)
and private (accounting for 30 percent) institutions. The public health care system is based on
two components: access to free health services and access to free medicine (for certain chronic
conditions). Free medical care at public hospitals and polyclinics and this includes a wide range
of benefits and services including maternity, HIV/ AIDS treatment, geriatric care, nutrition
services and emergency care.
Maternal health rates have shown significant improvement, with almost 100% coverage on
births attended by skilled staff. The mortality rate in Barbados is 12.6 per 1000 live births, under
5 mortality rate is 13.8 to 1000 live births. One out of four children (0-5 months) in Barbados
are exclusively breastfed. The adolescent fertility rate (births per 1000 teenagers between the
ages of 15-19) has decreased from 33.5 in 2017 to 26.29 in 2020. Barbados also boasts of a
consistent childhood immunization and vaccination programmes. In the context of COVID-19,
over 55% of the population has received at least two doses of COVID-19 vaccine. The
government’s handling of the COVID-19 pandemic was lauded as a best practice given its ability
to quickly mobilise multisectoral support for the effort and establish sound management
protocols. We leveraged this support to quickly establish a specialized facility at Harrison’s
Point in the north of the island to provide care and support for COVID 19 positive patients,
allowing our main hospital, the Queen Elizabeth Hospital (QEH) to continue to provide other
critical care.
Reduce
maternal
mortality
End preventable
deaths of children
& new-borns
Epidemics- AIDS
& communicable
diseases
Universal
health
coverage
Barbados Voluntary National Review 2023
66
The QEH, which is a public institution, has over 600 beds and provides specialized care in areas
such as pediatrics, obstetrics, plastic surgery and radiology. There are also five (5) district
hospitals for care of the elderly. To support the existing complement of district hospitals,
construction has begun on a new four hundred (400) bed facility which will cost over BDS $100
million. The hospital has been focused on improving its service delivery across several
departments. Five hundred (500) cataract surgeries were performed by the Ophthalmology
Department over an eight-month period after they commenced a programme to clear the
backlog of cases. After a hiatus of 10 years, the Orthopedic department restarted knee and hip
replacement surgeries in 2022. We have also seen a decrease in readmission of vulnerable
patients and launched a pre-anesthesia clinic to help with cancelation of surgeries.
One of the more significant epidemiological trends in Barbados has been the increase in NCDs
and an increased prevalence of overweight and obesity in the population. NCDs are the leading
cause of death in Barbados and approximately 5% of deaths from NCDs are in those less than
70 years old.32 They also consume 65% of the budget allocated to the QEH, and 60% of the
budget of the Barbados Drug Service is allocated to pharmaceuticals used in the management
of chronic diseases. In fiscal year 2017-2018, the Barbados Drug Service Special Benefit Service
which provides formulary medicines free of cost to children under 16 years of age, persons
over age 65, and persons diagnosed with diabetes, cancer, hypertension, glaucoma, asthma,
and/or epilepsy, spent 49.8% of its total expenditure on prescriptions for hypertension; 32.4%
on diabetes; 8.6% on glaucoma; 7.4% on asthma; and 1.9% on cancer. These human and
economic costs are not sustainable, especially in light of the inherent social, economic, and
environmental vulnerabilities.33
32 WHO/PAHO. 2017. Available at: https://apps.who.int/iris/handle/10665/272540 33 Ministry of Health and Wellness National Strategic Plan for the Prevention of NCDs
Barbados Voluntary National Review 2023
67
Snapshot of Barbados’ progress towards achieving SDG 3
Maternal mortality rate (per 100,000 live births) (2017) 27
Neonatal mortality rate (per 1,000 live births) (2020) 8.1
Mortality rate, under 5 (per 1,000 live births) (2020) 12.2
Incidence of tuberculosis (per 100,000 population) (2020) 2.4
New HIV infections (per 1,000 uninfected population) (2020) 1.0
Prevalence of HIV: total % of population aged 15-49 (2021 0.90
Age-standardized death rate due to cardiovascular disease,
cancer, diabetes, or chronic respiratory disease in adults aged 30
– 70 years (%) (2019)
16.0
Age-standardized death rate attributable to household air
pollution and ambient air pollution (per 100,000 population)
(2016)
31
Traffic deaths (per 100,000 population) (2019) 8.2
Life expectancy at birth: total (years) (2020) 79.30
Life expectancy at birth: female (years) (2020) 80.57
Adolescent fertility rate (births per 1,000 females aged 15 to 19)
(2020)
29.29
Births attend to by skilled personnel (%) (2016) 99.1
Surviving infants who received 2 WHO-recommended vaccines (%)
(2020)
85
Universal Health Coverage (UHC) index of service coverage (worst
0 – 100 best) (2019)34
74
Prevalence of diabetes in adults aged 18 and over-female (2019) 15.8
Prevalence of obesity in adults aged 18 and over-female (2019) 34.7
Prevalence of diabetes in adults aged 18 and over-male (2019) 12.2
Prevalence of obesity in adults aged 18 and over-male (2019) 17.135
34 World Health Organization. “UHC Service Coverage Index (SDG 3.8.1),”, https://www.who.int/data/gho/indicator-metadataregistry/imr-details/4834#:~:text=Rationale%3A,medicines%20and%20vaccines%20for%20all%E2%80%9D
35 Compiled from Global Nutrition Report 2021. Country Profile Barbados. Available at:
https://globalnutritionreport.org/resources/nutrition-profiles/latin-america-and-caribbean/caribbean/barbados/ and the
Annual SDG Report, 2022.
Barbados Voluntary National Review 2023
68
Policies
Several factors, including the COVD-19 pandemic, led to a reduction in the number of persons
seeking rehabilitative care for NCDs.36 Despite the challenges faced with NCDs and the financial
burden on the healthcare system, this sector remains a top priority. The GOB remains
committed to providing healthcare service that ensures the population achieves optimum
physical, mental and social wellbeing, giving credence to the belief that health is a right for all
Barbadians.
National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2020 –
2025 (NSP-NCD)
The goal of the Barbados National
Strategic Plan for the Prevention and
Control of NCDs 2020-2025 is to reduce
mortality, morbidity, and disability due
to the major NCDs. The intended impact
of the Plan is i) a reduction in the main
NCD risk factors and ii) strengthening
the management of the major NCDs by focusing on the first level of care. The NSP-NCD 20-25
was developed through a participatory and iterative process that sought input and feedback
from key stakeholders including government, civil society, and the private sector. It provides a
blueprint for action and reflects multi-sectoral, whole-of-government, whole-of-society,
health-in-all-policies approaches that are essential to address NCD and their risk factors, as
well as their social, economic, environmental, commercial, and other determinants.
New Health Financing Model
The Government is developing a new health financing model, underpinned by four key
principles to ensure universal health coverage:
36 Cardiovascular Disease Annual report 2022. Available at: http://www.bnr.org.bb/cms/remository/func-startdown/72/
Barbados Voluntary National Review 2023
69
strengthening of the public health and primary health care system;
higher levels of efficiency in the provision of health care and the efficient use of scarce
resources;
a health care system that is resilient and can respond to potential natural disasters and
pandemics; and
partnerships and a whole-of-government approach to health delivery.
The Barbados School Nutrition Policy
With the technical and administrative support of the Pan American Health Organization
(PAHO), the MHW in collaboration with the METVT spearheaded a consultative process for the
development of a national School Nutrition Policy for Barbados. This Policy, which came into
effect in April 2023, will significantly advance SDG 3: Good Health and Well-being among the
school-aged population in Barbados.
Barbados National Action Plan on Combating
Antimicrobial Resistance 2017-2022 for Human
and Animal Health
The strategic vision of the National Action Plan
is ‘Integrated health care systems in Barbados
that by 2027, work to prevent, detect, and
control illness and death related to infections
caused by antimicrobial resistance through
shared responsibility whilst ensuring sustainable medical care’. The National Action Plan
provides the roadmap for Barbados in the effort to address the urgent and serious threat of
antimicrobial resistance. The Plan comprises of three (3) goals as follows:
Goal 1: Slow/Reduce the emergence of resistant bacteria and prevent the spread of
resistant infections;
Goal 2: Strengthen national “One-Health” surveillance efforts to combat resistance;
and
Barbados Voluntary National Review 2023
70
Goal 3: Improve international collaboration and capacities for antimicrobial resistance
prevention, surveillance, control and antibiotic research and development.
The Plan also includes four (4) strategic objectives as follows:
strengthen, coordinate and institutionalise interdisciplinary efforts through National
and Health Establishment level governance structures;
optimize surveillance and early detection of antimicrobial resistance to enable
reporting of local, regional and national resistance patterns to optimize empiric and
targeted antibiotic choice;
enhance infection prevention and control the spread of resistant microbes to patients
in healthcare settings, focusing on improvement in hand hygiene and the identification
and isolation of patients with resistant organisms. Community measures include
preventing infection through wide reaching vaccination programmes and
improvements in water and sanitation; and
promote appropriate use of antimicrobials in human and animal health through
antimicrobial stewardship.
The National Task Force on Physical Activity and Exercise
The Physical Activity Guidelines for
Barbados were developed as a key
component in support of the
mandate of the Task Force on
Physical Activity and Exercise. It helps
Barbadians at all stages of the life
cycle to increase their physical
activity levels through active play,
leisure activities and sports. The
guidelines provide a listing of sporting associations, councils and recreational facilities in
Barbados.
Barbados Voluntary National Review 2023
71
Ministry of Health and Wellness Initiatives
The Geriatric and the District Hospitals introduced therapeutic dietary services in January 2021.
Therapeutic dietary services aim to enhance the health of elderly clients who easily become
frail and weak through poor dietary intake, and to improve the management of nutritionrelated medical conditions. Additionally, refurbishments at the Geriatric Hospital in 2018 and
the completion of outstanding repairs at the St. Philip District Hospital resulted in increased
total bed capacity of 408. These actions will further enhance the rehabilitative services and
promote the independence, dignity and well-being of all clients. The construction of a new
Geriatric Hospital with the first phase of construction costing over BDS $100 million is expected
to be completed in eighteen (18) months.
Barbados Voluntary National Review 2023
72
Civil Society and NGO initiatives
Barbados Association of Medical Practitioners (BAMP)
The Better Health Radio Show focuses on a wide range of health topics and serves as a
knowledge platform to disseminate information to the public. In 2023, the focus has been on
NCDs under the theme ‘trying my best’ to encourage the public to maintain healthy lifestyles.
Additionally, the BAMP has a range of preventative healthcare activities which are targeted at
NCDs as this is a significant issue in Barbados and ultimately places a financial burden on the
healthcare system. In June 2023, BAMP will be launching a project aimed at increasing
awareness of cancer as a means of preventative care. The BAMP has partnered with the Heart
and Stroke Foundation (HSFB)to increase awareness of childhood obesity and provide
continuous education to the public.
The Barbados Trailway:
The Barbados Trailway project aims to repurpose approximately twenty-four (24) old train lines
in Barbados into a multi-use recreational area. The project involves clearing the land to create
safe spaces for locals and tourists to engage in activities such as cycling, walking, and hiking
away from main roads. The train lines pass through significant historic and cultural areas,
including plantations. While tourism is a potential aspect, the primary focus is to provide a safe
environment for recreation. As part of the project, five thousand (5,000) fruit trees will be
planted along the Trailway, serving as carbon offsets and providing free fruit to trail users. The
project has the potential to extend the Trailway all the way to Bridgetown, offering additional
benefits along the entire length of the space such as creating safe spaces, with reduced vehicle
emissions, and promoting public health by combating non-communicable diseases.
The University of the West Indies, Cave Hill Campus (UWI)
The University of the West Indies (UWI) Cave Hill Campus has provided expertise to assist not
only Barbados, but also the wider Caribbean communities to cope with the COVID-19
pandemic. UWI Cave Hill established a UWI COVID-19 Task Force and published several works
related to testing regimes, psychological vulnerabilities, non-pharmaceutical interventions and
produced a COVID in the islands e-book entitled “COVID-19 in the Caribbean and Pacific Island
Regions”.
Barbados Voluntary National Review 2023
73
Business and Professional Women’s Club
BPW engages in policy implementation in collaboration with the GOB on universal health
coverage. BPW has hosted several lectures and discussions on areas such as Nutrition and Diet
as an increase in NCDs is being fueled by Fast Food and reduction in consumption of vegetables
and fruits as well as inactivity. In 2022 these discussions reached 30 women.
The Heart and Stroke Foundation of Barbados
The HSFB is a key entity in the fight against non-communicable diseases in Barbados, with a
focus on cardiovascular diseases and strokes. The organization offers cardiac rehabilitation
service and professional certifications in First Aid and Basic Life Support. HSFB has facilitated
some of the major advocacy campaigns such as those linked to preventing childhood obesity,
the banning of sweet and unhealthy foods in schools and the “Know Your Numbers” campaign
which encourages persons to monitor their blood pressure.
Barbados Voluntary National Review 2023
74
SDG Targets under Goal 3 and Barbados’ Progress
This dashboard highlights Barbados’ progress with respect to the achievement of the SDG
targets under SDG 3: Ensure healthy lives and promote well-being for all at all ages.
Targets - SDG 3 – Ensure Healthy Lives and Promote Well-Being For All At All Ages Barbados’
Progress
By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live
births
By 2030, end preventable deaths of newborns and children under 5 years of age, with
all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live
births and under-5 mortality to at least as low as 25 per 1,000 live births
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne diseases and other communicable
diseases
By 2030, reduce by one third premature mortality from non-communicable diseases
through prevention and treatment and promote mental health and well-being
Strengthen the prevention and treatment of substance abuse, including narcotic drug
abuse and harmful use of alcohol
By 2030, ensure universal access to sexual and reproductive health-care services,
including for family planning, information and education, and the integration of
reproductive health into national strategies and programmes
Achieve universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable
essential medicines and vaccines for all
By 2030, substantially reduce the number of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and contamination
Substantially increase health financing and the recruitment, development, training
and retention of the health workforce in developing countries, especially in least
developed countries and small island developing States.
Target met or likely to be met by 2030/ substantial progress Moving away from target/ deterioration
Fair progress but acceleration is needed No trend data available
Limited or no progress Insufficient data/ not applicable
|
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{
"country": "brb",
"file_id": "sdg-03/vnr-report-brb-2023-en-8.pdf",
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|
Barbados Voluntary National Review 2023
4
Barbados’ Progress in Achieving the 17 Sustainable Development Goals
SDG in Focus Progress toward the Goal
The health and wellbeing of citizens is of paramount importance and Barbados has
advanced on many fronts in this regard. Our maternal, infant and child mortality rates
are low and our life expectancy is higher than the regional average. In 2020, the current
life expectancy was 80 years for females and 79 years for males. While noncommunicable diseases continue to pose a challenge to the health of our people, we
are making concerted efforts to address the risk factors. Access to health care is
facilitated by our universal healthcare system and we continue to improve on our
health financing to further strengthen our health care system.
|
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Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 20
Sustainable Development Goal 3
Ensure healthy lives and promote well-being for all at all ages
As highlighted in its Wawasan Brunei 2035,
Brunei Darussalam recognises the
importance of health in determining the
quality of life and wellbeing of the people as
well as its contributing role to national
development. The country also
acknowledges that healthcare is one of its
major public investments in human
development and that healthy and productive
citizens will positively contribute to socioeconomic development.
TOGETHER TOWARDS A HEALTHY
NATION
Universal health coverage is the cornerstone
of Brunei Darussalam’s health policy. As
such, quality of life in the country is enhanced
through the planning and implementation of
a healthcare system framework towards
universal health coverage for people at all
levels.
The Ministry of Health (MOH) through their
vision of ‘Together Towards a Healthy
Nation’ ensures the country’s continuous
provision of a high quality and
comprehensive health system that is
effective, efficient, responsive, affordable,
equitable and accessible. Its comprehensive
health system covers all aspects of health
promotion, prevention and control of illness,
treatment and rehabilitation.
This vision is fully aligned with SDG3 which
emphasises the importance of achieving
universal health coverage, including financial
risk protection, access to quality essential
healthcare services and access to safe,
quality and affordable essential medicines
and vaccines for all.
As a commitment to strengthen the national
health system and service in the country, the
MOH has formulated a Strategic Plan 2019-
2023, which prioritises five key goals:
i) Excellence in healthcare services;
ii) Prevention and control of NonCommunicable Diseases (NCDs);
iii) Protection of public health through
effective policies and regulations;
iv) Sustainability through resource
optimisation and innovation; and
v) Transparent and proactive governance.
The Strategic Plan is aligned with the World
Health Organization (WHO)’s
recommendations on strategic health
indicators and targets as a measure of the
country’s health status, risk factors, service
coverage and health systems. Extending
beyond healthcare in a clinical setting, the
Strategic Plan includes prevention and
control of diseases as well as protection of
public health at large. Most importantly, this
Plan aspires to consistently place people,
and not merely the diseases, at the centre of
the country’s healthcare.
Image: Universal health coverage.
Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 21
Brunei Darussalam has made remarkable
achievements particularly in meeting most of
the global health targets, including the
attainment of universal health coverage and
certification of free from infectious diseases
namely polio, malaria, measles and rubella.
Quality and accessible medical, dental and
healthcare continues to be provided at a
nominal fee of B$1 for citizens. This includes
high quality maternal and child health
services covering vaccination programmes
and antenatal screenings, which have
significantly contributed to the country’s low
maternal and child mortality rates. In 2018,
the country’s life expectancy was about 77.5
years.
In addition to the provision of public health
services, there are also specialised private
healthcare centres, such as Jerudong Park
Medical Centre (JPMC), Gleaneagles JPMC
and Pantai Jerudong Specialist Centre,
which itself consists of three centres, namely
the Brunei Cancer Centre, Brunei
Neuroscience Stroke and Rehabilitation
Centre as well as the Maxillofacial, Facial
Plastic and Reconstructive Surgery Centre.
PRIORITISING HEALTH OF WOMEN AND CHILDREN
As one of its priority agenda on health,
Brunei Darussalam is continuously
committed to improving the health of women
and children. This has thus far resulted in the
maintenance of low maternal mortality rates
and the achievement of the target set under
the SDGs for neonatal and child mortality.
Such commitment is in line with the call by
the global community, such as the United
Nations (UN) and WHO, which recognises
and strongly advocates the importance for
the improvement of women and child health
as they are key to the progress on all
development goals. Brunei Darussalam is in
a good position to continue achieving the
targets of reducing the global maternal
mortality ratio to less than 70 per 100,000 live
births as well as reducing the neonatal
mortality rate to at least as low as 12 per
1,000 live births and under-5 mortality rate to
at least as low as 25 per 1,000 live births.
Maternal and Child Health (MCH) services in
Brunei Darussalam has expanded
Selected Health Achievements
High Quality
maternal and child
health services
>95%
100%
antenatal coverage
births attended by skilled health personnel
Universal health
coverage
>80%
80%
coverage of essential services
customer satisfaction
High immunisation
coverage
>95%
100%
immunisation coverage for Diphtheria, Tetanus,
Pertussis, Influenza, Polio, Hepatitis (DTP-HibIPV-HepB 3), Mumps, Measles, Rubella and
Hepatitis B (birth dose).
Treatment coverage for Tuberculosis (TB) and
drug resistant TB.
Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 22
throughout the country and there are
currently 14 health centres, three health
clinics, three travelling clinics and two flying
medical services. In addition to providing
high quality antenatal, postnatal and child
healthcare, the MCH services also provide
health screening and birth spacing service
for women through the Well-Woman Clinic.
Home nursing care for mothers and infants
are also included in the first week following
delivery as well as home visits for monitoring
certain high-risk patients and for tracing
patients who miss their appointments.
Image: Prioritising health of women and children.
The completion of the new Women and
Children Centre in 2014 marked a significant
milestone in the history of women and child
healthcare in the country. The new Centre
provides enhanced holistic care and
integrated services for better quality, more
efficient and effective healthcare system to
the patients. The MOH has also developed a
‘National Strategy for Maternal, Infant and
Young Child Nutrition’ (MIYCN) with a
mission to improve the health and nutritional
status of mothers and mothers-to-be, infants
and young children. It reflects global targets
outlined by the WHO in the Comprehensive
Implementation Plan on MIYCN to reduce
incidences of childhood stunting, wasting
and overweight, low birth weight infants and
to increase the rate of exclusive
breastfeeding.
IMPROVING MENTAL HEALTH AND
WELL-BEING
Recognising that health encompasses
mental health and well-being, the
Government has undertaken efforts to
improve the mental health and well-being of
its people. The Mental Health Order 2014,
which came into force on 1 November 2014
to replace the Lunacy Act 1929 (Cap. 48),
aims to ensure equality, non-discrimination
and shared responsibility of stakeholders
when addressing the care and treatment of
mentally disordered persons. It is also to
ensure a patient-centred and holistic
approach in the care and treatment of
mentally disordered persons including their
rehabilitation and reintegration into the
community. Specific provisions were
included for special categories of patients
including those who lack the capacity to give
consent for treatment. There are additional
provisions for safeguarding the welfare of
mentally disordered persons at risk of abuse
or neglect, and those incapable of managing
themselves and their affairs.
The country also stresses the importance of
giving support and respect to individuals who
are experiencing mental health issues. In this
regard, the Government launched the ‘Talian
Harapan 145’, a national mental health
helpline, where qualified counsellors are
available to provide advice or counselling in
handling situations or pressure that can
cause mental or emotional disruption.
Although mental health is a fundamental
component of health, recognition of mental
disorders and awareness about its
importance is limited. In Brunei Darussalam,
the social stigma and lack of understanding
about mental disorders are major barriers to
seeking help amongst the public. Therefore,
increasing understanding and overcoming
stigma through strategic communications
and social mobilisation are crucial steps
Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 23
towards strengthening mental health
programmes locally.
Mental health promotion usually involves
actions that improve psychological wellbeing. The MOH, through various
departments and in collaboration with
relevant stakeholders, has gradually
increased its mental health promotion
activities in addition to the services currently
provided. One such initiative is the anti - bully
programme, ‘Bully - Free Brunei’ (‘Brunei
Bebas Buli’), which focuses on children,
particularly in the school setting. So far, more
than 40 out of 152 schools have participated
in the workshops run by this programme
since it was first launched in 2018. This
campaign, which is a collaboration between
the MOH and the Ministry of Education
(MOE), is further complemented by other
mental health promotion activities conducted
in schools.
The MOH has also organised several mental
health promotion programmes in
workplaces. Dubbed the ‘i-Mind
Programme’, this initiative focuses on the
wellbeing and emotional resilience of the
workforce apart from increasing their
understanding of mental disorders. Mental
health awareness campaigns have also
been conducted in the community, through
an initiative called ‘Mind Your Mind’ (‘Jaga
Minda Kita’). This effort, which aims to raise
public awareness and understanding about
mental disorders, has been carried out
annually since 2014 in public places
including major shopping malls, cafes and
mosques.
Realising the multi-sectoral nature of the
social determinants of and interventions for
mental health, as well as its many
associations with NCDs, mental health
promotion has been elevated as a key
initiative under the MOH’s strategic goals on
the prevention and control of NCDs and also
recently included under the purview of the
Multi-Sectoral Taskforce on Health in 2019.
It is hoped that these actions can help the
country to achieve the vision of a mentally
healthy and resilient nation.
PROTECTING PUBLIC HEALTH
Brunei Darussalam’s focus is also to
maintain its relatively low communicable
disease burden, reduce the risk of
importation of communicable diseases and
maintain preparedness in responding to any
outbreaks of infectious disease of public
health concern. Emerging and re-emerging
infectious diseases remain as a significant
public health threat regionally and globally as
evidenced by the impacts of the COVID-19
pandemic.
Although Brunei Darussalam has made
significant improvements in making the
country safer, it needs to continue to
enhance its capacities and preparedness
level through a whole of nation approach
linking all relevant sectors and players,
including finance, health, agriculture,
environment, emergency responders,
security agencies and others, in working
closely together to protect the public health.
In October 2019, Brunei Darussalam
conducted the Joint External Evaluation
(JEE) of International Health Regulations
(IHR) Core Capacities, an assessment of
Brunei Darussalam’s capacity to prevent,
detect and respond to public health threats
(which may be biological, chemical or
radiological in nature) and a joint review of
the country’s capacities to prepare for and
respond to complex public health
emergencies. A team of international health
experts and their national counterparts met
to evaluate Brunei Darussalam’s capacities
in 19 technical areas.
Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 24
Together, these areas, including disease
surveillance, national legislation, risk
communication capacity, food safety,
zoonotic disease and biosafety and
biosecurity, span the capacities required
under the International Health Regulations
(2005) to respond to all known natural and
man-made emergency health threats. The
National Committee on the Implementation
of the WHO IHR 2005, chaired by the
Minister of Health, will review, consider and
plan for the implementation of the various
recommendations from the JEE, once the
official report is finalised and released by the
WHO. The official report is expected to be
released in 2020.
PREVENTING AND CONTROLLING NCDs
Brunei Darussalam’s ‘National Multisectoral
Action Plan for the Prevention and Control of
NCDs (BruMAP-NCD) 2013-2018’ was
developed to prevent and control NCDs
through enabling healthier environments as
well as reducing risk factors and better
management. The goal is to achieve 18%
relative reduction by 2018 in Brunei
Darussalam to be fully aligned with the global
target of a 25% relative reduction in
premature mortality from NCDs by 2025.
Evaluation on this goal has been done by two
WHO consultants in November 2019, in
which the report is currently being drafted.
There are two strategic themes to the Action
Plan, namely improving health through
enabling environment and healthy choices,
and improving health through enhancing the
continuum of care for NCDs, with five
objectives, which are to:
i) Reduce tobacco use;
ii) Promote balanced and healthy diet;
iii) Increase physical activity;
iv) Identify people at risk for NCDs and
manage effectively; and
v) Improve the quality of care and outcome
of NCDs management.
Brunei Darussalam is committed to the
global targets for NCDs, whereby within the
next five years, the country targets to curb
obesity and diabetes; reduce the rate of
tobacco use by 30%; reduce the rate of those
suffering from high blood pressure by 25%;
reduce the rate of high sugar drinks intake
among children by 50%; and reduce the rate
of tooth decay in children.
This whole of nation approach in tackling
NCDs has been further strengthened with
the establishment of the Multisectoral
Taskforce on Health that currently oversees
five main cross-functional issues, namely:
i) Giving Every Child the Best Start in Life;
ii) Reducing Smoking;
iii) Improving Brunei Darussalam’s Food
Environment;
iv) Supporting Active Communities; and
v) Ensuring A Mentally Health and Resilient
Nation.
The Task Force is chaired by the Minister of
Health and members comprised of several
Permanent Secretaries and Heads of
Departments from relevant government
agencies. Identified actions have been
agreed on for each initiative and
implemented by the MOH in collaboration
with related government agencies, with
quarterly reporting on the progress of the
various initiatives and actions.
Image: Promoting healthy lifestyles at all ages.
Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 25
EMPOWERING THE ELDERLY
Image: One of the regular Tai Chi sessions at
Tasek Lama Recreational Park.
In 2019, senior citizens aged 65 years or
above accounted for approximately 4.8% of
4 UN World Population Prospects (2019).
the total population. UN 2019 estimations
showed that the elderly population in the
country is expected to double by 20304
. In
2017, the National Council on Social Issues
(MKIS) reviewed and approved the Senior
Citizens Action Plan, which is in line with the
2002 Madrid International Plan of Action on
Ageing and the Global strategy and action
plan on ageing and health (2016-2020).
This Action Plan has three main objectives to
ensure healthy and active citizens, namely
develop productive and independent senior
citizens, ensure the welfare and wellbeing of
senior citizens and provide friendly support
systems for senior citizens in ensuring a
friendly environment and encourage them to
be actively involved in the community.
Prevention and Control of NCDs:
Introduction of the National Health
Screening Programme to detect
and prevent NCDs which allows
early and effective management of
these diseases.
Amendments to the Customs Import
Tax and Excise Duties which
includes an increase in excise duty
for food and beverages that contain
high sugar and monosodium
glutamate content.
No importation and sales of
tobacco products since May 2014.
Healthier Choice Logo to
encourage the reformulation and
production of healthier choice
products to help consumers make
informed food choices.
Development of School Canteen
Guidelines and Drinking Water
Policy, for health promotion in
schools.
Development of the National
Nutrition and Physical Activity
Guidelines for Child Care Centres.
Community engagement
programmes such as through the
Mukim Sihat Programme and
Health Ambassadors’ Programme.
Workplace and Health Programme
(WAH), a collaborative programme
between MOH and Gleneagles
Jerudong Park Medical Centre, to
provide workplace environment that
support employees to eat healthy, be
more active and tobacco-free, in
addition to having good mental wellbeing.
Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 26
In support of such Action Plan is the
implementation of the senior citizens’ health
promotion programme which was first
introduced at the Senior Citizen Activity
Centre in Lambak Kanan, Brunei-Muara
District in 2014.
This was followed by a similar programme
conducted specifically for a local senior
citizen association, PENYULUH, in the Belait
District in 2015. The programme was
reviewed and re-introduced at the Senior
Citizen Activity Centres in the Tutong District
in 2018 and in the Belait District in 2019. This
revised programme is planned to be rolled
out to the Brunei-Muara and Temburong
Districts in 2020. The aim of the programme
is to raise awareness of senior citizens on
health-related issues, specific health
services and issues related to ageing as well
as to empower senior citizens so that they
can continue to live a healthy lifestyle and
enjoy good quality of life.
Healthcare in Brunei Darussalam has
evolved rapidly over the years to where it is
now achieving universal health coverage and
the provision of comprehensive services
encompassing primary, secondary to tertiary
care and also public health services that
serve in protecting the health and safety of
the general population.
Recognising the cross-cutting nature of
health issues and the importance of
engagement and partnership for health
through a whole of nation approach, the
MOH continues to actively engage other
relevant stakeholders and together, the
country intends to translate the strategic plan
for health into integrated actions, to derive
significant health outcomes and improve the
wellbeing of the people.
Image: Supporting World Cancer Day 2019.
Brunei Darussalam’s Voluntary National Review Report at the 2020 United Nations High-Level Political Forum | 27
A WHOLE OF NATION APPROACH
Brunei Darussalam AIDS Council (BDAIDSCOUNCIL)
The BDAIDSCOUNCIL aims to educate the public about HIV and AIDS in
order to be well informed and live a healthier life, with activities including:
Establishment of the Penyinar Club, the youth division of the
BDAIDSCOUNCIL:
o To motivate the youth members and other youth to practise a
healthy and positive way of living;
o To reach out to as many youths as possible on HIV/AIDS related matters for HIV
and AIDS prevention; and
o To spread awareness on HIV, AIDS and related issues, especially among youth
in Brunei Darussalam.
HIV Awareness Programme for Peers and Youth (HAPPY), which is a youth-led
project that spreads awareness on HIV throughout the country, including knowledge on
teenage pregnancy and sexually transmitted infections. It combines videos, audio,
visuals, games, songs, jokes, debates as well as comic strips to pass the message to
young people.
Life Skills Training (LESTARI) is a programme to teach young people various life skills
in an interactive and youth-friendly setting. While physically, mentally and emotionally
challenging, the programme is expected to assist the participants in facing their future
life.
Organising World AIDS Day programmes with forums and engagements with
stakeholders.
National Workshop on reproductive health for school counsellors and school
leaders.
Anonymous HIV testing.
Future plans include:
o The formation and empowerment of Community Groups. Based on the success
of the Penyinar Club, BDAIDSCOUNCIL plans to reach out to the grassroots
level to further engage and educate society. In the long term, this includes
various community groups whenever possible.
o A wider range of HIV and AIDS related services e.g. anonymous testing, support
groups etc.
|
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30
SUSTAINABLE DEVELOPMENT GOAL 3
Ensure Healthy Lives and Promote Well-Being for All at All Ages
OVERVIEW OF TARGETS AND ACHIEVEMENTS
Brunei Darussalam remains committed to
strengthen the healthcare system through the
principles of Universal Health Coverage, ensuring
the provision of services that are fair and accessible
to all. The COVID-19 pandemic has proven that
strong health system is a vital component for
preparedness in addressing any health-related
emergency, especially in supporting response as
well as its management. MOH holds the position
that investment in health is critical for the well-being
of society; Investment in health generates long and
high quality of life. At the same time, it assists in
achieving and advancing the Sustainable
Development Goals which are not limited to healthrelated matters. Citizens and residents in Brunei
Darussalam are provided with comprehensive and
accessible health services in all districts that are
provided by the Government of His Majesty the
Sultan and Yang Di-Pertuan of Brunei Darussalam
through the MOH. The development observed
under Goal 3 has been encouraging with progress
maintained in several key indicators. Brunei
Darussalam has maintained high proportions of
births in health facilities and attended by skilled
personnel, with a low rate of maternal and child
mortality. Several notable achievements include
high immunisation coverage for diseases attributed
to the National Immunisation Programme. Brunei
Darussalam’s population has access to and depends
on the public healthcare system which provides
universal healthcare coverage through highly
subsidised healthcare costs. Indicators that show
some regressions are concerning, in particular, the
indicators that are related to NCDs due to the
prevalence of risk factors as a result of lifestyle
behaviours.
Figure 10 Progress of Selected Indicators in Goal 3
31
INITIATIVES AND IMPLEMENTATION
Universal Healthcare
Brunei Darussalam affirms the universal right to
healthcare, stipulating that each citizen has the right
to enjoy a healthy life and to receive comprehensive
healthcare with quality standards.
To support this a significant amount is invested in
the health sector on an annual basis. As a result,
Brunei Darussalam has achieved most of the WHO
health-related targets. These include significant
reductions in the under-five mortality rate (U5MR)
and infant mortality rate (IMR). Figures from the last
two decades have shown only slight fluctuations to
the current level, which is on par with the standard
set in developed nations.
Brunei Darussalam continues to prioritise the
development of the health sector as an integral
aspect of achieving sustainable development.
Progress has been made and continues in terms of
good health and well-being. MOH continues its
efforts to ensure the population is in good overall
physical and mental health.
As part of Brunei Darussalam’s effort to ensure that
the health system reaches everyone in need and
strengthen the global commitment to ensuring that
no one is left behind, Brunei Darussalam continues
to provide comprehensive primary health care to all.
This includes services to rural and remote villages in
the country that includes management of minor
illnesses and chronic diseases, and health
promotion and prevention through Flying Medical
Service.
COVID-19 Pandemic and Health
The COVID-19 pandemic has shown us the wisdom
of what is inherent within the 2030 Agenda and at
the same time strengthened the need for solutions
to be dealt with collaboratively and collectively.
Several key actions were put in place to respond to
COVID-19. In addition to setting up major swabbing
centres, an additional National Virology Laboratory
was constructed to increase the capacity and
accelerate the testing process for COVID-19 in the
country by ten-fold. To tackle the second wave, an
additional virology laboratory called the Brunei
COVID-19 AirLab was set up. The new lab was a
result of cooperation between the Government and
the Borneo Genomic Institution. Community
isolation centres were established including a new
extension to the National Isolation Centre. All
centres are equipped with medical facilities to treat
and monitor confirmed positive COVID-19 patients.
During the peak of the pandemic, quarantine
facilities and arrangements are also prepared for
arrivals into Brunei Darussalam from abroad who
are required to undergo self-isolation at designated
accommodations upon arrival.
One of the most significant efforts made was the
introduction of the BruHealth application. As an
epidemic response and population engagement
platform, BruHealth assists MOH in sharing
information and contact tracing. A self-assessment
tool was also made available on the BruHealth
application to help individuals self-assess possible
COVID-19 symptoms and provide real-time
information.
In an attempt to ensure information is delivered in a
timely and efficient manner, regular press
conferences were held to provide the latest
information on COVID-19 in Brunei Darussalam. The
Health Advice Line 148 was also set up for members
of the public who required additional information
and health advice. Additional sources of information
were also made available through other means, for
example, the mobile application Telegram for
Gov.bn. The application has been upgraded with
additional features to support digitalisation of
healthcare services, such as online booking of
vaccinations, medical appointments, personal
health records tracker, access to video
consultations, and an online payment platform.
32
The Government also developed a vaccination
strategy for the citizens and residents of Brunei
Darussalam, following the guidelines set by WHO
and advisory from the MOH Vaccine Technical
Committee. The vaccination strategy contributes
significantly in slowing down the COVID-19
transmission in the country and has shown an
evidence of higher immunity among the people. The
National Vaccination Programme is free for all
citizens and people residing in Brunei Darussalam
aged 18 years old and above. The vaccination
programme distribution strategy is divided into
three phases and a vaccination centre was allocated
for each district. As of May 2023, 79.2 per cent
received three doses of the vaccine. Mobile
vaccination services and home visits were also
offered to ensure rural and bedridden residents
have access to the vaccine.
Health Agenda
As the world transitions to recovering from COVID19 pandemic, Brunei Darussalam has eased most
control measures and looking at further action to
improve the healthcare systems. The health
initiatives implemented align with the World Health
Organisation (WHO) NCDs Global Monitoring
Framework with a target to combat a global NCDs
and reduce the mortality rate by 2025, which
includes reducing inactivity by 10 per cent. The
global indicators include overweight, obesity, and
raised blood pressure. These indicators have been
used as a basis for key performance indicators under
Brunei Darussalam’s NCDs prevention. Brunei
Darussalam is facing a rising incidence of NCDs.
NCDs including cancer, cardiovascular disease and
diabetes mellitus are major causes of mortality in
Brunei Darussalam, accounting for close to 67 per
cent of all premature deaths.
Noncommunicable Diseases
MOH published The Brunei Darussalam
Multisectoral Action Plan for the Prevention and
Control of Noncommunicable Diseases (BruMAPNCD) 2021 to 2025 which serves as guidance
towards achieving global and national targets on the
prevention and control of NCDs. The action plan
takes into consideration a whole-of-government
and whole-of-society approach in tackling NCDs
with a mission to prioritise and improve prevention,
early detection, and management of NCDs and their
risk factors. The goal is to reduce the probability of
dying between the ages of 30 and 69 years from
cardiovascular disease, cancer, diabetes, or chronic
respiratory diseases by 10 per cent by 2025 through
four objectives set out, namely:
• To strengthen national governance for NCDs
prevention and control;
• To reduce NCDs risk factors and protect
health;
• To strengthen early detection and clinical
management of NCDs and NCDs risk factors;
and
• To strengthen NCDs surveillance and research.
These objectives have a set of recommended
actions for all health and non-health sectors
involved and stakeholders identified. In
implementing this BruMAP-NCD 2021-2025, the
existing Multisectoral Taskforce for Health through
the Cross Functional Team and the Ministry of
Health Executive Committee through the National
NCD Technical Committee will be the coordinating
bodies to ensure the implementation of actions and
strengthen coordination.
Figure 11 Number of New Cases of NCDs in 2020
(Source: Ministry of Health, Brunei Darussalam)
33
Mental Health
In addition to physical health, good mental health is
also seen as key to achieving holistic well-being. In
recognition of the need to increase awareness of
mental health issues, the Mental Health Strategy
Group under the Health Promotion Centre (HPC) has
initiated several key actions, including the
development of guidelines with the collaboration of
key agencies such as the MOE in addressing
depression and bullying. Mental illness in Brunei
Darussalam has intensified during the COVID-19
pandemic. This has put more emphasis on the need
for a whole-of-nation approach to address the issue.
Brunei Darussalam developed a Mental Health
Action Plan 2021-2025 as part of its commitment to
improving mental health literacy and care. Four
main strategies and 12 priority actions are identified
in the Mental Health Action Plan:
• Strengthen Effective Leadership and
Governance for Mental Health.
• Strengthen Mental Health Services by
ensuring the availability and accessibility of
comprehensive quality mental health services.
• Strengthen Mental Health Promotion and
Mental Disorder Prevention.
• Develop Capacity for National Information
Systems and Research for Mental Health.
Sadly, there have been reports of increases in the
suicide rate, from an average of five cases reported
from 2010 to 2015, to an average of 10 cases from
2016 to 20203
. About 7,000 people (approximately
1.5 per cent of the country’s population) are
reportedly treated for mental illness, and up to 40
new adult cases and about 600 follow-up cases are
seen each month by the Adult Psychiatry Services3
.
As reported in 2021, Bru-HIMS data showed that
around 1,515 individuals were diagnosed with
anxiety disorder, and more than 900 individuals also
experienced depressive disorder. A health helpline
provides crisis support for those struggling with
mental disorders and awareness programmes are
actively carried out to tackle this issue, not just by
the government but also by private sectors as well
as NGOs, creating awareness on mental health
issues, reducing stigma and increasing support.
Brunei Darussalam, as the ASEAN Chair 2021, also
placed emphasis on caring for the people and each
other’s well-being. Towards this, among others, in
October 2021, the Declaration on the Elimination of
Bullying of Children in ASEAN was adopted, to
strengthen concerted efforts and undertake
appropriate measures to promote and protect
children in ASEAN against all forms of bullying in
different settings, ensuring that their best interests
and welfare are upheld. At the same time, ASEAN
and its Dialogue Partners also recognised the
importance of strengthening regional cooperation
especially towards addressing the impacts of the
pandemic on mental health.
Creating Health-Conscious Citizens
MOH encourages workplaces to provide supportive
environments and actions for employees in taking
preventative measures to control NCDs. In line with
this effort, HPC introduced various programmes
such as i) the Workplace and Health (WAH)
Programme; and ii) the Happy Environment and
Lifestyle (HEAL) Programme. The WAH Programme
focuses on encouraging the workplace to provide a
supportive environment where employees can be
more active, eat healthy diets and also have good
mental well-being.
3 Brunei Darussalam Mental Health Action Plan 2022-2025
Meanwhile, HEAL is aimed at physical activity
interventions. These programmes were funded by
Gleneagles Jerudong Park Medical Center (JPMC)
following the signing of the Memorandum of
Understanding between MOH and Gleneagles
JPMC, showcasing one of the biggest collaborations
of a public-private partnership (PPP) ever held. They
also engaged with a wide range of stakeholders
including schools, communities, and businesses. The
projects also include group health talks, counselling,
exhibition, BMI health screening, as well as free
after-work hours group exercise sessions for all civil
servants.
34
To date, over 10,000 government personnel from 13
ministries have participated in the WAH health
screen programme, and over 200 WAH exercises
have been conducted through their appointed
Fitness Studio Facilitators.
Other initiatives have been introduced to encourage
citizens to practice a healthy lifestyle including
National Physical Activity Guideline, which provides
recommendations on the amount of physical
activity, the health benefits and disadvantages of
sedentary behaviour for children, adolescents,
adults and elderly, and those with chronic
conditions and special physical needs. This guideline
was also prepared in alignment with the WHO
Guidelines on physical activity and sedentary
behaviour. Several initiatives have been introduced
to support this, such as a National Campaign to
improve walking steps known as BN on The Move,
and The Bandarku Ceria Weekly Car-Free Zone, to
encourage people to engage in sports, leisure,
business, and recreational activities.
Universal Health Through Digitalisation
The COVID-19 pandemic has accelerated digital
transformation in healthcare globally, and Brunei
Darussalam is no exception. There is now a need to
embrace technology to support the changing
demands within health. Brunei Darussalam is also
exploring the possibility of introducing telehealth
and telemedicine service, moving towards precision
public health, an emerging discipline that applies
genomics and other big data tools and technologies
to investigate and control health threats in
communities. This is part of the Ministry’s
continuous effort and initiative to embrace new
technology as well as strengthen the resilience of
Brunei Darussalam to the healthcare ecosystem.
CHALLENGES AND OPPORTUNITIES
Goal 3 seeks to ensure the health and well-being of
all ages. Investing in health remains a priority,
however, the challenges are in ensuring
sustainability in the long-term when faced with
future changes such as changes in demographics
due to ageing and advancements in disease control.
With that, future health spending is expected to rise
even further as new techniques and therapies
become available. Nonetheless, the future is
promising with the availability of data, technology,
and artificial intelligence which could enable
improved well-being and real-time interventions
that allow us to get ahead of sickness and be far
ahead of the disease.
35
FEATURE 3
Healthcare Data Intelligence and Cross Border Collaboration
MOH and EVYD Technology established the MOH
Intelligence Hub at EVYD Campus on 1 November
2022. The opening of the Hub is part of MOH’s
efforts to strengthen the resilience of Brunei’s
healthcare ecosystem. The Hub contains the
Epidemic Intelligence and Response Unit (Disease
Control Division), a surveillance centre to monitor
the nationwide spread of diseases; the Climate
Change Adaptation and Resilience Unit; and the
Digital Health Unit. In the future, more
government health units are planned including
the Behavioural Insights Programme, the
National Clinical Research Unit, and the NonCommunicable Disease Unit.
The MOH Intelligence Hub symbolise the
ministry’s strategic vision and forward planning. It
represents the Ministry of Health’s commitment
to embrace and adopt new technologies and in
digital health transformation. The ministry will
continue to proactively leverage technology to
further accelerate the digital optimisation of
Brunei’s healthcare ecosystem. Recognising the
efficacy of Big Data and Artificial Intelligence in
optimising sharper insights and outcomes for
public health, the intelligence hub will explore the
use of science and technology in transforming
public health policymaking. It also provides a
research ecosystem and infrastructure that
promotes partnerships, cross-learnings, and
collaboration with academic and scientific
experts for innovative solutions to modern
healthcare issues.
The Epidemic Intelligence and Response Unit
Surveillance Centre specifically leverages a
recently developed automated communicable
disease surveillance system linked with clinical
and laboratory data to track and monitor the
emergence and spread of over 50 infectious
diseases in real-time.
Cross-Border Collaboration to Strengthen
Health Systems
A Memorandum of Understanding (MOU) with
the National University of Singapore Saw Swee
Hock School of Public Health was signed as a
cross-border collaboration to strengthen health
systems between Brunei Darussalam and
Singapore. Under MOU includes key elements
such as:
• Building the research ecosystem and
infrastructure to conduct research
relevant to policy-making;
• Organising and participating in joint
academic and scientific activities; and
• Identifying opportunities for knowledge
transfer, capability building, and joint
research and development in areas of
mutual interest.
Given the increasingly complex health challenges
in a borderless world today, there is much value
that we can realise by fostering greater crossborder collaborations to improve our public
health responses collectively. Through this
regional collaboration, the healthcare systems in
Brunei Darussalam and Singapore can be
strengthened. Brunei Darussalam is also happy to
share key initiatives and learnings with the rest of
our ASEAN member countries to improve public
health across the region.
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{
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|
BOTSWANA VOLUNTARY NATIONAL REVIEW ON
SUSTAINABLE DEVELOPMENT GOALS 2017 21
4.3SDG3:ENDINGPOVERTYANDENSURING
HEALTHYLIVESANDWELL-BEING
BOTSWANA VOLUNTARY NATIONAL REVIEW ON
SUSTAINABLE DEVELOPMENT GOALS 2017 22
4.3.3.1 KEY INTERVENTIONS SDG TARGET 3.1
MATERNAL MORTALITY
4.3.3.2 CHALLENGES FACED
23 BOTSWANA VOLUNTARY NATIONAL REVIEW ON
SUSTAINABLE DEVELOPMENT GOALS 2017
BOTSWANA VOLUNTARY NATIONAL REVIEW ON
SUSTAINABLE DEVELOPMENT GOALS 2017 24
|
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3
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{
"country": "bwa",
"file_id": "sdg-03/vnr-report-bwa-2017-en-3.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2017
}
|
République centrafricaine Examen volontaire sur la mise en œuvre des objectifs du développement durable 2019 26
ODD3 : Permettre à tous de vivre en bonne
santé et promouvoir le bien-être de tous à tout
âge
Depuis plus d’une décennie, les politiques menées
par le Gouvernement ont placé l’amélioration de la
santé des populations au centre de leurs
préoccupations. L’accès à un état sanitaire de qualité
prend nécessairement en compte l’ensemble des
déterminants de la santé que sont : des services de
santé accessibles à tous surtout aux pauvres ; un
environnement social et politique favorable à la
santé ; une responsabilisation plus accrue des
individus, des familles et des communautés vis-à-vis
de leur santé.
Le Plan National de Développement Sanitaire
(PNDS), en tant qu’instrument de mise en œuvre de
la Politique Nationale de Santé (PNS) en
République Centrafricaine, est basé sur une
programmation à long terme (10 ans) et regroupe de
ce fait l’ensemble des interventions prioritaires dans
le secteur.
En RCA, la politique de santé du pays est fondée sur
les Soins de Santé Primaires (SSP) dont les
composantes ont été déclinées en programmes de
santé contenus dans le PNDS II (2006-2015). Avec
la crise humanitaire qui a entrainé une déliquescence
du système de santé, un Plan de Transition du
Secteur de Santé (PTSS) a été élaboré pour la
période de 2015-2017 en vue de répondre aux
urgences humanitaires.
⇒ le taux de mortalité maternel en RCA est très
élevé avec 880 décès pour 100 000 naissances
vivantes entre 2016 et 2018. Ce taux
représente le 2ème taux le plus élevé au niveau
mondial (UNICEF 2018) ;
⇒ la proportion d’accouchements assistés par le
personnel de santé qualifié (accouchements
assistés effectués à domicile et accouchements
assistés effectués en milieu surveillé) a
légèrement augmenté, car elle est passée de
52% en 2015 à 54% en 2018 soit une hausse
de 3,7% sur la période (RNDH, 2017);
⇒ le taux de mortalité des enfants de moins de 5
ans affiche une tendance à la baisse entre 2016
et 2018, passant de 179%0 à 139%0. Mais ce
taux demeure très élevé, car il occupe le 3eme
rang au niveau mondial (UNICEF 2018);
⇒ le nombre de nouvelles infections au VIH
affiche une tendance plus ou moins stagnante
entre 2015 et 2018, passant de 9200 personnes
en 2015 à 11 200 en 2016 avant de revenir à
9200 personnes en 2018. Spécifiquement, le
nombre des enfants nouvellement infectés de
moins de 15 ans (fille et garçon) dont l’âge
varie entre 0 et 14 ans, est passé
respectivement de 1100 et 1700 en 2015 à
1100 pour les garçons et 1500 filles en 2018.
Pour les hommes et les femmes de plus de 15
ans, le nombre est passé de 3500 pour les
femmes, 2900 pour les hommes en 2015 à
3800 femmes et 2800 hommes en 20186
.
⇒ le nombre de personnes mis sous ARV est
passé de 28 303 en 2015, à 42 000 en 2018.
Tandis que le nombre des décès liés au VIH
(jeunes et adultes) est passé de 7 800 à 2015 à
5 200 en 2018. Cette baisse s’explique par les
principes de 3-907
, et de dépister et traiter mise
République centrafricaine Examen volontaire sur la mise en œuvre des objectifs du développement durable 2019 27
en œuvre par le Gouvernement avec l’appui
des partenaires (ONUSIDA, 2018).
⇒ L’incidence de la tuberculose pour 100 000
habitants est passée de 391 en 2015 à 423 en
2018. La tendance est en progression sur la
période du fait de non prise en compte des
mesures adéquates d’hygiène, de l’insalubrité
et de la promiscuité parmi les populations
déplacées dans les sites. (OMS, Profil pays de
la tuberculose, 2018)
⇒ Le taux d’incidence annuelle des cas confirmés
du paludisme a augmenté entre 2012 et
2016passant de 19 à 204 cas pour 1000
habitants avant de diminuer légèrement à 198
cas pour 1000 habitants entre 2017 et 20188
.
Selon les études du Ministère de la santé, le
paludisme s’établit comme la première cause
de morbidité en RCA.
Pour assurer le bien-être des populations, 4 cibles
ont été retenues sur 9 pour traduire les efforts du
Gouvernement à savoir : C3.1 : d’ici à 2030, faire
passer le taux mondial de mortalité maternelle audessous de 70 pour 100 milles naissances vivantes ;
C3.2 : d’ici à 2030, éliminer les décès évitables de
nouveau-nés et d’enfants de moins de 5 ans, tous les
pays devant chercher à ramener la mortalité
néonatale à 12 pour mille naissances vivantes au
plus et la mortalité des enfants de moins de 5 ans à
25 pour mille naissances vivantes au plus ; C3.3:
d’ici à 2030, mettre fin à l’épidémie de sida, à la
tuberculose, au paludisme et aux maladies
tropicales négligées et combattre l’hépatite, les
maladies transmises par l’eau et d’autres maladies
transmissibles et C3.6 : d’ici à 2020, diminuer de
moitié à l’échelle mondiale le nombre de décès et de
blessures dus à des accidents de la route.
Au cours des dix dernières années, les autorités
centrafricaines et les différents partenaires au
développement ont déployé des efforts pour réduire
la mortalité maternelle et infanto-juvénile. Des
actions suivantes ont été menées : (i) l’élaboration
du Plan de Transition du Secteur de la Santé pour la
période 2015-2016 pour servir de boussole pour la
relance du système de santé de la RCA à la suite des
évènements qu’a connu le pays entre 2012 et 2013 ;
(ii) le renforcement de la prise en charge des
urgences obstétricales par le gouvernement ; iii)
l’implication des ONG et de la communauté à
travers la formation et l’équipement des
accoucheuses traditionnelles pour la détection
précoce et l’orientation dans les centres mieux
équipés ; iv) l’intégration d’un paquet à haut impact
8 Word Vision RCA, Projet de lutte contre le
paludisme/financement Fond Mondial
pour la réduction de la mortalité maternelle
(SONU/GATPA, vaccination antitétanique,
supplémentation en fer, prise en charge des femmes
enceintes vivant avec le VIH/SIDA, la planification
familiale) ; et v) la multiplication des campagnes
nationales de distribution de moustiquaire
imprégnée d’insecticide de longue durée (MILD),
ayant contribué à la réduction de la morbidité et la
mortalité liées au paludisme.
En perspective, le récent décret n°19.037 du 15
février 2019 portant gratuité ciblée aux femmes
enceintes, femmes allaitantes, aux femmes victimes
de VBG et les enfants de 0-5 ans permettra
d’améliorer la situation sanitaire des populations et
du bien-être de tous.
|
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{
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|
25
ODD3 : Permettre à tous de vivre en bonne santé
et promouvoir le bien-être de tous à tout âge
L’amélioration de la santé et du bien-être des populations a été au centre des préoccupations
majeures des politiques du gouvernement centrafricain depuis des décennies. L’accès à un
état sanitaire de qualité prend nécessairement
en compte l’ensemble des déterminants de la
santé que sont : des services de santé accessibles à tous ; un environnement social et politique favorable à la santé ; une responsabilisation plus accrue des individus, des familles et
des communautés vis-à-vis de leur santé.
Ainsi, durant les périodes de mise en œuvre des
ODD en RCA, les autorités centrafricaines et les
différents partenaires au développement ont déployé des nombreux efforts. Des actions suivantes ont été menées : le pays s’est doté d’un
Plan de Réponse au COVID-19 ; d’un document
d’investissement pour « la réduction de la mortalité maternelle, néonatale et infanto-juvénile, et
pour l’amélioration de la santé des adolescents » sur la période 2020-2022.
6 Rapport SARA HERAMS 2017
A cause des différents événements qu’a
connus le pays, trois Plans intérimaires ont
été élaborés à savoir : Plan Intérimaire de
Santé (PIS) de 2000 à 2002, le Plan de
Transition du Secteur de la Santé (PTSS)
de 2015 à 2017, et enfin, le Plan Intérimaire
du Secteur de la Santé (PISS) de 2018 à
2019. Ce n’est qu’en 2021 après l’élaboration de la Politique Nationale de Santé
2019-2030 que le pays avec l’aide des
PTFs s’est doté du Plan National de Développement Sanitaire 2022-2026 qui a été
approuvé par le Gouvernement en Conseil
des Ministres le 18 novembre 2022. Ce
plan a défini 4 orientations stratégiques à
savoir : i) amélioration de la gouvernance
du système de la santé, ii) renforcement de
la résilience du système de santé, iii) structuration de l’offre en vue d’une réponse
adéquate à la demande de soins et services de santé et iv) renforcement de la
préparation et de la riposte contre les endémo-épidémies et pandémies y compris
la pandémie à Covid-19 qui doivent guider
nos interventions pour amorcer la marche
du pays vers la couverture sanitaire universelle en vue de l’atteinte des ODD.
Par ailleurs, avec la crise humanitaire qui a
entrainé une dégradation du système de
santé, la densité des professionnels de
santé est de 7,3 pour 10000 habitants
contre 23 recommandés par les normes
en 2017 contre 6,03 en 2021, l’indice de
disponibilité de l’infrastructure est de
67,1% au niveau national en 20176 l’indice
de l’utilisation des services de santé est de
2,3% au niveau national en 2021, l’indice de
disponibilité des services de santé au niveau national est de 33,7% en 2017 et la
capacité opérationnelle générale des services est évaluée à 50% en 2017.
Au regard du taux élevé de morbidité et de
mortalité dans le pays, l’intégration d’un
paquet à haut impact pour la réduction de
la mortalité maternelle (SONU/GATPA, la
vaccination antitétanique, la supplémentation en fer, la prise en charge des femmes
enceintes vivant avec le VIH/SIDA, la planification familiale) , la multiplication des
campagnes nationales de distribution de
moustiquaire imprégnée d’insecticide de
26
longue durée (MILD), et la couverture vaccinale
ont été des actions engagées par le gouvernement.
Pour assurer la santé et le bien-être des populations, 4 cibles sur 9 ont été retenues pour traduire les efforts du Gouvernement.
Cible 3.1 : D’ici à 2030, faire passer le taux mondial de mortalité maternelle au-dessous de 70
pour 100 000 naissances vivantes
Le ratio de mortalité maternelle en RCA reste
élevé avec 880 décès pour 100 000 naissances
vivantes entre 2016 et 2018. Il est passé à 829
décès pour 100 000 naissances en 2020 à 835
deces pour 100.000 naissances vivantes en
2022. Ce ratio représente le 2ème ratio le plus
élevé au niveau mondial selon l’OMS (2021).
Cible 3.2 : d’ici à 2030, éliminer les décès évitables de nouveau-nés et d’enfants de moins de
5 ans, tous les pays devant chercher à ramener
la mortalité néonatale à 12 pour mille naissances vivantes au plus et la mortalité des enfants de moins de 5 ans à 25 pour mille naissances vivantes au plus
Le taux de mortalité des enfants de moins de 5
ans affiche une tendance à la baisse entre 2016
et 2021, passant de 179%0 à 99%0.
Les progrès réalisés en 5 ans montrent que le
pays pourrait atteindre la cible de 25 pour 1000
naissances vivantes à l’horizon 2030 et il faudra
donc soutenir et développer également dans ce
secteur des interventions à haut impact.
Le taux de mortalité néonatale est passé de 43‰
en 2015 à 28‰ en 2020. Une analyse des progrès montre qu’en 5 ans le pays a réduit la mortalité néonatale de 15 pas.
Si cette tendance se maintient le pays pourra
être en mesure d’atteindre la cible de cet ODD
qui est de 12 décès pour 1000 naissances vivantes en 2030.
Cible 3.3: d’ici à 2030, mettre fin à la pandémie
du sida, à la tuberculose, au paludisme et aux
maladies tropicales négligées et combattre
l’hépatite, les maladies transmises par l’eau et
d’autres maladies transmissibles
Selon les estimations de l’ONUSIDA, la prévalence est passée de 3,6% en 2016 à 2,6% en
2022. Elle est estimée à 3,4% [2,7 – 4,2] chez les
femmes de 15 à 49 ans et de 2,1% [1,6 – 2,6]
chez les hommes de même âge. Chez les
jeunes de 15 à 24 ans, la prévalence est de
1,2%, plus élevée chez les jeunes filles que
chez les garçons (1,5% versus 1,0%). les
nouvelles infections sont passées de 4205
en 2016 à 2700 en 2021, soit une baisse
de 36%. Le nombre de personnes mises
sous ARV est passé de 28 303 en 2015, à
59 055 en 2022 soit une augmentation de
52% des personnes mises sous ARV. Malgré cet effort, l’objectif de 95% des personnes vivant avec le VIH à mettre sous
ARV d’ici 2025 est loin d’être atteint.
Les hépatites virales constituent une véritable menace pour les populations centrafricaines. Dans la population générale, la
prévalence de l’hépatite B est à 12,86% soit
environ 5 fois celle du VIH.
L’incidence des cas de TB est estimée à 29
000 (19000 - 42000) dans le rapport mondial de l’OMS 2021 alors que le pays n’a notifié que 13 216 cas de TB.
Le paludisme demeure un problème important de santé publique en RCA de part
son ampleur et ses conséquences. La
transmission est stable sur toute l’étendue
du territoire, toute la population est à
risque mais, les plus vulnérables sont les
femmes enceintes et les enfants de moins
de 5 ans ainsi que les personnes venues
des pays non endémiques. L’incidence du
paludisme a connu une baisse régulière,
sur 5 ans, passant de 346,4 en 2015 à
322,9 pour 1000 habitants en 2019
(source Rapport Mondial 2022 de l’OMS
sur le paludisme). Concernant la mortalité
due au paludisme on a constaté une
baisse régulière du taux passant de 12,8
en 2015 à 9,4 pour 10 000 habitants en
2021 sans atteindre la cible intermédiaire
de 2020 fixée dans la stratégie technique
mondiale 2016-2030 qui devrait conduire à
un taux de mortalité de 7,7 pour 10 000 habitants.
Cible 3.6 : d’ici à 2030, diminuer de moitié
à l’échelle mondiale le nombre de décès et
de blessures dus à des accidents de la
route
L’indicateur retenu pour cette cible est le
taux de mortalité lié aux accidents de la
route. Le pays ne dispose pas des données
27
statistiques sur cet indicateur. Toutefois, pour
réduire les accidents de la route, le gouvernement avec l’appui des partenaires a organisé plusieurs campagnes de sensibilisation à l’endroit
des conducteurs principalement des conducteurs de mototaxis afin d’améliorer leurs connaissances sur la sécurité routière.
|
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32
Goal-by-goal actions
SDG 3: Ensure healthy lives and
promote well-being for all at all
ages
Health is a key driver of sustainable
development. Good physical and
mental health is essential for individual
well-being, supports gender equality
and the empowerment of women and
girls, enables inclusive and sustainable
growth and effcient labour markets,
and enables robust community
participation and engagement. By
achieving good health for all, societies
can be more peaceful, more inclusive
and more prosperous.
Canada is committed to fulflling
the right of everyone to enjoy the
highest attainable standard of
physical and mental health, in line
with the International Covenant on
Economic, Social and Cultural Rights.
Canada recognizes that fulflling this
right depends on realizing its other
human rights commitments, including
ensuring freedom from all forms of
discrimination and protecting the
most vulnerable.
The Government of Canada works
with provincial and territorial partners
on measures to improve access to
health services and address the health
determinants associated with attaining
and maintaining the physical and
mental well-being of all Canadians. In
addition, Veterans Affairs Canada has
developed a Well-being Framework
to provide ongoing, systematic
assessment and to measure veterans’
well-being.
Canada’s predominantly publicly
fnanced and administered healthcare system is designed to ensure
that all eligible residents have no-cost
access to hospital and physician
services. This system is governed by
the principles of public administration,
comprehensiveness, universality
and accessibility, and refects the
underlying Canadian values of equity
and solidarity. While the provinces
and territories lead in the design and
delivery of health care and health
services, the federal government
SDG 3: Ensure healthy lives and promote well-being for all at all ages 33
ensures a national standard is
maintained through the Canada
Health Act and provides long-term
predictable funding through the
Canada Health Transfer.
Leaving no one behind
Canada recognizes the importance
of identifying and eliminating
inequalities in health outcomes.
Health inequalities, in Canada as
elsewhere, are frequently associated
with social determinants of health,
that is, those factors outside of the
health-care system that affect health,
including income and social status,
employment, education, childhood
experiences, race, ethnicity, gender
and culture.
The Pan-Canadian Health Inequalities
Reporting Initiative strengthens
understanding of health inequalities
and their main drivers in Canada. One
of its key products, the interactive
Health Inequalities Data Tool, was
launched in 2017. The Data Tool
contains inequality results for over
70 indicators of health outcomes and
health determinants, broken down at
national and provincial/territorial levels
by a range of social, economic and
demographic factors. This new source
of evidence can help inform policy
and program development and more
effectively reduce health inequalities
experienced in Canada, particularly
those faced by Indigenous peoples.
Signifcant health disparities still
persist between Indigenous and
non-Indigenous populations in
Canada, including higher rates of
infant and young child mortality,
infectious and chronic diseases
(e.g. tuberculosis, HIV/AIDS, diabetes
and cardiovascular disease) and
diseases caused by environmental
contamination.
In August 2017, the Prime Minister
of Canada announced the creation
of a new Department of Indigenous
Services Canada (ISC). The
overarching vision of this new
department is to support the selfdetermination of Indigenous peoples,
who should control service delivery for
their own communities. ISC’s mandate
offers tremendous opportunity to
reduce health disparities within
Canada’s Indigenous populations.
Nearly $12 billion from the last two
federal budgets was designated to
improve the social determinants of
Indigenous peoples’ health. This
investment will expand addictions
treatment and prevention services
for First Nations, respond to high TB
rates in Inuit communities, support
access to First Nations-controlled
quality health care and dedicate
resources to work with First Nations
partners to transform their health
systems.
In support of this, the Government of
Canada is also working in partnership
with Indigenous partners at the
national, regional and local levels to
implement an approach to service
delivery that is patient-centred,
focused on community wellness
and effectively linked to provincial/
territorial health-care systems.
Furthermore, the Government of
Canada has signed the Canada–Métis
Nation Accord, the Assembly of First
Nations–Canada Memorandum of
Understanding on Joint Priorities and
the Inuit Nunangat Declaration on
Inuit–Crown Partnership, which all
identify health and wellness priorities
for their communities.
Rising to the challenge
Child health
Children are vulnerable to health
disparities, as negative early
childhood experiences can have
life-long affects. For this reason,
Canada has dedicated children’s
health surveillance programs that
focus on congenital anomalies, rare
and emerging paediatric diseases,
childhood cancers, injuries, as
well as risk and protective factors
(e.g. obesity, physical activity, sleep
and child maltreatment). Canada
works with leading experts and
partners from across the country to
improve maternal and infant health
surveillance through collecting and
providing timely, comprehensive
information.
SDG 3: Ensure healthy lives and promote well-being for all at all ages
34
Chronic diseases
Major chronic diseases—e.g.
cardiovascular diseases, cancer,
chronic respiratory diseases and
diabetes—cause 65% of all deaths in
Canada each year. In partnership with
private and non-proft organizations
and other levels of government,
Canada tests and scales up
interventions to prevent chronic
diseases, focusing on common risk
factors, e.g. unhealthy eating, physical
inactivity, tobacco, drug and alcohol
use. Canada continues to implement
the World Health Organization
Framework Convention on Tobacco
Control and through its tobacco
strategy, has helped reduce smoking
rates to an all-time low in Canada.
Canada’s revamped tobacco strategy
aims to reach a target of less than
5% tobacco use by 2035. Canada
is implementing a regime for vaping
products as a less harmful alternative
to smoking and is cooperating on
cross-border efforts to stop, prevent
and address the traffcking of illegal
tobacco products.
Canada’s Healthy Eating Strategy aims
to improve the food environment in
Canada to make it easier for Canadians
to make healthier choices. The Strategy
is made up of complementary initiatives,
including a ban on using partially
hydrogenated oils, regulations to restrict
marketing of unhealthy foods and
beverages to children, revised national
dietary guidance and front-of-package
labelling to indicate when food is high
in sodium, sugars and saturated fats.
The Government is also modernizing its
food labelling approach and updating
its acts and regulations to strengthen
Canada’s food safety system.
Through the Canadian Institutes of
Health Research and programs such
as Healthy Living and the Aboriginal
Diabetes Initiative, Canada invests in
diabetes prevention, early detection
and management, and research.
The Government of Canada is
committed to a comprehensive,
collaborative, compassionate and
evidence-based approach to drug
policy that uses a public health lens
on drug issues. The new Canadian
Drugs and Substances Strategy
restores harm reduction as a key
pillar—which better enables the
Government to address the ongoing
opioid crisis and prevent new crises—
alongside prevention, treatment and
enforcement.
Recently published scientifc and
policy reports, including the 2016
Global Burden of Disease (GBD)
project ranked air pollution as the
fourth-leading risk factor contributing
to early deaths (6.9 million deaths
worldwide) each year. In Canada,
the GBD ranked air pollution as
the 11th leading risk factor for
premature death. Federal, provincial
and territorial governments in
Canada collaborate in the Air Quality
Management System, which includes
ambient air quality standards for
key pollutants and actions to reduce
emissions from signifcant sources of
air pollution. In June 2016, Canada
published the Multi-sector Air
Pollutants Regulations to reduce air
pollution from industrial boilers and
heaters, cement manufacturing and
stationary engines. The improvements
in air quality expected from these
regulations would mean 1200 fewer
deaths from air pollution between
2016 and 2035.
Grand Challenges Canada
Grand Challenges Canada is an innovation platform to accelerate the
achievement of the SDGs. Its model enables innovators and convenes
new partnerships to address collective challenges in new ways. Grand
Challenges Canada has supported over 1000 programs and innovations
in low- and middle-income countries and Canada, including, for example,
the development of a mobile app to enhance women’s reproductive health
services provided by mobile delivery units in confict-affected areas of Iraq
and projects integrating sexual and reproductive health, rights and mental
health needs of refugee women in Ethiopia. Grand Challenges Canada is
launching new programs such as the Humanitarian Grand Challenge, which
fnds innovations to help the most-vulnerable and hardest-to-reach people
affected by humanitarian crises, and the Indigenous Innovation Initiative,
which identifes and supports Indigenous innovators addressing the mostpressing challenges facing their people and their communities.
SDG 3: Ensure healthy lives and promote well-being for all at all ages 35
Infectious diseases
The rate of HIV within the general
population in Canada is very low,
but it is higher among gay and other
men who have sex with men, people
from HIV-endemic countries, people
who inject drugs and Indigenous
people. Canada’s HIV and Hepatitis
C Community Action Fund supports
projects that could have the greatest
impact through targeted, evidencebased interventions focused on
priority populations. These projects
work to prevent new infections,
reduce stigma and discrimination,
and increase access to testing and
treatment in Canada.
Canada’s National Immunization
Strategy works to improve
immunization coverage across
Canada. The Strategy’s 2016 to 2021
objectives include a vaccination
coverage goal of 95% for children by
2 years of age for vaccines that are
publicly funded in all provinces and
territories.
The Government of Canada works
closely with provincial, territorial and
international partners to prepare for
and respond to emerging infectious
diseases and have fully implemented
international health regulations
(IHR), per WHO’s IHR Core Capacity
Framework. In 2018, Canada is
examining pan-Canadian compliance
with IHR through a joint external
evaluation, which will further assess
our collective capacities to respond to
public health emergencies.
clinics and programs and pregnancy
health services. Canada also provides
fnancial support for culturally
appropriate and safe midwifery in
First Nations and Inuit communities.
The Canadian Guidelines for Sexual
Health Education guides Canada’s
support for providing comprehensive,
inclusive, evidence-based, ageappropriate and culturally sensitive
sexual health education.
Mental health
Improving mental health and
preventing mental illness is a crosscutting priority for the Government
of Canada. Working collaboratively,
the Government invests in a range of
initiatives and programs to improve
the availability and quality of mental
health services, promote positive
mental health and contribute to the
prevention of mental illness and
suicide. For Indigenous peoples, this
work includes support for the National
Inuit Suicide Prevention Strategy and
the culturally competent counselling
services offered by the First Nations
and Inuit Hope for Wellness help line.
Canada released the 2016 Progress
Report on the Federal Framework for
Suicide Prevention in December 2016.
The Framework focuses on raising
public awareness and reducing stigma
associated with suicide, disseminating
information and data to help prevent
suicide and promoting the use
of research and evidence-based
practices in suicide prevention.
2015 4.8
2014 4.6
2016 6.4
2015 5.8
Indicator 3.3.2: Tuberculosis incidence per 100,000
population
Rate (per 100,000)
Rate (per 100,000)
SDG indicator 3.3.2: Tuberculosis
incidence per 100,000 population
2015 4.8
2014 4.6
2016 6.4
2015 5.8
Indicator 3.3.2: Tuberculosis incidence per 100,000
population
Rate (per 100,000)
Rate (per 100,000)
SDG indicator 3.3.1: Number of new
HIV infections per 100,000 uninfected
population
Sexual and reproductive health and
rights
The Government of Canada
recognizes the importance of
ensuring that all Canadians have
access to sexual and reproductive
health information and services that
are relevant and sensitive to their
needs. The funding the Government
provides through the Canada Health
Transfer helps ensure Canadians have
access to comprehensive health care,
services and information aimed at
promoting sexual and reproductive
health, including family planning
programs and services, STI/HIV
SDG 3: Ensure healthy lives and promote well-being for all at all ages
36
Engagement
Canada routinely engages a range of
public health stakeholders, including
regional health authorities, NGOs and
disease-specifc organizations, and is
committed to continuing to enhance
stakeholder relations. As part of
these efforts, the Chief Public Health
Offcer’s Health Professional Forum
was established in January 2018
to facilitate enhanced relationships
with national health professional
organizations and collaboratively
advance public health priorities.
Canada and the world
Despite impressive gains in global
health and well-being over the past
three decades, millions continue
to struggle with persistent poverty
and inequality. Women and girls
have particular challenges in
achieving healthy lives amid harmful
social norms and discrimination.
Adolescents in particular face poor
health and nutrition outcomes due to
their often marginalized status.
As a strong global advocate for
the health, rights and well-being of
the poorest and most vulnerable
in developing countries, Canada is
committed to advancing a human
rights-based approach to health.
Through signifcant engagement at
the WHO and other key multilateral
forums, Canada advances this
approach on important issues
including gender equality and the
empowerment of women and girls,
access to sexual and reproductive
health and rights, and global health
security.
To reduce unacceptably high levels
of maternal and child deaths in
developing countries, Canada
pledged $3.5 billion for maternal,
newborn and child health from
2015 to 2020, contributing to better
nutrition, access to immunization,
increased inclusive and equitable
access to gender-sensitive health
services, strengthened health and
data systems, and combating
infectious diseases, including efforts
to eradicate polio.
Canada is a long-standing donor to
the Global Polio Eradication Initiative
(GPEI), having disbursed over
$670 million since the beginning of
the initiative in 2000. In 2017, Minister
of International Development and La
Francophonie Marie-Claude Bibeau
announced a new $100-million pledge
to the GPEI at the Rotary International
Polio Pledging Event, which will
count toward Canada’s $3.5-billion
commitment to improve the health
and rights of women and children.
Sexual and reproductive health and
rights have an enormous impact
on the trajectory of the lives of
women and girls, including their
health and well-being and economic
opportunities. Canada is a member
of She Decides, which advocates for
women’s right to access all sexual and
reproductive health services, including
safe abortion.
Canada announced $650 million
over 3 years to support access for
women and adolescent girls to the
full range of sexual and reproductive
health services, family planning and
contraceptives, and comprehensive
sexuality education, as well as to
choose safe and legal abortion and
access post-abortion care.
SDG 3: Ensure healthy lives and promote well-being for all at all ages 37
In 2016, Canada hosted global
leaders at the Fifth Replenishment
Conference of the Global Fund to
Fight AIDS, Tuberculosis and Malaria.
The more than US$12.9 billion raised
is expected to save 8 million lives.
Canada has contributed $2.9 billion to
the Global Fund since 2002.
Canada also supports the
Global Alliance for Vaccines and
Immunization (GAVI) and has
committed $520 million over 5 years
(2016-2020) to the initiative. GAVI is a
key partner in improving coverage and
equity through strengthening specifc
aspects of health systems such as:
providing in-country leadership,
management and coordination;
promoting effective supply chain
management; improving reliability
of data; and supporting community
engagement and buy-in.
Canada is fnding innovative ways to
support countries in achieving SDG
3. It is a founding member and key
donor ($240 million, 2015 to 2020) to
the Global Financing Facility for Every
Woman Every Child, an innovative
and catalytic fnancing mechanism
that accelerates country-driven
progress on improving the health and
well-being of women, children and
adolescents.
Data and research
As a global leader in health research,
Canada’s IDRC houses the Centre
of Excellence for Civil Registration
and Vital Statistics (CRVS) Systems,
a global resource hub supporting
national efforts to develop, strengthen
and scale up these key tools for
informing national health-care policies.
IDRC also supports a network of 43
think tanks in developing countries
to generate high-quality evidence
and convene different stakeholders
to strengthen primary health-care
systems to better serve the mostvulnerable populations.
Next steps
• Canada will target investments
announced in Budget 2017 and
Budget 2018 to address specifc
gaps in the Canadian health-care
system, such as increasing the
availability of home and palliative
care, helping youth access needed
mental health services, and lowering
the cost of prescription drugs.
• The recently announced Advisory
Council on the Implementation of
National Pharmacare—a publicly
funded, universal prescription drug
coverage program—will release
recommendations by the spring
of 2019 to guide future actions in
this area.
• The Government of Canada remains
committed to advancing the
important work of closing socioeconomic gaps between Indigenous
and non-Indigenous peoples in
Canada, including through improved
quality and satisfaction of care,
sustainable and suffcient health
resources in communities, and
predictable, long-term funding
to support Indigenous-led health
systems.
• Canada will host the next Women
Deliver global conference in June
2019. Women Deliver is the world’s
largest gathering on the health,
rights and well-being of women
and girls, and the event is an
opportunity to bring focus and
energy to Canada’s feminist agenda
domestically and internationally.
|
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62
35
ODD 3 : Permettre à tous de vivre
en bonne santé et promouvoir le
bien-être de tous à tout âge
La santé est un facteur essentiel
du développement durable. Une
bonne santé physique et mentale est
essentielle au bien-être individuel,
soutient l’égalité des genres et le
renforcement du pouvoir des femmes
et des !lles, favorise une croissance
inclusive et durable et des marchés
du travail ef!caces, et permet une
participation et un engagement
communautaires solides. Lorsque la
santé de tous est assurée, les sociétés
peuvent être plus paci!ques, plus
inclusives et plus prospères.
Le Canada s’est engagé à faire
respecter le droit de chacun de jouir
du meilleur état de santé physique et
mentale possible, conformément au
Pacte international relatif aux droits
économiques, sociaux et culturels. Le
Canada reconnaît que le respect de
ce droit dépend de la réalisation de
ses autres engagements en matière
de droits de la personne, y compris
la protection contre toutes les formes
de discrimination et la protection des
personnes les plus vulnérables.
Le gouvernement du Canada collabore
avec ses partenaires provinciaux
et territoriaux à l’élaboration de
mesures visant à améliorer l’accès
aux services de santé et à s’attaquer
aux déterminants de la santé
associés à l’atteinte et au maintien
du bien-être physique et mental de
tous les Canadiens. En outre, Anciens
Combattants Canada a élaboré un
cadre du bien-être pour offrir une
évaluation continue et systématique
et mesure le bien-être des anciens
combattants.
Le système de soins de santé du
Canada, principalement !nancé et
administré par l’État, est conçu pour
s’assurer que tous les résidents
admissibles n’ont pas à payer les
frais d’accès aux services hospitaliers
et médicaux. Ce système est régi
par les principes d’administration
publique, d’intégralité, d’universalité
et d’accessibilité, et re"ète les valeurs
canadiennes sous-jacentes que ce
sont l’équité et la solidarité. Bien que
ce soit les provinces et les territoires
Mesures prises,
objectif par objectif
ODD 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge
36
qui dirigent la conception et la
prestation des soins de santé et des
services de santé, le gouvernement
fédéral veille au maintien d’une
norme nationale au moyen de la Loi
canadienne sur la santé et fournit un
!nancement prévisible à long terme
par l’entremise du Transfert canadien
en matière de santé.
Ne laisser personne de côté
Le Canada reconnaît l’importance de
cerner et d’éliminer les inégalités dans
les résultats de santé. Les inégalités
en matière de santé, au Canada et
ailleurs, sont souvent liées à des
déterminants sociaux de la santé,
c’est-à-dire des facteurs qui ne sont
pas visés par le système de soins de
santé, mais qui in"uent sur la santé,
comme le revenu, le statut social,
l’emploi, l’éducation, les expériences
vécues pendant l’enfance, le genre et
la culture.
L’Initiative pancanadienne sur les
inégalités en santé permet de mieux
comprendre les inégalités en santé et
leurs principaux facteurs au Canada.
L’un de ses principaux produits,
l’outil interactif de données sur les
inégalités en santé, a été lancé en
2017. L’outil de données contient
des résultats relatifs à l’inégalité pour
plus de 70 indicateurs des résultats
de santé et des déterminants de la
santé, ventilés à l’échelle nationale,
provinciale et territoriale selon
une gamme de facteurs sociaux,
économiques et démographiques.
Cette nouvelle source de données
probantes peut contribuer à éclairer
l’élaboration des politiques et
des programmes et à réduire plus
ef!cacement les inégalités en matière
de santé au Canada, en particulier
celles auxquelles sont confrontés les
peuples autochtones.
D’importantes disparités en matière
de santé persistent encore entre
les populations autochtones et non
autochtones du Canada, notamment
des taux plus élevés de mortalité
infantile et juvénile, des maladies
infectieuses et chroniques (p. ex.
tuberculose, VIH/sida, diabète
et maladies cardiovasculaires)
et des maladies causées par la
contamination de l’environnement.
En août 2017, le premier ministre
du Canada a annoncé la création
d’un nouveau ministère des Services
aux Autochtones du Canada
(SAC). La vision première de ce
nouveau ministère est d’appuyer
l’autodétermination des peuples
autochtones, qui devraient contrôler
la prestation des services dans leurs
collectivités. Le mandat de SAC offre
d’énormes possibilités de réduire
les disparités en santé au sein des
populations autochtones du Canada.
Près de 12 milliards de dollars
provenant des deux derniers
budgets fédéraux ont été alloués
à l’amélioration des déterminants
sociaux de la santé chez les peuples
autochtones. Cet investissement
permettra d’élargir les services de
traitement et de prévention des
toxicomanies pour les Premières
Nations, de freiner les taux élevés
de tuberculose dans les collectivités
inuites, d’appuyer l’accès à des soins
de santé de qualité contrôlés par les
Premières Nations et d’affecter des
ressources qui travailleront avec les
partenaires des Premières Nations
a!n de transformer leurs systèmes
de santé.
À cette !n, le gouvernement du
Canada travaille également en
partenariat avec des partenaires
autochtones à l’échelle nationale,
régionale et locale a!n de mettre en
œuvre une approche de prestation
des services axée sur le patient et
le mieux-être communautaire et liée
ef!cacement aux systèmes de soins
de santé provinciaux et territoriaux.
De plus, le gouvernement du Canada
a signé l’Accord entre le Canada et la
Nation métisse, le Protocole d’entente
sur les priorités communes entre
l’Assemblée des Premières Nations et
le Canada et la Déclaration de l’Inuit
Nunangat sur le partenariat entre les
Inuits et la Couronne, qui dé!nissent
les priorités en matière de santé et de
mieux-être pour leurs collectivités.
Relever le défi
Santé de l’enfant
Les enfants sont vulnérables aux
disparités en matière de santé, car
les expériences négatives de la
petite enfance peuvent avoir des
effets tout au long de la vie. C’est
pourquoi le Canada a mis sur pied
des programmes de surveillance
ODD 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge 37
de la santé des enfants axés sur les
anomalies congénitales, les maladies
pédiatriques rares et émergentes,
les cancers infantiles, les blessures,
ainsi que les facteurs de risque
et de protection (p. ex. l’obésité,
l’activité physique, le sommeil et la
maltraitance des enfants). Le Canada
collabore avec d’éminents experts et
partenaires de partout au pays pour
améliorer la surveillance de la santé
maternelle et infantile en recueillant
et en fournissant des renseignements
complets en temps opportun.
Maladies chroniques
Les maladies chroniques majeures,
par exemple les maladies
cardiovasculaires, le cancer, les
maladies respiratoires chroniques
et le diabète, causent 65 % de tous
les décès au Canada chaque année.
En partenariat avec des organismes
privés et sans but lucratif et d’autres
ordres de gouvernement, le Canada
met à l’essai et élargit les interventions
visant à prévenir les maladies
chroniques, en mettant l’accent sur
les facteurs de risque communs,
comme la mauvaise alimentation,
l’inactivité physique, le tabac et la
consommation de drogues et d’alcool.
Le Canada continue d’appliquer
la Convention-cadre pour la lutte
antitabac de l’Organisation mondiale
de la Santé et a contribué par sa
stratégie sur le tabagisme à réduire
le taux de tabagisme à son taux le
plus bas dans l’histoire du pays. La
stratégie remaniée du Canada sur le
tabagisme vise à atteindre le taux de
tabagisme cible de moins de 5 % d’ici
2035. Le Canada met en place un
régime pour les produits de vapotage
qui sont une solution de rechange
moins nuisible que le tabagisme et
collabore aux efforts transfrontaliers
pour lutter contre le tra!c de produits
illégaux du tabac, le prévenir et
l’empêcher.
La Stratégie en matière de saine
alimentation du Canada vise à
améliorer l’environnement alimentaire
au Canada pour qu’il soit plus facile
pour sa population de faire des choix
sains. La Stratégie se compose
d’initiatives complémentaires, y
compris l’interdiction des huiles
partiellement hydrogénées, un
règlement restreignant la publicité
visant la consommation de boissons
et d’aliments malsains destinée
aux enfants, la révision des lignes
directrices nationales en matière
d’alimentation et l’exigence
d’un étiquetage sur le devant de
l’emballage des aliments riches
en sodium, en sucres et en gras
saturés. Le gouvernement modernise
également son approche en matière
d’étiquetage des aliments et met à
jour ses lois et règlements a!n de
renforcer le système canadien de
salubrité des aliments.
Par l’entremise des Instituts de
recherche en santé du Canada et
de programmes comme Vie saine
et l’Initiative sur le diabète chez les
Autochtones, le Canada investit
dans la prévention, la détection et la
gestion précoces du diabète, ainsi
que dans la recherche.
Le gouvernement du Canada
s’engage à adopter une approche
globale, collaborative, humaniste et
fondée sur des données probantes
à l’égard de la politique en matière
de drogues, qui repose sur une
optique de santé publique en matière
de problèmes liés aux drogues. La
nouvelle Stratégie canadienne sur
les drogues et autres substances
rétablit la réduction des méfaits en
tant que pilier clé (ce qui permet au
gouvernement de mieux s’attaquer
à la crise actuelle des opioïdes et
de prévenir de nouvelles crises)
à côté des autres piliers que sont
la prévention, le traitement et
l’application de la loi.
Grands Défis Canada
Grands Dé!s Canada est une plateforme d’innovation qui vise à
accélérer la réalisation des ODD. Il s’agit d’un modèle qui encourage les
innovateurs à trouver de nouvelles façons de surmonter les dé!s collectifs
et d’établir des partenariats en ce sens. Grands Dé!s Canada a appuyé
plus de 1000 programmes et innovations au Canada et dans des pays
à revenu faible et moyen, notamment, par exemple, la conception d’une
application mobile pour améliorer l’accès des femmes aux soins de santé
reproductive fournis par des unités mobiles dans des zones de con"it
en Iraq. L’organisation a également appuyé des projets qui intègrent la
santé et les droits sexuels et reproductifs ainsi que les besoins en santé
mentale des réfugiées d’Éthiopie. Grands Dé!s Canada lance aussi de
nouveaux programmes, comme le Grand dé! humanitaire, qui mise sur
l’innovation pour aider les personnes les plus vulnérables et les plus
dif!ciles à atteindre qui sont touchées par une crise humanitaire, ainsi que
l’Initiative sur l’innovation autochtone, qui révèle et appuie les innovateurs
autochtones qui cherchent à répondre aux dé!s les plus pressants
auxquels sont confrontées leurs collectivités.
ODD 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge
38
Des rapports scienti!ques et des
rapports sur les stratégies récemment
publiés, y compris l’étude de 2016
sur la charge mondiale de morbidité
ont classé la pollution de l’air au
quatrième rang des facteurs de
risques de décès précoce (6,9 millions
de morts dans le monde) chaque
année. En ce qui concerne le Canada,
l’étude a classé la pollution de l’air au
onzième rang des principaux facteurs
de risque de décès précoce. Les
gouvernements fédéral, provinciaux
et territoriaux au Canada collaborent
au fonctionnement du Système
de gestion de la qualité de l’air qui
comprend des normes de qualité de
l’air ambiant visant les principaux
polluants et des mesures de réduction
des émissions venant d’importantes
sources de polluants de l’air. En juin
2016, le Canada a publié le Règlement
multisectoriel sur les polluants
atmosphériques a!n de réduire la
pollution atmosphérique émanant des
chaudières et des fours industriels,
des cimenteries et des machines
!xes. L’amélioration de la qualité
de l’air attendue de ce règlement
correspondrait à 1200 décès de
moins de 2016 à 2035.
Maladies infectieuses
Le taux de VIH au sein de la
population générale du Canada est
très faible, mais il est plus élevé chez
les gais et autres hommes qui ont des
rapports sexuels avec des hommes,
les personnes provenant de pays où le
VIH est endémique, les personnes qui
s’injectent des drogues et les peuples
autochtones. Le Fonds d’initiatives
communautaires en matière de
VIH et d’hépatite C du Canada
appuie des projets qui pourraient
être les plus ef!caces grâce à des
interventions ciblées, fondées sur
des données probantes et axées
sur les populations prioritaires. Ces
projets visent à prévenir de nouvelles
infections, à réduire la stigmatisation
et la discrimination et à accroître
en œuvre le Règlement sanitaire
international (RSI), conformément au
Cadre de capacité de base du RSI de
l’OMS. En 2018, le Canada examinera
la conformité pancanadienne au RSI
au moyen d’une évaluation externe
conjointe, qui permettra d’évaluer en
profondeur notre capacité collective
d’intervenir en cas d’urgence de santé
publique.
Santé sexuelle et génésique et droits
connexes
Le gouvernement du Canada
reconnaît l’importance de veiller à
ce que tous les Canadiens aient
accès à de l’information et à des
services de santé sexuelle et
génésique pertinents et adaptés à
leurs besoins. Le !nancement fourni
par le gouvernement par l’entremise
du Transfert canadien en matière
de santé permet aux Canadiens
d’avoir accès à des soins de santé
complets, à des services et à de
l’information visant à promouvoir
la santé sexuelle et génésique,
notamment des programmes et des
services de plani!cation familiale,
des cliniques et des programmes
de lutte contre les ITS/VIH et des
services de santé liés à la grossesse.
Le Canada fournit également un
soutien !nancier pour la prestation
de services de sages-femmes sûrs et
adaptés sur le plan culturel dans les
collectivités des Premières Nations
et des Inuits. Les Lignes directrices
nationales pour l’éducation en matière
de santé sexuelle orientent le soutien
du Canada pour une éducation en
matière de santé sexuelle complète,
inclusive, fondée sur des données
probantes, adaptée à l’âge et à la
culture.
Indicateur d’ODD 3.3.1 Nombre de nouvelles infections
à VIH pour 1 000 personnes séronégatives
Taux (pour 100 000)
Indicateur d’ODD 3.3.2 Incidence de la
tuberculose pour 100 000 habitants
Indicateur d’ODD 3.3.1 Nombre de nouvelles infections
à VIH pour 1 000 personnes séronégatives
Taux (pour 100 000)
l’accès aux tests et au traitement au
Canada.
La Stratégie nationale d’immunisation
du Canada vise à améliorer la
couverture vaccinale partout au
Canada. Les objectifs de la Stratégie
de 2016 à 2021 comprennent un
objectif de couverture vaccinale de
95 % pour les vaccins destinés aux
enfants avant leur deuxième année
de vie qui sont !nancés par l’État
dans toutes les provinces et tous les
territoires.
Le gouvernement du Canada travaille
en étroite collaboration avec ses
partenaires provinciaux, territoriaux
et internationaux pour se préparer
et réagir aux maladies infectieuses
émergentes et a pleinement mis
ODD 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge 39
Santé mentale
L’amélioration de la santé mentale et
la prévention de la maladie mentale
sont une priorité transversale du
gouvernement du Canada. Dans
le cadre d’une collaboration, le
gouvernement investit dans une
gamme d’initiatives et de programmes
visant à améliorer la disponibilité et la
qualité des services de santé mentale,
à promouvoir une santé mentale
positive et à contribuer à la prévention
de la maladie mentale et du suicide.
Pour les peuples autochtones, ce
travail comprend l’appui à la Stratégie
nationale de prévention du suicide
chez les Inuits et les services de
consultation adaptés aux différences
culturelles offerts par la Ligne
d’écoute d’espoir pour le mieux-être
des Premières Nations et des Inuits.
Le Canada a publié le rapport
d’étape de 2016 sur le Cadre
fédéral de prévention du suicide
en décembre 2016. Le Cadre est
axé sur la sensibilisation du public
et la réduction de la stigmatisation
associée au suicide. Il communique
des renseignements et des données
destinés à favoriser la prévention du
suicide et fait la promotion du recours
à la recherche et aux pratiques
fondées sur des données probantes
dans les activités de prévention du
suicide.
Engagement
Le Canada fait régulièrement appel
à un éventail d’intervenants en santé
publique, y compris des autorités
régionales de la santé, des ONG et
des organismes voués à des maladies
particulières, et s’engage à continuer
d’améliorer les relations avec les
intervenants. Dans le cadre de ces
efforts, le Forum des professionnels
de la santé de l’administrateur en
chef de la santé publique a été créé
en janvier 2018 a!n de favoriser
l’amélioration des relations avec
les organisations nationales de
professionnels de la santé et de faire
progresser les priorités en santé
publique.
Le Canada et le monde
Malgré les progrès impressionnants
accomplis en matière de santé et
de bien-être à l’échelle mondiale au
cours des trois dernières décennies,
des millions de personnes continuent
de lutter contre la pauvreté et les
inégalités persistantes. Les femmes
et les !lles ont des dif!cultés
particulières à mener une vie saine
dans un contexte de normes sociales
néfastes et de discrimination. Les
adolescents, en particulier, doivent
faire face à des problèmes de santé
et de nutrition en raison de leur statut
souvent marginalisé.
En tant qu’ardent défenseur
mondial de la santé, des droits et
du bien-être des plus pauvres et
des plus vulnérables dans les pays
en développement, le Canada s’est
engagé à promouvoir une approche
de la santé fondée sur les droits de
la personne. Grâce à un engagement
important au sein de l’OMS et
d’autres tribunes multilatérales
d’envergure, le Canada fait progresser
cette approche sur des questions
importantes, notamment l’égalité des
genres et le renforcement du pouvoir
des femmes et des !lles, l’accès
à la santé et aux droits sexuels et
génésiques, et la sécurité sanitaire
mondiale.
Pour réduire les taux inacceptables
de mortalité maternelle et infantile
dans les pays en développement,
le Canada s’est engagé à consacrer
3,5 milliards de dollars à la santé
maternelle, néonatale et infantile
de 2015 à 2020, contribuant ainsi à
une meilleure nutrition, à l’accès à
la vaccination, à un accès élargi et
équitable à des services de santé
sensibles au genre, au renforcement
des systèmes de santé et de données,
et à la lutte contre les maladies
infectieuses, dont les efforts visant à
éradiquer la poliomyélite.
Le Canada est un donateur de longue
date au titre de l’Initiative mondiale
pour l’éradication de la poliomyélite
(IMEP) : il y a consacré plus de
670 millions de dollars depuis la
création de l’Initiative, en 2000. En
2017, la ministre du Développement
international et de la Francophonie,
Marie-Claude Bibeau a annoncé une
nouvelle contribution de 100 millions
ODD 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge
40
de dollars à l’IMEP lors d’une
activité d’annonce de contributions
pour la lutte mondiale contre la
poliomyélite à la convention du Rotary
International. Cette somme fera partie
de l’engagement de 3,5 milliards
de dollars pris par le Canada pour
l’amélioration de la santé et du
respect de droits des femmes et des
enfants.
La santé sexuelle et génésique et les
droits connexes ont une incidence
énorme sur la trajectoire de la vie
des femmes et des !lles, y compris
leur santé et leur bien-être et les
possibilités économiques qui s’offrent
à elles. Le Canada est membre de
She Decides, qui défend le droit des
femmes d’accéder à tous les services
de santé sexuelle et génésique, y
compris l’avortement sans risque.
Le Canada a annoncé un
investissement de 650 millions
de dollars sur trois ans pour
soutenir l’accès des femmes et des
adolescentes à la gamme complète
des services de santé sexuelle
et génésique, à la plani!cation
familiale, aux contraceptifs et à une
éducation sexuelle complète et pour
leur permettre d’avoir accès à un
avortement sûr et légal ainsi qu’à des
soins après un avortement.
En 2016, le Canada a accueilli des
dirigeants mondiaux à la cinquième
Conférence de reconstitution des
ressources du Fonds mondial de lutte
contre le sida, la tuberculose et le
paludisme. Les fonds recueillis, soit
12,9 milliards de dollars américains,
pourraient sauver huit millions de
vies. Depuis 2002, le Canada a versé
2,9 milliards de dollars au Fonds
mondial.
Il soutient aussi l’Alliance mondiale
pour les vaccins et la vaccination
(GAVI) en s’engageant à lui versant
520 millions de dollars sur cinq
ans, entre 2016 et 2020. L’Alliance
GAVI est un partenaire crucial en
vue d’améliorer la couverture et
l’égalité du système de santé par
le renforcement de certains de ses
aspects, par exemple : assurer
un leadership, une gestion et une
coordination ef!caces dans le pays;
promouvoir la gestion ef!cace de
la chaîne d’approvisionnement;
améliorer la !abilité des données
et soutenir la mobilisation de la
collectivité.
Le Canada trouve des moyens
novateurs d’aider les pays à atteindre
l’ODD 3. Il est un membre fondateur
et un donateur important (240 millions
de dollars, de 2015 à 2020) du
Mécanisme de !nancement mondial à
l’appui de l’initiative Chaque femme,
chaque enfant, un mécanisme de
!nancement novateur et catalyseur
qui accélère les progrès accomplis
par les pays pour améliorer la santé et
le bien-être des femmes, des enfants
et des adolescents.
Données et recherche
En tant que chef de !le mondial de
la recherche en santé, le Centre de
recherches pour le développement
international (CRDI) du Canada abrite
le Centre d’excellence pour le registre
et les statistiques de l’état civil, un
centre mondial de ressources qui
appuie les efforts nationaux visant
à élaborer, renforcer et élargir ces
outils clés a!n d’éclairer les politiques
nationales en matière de soins de
santé. Le CRDI appuie également un
réseau de 43 groupes de ré"exion
dans les pays en développement a!n
de produire des données probantes
de grande qualité et de réunir
différentes parties prenantes pour
renforcer les systèmes de soins de
santé primaires a!n de mieux servir
les populations les plus vulnérables.
ODD 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge 41
• Le gouvernement du Canada
demeure déterminé à faire
progresser les importants travaux
destinés à réduire les écarts
socioéconomiques entre les peuples
autochtones et non autochtones
du Canada, notamment grâce à
l’amélioration de la qualité des
soins et de la satisfaction à l’égard
des soins, des ressources de santé
durables et suf!santes dans les
collectivités, et un !nancement
prévisible et à long terme pour
soutenir les systèmes de santé
dirigés par les Autochtones.
• Le Canada accueillera la prochaine
conférence mondiale de Women
Deliver en juin 2019. La conférence
Women Deliver est le plus grand
évènement sur la santé, les droits
et le bien-être des femmes et des
femmes, et cet évènement est
l’occasion d’attirer l’attention sur le
programme féministe du Canada et
de lui donner un élan au Canada et
à l’étranger.
Prochaines étapes
• Le Canada orientera les
investissements annoncés dans
le budget de 2017 et le budget
de 2018 de façon à combler des
lacunes précises du système
de soins de santé canadien,
notamment pour accroître la
disponibilité des soins à domicile
et des soins palliatifs, aider les
jeunes à accéder aux services
de santé mentale nécessaires et
réduire le coût des médicaments
d’ordonnance.
• Annoncé récemment, le Conseil
consultatif sur la mise en œuvre
d’un régime national d’assurancemédicaments, un programme
universel d’assurance-médicaments
!nancé par l’État, publiera
d’ici le printemps 2019 des
recommandations qui orienteront
les mesures à venir dans ce
domaine.
|
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"year": 2018
}
|
ODD 3 : Permettre à tous de vivre en bonne santé
et promouvoir le bien-être de tous à tout âge
AMBITIONS CANADIENNES
• Les Canadiens adoptent des comportements sains.
• Les Canadiens ont des vies saines et satisfaisantes.
• Le Canada prévient les causes de décès prématurés.
ÉVALUATION DES PROGRÈS DU
CANADA PAR LE GOUVERNEMENT
• Bien que les Canadiens jouissent d’une santé
et d’un bien-être relativement bons, la situation
varie à l’échelle du pays en raison notamment
d’inégalités sociales, politiques et économiques.
• La pandémie de COVID-19 a aggravé les
inégalités au chapitre de la santé, en particulier
chez les Premières Nations, les Inuits et les Métis,
ainsi que chez d’autres populations racisées
et marginalisées pour lesquelles les déterminants de la santé et les résultats en matière de
santé demeurent lacunaires. Par exemple, les
communautés autochtones font face à des taux
disproportionnellement élevés de tuberculose
par rapport aux populations non-Autochtones
au Canada. En 2021, l’incidence de la tuberculose progressive (par 100 000 habitants) était de
0,2 pour les personnes non autochtones nées
au Canada, de 13,4 pour les personnes nées à
l’extérieur du Canada, de 135,1 pour les Inuits,
de 16,1 pour les membres des Premières Nations
et de 2,1 pour les Métis.
• La pandémie de COVID-19 a également eu des
répercussions négatives sur la santé et le bienêtre en général, ce qui comprend un déclin de
la santé mentale, qui ne sont pas revenus aux
niveaux d’avant la pandémie.
PLEINS FEUX : Un nombre accru de Canadiens ont estimé que leur santé mentale s’est détériorée
en 2021 à la suite du début de la pandémie de COVID-19 en 2020.
Les Canadiens ont estimé que leur santé mentale
s’est détériorée en 2021 à la suite du début de
la pandémie de COVID-19 en 2020 et en raison
des répercussions sociales persistantes. Parmi les
Canadiens, 59,0 % ont estimé que leur santé mentale
allait de très bonne à excellente en 2021, ce qui
représente une baisse par rapport à 68,6 % en 2018
et constitue un obstacle à la réalisation de l’ambition
selon laquelle les Canadiens ont une vie saine et satisfaisante. Il a été signalé que la santé mentale chez les
femmes était particulièrement moins bonne que celle
des hommes en 2018 et en 2021. En 2021, 55,1 %
des femmes ont déclaré avoir une très bonne ou une
excellente santé mentale comparativement à 63,0 %
chez les hommes. Chez les femmes âgées de 18 à
34 ans, moins de la moitié (45,8 %) ont déclaré avoir
une très bonne ou une excellente santé mentale en
2021, soit beaucoup moins qu’en 2018, et ce taux est
considérablement plus faible que celui des hommes.
Bien que des hommes jeunes aient également déclaré
qu’il y a eu des répercussions sur leur santé mentale
entre 2018 et 2021, la proportion de ceux-ci qui
ont déclaré avoir une très bonne ou une excellente
santé mentale est demeurée plus élevée que chez
les femmes.
5
-2,5 2,5 0
-5
Détérioration
0
10
20
30
40
50
60
70
80
Figure 10
Indicateur national 3.7.1 – Pourcentage des Canadiens
qui perçoivent leur santé mentale comme très bonne
ou excellente, Canada
Toutes les
personnes
Femmes Hommes Femmes
âgées de
18 à 34 ans
Hommes
âgés de
18 à 34 ans
Pourcentage
2018 2021
Source : Statistique Canada, Enquête
sur la santé dans les collectivités canadiennes
SECTION III 53
INITIATIVES NATIONALES PRIORITAIRES
Le portail Espace mieux-être Canada a été créé en
réaction à une hausse des préoccupations en matière
de santé mentale et de toxicomanie depuis le début
de la pandémie de COVID-19. En avril 2023, plus de
3,42 millions de personnes au Canada avaient accédé
au portail dans le cadre de plus de 9,59 millions de
séances Web.
Le Canada continue de soutenir l’amélioration du
bien-être mental dans les communautés autochtones
au moyen d’approches communautaires dirigées
par les Autochtones en matière de prévention du
suicide, de promotion de la vie, d’intervention en cas
de crise et de services de traitement et de prévention
de la toxicomanie adaptés à la culture. Cela comprend également un financement pour l’accès à des
soutiens en santé mentale, culturels et émotionnels
tenant compte des traumatismes pour les personnes
touchées par des traumatismes intergénérationnels
et subis durant l’enfance, notamment les survivants
des pensionnats autochtones et les membres de
leur famille, les anciens élèves des externats indiens
fédéraux et les membres de leur famille, et ceux
et celles concernés par la tragédie nationale des
femmes, des filles et des personnes 2ELGBTQI+
autochtones disparues et assassinées.
Comme première étape pour éliminer les inégalités
dans l’accès aux services de soins dentaires, la
Prestation dentaire canadienne provisoire a été lancée
en 2022 afin de permettre aux parents d’obtenir des
paiements directs pour les enfants admissibles de
moins de 12 ans (pendant 2 ans, jusqu’à concurrence
de 1 300 $ par enfant) en vue d’aider à payer les
coûts des services de soins dentaires. On estime
que plus de 500 000 enfants en profiteront.
De plus, la Politique financière collaborative du
Canada sur l’autonomie gouvernementale (lancée
en 2019) a commencé à établir une nouvelle relation
financière entre les gouvernements autochtones
autonomes et le Canada, et elle comprend un volet
sur le bien-être social qui vise à aider à combler les
lacunes grâce à des initiatives fructueuses fondées
sur des données probantes qui reconnaissent que
la culture, la langue et le patrimoine constituent des
éléments fondamentaux du bien-être social. En tout,
25 gouvernements autochtones autonomes ont reçu
189,2 millions de dollars en 2018 pour appuyer des
initiatives de processus de collaboration, y compris
du financement pour aider à combler les lacunes en
matière de bien-être social.
MESURES PRISES À L’ÉCHELLE INTERNATIONALE
Le Canada est un chef de file de longue date en
matière de santé dans le monde. L’Engagement de
10 ans en matière de santé et de droits dans le monde
du Canada s’appuie sur l’initiative de Muskoka (2011
à 2020) et renforce son soutien à l’ODD 3. Le nouvel
engagement de 10 ans comprend 1,4 milliard de
dollars par année pour les programmes en matière de
santé mondiale à compter de l’exercice 2023-2024,
dont 700 millions consacrés à la promotion de la
santé et des droits sexuels et reproductifs. En 2020,
le Canada a versé plus de 3,5 milliards de dollars
supplémentaires dans le cadre de l’intervention relative
à la pandémie. De plus, en 2021-2022, le Programme
de subventions internationales à la santé a versé
2,3 millions de dollars à des bénéficiaires étrangers
pour contribuer à l’amélioration de la santé et du
bien-être, ce qui comprend des projets visant à protéger les personnes contre les risques liés aux agents
pathogènes et aux toxines, à favoriser la santé et
l’équité entre les sexes ainsi qu’à protéger les populations vulnérables, à permettre une intervention rapide
et coordonnée relativement aux pandémies futures,
à améliorer la salubrité de l’eau et à lutter contre les
changements climatiques.
Le Canada continue de chercher à résoudre les
problèmes liés aux maladies infectieuses et à la
vaccination, comme la diminution de la vaccination
systématique des enfants. En 2022, le Canada a
versé 1,21 milliard de dollars pour renflouer le Fonds
mondial de lutte contre le sida, la tuberculose et le
paludisme. Le soutien du Canada au Dispositif pour
accélérer l’accès aux outils de lutte contre la COVID-19
(Accélérateur ACT) a aidé le mécanisme COVAX à
livrer plus de 1,9 milliard de doses de vaccins contre
la COVID-19 à l’échelle mondiale, ce qui a accru
l’accès aux tests de dépistage et aux traitements de
la COVID-19 et a renforcé les systèmes de santé.
Le Canada a versé plus de 2 milliards de dollars aux
partenaires de l’Accélérateur ACT pour combler les
lacunes continues en matière d’accès aux vaccins, aux
traitements et aux diagnostics pour les populations à
risque élevé dans les pays à revenu faible et moyen
jusqu’en 2024. Cela comprend l’Initiative mondiale
pour l’équité vaccinale du Canada, une initiative phare
de 275 millions de dollars, lancée en 2022, qui vise
à améliorer la livraison et la distribution des vaccins,
à renforcer la capacité des systèmes de santé et à
diversifier la fabrication locale de vaccins dans 12 pays.
54
Examen national volontaire 2023 du Canada
UNE DÉMARCHE CONTINUE À L’APPUI DE LA MISE EN ŒUVRE DU PROGRAMME
2030 ET DE L’ATTEINTE DES OBJECTIFS DE DÉVELOPPEMENT DURABLE
Le leadership du Canada assuré par le Groupe
d’Ottawa sur la réforme de l’OMC a donné lieu à une
Initiative sur le commerce et la santé en réaction à la
pandémie de COVID-19, en 2020. Dans le cadre de
l’Initiative, le Groupe d’Ottawa a prôné une coopération accrue entre tous les membres de l’OMC pour
renforcer les chaînes d’approvisionnement à l’échelle
du globe et faciliter la circulation des produits médicaux essentiels, dont les vaccins, dans le contexte
de la pandémie.
DÉFIS ET POSSIBILITÉS
Les jeunes, les Autochtones, les Canadiens noirs
et racisés et les membres de la communauté
2ELGBTQI+ sont touchés de façon disproportionnée
par des problèmes importants et uniques en matière
de santé mentale. La pandémie de COVID-19 a
eu une incidence sur la santé mentale perçue, et
cela s’est accompagné d’une augmentation du
nombre de Canadiens ayant eu un dépistage positif
pour la dépression, l’anxiété ou le trouble de stress
post-traumatique.
Le Canada continuera de travailler à l’amélioration des
résultats en matière de santé et de bien-être dans le
cadre de l’ODD 3 afin de surmonter les difficultés et
les épreuves découlant de la pandémie de COVID-19.
Les prochaines étapes et les occasions à exploiter
sont les suivantes :
• En s’appuyant sur la Prestation dentaire
canadienne provisoire, le gouvernement du
Canada s’emploie à créer un programme pancanadien complet de soins dentaires à long terme
afin de remédier aux inégalités dans l’accès aux
services dentaires pour de nombreux Canadiens.
• Poursuivre la collaboration étroite avec les partenaires autochtones pour améliorer l’accès aux
services de mieux-être mental, en particulier les
soutiens en mieux-être mental culturellement
adaptés et tenant compte des traumatismes qui
répondent aux besoins uniques des communautés
des Premières Nations, des Inuits et des Métis.
• Mettre en place le service téléphonique 988, un
nouveau numéro à trois chiffres permettant aux
personnes de partout au Canada d’appeler ou
d’envoyer un message texte lorsqu’ils ont besoin
de soutien pour la prévention du suicide et en cas
de crise de santé mentale. En préparation au lancement en novembre 2023, le Canada collabore
avec des intervenants, des organisations autochtones et des représentants des gouvernements
provinciaux et territoriaux relativement à la mise
en œuvre du service téléphonique 988.
PLEINS FEUX : Mesures prises par les intervenants
Black Youth Helpline [disponible en anglais seulement]
est un organisme de bienfaisance national qui offre
des services directs et dirige des initiatives novatrices
de changement stratégique axées sur la prévention
de la rupture sociale pour les populations d’enfants,
de jeunes et de familles les plus vulnérables. Il sert
tous les jeunes et comble tout particulièrement le
besoin concernant l’offre d’un service destiné aux
jeunes Noirs, et il est bien placé et doté de ressources
pour promouvoir l’accès à un soutien professionnel
et culturellement adapté pour les jeunes, les familles
et les écoles. En plus de fournir des services directs,
l’organisme mène des initiatives axées sur des
solutions de rechange à l’exclusion des écoles, sur
l’accès à des soins professionnels en santé mentale
et sur le développement communautaire au moyen
d’approches qui accordent la priorité à la prévention
primaire et à la pertinence culturelle. L’organisme
fait actuellement équipe avec 84 districts scolaires
partout au Canada et a constaté une augmentation
des partenariats et de la collaboration avec des
dirigeants des systèmes de santé qui cherchent des
moyens de favoriser l’accès à des soins de santé
mentale efficaces.
SECTION III 55
|
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[
3
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{
"country": "can",
"file_id": "sdg-03/vnr-report-can-2023-fr-3.pdf",
"language": "fr",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
16
9 Health (SDG 3)
• The growing burden of illness caused by non-communicable and mental conditions is contained, and early deaths reduced.
• The proportion of the resident population which does not take enough exercise is 10% lower than in 2015.
• A smaller proportion of the population suffers from substance abuse and other addictions. Those who suffer from addiction receive the help and treatment they need.
• People suffering chronic illnesses receive the support and treatment they need.
• Switzerland maintains a high level of health protection and continues to combat communicable diseases effec-tively.
• The resident population of Switzerland is well informed and educated about health issues.
• There are suffcient well-qualifed healthcare professionals to ensure the high quality of healthcare provision.
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[
3
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{
"country": "che",
"file_id": "sdg-03/vnr-report-che-2016-en-1.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2016
}
|
9
SDG 3
Ensure healthy lives and promote well-being
for all at all ages
In its Health 2020 strategy, the Federal Council set out the following goals for the Swiss healthcare system:
maintain quality of life, increase equal opportunities, raise the quality of healthcare and improve transparency. Mandatory health insurance guarantees all Swiss residents access to medical services and products. Life
expectancy in Switzerland is very high at 81.5 for men and 85.3 for women in 2016. However, according
to Eurostat, in terms of the healthy life expectancy (HLE), Switzerland was below the EU average in 2015.
In recent years, demographic developments, advancements in medical technology and growing capacities have led to a steady increase in healthcare costs, with correspondingly higher funding requirements
through health insurance premiums and taxes.
In Switzerland, a quarter of the population suffers from at least one chronic disease and almost 90%
of deaths are due to non-communicable diseases (NCDs) such as cancer, diabetes, cardiovascular and
respiratory diseases. Such diseases generate about 80% of Swiss healthcare costs.
By improving the health literacy of the population and through framework conditions which make it easier to adopt healthier lifestyles, a high quality of life should be maintained. An integrated approach that
includes veterinary medicine, agriculture and the environment in addition to human medicine is applied to
ensure the long-term efficacy of antibiotics for health. A spread of the HIV epidemic among the general
population was averted thanks to preventive approaches. However, challenges remain in the increase in other sexually-transmitted infections and immunisation coverage for vaccine-preventable diseases. The WHO’s
International Health Regulations are of critical importance for combating global health risks.
GOOD HEALTH AND WELL-BEING
10
International level: Geneva has a special role in international health policy since it is the seat of relevant
international organisations, NGOs and many global initiatives. Moreover, Switzerland is also important
as a centre for innovation and research in health. The pharmaceutical, biotechnology and medtech
industries are among the most significant Swiss export sectors. Switzerland is involved in multilateral
forums and/or projects with partner countries and focuses on (i) combating communicable diseases;
(ii) sustainably improving access to medical products without undermining intellectual property rights;
(iii) combating non-communicable diseases and promoting a health and human rights-based addiction
policy; (iv) enhancing health systems; (v) improving the health of mothers, newborns and children, and
strengthening sexual and reproductive health and rights.
QUALITY
EDUCATION
|
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3
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{
"country": "che",
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|
9
ODD 3
Permettre à tous de vivre en bonne santé et
promouvoir le bien-être de tous à tout âge
Dans sa stratégie Santé 2020, le Conseil fédéral a défini les objectifs suivants pour le système de santé suisse :
assurer la qualité de vie, renforcer l’égalité des chances, améliorer la qualité des soins et optimiser la transparence.
L’assurance-maladie obligatoire vise à garantir à l’ensemble de la population un accès sûr à des prestations et produits médicaux. L’espérance de vie de la population suisse est très élevée : en 2016, elle était de 81,5 ans pour les
hommes et de 85,3 ans pour les femmes. S’agissant de l’espérance de vie en bonne santé, selon l’Eurostat 2015, la
Suisse se situe en revanche en-deçà de la moyenne de l’UE.
Les dépenses de santé n’ont cessé de croître ces dernières années sous l’effet de l’évolution démographique, des
progrès de la médecine et de l’augmentation des prestations. Cette hausse se répercute sur les primes d’assurance-maladie et les impôts.
Un quart de la population souffre au moins d’une maladie chronique et près de 90 % des décès sont liés à des
maladies non transmissibles (MNT) comme le cancer, le diabète, les maladies cardiovasculaires et les affections des
voies respiratoires. Ces maladies sont à l’origine d’environ 80 % des coûts de la santé en Suisse.
L’amélioration des compétences en matière de santé de la population et l’instauration de conditions facilitant un
mode de vie plus sain sont autant d’actions permettant de maintenir un niveau de qualité de vie élevé. Une approche intégrée associant la médecine humaine, la médecine vétérinaire, l’agriculture et l’environnement a pour
objectif de garantir sur le long terme l’efficacité des antibiotiques afin de préserver la santé. Les actions de prévention ont permis d’éviter une généralisation de l’épidémie de VIH. Parmi les défis à relever figurent le développement
d’autres infections sexuellement transmissibles et les taux de couverture vaccinale de maladies pouvant être évitées
par vaccination. Les directives internationales de l’Organisation mondiale de la santé (OMS) sont fondamentales
pour lutter contre des risques sanitaires mondiaux.
10
3.3 Couverture vaccinale de la rougeole
3.4 Années potentielles de vie perdues
Taux de suicide
3.5 Consommation d’alcool à risque
3.6 Accidents de la circulation routière
3.8 Privations pour raison financière en matière de soins
3.9 Concentrations de particules fines
3.a Taux de fumeurs
Potential years of life lost (premature deaths)
En 2015, le nombre d’années
de vie potentielle perdues
avant 70 ans pour 100 000
habitants suisse se montait à
1 521 pour les femmes et
2 703 pour les hommes
ONU : « Donner les moyens de vivre une vie saine et promouvoir le bien-être de tous à tous les âges est essentiel pour le
développement durable. Des progrès sensibles ont été accomplis dans l’accroissement de l’espérance de vie […]. Toutefois,
il faut faire beaucoup plus pour éradiquer un large éventail de
maladies et s’occuper de nombreuses questions de santé fort
différentes, persistantes ou nouvelles. »
Objectif
Tendence
Évaluation
–33% pour les femmes et
–39.6% pour les hommes
depuis 2000
Objectif de la Confédération : l’augmentation de la charge
de morbidité due aux maladies non transmissibles et aux
maladies mentales est freinée et les décès prématurés sont
en baisse.
Au niveau international : siège d’importantes organisations internationales, d’ONG et de diverses initiatives
mondiales, Genève joue un rôle particulier dans la politique de santé internationale. La Suisse est par ailleurs un
site d’innovation et de recherche important en matière de santé. L’industrie pharmaceutique, la biotechnologie
et la technologie médicale comptent parmi les principaux secteurs d’exportation suisses. La Suisse s’engage
au sein de forums multilatéraux et/ou dans le cadre de projets avec des pays partenaires dans les domaines
suivants : (i) lutte contre les maladies transmissibles, (ii) amélioration durable de l’accès aux produits médicaux
sans pour autant restreindre les droits de propriété intellectuelle, (iii) lutte contre les maladies non transmissibles
et promotion d’une politique en matière d’addictions fondée sur la santé et les droits de l’homme, (iv) renforcement du système de santé, (v) promotion de la santé des mères, des nouveau-nés et des enfants, de même que
renforcement de la santé sexuelle et reproductive et des droits qui y sont liés.
|
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|
20 Switzerland's Voluntary National Review 2022
SDG 3
Ensure healthy lives and promote well-being for all at all ages
SDG 3 represents better health for people everywhere. Everyone should
be protected against disease, and have access to quality healthcare
services and medication, without experiencing financial hardship.
Switzerland and SDG 3
Switzerland has an excellent health system, and the health
status of the population is very good in comparison with other
countries. However, the COVID-19 pandemic has affected the
attainment of SDG 3 in Switzerland, as it has elsewhere. For
example, while the preventive measures that have been put in
place have reduced the incidence of infectious diseases, the
mental health of some sections of the population has suffered.
In its Health Policy Strategy 2020-30 (Health2030)52
Switzerland has set itself the vision of an environment that is
conducive to health and access to a high-quality, financially
sustainable health system, regardless of an individual's state
of health or socio-economic status. The implementation of a
variety of national strategies, action plans and programmes
will play an important part in achieving this goal.
Examples include the National Strategy on Addiction,53
the eHealth Schweiz 2.0 strategy,54 the Radiss
action plan to strengthen radiological security 55
and the action plan on suicide prevention.56
In the international context the Federal Council has
adopted the Swiss Health Foreign Policy 2019-24.57 With
its participation in multilateral bodies and its support
for projects with international cooperation partner
countries, Switzerland lends its weight to the fight against
communicable and non-communicable diseases, for
example, to sustainable improvements in access to medical
products, and to reinforcing health systems in general.
Years of potential life lost
Standardised rate by age for 100 000 population, all causes of
death
A decrease in years of potential life lost means an increase in life
expectancy.
2000 2005 2010 2015 2020
0
1000
2000
3000
4000
5000
1361
2354
Men
Women
Data state: 28.02.2022
Source: FSO – Cause of death statistics (CoD) © FSO 2022
Years of potential life | -40% for
the women and -47.4% for the men
since 2000
Suicide rate | 9.8 suicides per 100,000
people in 2019 | -40% since 2000
Measles vaccine | 89.7% of children under
2 years old vaccinated against measles
in 2017/19 | +18.7 pp since 2005/07
Particulate matter concentrations |
14.3 μg/m3
in urban areas
| -49.8% since 2000
Smoking rate | 27% of the population
in 2017 | -3.4 pp since 2002
Overweight | 41,9% of the population
in 2017 | +4.7 pp since 2002
Foregoing medical care for financial reasons |
6.1% of the population at risk of poverty in
2019 | No significant evolution since 2015
Life satisfaction | 72% of the population
satisfied or very satisfied in 2020 | No
significant evolution since 2014
Indicators for the monitoring in Switzerland
Source: FSO – MONET 2030
Switzerland's Voluntary National Review 2022 21
In the national context
Health2030: The Health2030 strategy sets new priorities
for Swiss health policy. It pays particular attention to
technological and digital change, demographic and social
trends, maintaining high-quality care and a financially
sustainable system, as well as opportunities for a healthy life.
Health insurance: In 2021 the Federal Act on Health Insurance
(HIA)58 was amended to improve standards of
healthcare in Switzerland and ensure that it is provided
more cost-effectively. Healthcare providers are now
obliged to improve the quality of their services.
Access to mental health services: To simplify access to
psychotherapy and ensure suitable availability, in 2021 the
Federal Council approved a change of system away from
the present 'delegation' model – in which therapists work
under a doctor's supervision – to a prescription model.
COVID-19: Switzerland is tackling the present health crisis with
the necessary care and the requisite resources. The lessons
learned from the crisis inform current and forthcoming work to
improve the prevention and handling of future pandemic risks.
In the international context
Health systems: As part of its international cooperation work,
Switzerland supports low and middle-income countries
with measures to strengthen their health systems. The
objective is to enable these countries to prevent and respond
to pandemics and other health risks more effectively.
COVID-19: At the international level Switzerland acts in
accordance with the priorities of its Health Foreign Policy.
These also apply to the COVID-19 pandemic. Working in the
World Health Organization (WHO) context, especially, it is
committed to improving preparations for and responses to
pandemics in the future. It is also a major financial backer of
the Access to COVID-19 Tools Accelerator (ACT-A)59 initiative,
which promotes access to COVID-19 diagnostics, medicines and
vaccines for all countries. Moreover, Switzerland supports the
logistics of the International Organization for Migration (IOM),
UNICEF and the International Federation of Red Cross and Red
Crescent Societies (IFRC) as they distribute vaccines, tests and
treatments in the field, ensuring that people in crisis-affected
and remote regions in fragile contexts can be reached.
In the national context
Prevention: Defining consistent, structural and effective
behaviour-based preventive programmes requires
close and well-focused teamwork between various
sector policies and levels of the federal system.
Climate change: The direct and indirect impacts of climate
change on health are already being felt. These will further
accentuate despite climate action, and must therefore be
addressed together with other environmental risks to health.
Cost control: The cost containment programme adopted by
the Federal Council in 2018 places a responsibility on all
healthcare actors to ensure that costs should increase only
by a degree that is medically justifiable. New measures are
examined, and implemented in stages. First measures under
the programme entered into effect in January 2022, and
others are at various stages of the legislative process.
COVID-19: Managing the crisis absorbed considerable resources
and slowed down progress in attaining some of the targets. That
said, cross-sectoral cooperation was reorganised to manage the
crisis and became more efficient as a result. The challenge now is
to turn the lessons learned into a lasting benefit for the future.
In the international context
COVID-19: The pandemic has set low and middle-income
countries back enormously in their progress towards SDG 3.
This extends to health in general and the determinants of
health. The international response to the pandemic and its
impact on the various targets remains a key challenge.
Progress Challenges
|
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Rapport National Volontaire sur les ODD - Année 2022 43
République de Côte d’Ivoire RNV 2022
Objectif 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de
tous à tout âge
Cible 3.1 : D’ici à 2030, faire passer le taux mondial de mortalité maternelle en-dessous de
70 décès pour 100 000 naissances vivantes.
Indicateur 3.1.1 : Taux de mortalité maternelle
122.Le décès maternel se définit « comme le décès d’une femme pendant la grossesse ou
dans un délai de 42 jours après la fin de la grossesse, quelques soient sa durée et sa
localisation, pour une cause quelconque déterminée ou aggravée par la grossesse ou
par les soins qu’elle a motivés mais ni accidentelle ni fortuite ». (OMS)
123.Selon l’EDS 2012, il ressort un fort taux de décès maternels en côte d’Ivoire (614 pour
100 000 naissances vivantes). Cependant, même si les données de routine de 2020
donnent une estimation en baisse de 120 décès pour 100 000 naissances vivantes
(RASS 2020), on note une faible implication communautaire dans la surveillance des
décès maternels avec un taux de notification faible (20% en 2019).
124.En vue d’accélérer l’amélioration des indicateurs en lien avec la santé maternelle, le
Gouvernement a entrepris des mesures visant à renforcer la capacité de prise en
charge des parturientes à Abidjan avec la réhabilitation du service gynécoobstétrique de Treichville, les services de proximité de Wassakara, Blockauss,
Yopougon-Attié et Adjamé, la construction/ réhabilitation du pôle gynécoobstétrique de Cocody et la réhabilitation/construction et équipement de blocs
opératoires et services de maternité dans 62 localités de l'intérieur du pays.
125.Aussi des opérations ciblées de réduction de la mortalité maternelle ont été réalisées
dans les sept (07) régions sanitaires notifiant les plus grands nombres de cas de
mortalité maternelle notamment le Gbeke, le Loh-Djiboua, Abidjan 1 et 2 y compris
Rapport National Volontaire sur les ODD - Année 2022 44
République de Côte d’Ivoire RNV 2022
le Grand Abidjan (Jacqueville, Songon, Kassemblé, Dabou, Sikensi), le Poro, la Nawa,
San Pedro et le Cavally.
126.En outre, des produits sanguins en quantité suffisante ont été mis à disposition grâce
à l’accroissement des capacités de production de sang par le CNTS et ses
démembrements régionaux. Les prix de cession de ces produits sanguins ont été
uniformisés à tous les niveaux de la pyramide sanitaire aussi bien dans le secteur
public que dans le secteur privé.
127.Cependant, malgré ces efforts, il est à noter que les principales causes de mortalité
maternelle sont liées aux insuffisances dans les capacités de gestion des
complications obstétricales. En effet, seulement 4,4% des établissements offrent des
Soins Obstétricaux et Néonataux d’Urgence de Base (SONU B) et 11,1% offrent des
Soins Obstétricaux et Néonataux d’Urgence Complet (SONU C). Aussi, concernant
l’utilisation de services des soins prénatals, il est observé (i) le retard dans la
réalisation de la première CPN (33,88% des CPN1 ont été effectuées au cours du
premier trimestre de la grossesse) ; (ii) le faible taux de couverture en CPN4 qui est
passé de 38,2% en 2015 à 42,31% en 2020 et ; (iii) le faible taux de couverture en SP3
(47,33%). Ces faibles taux s’expliquent par l’insuffisance d’éducation sanitaire pour
promouvoir les soins prénatals, la préparation à l’accouchement et à la prise en
charge des complications.
128.La couverture en consultation postnatale reste insuffisante bien qu’elle soit passée
de 20,13% en 2016 à 42,39% en 2020 (RASS).
129.Les principaux défis à relever en matière de santé maternelle, sont : (i) rendre
disponible la loi en matière de santé sexuelle et reproductive ; (ii) opérationnaliser la
politique nationale de délégation des tâches aux ASC pour l’offre des services de PF
et de santé mère-enfant et le transfert de compétences aux médecins généralistes
pour la chirurgie essentielle ; (iii) redynamiser les comités de lutte contre la mortalité
maternelle, néonatale et infantile et ; (iv) accélérer la mise à l’échelle des SONU B en
les déclarant « Priorité nationale ».
Indicateur 3.1.2 : Proportion d’accouchements assistés par du personnel de santé
qualifié
130.Un accouchement assisté est un accouchement qui se fait dans un établissement de
santé par un personnel qualifié (sage-femme, infirmier(ère) ou médecin).
131.En Côte d’Ivoire, le taux d’accouchement assisté par un personnel qualifié est de 84
% en 2021 (EDS) contre 62,3% en 2012 (EDS). Les données collectées en 2021, dans
les régions d’Abidjan (96,5%), de Comoé (95,2%) et de la Vallée du Bandama (89,2%)
enregistrent les taux d’accouchements assistés les plus élevés du pays. Les taux les
moins élevés se rencontrent dans les régions du Woroba avec 62,3% et Denguélé
avec 65,7%.
Rapport National Volontaire sur les ODD - Année 2022 45
République de Côte d’Ivoire RNV 2022
132.En vue de réduire ces disparités, l’Etat a procédé au déploiement du personnel
qualifié dans les différents services de gynéco-obstétrique périphériques et à
l'intérieur du pays y compris les Professeurs, Assistants et Internes des Hôpitaux
(déploiement en cours notamment à Aboisso, Adzopé, San-Pedro, Adjamé,
Wassakara, Yopougon-Attié, Bingerville, Abobo etc…
133.Dans le cadre du renforcement des capacités, l’Etat a financé la formation des
spécialistes en tenant compte des besoins du pays et accéléré les travaux de
construction de l’antenne de l’INFAS d’Aboisso.
134.Pour l’accessibilité aux soins au niveau primaire, 113 Établissements Sanitaires de
Premier Contact (ESPC) ont été construits, réhabilités et équipés en 2021. Le nombre
total d’établissements qui ont reçu les équipements nécessaires et le personnel pour
leur mise en service au cours de cette même année s'élève à 264 y compris les
équipements réalisés par les collectivités territoriales et les autres acteurs.
135.Malgré les efforts sus cités, le secteur reste confronté à des défis, notamment : (i)
assurer le renforment et la répartition équitable des Ressources Humaines de la
Santé aux différents postes en tenant compte du profil épidémiologique et de la
charge de travail des personnels de santé et (ii) améliorer la collaboration
intersectorielle entre le ministère en charge de la santé et les collectivités
territoriales dans le cadre de l’implantation et l’équipement des structures sanitaires.
Cible 3.2 : D’ici à 2030, éliminer les décès évitables de nouveau-nés et d’enfants de moins
de 5 ans, tous les pays devant chercher à ramener la mortalité néonatale à 12 pour 1 000
naissances vivantes au plus et la mortalité des enfants de moins de 5 ans à 25 pour 1 000
naissances vivantes au plus.
Indicateur 3.2.1 : Taux de mortalité des enfants de moins de 5 ans
136.La santé des enfants demeure également préoccupante avec des niveaux de
mortalité élevés notamment ceux de moins de 5 ans. En effet, bien que le taux de
mortalité infanto-juvénile en Côte d’Ivoire diminue à un rythme plus rapide que lors
de la dernière décennie (2005 : 125‰ ; 2012 : 108‰) et 96‰ en 2016 (MICS-5) il
reste élevé selon l’EDS 2021 (74‰ contre une cible attendue de 65‰).
137.Selon le RASS 2020, chez les enfants de moins de 5 ans, le paludisme était la
première cause de morbidité avec une incidence de 440,97‰ suivi des IRA
(167,44‰) et de l’anémie (158,66‰).
138.Pour la lutte contre le paludisme chez les enfants de moins de cinq ans, 93% des cas
de paludisme confirmé ont été traités par Combination TA dans le secteur public,
89% dans le secteur privé et 97% au niveau communautaire (Rapport PNLP, 2020).
139.En outre, le Gouvernement a multiplié les initiatives dans le cadre de son Programme
National de Lutte contre le Paludisme (PNLP). Ainsi, dans neuf zones endémiques du
pays, notamment dans les régions du Moronou, de l’Indénié-Djuablin, du N’Zi, du
Rapport National Volontaire sur les ODD - Année 2022 46
République de Côte d’Ivoire RNV 2022
Bélier, du Bounkani, du Folon, du Cavally, du Guémon et du Bafing les actions de lutte
ont a été intensifiées. En somme, plus de 19 millions de moustiquaires imprégnées
ont été gratuitement distribuées aux ménages, soit un taux de couverture de 97%. Le
taux d’utilisation des MILDA est passé de 33% en 2012 à 63% en 2020.
Indicateur 3.2.2 : Taux de mortalité néonatale
140.Pour ce qui est de la mortalité néonatale, elle est en baisse avec une proportion
moins importante. Elle a été réduite en passant de 38‰ en 2012 (EDS) à 33‰ en
2016 (MICS) pour se situer à 30‰ selon l’EDS 2021. Ce taux devrait être à 22,5‰ en
2025 d’après les estimations du Plan National de Développement 2021-2025. Elle
représente la moitié de la mortalité infantile, et le tiers de celle des enfants de moins
de cinq (05) ans.
141. Près de 90% des décès néonataux ont lieu dans les six premiers jours de la vie du
nouveau-né. Les principales causes de mortalité néonatale sont la prématurité,
l’asphyxie et le traumatisme néonatal, les infections sévères, la pneumonie et les
anomalies congénitales. La mortalité néonatale est près de deux fois plus élevée chez
les enfants de petit poids de naissance.
142.En vue de répondre aux besoins d’urgence de prise en charge, l’Etat a engagé les
travaux de réhabilitation des CHU à Abidjan et la construction de huit (08) CHR (en
cours). Ces travaux permettront d’améliorer la qualité de l’offre à travers la mise aux
normes des plateaux techniques de ces structures. La réalisation de ce programme
permettra de mettre en place les cinq (05) premiers Pôles Régionaux d’Excellence
Santé (PRES) dès 2022 à San Pedro, Bouaké, Yamoussoukro, Korhogo et Abidjan.
Cible 3.3 : D’ici à 2030, mettre fin à l’épidémie de sida, à la tuberculose, au paludisme et
aux maladies tropicales négligées et combattre l’hépatite, les maladies transmises par
l’eau et autres maladies transmissibles.
Indicateur 3.3.1 : Nombre de nouvelles infections au VIH pour 1 000 personnes
séronégatives, par sexe, âge et appartenance à un groupe de population à risques
143.Concernant la lutte contre le VIH/Sida, des progrès encourageants ont été enregistrés
ces dernières années, notamment en termes de réduction des nouvelles infections à
VIH (64% entre 2016 et 2020), des décès dus au sida (50% entre 2016 et 2020) et
dans l’atteinte des 90-90-90 (Graphique 2).
Graphique 2 : Evolution des nouvelles infections de 2000 à 2020
Rapport National Volontaire sur les ODD - Année 2022 47
République de Côte d’Ivoire RNV 2022
Source : Spectrum 2020
144.Pour le premier objectif 90, en 2020, 83,8% des PVVIH connaissaient leur statut
contre 79% en 2019. Pour le deuxième objectif 90, 78% des PVVIH connaissant leur
statut recevaient des ARV contre 63% en 2019. Pour le troisième objectif 90, 81,6%
(66,1% chez les enfants de 0-14 ans, 81,9% chez les hommes et 81,5% chez les
femmes) des PVVIH en suppression virale contre 45% en 2019.
145.Le taux de transmission Mère-Enfant (TME) du VIH sur la période d’allaitement est
passé de 16,15% (2016) à 7,18% (2020) selon Spectrum 2020 soit une réduction de
55,5%.
Graphique 3 : Taux de transmission final incluant la période d'allaitement
Source : Spectrum 2020
146.Dans le cadre de la lutte contre le VIH, au titre de l’activité de Prise en Charge ARV
(PEC ARV) des femmes enceintes infectées par le VIH pour la PTME, ce sont 2 465
centres de santé qui offrent les services de prise en charge ARV aux femmes
enceintes pour la prévention de la transmission du VIH de la mère à l’enfant sur toute
l’étendue du territoire national en 2021. Le nombre de femmes enceintes conseillées
et testées qui ont reçu leur résultat du test VIH est de 431 297 en 2021. Parmi elles, 2
834 sont dépistées positives et 2 694 ont nouvellement commencé le traitement
ARV. Aussi, le nombre total de femmes enceintes (nouvelles + anciennes) mises sous
traitement ARV est de 6 767.
Rapport National Volontaire sur les ODD - Année 2022 48
République de Côte d’Ivoire RNV 2022
147.Par ailleurs le nombre d’enfants nés de mères séropositives qui ont bénéficié du
dépistage précoce avant l’âge d’un an au cours du 1er semestre 2021 est 4 368.
Parmi eux, 142 sont dépistés positifs au VIH soit 3,25% de taux de positivité.
148.Au total, 92% de personnes dépistées VIH positives et informées de leur statut contre
95% attendus ; 86% des cas de paludisme des enfants de moins de 5 ans ont
bénéficié d’un traitement à base de Combinaison Thérapeutique à base
d’Arthémisinine (CTA) et ; 83% de succès thérapeutique de nouveaux cas et rechutes
de tuberculose contre 88% attendus. Par ailleurs, la sensibilisation et prise en charge
des maladies non transmissibles telles que le Diabète, Hypertension artérielle,
Cancers, et Insuffisance rénale ont été intensifiée.
149.Les progrès enregistrés ces dernières années sont liés à : (i) des investissements
importants et continus sur les dix dernières années provenant essentiellement de
PEPFAR (President Emergency Plan for AIDS Relief), du Fonds Mondial, de l’Etat
Ivoirien et du Système des Nations Unies. Ces financements ont permis de soutenir à
grande échelle des programmes pertinents, informés par des données d’évidence et
d’accélérer l’accès des PVVIH aux services de prévention, soins et soutien ; (ii) une
adhésion rapide de la Côte d’Ivoire aux traitements optimaux (TLD, DTG 10mg) pour
tous ceux qui en ont besoin ainsi que son fort engagement dans la mise à échelle
effective des services de soins différenciés ; (iii) des efforts de plus en plus visibles
pour lutter contre les obstacles (notamment la stigmatisation et la discrimination) qui
empêchent l’accès aux services essentiels du VIH pour les populations qui en ont le
plus besoin.
150.Toutefois, les faiblesses majeures portent sur la faible utilisation des services VIH par
les populations vulnérables notamment, les populations clés (HSH 44%, UD 18%) et
les femmes enceintes au premier trimestre de la grossesse (34% venues en CPN1).
151.En outre, il est constaté que seuls 53% des enfants exposés bénéficient de la PCR ;
une faible rétention dans les soins (couple mère-enfant en particulier et patients
PVVIH en général) et l’insuffisance dans le suivi des PVVIH. Ces faiblesses sont dues à
la stigmatisation et discrimination, les croyances religieuses, les coûts de transport et
frais de consultation.
Indicateur 3.3.2 : Incidence de la tuberculose pour 100 000 habitants
152.Selon le RASS, l’Incidence de la tuberculose pour 100 000 habitants est passée de 83
pour 100 000 habitants (2019) à 74,53 pour 100 000 habitants (2020). Le nombre de
cas de tuberculose est passé de 22 879 en 2015 à 19 972 en 2020.
153.Les efforts du Gouvernement ont permis de renforcer le nombre de structures
sanitaires impliquées dans la lutte contre la tuberculose (245 en 2016 à 358 en 2020).
Ainsi, le taux de succès thérapeutique de tuberculose chez les nouveaux cas et
rechutes confirmés bactériologiquement est en augmentation, passant de 85% en
2018 à 87% en 2020 grâce au renforcement du réseau de laboratoires avec
Rapport National Volontaire sur les ODD - Année 2022 49
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l’acquisition d’outils de diagnostic plus performant, en l’occurrence les GeneXpert
dont le nombre est passé de 11 en 2016 à 29 à 2020. Le taux de perdus de vue est
passé de 6% en 2015 à 3% en 2020.
154.La sous-notification qui est un défi pour la lutte contre la tuberculose a connu
quelques avancées à partir de 2017. En effet, la baisse de la notification, de 5% en
moyenne en 2016, a été de -2% en 2017. En 2019, la tendance à la baisse de la
notification s’est inversée et la courbe de notification est dans une phase
ascendante. Cela s’explique par le renforcement des activités communautaires, à
partir de 2017 qui a contribué à accroître la notification même si en 2020, dans le
contexte de la pandémie à COVID-19, une cassure importante de la courbe de
notification a été observée avec une diminution de 7% du nombre de cas notifiés.
155.En 2020, 98% des patients tuberculeux ont bénéficié du test de dépistage pour le VIH
et 99% des patients co-infectés ont bénéficié d’une thérapie ARV. Le taux de
recherche active de la tuberculose est en nette progression de 34% en 2015 à 79% en
2020 (Graphique 4). Le screening s’est amélioré au fil des années, du fait d’une
appropriation par les services de prise en charge du VIH ; mais également un meilleur
remplissage des outils de gestion (dossiers patients, registres).
156.La stratégie de la Thérapie Préventive à l’Isoniazide (TPI) a également été mise en
place. L’investigation des enfants contacts est un excellent moyen de prévention et
aussi de dépistage de la tuberculose pédiatrique. Entre 2015 et 2019, il y a eu une
nette amélioration du traitement préventif à l’isoniazide des enfants. Cela s’explique
par le fait que le PNLT a enclenché plusieurs actions pour améliorer ce volet. Les
directives de prise en charge de la tuberculose pédiatrique ont été élaborées avec
l’appui de l’UNICEF et de l’OMS. Les modules de formation ont été élaborés, et des
formations ont eu lieu dans tout le pays. Le passage aux nouvelles formulations
pédiatriques a été adopté. En 2020, 5 370 enfants de moins de 5 ans au contact des
patients atteints de tuberculose contagieuse ont initié une thérapie préventive à
l’isoniazide, soit un ratio de 39% par rapport aux formes contagieuses.
Graphique 4 : Evolution des cas notifiés de tuberculose de 2009 à 2020
Rapport National Volontaire sur les ODD - Année 2022 50
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157.Pour la prise en charge de la Tuberculose MultiRésistante (TBMR), le dépistage de la
tuberculose multirésistante s’est amélioré avec le déploiement d’appareils
GeneXpert dans le pays et le taux de succès thérapeutique des TBMR est de 72,34%
en 20201
.
158.On a cependant noté à partir de 2016 une diminution du dépistage malgré
l’augmentation des capacités diagnostic du pays.Après un pic observé en 2018, on
observe une diminution importante des cas de TBMR/RR en 2019 et une légère
tendance à l’augmentation en 2020 (Graphique 5).
Graphique 5: Evolution du nombre de cas de TBMR notifiés et mis en traitement de seconde ligne de 2012 à
2020
Source : Rapport PNLT 2020
159.Les défis majeurs en matière de lutte contre le sida sont en lien avec : (i) la
stigmatisation et la discrimination à l'endroit des PVVIH ; (ii) la charge élevée de
travail du personnel de santé ; (iii) la faible intégration de la prise en charge
pédiatrique dans les structures de prise en charge adulte ; (iv) la réduction des
financements des partenaires ; (v) l’insuffisance de financement pour les activités
d'accompagnement des PVVIH et ; (vi) l’absence d'un statut des Agents de Santé
Communautaire (ASC).
Indicateur 3.3.3 : Incidence du paludisme pour 1 000 habitants
160.La morbidité liée au paludisme demeure un fardeau pour le système sanitaire et le
développement du pays en dépit des progrès enregistrés. En effet, selon le RASS,
l’incidence du Paludisme dans la population générale est passée de 229,8‰ en 2019
à 173,43‰ en 2020 soit une baisse de 24,5‰.
1 Rapport PNLT 2020
Rapport National Volontaire sur les ODD - Année 2022 51
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161.Les plus fortes incidences du paludisme sont rapportées dans les régions du Bafing
(328,45‰), du Gbôklè (304,44‰) et du Cavally (296,94‰). Les plus faibles
incidences ont été observées dans les régions sanitaires d’Abidjan 2 avec 77,08‰,
d’Abidjan 1 avec 87,50‰ et du Poro avec 101,60‰.
162.Pour réduire cette incidence du Paludisme, le Gouvernement a mené plusieurs
campagnes de sensibilisation envers les populations, suivies de distribution de
moustiquaires imprégnées. En 2020, ce sont 4 567 426 patients qui ont été
gracieusement pris en charge dans le cadre de leur traitement contre le paludisme et
1 349 414 divers produits ont été mis à la disposition des établissements sanitaires
par la Nouvelle Pharmacie de la Santé Publique (NPSP).
163.En outre, la Pulvérisation Intra Domiciliaire (PID), deuxième méthode principale de
lutte anti vectorielle du paludisme a été mise en œuvre pour la première fois dans
deux (02) districts sanitaires en 2020 avec 91,9% de structures (ménages)
pulvérisées. Pour une coordination optimale de la lutte anti vectorielle, un comité
national regroupant plusieurs ministères a été créé par l’arrêté N° 393 MSHP/CAB du
02 août 2019. Enfin, des stratégies innovantes de prévention des maladies pour la
réduction des nouveaux cas notamment la chimio prévention saisonnière du
paludisme ont été adoptés.
164.Les principaux défis à relever demeurent : (i) la faible utilisation des moyens de
prévention (MILDA, SP3). En effet, l’utilisation des MILDA dans la population générale
est de 63,2% en 20192 et la couverture des femmes enceintes en SP3 reste
insuffisante avec 47,33% contre une couverture attendue de 80% en 2020 ; (ii)
l’insuffisance dans l’application des directives de prise en charge du paludisme due à
des ruptures de TDR et/ou intrants de laboratoire, l’automédication. Le rapport EUV
2019 rapporte qu’au cours des trois derniers mois précédents l’enquête, en moyenne
22,5% des sites ont connu une rupture sur les intrants de lutte contre le paludisme.
Cible 3.7 : D’ici à 2030, assurer l’accès de tous à des services de soins de santé sexuelle et
procréative, y compris à des fins de planification familiale, d’information et d’éducation, et
veiller à la prise en compte de la santé procréative dans les stratégies et programmes
nationaux.
Indicateur 3.7.1 : Proportion de femmes en âge de procréer (15 à 49 ans) qui utilisent
des méthodes modernes de planification familiale
165.En matière de planification familiale, la proportion des établissements sanitaires
offrant au moins trois (03) méthodes modernes de contraception est de 71%. Selon
les données de l’EDS, la prévalence contraceptive des femmes de 15-49 ans (en
union) est passée de 18% en 2012 à 21% en 2021. Cette enquête estime les besoins
non satisfaits en PF à 22,3% en 2021 contre 27,1% en 2012.
2 Rapport évaluation enquête post campagne 2019
Rapport National Volontaire sur les ODD - Année 2022 52
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166.Cette faible prévalence a pour causes majeures : (i) une faible accessibilité des
services adaptés aux besoins des utilisateurs et (ii) l’environnement socio-culturel
peu favorable à l’accès aux services de la PF. La méthode contraceptive moderne la
plus utilisée dans les établissements publics en 2020 est l’injection de trois (03) mois
(58,14%), suivie des implants (26,50%).
167.Le défi demeure l’accroissement des services de planification familiale, et la
sensibilisation des femmes en âge de procréer.
Indicateur 3.7.2 : Taux de natalité chez les adolescentes (15 à 19 ans) pour 1000
adolescentes du même groupe d’âge
168.Le taux de fécondité chez les adolescents (15 ans-19 ans) pour 1 000 adolescents du
même groupe d’âge est en baisse. Il est passé de 129‰ en 2012 à 96‰ en 2021.
Cependant, l’offre de service en matière de santé des adolescents et jeunes, reste
encore inadaptée aux besoins de ce groupe d’âge. La santé des adolescents et jeunes
est marquée par : (i) un faible taux de réalisation des Visites Médicales Systématiques
(VMS) en milieu scolaire (30% contre une norme nationale de 80%) et ; (ii) une
insuffisance de l’offre des services de santé de la reproduction. Cette situation a pour
conséquence, une augmentation du nombre de cas d’infections à VIH et de violences
diverses et des comportements à risque, notamment les rapports sexuels précoces et
non protégés, les grossesses précoces (49,69% de 2018 à 2020) et non désirées, des
avortements provoqués clandestins, les mariages précoces, la consommation abusive
d’alcool, de tabac, de drogues et d’autres substances psychotropes.
169.En vue de l’amélioration de la santé des adolescents et des jeunes, l’implication
communautaire a été renforcée avec la création et l’équipement de 37 espaces sûrs
en 2020 et 23 espaces en 2021. La promotion de la santé des adolescents et jeunes a
été renforcée par la création d’une plateforme digitale dénommée « E-Santé
Jeunes ». Selon le rapport du Programme National de Santé Scolaire Universitaire
Santé Adolescents et Jeunes (PNSSU-SAJ), le taux de fréquentation des SSSU-SAJ est
passé de 16,39% en 2020 à 27% en 2021 avec la formation des prestataires de santé
en prise en charge holistique des adolescents et jeunes. La mise en œuvre de la Visite
médicale Systématique en milieu scolaire pour la détection précoce des pathologies
handicapantes a abouti à la visite de 30% des élèves et étudiants en 2020 et 29,80%
en 2021.
170.Des défis restent à relever pour améliorer l’état de santé des adolescents et des
jeunes en Côte d’Ivoire. Il s’agira : (i) d’accroître la couverture en infrastructures
spécialisées, ou des services adaptés aux adolescents et jeunes ; (ii) de mettre en
place des réseaux de soins dédiés aux adolescents ; (iii) d’améliorer la qualité des
prestations de services offertes ; (iv) d’assurer l’offre gratuite de méthodes
contraceptives modernes aux adolescents dans toutes les structures de santé et ; (v)
Rapport National Volontaire sur les ODD - Année 2022 53
République de Côte d’Ivoire RNV 2022
d’offrir la visite médicale systématique à tous les adolescents en cours de
scolarisation ou non.
Cible 3.8 : Faire en sorte que chacun bénéficie d’une couverture sanitaire universelle,
comprenant une protection contre les risques financiers et donnant accès à des services
de santé essentiels de qualité et à des médicaments et vaccins essentiels sûrs, efficaces,
de qualité et d’un coût abordable.
Indicateur 3.8.1 : Couverture des services de santé essentiels (définie comme la
couverture moyenne des services essentiels mesurée à partir des interventions de
référence concernant notamment la santé procréative, maternelle, néonatale et
infantile, les maladies infectieuses, les maladies non transmissibles, la capacité
d’accueil et l’accessibilité des services pour la population en général et les plus
défavorisés en particulier)
171.En matière de couverture des services de santé essentiels, il est important d’indiquer
que le versant offre de soins ou prestataire du secteur de la santé comprend trois
niveaux.
172.Le niveau primaire ou périphérique composé de tous les établissements sanitaires
publics qui assurent une fonction de premier contact avec les usagers pour dispenser
des prestations de type curatif, préventif, éducatif et promotionnel. Il compte 3 410
ESPC comme indiqué plus haut.
173.Le niveau secondaire comprend tous les établissements de soins publics assurant une
fonction de premier recours pour les cas ne pouvant pas être pris en charge par le
niveau primaire et possédant une capacité technique de diagnostic et de traitement.
Le pays compte 131 hôpitaux de référence (100 hôpitaux publics, 12 confessionnels
et 19 Centres Hospitaliers Régionaux) et 02 Centres Hospitaliers Spécialisés (Hôpitaux
psychiatriques de Bingerville et de Bouaké).
Rapport National Volontaire sur les ODD - Année 2022 54
République de Côte d’Ivoire RNV 2022
Figure 3 : Travaux de construction de l’Hôpital Général de Yopougon
Source : Ministère de la Santé
174.Le niveau tertiaire est constitué de toutes les structures sanitaires publiques assurant
une fonction de second recours pour les cas ne pouvant pas être pris en charge par le
niveau secondaire et possédant une capacité technique de diagnostic, de traitement,
de formation et de recherche. Ce sont les cinq (05) Centres Hospitaliers Universitaires
et les Instituts Nationaux Spécialisés dont l’Institut de Médecine Nucléaire d’Abidjan
(IMENA), le Centre National de Radiothérapie Alassane Ouattara (CNRAO), le Centre
National de Transfusion Sanguine (CNTS), le Laboratoire National de Santé Publique
(LNSP), la Nouvelle Pharmacie de la Santé Publique de Côte d’Ivoire (Nouvelle PSP CI),
l’Institut de Cardiologie d’Abidjan (ICA), l’Institut Raoul Follereau de Côte d’Ivoire
(IRFCI), l’Institut National d’Hygiène Publique (INHP), l’Institut National de la Santé
Publique (INSP) et le Service d’Aide Médicale d’Urgence (SAMU).
175.A côté de ce secteur public, il existe le secteur privé de la santé qui est en plein essor
et contribue au niveau national à environ 40% de l’offre de service de santé. En plus
du système de soin public ou privé, il existe un système communautaire basé sur les
prestations des agents de santé communautaire. Ces agents de santé
communautaires, environ 11 4003
, sont encadrés et supervisés par les agents de
santé des ESPC (infirmier et ou sage-femme).
176.Enfin, il existe un secteur en pleine extension de médecine traditionnelle dont
l’exercice et l’organisation sont réglementés par la Loi n°2015-536 du 20 juillet 2015
et le Code d’Ethique et de Déontologie des praticiens de médecine et pharmacopée
traditionnelles par le Décret n°2016-24 du 27 janvier 2016. Le répertoire national des
PMT a enregistré 7 020 praticiens en 2020.
177.En vue d’améliorer l’accessibilité financière des populations aux services de santé, le
Gouvernement a entrepris des réformes du financement de la santé à travers le
projet de Financement Basé sur la Performance (FBP) et la mise en œuvre du
mécanisme de Couverture Maladie Universelle (CMU) dont le pourcentage de la
population enrôlée a progressé passant de 11,57% en 2020 à 12,97% en 2021. De
3 Rapport DSC
Rapport National Volontaire sur les ODD - Année 2022 55
République de Côte d’Ivoire RNV 2022
plus, l’Etat a poursuivi la mise en œuvre de la mesure de gratuité ciblée au bénéfice
des femmes enceintes et des enfants de moins de cinq ans.
Indicateur 3.8.2 : Proportion de la population consacrant une grande part de ses
dépenses ou de ses revenus domestiques aux services de soins de santé
178.Concernant le financement de la santé, en 2020, l’Etat a fait des efforts si bien que
les financements publics du secteur de la santé ont connu un accroissement
important au cours des dernières années (330,4 milliards FCFA en 2016 à 588
milliards FCFA en 2019). Alors que le budget du ministère de la santé oscillait entre
5% et 6% du budget de l’État par le passé, il représentait 7,43% du budget en 2020.
179.Concernant le secteur privé, la contribution au financement de la santé est de
19,44% en 2018. Les entreprises apportent des contributions au financement de la
santé à travers les paiements des frais d’assurance privée à leurs employés, et
diverses dépenses au titre d’activités d’établissements de santé d’entreprises et des
dons.
180.Les partenaires techniques et financiers dont la contribution est de 12,32% mettent à
disposition des ressources par des accords de dons et prêts. Ces dons et prêts ciblent
en général la lutte contre la maladie et le renforcement du système de santé.
181.Les ménages demeurent la principale source de financement à travers les paiements
directs. Malgré la gratuité des soins de santé pour les femmes enceintes, les enfants
de 0 à 5 ans et la prise en charge des quatre premières causes de morbidité du
nouveau-né et les 48 premières heures d’urgences médico-chirurgicales, les
paiements directs par les patients restent élevés même si de 2011 à 2018 leur part
relative a connu une baisse, passant de 60,2% à 39,43%. Les ménages et les
financements extérieurs couvrent plus de 60 %4 des dépenses de santé.
182.Sur la période du PNDS 2016-2020, le Gouvernement a également entrepris la mise
en œuvre de la couverture maladie universelle (CMU) et le projet de financement
basé sur la performance (FBP) tout en poursuivant la politique de la gratuité ciblée au
bénéfice des femmes enceintes et des enfants de moins de cinq ans.
4 Financement de la santé : Dossier d’investissement 2020-2023 de la côte d’ivoire
|
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EXAMEN NATIONAL 95 VOLONTAIRE ODD
ODD 3 : PERMETTRE À TOUS DE VIVRE EN BONNE SANTÉ
ET PROMOUVOIR LE BIEN-ÊTRE DE TOUS À TOUT ÂGE .
4.2.3. Progrès réalisés concernant l’ODD 3 : « Permettre à tous de
vivre en bonne santé et promouvoir le bien-être de tous à tout âge »
L’ODD 3 de l’agenda 2030 a pour ambition de « permettre à tous de vivre
en bonne santé et promouvoir le bien-être de tous à tout âge ». Il vise à assurer la santé et
le bien-être des populations à travers notamment l’amélioration de la santé procréative, maternelle et infantile ; l’éradication des épidémies des principales maladies transmissibles ; la
réduction des maladies non transmissibles et environnementales ; la mise en place d’une assurance santé universelle et la garantie de l’accès pour tous à des médicaments et des vaccins
sûrs, abordables et effcaces.
Pour permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout
âge, le Cameroun a identifé les cibles suivantes comme pertinentes pour lui au regard
de son contexte et de ses politiques :
- Cible 3.1 : D’ici à 2030, faire passer le taux mondial de mortalité maternelle au-dessous
de 70 pour 100 000 naissances vivantes ;
- Cible 3.2 : D’ici à 2030, éliminer les décès évitables de nouveau-nés et d’enfants de
moins de 5 ans, tous les pays devant chercher à ramener la mortalité néonatale à 12
pour 1 000 naissances vivantes au plus et la mortalité des enfants de moins de 5 ans à
25 pour 1 000 naissances vivantes au plus ;
- Cible 3.3 : D’ici à 2030, mettre fn à l’épidémie de sida, à la tuberculose, au paludisme et
aux maladies tropicales négligées et combattre l’hépatite, les maladies transmises par
l’eau et autres maladies transmissibles ;
- Cible 3.5 : Renforcer la prévention et le traitement de l’abus de substances psychoac-
EXAMEN NATIONAL 96 VOLONTAIRE ODD
tives, notamment de stupéfants et d’alcool ;
- Cible 3.7 : D’ici à 2030, assurer l’accès de tous à des services de soins de santé sexuelle
et procréative, y compris à des fns de planifcation familiale, d’information et d’éducation, et la prise en compte de la santé procréative dans les stratégies et programmes
nationaux ;
- Cible 3.8 : Faire en sorte que chacun bénéfcie d’une couverture sanitaire universelle,
comprenant une protection contre les risques fnanciers et donnant accès à des services
de santé essentiels de qualité et à des médicaments et vaccins essentiels sûrs, effcaces, de qualité et d’un coût abordable ;
- Cible 3.9 : D’ici à 2030, réduire nettement le nombre de décès et de maladies dus à des
substances chimiques dangereuses à la pollution et à la contamination de l’air, de l’eau
et du sol ;
- Cible 3.a : Renforcer dans tous les pays, selon qu’il convient, l’application de la Convention-cadre de l’Organisation mondiale de la Santé pour la lutte antitabac.
L’analyse de l’ODD 3 dans le présent rapport fait état des progrès réalisés, des défs et perspectives en termes de : (a) lutte contre la mortalité maternelle, infanto-juvénile et les décès dus
aux substances chimiques dangereuses à la pollution et à la contamination de l’air, de l’eau et
du sol ; (b) lutte contre la maladie ; (c) prévention et traitement de l’abus de substances psychoactives ; (d) promotion de santé sexuelle et procréative et (e) couverture sanitaire universelle.
En cohérence avec les différentes cibles contextualisées, en 2016, 12 indicateurs ont été retenus pour mesurer les progrès réalisés pour l’atteinte de l’ODD3. L’encadré ci-après présente
lesdits indicateurs, y compris les valeurs de référence.
L’analyse de l’ODD 3 dans le présent rapport fait état des progrès réalisés, des défs et perspectives en termes de : (a) lutte contre la mortalité maternelle, infanto-juvénile et les décès dus
aux substances chimiques dangereuses à la pollution et à la contamination de l’air, de l’eau et
du sol ; (b) lutte contre la maladie ; (c) prévention et traitement de l’abus de substances psychoactives ; (d) promotion de santé sexuelle et procréative et (e) couverture sanitaire universelle.
En cohérence avec les différentes cibles contextualisées, en 2016, 12 indicateurs ont été retenus pour mesurer les progrès réalisés pour l’atteinte de l’ODD3. L’encadré ci-après présente
lesdits indicateurs, y compris les valeurs de référence.
Encadré 8 : Liste des cibles contextualisées de l’ODD 3
3.1.1 : Taux de mortalité maternelle pour 100 000 naissances vivantes : 782 (2011)
3.1.2 : Proportion d’accouchements assistés par du personnel de santé qualifé : 64,7 (2014)
3.2.1 :Taux de mortalité des enfants de moins de 5 ans MICS-2014 103 (2014) : 103
3.2.2 :Taux de mortalité néonatale MICS-2014 28 (2014) : 28 ;
3.3.1 : Nombre de nouvelles infections à VIH pour 1 000 personnes séronégatives, par sexe, âge et
principaux groupes de population : 2,4;
3.3.2 : Incidence de la tuberculose pour 1 000 habitants : 1,14 ;
3.3.3 : Prévalence du paludisme ;
3.3.4 : Prévalence de l’hépatite : 11,9% ;
EXAMEN NATIONAL 97 VOLONTAIRE ODD
3.3.5 : Poids des maladies tropicales négligées : 1,8% ;
3.5.1 : Poids des maladies mentales et abus de substances : 3,5% ;
3.5.1 : Poids des maladies mentales et abus de substances : 3,5%
3.5.2 : Abus d’alcool, défni en fonction du contexte national par la consommation d’alcool pur (en
litres) par habitant (âgé de 15 ans ou plus) au cours d’une année civile ;
3.7.1 : Proportion de femmes en âge de procréer (15 à 49 ans) qui utilisent des méthodes modernes de
planifcation familiale ;
3.8.1.a : Couverture vaccinale pour la rougeole chez les enfants 12 -23 mois :79,9%;
3.8.1.b : Proportion de nouveau-nés et de leur mère ayant bénéfcié d’une consultation postnatale 2
jours après la naissance : 68,5% et 65% ;
3.9.2 : Poids de décès dus aux maladies diarrhéiques ;
3.a.1 : Prévalence de la consommation actuelle de tabac chez les plus de 15 ans ;
3.b.2. Montant total net de l’aide publique au développement consacrée à la recherche médicale et aux
soins de santé de base ;
3.c.1. : Nombre de médecins par habitant ;
3.d.1 Application du Règlement sanitaire international (RSI) et préparation aux urgences sanitaires ;
3.a.1 : Prévalence de la consommation actuelle de tabac chez les plus de 15 ans ;
3.b.2 : Montant total net de l’aide publique au développement consacrée à la recherche médicale et aux
soins de santé de base ;
3.c.1 : Nombre de médecins par habitant ;
3.d.1 : Application du Règlement sanitaire international (RSI) et préparation aux urgences sanitaires.
4.2.3.1. Progrès réalisés en matière de lutte contre la mortalité maternelle, infanto-juvénile et les décès dus aux substances chimiques dangereuses, à la
pollution et à la contamination de l’air, de l’eau et du sol
L’ensemble des six indicateurs retenus pour mesurer les progrès réalisés en vue d’apprécier les efforts consentis par le Cameroun en matière de lutte contre la mortalité maternelle néonatale et infanto juvénile, y compris les autres décès susmentionnés, n’ont pas
été actualisés pendant la période sous-revue.
Néanmoins, plusieurs actions ont été entreprises par le Gouvernement dans ce sens. Toutefois, les résultats enregistrés en matière de réduction de la mortalité maternelle et infantile restent très marginaux. Au rang des actions menées l’on peut noter : la mise en place
du Programme National multisectoriel de Lutte contre la Mortalité Maternelle, Néonatale et
Infanto-juvénile (PLMI) qui ambitionne d’apporter une réponse globale et intégrée aux problèmes de santé de la mère, de l’enfant et de l’adolescent. Il en est de même de la CPNR
(consultation prénatale recentrée) et l’accouchement assisté par un personnel qualifié.
De plus le Gouvernement a initié le processus de revue des décès maternels. Soulignons
d’autre part que l’introduction des chèques santé a permis d’accroître la demande des
services maternels et néonatales. Toutes ces actions ont notamment été tonifiées par
le recrutement des sages-femmes et l’introduction de l’approche financement basé
EXAMEN NATIONAL 98 VOLONTAIRE ODD
sur la performance au sein du système de
santé.
En matière de lutte contre la mortalité maternelle, le taux de mortalité est de 782 (EDS
2011) dernières données disponibles à date. Il
est donc question de le ramener à 195 cas de
mortalité maternelle pour 100 000 naissances
vivantes en 2020. En attendant les résultats de
l’EDS qui sont attendus au courant de l’année
2019 pour évaluer la progression de cet indicateur, il convient de relever pour le déplorer
que la proportion d’accouchements assistés a
quasi-stagné à 64,7% en 2014 (MICS 5).
Pour ce qui est de la mortalité infantile, l’objectif du DSCE est de réduire de deux tiers la
mortalité infantile à l’horizon de la stratégie. Il
importe de noter que le taux de mortalité infantile est de 60 pour 1 000 en 2014. En ce qui
concerne la mortalité infanto-juvénile, le taux
de mortalité s’est amélioré et est de 103 pour 1
000 en 2014 (MICS 5). Ainsi, dans l’attente des
résultats de l’EDS 2019, ces données restent
d’actualité.
4.2.3.2. Progrès réalisés en matière de lutte contre la maladie
Dans le domaine de la lutte contre la maladie, il est question de mettre fin à l’épidémie
de sida, à la tuberculose, au paludisme et aux maladies tropicales négligées et combattre
l’hépatite, les maladies transmises par l’eau et les autres maladies transmissibles. Cinq indicateurs contextualisés auxquels on peut ajouter ceux du DSCE (Taux de prévalence du
paludisme, du VIH/SIDA, de la tuberculose, et des Maladies Non Transmissibles (MNT)),
nous permettent de mesurer les progrès enregistrés en la matière. Il s’agit notamment :
• du nombre de nouvelles infections à VIH pour 1 000 personnes séronégatives, par
sexe, âge et principaux groupes de population : 2,4 ;
• de l’incidence de la tuberculose pour 1 000 habitants ; 1,14 ;
• de la prévalence du paludisme ;
• de la prévalence de l’hépatite : 11,9% ;
• du poids des maladies tropicales négligées : 1,8%.
En matière de VIH/SIDA, en 2018, la prévalence est de 3,4% chez les 15-49 ans et de
3,7% chez les 15-64 ans (CAMPHIA, 2018). Quant au taux de couverture par ARV des
personnes vivant avec le VIH, il est passé de 42,5% en 2017 à 51% en 2018. L’une des
EXAMEN NATIONAL 99 VOLONTAIRE ODD
mesures décisives a été la large décentralisation des opérations de dépistage dans les
centres de santé et une sensibilisation offensive et permanente dans la région Afrique
(OMS, 2017). En ce qui concerne la prise en charge du VIH/SIDA, on note que la gratuité des ARV a permis l’augmentation du nombre de PVVIH sous traitement ARV. Ainsi, le
nombre de PVVIH prises en charge par ARV est passé de 122 783 en 2012 à 281 083 en
2018. Par ailleurs, la proportion des femmes enceintes séropositives sous prophylaxie
ARV devrait être portée de 37,3% à 41,9%, soit de 26 433 à 29 686 à la fin de l’année
2018.
Concernant la tuberculose, le taux de guérison de nouveaux cas de Tuberculose Pulmonaire à Microscopie Positive (TPM+) est de 84% pour la cohorte de 2017.
En ce qui concerne les Maladies Non Transmissibles, le Cameroun est en phase de transition épidémiologique avec l’augmentation des Maladies Chroniques Non Transmissibles
telles que les affections cardiovasculaires dont l’Hypertension Artérielle, le Diabète, les
maladies rénales et chroniques.
Quant au paludisme, il demeure l’endémie majeure et la première cause de morbidité et
de mortalité dans les groupes les plus vulnérables que sont les enfants de moins de cinq
ans et les femmes enceintes. Toutefois, grâce à l’utilisation des moustiquaires imprégnées
aux insecticides (47,5% dans la population générale et de 54,8% chez les enfants de 0 à
59mois) et au traitement préventif intermittent (TPI) (26% des femmes enceintes ont bénéficié d’au moins trois doses), la morbidité palustre chez les enfants de moins de 05 ans est
passée de 56% à 31%, de 49% à 22% chez les femmes enceintes et de 33% à 24% chez
les personnes de plus de 05 ans (femmes enceintes exclues) de 2010 à 2018. Au cours de
la même période, la morbidité hospitalière due au paludisme est passée de 41,6% à 24%.
Au sujet des hépatites virales, la séroprévalence moyenne de l’hépatite virale B est de
12% avec un pic de 17% dans la région de l’Extrême-Nord. La prévalence moyenne de
l’hépatite virale D est de 10%. Celle de l’hépatite virale C est de 1.03% et est plus élevée
chez les 50 ans et plus. La comorbidité VIH-hépatites virales B est faible de l’ordre de
1.5%. Une proportion importante des hépatites virales est due aux actes de transfusion
sanguine.
4.2.3.3. Progrès réalisés en matière de prévention et de traitement de l’abus de
substances psychoactives, notamment de stupéfiants et d’alcool
Poids des maladies mentales et abus de substances : 3,5%. Les principales avancées
pourraient concernées la prise en compte de ces thématiques dans la nouvelle stratégie
santé qui couvre la période 2016-2027.
4.2.3.4. Progrès réalisés en matière de promotion de santé sexuelle et procréative
Cette thématique consiste à assurer l’accès de tous à des services de soins de santé
sexuelle et procréative, y compris à des fins de planification familiale, d’information et
d’éducation, et la prise en compte de la santé procréative dans les stratégies et programmes nationaux. Quelques indicateurs contextualisés contribuent à l’analyse de ces
progrès, notamment :
EXAMEN NATIONAL 100 VOLONTAIRE ODD
• proportion de femmes en âge de procréer (15 à 49 ans) qui utilisent des méthodes
modernes de planification familiale ;
• taux de natalité chez les adolescentes (10 à 14 ans et 15 à 19 ans) pour 1 000 ;
• proportion de nouveau-nés et de leur mère ayant bénéficié d’une consultation postnatale 2 jours après la naissance : 68,5%et 65%.
D’une manière générale, en vue d’atteindre ses objectifs de promotion de santé sexuelle et
procréative, le Cameroun a élaboré sa stratégie sectorielle de la santé et son programme
de performance du Ministère de la Santé publique. Ces derniers visent à amener la population à adopter des comportements sains et favorables à la santé d’ici à 2027. Le budget
reçu pour ce programme en 2016 était de FCFA 23 297 497 000. Les activités concernant
les actions de ce programme ont permis d’atteindre les résultats suivants :
- la formation de 50 prestataires à l’offre de service de Santé de Reproduction des
Adolescents et 03 missions de supervisions formatives et intégrées des prestataires
de soins ont eu lieu dans les 10 Régions du Pays ;
- le renforcement de la Planification Familiale (PF), 2085 sur 3379 formations sanitaires ont été renforcées en Planification Familiale (soit 61,7 %). En marge des
services de contraception, elles offrent désormais des services de dépistage des
cancers génésiques, de prise en charge de l’infertilité et de PTME et de prévention
et prise en charge des IST.
En somme, conscient des multiples défis auxquels il fait face, et pour rendre financièrement accessible un certain nombre d’interventions, le Gouvernement a consenti depuis
quelques années, à la mise en œuvre d’un ensemble de mesures portant soit sur la gratuité totale, soit sur la subvention partielle des intrants et services médicaux au rang desquels on peut citer : les ARV, les antituberculeux, les antipaludéens, la vaccination, les kits
obstétricaux, la prise en charge des jeunes diabétiques de moins de 18 ans.
4.2.3.5. Progrès réalisés en matière de couverture sanitaire universelle
Elle ambitionne de faire en sorte que chacun bénéficie d’une couverture sanitaire universelle, comprenant une protection contre les risques financiers et donnant accès à des
services de santé essentiels de qualité et à des médicaments et vaccins essentiels sûrs,
efficaces, de qualité et d’un coût abordable. Ceci peut se mesurer par :
• Montant total net de l’aide publique au développement consacré à la recherche médicale et aux soins de santé de base ;
• Nombre de médecins par habitant ;
• Application du Règlement sanitaire international (RSI) et préparation aux urgences
sanitaires.
S’agissant du montant total net de l’aide publique au développement consacré à la recherche médicale et aux soins de santé de base, l’on peut relever pour le déplorer l’absence des informations y relatives. Toutefois, il apparait que de 2010 à 2018, le budget de
l’état consacré à la santé a connu une augmentation sur la période 2010-2015 passant de
EXAMEN NATIONAL 101 VOLONTAIRE ODD
4,89% à 5,54%, pour ensuite connaitre une baisse progressive sur la période 2015-2018,
se situant à 5,09% en 2016, 4,76% en 2017 et 3,89% en 2018. Cette évolution contraste
avec les engagements pris par les gouvernements africains à Abuja de consacrer 15 %
des budgets nationaux à la santé.
Pour ce qui est de la densité moyenne du personnel soignant, l’objectif fixé par le DSCE
à l’horizon 2020 est de porter cette densité à 1 médecin pour 5 000 habitants. Le recensement des personnels du secteur de la santé effectué en 2011 au Cameroun révèle que
la densité moyenne du personnel soignant était de 0,46 médecin pour 5 000 habitants et
6,56 infirmiers pour 10 000 habitants. On note toutefois que le processus de recrutement
dans la Fonction publique des personnels du secteur de la santé s’est poursuivi tout au
long de la période 2010-2018. En 2018, ils sont 460 médecins diplômés, 16 Administrateurs Principaux de la Santé issus de l’ENAM, 66 médecins généralistes sur concours
direct, 10 Pharmaciens, 06 médecins spécialisés, 148 sages-femmes, 50 aides-soignants,
05 Techniciens Principaux et 10 Techniciens du Génie Sanitaire, 15 infirmiers principaux,
18 Infirmiers Diplômés d’État et 38 infirmiers.
Bien que les capacités de formation soient en nette augmentation, le secteur de la santé
souffre encore d’un déficit en personnel de santé qualifié.
En outre, le DSCE s’est proposé de viabiliser 90% des Districts de Santé en 2020. Cela
passe par le renforcement de l’offre des services et soins de santé, le développement des
ressources humaines en quantité et en qualité, et l’amélioration des partenariats dans le
secteur.
Les critères d’un District de Santé tels que définis dans le cadre conceptuel, n’ont pas été
exploités de façon systémique pour permettre une évaluation du niveau d’atteinte de cet
indicateur. Toutefois, pour la période 2010-2018, le Cameroun s’est doté de plusieurs infrastructures hospitalières dont on peut citer : la construction et la mise en service de l’Hôpital Gynéco-Obstétrique de Douala, l’Hôpital de Référence de Sangmélima, le Centre des
Urgences de Yaoundé et enfin l’Hôpital de Référence de Garoua en cours de construction
dont les travaux ont démarré le 1er septembre 2017. En outre plus, plusieurs CSI et CMA
ont été mis en place avec l’appui des CTD qui sont par ailleurs membre des comités de
gestion de ces formations sanitaires.
Bien plus, 11 formations sanitaires dont 03 formations de première catégorie, Hôpital Général de Douala (HGD), Hôpital Général de Yaoundé (HGY) et Centre Hospitalier Universitaire de Yaoundé (CHUY), pour lesquelles s’exécutent les travaux de réhabilitation et
de relèvement des plateaux techniques avec un taux de réalisation de 25% ; 08 hôpitaux
de deuxième catégorie qui sont les formations sanitaires nouvelles à construire dans les
chefs-lieux de Régions autres que Yaoundé et Douala. Le niveau d’exécution physique se
situe autour de 60%. Malgré les efforts qui sont faits par le Gouvernement pour rendre les
districts de santé viables, les Régions souffrent encore d’une insuffisance de formations
sanitaires.
EXAMEN NATIONAL 102 VOLONTAIRE ODD
4.2.3.6. Principaux défis en matière de santé
Pour assurer une meilleure santé à ses citoyens, le Cameroun devra relever plusieurs défis. Au premier rang desquels celui du recrutement du personnel de santé et sa formation.
En effet, en ce qui concerne la densité moyenne du personnel soignant, l’objectif fixé par
le DSCE est de porter cette densité à 1 médecin pour 5 000 habitants à l’horizon 2020.
Ce qui est encore très loin car le dernier recensement des personnels du secteur de la
santé au Cameroun révèle qu’en 2011, la densité moyenne du personnel soignant était de
0,46 médecin pour 5 000 habitants, et 6,56 infirmiers pour 10 000 habitants. En 2015, la
densité moyenne du personnel soignant était estimée par l’OMS à 6 pour 10 000 contre
14,1pour 10 000 habitants.
L’autre défi majeur est celui du plateau technique et de la promotion de la santé. Sur cette
question, l’objectif stratégique est d’amener la population à adopter les comportements
sains et favorables à la santé d’ici 2027. Pour atteindre cette vision, le Cameroun a retenu
quatre axes spécifiques. Il s’agit entre autres de renforcer les capacités institutionnelles,
communautaires, et d’assurer la coordination dans le domaine de la promotion de la santé dans 80% des districts de santé ; d’améliorer le cadre de vie des populations dans au
moins 70% des districts de santé d’ici 2027 ; de renforcer les aptitudes favorables à la
santé des individus et des communautés dans au moins 75% des districts de santé d’ici
2027. Enfin, d’ici 2027 l’Etat camerounais se propose d’amener les familles à adopter les
pratiques familiales essentielles notamment la planification familiale. L’objectif stratégique
de la prise en charge des cas est de réduire de 50% la létalité hospitalière et communautaire des maladies prioritaires transmissibles, non-transmissibles, ainsi que la mortalité
maternelle et infanto-juvénile.
L’autre défi à prendre en considération ici relève de la qualité des soins. En effet, la régulation des activités du MINSANTE à travers une coordination et un contrôle accru des
structures et intervenants, est encore insuffisante. Toutes choses qui contribuent à mitiger
considérablement la qualité des soins.
En outre, l’on pourrait relever le défi majeur du retrait du Fonds GAVI en 2020. Ledit fonds
finance notamment la vaccination en général et le renforcement du Système de Santé
dont la deuxième phase est en cours de lancement au Cameroun. Un tel retrait impacterait
considérablement tout le système sanitaire du pays et appellerait malheureusement à une
plus grande mobilisation de ressources internes pour la santé.
Enfin, le pays devra parachever les réflexions entamées en vue de la mise en place du
mécanisme de couverture santé universelle (CSU).
|
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60
3.2.3. ODD3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout
âge
En vue de contribuer au développement d’un capital humain sain, productif et capable de porter
une croissance forte, inclusive et durable, les autorités publiques entendent garantir à toutes les
couches de la population, un accès équitable et universel aux services et soins de santé de base et
aux soins spécialisés prioritaires de qualité, avec la pleine participation de la communauté. A cet
effet, en lien avec l’ODD 3 relatif à la santé, le pays envisage de : (i) faire passer le taux de
mortalité maternelle en dessous de 70 pour 100 000 naissances vivantes ; (ii) ramener la mortalité
néonatale à 12 pour 1 000 naissances vivantes au plus et la mortalité des enfants de moins de 5
ans à 25 pour 1 000 naissances vivantes au plus ; (iii) réduire d’au moins 30% la prévalence et la
mortalité des principales maladies transmissibles et non transmissibles ; (iv) réduire de 2/3 la
malnutrition chez les enfants de moins de 5 ans.
3.2.3.1 Progrès enregistrés et réalisations saillantes de ODD
Progrès réalisés en matière de santé maternelle, reproductive et infantile
Les indicateurs liés à la santé maternelle et reproductive traduisent des progrès en matière de
santé maternelle. Ces performances peuvent s’expliquer notamment par la mise en œuvre, avec
l’appui des partenaires au développent, des interventions à haut impact et d’intenses programmes
d’information et d’éducation menés auprès des communautés et des jeunes en santé de la
reproduction y compris la planification familiale, menées dans les régions identifiées comme
prioritaires.
Ces interventions ont en effet amélioré l’accès aux soins de qualité pendant la grossesse,
l’accouchement et le post partum, et ont accru l’amélioration de la qualité des soins, via le
renforcement de capacité des prestataires en soins obstétricaux et néonataux d’urgence (SONU).
61
Tableau 12 : Quelques indicateurs liés à la santé maternel et reproductive
Indicateurs 2011 2018
Ratio de mortalité maternelle (décès pour 100 000
Naissances vivantes 782 406
Proportion de naissances assistées par le personnel qualifié 65% 69%
Prévalence de la fistule obstétricale 0,4% 0,3 %
Taux de prévalence contraceptive 14,4% 15,4 %
Indice Synthétique de fécondité 5,1 4,8
Besoins non satisfaits en planification familiale 18 % 23 %
Source : EDS 2011 et 2018
Il s’agit entre autres du Programme National de Lutte contre la Mortalité Maternelle, Néonatale
et Infantile, le projet cheque santé, la mise sur pied du Centre National de Transfusion Sanguine,
le Programme d’Accès aux Services de Santé de Reproduction (PASSR), le Projet de
Financement Basé sur la Performance en santé. Ces efforts doivent continuer et s’intensifier si
l’on veut atteindre l’objectif de moins de 70 décès maternels pour 100 000 Naissances vivantes
en 2030.
La mortalité infanto juvénile a diminué passant de 103 décès pour 1000 naissances vivantes en
2014 à 80 décès en 2018. La mortalité des nouveau-nés est restée stagnante à 28 pour 1000
naissances vivantes. Les principales causes de cette mortalité chez les enfants sont le paludisme,
les infections respiratoires aigües, les maladies diarrhéiques, la rougeole, la malnutrition et le
manque d’équipement hospitalier dans les services de prématurité.
Les progrès enregistrés dans la baisse de la mortalité infanto juvénile se justifient par la mise en
œuvre d’une politique de prévention contre les maladies infantiles à travers l’immunisation,
l’intensification de la lutte contre le paludisme (distribution à grande échelle des moustiquaires
imprégnées d’insecticide, la gratuite du traitement de paludisme chez les enfants de moins de 5
ans, chimioprophylaxie saisonnière dans les zones ciblées) ; et la lutte contre la malnutrition chez
les enfants de moins de cinq ans (projet S’attaquer à la malnutrition chez les enfants de moins de
cinq ans dans les zones affectées par les crises humanitaires).
Progrès réalisés en matière de lutte contre la maladie
Dans le domaine de la lutte contre la maladie, hormis la prévalence nationale du VIH SIDA qui
a connu un net recul, en passant de 4,3% à 2,7%, les indicateurs de prévention des maladies
transmissibles ne se sont pas beaucoup améliorés au cours de la période 2016-2020. L’incidence
de la tuberculose est passée de 117 nouveaux cas pour 100 000 habitants à 194 nouveaux cas
pour 100 000 habitants, en raison de l’apparition de résistance aux traitements antirétroviraux de
première ligne, causant une baisse de l’immunité. De nouveaux protocoles de prise en charge du
VIH SIDA et de la tuberculose ont été adoptés. On note néanmoins une meilleure acceptabilité
de la maladie au sein de la population grâce aux campagnes de communication sur la non
stigmatisation de ces malades (DLMEP/MINSANTE).
62
Progrès réalisés en matière de couverture sanitaire universelle
La couverture santé universelle est progressivement mise en œuvre au Cameroun. Plusieurs
actions ont de ce fait déjà été entreprises, telles que
l’élaboration d’avant-projets de loi relatifs à la CSU et les textes réglementaires ;
l’élaboration du panier de soins et services de santé (5 Protocoles de soins) ;
le Plan opérationnel ;
la proposition de la Soutenabilité budgétaire ;
l’élaboration critère de ciblages des personnes indigentes dans le cadre de la CSU.
Malgré tous ces progrès, la faiblesse du système sanitaire reste préoccupante pour l’atteinte des
objectifs de Développement Durable. Néanmoins, la politique stratégique de la couverture sante
universelle adoptée par le MINSANTE et déclarée comme priorité nationale pourrait contribuer
à améliorer la réalisation de l’ODD3.
Aussi, le pays fait face à des urgences sanitaires et humanitaires telles que la Covid 19, l’épidémie
de choléra. Malgré les réponses en cours, la situation des réfugiés, des Populations Déplacées
Internes et des populations locales reste préoccupante dans zones humanitaires du fait de leur
accès limité aux soins et services de santé.
Plusieurs formations sanitaires font face à l’insuffisance des ressources humaines et matériels
pour répondre efficacement aux besoins de santé des populations, en particulier les plus
vulnérables tels les enfants, les femmes, les adolescents et jeunes filles. Ces insuffisances encore
plus poussées dans les situations humanitaires, limitent davantage la disponibilité et l’accès, à de
soins de santé de qualité. La faiblesse du système humanitaire est encore plus accrue en milieu
rural et dans les zones affectées par les crises sécuritaires.
3.2.3.2. COVID-19 : effets et mesures d’atténuation
Le Cameroun est classé en pole position parmi les pays les plus infectés par la pandémie de la
COVID-19 dans la sous-région d'Afrique centrale. Les chiffres du Ministère de la sante en date
du 09/02/2022 révèlent qu’il y a eu environ 118 933 cas confirmés de COVID19 avec 116 473
remissions et 1 918 décès soit un taux de létalité de 1,6% (CCOUSP MINSANTE).
Cette pandémie a aggravé davantage les inégalités en creusant l’écart entre les différentes couches
socio-économiques avec un plus grand impact sur les couches les plus démunies, dans le secteur
de la santé à savoir :
- Une baisse de la demande en services de santé : Une baisse du taux de fréquentation des
formations sanitaires par les patients qui ont peur de s’y rendre avec de simples maladies,
de contracter le virus ou même d’en mourir, d’être confiner automatiquement (rapport
enquête de recherche sur la place des instruments d’achat stratégique de la santé dans la
lutte contre la pandémie à Covid-19 au Cameroun- 2021).
- Un changement d’itinéraire thérapeutique des patients : Les patients atteints d’autres
pathologies, décident de se soigner chez eux par (l’automédication, la consultation à
domicile, le recours à la médecine traditionnelle).
63
- L’asphyxie financière des formations sanitaires : du fait de cette baisse de fréquentation
des hôpitaux et du ralentissement des activités, plusieurs formations sanitaires ont connu
des chutes de recettes et une insuffisance des fonds pour leur fonctionnement, l’achat des
intrants et la motivation du personnel à travers les quotes-parts.
- La baisse des subventions pour les autres maladies : le 4 avril 2020, le Fonds mondial a
publié une note d'orientation permettant aux pays bénéficiaires d'utiliser les subventions
pour le VIH, la tuberculose et le paludisme en faveur de la lutter contre la COVID-19,
et aussi en dépensant les fonds sous-utilisés (rapport enquête de recherche sur la place
des instruments d’achat stratégique de la santé dans la lutte contre la pandémie à Covid19 au Cameroun- 2021).
3.2.3.3. Défis et mesures à prendre
Pour assurer une meilleure santé à ses citoyens, le Cameroun devra relever plusieurs défis au
rang desquels :
une mobilisation suffisante des ressources pour pallier l’insuffisance des financements du
secteur santé ;
le renforcement de la redevabilité et du suivi de la mise en œuvre des programmes ;
la disponibilité des données de qualité, désagrégées et à jour pour permettre un suivi
adéquat de l’ODD 3;
l’accélération de la mise à l’échelle de la Couverture Santé Universelle ;
l’amélioration de l’accessibilité aux services et soins de santé, surtout pour les populations
vulnérables, à risque d’être laissé de côté;
L’équipement adéquat des formations sanitaires pour améliorer le plateau technique
nécessaire pour une offre de soins de qualité et la prise en charge des cas y compris en
situation des urgences sanitaires
En termes de mesures à prendre, il s’agit :
développer des stratégies de résilience du système de santé pour faire face à de futures
ripostes consistantes par exemple ;
pérenniser le numéro d’urgence afin qu’il soit utilisé pour d’autres pandémie telle que le
choléra ;
créer des centres spéciaux dans les régions ou les districts prêts à intervenir en cas de
pandémie ;
accélérer l’opérationnalisation de la mise en œuvre de la CSU au Cameroun.
renforcer le système national d’information sanitaire
Appuyer la réalisation des opérations de production régulière des données nécessaires
pour le suivi de l’ODD3
|
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27 RDC - Examen National Volontaire des Objectifs de Développement Durable - 2020
La santé demeure indispensable. Elle va de
la conception jusqu’à l’âge adulte. Il faut donc y
consacrer des moyens considérables au risque de
créer davantage des problèmes dans la société.
Santé procréative, maternelle, néonatale et
infantile
En dépit des progrès importants réalisés entre
2013 et 2018 dans la santé maternelle, 680 décès
maternels pour 100 000 naissances vivantes ont été
observés au courant de l’année 2018. En sus, le ratio de mortalité maternelle n’est pas encore revenu
au niveau de celui de l’année 2010 et est demeure
très loin de la cible mondiale de 70 décès maternels
pour 100 000 naissances vivantes d’ici à 2030. Une
part importante de cette mortalité maternelle est
attribuable à la mortalité des adolescentes, qui est
de 29%. En effet, les complications liées à la grossesse et à l’accouchement sont une cause principale de décès chez les filles adolescentes de moins
de 15 ans dans les pays en développement. Le taux
de fécondité des filles de 15-19 ans est de 109 naissances pour 1000 filles adolescentes en 2019. Ce
taux est nettement plus important que la moyenne
mondiale (44 naissances pour 1.000 filles adolescentes) mais proche de la situation de l’Afrique
subsaharienne (101 naissances pour 1.000 filles
adolescentes).
Ces décès surviennent le plus souvent pendant le post-partum et restent dominés par les
hémorragies (47%), l’éclampsie/la pré-éclampsie
(9%), la rupture utérine (8%), les infections sévères (3%) et les complications d’avortement (2%).
D’autres causes sont l’anémie (9%) et le paludisme
(2%)5
. Normalement, les raisons de cette morbidité et cette mortalité maternelles peuvent être évitées si les soins prénatals durant la grossesse, les
soins prodigués par des professionnels de la santé
qualifiés durant l’accouchement ainsi que les soins
et l’aide durant les semaines suivant l’accouchement sont respectés. A propos, 82,40% des femmes
bénéficient d’une consultation prénatale (CPN) au
moins une fois par un personnel de santé qualifié.
En 2018, près de 85,20% des naissances vivantes
ont eu lieu avec l’aide de professionnels de santé qualifiés, contre 86,20% en 2016 et 80,10% en
2013. La situation congolaise est meilleure que
celle de l’Afrique subsaharienne (60% d’assistance
par un personnel qualifié). Enfin, les examens de
santé postnataux en revanche ne concernent que
50% des femmes qui ont accouché dans les deux
dernières années et 57% de leurs bébés. Ces examens demeurent l’élément de la prise en charge qui
n’a pas connu des progrès substantiels. Toutefois,
dans l’ensemble, cette amélioration relative de la
prise en charge est à la base de l’inflexion constatée
récemment de la courbe de la mortalité maternelle.
Au sujet de la survie des enfants, la RDC a accompli des progrès remarquables. Le taux de mortalité des enfants de moins de 5 ans présente une
pente négative, passant de 104 décès pour 1000
naissances vivantes en 2013 à 70 décès pour 1000
naissances vivantes en 2018, soit une chute de
32,70%. Les causes de la mortalité infanto-juvénile
les plus incriminées sont respectivement la malnutrition chronique (47%), les affections néonatales
(32,70%), la triade paludisme (14,90%), la pneumonie (13,40%), ainsi que la diarrhée (10,30%).
Quant à la mortalité néonatale, de 2016 à 2018, le
taux y relatif a été divisé par 2 : soit de 30,10 décès pour 1000 naissances vivantes à 14 décès pour
1000 naissances vivantes. Néanmoins, il y a lieu
de signaler que le taux de mortalité des enfants de
moins de 5 ans demeure encore supérieur à la cible
de 25 décès pour 1 000 naissances vivantes.
Malgré ces progrès, il existe encore des
marges de manœuvre importante pour le gouvernement et ses partenaires pour améliorer sensiblement la situation des enfants. Les interventions
visant la nutrition (cf. ODD2), l’accès à des services d’approvisionnement en eau potable et d’as5 Plan Stratégique Intégré SRMNEA-Nutrition, 2019
ODD 3. Permettre à tous de vivre en bonne santé et promouvoir le bien-être
de tous à tout âge
28 RDC - Examen National Volontaire des Objectifs de Développement Durable - 2020
sainissement gérés en toute sécurité (cf. ODD 6),
la vaccination, l’allaitement exclusif, le traitement
approprié des infections courantes de l’enfance,
ainsi que la réduction de la pollution de l’air sont
nécessaires. Pour l’instant, ces différents domaines
présentent de déficits criants. A titre indicatif, seulement 35% des enfants de 12-23 mois ont été complètement vaccinés avant leur premier anniversaire
et 20% n’ont reçu aucun vaccin, alors que le Programme Elargi de Vaccination (PEV) avait prévu
d’atteindre 93% en 2019. En 2018, près de 47%
des femmes allaitent exclusivement les enfants
contre 37% en 2010. Concernant le traitement approprié, pour seulement 28% des enfants de moins
de 5 ans, des conseils et/ou un traitement ont été
recherchés auprès d’un établissement de santé ou
d’un prestataire de santé qualifié, lors d’un épisode
de diarrhée.
Maladies infectieuses et maladies non
transmissibles
Les maladies infectieuses et parasitaires
(MIP) sont très présentes en RDC. Les plus répandues de ces maladies sont essentiellement le VIH,
la tuberculose, le paludisme, l’hépatite B et les
maladies tropicales négligées. L’Etat congolais y
consacre en moyenne, pour la période 2013-2017,
70,8% de son budget des dépenses courantes par
catégorie des maladies. L’incidence du VIH a diminué de 0,26 à 0,17 pour 1000 personnes séronégatives entre 2011 et 2016. Il découle une situation
favorable par rapport à la moyenne de l’Afrique
subsaharienne qui présente un taux d’incidence
au tour de 2,6 pour 1000 non infectées. Plus spécifiquement pour la période de l’Agenda 2030, la
prévalence du VIH est également en diminution,
passant de 0,91% en 2016 à 0,87% en 2018.
L’engagement et le financement communs
du Gouvernement et des principaux PTF (Fonds
Mondial, PEPFAR, OMS, UNICEF et ONUSIDA) sont à la base de ce résultat. Les différents programmes et plans spécifiques dont le Plan National de Développement Sanitaire (PNDS) et le Plan
Stratégique National VIH 2016 – 2020 ont permis
une meilleure coordination des efforts. Entre 2013
et 2017, selon le Programme National de Comptes
Nationaux de la Santé – PNCNS – (2019), le gouvernement a augmenté de 125,3% ses allocations
à la lutte contre le VIH/Sida et d’autres maladies
sexuellement transmissibles (MST), soit de 83,5
millions d’USD à 188 millions d’USD. C’est cette
sous-catégorie des MIP qui figure à la deuxième
position en termes d’allocations budgétaires des
dépenses par catégorie des maladies.
La RDC demeure encore parmi les pays où
les maladies infectieuses bannies ailleurs sont encore importantes. C’est le cas notamment de la
tuberculose. Entre 2010 et 2014, l’incidence pour
1000 habitants est passée de 177 à 156. Les chiffres
post-2014 ne sont pas disponibles. Les allocations
budgétaires réservées à cette maladie sont passées
de 19 millions d’USD en 2013 à 27 millions d’USD
en 2017. Cependant, sous la période de l’Agenda
2030, ces dépenses ont plutôt connu une chute,
soit de 40 millions d’USD en 2016 à 27 millions
d’USD en 20176
. Pour prendre en charge cette maladie, le gouvernement s’appuie sur le Programme
National de Lutte contre la Tuberculose.
L’incidence de paludisme continue à être
une préoccupation pour la RDC. Des avancées
constatées entre 2010 et 2015 ont laissé place à un
aplatissement de la courbe. En 2017, 307,62 de cas
de paludisme pour 1000 habitants ont été déclarés contre 367,10 en 2010 et 317,07 en 2015. Notons que le taux de prévalence congolaise demeure
très élevé au reste du monde (59 cas pour 1 000
personnes à risque). En réponse à cette maladie,
le gouvernement a mis sur pied le Plan National
Stratégique de Lutte contre le Paludisme 2016 –
2020 (PNSLP).
En revanche, au-delà de ce cadre programmatique, les actions étatiques ont perdu de leur
vigueur. En effet, dans un pays endémique comme
la RDC, la distribution et l’utilisation des moustiquaires imprégnées d’insecticides (MII) constituent une mesure redoutable pour faire face au paludisme. La réponse congolaise a fléchi inoppor6 Programme National de Comptes Nationaux de la
Santé, 2019
29 RDC - Examen National Volontaire des Objectifs de Développement Durable - 2020
tunément: après une décennie d’avancées significatives entre 2001 et 2012, la proportion d’enfants
sous MII a décliné sensiblement, en quittant de
92,1% en 2012 à 51% en 2018. Aussi, après l’adoption de l’Agenda 2030, les dépenses budgétaires y
relatives ont timidement augmenté, quoi qu’elles
occupent toujours la première place en termes de
soutien étatique dans le cadre de MIP7
. Ceux-ci expliquent notamment l’aplatissement de la courbe
de l’incidence du paludisme.
En ce qui concerne les cas d’hépatite B, pour
100 000 habitants, ils s’élèvent à 0,0018 en 2016,
contre 0,0038 en 2010 et 0,0016 en 2015. Dit plus
simplement, des progrès ont été enregistrés au courant de cette période. Il y a lieu de noter que cette
MIP est celle qui reçoit le moins d’appui gouvernemental. En 2017, à peine 1 million d’USD a été
consacré à cette cause8
.
Enfin, en ce qui concerne les maladies tropicales négligées9
(MTN), le nombre de personnes
pour lesquelles des interventions contre les MTN
sont nécessaires est passé de 54,58 millions en
2014 à 74,95 millions en 201610. Plus de ¾ de la
population congolaise est exposée aux MTN. Ceci
est une indication que l’essentiel de la population
congolaise vit dans la pauvreté et ne dispose pas
des bons services d’assainissement appropriés.
Aussi, elle est en contact étroit avec des vecteurs
infectieux et des animaux domestiques. Ces condi7 Programme National de Comptes Nationaux de la
Santé, 2019
8 Idem
9 Ce terme renvoie à un groupe de diverses infections
fréquentes, pour lesquelles les activités de recherche et
de traitement ne bénéficient pas du même financement
que le VIH, la tuberculose et le paludisme. C’est dans
ce sens qu’elles sont considérées comme négligées.
10 Les chiffres relatifs aux MTN ne portent que sur
quatre maladies (onchocercose, schistosomiase, géohelminthiase, filariose lymphatique) pour les années
2014 et 2015. Quant à l’année 2016, parmi les MTN
considérées, il y a également la maladie trachome.
tions constituent les vecteurs de MTN. Nonobstant sa progression, la volonté étatique pour l’enrayer semble faible. En effet, selon les chiffres du
PNCNS (2019), les dépenses courantes y relatives
ne représentent que 1% des dépenses courantes des
maladies infectieuses et parasitaires, soit à peine 6
millions d’USD en 2017.
Systèmes de santé et financement
Le système de santé englobe notamment la
prévention, la disponibilité du personnel et le financement. De ce fait, la suite de ce point s’articule respectivement autour de ces différents axes.
Prévention
La vaccination constitue unanimement aujourd’hui un des moyens efficaces pour enrayer un
grand nombre de maladies afin de sauver des vies.
La quête de la vaccination contre la pandémie
de Covid-19 en est l’illustration la plus évidente.
L’insuffisance de la vaccination ou des faibles couvertures s’avèrent fatales. C’est notamment l’explication de la mortalité néonatale en RDC sus-évoquée.
En RDC, la proportion de la population cible
ayant accès à trois doses de diphtérie, de tétanos
et de coqueluche (DPT 3) a connu une évolution
positive entre 2010 et 2017, soit 60% à 81%. Toutefois, la courbe a pris le sens inverse depuis 2017. Le
recul est net : une perte de 33 points de pourcentage. Ceci fait courir davantage un sérieux risque
de contracter des maladies potentiellement fatales.
En ce qui concerne la proportion de la population
cible ayant accès à la troisième dose du conjugué
contre le pneumocoque (PCV 3), la situation s’est
sensiblement améliorée : le taux est passé de 9% en
2010 à 79% en 2017.
30 RDC - Examen National Volontaire des Objectifs de Développement Durable - 2020
Comparé à 2015, le pays a gagné 6 points
de pourcentage. Comme pour le vaccin DPT3,
l’année 2018 connaît une rupture franche de la
tendance, avec une perte de même ampleur (-33
points de pourcentage). L’explication à la base,
d’abord de la stationnarité de la couverture de
ces deux vaccins et, ensuite sa chute, tient entre
autres à la rupture de stock. En effet, près de 95%
en moyenne entre 2013-2017, du coût de la vaccination sont pris en charge par l’aide internationale.
Pour la même période, l’Etat n’y a contribué en
moyenne que pour 7%. Or, ces acteurs de financement ont atteint leur pic en 2015. Et depuis, la
contribution de l’aide internationale a connu une
baisse de 19% entre 2015 et 2017 et de 84% pour
la contribution étatique11. Naturellement, les effets
de ces baisses ne peuvent se faire ressentir qu’avec
un léger décalage, le temps que le stock s’épuise.
Quant à l’application du règlement sanitaire
international (RSI) et préparation aux urgences sanitaires – dont l’échelle n’est pas en pourcentage,
mais plutôt un score évoluant entre 1 à 100 –, le
pays a bénéficié de la note 65,21 sur 100 en 2017
contre 39,6 en 2010. D’où il se dégage une nette
amélioration. Cependant, cette amélioration n’est
pas encore suffisante. C’est ainsi que l’épidémie
d’Ebola et la pandémie Covid-2019 ont suscité un
intérêt majeur de la communauté internationale à
la RDC, redoutant le pire.
11 Programme National de Comptes Nationaux de la
Santé, 2019
Concernant le tabac, sa prévalence de
consommation actuelle chez les plus de 15 ans
est en hausse, soit 18,25 en 2018 en 2010 contre
18,07 en 2013. L’évolution de la prévalence de la
consommation actuelle de tabac chez les jeunes
congolais est très contrastée, avec des écarts considérables. Le taux a été plus faible chez les femmes
(4,9%) que chez les hommes (31,6%) en 2018
contre un taux de 3,13% pour les femmes et 33%
pour les hommes en 2013.
Personnel et financement
L’aide publique au développement consacrée
à la santé de base, fournie par l’ensemble des donateurs, a augmenté de 66% depuis 2010. Elle a totalisé 433,04 millions de dollars en 2017. Sans elle, la
vaccination en RDC serait quasiment inexistante
d’autant plus qu’elle supporte près de 95% du coût
de cette opération. Dans l’entre-temps, l’évolution
de la densité des infirmiers pour 1000 habitants
comme celle des médecins n’a pas trop changé
entre 2010 et 2016. Respectivement, la densité est
passée de 0,82 en 2010 à 0,81 en 2016 et de 0,08
en 2010 à 0,07 en 2016. Ce faible niveau est couplé
à des insuffisances en termes des outils médicaux.
Par exemple, le nombre de lits pour mille habitant
s’établit à un niveau très faible de 0,6 lits. Toutefois, le Gouvernement bénéficie des interventions
des plusieurs partenaires, notamment dans le
cadre du projet PRISE de la BAD qui a permis la
construction de 60 Centres de Santé équipés dans
le milieu rural.
|
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Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 42 43
Rapport d’Examen NationalVolontaire de laRDC 2023 37
Objectif 3.
Permettre à tous de vivre en bonne santé et
promouvoir le bien-être de tous à tout âge
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 42 43
La santé maternelle et infantile demeurent des priorités nationales
La mortalité maternelle est une situation très
inquiétante en RDC. Les estimations le plus récentes font montrer un taux élevé de la mortalité
maternelle, de l’ordre 547,4 décès maternels pour
100.000 naissances vivantes en 2020, en dépit des
progrès importants réalisés dans la santé maternelle au cours de la décennie passée. En plus, le
ratio de la mortalité maternelle demeure nettement très élevé comparativement à celui de 2010,
et de très loin supérieure à la cible mondiale de 70
décès maternels pour 100.000 naissances vivantes
d’ici 2030.
72
74
76
78
80
82
84
86
88
90
92
520,0
530,0
540,0
550,0
560,0
570,0
580,0
590,0
2015 2016 2017 2018 2019 2020
Proportion d'accouchements assistés par du personnel de santé qualifié (%)
Mortalité maternelle (pour 100 000 naissances vivantes)
Source : OCDD, à partir des données de MICS-Palu, Ministère de la Santé et UNStat-SDG
Graphique 3.1 Evolution de la santé maternelle
Plusieurs facteurs se conjuguent pour conduire à cette situation. Premièrement, la tranche de la population la plus
concernée par cette mortalité demeure celle des adolescentes, soit 29% (EDS, 2014). En efet, les flles de moins
de 15 ans sont plus exposées à des complications pendant
la grossesse et lors de l’accouchement ; ce qui augmente
considérablement le nombre de décès chez les flles adolescentes. Le taux de fécondité des flles congolaise de 15-19
ans est de l’ordre de 109 naissances pour 1000 flles adolescentes en 2019. Ce taux est nettement plus important
que la moyenne mondiale (44 naissances pour 1 000 flles
adolescentes) mais proche de la situation de l’Afrique subsaharienne (101 naissances pour 1 000 flles adolescentes).
Il y a lieu d’indiquer que les facteurs comme l’exposition à la sexualité, le mariage précoce et la non-utilisation des méthodes de contraception moderne contribuent à cette situation. En efet, s’agissant de la sexualité,
23,4% des femmes de 15-19 ans ont commencé leur vie
féconde. 4% des femmes ont déjà eu une naissance vivante avant l’âge de 15 ans. 49,3% des femmes de l’âge de
15-19 ans ont déjà eu des rapports sexuels. Concernant
la contraception, 71,9% de femmes actuellement mariées
ou en union n’utilisent pas de méthodes de contraception. En ce qui concerne le mariage précoce, 8,3% des
femmes de 15 à 49 ans ont été mariés avant l’âge de 15 ans.
Les filles de moins de 15 ans sont
plus exposées à des complications
pendant la grossesse et lors de
l’accouchement ; ce qui augmente
considérablement le nombre de décès chez les filles adolescentes.
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 44 45
Deuxièmement, il sied d’indiquer que la majorité de ces décès ont été constatés pendant le post-partum et restent dominés par les hémorragies (47%), l’éclampsie/la pré-éclampsie
(9%), la rupture utérine (8%), les infections sévères (3%) et
les complications d’avortement (2%). A cela s’ajoute le paludisme qui représente 2% et l’anémie 9%10. Ce risque peut
être contrôlé si la prise en charge est prise conséquemment.
Quoique la situation semble s’améliorer dans la mesure où
82,4% de femmes bénéfcient d’une consultation prénatale
(CPN) au moins une fois par un personnel de santé qualifé
et en 2020, 80% des naissances vivantes ont eu lieu avec
l’aide de personnel de santé qualifé, contre une prévision
de 84% pour l’année 2020 tel que prévu dans le PNDS, il
reste cependant des millions de femmes qui ne sont pas
prises en charge pendant la grossesse ou lors de l’accouchement. La Covid-19 n’a pas non plus facilité la tâche avec
les diférentes mesures du confnement qui ont conduit à
la fermeture de nombreux établissements et/ou à la réduction des services. Ce qui afecte aussi bien la situation de
la mortalité en amont avec l’augmentation de nombre de
grossesses non désirées découlant notamment du non-accès aux contraceptifs qu’en aval lors de l’accouchement.
Enfn, les examens de santé postnatals en revanche ne
concernent que 50% des femmes qui ont accouché dans les
deux dernières années et 57% de leurs bébés (MICS, 2018).
Ils demeurent l’élément de la prise en charge qui n’a pas
connu des progrès substantiels. Toutefois, cette amélioration relative de la prise en charge est à la base de l’infexion
constatée récemment de la courbe de la mortalité maternelle.
En République Démocratique du Congo (RDC), la santé
et le bien-être des enfants de moins de cinq ans demeurent
préoccupants, en dépit de progrès substantiels accomplis
302
304
306
308
310
312
314
316
318
320
0
20
40
60
80
100
120
2015 2016 2017 2018 2019 2020 2021
M
ortalité infa
ntile
Taux de mortalité des moins de 5 ans (décès pr 1000 naissances vivantes)
Taux de mortalité néonatale (décès pr 1 000 naissances vivantes)
Taux de mortalité infantile (décès pr 1 000 naissances vivantes)
Source : OCDD, à partir des données de MICS-Palu, Ministère de la Santé et UNStat-SDG
Graphique 3.2 Evolution de la survie des enfants
10 Plan Stratégique Intégré SRMNEA-Nutrition, 2019
dans la réduction de la mortalité dans cette tranche d’âge
comme illustré dans le graphique. On observe une baisse
considérable du taux de mortalité des enfants de moins de 5
ans, passant de 96,5 décès pour 1 000 naissances vivantes en
2015 à 79 décès pour 1 000 naissances vivantes en 2020. Les
causes les plus récurrentes des décès infanto-juvéniles sont
entre autres la diarrhée (10,3%), la pneumonie (13,4%), la
triade paludisme (14,9%), les maladies néonatales (32,7%)
et la malnutrition chronique (47%). De 2016 à 2018, le taux
de mortalité néonatale a diminué de moitié : il est passé de
29,6 décès pour 1000 naissances vivantes à 26,5 décès pour
1 000 vivantes. Ce qui n’a pas été le cas pour le taux de mortalités infantile qui demeure encore très important, en dépit
du relatif recul, soit de 318,262 en 2015 à 307,593 en 2021.
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 44 45
Lutte contre le Paludisme : La prévention, Prise en charge et stratégies de soutien
Endémique, le paludisme reste l’une des maladies parasitaires les plus répandues en RDC. Pour preuve, en 2021,
plus de 21 millions de cas de paludisme ont été enregistrés
dont plus de 2 millions de cas de paludisme grave (9,77%) et
10 millions d’enfants âgés de moins de 5 ans en ont soufert
dont 1 million de cas de paludisme grave. Les femmes enceintes n’ont pas non plus été épargnées, avec un décompte
de 1 million de cas de paludisme enregistrés dont 894.196
cas de paludisme simple et 221.421 cas de paludisme grave
(19,84%). En comparaison avec l’année précédente, le
nombre de cas du paludisme a décru de -5,51%. A contrario, l’incidence du paludisme (pour 1000 habitants, - échelle
de droite) a augmenté de 3,05%. Au-delà de l’endémicité,
le paludisme demeure l’une des maladies les plus meurtrières. En 2021, 22.729 congolais ont perdu la vie à la suite
du paludisme dont 15.297 décès survenus chez les enfants
âgés de moins de 5 ans, soit un taux de mortalité de 67%.
0
50
100
150
200
250
300
350
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2015 2016 2017 2018 2019 2020 2021
Décès dus au paludisme (en milliers) Cas de paludisme (en milliers)
Paludisme pour 100hab
Source : OCDD, à partir des données du PNLP et du Ministère de la Santé
Graphique 3.3 Evolution de l’endémicité/mortalité du paludisme
Pour 1000 hab.
A vrai dire, le Gouvernement n’est pas resté indiférent face
à ce problème de santé publique au regard de la hausse du
décaissement efectué pour faire face à cette maladie. Plus
spécifquement, le Gouvernement a axé sa riposte sur la
prévention, la prise en charge et la stratégie de soutien. Au
sujet de la prévention, l’Etat a consacré la plus grande part
de ce décaissement, soit 29% en 2021, à la distribution des
moustiquaires imprégnées d’insecticides à longue durée
d’action (MILD). Ce qui a permis sans doute de faire passer le nombre de MILD distribuées de 20,6 millions à 22,6
En 2021, plus de 21 millions de cas
de paludisme ont été enregistrés
Les ressources publiques destinées à lutte
contre le paludisme, ont cru de 15% en moyenne
au cours de deux dernières années
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 46 47
millions entre 2020 et 2021, soit une croissance de 9,5%.
L’essentiel de cette distribution porte sur les campagnes
de masse (16,7 millions) contre la distribution en routine
(5,2 millions). Néanmoins, en dépit de cette croissance, il
est clair que le niveau actuel demeure encore loin de celui
de 2016, lorsque le nombre de distribution de MILD avait
dépassé 31 millions. En sus, l’augmentation du nombre
de MILD distribué n’a pas permis de lever totalement le
déf. En efet, à peine 44,1% de la population ont accès aux
Moustiquaires imprégnées d’insecticide (MII) selon les
données de MICS-Palu 2018. Aussi, cette distribution estelle demeurée inégale : 59,4% de la population la plus riche
y ont accès contre 28,4% de la population la plus pauvre.
L’usage de ces MII pose également problème. Pour ceux
qui en ont accès, 83% de la population l’ont utilisée la nuit
et 52% seulement des membres des ménages qui ont dormi la nuit précédente ont utilisé n’importe quelle moustiquaire. Autant de défs donc qui expliquent notamment
la non-corrélation entre l’incidence du paludisme et la
distribution de MILD/MII. Pour faire face à ces défs, des
actions multisectorielles ont été envisagées dans le cadre
de la stratégie nationale de lutte contre le paludisme pour
maintenir et renforcer le niveau de disponibilité des MILD
dans les ménages ainsi que leur utilisation systématique et
continue.
Dans cet esprit, le PNLP, en collaboration avec le Ministère
de l’Enseignement Primaire, Secondaire et Technique, avec
l’appui du partenaire technique et fnancier de PMI/ CHEMONICS, ont distribué un grand nombre de MILD aux
communautés par le canal des élèves des écoles primaires.
Ces actions ont été accompagnées par des campagnes de
sensibilisation à travers des leçon types, des poème et slogan sur l’importance et l’utilisation correcte des MILD.
En plus de la distribution de MILD, la RDC, au travers de
son PNLP, poursuit ses eforts pour mieux respecter les
recommandations de l’OMS en matière de traitement préventif intermittent chez la femme enceinte. En dépit d’un
léger recul de la prise de dose, la proportion des femmes
enceintes ayant reçu la SP2 et la SP3 est respectivement de
73% et 60% pour la moyenne nationale en 2021 contre 74%
et 61% en 2020. Il y a lieu d’indiquer également que le Gouvernement travaille à mieux communiquer et davantage à
faire le plaidoyer circonstancié au sujet de cette maladie.
Ainsi, il consacre 6% de ressources allouées à la lutte contre
la maladie à ce chapitre.
En ce qui concerne la prise en charge, l’Etat a, en 2021,
actualisé les directives de prise en charge des cas de paludisme et élaboré les fches techniques de prise en charge.
Aussi, 26.740.915 cas suspects ont été testés sur l’ensemble
de 31.527.779 cas suspects, soit 85% de taux de testing. Le
nombre de cas de paludisme traités conformément à la politique nationale a en absolu baissé de 20.821.915 en 2020 à
20.153.499 en 2021. Rapporté au cas total de paludisme, la
proportion a plutôt connu une augmentation, soit de 92%
à 94%. Ce taux demeure inférieur, d’une part, à la cible de
100% fxé par l’Etat et d’autre part, du niveau de 2017 où ce
taux s’était situé à 96%.
Par rapport à la stratégie de soutien (formation, suivi et
évaluation, surveillance épidémiologique, approvisionnement en intrants, recherche opérationnelle), il y a lieu de
constater que cette composante stratégique de l’intervention étatique face à la lutte vectorielle reçoit davantage de
décaissements. Toutefois, certaines provinces ont connu
des stocks de certains médicaments antipaludiques inférieurs au seuil de 80%. C’est le cas par exemple de Haut-Lomami, Sankuru, etc.
Au sujet de la prévention, l’Etat a consacré la plus grande
part de ce décaissement, à la distribution des moustiquaires imprégnées d’insecticides à longue durée d’action
(MILD).
L’Etat a, en 2021, actualisé les directives de
prise en charge des cas de paludisme et élaboré les fiches techniques de prise en charge.
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 46 47
-
50,00
100,00
150,00
200,00
250,00
-
5 000,00
10 000,00
15 000,00
20 000,00
25 000,00
30 000,00
35 000,00
2015 2016 2017 2018 2019 2020 2021
Montant décaissé pour la lutte contre le paludisme (en millions d'USD)
MILD distribuées (en milliers)
Cas suspects (en milliers)
Cas suspects testés (en milliers)
Cas traités conformément à la politique nationale (en milliers)
Source : OCDD, à partir des données du PNLP et du Ministère de la Santé
Graphique 3.4 Intervention étatique pour la lutte contre le paludisme
Pour 1000 hab.
Lutte contre le VIH-Sida : Communication, prévention, dépistage et prise en charge
La population congolaise vivant avec le VIH est estimée
en 2022 à 490.000, avec une incidence de l’ordre de 0,13
contre 0,34 selon les données de l’ONUSIDA et probablement un peu moins avec les données du PNMLS (graphique 3.6). De manière générale, l’incidence des infectons est en recul. Dans la même logique, la mortalité liée
à cette pandémie connait sensiblement une baisse depuis
l’adoption de l’Agenda 2030. Toutefois, 12.000 personnes
sont décédées de suite du VIH-Sida en 2022. Aussi, en dépit de ce tableau globalement positif d’une pandémie qui
semble disparaître progressivement de la liste des problèmes de santé publique de la RDC, il n’en demeure pas
moins un réel problème pour les personnes afectées car
victimes de la discrimination. Conformément aux résultats de MICS-Palu 2018, la proportion de congolais qui
pensent que les gens hésitent à passer un test de dépistage
du VIH parce qu’ils ont peur de la réaction des autres si
le résultat du test était positif s’élève à 81,8%. Le taux de
congolais qui rapporte des attitudes discriminatoires à
l’égard des personnes vivant avec le VIH est de 53,75%.
La population congolaise vivant
avec le VIH est estimée en 2022
à 490.000
Les performances congolaises sont supérieures
à celle du monde (0,24 pour 1000 personnes) et
de très loin par rapport à l’Afrique sub-saharienne (0,87 pour 1000 personnes en 2018).
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 48 49
Les mesures prises pour ralentir la propagation du virus
s’inscrivent dans le cadre de l’objectif 95-95-9511, avec
une logique de communication, prévention, dépistage
et prise en charge. En conséquence, la proportion des
personnes vivant avec le VIH connaissant leur statut sérologique est en augmentation continue, passant par
exemple de 64% en 2020 à 83% en 2022. S’agissant de la
prise en charge, la tendance traduit également une évolution positive : en 2022, 82% de toutes les personnes vivant avec le VIH ont eu accès à un traitement antirétroviral. Aussi, la proportion des personnes vivant avec le
VIH dont la charge virale a été supprimée s’est élevée à
39,4% en 2021 contre 22,5%, une année plus tôt. Du chemin reste à parcourir pour atteindre les objectifs 95-95-95.
Ces résultats sont la contribution des eforts consentis par le
Gouvernement de la République, les exécutifs provinciaux
et les principaux partenaires au développement. Toutefois,
ces performances cachent des inégalités notamment pour
les enfants et les femmes enceintes séropositives. En efet,
seulement 44% des enfants (0-14 ans) ont eu accès au traitement antirétroviral en 2022 versus 88% chez les adultes
(15 ans et plus) et 37% des femmes enceintes séropositives
ont reçu des ARV pour réduire la transmission du VIH de
la mère à l’enfant. En plus, il demeure des défs importants
auxquels il faudrait faire face. Il s’agit notamment de l’accès
aux services VIH (prévention, dépistage, prise en charge
…) des femmes enceintes, des populations clés, des contacts
des cas positifs, de la prise en charge pédiatrique, du diagnostic précoce et l’accès à la mesure de la charge virale ainsi que la production de l’information stratégique de qualité.
0
20
40
60
80
100
-
0,05
0,10
0,15
0,20
0,25
0,30
0,35
0,40
0,45
2015 2016 2017 2018 2019 2020 2021 2022
pour 1000 hab.
VIH pour 1000 hab - ONUSIDA
VIH pour 1000 hab - PNMLS
Nbre total de personnes qui sont décédées d'une maladie due au sida sur une pop.
de 100 000 personnes
0
10
20
30
40
50
60
70
80
90
2015 2016 2017 2018 2019 2020 2021 2022
% des pers. vivant avec le VIH recevant un traitement antirétroviral
% des pers. vivant avec le VIH connaissant leur statut sérologique
% de pers. vivant avec le VIH dont la charge virale a été supprimée
Source : OCDD, à partir des données du PNMLS, de l’ONUSIDA et du
PNLS
Source : OCDD, à partir des données du PNMLS, de l’ONUSIDA et du
PNLS
Graphique 3.6 Evolution de la couverture en paquet VIH/
Sida de 2015 - 2021
Graphique 3.5 Evolution de l’incidence/mortalité du VIH
L’objectif 95-95-95 est une cible ambitieuse de traitement pour aider à mettre fn à l’épidémie du sida. L’idée au départ est qu’à l’horizon 2030,
95% des personnes vivant avec le VIH connaissent leur statut sérologique ;
95% de toutes les personnes infectées par le VIH dépistées reçoivent un traitement anti rétroviral durable ;
95% des personnes recevant un traitement antirétroviral ont une charge virale durablement supprimée
11
96,6% de toutes les personnes vivant
avec le VIH ont eu accès à un traitement antirétroviral.
Ce qui implique qu’à l’ère actuelle, la
RDC a atteint un des objectifs de
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 48 49
Couverture sanitaire universelle : Une réforme qui se concrétise
Seulement près de 5% de la population congolaise bénéfcient de l’assurance sociale, à en croire l’enquête EGI-ODD
2020. L’indice de couverture des services en vue de la couverture sanitaire universelle est passé de 37 sur 100 en 2017
à 39 sur 100 en 2019. Ce qui rappelle combien l’accès aux
soins de santé est difcile. Pour faire face à ce déf, l’ambition du Gouvernement est de mettre en place la couverture
santé universelle (CSU). Celle-ci devrait se caractériser par
des réformes structurelles dans l’ensemble du secteur et des
actions, notamment la construction, la réhabilitation des
infrastructures, le renforcement en équipements médicaux
et approvisionnement en médicaments, des formations sanitaires ainsi que la réduction sensible du coût de l’hospitalisation. A cet efet, avec le soutien de l’OIT notamment, le
Gouvernement a élaboré une feuille de route pour la mise
en place de la Couverture Santé Universelle.
En ce qui concerne les réformes structurelles, le Président
de la République a pris en 2021 une série de décisions dans
ce sens, en l’occurrence la mise en place du Conseil National de la CSU, cadre du pilotage politique et technique du
processus (ordonnance n°21/032 du 01 juin 2021), la nomination en août 2022 des animateurs des cinq établissements publics d’appui à la mise en œuvre de CSU (l’Autorité
de régulation et de contrôle de la CSU, le Fonds de Promotion de la Santé, le Fonds de Solidarité de Santé, l’Institut
national de Santé Publique et l’Agence Nationale d’Ingénierie Clinique et du Numérique de la Santé). Toujours dans
le chapitre réglementaire appuyé par l’OIT, le Ministère de
la Santé a mis sur pied une Commission pour identifer et
0
0,2
0,4
0,6
0,8
1
1,2
1,4
0
5
10
15
20
25
30
35
2015 2016 2017 2018 2019 2020 2021 2022
Ratio infirmiers/hab (pr 5000) Aide pour la santé/Aide totale
Allocation budgétaire pour la santé Ratio médecins/hab (pr 10000)
Ratio accoucheuses/hab (pr 10000)
Source : OCDD, à partir des données du Ministère de la Santé publique, PGAI et ESB
Graphique 3.7 Evolution du personnel et des allocations dans le secteur de la santé
l’ambition du gouvernement
est de mettre en place la
couverture santé universelle
(CSU)
le gouvernement a élaboré
une feuille de route pour la
mise en place de la Couverture Santé Universelle.
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 50 51
préparer les actes réglementaires au titre des mesures d’application de l’Ordonnance-Loi modifant et complétant la
Loi fxant les principes fondamentaux relatifs à l’organisation de la santé publique. Parallèlement, dans la perspective
de l’organisation de la solidarité en faveur de l’assurance
maladie, de la collecte des cotisations des bénéfciaires avec
un accent particulier sur le secteur informel et de la mobilisation des ressources additionnelles en vue de la Couverture Santé Universelle, l’Etat est entrain de travailler à la
mise en place d’une carte nationale d’Assurance Maladie.
S’agissant des autres aspects notamment la construction, la réhabilitation des infrastructures et le renforcement en équipements médicaux, dans le cadre du PDL
145-T, le Gouvernement est en train de construire et/ou
réhabiliter 788 centres de santé dans 145 territoires, lesquels vont permettre à 5 millions de congolais supplémentaires d’avoir accès à un service de santé de proximité. Aussi, dans le cadre du même programme, 90 %
des établissements sanitaires dans les 145 territoires devraient être alimentés en eau et en électricité en 2023.
Par rapport au personnel, il est clair que les ratios médecin/habitants, accoucheuses/habitants (échelle de droite)
et infrmiers/habitants sont en diminution. Une des explications de cette baisse est le faible salaire dans ce secteur et à la non prise en charge d’un nombre élevé de
médecins et infrmiers. Afn d’accroitre le nombre du
personnel de santé, notamment dans les milieux ruraux,
le Gouvernement procède par une prise en charge par le
pallier des médecins en 2022, 7608 agents et autres catégories professionnelles ont été alignés à la prime de risque.
Vaccination universelle : Un engagement gouvernemental sans précédent
Dans un pays où le respect à la conformité aux règlements
sanitaires internationaux est faible, avec un score de 55,3
sur 100 en 2021 - une légère amélioration constatée en
2020, l’apparition de la Covid-19 était un vrai déf. Cette
pandémie a perturbé les activités du secteur de la santé,
entre autres la rupture du stock de vaccins. Le nombre
d’enfants recevant le DTC3 a connu ainsi une diminution
en novembre 2020. Plus généralement, la proportion de
la population cible ayant accès à 3 doses de diphtérie-tétanos-coqueluche (DTC3) est restée quasiment station0
1
2
3
4
0
20
40
60
80
2015 2016 2017 2018 2019 2020 2021
PEV ds le budget de la santé
% de la pop. cible ayant accès à trois doses de diphtérie, de tétanos et de coqueluche (DPT 3)
% de la pop. cible ayant accès au troisème dose du conjugué contre la pneumocoque (PCV 3)
Conformité aux Règlements sanitaires internationaux (RSI)
Vaccination
Source : OCDD, à partir des données de la Fondation Mo Ibrahim, IAEG-SDG et PEV
Graphique 3.8 Vaccination et qualité de prise en charge
Rapport d’Examen National Volontaire de la RDC 2023 Rapport d’Examen National Volontaire de la RDC 2023 50 51
naire durant toute la période, en s’établissant à 57%. Il en
est quasiment de même avec la proportion de la population
cible ayant accès à la 3e dose PCV3 : elle est à 58%. La note
de la qualité de la vaccination demeure inférieure, avec un
score de 44,2 sur 100.
La réponse de l’Etat congolais aux défs de la vaccination
s’est traduite par son engagement, couchée dans la Déclaration de Kinshasa12, signée par le Président de la République
à l’issue du forum sur la vaccination et l’éradication de la
poliomyélite organisé à Kinshasa, les 22 et 23 juillet 2019.
A travers cette Déclaration, l’Etat congolais a exprimé sa
volonté de rompre d’avec le cycle d’une vaccination pris en
charge essentiellement par l’aide internationale. Par voie de
conséquence, il a pris des engagements essentiels : l’achat
de vaccin, le suivi ministériel, le suivi par les gouverneurs,
le fnancement provincial, le suivi des activités de la vaccination et de la couverture vaccinale. Ce qui renforce le
Programme Elargi de Vaccination (PEV). En termes de résultats, le tableau 3.1 ci-dessous suggère qu’au courant des
années 2020 et 2021, le bilan semble être mitigé.
12 La Déclaration est disponible ici : https://cdn.buttercms.com/0liKZhQwTDqCrW8vubD9 (page consultée le 25/04/2023).
Tableau 3.1 Bilan de la mise de la déclaration de Kinshasa
Achat de
vaccins
Suivi
ministériel
Suivi par les
gouverneurs
Financement
provincial
Suivi des activités de la
vaccination
Couverture
vaccinale
2020
16,4 millions USD sur 23,6
2 réunions sur 7
5 gouverneurs sur 26
16 provinces sur 26
18 provinces
sur 26
9 provinces
sur 18
2021 16,4 millions USD sur 23,6
3 réunions sur 10
10 gouverneurs sur 18 provinces sur 26
23 provinces sur 26
9 provinces
sur 18
Explication
des rubriques
Paiement de
l’enveloppe nécessaire à l’achat
des vaccins au
niveau central
Réunions mensuelles avec le
Ministre de la
Santé pour le
suivi des engagements
Gouverneurs ayant
réalisé au moins
une réunion de
suivi des engagements
Provinces ayant
promulgué un
édit pour le
des activités de
la vaccination
Provinces réalisant un suivi
digital en temps
réel des activités
de la vaccination
Provinces avec
une couverture vaccinale
complète
supérieure ou
égale à 50% par
enquête
-
cation
des couleurs
Attention En cours Non
respecté
Tableau 3.1 Bilan de la mise de la déclaration de Kinshasa
|
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|
30
ODD3. Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à
tout âge
Etat des lieux
A travers l’ODD 3, le Congo s’engage à permettre à tous de vivre en bonne santé et à
promouvoir le bien-être de tous à tout âge.
Les mesures institutionnelles prises par le gouvernement (gratuité de plusieurs actes médicaux
liés à la femme enceinte et à l’accouchement) se sont positivement répercutées sur la plupart
des indicateurs de santé. Concernant les soins prénatals, le taux de couverture par un
personnel qualifié, qui s’est établi à 88% en 2005, a atteint 97,9% en 2012 avant de reculer à
94 % en 2015. Dans le même temps, la proportion des femmes enceintes ayant effectué au
moins quatre consultations prénatales est passée de 75% en 2005 à 79% en 2015. Toutes ces
performances ont permis une amélioration du taux de mortalité maternelle. Celui-ci est passé
de 781 pour 100 000 naissances en 2005 à 426 en 2012, soit une baisse de 45,5%. Cependant,
entre 2012 et 2015, ce taux a enregistré une légère remontée de 1,62%, atteignant 433 décès
pour 100 000 naissances.
Depuis 2005, la mortalité des enfants de moins de 5 ans pour 1 000 naissances vivantes a
connu une amélioration substantielle. Ainsi, son taux de 88,7 pour 1 000 naissances vivantes
en 2005 a baissé à 57,6 ‰ en 2012 et à 51,3 ‰ en 2015. S’agissant du taux de mortalité
néonatale pour 100 000 naissances vivantes, la République du Congo a amélioré ce taux en le
faisant passer de 22 pour 100 000 naissances vivantes en 2014 à 21 en 2015.
Le paludisme, principale cause de consultations depuis plusieurs années (soit 54% de
consultations au cours de l’année 2016), affiche, selon les estimations de la banque mondiale,
un taux d’incidence pour 1 000 personnes à risque qui passe de 190,5 en 2010 à 208,9 en
2015, soit une baisse de 9,7%. Cette maladie demeure également la première cause de
mortalité au Congo. Au total, 5 093 décès ont été répertoriés en 2015 dont 60% dans les
services de pédiatrie. En 2022, le Gouvernement entend réduire le taux de mortalité lié au
paludisme à 60 pour 100 000 habitants alors qu’il se situe actuellement à 100 pour 100 000
habitants.
Les données du ministère de la Santé et de la Population indiquent que 503 nouvelles
infections à VIH ont été recensées par les structures étatiques en 2016 (480 décès) contre
2 059 cas en 2015. Selon l’enquête IBBS de 2017, la prévalence du VIH est plus prononcée
chez les hommes ayant des rapports sexuels avec des partenaires de même sexe (42,1%), les
professionnels du sexe (34,5%) et les détenus (50%). La couverture en ARV a régressé de
36% à 32% respectivement en 2012 et 2017.
L’incidence de la tuberculose est sur une pente descendante. De 426 cas pour 100 000
habitants en 2005, elle s’est chiffrée à 382 en 2012, puis à 379 en 2015 pour se situer à 376 en
2017. En matière de dépistage de la tuberculose, les moyens déployés par le Gouvernement
ont donné des résultats satisfaisants, en ce sens qu’ils ont permis une nette augmentation du
31
taux de dépistage, qui a culminé à 88% en 2016, soit une amélioration de 25 points de
pourcentage par rapport à son niveau de 2014.
Soulignons que pour favoriser l’accès aux soins de qualité à la mère et à l’enfant et pour
minimiser la mortalité liée au VIH, plusieurs mesures de gratuité ont été mises en place.
C’est le cas de la césarienne, du traitement antipaludique chez les enfants de 0 à 15 ans et les
femmes enceintes, de la distribution des moustiquaires imprégnées d’insecticides à longue
durée d’action, du traitement antituberculeux, ainsi que de la provision gratuite des ARV et
des examens biologiques pour les personnes vivant avec le VIH.
L’hypertension artérielle (HTA) et les accidents vasculaires cérébraux (AVC) ont été à
l’origine de 1157 décès en 2015 et 113 en 2016, ce qui équivaut à une chute de 90,2%. Les
affections respiratoires et pulmonaires sont la cause directe de 23 décès en 2016 contre 669 en
2015.
Pour l’année 2015, les statistiques du ministère en charge de la santé rapportent 1 593 cas de
diabète et 397 décès en 2015 et 153 nouveaux cas et 6 décès en 2016.
Concernant la santé reproductive, le taux de prévalence contraceptive chez les femmes de 15 à
49 ans demeure faible dans l’ensemble. En 2015, d’après le MICS 2014-2015, 29% de
femmes en milieu urbain utilisent des méthodes modernes de contraception, soit 3,5 points de
pourcentage de moins que le milieu rural. Par ailleurs, pour 1 000 adolescentes âgées de 15 à
19 ans, cette enquête montre un taux de natalité chez les adolescentes du même groupe d’âge
de 82 pour 1000 en milieu urbain et de 202 pour 1000 en milieu rural.
L’indicateur 3.8.1 « couverture des services de santé essentiels » est rapproché par le
« nombre de personnes directement couvertes par les districts sanitaires ». En 2015, sur toute
l’étendue du territoire national plus de 5,6 millions de personnes ont été couvertes par des
districts sanitaires. En 2016, ce nombre est passé à un peu de 5,8 millions. Cette progression
tient notamment de l’augmentation du nombre des centres de santé intégré dans les différentes
localités du Congo.
A ce jour, la République du Congo ne dispose pas d’un système d’assurance publique
permettant d’assurer les populations face à des risques financiers de soins en cas de maladie,
ainsi qu’un revenu minimal lorsqu’une affection les prive de travail. L’assurance maladie au
Congo demeure une initiative individuelle ou celle d’une organisation (entreprises, ONG…)
au profit de ses membres (salariés et dirigeants).
Le Taux de mortalité imputable à l’insalubrité de l’eau, aux déficiences du système
d’assainissement et au manque d’hygiène a été de 38,7% en 2015 et celui attribuable à
l’empoisonnement accidentel de 1,3%.
Le secteur de la santé au Congo est marqué par la récurrence et l’ampleur de plusieurs défis.
Pour les relever, outre les mesures rappelées plus haut, le Gouvernement poursuit le vaste
chantier de construction et d’équipement des formations sanitaires dans tous les départements,
un faisceau de projets résolument amorcé au cours de la période de mise en œuvre du PND
2012-2016. Ces projets portent sur la construction de 12 hôpitaux départementaux à vocation
générale, d’un hôpital spécialisé à Oyo, d’un nouvel hôpital militaire, et de plusieurs centres
32
de santé intégrés. Ce qui devrait améliorer le taux de couverture en infrastructures et
équipements sanitaires.
Programmes/Actions prévu(e)s par le PND 2018-2022
Les principales priorités en matière de santé, pour les prochaines années sont orientées vers
les soins de santé primaire ou de base, l’accroissement du personnel qualifié (dont la
formation d’au moins 2000 étudiants en médecine à Cuba), l’approvisionnement des districts
sanitaires en médicaments essentiels, la mise en place d’une centrale d’achat opérationnelle
ou encore la mobilisation des financements auprès des partenaires techniques et financiers.
Plus largement, pour atteindre les cibles de l’ODD 3, le PND 2018-2022 entend engager
quatre programmes d’envergure : (i) renforcement de la gouvernance et pilotage du secteur
de la santé, (ii) amélioration de l’accès équitable des populations à des paquets de services
essentiels et de qualité en vue d’atteindre la couverture sanitaire universelle, (iii) sécurité
sanitaire et gestion des situations d’urgences selon l’approche englobant l’ensemble des
menaces, (iv) promotion d’un meilleur état de santé et de bien-être de la population.
Le tableau 5 ci-après présente la situation des indicateurs de l’ODD 3 de 2014 à 2017.
|
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[
3
] |
{
"country": "cog",
"file_id": "sdg-03/vnr-report-cog-2019-fr-5.pdf",
"language": "fr",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2019
}
|
8
Objectif 3 : les mesures prises par le Gouvernement, telles que la gratuité de plusieurs actes
médicaux liés à la femme enceinte et à l’accouchement, se sont positivement répercutées sur
les indicateurs de santé. Le taux de mortalité maternelle est passé de 781 décès pour 100 000
naissances en 2005 à 433 en 2015 et celui des enfants de moins de 5 ans pour 1 000
naissances vivantes s’est établi à 88,7 en 2005 contre 51,3 en 2015. Le paludisme affiche un
taux d’incidence de 208,99 en 2015 et 197,3 en 2017.
|
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|
Garantizar la salud de los colombianos es una
prioridad para el Gobierno nacional. La línea
“Salud para todos con calidad y efciencia,
sostenible por todos” consignada en el
PND 2018-2022 busca facilitar el acceso
a servicios de salud para toda la población
colombiana, particularmente de las mujeres.
Uno de los puntos críticos requeridos para
la prestación de un buen servicio de salud
ODS 3
SALUD Y BIENESTAR
es la sostenibilidad fnanciera del sistema. Históricamente, el sistema de salud
colombiano ha visto comprometido su
nivel de endeudamiento con consecuencias
directas sobre la prestación de un servicio
de calidad. Por esta razón, una de las
principales estrategias transformadoras
de los últimos dos años ha sido la implementación del Acuerdo de Punto Final14
para sanear las fnanzas del sistema de
salud. Por medio de este esquema, con
corte a 31 de marzo de 2021, se han girado alrededor de COP 1,8 billones (USD
1.366 millones PPA) (ADRES, 2021).
Dentro de las principales apuestas defnidas en el Documento CONPES 3918
a 2030 se encuentra la meta trazadora
para el ODS 3 de reducción de la tasa
de mortalidad materna —32 defunciones por cada 100.000 nacidos vivos—.
Así, con el objetivo de defnir e implementar intervenciones en salud pública
para la transformación de la calidad de
vida con deberes y derechos a nivel de
prevención, y para cumplir con las metas
trazadas en el Documento CONPES y
en el PND, MinSalud defnió la salud
materna y de la mujer como una de las
diez prioridades nacionales en salud.
Gracias a las acciones emprendidas, la
tasa de mortalidad materna ha disminuido desde la adopción de la Agenda
2030, especialmente entre 2017 y
2018, cuando se presentó una varia14 Política que tiene por objeto preservar
la sostenibilidad financiera del Sistema
General de Seguridad Social en Salud,
como vía para garantizar el derecho
fundamental de salud, en el mediano y
largo plazo.
2015
40
45
50
55
2016 2017 2018 2019
53,71
50,73
45,29
Gráfico 5. Tasa de mortalidad materna, 2015-2019
Fuente: DANE (2021b).
36 REPORTE NACIONAL VOLUNTARIO 2021
ción de –11,17 %, la más alta dentro
del periodo analizado, como se observa en el gráfico 5 (DANE, 2021b).
No obstante, aún persisten retos importantes para disminuir la mortalidad materna a nivel nacional y local. Entre 2018
y 2019, la mortalidad materna registró un
aumento de 5,4 pp (50,7 muertes por cada
100.000 nacidos vivos). A nivel territorial,
14 departamentos del país registraron
tasas de mortalidad materna superiores a
la tasa nacional en 2019 por cada 100.000
nacidos vivos; en particular, Vichada
(326,8), Guainía (312,5), Chocó (128,2) y
Putumayo (68,7) fueron quienes registraron tasas más altas. Para atender esta situación, el Gobierno nacional, en el marco
del PMI del Acuerdo de Paz, en la estrategia de Atención Integral a la Primera
Infancia, diseñó e implementó el Proyecto
Plan de Acción de Salud Primeros 1.000
Días de Vida, dirigido a la atención integral en salud materna e infantil en 30 municipios PDET. Adicionalmente, según
información del MinSalud, el número de
mujeres gestantes atendidas en servicios
de primera infancia aumentó un 52 % entre 2018 y 2020, para un total de 215.358
atenciones a mujeres embarazadas. Se
espera lograr 427.280 atenciones en el
marco de Atención Integral a la Primera
Infancia hasta 2022 (MinSalud, 2021d).
De igual forma, y con el objetivo de
atender a las poblaciones indígenas con
mayores tasas de mortalidad materna
—195,9 muertes por cada 100.000 nacidos vivos en 2016 (DANE, 2021b)—,
y con el liderazgo del MinSalud, se
elaboró el documento Orientaciones
para la adecuación sociocultural de los
servicios de salud materno perinatal para
pueblos indígenas. El principal objetivo
de este instrumento de política pública
es orientar los procesos de adecuación
intercultural de los servicios de salud
prestados por instituciones prestadoras de
salud (IPS) públicas y privadas en el nivel
departamental y municipal para la incorporación del enfoque intercultural. Con
dicho fn, se adelantan procesos de articulación complementaria entre la biomedicina, la academia y la medicina tradicional, de manera que se pueda responder
a las demandas, los usos, los hábitos, las
costumbres y las prácticas de la población indígena y así disminuir las barreras
culturales de acceso, aportando al cuidado de la salud de estas comunidades.
Como parte de las acciones descritas, a
pesar de que aún existes enormes retos,
se observa en el gráfco 6 una disminución signifcativa en aquellos departamentos con tasas de mortalidad
materna más altas entre 2018 y 2019.
Estos departamentos, principalmente
rurales y fuertemente golpeados por el
conficto, han presentado registros que
demuestran el avance en la dirección
correcta. Por ejemplo, el departamento
del Vichada refejó una disminución del
40 % en la tasa de mortalidad por cada
100.000 nacidos vivos (DANE, 2021b).
547,3
2018
326,80
2019
323,28
2018
Gráfico 6. Tasa de mortalidad materna, cinco departamentos, 2018-2019
Fuente: DANE (2021b). Vichada
Chocó Putumayo
Guainía
La Guajira
312,50
2019
157,93
2019
130,67
2018
90,35
2018
92,89
2018
68,70
2019
128,24
2019
37
Lo anterior, unido con el Plan Contra la
Desnutrición Infantil Ni1+, ha permitido
avanzar en la meta ODS 3.2 de prevenir
la muerte en menores de cinco años a lo
largo del país. Bajo este proyecto se fortalecen los procesos de identifcación, captación, atención y seguimiento de los niños y
las niñas con desnutrición aguda, para lograr la recuperación del estado nutricional
y así disminuir las muertes prevenibles.
Para luchar contra las defunciones de
niñas y de niños, combatir las enfermedades transmisibles (meta ODS 3.3)
constituye una prioridad nacional. Para
esto, el Programa Ampliado de Inmunizaciones (PAI) fue fortalecido con un
presupuesto de inversión de COP 433
mil millones en 2021 (USD 328 millones
PPA), el más alto en la historia del país.
Esto ha permitido contar con un total de
21 biológicos para la prevención de 26
enfermedades. De acuerdo con el sistema
de información del PAI de MinSalud,
el porcentaje de niñas y de niños con
tercera dosis de pentavalente fue 93,37
% en 2019, evidenciando que el país está
en el camino correcto hacia el cumplimiento de la meta de 95 % en 2030. Por
otra parte, el porcentaje niños y niñas de
un año con vacunación de triple viral fue
de 94,4 % en 2019 (MinSalud, 2021b).
Se destaca, adicionalmente, el incremento en las coberturas de vacunación
contra el virus de papiloma humano
(VPH), pasando de menos del 10 % a
valores del 30 % en 2019 al aplicar 150
mil dosis para prevenir el cáncer de
cuello uterino en mujeres (cuarta causa
de muerte de mujeres en el país). De
igual manera, se resalta la aplicación de la
dosis cero de la vacuna contra el sarampión, la cual protege de esta enfermedad
no solo a la población colombiana, sino
a los migrantes (MinSalud, 2021c).
En cuanto a lucha contra enfermedades como la malaria y el dengue, el país
ingresó a la Iniciativa Regional para la
Eliminación de la Malaria, que le permite
recibir asistencia técnica y recursos para
el tratamiento oportuno y la prevención
de la malaria, específcamente en municipios del Pacífco colombiano, donde la
incidencia es mayor (en 2015 en Chocó,
uno de los departamentos más afectados,
la incidencia era de 62,2 por cada 1.000
habitantes, mientras que a nivel nacional
era del 5,3). Como consecuencia de las
acciones emprendidas, la incidencia de
malaria a nivel nacional —número de
casos en un año por cada 1.000 habitantes— se redujo un 52,4 % entre 2015
y 2019, como se observa en el gráfco 7,
permitiendo el avance a la meta de dos
casos por cada 1.000 habitantes en 2030.
De igual manera, Chocó y Amazonas, dos
departamentos con incidencia de malaria
más alta en 2015, han registrado reducciones del 60,8 % y 25,0 % respectivamente
durante este periodo (MinSalud, 2021c).
Además, se obtuvieron recursos por
USD 19,5 millones para la continuidad
2015
0,0
40,0
20,0
80,0
60,0
120,0
100,0
2016 2017
62,2
Gráfico 7. Incidencia de malaria por cada 1.000 habitantes, 2015-2019
Fuente: Sivigila-INS, 2020.
53,5
5,3
38 REPORTE NACIONAL VOLUNTARIO 2021
del Fondo Mundial para la lucha contra
el síndrome de inmunodefciencia
adquirida (SIDA), la tuberculosis y la
malaria, los cuales permitirán acercarse
a las metas de 2,4 tasa de mortalidad por
VIH/SIDA por 100.000 habitantes, 10
casos en la incidencia de tuberculosis
por cada 100.000 habitantes, y dos casos
en la incidencia de malaria por cada
100.000 habitantes, propuestas a 2030.
En el marco de la meta ODS 3.7, de
garantizar el acceso a los servicios de
educación sexual y reproductiva, el
Gobierno nacional ha enfocado su
estrategia al acompañamiento técnico
y metodológico a los entes territoriales
para la implementación de la Estrategia
Nacional para la Prevención del Embarazo en la Infancia y Adolescencia,
con el propósito de establecer el marco
conceptual, técnico y metodológico para
la construcción y despliegue de planes
y proyectos ajustados desde un enfoque
de derechos y determinantes sociales.
Adicionalmente, se desarrolló el Capítulo de Uniones Tempranas y Exposición
al Riesgo de Embarazo de la Encuesta
Nacional de Demografía y Salud, y se
implementó el seguimiento departamental, distrital y municipal de las tasas de
fecundidad adolescente mediante Decreto
028 de 2008, con el objetivo de contar
con información precisa para combatir el
embarazo adolescente. No obstante, de
acuerdo con información de Estadísticas
Vitales del Departamento Administrativo Nacional de Estadística (DANE),
el porcentaje de mujeres de 15 a 19 años
con embarazo subsiguiente mostró un
aumento de 0,9 pp entre 2018 y 2019
(21,5 % en 2019), evidenciando los retos
que enfrenta el país para alcanzar la meta
en 2030 de 14 % de mujeres en este rango
de edad con embarazo subsiguiente.
Lograr la meta ODS 3.8 (de lograr la
cobertura sanitaria universal) requiere una
efectiva territorialización de los esquemas
de salud en las zonas apartadas del país
para garantizar el acceso a servicios de
este tipo esenciales y de calidad. La prestación de esta clase de atención en Colombia se encuentra reglamentada por la Política Nacional de Prestación de Servicios
de Salud, obedeciendo a la Ley 1122 de
2007 y sus decretos reglamentarios, cuyo
principal objetivo es garantizar el acceso y
la calidad de los servicios, optimizar el uso
de los recursos y promover los enfoques
de atención centrada en el usuario. En
2019 se contó con 1,22 médicos por cada
1.000 habitantes en las zonas rurales
dispersas de Colombia, lo cual demuestra los esfuerzos realizados para contar
con profesionales capacitados en estas
zonas del país, en la medida en que los
municipios de zonas rurales dispersas
cuentan con 0,091 médicos en servicio
social obligatorio por cada 10.000 habitantes, en comparación con los municipios del resto del país, que cuentan con
0,775. Adicionalmente, reconociendo
las particularidades de cada territorio, se
ha avanzado en la gestión de modelos de
2018 2019
46,7
Como consecuencia
de las acciones
emprendidas,
la incidencia de
malaria a nivel
nacional —número
de casos en un
año por cada 1.000
habitantes— se
redujo un 52,4 %
entre 2015 y 2019.
20,9
2,5
Chocó
Amazonas
Colombia
39
salud en las zonas dispersas del país. Es
así como, durante 2020, dos entidades
territoriales contaban con un modelo de
salud diferencial (MinSalud, 2021a).
Asimismo, en el marco del programa Salud
para la Paz, impulsado por el Minsalud,
en 2020 se brindó apoyo logístico a los
hospitales para realizar 60 jornadas de salud
donde participaron 8.251 personas (3.806
mujeres, 1.274 hombres, 1.432 niños y 1.739
niñas) de las zonas rurales priorizadas1 5,
quienes recibieron servicios de prevención
de la enfermedad y promoción de la salud,
atención por medicina general y algunas
especialidades (ginecología, pediatría). Esto
representa una oportunidad de acercar los
servicios a las zonas rurales y rurales dispersas, cerrar las brechas en la atención de
las comunidades más afectadas por el conficto en armonía con lo contemplado en el
Punto 1 del Acuerdo de Paz (Reforma Rural
Integral), y dar continuidad a servicios que
habían estado restringidos por la pandemia.
Ahora bien, una de las apuestas del Documento CONPES 3918 para alcanzar los
ODS es el acceso de la población a sistemas
de protección social en salud: 99 % en 2030.
En este tema Colombia ha experimentado
un cambio en las últimas décadas, pasando
de niveles de aseguramiento de 29 % en
1995 a 95,6 % en 202016. Por su parte, el
porcentaje de afliados a administradoras de
riesgos laborales aumentó 2,7 pp entre 2015
y 2020 (DANE, 2021c). A pesar del comportamiento del mercado laboral formal,
se observa un incremento en el porcentaje
de población afliada en cada uno de los
regímenes que ofrece el sistema de salud.
En línea con la meta ODS 3.9 (relacionada
con reducción de enfermedades por químicos peligrosos), una prolongada exposición a
entornos con una defciente calidad del aire
puede repercutir directamente sobre la salud
humana, afectando el riesgo de infecciones respiratorias, enfermedades cardíacas,
accidentes cerebrovasculares y cáncer de
pulmón. Según el último informe de calidad
del aire del Instituto de Hidrología, Meteorología y Estudios Ambientales (IDEAM),
el porcentaje de estaciones que cumplen
con el objetivo intermedio III de las guías
de calidad del aire de la Organización
Mundial de la Salud (OMS) en material
particulado inferior a 2,5 micras (PM2,5)
y 10 micras (PM10) fue en 2019 de 39 %
y 34 % respectivamente, lo cual demuestra un avance en el camino correcto si se
compara con los resultados obtenidos en
2015: 25 % y 14,9 % (IDEAM, 2019).
No obstante, para alcanzar las metas
planteadas a 2030 de 70 % de estaciones
con material particulado inferior a 2,5 y
10 micras, se requieren acciones decididas
que de manera intersectorial contribuyan
a mejorar la calidad del aire. Para esto, en
2019 se promulgó la Ley 1972 de 2019, la
cual establece medidas de protección de
los derechos a la salud y al medio ambiente
sano tendientes a la reducción de emisiones contaminantes de fuentes móviles.
En este sentido se resalta por ejemplo, el
requerimiento de que todas las fuentes
móviles terrestres con motor ciclo diésel
que se fabriquen, ensamblen o importen
al país cumplan con los límites máximos
permisibles de emisión de contaminantes
al aire correspondiente a tecnologías Euro
VI o superiores. Por otra parte, a 2030, se
espera que todos los sistemas integrados
de transporte masivo, sistemas estratégicos
de transporte público, sistemas integrados
de transporte público y sistemas integrados de transporte regional cuenten con
40 REPORTE NACIONAL VOLUNTARIO 2021
un mínimo de 20 % de la fota total nueva
correspondiente a tecnología cero emisiones.
Ahora bien, entendiendo que la salud y el
bienestar no se remiten únicamente a lo
físico, en 2018 se lanzó la Política Nacional de Salud Mental, que tiene como
objetivo la promoción de la salud mental
en diferentes entornos, y la prevención
y atención integral de los problemas de
salud mental individuales y colectivos.
Adicionalmente, se elaboró el Documento CONPES 3932 de 2020, “Estrategia
para la promoción de la salud mental en
Colombia”, a través del cual se defnen las
estrategias de salud mental y se adelantó el
proceso de elaboración de la Ruta Integral
de Atención para personas con problemas
mentales, trastornos mentales, consumo
de sustancias psicoactivas y epilepsia. Este
conjunto de políticas resultan ser clave y
signifcan un avance para el país de cara
al reto existente en 2030 de aumentar el
porcentaje de personas que tienen acceso a
servicios de salud mental. De esta manera, el porcentaje de personas atendidas
en servicios de salud mental17 se ubicó en
2019 en 4,7 %, 1,6 pp más de lo observado en 2016: 3,1 % (MinSalud, 2020a).
Asimismo, las condiciones ambientales
inciden de manera transversal en el
ODS 3 al ser determinantes en la salud
y el bienestar de la población. En este
sentido, el país cuenta con un Plan
Decenal de Salud Pública 2012-2021
que propuso acciones en materia de
salud ambiental y cuyos logros incluyen la actualización de los modelos de
inspección, vigilancia y control sanitario en temas de especial importancia
como uso y manejo de plaguicidas y
sustancias químicas, y establecimientos
de interés sanitario como cementerios, cárceles, batallones, entre otros.
También cabe mencionar en este punto
el desarrollo de programas de enfermedades transmitidas por vectores (ETV) y
zoonosis, destacando la construcción de
la estrategia de gestión integral para las
ETV. Por su parte, la Comisión Nacional Técnica Intersectorial para la Salud
Ambiental (Conasa) avanza en 2021
en la formulación de nuevas estrategias
de política pública en materia de salud
ambiental, enfatizando en los componentes de calidad de aire, calidad del
agua, seguridad química, ETV, cambio
climático, zoonosis y entornos saludables.
Si bien Colombia ha avanzado en la consolidación institucional y en la formulación
de diferentes políticas que no solo garanticen la prestación de los servicios de salud,
sino también que estos sean de calidad, en
la vigencia 2019 se adoptó, a través de la
Resolución 089, la Política Integral para
la Prevención y Atención del Consumo de
Sustancias Psicoactivas, que tiene como
objetivo garantizar la atención integral
de las personas, familias y comunidades
con riesgos o consumo problemático
de sustancias psicoactivas, mediante
respuestas programáticas, continuas y
efectivas, en su reconocimiento como
sujetos de derechos. Este instrumento
permitirá brindar soluciones oportunas que
permitan acercarse a las metas propuestas
en 2030 de que solo el 1 % de la población
abuse de sustancias ilícitas y el 5 % esté en
riesgo perjudicial de consumo de alcohol.
15 Municipios PDET, 170 municipios priorizados por ser los más
afectados por el conflicto armado.
16 El dato 2020 es calculado con el Censo 2018, mientras que el
dato de 1995 es con base del Censo 2005.
17 Número de personas atendidas por diagnóstico en salud mental
(al menos una atención), entre la población total atendida.
41
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46
L’ODD 3 est pris en charge par le catalyseur 3 « un
capital humain qui prépare l’avenir » du Plan Comores
Emergent (2030). Le Gouvernement comorien et ses
différents partenaires au développement multiplient leurs
efforts pour (i) un accès aux services de santé de qualité
à tous, (ii) une amélioration de l'état nutritionnel de la
population, en particulier des femmes et des enfants et
(iii) une accélération de la transition démographique. Dans
l’ensemble, la réalisation de cet objectif connait des progrès
contribuant à la promotion et à la protection des droits de
l'homme, y compris le droit à la santé et le droit à la vie.
Le suivi de cet ODD se fera à travers six cibles retenues
comme prioritaires par l’Union des Comores. Il s’agit des
cibles : 3.1; 3.2; 3.4; 3.6; 3.7 et 3.8.
Cible 3.1. D’ici à 2030, faire passer le taux
mondial de mortalité maternelle au-dessous de
70 pour 100 000 naissances vivantes
Permettre à tous de vivre en bonne santé et
promouvoir le bien-être de tous à tout âge
La cible 3.1 vise, d’ici à 2030, à faire passer le taux
mondial de mortalité maternelle en dessous de 70 pour
100 000 naissances vivantes. Les efforts fournis par
le Gouvernement, avec l’appui de ses partenaires, ont
donné des résultats probants. Les données provisoires
de l’enquête MICS réalisée en 2022 montrent que le taux
de mortalité maternelle est estimé à 53 pour 100 000
naissances vivantes contre 172 pour 100 000 naissances
vivantes en 2012 (EDS-MICS). La proportion de décès
pour cause maternelle est passée de 17% en 2012
(EDS-MICS) à 7,4% en 2022 (MICS-2022). D’importants
investissements soutenus par les partenaires au
développement (Agence Française de Développement,
Banque Mondiale et Système des Nations Unies…)
contribuant à cette réduction de la mortalité maternelle ont
été consentis à travers l’approche du fnancement basé
sur les performances qui consiste à subventionner une
grande partie des coûts des soins de santé au bénéfce des
femmes enceintes. S’y ajoutent également les formations
Rapport National Volontaire sur la mise en œuvre des ODD en Union des Comores
47
des personnels des structures de santé notamment les
maternités et les dotations en équipements au proft de
ces dernières.
Les données hospitalières des quatre dernières années
en comparaison à la situation de 2018 indiquent une
persistance quoique minime des décès maternels
(graphique 14).
La prise en charge des complications maternelles pourrait
être un facteur explicatif de cette persistance de décès
maternels en milieu hospitalier. Selon l’enquête HHFA-SDI
de 2020, en Union des Comores, les agents de santé de
manière générale n’appliquaient que 11,77% des directives
cliniques de prise en charge des complications maternelles
et néonatales, de plus, 85% à 90% des établissements
de santé du pays n'adhéraient pas à la prise en charge
correcte des complications maternelles et néonatales.
Les accouchements en milieu hospitaliers ont connu un
fort progrès ces dix dernières années, l’enquête MICS de
2022 montre que 95,1% des femmes ont accouché en
milieu hospitalier; cette proportion était de 76,1% en 2012
(EDS-MICS).
Également, il ressort de l’enquête MICS de 2022 que
presque l’ensemble des accouchements (97,2%) ont lieu
sous l’accompagnement de personnels qualifés, c’est un
fort progrès en comparaison à la situation de 2012 où la
proportion des accouchements assistés par un personnel
qualifé était de 85,3% .
Cible 3.2. D’ici à 2030, éliminer les décès
évitables de nouveau-nés et d’enfants de
moins de 5 ans, tous les pays devant chercher
à ramener la mortalité néonatale à 12 pour 1
000 naissances vivantes au plus et la mortalité
des enfants de moins de 5 ans à 25 pour 1 000
naissances vivantes au plus
Cette cible vise, d’ici à 2030, à éliminer les décès évitables
de nouveau-nés et d’enfants de moins de 5 ans, tous les
pays devant chercher à ramener la mortalité néonatale à
12 pour 1 000 naissances vivantes au plus et la mortalité
des enfants de moins de 5 ans à 25 pour 1 000 naissances
vivantes au plus.
L’Union des Comores a enregistré des résultats notables
en matière de réduction de la mortalité des nouveaux
nés et des enfants de moins de 5ans, le taux de mortalité
infantile est passé de 43,5/1000 en 2017 (RGPH 2017)
à environ 30/1000 selon l’enquête MICS de 2022. Cette
mortalité touche plus les enfants résidant en milieu rural
(33/1000) que ceux du milieu urbain (24/1000). La mortalité
néonatale est estimée à 19/1000, elle est plus élevée en
milieu rural (20/1000) qu’en milieu urbain (16/1000). Elle
est surtout plus importante chez les enfants issus de mères
sans aucun niveau d’instruction (36/1000) et aussi chez
les enfants issus des ménages les plus pauvres (25/1000).
La mortalité juvénile connait pour sa part un fort recul au
cours des cinq dernières années, elle est estimée à 6/1000
alors qu’en 2017 elle s’élevait à 12,6/1000.
Quant à la mortalité néonatale - décès dans les 28 jours de
vie - elle est estimée à 19 pour 1 000 naissances vivantes
contre 24 pour mille en 2012.
47 EDS-MICS 2012
48
Cible 3.4. D’ici à 2030, mettre fn à l’épidémie
de sida, à la tuberculose, au paludisme et aux
maladies tropicales négligées et combattre
l’hépatite, les maladies transmises par l’eau et
autres maladies transmissibles
Cette cible vise, d’ici à 2030, à réduire d’un tiers, par la
prévention et le traitement, le taux de mortalité prématurée
due à des maladies non transmissibles et promouvoir
la santé mentale et le bien-être. Les maladies non
transmissibles (MNT) constituent une urgence de santé
publique en Union des Comores notamment le diabète.
Elles sont la cause de plus de 42% des décès (OMS
2018). Afn de faire face, le pays s’est doté d’une politique
nationale de lutte contre les MNT pour la période 2020-
2029.
Prévalence du diabète, de l’hypertension
et de la flariose
Le diabète constitue un problème majeur de santé
publique en Union des Comores, selon l’ONG santé
Diabète, la prévalence du diabète aux Comores est de
12,3% (2019/2018). Il ressort des données collectées
auprès de l’organisme Santé Diabète que pour un total
cumulé de 11659 personnes dépistés en 2022, 1236 cas
ont avéré être diabétique soit, ce qui représente 10,6%
de la population dépisté en 2022. Cela montre l’ampleur
que prend le diabète dans la population comorienne.
Des actions sont entreprises pour répondre aux enjeux
liés à cette forte prévalence, en effet depuis 2016, Santé
Diabète accompagnent le pays dans la prévention, la prise
en charge, l’accès aux traitements, le développement des
associations de patients ainsi que le renforcement des
stratégies nationales de lutte contre les maladies non
transmissibles, particulièrement le diabète.
Prévalence de l’hypertension chez les adultes et
la flariose
L’hypertension artérielle touche une partie importante des
adultes selon l’OMS, la prévalence chez la population
âgée entre 30 et 70 ans en Union des Comores est de
33,2% (World Health Statistics 2022).
La prévalence de la flariose est en baisse selon les
statistiques sanitaires de 2020, elle est estimée à 2% en
2020 contre 7% en 2018 et en 2019.
Mortalité liée aux MNT
Selon l’OMS, Le taux de mortalité lié aux maladies
cardiovasculaires, au cancer, au diabète ou à des maladies
respiratoires chroniques chez la population âgée entre
30 à 70 ans en Union des Comores est estimé à 20,6%
(World Health Statistics 2022).
Cible 3.6. D’ici à 2020, diminuer de moitié à
l’échelle mondiale le nombre de décès et de
blessures dus à des accidents de la route
Cette cible vise, d’ici à 2020, à diminuer de moitié à
l’échelle mondiale le nombre de décès et de blessures dus
à des accidents de la route.
Malgré les efforts déployés par le Gouvernement en
matière de renforcement des capacités des structures
chargées de la sécurité routière notamment la mise en
place d’une brigade routière bien visible partout sur le
territoire et les mesures prises comme l’interdiction de
téléphoner en conduisant et le port obligatoire de la
ceinture de sécurité, le taux de mortalité lié aux accidents
de la route a augmenté, passant de 26,13 en 2016 à 31
en 2022.
Selon les autorités de la gendarmerie nationale, l’excès
de vitesse constitue la principale cause des accidents. Il
est ainsi nécessaire de mettre en place plus de mesure de
prévention à ce propos afn de réduire considérablement
les décès ainsi que les blessures liées à la circulation
routière.
Rapport National Volontaire sur la mise en œuvre des ODD en Union des Comores
49
Cible 3.7. D’ici à 2030, assurer l’accès de tous
à des services de soins de santé sexuelle et
procréative, y compris à des fns de planifcation
familiale, d’information et d’éducation, et veiller
à la prise en compte de la santé procréative dans
les stratégies et programmes nationaux
Cette cible vise, d’ici à 2030, à assurer l’accès de tous à
des services de soins de santé sexuelle et procréative, y
compris à des fns de planifcation familiale, d’information
et d’éducation, et veiller à la prise en compte de la santé
procréative dans les stratégies et programmes nationaux.
Planifcation familiale
Selon l’enquête MICS de 2022, la proportion de femmes en
âge de procréer (15 à 49 ans) qui utilisent des méthodes
modernes de planifcation familiale a baissé par rapport à
la situation qu’elle était dix ans auparavant. En effet selon
cette enquête, la proportion de femmes qui utilise une
méthode moderne de planifcation est estimée à 8,40% en
2022 alors qu’en 2012 (EDS-MICS 2012) elle était estimée
à 14%. Le pays enregistre une évolution baissière sur
l’utilisation des méthodes de planifcation au cours de ces
dix dernières années, le nombre des nouvelles utilisatrices
des méthodes de planifcation est passé 5 710 en 2019 à
3727 en 2022.
Cette baisse serait plutôt liée à une baisse de l’offre due à
une rupture de stock plutôt qu’à une baisse de la demande.
48 Femmes âgé de 15-19 ans
49 RGPH 2012, rapport P.42, Tableau 35
Fécondité des adolescents
Le taux de fécondité des adolescentes48 est estimé à 60
naissances pour 1000 femmes âgées entre 15 et 19, elle
est en baisse en comparaison à celui de 201749 . Elle est
plus élevée en milieu rural (65,7/1000) qu’en milieu urbain
(46,3/1000). Aussi, elle reste en dessus du taux brut de
natalité qui est de 29,3 mais largement en dessous du taux
de fécondité générale qui est de 132,9.
Cible 3.8. Faire en sorte que chacun bénéfcie d’une
couverture sanitaire universelle, comprenant une
protection contre les risques fnanciers et donnant
accès à des services de santé essentiels de qualité
et à des médicaments et vaccins essentiels sûrs,
effcaces, de qualité et d’un coût abordable
Cette cible vise à faire en sorte que chacun bénéfcie
d’une couverture sanitaire universelle, comprenant une
protection contre les risques fnanciers et donnant accès
à des services de santé essentiels de qualité et à des
médicaments et vaccins essentiels sûrs, effcaces, de
qualité et d’un coût abordable.
50
Le Gouvernement de l’Union des Comores s’est engagé
dans son ambition de faire les Comores un pays émergent
en 2030 de faciliter l’accès de toute sa population aux
services de santé à moindre cout via une meilleure
couverture du pays en infrastructures sanitaires de très
haute qualité. La construction du Centre Hospitalier
Universitaire (CHU) de Moroni, l’augmentation du nombre
des médecins spécialistes, la dotation des appareils
de haute qualité aux différentes structures sanitaires, le
déploiement des centres ambulatoires sont des signaux
montrant les efforts engagés par le gouvernement ces
trois dernières années. Par ailleurs, un processus de mise
en place de l’assurance maladies généralisée (AMG) est
en cours
Couverture médicale des femmes de 15-49 ans
L’assurance santé reste trop limitée en Union des
Comores. Selon l’enquête MICS de 2022, seulement 4,9%
des femmes âgées de 15 à 49 ans déclarent être couvertes
par une assurance maladie. Ce sont les mutuelles ou les
assurances maladies communautaire (43%) qui assurent
le plus de couverture ainsi que les régimes de sécurité
sociale (30,8%). Les autres types de régime portent
sur l’assurance santé commerciale privée (9,8%) et
l’assurance maladie par l’employeur (15,9%). C’est plus
en milieu urbain que la proportion des femmes couvertes
est peu importante avec 7,9% de femmes couvert contre
3,5% en milieu rural. Les femmes issues des ménages
plus pauvres ne représentent que 3% des femmes couvert
par une assurance santé.
Par ailleurs, beaucoup d’actions en vue d’assurer un
accès des services sanitaires aux femmes en âge de
procréer sont mises en place tels que la prise en charge
d’une grande partie des frais de consultation prénatale, de
césariennes ou d’accouchements normaux en faveur des
patients à travers le projet PASCO 2 fnancé par l’Union
Européenne et par la suite le Projet COMPASS fnancé par
la Banque Mondiale.
Dépenses en santé
Les ménages comoriens consacrent une grande partie
de leurs revenus pour ses besoins en santé malgré
la persistance de la pauvreté50. La vision à atteindre
l’émergence en 2030 accorde à la santé une place
centrale; en 2019, la part du budget allouée au secteur de
la santé est revue à la hausse51 et représentait 19,34 % du
budget contre 5,66%53 en 2016. En 2022, la part d budget
allouée à la santé s’élevait à 14,82 %54. Cela montre qu’il
y’a eu assez de progrès en vue de soutenir le secteur de
la santé ces trois dernières années. Parallèlement, les
dépenses des ménages pour subvenir à leurs besoins
en santé restent de plus élevées. Selon les CNS de la
santé, en 2019 la part des dépenses des ménages dans le
fnancement de la santé était estimée à 61,8%, elle était de
77,6% en 2015 et 64% en 201155.
50 44,8% de la population vit en dessous du seuil national de
pauvreté (EHCVM-2020)
51 En lien avec le fnancement de la construction de l’hôpital Elalouf
52 Cette hausse pourrait être liée au fort budget d’investissement
interne pour la construction de l’hôpital Elmaarouf
53 Compte Administrative de 2016
54 Loi de fnance rectifcative de 2022
55 CNS de 2011 révisé
|
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[
3
] |
{
"country": "com",
"file_id": "sdg-03/vnr-report-com-2023-fr-3.pdf",
"language": "fr",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
45
VOLUNTARY NATIONAL REPORT ON THE
IMPLEMENTATION OF THE 2030 AGENDA FOR
SUSTAINABLE DEVELOPMENT
46
47
VOLUNTARY NATIONAL REPORT ON THE
IMPLEMENTATION OF THE 2030 AGENDA FOR
SUSTAINABLE DEVELOPMENT
incidence of infectious diseases, with
the sporadic occurrence of epidemics
related to vector-borne diseases given
the country’s vulnerability. Thus, the
proportion of deaths attributed to circulatory system diseases has increased
from about 26 out of every 100 in 2011 to
30 in 2016 and the incidence of diabetes
is increasing. The deaths attributed to
malignant tumors fuctuate around 13
and 14%, while deaths from respiratory
diseases have increased from 9.2% in
2011 to 11.5% in 2015.
This is a more challenging segment,
considering the high costs of prolonged
treatment of these chronic diseases.
Reducing the incidence and prevalence of Priority None Communicable
Diseases, with the implementation of
the NHS’ Health Care Quality Improvement Program, is one of the outcomes
of the health sector reform and the
PEDS, as regards reducing evacuations,
which presupposes increasing the NHS’
response capacity on all islands and
overall in the country.
In Cabo Verde, the annual expenditure
on health per capita is US $83.9 and has
been increasing, seeing that it was US
$66.5 in 2015. This is due to the fact that
public spending on health has grown at
a faster pace than the average population growth. However, this should not
overshadow the more important fact,
which is the share of public spending on
health has decreased from 9.6% in 2015
to 7.6% in 2017, in the context of rising
health costs.
The occurrence of dengue and zika epidemics in the last 9 years and of malaria
in 2017, in the Municipality of Praia, pose
new challenges to health. In 2016, the
country was certifed poliomyelitis-free
and received the 2017 Excellence Award
from the African Leaders Malaria Alliance (ALMA) for its efforts to fght malaria, and we intend to eliminate malaria
by 2020. So, we are drafting a plan to
SDG 3. Ensure healthy lives and promote well-being for all at all ages
In the feld of Health, Cabo Verde has
had a successful journey and has
made great progress, especially in
recent years, reaching the Millennium
Development Goals related to under-fve
mortality and maternal mortality, in
2015. In Cabo Verde, life expectancy is
80.2 years for women and 72.2 years for
men. The overall maternal mortality rate
was reduced to less than 70 deaths per
100,000 live births by 2015. By 2016, it
was 18.8 deaths per 100,000 live births.
Improvements are continuing and there
appears to be no risk of regression.
In addition, the vast majority of births
are attended by qualifed health professionals.
Signifcant progress has been made in
the area of reproductive health, with the
average number of children per woman
decreasing from seven children in the
1970s to 2.33 children per woman in
2017. And, coupled with investments in
human capital and especially in education
and in health in general, such progress
have led to the current demographic
transition.
In 2016, there were only 17 deaths per
thousand children under the age of fve,
and neonatal mortality was reduced in
a sustainable way. The early neonatal
mortality rate (0 to 6 days) was reduced
from 11.2 deaths per 1000 live births in
2010 to 8.1 in 2015 and 7.6 in 2016, while
late neonatal mortality (7 to 27 days)
decreased from 3.1 deaths per 1000 live
births in 2010 to 2.0 in 2015, standing
at 2.5 in 2016. Post-neonatal mortality
has followed the same trend, reducing
from 8.5 deaths per 1000 live births in
2010 to 5.3 in 2015 and 2016. Thus, in
Cabo Verde, both neonatal mortality and
under-fve mortality are at levels below
the SDG target, and it is believed that
the country may, well before 2030, end
the preventable deaths of newborns and
children under 5 years-old.
Road accidents are relatively high and
road accidents deaths accounted for
1.3% of total deaths in 2015.
There is high coverage for prenatal care.
Thus, in 2016 about 87 out of every 100
pregnant women benefted from prenatal visits with nurses and about 4.7%
with doctors. Almost all (94.8%) children
under the age of 1 have benefted from
postnatal visits with nurses and about
10 out of every 100 with doctors.
The success of Cabo Verde in the feld
of health is mainly related to the preventive aspect and especially to the
high vaccination coverage of children.
This is a good practice that has prevented many inequities, that is, it has
reduced avoidable inequalities in health
care. By 2016, at least 91 out of every
100 children under 1-year-old had been
vaccinated. This performance is due in
large part to the solidarity of the international community, particularly the World
Health Organization.
The country is in an epidemiological
transition phase, with chronic diseases
being the main causes of death (brain/
cardiovascular diseases and cancers
are the frst and second main causes
of death, respectively) and a signifcant
48
49
VOLUNTARY NATIONAL REPORT ON THE
IMPLEMENTATION OF THE 2030 AGENDA FOR
SUSTAINABLE DEVELOPMENT
adolescent and elderly health, and nutrition programs, and strengthening the
fght against alcohol abuse and other
drug use, and improving the pharmaceutical sector.
Cabo Verde's progress in the health
sector is also thanks to the cooperation,
notably, technical cooperation, by the
strengthening multilateral and bilateral
cooperation (CPLP, countries) as well as
with a number of organizations such as
the West African Health Organization,
the Global Fund, WHO and agencies
such as FAO and OIE (Animal Health),
UNICEF, UNFPA and the African Medicine
Agency.
Technical cooperation has been
strengthened, within the framework
strengthening the institutional capacity
of the new structure coordinating alcohol
and other drugs and in the reformulation
of the prevention and treatment policy
on dependencies through UNODC.
The Government of Cabo Verde takes
on the challenge of ensuring access to
quality health and promoting well-being
for all at all ages and, to this end, improving the health information system,
increasing equipment acquisition and
maintenance, increasing health research
capacity, increasing fnancial resources,
completing the implementation of the
pre-hospital emergency system, improving human resources quality and
capacity, and strengthening primary
health care.
eliminate it, with the support of WHO.
We are developing action plans to fght
vector-borne diseases, including Zika
virus infection.
The Government of Cabo Verde has
elected health as one of its priority areas
with a commitment to ensure a strong
social policy, particularly in the health
system, in order to address the issues of
universality, justice, accessibility, solidarity,
equity, effciency and effectiveness,
which affect people specifcally. Improving health sector performance is
the subject of a reforms program aimed
at achieving a quality level and ensuring
the availability of health care for all.
As part of the reform, we address sector
governance and institutional development, with adjustment measures aimed
at adapting to the new health sector
governance agenda, while strategic
planning in health regions, islands and
central hospitals and health sector regulation will address the private health
sector. In terms of health care provision, the reform focuses on improving
access to differentiated and quality
health care with therapeutic protocols,
increasing human resources, improving
the capacity for diagnoses, complementary tests and medicines provision and
increasing medical and hospital equipment, improving prenatal and vaccine
coverage, implementing screening for
cervical cancer in some health centers,
strengthening public health programs,
namely schools that promote health,
50
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63
SDG 3. QUALITY
HEALTH
64
SDG 3. QUALITY HEALTH
Ensuring access to quality healthcare and
promoting well-being for all, at all ages.
After making great progress – in particular
meeting the Millennium Development Goals
related to mortality among children under 5
and maternal mortality in 2015 – signifcant
progress has been made in the last fve years
in the feld of health, with the strengthening
of the leadership, governance and regulation
of the sector, the creation of a regulatory
entity and a more favorable environment
for private initiative and public-private
partnerships, as well as the consolidation
of health regions and regional hospitals.
Through an ambitious infrastructure program, the network of health facilities has
been strengthened and medical and hospital equipment in regional health centers
and hospitals has been modernized, as has
medical diagnosis capacity in the areas of
laboratory and imaging, as well as in the provision of oral health care and physiotherapy.
Important investments have been made in
central hospitals and in equipment for clinical
laboratory services, neonatology, pediatrics,
gastroenterology and digestive endoscopy,
imaging, and the National Institute of Public
Health was consolidated with the expansion
of the network of public health laboratories,
creating skills in the areas of virology and
entomology. Cabo Verde has health indicators
among the best in sub-Saharan Africa, with a
life expectancy of 77.0 years, 73.4 for men and
80.7 years for women. The NHS is now better
prepared to respond to challenges, namely in
the provision of healthcare, surveillance and
security, prevention and health promotion.
The COVID-19 pandemic substantially
expanded the role of the State and the health
emergency took its place at the center of
priorities, involving an essential part of public
structures, and in particular, of the National
Health System, civil protection and the public safety system, but also of civil society
organizations. In line with best international
practices, Cabo Verdean authorities mobilized society, municipalities, the business
sector, NGOs and development partners to
fght the pandemic and especially to preserve
the health and life of Cabo Verdeans and to
prepare for the recovery of tourism and the
internal and international mobility necessary
for the recovery of economic growth.
With the onset of the pandemic, Cabo
Verdean authorities reoriented budget priorities, interrupting fscal consolidation and
the reduction of public debt and amending
the 2020 budget to reinforce the National
Health System in an amount equivalent to
about 5% public expenditure in order to meet
the primary priority of saving lives, including
the reinforcement of budget allocations for
the adaptation of NHS structures, medicines, the reinforcement of human resources,
protection and life insurance, actions to
strengthen the health response to COVID-19,
prevention and combat, capacity building and
65
decentralization of the Virology Laboratory,
and henceforth the start of vaccination to
cover 70% of the population in 2021 and the
population as a whole in 2022.
The pandemic has tested the capacities
and resilience of the national health system
and the mobilization of Cabo Verdean society and development partners for health.
However, in addition to these emerging challenges, others persist, such as improving
access to healthcare, promoting equity, the
prevalence of non-communicable diseases,
the involvement of diaspora professionals
and specialists, the reinforcement of human
resources and their continuous capacity
building, and especially the increase in the
participation of the private sector in this feld.
The maternal mortality rate increased considerably in 2019, reaching 105.5 per 100,000
live births, the highest level ever recorded and
well above the average (37.6 per 100,000) of
the last 4 years, and more than double the
level reached in 2017, when it stood at 47.2
per 100,000 live births (in 2017).
Remarkable progress has been made in the
feld of reproductive health, with the average
number of children per woman dropping
from 7 in 1981 to 2.5 in 2018, and this, associated with investments in human capital and,
in particular, in education and, globally, in
health, is a determining factor in the ongoing
demographic transition. In 2018, only 6.1% of
births were not assisted by qualifed health
professionals (that is, doctors and nurses),
which means an increase of 2.6 percentage
points as compared to 2015, but in 2019
there was a strong deterioration – in that
year, only 88.4% of births were assisted
by health professionals, a reduction of 2.5
percentage points compared to the previous
year and 1.9 compared to 2015.
In 2019, infant mortality rate reached 15.6
per 1,000 live births, a slight increase of
about 0.5 percentage points above the 2015
level, after signifcant improvements in 2018,
when it reached 14.6 per 1,000 live births.
Thus, the survival of children under 5 years
did not improve.
The Early Neonatal Mortality Rate has
decreased slightly, settling in 2019 at 7.2
deaths per 1,000 live births, or about 0.9
percentage points below the 2015 level,
while late neonatal mortality worsened,
reaching, in 2019, 3.4 deaths per 1,000 live
births, about 1.4 percentage points above
2015.
However, in Cabo Verde, both neonatal and
infant mortality are at levels below the SDG
target and it is considered that the country may, well before 2030, end preventable
deaths of newborns and children under 1
year of age.
In 2019, there were 62.5 new cases of HIV
infection per 100,000 inhabitants, down
from 2015 when 74.9 new cases of infection
were registered, but especially from the
previous year when it worsened, with 92.4
being registered. According to the IDSR III,
the seroprevalence rate for HIV1 in the 15- to
49-year-old population is 0.4%, standing
at 0.6% among women and 0.2% among
men. When HIV2 is included, the seroprevalence rate stands at 0.6%, with 0.7% among
women and 0.4% among men. Most of the
new cases reported in 2019 belong to the
25-49 age group (average of 12.2%), a stage
in which people are more sexually active,
but this trend does not differ from 2015.
Table 3. Mortality rate and new HIV cases
Indicators 2015 2016 2017 2018 2019
Maternal Mortality rate per
100,000 live births 47.0 18.8 47.2 37.9 105.1
Infant mortality rate (per
thousand live births) 15.3 15.4 15.8 13.0 15.6
Early Neonatal Mortality (0
to 6 days) 8.1 7.6 8.3 6.3 7.2
Late Neonatal Mortality (7
to 27 days)* 2.0 2.5 2.6 2.3 3.4
New HIV+ cases 393 480 480 503 281
Source: Ministry of Health and Social Security
Table 4. Fecundity Indicators
Indicators FI
1981
FI
1988
IDSR
1998
IDSR
2005
IDSR
2018
Synthetic Fertility Index
(children per woman) 7.1 6.6 4.1 2.9 2.5
Source: INE
Table 5. HIV prevalence Indicators
Indicator 2018
HIV1 prevalence rate in the 15- to 49-year-old population (%) 0.4
Women (%) 0.6
Men (%) 0.2
HIV1 and HIV2 prevalence rate in the 15-49-year-old population (%) 0.6
Women (%) 0.7
Men (%) 0.4
Source: INE IDSR 2018
66
The tuberculosis incidence rate has
decreased, from 47 per 100,000 inhabitants
in 2015 to 35 per 100,000 inhabitants in 2019.
There is a marked trend towards a reduction
in incidence and, if this continues, Cabo
Verde has a high likelihood of reaching the
SDG target, which is to eliminate tuberculosis as a public health problem in 2030
(Incidence rate < 10/100,000 inhabitants).
Furthermore, there has been no shortage
of medicine to treat tuberculosis cases in
the country.
The malaria incidence rate ranged between
0.09 and 0.14 for every 1,000 inhabitants
in the 2015-2016 period, but in 2017 there
was a considerable increase in malaria
cases and, consequently, an increase in the
incidence rate to 0.83 per 100 inhabitants.
However, thanks to prevention measures, no
autochthonous cases have been registered
since 2018, which is one of the criteria for
certifying the elimination of malaria as a
public health problem in Cabo Verde.
The hepatitis incidence rate reached, in
2019, 26.9 per 100,000 inhabitants, which
represents a strong decrease compared
to 2015, when it reached 54.5 per 100,000
inhabitants, or more than double the last
year under analysis. The level of hepatitis
incidence in 2019 is, however, much higher
than the previous year (16.9 per 100,000), but
2016 was the worst year in that period with
an incidence of 70 per 100,000 inhabitants.
Available data mentions only hepatitis and
does not differentiate between the variants,
but according to the health authority, most
cases in the country stem from hepatitis B.
Table 6. Tuberculosis and hepatitis Incidence
Indicator 2015 2016 2017 2018 2019
Tuberculosis Incidence Rate (per
100.000 inhabitants) 47 42 44 33 35
Hepatitis Incidence Rate (per 100
mil inhabitants) 54.5 70.0 16.9 26.9
Source: Ministry of Health and Social Security
Table 7. Main causes of general mortality
Indicator 2019
Circulatory system diseases (per 100,000 inhabitants) 157.9
Respiratory disorders (per 100,000 inhabitants) 74.3
Tumors or neoplasms (per 100,000 inhabitants) 61.2
Source: Ministry of Health and Social Security
67
Diseases of the circulatory system continue
to be the main cause of mortality, with a
rate of 157.9 per 100,000 inhabitants, being
higher among women (174.1) than among
men (141.9). Respiratory affections are
the second cause of death, representing
74.3 per 100,000 inhabitants. Tumors or
neoplasms are the third leading cause of
death, corresponding to 61.2 per 100,000
inhabitants in 2019.
Mortality rates from intentionally self-inficted injuries (suicide) have been decreasing
since 2015, when they reached 25.5 deaths
per 100,000 inhabitants, registering 19.1 per
100,000 in the last year under analysis (2019),
which is also below the previous year (21.1
per 100,000 inhabitants).
The traffc accident rate is relatively high, and
deaths from road accidents represented 0.96%
of total deaths in 2020. However, the mortality
rate from road accidents declined from 1.3% in
2015 to 0.78% in 2019, and worsened in 2020
(0.96%), at about half of the 2015 level.
According to the IDSR III carried out by
INE, in 2018, in Cabo Verde, 82 out of every
100 women who are married or living with
their partners seek family planning services,
a demand that is higher than that of all
sexually active single women and women
not cohabiting (72%), without signifcant
differences between urban and rural areas.
The rate of family planning needs met reached
50.75%, being 57.5% among the frst and lower,
(44%) among those in the second group.
As a result, about 21.6% of women who
seek family planning services are not able
to obtain them, which represents unmet
needs, a fgure higher among married women
or women with live-in partners (24.6%) than
among all single women or women in sexually
active non-unions (18.5%).
Demand for family planning is higher among
women aged 25-29 (85.0%), but it is in the
30-34 age group that the rate of needs met is
higher (67.6%), both among married/cohabiting
women (65.6%) as among all sexually active
women and single/in sexually active non-cohabiting women (56.4%). The level of education
does not determine signifcant differences in
the demand for family planning, except for
women without any education.
Table 8. Mortality Rate per auto-provoked
injuries and deaths by road accidents
Traffc accidents 2015 2018 2019
Mortality rates from self-inficted injuries (per
100,000 inhabitants) 25.5 21.1 19.1
Deaths from road accidents as % of deaths 1.3 0.78
Source: Ministry of Health and Social Security
Table 9. Family planning Total Demand and
satisfed demand
Indicator 2018
Demand for family planning services by women who are married or in stable
relationship (%) 82.1
Demand for family planning services by women and sexually active single/
non-stable rel. women (%) 62.5
Needs met among women who are married or in stable relationship (%) 57.5
Needs met among women and sexually active single/non-stable rel. women (%) 44.0
Needs met 30 - 34 women married/in stable relationship - maximum level (%) 65.6
Needs met 30 - 34 women and sexually active single/non-partner women
- maximum level (%) 56.4
Source: INE IDSR 2018
68
The rate of needs met by modern family
planning methods for women of reproductive
age is 68.75%, with 68.5% among married/
cohabiting women and 69.0% among sexually
active single/non-married women.
According to IDSR III, around 11.7% of 15-
to 19-year-old women declared they had
already had a live-born child, 3.5 pp below
the 2005 level. 6% of girls have already
had a live-born child, roughly double the
2005 level, a year in which around 1.9%
of teenagers of this age reported having
had a live-born child. At 19 years of age,
around 28.9% of teenagers have already
had a live-born child.
According to the Non-Communicable Diseases
Risk Factor Survey (IDNT II -2020), the average
age of smoking initiation in Cabo Verde is 18.9
years, 19 years among men and 18.4 years
among women. The prevalence of smoking
among people aged 15 and over is 9.6% and
among people aged 18 to 69 years is higher
among men (15.7%) than among women
(3.2%).
Cabo Verde’s success in the feld of health
has to do, above all, with the preventive
aspect and, especially, with the high vaccination coverage of children. This is indeed a
good practice that has allowed the country
to avoid many inequities - that is, to reduce
avoidable inequalities in health care. In
2018, about 94.6% of children under one
year of age were fully vaccinated, with the
coverage rate of 95.8% for BCG vaccination and 97% against Pentavalent Polio 3,
above 2015 levels. Thus, we guarantee high
levels of vaccination coverage for children
and introduced the HPV vaccine into the
national vaccination calendar.
In these past 5 years, there has been an
effective reinforcement of health professionals, in both numbers and diversity,
but both are still insuffcient, particularly
with regard to professionals specialized in
various domains, both clinical as well as
public health and management.
Thus, the ratio of Health Professionals per
10,000 inhabitants reached 58.8 in 2019,
about 6.2 points above the 2015 level.
Contributing to this ratio is a positive
evolution in the number of doctors, which
went from 338 in 2017 to 442 in 2019, in
the number of nurses, from 757 nurses in
2017 to 772 in 2019, in the number of level I
technicians from various areas of expertise,
such as physiotherapy, psychology, clinical
analysis laboratory and administration area
personnel, who rose from 321 to 369, in
2019, and due to the fact that the number
of specialist physicians rose from 182 to 259.
Cabo Verde’s Strategic Sustainable Development Agenda proposes to guarantee
access to quality healthcare and promote wellbeing for everyone at all ages,
creating value for the economy. Thus, it
proposes to ensure, during this year, the
vaccination of at least 70% of the population against COVID-19 and to make vaccination universal in 2022, institutionalize
the family physician system, strengthen
national psychiatric and mental health
coverage in the primary care network,
expand the coverage network of care
related to the abusive use of alcohol and
other drugs, strengthen health centers’
supply of medical consultations in specialized medical felds, implement the
training program for health technicians,
including epidemiologists, and expand
the network of health centers.
Table 10. Teenagers Sexuality
Indicator 2005 2018
Teenagers aged 15-19 declaring having had a live birth child 15.2 11.7
Teenagers declaring that at age 15 they had already had a child
who was born alive 1.9 3.6
Teenagers declaring that at age 19 they had already had a child
who was born alive 33.9 28.9
Source: INE IDSR 2005 and 2018
Table 11. Vaccination of children under 1 year old
Indicator 2018
Children under 1 completely vaccinated (%) 94.6
BCG (%) 95.8
Polio 3 (%) 97.6
Pentavalent 3 (%) 97.0
Source: Ministry of Health and Social Security
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44
5.4. ODS 3: ‘Salud y bienestar’
Desde la década de 1970, Costa Rica estableció la salud como un bien de interés público
lo cual condujo a una aceleración en la mejoría de los indicadores de salud y un proceso
de transición epidemiológica. Con ello, el país ha logrado situarse entre los países con los
mejores índices en salud junto con Cuba, Chile y Uruguay.
El „Sistema Nacional de Salud‟, es el conjunto de entes públicos y privados, nacionales e
internacionales, que tienen entre sus fines primordiales la protección y el mejoramiento
del estado de la salud en la población.
En el Sistema Nacional existe una clara separación de funciones, en el cual el Ministerio
de Salud ejerce la rectoría y la Caja Costarricense de Seguro Social (CCSS) se encarga
de la prestación de los servicios de salud.
Costa Rica goza de índices generales estables de salud. Con un sistema de salud público
solidario que cubre el 97% de la población, una cobertura de agua apta para consumo
humano superior al 96%. También, presenta una disminución sostenida de la tasa de
mortalidad infantil, la natalidad está en disminución y la esperanza de vida se encuentra
en aumento por lo que el país experimenta un fenómeno de envejecimiento poblacional.
Aunado a lo anterior, el país experimenta aumento en enfermedades como la diabetes,
hipertensión arterial y obesidad.
Respecto a las enfermedades transmisibles, las causas principales de consulta
ambulatoria son las infecciones respiratorias agudas y los cuadros diarreicos. Además, al
ser un país tropical, Costa Rica, tiene una presencia importante de enfermedades
transmitidas por vectores, como el dengue (desde el 1993), chikungunya (desde el 2014)
y Zika (desde el 2016) que han provocado en las últimas tres décadas una carga para el
sistema de salud del país.
En el marco de la Agenda 2030, durante el periodo 2015- 2017, el ODS 3 es abordado por
iniciativas para la salud sexual y reproductiva; promoción de la salud mental; prevención
de casos del VIH; promoción de estilos de vida saludables; reducción de muertes y
lesiones por accidentes de tránsito; saneamiento del agua y reducción de la
contaminación (Figura 8).
45
Figura 8. Iniciativas multidimensionales del ODS 3 y su vinculación con otros ODS
Fuente: elaboración propia
5.4.1. Iniciativas para la salud sexual y reproductiva
A nivel nacional, la oferta anticonceptiva es limitada y presenta un rezago de
aproximadamente 20 años que impiden el conocimiento de la población y actualización de
la oferta institucional por métodos modernos.
La Iniciativa Mesoamérica inició en el año 2013 y tiene el objetivo de reducir el embarazo
adolescente, brindar atención a la maternidad y paternidad tempranas, garantizar la
protección de los derechos a la salud y ofrecer acciones interinstitucionales oportunas y
eficaces dirigidas a la promoción, prevención y atención por parte del Ministerio de Salud,
MEP, la CCSS, el Patronato Nacional de la Infancia (PANI) y la Dirección Nacional de los
Centros de Educación y Nutrición y de Centros Infantiles de Atención Integral
(CENCINAI).
Esta iniciativa, se implementa en las regiones Brunca y Huetar Caribe debido a que son
las zonas del país, en las cuales se presenta más baja escolaridad entre la población, se
presentan mayores casos de abusos sexuales y se presentan altas tasas de embarazos
adolescentes.
El SNU a través del Fondo de Población de las Naciones Unidas (UNFPA) implementa
una iniciativa similar a la Mesoamérica en la zona de la Cruz de Guanacaste la cual se
dirige a empoderar a las mujeres adolescentes para que tengan apropiación de sus
cuerpos, conocimiento de métodos anticonceptivos y prevengan embarazos tempranos.
UNFPA también ha implementado campañas sobre educación sexual, violencia sexual y
prevención del VIH a la población sorda del país. Además, han apoyado con el MEP en la
46
reproducción de material para formar a padres, madres y docentes con hijos e hijas
sordas en cuanto a la enseñanza de la salud sexual y reproductiva.
Desde el 2013, el país ha implementado una „Estrategia Nacional de Acceso a Condón
Masculino y Femenino‟ que busca “facilitar que las instituciones y organizaciones
directamente involucradas en la provisión de servicios vinculados a la salud sexual y salud
reproductiva, puedan garantizar el acceso oportuno y efectivo de condones; y así,
contribuir a la promoción de prácticas, conocimientos y actitudes que acerquen a la
población a la vivencia de una sexualidad segura, informada, placentera y en
corresponsabilidad”60.
A su vez, “se han instalado unidades especializadas con enfoque de derechos humanos,
que atienden dignamente a personas LGBTIQ y les ayudan a prevenir y combatir
enfermedades de transmisión sexual de forma especializada”61.
5.4.2. Iniciativas para promover la salud mental
El Ministerio de Salud implementa desde el año 2012, la „Política Nacional de Salud
Mental‟ (2012-2021), en la cual se definen los principios, enfoques, lineamientos y plan de
acción para prevenir enfermedades, mejorar la atención y tratamiento de personas con
trastornos mentales en el ámbito comunitario bajo un enfoque de derechos humanos.
El objetivo de esta política es “promover el bienestar y desempeño personal y colectivo
caracterizado por la autorrealización, la autoestima, la autonomía, la capacidad para
responder a las demandas de la vida en diversos contextos: familiares, comunitarios,
académicos, laborales y disfrutar de la vida en armonía con el ambiente”
62.
5.4.3. Iniciativas para la prevención de casos del VIH
En el año 2016, el país implementó el Plan Estratégico Nacional del VIH (2016-2021) el
cual responde al marco intersectorial entre instituciones públicas, privadas y OSC para
coordinar el trabajo de todos los asociados, con la conducción del „Consejo Nacional de
Atención Integral al VIH y Sida‟ (CONASIDA).
Este Plan, está orientado a colocar al VIH como amenaza para la salud pública para el
año 2030, a la eliminación del estigma y discriminación relacionada a la enfermedad, y al
60 UNFPA y Ministerio de Salud (2013). “Estrategia Nacional de Acceso al Condón Masculino y Femenino”. Recuperado el
13 de junio 2017 en: https://w w w .ministeriodesalud.go.cr/index.php/biblioteca-de-archivos/sobre-el-ministerio/politcas-yplanes-en-salud/estrategias/2305-estrategia-de-acceso-universal-a-condones-y-femeninos/file 61 MREC (2015). “Buenas practicas de Costa Rica con la población LGBTIQ en el marco de la sesión del Consejo de
Derechos Humanos de las Naciones Unidas”. Recuperado el 13 de junio 2017 en:
http://w w w .ohchr.org/Documents/Issues/Discrimination/LGBT/Res_27_32/Costa%20Rica.pdf
62 Ministerio de Salud (2012). “Plan Nacional de Salud Mental 2012-2021”. Recuperado el 10 de junio 2016 en:
http://w w w .bvs.sa.cr/saludmental/politicasaludmental.pdf
47
aseguramiento del compromiso que el país adquirió a: que el 90% de las personas que
viven con VIH conozcan su estado serológico; que el 90% de las personas que sí lo
conocen reciban un tratamiento adecuado y de calidad; y que el 90% de las personas que
ya reciben este tratamiento puedan suprimir la carga viral63.
Además, se cuenta con un proyecto país llamado „Costa Rica, Modelo Sostenible de
Prevención Combinada y Atención a la Población de Hombres que tienen Sexo con
Hombres (HsH) y Trans Fémina‟ el cual fue aprobado por el Fondo Mundial de lucha
contra el SIDA, la Tuberculosis y la Malaria para el periodo (2015-2018).
El objetivo principal de este proyecto es contener la epidemia VIH en estas poblaciones, al
asegurar el acceso universal a la prevención, tratamiento, atención y cuidado del VIH;
mejorar el entorno legal, social y político para el ejercicio pleno de los derechos humanos
de estas poblaciones y proveer al país con información estratégica en VIH necesaria, para
las poblaciones clave, para una mejor y adecuada toma de decisiones a nivel político e
institucional64.
5.4.4. Iniciativas para incentivar estilos de vida saludables
Con el fin de reducir el problema de la obesidad en niños, niñas, adolescentes y personas
adultas, el país ha desarrollado la „Estrategia Nacional para el Abordaje Integral de las
Enfermedades Crónicas No Transmisibles y Obesidad‟ (2013 – 2021); el „Plan Nacional
de Actividad Física y Salud‟ (2011-2021); y se encuentra en proceso de formulación del
„Plan de Abordaje Integral del Sobrepeso y la Obesidad en la Niñez y la Adolescencia
(2017-2021).
Estas estrategias y planes tienen como fin la reducción de la mortalidad prematura por el
grupo de enfermedades cardiovasculares, cerebrovasculares, respiratorias crónicas, renal
crónicas, diabetes, hipertensión y cáncer; reducir el consumo nocivo del alcohol; promover
la actividad física y reducir el sedentarismo en la población; así, como del consumo del
tabaco; entre otras.
En esta misma línea, el país cuenta con clínicas de cesación de fumado, prevención de
las adicciones a drogas con énfasis en la prevención desde la niñez y adolescencia; y
cuenta con toda una normativa para desincentivar el uso de tabaco principalmente en los
espacios públicos.
63 Ministerio de Salud (2016). “Plan Estratégico Nacional del VIH (2016-2021)”. Recuperado el 13 de junio 2017 en:
https://w w w .ministeriodesalud.go.cr/index.php/biblioteca-de-archivos/963-plan-estrategico-nacional-pen-vih-sida/file 64 CONASIDA (2016). “Costa Rica, Modelo Sostenible de Prevención Combinada y Atención a la Población de Hombres que
tienen Sexo con Hombres (HsH) y Trans Fémina”. Recuperado el 13 de junio 2017 en:
http://w w w .conasida.go.cr/index.php/mcp-proyectos/106-resumen-sobre-proyecto-pais/file
48
5.4.5. Iniciativas para reducir muertes y lesiones por accidentes de tránsito
Debido al rezago que Costa Rica presenta en infraestructura vial65 y con el fin de reducir
el número de muertes y lesiones causadas por accidentes de tránsito, en marzo 2017 se
puso en marcha el „Plan Integral para la Pacificación de las Vías Públicas‟ con el cual “se
busca a corto, mediano y largo plazo reformas legales, programas educativos, controles
policiales, promoción de la salud, programas de sensibilización y fortalecer un sistema de
atención de accidentes e infraestructura en el país”66.
5.4.6. Iniciativas sobre saneamiento del agua y reducción de contaminación
Con el fin de abastecer a la población con agua potable y lograr una gestión sostenible, el
país implementa la „Política Nacional de Saneamiento en Aguas Residuales‟ (2016-2045),
con la cual se convierte en el primer referente para definir lo que se espera del sector en
relación con los ODS para garantizar que las aguas residuales no afecten el medio
ambiente y la salud de la población del país67. Además, se han realizado acciones de
control sobre el uso de plaguicidas en agricultura con énfasis en las plantaciones de piña.
5.4.7. Desafíos nacionales identificados para la implementación del ODS 3
Capacitar y sensibilizar al personal de salud bajo un enfoque de derechos
humanos para una atención adecuada y de calidad a niñas, niños, personas
adolescentes, personas con discapacidad, población LGBTIQ (considerando las
necesidades y características de cada uno de los segmentos de esta población) y
mejorar protocolos de atención a las personas privadas de libertad.
Promover y modernizar la oferta de los métodos anticonceptivos que ofrece el
Estado e implementar la Anticoncepción Oral de Emergencia a nivel país.
Mejorar la calidad del registro de Mortalidad Materna y Mortalidad Infantil.
Reducir la mortalidad neonatal y fortalecer la atención de recién nacidos en
servicios de pediatría y unidades de cuidados intensivos neonatal.
Promover una implementación adecuada y oportuna del Protocolo Interinstitucional
de Atención Integral a Víctimas de Violación Sexual.
65 Ver sección del ODS 9 en el presente informe. 66 Gobierno de Costa Rica (2017). “Plan para pacificar vías se basa en 7 pilares para poner un alto a la violencia en las
carretera”. Recuperado el 12 de junio 2017 en: http://gobierno.cr/plan-para-pacificar-vias-se-basa-en-7-pilares-para-ponerun-alto-a-la-violencia-en-las-carretera/#more-23901 67 AYA, MINAE y Ministerio de Salud (2016). “Política Nacional de Saneamiento de Aguas Residuales 2016-2045”.
Recuperado el 12 de junio 2016 en:
https://www.aya.go.cr/Noticias/Documents/Politica%20Nacional%20de%20Saneamiento%20en%20Aguas%20Residuales%
20marzo%202017.pdf
49
Prevención del VIH desde épocas de infancia y adolescencia.
Intensificar acciones conjuntas y sostenidas de manera intersectorial
(municipalidades, centros de trabajo, comunidad) en las áreas de alta
concentración del Anopheles)
Incorporación de la vacuna contra el dengue al 2030.
Mejorar los mecanismos de control de calidad del agua de las Asociaciones
administradoras de los Sistemas de Acueductos y Alcantarillados comunales en
Costa Rica (ASADAS) y otros administradores de servicios de acueductos rurales.
Así como también, garantizar la disponibilidad continua del agua de calidad
potable y aumentar el número de acueductos con vigilancia de la calidad de agua.
Mejorar la educación vial en programas educativos viales con el fin de reducir las
muertes y lesiones por accidentes de tránsito. Además, renovar y desarrollar una
planificación urbana y vial adecuada para lograr mayor bienestar humano y
mejorar el monitoreo en la calidad del aire del área metropolitana.
Regular la aplicación terrestre de plaguicidas, mediante sistema spray boom –
transporte.
Controlar los altos precios de las vacunas para que sean adquiridas por el país.
Así como también, fortalecer la capacidad instalada para la evaluación de calidad,
seguridad de las vacunas y fortalecer las acciones de control y vigilancia de los
medicamentos y vacunas.
5.4.8. Desafíos nacionales identificados por personas adultas mayores,
personas con discapacidad, población LGBTIQ e Indígenas
En el taller realizado con personas adultas mayores se identificaron como desafíos para
la salud y bienestar:
Mejorar la atención pronta en los servicios de salud y la reducción de listas de
espera para esta población y subsanar la deficiencia en infraestructura que
obstaculiza el acceso a la salud.
Establecer medidas para la promoción del envejecimiento activo por sus efectos
en salud.
50
En una consulta realizada a representantes de la población con discapacidad, se
identificaron los siguientes desafíos para el abordaje del ODS 3:
Generar estadísticas diferenciadas en el tema de salud con el fin de no generalizar
los apoyos específicos que requieren las personas con discapacidad, tanto en
zonas rurales como urbanas. Lo anterior, debido a que incluso los apoyos que
requieren las personas con discapacidad son diversos y no pueden ser
generalizados basados en la deficiencia visual, auditiva, cognitiva, física y/o
psicosocial, pues son muy particulares.
Implementar capacitación, sensibilización y preparación a las personas
funcionarias en todos los niveles de salud con el fin de que esta población pueda
acceder a un servicio de calidad y oportuno.
En la consulta realizada a representantes de la población LGBTIQ se identificaron los
siguientes desafíos en salud y bienestar:
Gestionar servicios diferenciados para las necesidades particulares de cada grupo
que conforman la población LGBTIQ.
Garantizar el acceso al derecho de la salud por parte de los grupos que
conforman la población LGBTIQ, pues por lo general este se ve obstaculizado
debido a que a pesar de la existencia de protocolos institucionales para la
eliminación de la discriminación por orientación e identidad sexual el personal de
los servicios de salud no está capacitado para brindar estas modalidades de
atención.
Los desafíos en salud y bienestar identificados por los Pueblos Indígenas de cara al
Encuentro Nacional realizado son los siguientes:
Mejorar el acceso a los servicios de salud con pertinencia sociocultural para
poblaciones indígenas.
Garantizar el reconocimiento y respeto de las prácticas de medicina tradicional por
parte del personal médico.
|
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[
3
] |
{
"country": "cri",
"file_id": "sdg-03/vnr-report-cri-2017-es-3.pdf",
"language": "es",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2017
}
|
SECOND VOLUNTARY NATIONAL REVIEW
124
SDG 3: Ensure healthy lives and promote well-being for all at all ages
For this SDG, according to the series of monitoring indicators, Costa
Rica has a favorable performance in 11 indicators (55%), negative
in 5 (25%) and 4 (20%) where they maintain their trend (the same). In
favorable cases, maternal mortality is estimated at 16.1 maternal
deaths per 100,000 live births by 2018, down from 28.6 in 2016 (13
deaths per 100,000 inhabitants).
On the other hand, available statistical data show that the country has been
experiencing an increase in the rate of new HIV diagnoses per 100,000 inhabitants.
Thus, the rate of new diagnoses has increased from 8.6 to 19.6 over a period of 15
years. The data available up to 2017 indicate that the most affected population is
the male population, since for every woman there are 6 men diagnosed with HIV.
In the case of the indicators that keep the same trend, births attended by skilled
health personnel in Costa Rica were in the order of 99.1% in 2018. During the past
nine years this number has not changed significantly. Thus, in the area of health and
well-being, the country has the standard for Comprehensive Care for Women during
Low Obstetric Risk Pregnancy and the Guide for Comprehensive Care for Women,
Children in the prenatal, childbirth and post-natal period, as well as a series of
protocols in the health care services that allow to address risk conditions in pregnant
women, which allows to guarantee an adequate maternal and child health. It also
keeps the goal of maintaining the AIDS mortality rate between 2019 and 2022 at 3.7;
seeking to ensure the sustainability of the combined prevention model that is part
of the HIV care cascade, which targets more vulnerable populations such as the
sexually diverse population.
|
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[
3
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{
"country": "cri",
"file_id": "sdg-03/vnr-report-cri-2020-en-3.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2020
}
|
129
ODS 3. Salud y Bienestar: Garantizar una vida sana y promover el bienestar de todos a
todas las edades
Para este ODS, de acuerdo con las series de los indicadores de
seguimiento, Costa Rica posee un comportamiento favorable en 11
indicadores (55%), negativo en 5 (25%) y 4 (20%) donde mantienen su
tendencia (igual). En los casos favorables se encuentran en la
mortalidad materna que representa una razón de 16,1 defunciones
maternas por cada cien mil nacidos vivos para 2018, la cual ha tenido
una disminución, ya que en el 2016 fue de 28,6 (13 defunciones por 100
mil habitantes).
Por otro lado, los datos estadísticos disponibles muestran que en el país se ha venido
dando un aumento en la tasa de nuevos diagnósticos de VIH por cada 100 000
habitantes. Así, la tasa de nuevos diagnósticos ha pasado de 8,6 a 19,6 en un período
de 15 años. Los datos disponibles hasta el 2017 expresan que la población más
afectada es la población masculina, puesto que por cada mujer hay 6 hombres
diagnosticados con VIH.
Para el caso de los indicadores que mantienen la misma tendencia están los
nacimientos asistidos por personal de salud capacitado en Costa Rica fueron del
orden del 99,1% en 2018. Durante los últimos nueve años este número no ha tenido
variaciones significativas. Así, en la temática de la salud y del bienestar, el país cuenta
con la norma para la atención Integral a la Mujer durante el Embarazo de Bajo Riesgo
Obstétrico y la Guía de Atención Integral a las Mujeres Niños y Niñas en el período
prenatal, parto y posparto, así como una serie de protocolos en los servicios de
atención en salud que permiten abordar condiciones de riesgo en mujeres
embarazadas, lo que permite garantizar una adecuada salud materno-infantil. Por
otra parte, mantiene el objetivo de mantener la tasa de mortalidad por sida entre el
2019 y 2022 en 3,7; buscando asegurar la sostenibilidad del modelo de prevención
combinada que forma parte de la cascada de atención del VIH, la cual está dirigida
a poblaciones de mayor vulnerabilidad como la población sexualmente diversa.
|
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72 73
I INFORME NACIONAL VOLUNTARIO CUBA 2021
PARTE III. ESTADO DE IMPLEMENTACIÓN DE LOS ODS EN CUBA
ODS 3
Garantizar una vida sana y promover
el bienestar de todos a todas las edades
METAS
3.1 Reducir la mortalidad materna.
3.2 Terminar con todas las muertes prevenibles en menores de 5 años de edad.
3.3 Combatir enfermedades trasmisibles.
3.4 Reducir la mortalidad por enfermedades no trasmisibles y promover la salud mental.
3.5 Prevenir y tratar el abuso de sustancias.
3.6 Reducir las lesiones y las muertes en carreteras.
3.7 Acceso universal al cuidado de la salud sexual y reproductiva, la planificación
familiar y la educación.
3.8 Alcanzar cobertura de salud universal.
3.9 Reducir las enfermedades y la muerte por productos químicos peligrosos,
y por la contaminación.
3a. Aplicar el convenio marco de la OMS sobre control del tabaco.
3b. Apoyar la investigación, el desarrollo y el acceso universal a vacunas
y medicamentos asequibles.
3c. Aumentar la financiación de la salud y apoyar la fuerza laboral de la salud
en los países en desarrollo.
En Cuba, la salud constituye
un área de alta prioridad para el
gobierno, con cobertura y acceso
universal y gratuito, fundamen
-
tados en la estrategia de Atención
Primaria de Salud (APS). A partir
de la creación del Programa del
Médico y Enfermera de la Fami
-
lia, la salud pública cubana situó
a estas dos figuras como los máxi
-
mos responsables de la salud de
los individuos, las familias y la co
-
munidad, enfocando sus acciones
hacia la prevención de factores de
riesgo y la promoción de estilos de
vida saludables. Los resultados al
-
canzados en el país constituyen un
referente internacional y, en espe
-
cial, para los países en desarrollo.
El SNS ha ido adaptando en
cada momento sus prioridades,
objetivos y acciones.
PRIORIDADES DE LA SALUD PÚBLICA
CUBANA: 2020
-2021
AVANZAR EN EL DESARROLLO DE LAS VACUNAS
CONTRA COVID
-19 Y VACUNAR A TODA LA POBLACIÓN
AMPLIACIÓN
DE LOS SERVICIOS
DESARROLLO DE TECNOLOGÍAS
DE PUNTA
INCREMENTO EN EL
APORTE ECONÓMICO
INVESTIGACIÓN Y PROGRAMAS DE PERFECCIONAMIENTO MÉDICO,
EN CORRESPONDENCIA CON AGENDA 2030 Y PNDES 2030
74 75
I INFORME NACIONAL VOLUNTARIO CUBA 2021
PARTE III. ESTADO DE IMPLEMENTACIÓN DE LOS ODS EN CUBA
CUADRO III.3.2. INDICADORES RELACIONADOS CON EPIDEMIAS
Fuente: Minsap
Desde 1983, se aprobó el Programa de Atención
Materno Infantil (Pami), que ofrece atención a las
mujeres embarazadas y sus hijos bajo una óptica de
prevención, promoción, tratamiento y rehabilitación.
El Pami constituye una plataforma programática centralizada para planificar, controlar y aplicar las acciones referidas a la salud reproductiva, garantizando el
acceso equitativo a los servicios de salud.
Según datos de 2019, el 99,9 % de los partos en Cuba
es atendido por personal sanitario especializado y de
forma gratuita (meta 3.1). La cobertura de atención prenatal por personal capacitado fue de 99,1 %, de acuerdo
con la Encuesta CUBA/MICS 2020;
y la tasa de mortalidad materna de
37,4 por cada 100 mil nacidos vivos,
indicador que disminuye en 4,2
unidades en relación al año 2015.
Aunque Cuba cumple con este indicador ODS, a partir de la prioridad
a la atención materno-infantil en el
sistema de salud cubano, existe una
estrategia para reducir aún más su
valor en los próximos años.
Los indicadores de mortalidad
infantil (meta 3.2) muestran valores entre los más bajos del mundo
(Cuadro III.3.1) sin grandes disparidades en su comportamiento a nivel territorial.
Fuente: Minsap
CUADRO III.3.1. TASAS DE MORTALIDAD INFANTIL POR CADA MIL NACIDOS VIVOS
Cuba
Asia Oriental y Pacífco
Europa y Asia Central
América Latina y el Caribe
Medio Oriente y África del Norte
América del Norte
Asia del Sur
África subsahariana
Países menos adelantados
Mundo
Tasa de mortalidad
menores de 5 años
6,6
15
9
16
22
6
42
78
64
39
INDICADOR
Tasa de nuevos diagnósticos de VIH-SIDA (por cada mil habitantes)
Tasa de prevalencia VIH-SIDA (de 15 a 49 años)
Tasa de prevalencia VIH-SIDA (de 15 a 24 años)
Tasa de mortalidad por VIH-SIDA
Tasa de notifcación de tuberculosis (por cada 100 mil habitantes)
Tasa de incidencia de malaria35 importada (por cada mil habitantes)
Tasa de incidencia de Hepatitis B (por cada 100 mil habitantes)
Casos confrmados de dengue
Casos confrmados de ZIKA
Casos confrmados de Chicungunya
Tasa de mortalidad
menores de 1 año
5,6
12
8
14
18
5
35
53
46
29
Tasa de mortalidad
neonatal precoz
2,8
8
5
9
12
3
26
28
26
18
2019
0,2134
0,37
0,15
3,8
5,7
0,003
0,4
3 259
131
0
De igual modo, el país ostenta resultados satisfactorios en el cumplimiento de la meta 3.3 (Cuadro III.3.2),
con programas nacionales priorizados para el seguimiento y la atención de las enfermedades transmisibles reconocidos internacionalmente.
En el caso específico del VIH-SIDA, el país cuenta
con un Plan Estratégico para su prevención y control
que, con el foco en las poblaciones clave y grupos más
vulnerables, guía las diversas acciones para garantizar el cumplimiento de las metas de ONUSIDA/OMS
90/90/90.36 Al cierre de 2019, Cuba se encontraba en
un 87/90,7/76,1, cifras superiores a las mostradas en
los años 2017 y 2018. También en ese periodo se garantizó el tratamiento antirretroviral a más de 24 mil personas con medicamentos recomendados por la OMS.
Cuba fue el primer país que obtuvo la validación de
la eliminación de la transmisión materno-infantil de
sífilis congénita y del VIH, condición ratificada por la
OMS en 2019.
Otra de las prioridades del sistema de salud cubano
es la reducción de la mortalidad prematura por enfermedades no transmisibles (meta 3.4), indicador que se
ha mantenido estable para las enfermedades crónicas
de las vías respiratorias y diabetes mellitus; y ha crecido con respecto a 2015 para las enfermedades cardiovasculares y tumores malignos, lo cual constituye un
desafío.
34 Mayor participación del sexo masculino: 0,23 frente a 0,4 del sexo femenino.
35 Cuba es un país libre de esta enfermedad desde el año 1967, lo cual fue certificado por la OPS/OMS en el año 1973. Desde entonces, se han producido brotes muy esporádicos por viajeros que han introducido la enfermedad en zonas donde persiste el vector trasmisor, el mosquito Anopheles Albimanus. En
2017, año en que se reportó un pequeño brote de la enfermedad en el centro del país, ocurrieron a punto de partida de un viajero procedente de Guyana,
dos casos introducidos que fueron reportados a la OPS. Como resultado del trabajo realizado, no se produjeron casos autóctonos de la enfermedad.
36 Ello significa que para esa fecha se conozca el 90 % de las personas con VIH, que el 90 % de los diagnosticados reciban tratamiento antirretroviral y que
el 90 % de los que están con tratamiento tengan carga viral suprimida.
76 77
I INFORME NACIONAL VOLUNTARIO CUBA 2021
PARTE III. ESTADO DE IMPLEMENTACIÓN DE LOS ODS EN CUBA
En esta dirección, el país ha fortalecido las acciones de prevención y control y actualizó recientemente su Estrategia Nacional para la prevención y control
de las enfermedades no transmisibles y sus factores de
riesgo 2019-2025. La misma cuenta con cuatro líneas
estratégicas dirigidas a fortalecer: a) el marco legal, la
intersectorialidad y la gestión integrada del Minsap; b)
la promoción de salud y prevención de enfermedades
con participación comunitaria, específicamente con la
promoción de estilos de vida saludables, la creación de
entornos que fomenten salud y el control de factores de
riesgo; c) la atención médica y garantizar los medicamentos y la tecnología médica para la atención a las principales enfermedades no transmisibles; y d) el incremento
de las capacidades para la vigilancia, evaluación, investigación, utilizando la informática y argumentos económicos; teniendo en cuenta la determinación social.
La tasa de mortalidad por suicidios ha tenido un comportamiento estable en el periodo. En 2019, fue de 13 por
cada 100 mil habitantes, con una ligera reducción con
relación a 2015 (13,5). La mayor incidencia es del sexo
masculino, con 21,6, mientras para las mujeres es de 4,6.
En Cuba se prioriza la atención integral a las adicciones mediante un Plan de acción para el Enfrentamiento al Consumo de Drogas, Fármacos y Psicotrópicos, como parte de la Estrategia de Prevención
y Atención Integral a las Adicciones aprobado para la
etapa 2017-2022 (meta 3.5).37
incremento de métodos anticonceptivos modernos, la
reducción del número de abortos, mayoritariamente
realizados con el método medicamentoso y una estrategia de promoción de salud.38
También existe en el país un Programa de Atención a
la Pareja Infértil, creado en 2016 y completamente gratuito, para dar respuesta a la creciente demanda de este
servicio, aun no satisfecha en su totalidad. A su vez, se
mantiene desde hace diez años una elevada cobertura
anticoncepcional familiar con métodos modernos. En
2019, de acuerdo con la Encuesta CUBA/MICS 2020,
esta cifra fue de 67,9 %; mientras el 15,9 % de las mujeres entre 15 y 49 años no casadas o unidas declaró tener
necesidades no satisfechas de anticoncepción, cifra
que se reduce al 8,8 % para aquellas casadas o unidas.
Por su parte, la tasa de fecundidad adolescente (entre 15 y 19 años, incluyendo los nacimientos en mujeres
menores de 15) presentó en 2019 una discreta disminución de 0,2 en relación al año 2015, con un valor de 52,3
por cada mil mujeres en ese rango de edad. Reducir
este indicador constituye uno de los actuales desafíos
del sistema de salud cubano, desde su abordaje integral
y en conjunto con otros organismos. Se le brinda especial atención al seguimiento de este indicador en los
territorios de la zona oriental del país. El Ministerio de
Salud Pública ha aprobado y aplica los Estándares de
Calidad para los servicios de salud para adolescentes,
con énfasis en la salud sexual y reproductiva. Con ello
se busca asegurar la calidad de los servicios de salud
para adolescentes con enfoques de género y derechos
y es una de las iniciativas clave para la prevención del
embarazo adolescente y la prevención de las infecciones de transmisión sexual y el VIH.39
En Cuba, los servicios sanitarios son gratuitos, con
total cobertura (meta 3.8) y garantizados por el presupuesto del Estado, según se refrenda en la Constitución
de la República de Cuba de 2019 y en la Ley 41 de la
salud. El presupuesto asignado a la salud pública y asistencia social representa cada año alrededor del 27 %
del total y el 11 % del PIB. Al cierre de 2019, se reportó
un crecimiento del número de consultas médicas y estomatológicas por habitante (Gráfico III.3.1).
RECUADRO III.3.1. ATENCIÓN INTEGRAL A LAS ADICCIONES
Cuba dispone de una red de servicios especializados para la atención integral a las adicciones. Desde 2005
funciona un servicio gratuito de consejería telefónica (103) con alcance nacional. En el nivel primario de
atención existen 178 departamentos de Salud Mental que constituyen la piedra angular de la atención
especializada en la comunidad, cuyos equipos multidisciplinarios emprenden, con un enfoque integral,
las acciones pertinentes para promover estilos de vida saludable, preventiva con los grupos de riesgo, así
como educativa, de tratamiento personalizado y de rehabilitación. Garantizan, además, la continuidad de
atención entre el nivel primario y el segundo nivel. En la atención secundaria se dispone de 17 servicios
de psiquiatría ubicados en Hospitales Generales y Clínico Quirúrgicos, 17 servicios de psiquiatría que se
encuentran en Hospitales Pediátricos y 19 Hospitales Psiquiátricos que garantizan la atención a pacientes
con trastornos en su salud mental, cuya complejidad así lo requieren. Para la atención a los adolescentes se
disponen de dos Centros de Deshabituación. Desde la investigación, se cuenta con un Comité Académico
Nacional para la Capacitación en Drogas y una Maestría en Adicciones.
En cuanto al consumo per cápita de alcohol (en personas de 15 años y mayores), el país muestra una tasa
de 6,8 litros por persona por año en 2018, similar a la
media de la región e inferior a la media de los países de
la OECD (9,3).
Por otra parte, se ha reducido la tasa de mortalidad
por accidentes fatales de tráfico (meta 3.6) de una tasa
de 8,1 por 100 mil habitantes en 2015 a 6,2 en 2019. Ello
ha sido resultado de un plan estratégico de comunicación social e intersectorial dirigido al cumplimiento del
código de seguridad vial, recientemente actualizado.
En Cuba se garantiza el 100 % del acceso universal a
los servicios de salud sexual y reproductiva (meta 3.7),
incluidos los de planificación familiar, información y
educación, y la integración de la salud reproductiva en
las estrategias y los programas nacionales. Entre las
principales acciones se destacan el fortalecimiento de
los servicios municipales de planificación familiar con
37 Esta Estrategia tiene un alcance nacional, utilizando la estratificación; está destinado a adolescentes y jóvenes, madres y padres de adolescentes, personal de salud y maestros/as y profesores/as y en su implementación participan diferentes sectores de la sociedad. Ha contribuido a perfeccionar el sistema
de trabajo con los organismos y organizaciones, intensificándose las acciones de promoción, educación para la salud y prevención del riesgo, controlar el
proceso de prescripción, dispensación, control y fiscalización de psicotrópicos, estupefacientes y sustancias de efectos similares, así como la capacitación
intra y extrasectorial.
GRÁFICO III.3.1. CONSULTAS MÉDICAS Y ESTOMATOLÓGICAS POR HABITANTE
Fuente: Minsap
Fuente: Minsap
9,5
9
8,5
8
7,5
5
3,2
3
2,8
2,6
2,4
2,2
2015 2016 2017 2018 2019
Consultas
médicas
por habitantes
Consultas
estomatológicas
por habitantes
38 El Unfpa acompaña al Minsap (en particular al Programa de Atención Materno Infantil) en el fortalecimiento de los servicios de salud sexual y reproductiva.
39 El Unfpa ha apoyado este programa desde sus inicios. Actualmente se implementa un piloto en 4 municipios con elevada fecundidad adolescente.
78 79
I INFORME NACIONAL VOLUNTARIO CUBA 2021
PARTE III. ESTADO DE IMPLEMENTACIÓN DE LOS ODS EN CUBA
Por otra parte, es importante señalar que el 20,8 %
de la población cubana tiene 60 años o más (para el
año 2030 se estima que alcance el 30,3 %). Por consiguiente, Cuba es uno de los países más envejecidos
de la región, lo cual constituye un desafío, a partir de
la elevación de los costos de los servicios y la necesidad de introducir nuevos procesos tecnológicos que
traerán consigo la reorganización del sistema y de los
servicios de salud. Se trabaja como prioridad en el aumento de las capacidades, aún insuficientes en lo relativo a la cantidad de plazas en las casas de abuelos para
el cuidado de día, las camas en hogares de ancianos y
la disponibilidad de ayudas técnicas que, si bien se han
incrementado, no satisfacen la elevada demanda para
la población de adultos mayores. Ello conllevó al diseño y la implementación de un Programa Nacional40
para incrementar la natalidad, atender el envejecimiento poblacional y mejorar la calidad de la atención
a las personas mayores. Cuba se propone avanzar en
una política de atención integral a los cuidados.
Con relación al número de muertes y enfermedades producidas por productos químicos peligrosos y la
contaminación del aire, el agua y el suelo (meta 3.9),
Cuba cuenta con una definición directa de mortalidad
por envenenamiento accidental por sustancias nocivas, que hasta diciembre de 2019 fue de 0,2 por 100 mil
habitantes, con un comportamiento estable en relación a 2015.
En cuanto a la prevalencia del consumo actual de
tabaco a partir de los 15 años de edad (meta 3.a), la Encuesta Nacional de Salud (2018-2019) arrojó como resultado una prevalencia global de 21,6 %, con un 28 %
para el caso del sexo masculino y un 15,2 % para el femenino. El Programa Nacional de Prevención y Control del Tabaquismo tiene cinco componentes o líneas
estratégicas: vigilancia y monitoreo; legislación; ambientes libres de humo; tratamiento y rehabilitación; e
información, educación y comunicación. El Programa
consta de dos comisiones de trabajo para el desarrollo
de las acciones de prevención y control del tabaquismo:
una comisión intersectorial constituida por representantes de diferentes organismos y organizaciones que
ejecutan acciones planificadas, priorizando el ámbito
escolar y laboral con énfasis en el desarrollo de ambientes libres de humo para la prevención del tabaquismo
pasivo; y una comisión multidisciplinaria o técnica asesora constituida por especialistas de diversas direcciones de salud, quienes asesoran técnicamente las acciones a realizar como parte del Programa. La vigilancia
y el monitoreo incluye la realización de encuestas nacionales que permiten conocer el comportamiento del
consumo. Dentro de las acciones se desarrollan las advertencias sanitarias en el empaquetado de los productos del tabaco establecidas por resolución ministerial.
Cuba ha desarrollado sus capacidades productivas,
así como transferencias tecnológicas y evaluaciones
de tecnología sanitaria, las cuales apoyan el SNS. El
Programa Nacional de Medicamentos garantiza un
cuadro básico que responde a los problemas de salud
de la población y está compuesto por 757 renglones, de
los cuales 492 (65 %) son de producción nacional. Los
de origen natural constituyen una prioridad, para lo
cual se aseguran 153 reglones de estos productos, con
un incremento de sus producciones cada año. El gasto
del presupuesto del Estado para medicamentos fue de
400 millones en 2019; de ellos, 11 millones en importaciones y el resto en la producción nacional.
En los dos últimos años, las restricciones económicas y financieras, derivadas principalmente del bloqueo
económico, comercial y financiero impuesto por los Estados Unidos, han limitado los esfuerzos de Cuba para
garantizar la totalidad de los medicamentos del cuadro
básico de salud de la población cubana, lo cual constituye uno de los principales desafíos actuales del sector. En este sentido, el gobierno cubano ha continuado
priorizando la sustitución de importaciones, el fortalecimiento de la industria biofarmacéutica nacional, la
aplicación del programa de Medicina Natural y Tradicional, y el desarrollo de los servicios farmacéuticos y de
la farmacoepidemiología. Dicha estrategia ha sido muy
efectiva en el contexto de la pandemia de COVID-19,
con la introducción de protocolos de tratamiento desarrollados por expertos y científicos cubanos.
A su vez, el desarrollo acelerado de la ciencia y la
innovación en las instituciones científicas cubanas
ha logrado la introducción y extensión en el sistema
de salud de nuevos productos de los centros de la industria médico-farmacéutica y biotecnológica, con un
marco regulador de referencia internacional y el desarrollo de ensayos clínicos (meta 3.b). Ello ha permitido
mejorar la calidad de vida de los pacientes. Existen en
total mil 16 productos de la industria farmacéutica y
biotecnológica cubana introducidos en el SNS en el periodo 2017-2018, de los cuales 499 son medicamentos.
Ejemplos de lo anterior son el Heberprot-P para el tratamiento de la úlcera del pie diabético, las terapéuticas
para el cáncer avanzado de pulmón, conjuntamente
con el ya conocido factor de crecimiento epidérmico,
entre otros.
El desarrollo de las vacunas, como es el caso de la
antimeningocócica B, haemophilus influenzae tipo b
por síntesis química, antileptospirósica, antitifoídica, antihepatitis B recombinante, antisalmonella y la
pentavalente, ha tenido un papel preponderante en los 40 A través de sus contrapartes nacionales, el Unfpa ha acompañado la implementación del Programa para atender la dinámica demográfica. Aquí se destaca
la aprobación de los observatorios demográficos en todo el país, experiencia que cuenta con el apoyo de Unfpa y Pnud en el marco de Padit.
80 81
I INFORME NACIONAL VOLUNTARIO CUBA 2021
PARTE III. ESTADO DE IMPLEMENTACIÓN DE LOS ODS EN CUBA
GRÁFICO III.3.2. PERSONAL DE LA SALUD SEGÚN DETERMINADAS ESPECIALIDADES
Fuente: Minsap
programas de prevención de enfermedades. Actualmente, el país posee cinco candidatos vacunales contra
la COVID-19, todos en fase de ensayos clínicos .
Por otro lado, se han eliminado 14 enfermedades
infecciosas, seis de ellas por medio del Programa de
Inmunización (poliomielitis, difteria, sarampión, parotiditis, tosferina y rubéola); y son controladas dos
formas clínicas graves (tétanos neonatal y meningitis tuberculosa) y dos complicaciones graves (rubéola
congénita y meningitis posparotiditis). Todas ellas con
la aplicación de once vacunas, de las cuales ocho son
de producción nacional. Por campañas y riesgos específicos se administran las vacunas antileptospirósica,
influenza estacional, influenza pandémica, antirrábica
humana y antiamarílica. Al cierre de 2019, se mantenía
el 95,1 % de la población protegida, según el Programa
Nacional de Vacunación.
Con relación a la meta 3.c, al cierre de 2019, el SNS
contaba con un total de 479 mil 623 trabajadores (Gráfico III.3.2). Del total del presupuesto del Estado destinado a la salud, el 34 % es para salario, que representa 2 mil
500 millones de pesos. Asimismo, el Estado garantiza el
empleo a todos los graduados de las carreras de las ciencias médicas. Existen en el país 86,6 médicos, 17,7 estomatólogos y 75 enfermeros por cada diez mil habitantes.
En Cuba están elaborados los planes de reducción
del riesgo de desastres para minimizar vulnerabilidades, con el propósito de preservar la vida de la población, garantizar el aseguramiento médico y la protección de los recursos, en particular en aquellas zonas
del país más vulnerables. Todo ello ha fortalecido el
sistema de respuesta ante los eventos hidrometeorológicos extremos y otras situaciones de desastres que
puedan ocurrir (meta 3.d).
El Minsap ha fortalecido los sistemas de vigilancia en salud integral, como segunda función esencial
para el enfrentamiento al Ébola y desde 2014 existe la
Dirección de Vigilancia en Salud (DVS).41 Se ha fortalecido la concepción integral de la salud hombre-animal-ambiente, con la aprobación de la Estrategia Sanitaria «Una Salud», que está acompañada de un comité
interministerial y un grupo científico-técnico para el
diseño y ejecución de tareas integrales, con énfasis en
la vigilancia y el diagnóstico.
En el escenario internacional, Cuba se destaca por
la cooperación que brinda a otros países del mundo
en materia de salud. Luego de que varias naciones de
Centroamérica y el Caribe sufrieran los devastadores
efectos de los huracanes Georges y Mitch en 1998, cobrando más de 11 mil vidas, fue inaugurada en Cuba, en
noviembre de 1999, la Escuela Latinoamericana de Medicina (Elam), con el objetivo de apoyar la formación
de médicos en América Latina, África y otras partes del
mundo para aumentar la capacidad de los servicios de
salud en zonas necesitadas. Desde entonces, dicha institución se ha dedicado a preparar recursos humanos
que puedan trabajar en la APS en sus regiones de origen, priorizando las comunidades con mayores demandas en el orden sanitario. Más de 30 mil profesionales
de cientos de países han sido formados en sus aulas.
Asimismo, el país se destaca por sus acciones de
cooperación en el área de salud, en especial, a través de
las brigadas del Contingente Médico Henry Reeve, especializado en la atención a situaciones de desastres y
graves epidemias. En la actualidad, 56 brigadas Henry
Reeve han contribuido al enfrentamiento de la pandemia de COVID-19 en 40 países.
41 Sobre la base de las nuevas concepciones internacionales y la experiencia acumulada hasta el momento, en Cuba se ha redimensionado y desarrollado un
modelo de vigilancia en salud que responda a las necesidades del sistema sanitario, de acuerdo con los cambios del patrón epidemiológico, las transformaciones operadas en las condiciones de salud de la población, la introducción de nuevas tecnologías y equipos, el desarrollo de los servicios y programas de salud,
la vigilancia en fronteras, de medicamentos, vacunas, en la atención primaria, hospitalaria y terciaria (Institutos), entre otros. La vigilancia en salud se ha
ido desarrollando en el país y sus resultados tienen un impacto decisivo en la mejoría de la gestión de los indicadores de salud a todos los niveles de atención.
100 000
80 000
60 000
40 000
20 000
25 000
20 000
15 000
10 000
5 000
Médicos
Personal
de enfermería
Tecnólogos y otros
licenciados de la salud
Médicos de la familia
en la comunidad
Estomatólogos
2015 2016 2017 2018 2019
|
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3
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{
"country": "cub",
"file_id": "sdg-03/vnr-report-cub-2021-es-3.pdf",
"language": "es",
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}
|
18
SDG 3. Ensure healthy lives and promote well-being for all at all ages
The Republic of Cyprus takes pride in successfully completing a number of the SDG3 targets in
full. Those are the Maternal Mortality Ratio, (SDG 3.1.1); the Proportion of births attended by
skilled health personnel (SDG 3.1.2); the Under-five mortality rate (SDG 3.2.1); the Neonatal
Mortality Ratio, (SDG 3.2.2); the number of people requiring interventions against neglected
tropical diseases (SDG 3.5.5); the suicide mortality rate and the deaths and illnesses from
hazardous chemicals and air, water and soil pollution and contamination (SDG 3.9).
Despite high scores in the majority of the SDG3 targets, as will be further analyzed below, a major
challenge is the absence of a Universal Health Coverage. It is estimated that 75% of the
population have the right to health care by the Public Health System (626/900). According to the
Information provided by the Health Insurance companies, 23% of the population is covered by
private health insurance. Cyprus is currently in the process of introducing a National Health Care
System. More specifically, the NHIS draft Bill was approved by the Ministerial Council and was
henceforth submitted to the House of Representatives, where its article by article examination
by the Health Committee commenced on November 24th 2016. The review of the Bill by the
Health Committee is currently in its final stages. Once the NHS Bill is adopted by the Parliament,
19
the First Phase of the NHS (FD, Outpatient Specialist, Drugs and Laboratories) will be
implemented on 1st June 2019, while the second (and final) phase (full NHS implementation -
Inpatient, A&E, Ambulance, Rehabilitation, Dentist, Palliative, Allied Health Professionals) will be
implemented on 1st June 20201
.
The main goals of the NHIS are increasing life expectancy and life-long health; guaranteeing the
sustainable financing of the health-care system; decreasing the number of new HIV cases and
reducing the number of injuries and death from injuries, as well as prevention. Specifically, NHIS
implementation will contribute to:
- Better utilization of resources of both the public and the private sector, resulting in market
normalization
- Universal health coverage of the population
- Reduction of inequalities in health care through equal treatment of beneficiaries
- Better control of health spending and better use of resources
- Improvement of quality of health care, amongst others through competition
- Reduction of out-of-pocket payments and economic protection of the population from illness
- Transparency in the health care sector.
In the meantime, Cyprus already has numerous policies in place covering various SDG3 targets:
Related to target 3.7, a strategy on the sexually and reproductive health was currently
prepared and a workshop of all stakeholders involved under the auspices of the Worth Health
Organization was planned for June 2017.
Target 3.3 a Strategic Plan on Control HIV/AIDS epidemic is in place and a National Committee
implemented the various actions under the Ministry of Health, in which different government
and non-governmental organizations were represented. A National Strategy to control
tuberculosis was developed and approved by the Council of Ministers in 2016. A National
Committee nominated by the Minister of Health is responsible for its implementation. The
target is to reach a steady downward trend in the spread of HIV, hence the following activities
are being carried out: prevention activities for various target groups; HIV testing and
counselling; prevention of HIV and AIDS, as well as treatment, care, monitoring and
assessment; developing the related human and organisational resources.
A significant number of activities are undertaken or planned regarding target 3.4. The Council
of Ministers adopted a Strategy to control Diabetes in 2016 and the relevant National
Committee in which all stakeholders involved were represented is responsible for its
implementation. A Mental Health Strategy is in place and incorporated in the Strategic Plan
2017-2019, It prioritises the increasing problem of depression and the prevention of mental
health concerns targeting vulnerable population as early as possible. At the same time, it aims
at implementing the mental health reform and deinstitutionalization through the
development and expansion of Community Mental Health Services. Preventive Program on
Detection and Treatment of Depression in Children and Adolescents.
1 Financial services like medical insurance can provide a formal channel for mitigating the risks of health emergencies.
Women especially have a high demand for health insurance products to address the common health concerns
associated with pregnancy and child birth, including greater susceptibility to infection. For example, emerging
research in Jordan suggests that insurance can help women defray treatment costs and manage health-related
shocks that would otherwise disrupt their economic activities and result in lost income (Women’s World Banking
2012). Yet, to date, research on micro health insurance is limited, but a study on the adoption of micro health
schemes found practically no evidence that it improved welfare, suggesting the need to rethink the design of the
involved product offerings (Cole 2015). Furthermore, new products designed to leverage digital payments
technology might help reduce medical expenses and increase transparency of health subsidies. For instance, ongoing
research in Kenya tests the introduction of a “mobile health wallet” that operates on the M-Pesa mobile money
platform and is restricted to conditional spending at select healthcare providers (Pharm Access 2014).
Savings also is an important tool for managing medical expenses, whether planned or unplanned. In a field
experiment in Kenya, Dupas and Robinson (2013) found that providing people with a safe yet informal place to store
money increased their health savings by 66 percent. They also observed that study participants highly valued
earmarking funds for medical emergencies. Access to formal, interest-bearing accounts can further increase the
value of these investments. A study in Nepal found that when hit with health shocks, households with savings
accounts suffered smaller income drops than households without savings accounts (Prina 2013).
20
A National Strategy for the Prevention of Road Traffic Injuries is in place and is under the
coordination of the Ministry of Transport Communication and Works dealing not only with
prevention but also responding to all road traffic accidents regarding target 3.6. Similarly,
the Action Plan on Childhood Injuries Prevention, adopted by the Council of Ministers in 2017,
dedicates a particular pillar on Road Injuries.
On Industrial Pollution Control and Air Quality, the Republic of Cyprus has designed a specific
policy with main objective the prevention, reduction and control of air pollution arising from
industrial installations, so that the best possible protection of health and welfare of workers,
citizens and the environment is safeguarded. The achievement of this objective is
materialized through:
The effective implementation of the specific legislation for the control of industrial air
pollution, on the basis of which an integrated system of prevention and control has been
established. This system includes the licensing of industrial installations and the
monitoring of their operation.
The continuous monitoring of the concentration of various air pollutants in the
atmospheric environment as well as with the assessment and management of air
qualityFurthermore, the Council of Ministers approved an Action Plan for Air Quality
Improvement. As part of the Action Plan, the governance dealing with issues related to
the management and control of chemical products by safeguarding the conformity of
chemicals produced, distributed, placed on the market or used in a working or domestic
environment and protecting the environment. The complete control of hazardous
chemical substances is accomplished through the enforcement of the National, European
and International legislation for chemicals (REACH, CLP and PIC Regulations, Rotterdam
(PIC) and Stockholm (POPs) Conventions).
The Republic of Cyprus recognises that health is a necessary component for socio-economic
stability, and an essential aspect of sustainable development (SDGs 1, 3, 5). Achieving optimal
health, including access to necessary health care, food, water, clean air, sanitation, hygiene and
medicines, is a fundamental right. Taking into consideration the global trend of increased
longevity and subsequent lack of support systems for the elderly, as well as the increased of
spreading various types of health risks due to global movements, investments in health are a
reinvestment in the development of society as a whole. Scoring high in most of the SDG3 targets,
the greatest challenge for the Republic of Cyprus is the introduction of a National Health System
and its implementation, in order to achieve universal health coverage, including financial risk
protection, for which additional budget will be necessary.
|
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|
48
DEVELOPMENT IN NUMBERS VNR
2017
VNR
2020
2017-2020
Growth
SDG03 – GOOD HEALTH AND WELL-BEING
OVERALL IMPLEMENTATION LEVEL (%) 92.43 90.84 -1.72%
Life Expectancy at Birth (number of years) 81.8 82.9 1.3%
Share of People with Good or Very Good Perceived Health
(% of population aged 16 or over)
80.3 77.8 -3.1%
Smoking Prevalence (% of population aged 15 or over) 31.0 28.0 -9.7%
Death Due to Suicide
(Standardised death rate by 100,000 inhabitants)
4.5 4.1 -9.6%
Self-Reported Unmet Need for Medical Examination and
Care (% of population aged 16 and over)
1.5 1.0 -33.3%
Note: Green shows an improvement of the indicator, while red shows a decline in progress. White colour shows a stable perormance.
49
GOOD HEALTH AND WELL-BEING
SDG 3 | Ensure healthy lives and promote well-being for all at all ages
Highlights – 2020
• As of June 1st 2020, Cyprus introduced
in its entirety, its national healthcare
system called General Health System
(GHS). GHS gives every Cypriot citizen
equal and unhindered access to high
quality healthcare services.
Covid Response
• Establishment of an Advisory Scientific
Committee for the systematic surveillance
of the development of the epidemic and
the taking of preventive measures.
• Suspension of most economic activity
by businesses except for those providing
basic goods and services, the ban of
unnecessary movement by citizens, ban of
the operation of schools and of gatherings
either in public or in households.
• Implementation of control measures
at the entrance gates of the Republic,
including restriction of flights.
• Introduction of an extensive programme
of free rapid antigen testing for the wider
public and employees returning to work.
• Implementation of digital solutions to
support the collection and management
of data, such as the COVID-19 Platorm.
Looking Ahead
• Addressing the potential shortage
of medical professionals in specific
Medical Specialties.
• The implementation of the GHS
will require additional adjustments
pertaining to the integration stage of the
public and private health care sector.
• Reforms and investments in the
healthcare sector are promoted through
the National Recovery and Resilience
Plan (NRRP), which will increase the
eficiency, accessibility, and overall
resilience of the GHS.
EU
RANK TREND
HEALTHY LIVES
Life Expectancy at Birth 3
Healthy Life Years at Birth 13
Share of People with Good or
Very Good Perceived Health
3
HEALTH DETERMINANTS
Smoking Prevalence (Total) 16 :
Obesity Rate (Overweight: BMI ≥ 25) 8 :
Obesity Rate (Obese: BMI ≥ 30) 6 :
Population Living in Households
Considering that they Sufer from
Noise
15
Exposure to Air Pollution
(Particulates <2.5Μm)
16
Exposure to Air Pollution
(Particulates <10Μm)
22
CAUSES OF DEATH
Standardised Death Rate Due to
Chronic Diseases
4
Suicide Death Rate (15-19 Years) 2 :
Suicide Death Rate (50-54 Years) 3 :
Standardised Death Rate Due to
Tuberculosis, HIV and Hepatitis
11 :
Standardised Preventable and
Treatable Mortality
4 :
People Killed in Accidents at
Work (Total)
18
ACCESS TO HEALTHCARE
Self-Reported Unmet Need for
Medical Examination and Care
8
Note: Data comes from the Statistical Service of Cyprus. EU rank
presents the rank of Cyprus among the EU member states, for
the most recent available year. Trend presents the 10-year trend
from 2010-2019. Pos, Neg, Neg-Pos, and, Pos-Neg indicate
a positive, a negative, a U-shape and an inverse U-shape trend,
respectively. Green arrows indicate an improvement in the
perormance of Cyprus and red arrows indicate a decline in
the perormance of Cyprus. indicates a constant trend. :
indicates that the trend is not calculated, because less than 8
years of data are available.
50
victims of accidents both on the road and at
work. Particularly for the latter, Cyprus has more
deaths caused by accidents at work relative
to the EU, with 2.3 and 1.8 deaths per 100,000
employees, respectively (see Figure 13). Once
again though, a positive trend can be observed,
with improvements in the indicators, mirroring
the various work safety policies employed by
Cyprus Governments over the years.
NARRATIVE
Overall, Cyprus ensures high standards
of healthy living and well-being
and perorms well in key indicators,
including life expectancy and low
mortality rates due to chronic diseases.
The vast majority of Cypriots perceive
their health to be good or very good. In
a major Government initiative, Cyprus
rolled out its national healthcare
system providing equal access to
quality healthcare for all. During these
challenging times of the pandemic,
the Cyprus Government implemented
policies and practices to mitigate
the detrimental efects of COVID-19
on the health and well-being of the
population.
ANALYSIS
In regards to healthy living, Cyprus
ranks quite well amongst EU countries.
In particular, life expectancy in Cyprus
is 82.9 years, relative to 81 years in the
EU as a whole. Interestingly enough,
women in both Cyprus and the EU are
expected to live longer than men by
approximately 4 years. Additionally,
78% of Cypriots perceive their health
to be good or very good, which places
Cyprus in the 3rd place, among EU countries.
Another interesting fact is that while Cyprus
is quite close to the EU average on smoking
prevalence with 28% (the EU average is 27%),
there is a considerable diference between
men and women (see Figure 12). In particular,
Cyprus ranks 21st among EU countries in smoking
prevalence in males (39% relative to the EU’s
32%), and 4th in smoking prevalence in females
(17% relative to the EU’s 23%). Another important
health determinant is exposure to air pollution.
Even though Cyprus appears to be perorming
poorly relative to the EU, the observed negative
trend (22.2 mg/m3 in 2010 to 13.4 mg/m3 in 2019
for particulates < 2.5 Mm) shows that eforts are
being made to improve air quality.
In regards to the main causes of death (chronic
diseases, suicide, preventable and treatable
diseases) Cyprus ranks in the top positions
among EU countries with the number of deaths,
per 100,000 persons from the aforementioned
diseases being lower than the EU average.
However, an exacerbation has been observed
in some indicators for chronic diseases, like
Tuberculosis, Malaria, and HIV due to the arrival
of asylum seekers coming from highly infected
areas. Another problematic area relates to the
0
5
10
15
20
25
30
35
40
45
Total Males Females
%ofpopulation aged15orover
Cyprus EU
Figure 12.: Smoking prevalence
Figure 13.: People killed in accidents at work
Total Males Females
numberper100.000employees
0
1
2
3
4
Cyprus EU
51
GOVERNMENT INITIATIVES
Access to Healthcare for All—
General Health System (GHS) • A comprehensive and financially sustainable
national healthcare system was implemented
in June 2020 aimed at providing all Cypriot
citizens equal access to treatment and highquality healthcare by using, in the best possible
way, all available resources.
• The GHS more e
fectively formalises both
public and private sector resources, resulting in
market formalisation, reduction of inequalities
in healthcare through equal treatment of
beneficiaries, better control in health spending
and better use of resources, improvement of
quality in health care, among others, through
competition, reduction of out-of-pocket
payments and economic protection of the
population from illness, while also creating
transparency in the health care sector.
Coping with chronic diseases (HIV, Malaria, TB) • Eforts to deal with Chronic Diseases including
those a
fecting immigrants.
• National Strategic Plans are in place to cope
with mainly imported cases.
• National Committees are responsible for their
implementation and the management of the
dedicated budget.
Ensure Healthy Lives – Environmental Factors • Air Quality:
Prevention, reduction, and control of air pollution
from industrial installations achieved by: – the licensing of industrial installations and
the monitoring of their operation, and
– ongoing monitoring, assessment, and
management of air quality due to climate
change and the arrival of dust molecules
from the desert.
• Monitoring and control of hazardous chemical
products which are manufactured, imported,
exported, used and placed on the market of
Cyprus.
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"file_id": "sdg-03/vnr-report-cyp-2021-en-3.pdf",
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40
3.8 The right to healthcare and its availability from the
location and time aspects are stipulated by law in the
Czech Republic. The persisting shortage of healthcare
personnel is currently intensifed by the Covid-19 pandemic.
3.9 In 2019 the increase in premature deaths due to air
pollution was estimated by 3%, i.e. by 3,100 individuals.
3.a Within the terms of fulflment of the WHO Convention on Tobacco Control, a nationwide prohibition of
smoking in interior areas was implemented in 2017.
Prevalence of current tobacco use was 31.5% of the
population in 2018, and there is a clear declining trend
in this area.
3.b The Czech Republic’s ODA in support of medical
research and basic services in the healthcare sector
difers from year to year depending on the actual implementation of projects. EUR 0,45 million of aid was
provided in 2018, and EUR 2.34 million a year later.
3.c The Czech Republic is unable to directly infuence
the form of healthcare funding in developing countries, but is involved through government scholarships
allowing students from developing countries to study
medicine in the Czech Republic.
3.d The 13 core capacities for preparedness for health
emergencies were fulflled form 68% in 2019.
Non-infectious diseases and prevention
The probability of death as a result of cardiovascular disease, cancer, diabetes or chronic
respiratory illness has been falling in recent
years. Specifcally, the mortality rate from
tumours has been stabilised overall, even though the number of new cases per year is actually
rising. The growing number of reported cases
can be partially related to the aging population of the Czech Republic (the average age, or
specifcally the age at death, is rising). Age is
the main risk factor in cancer, partly through
the accumulative efect of risk factors. Other
potential reasons for the rising absolute inci3.1 Maternal mortality has been kept at low values in
the Czech Republic over the long term. An average of
2 women have died per 100,000 live births per year
from 2015.
3.2 Neonatal mortality has been kept below 2‰ since
2008. Child mortality is declining in the long term and
was 3.1‰ in 2019.
3.3 The dominant method of HIV infection is sexual
contact between men. On the other hand, most hepatitis C is transferred as a result of infections from
drug use. The number of men newly infected with HIV
rose by 30% between 2015 and 2018. The number of
people newly infected with hepatitis also doubled, to
724 in the case of type A, and from 739 cases to 840
in the case of type C, between 2013 and 2015. On the
contrary, the number of type B hepatitis cases fell. The
occurrence of tuberculosis has now been declining for
20 years.
3.4 The proportion of premature mortality as a result
of non-communicable disease in relation to the total
number of all mortalities fell by 6% between 2005 and
2019. The suicide rate in the Czech Republic remains
above the European-wide average in the long term,
and the risk of suicide has also grown rapidly as a result of the Covid-19 pandemic and the related government measures.
3.5. Excessive alcohol consumption is common in the
Czech Republic and is socially tolerated to a great degree. The average consumption is around 10 litres of
pure alcohol per person per year (including children)
in the long term, and around 1.6 million people who
abuse alcohol are registered.
3.6. The number of deaths and injuries from road trafc crashes has not been reduced by half as yet, but
their number is falling. 618 individuals died in this manner in 2019, which is signifcantly above the EU average.
3.7. Most women of reproductive age (15 to 49 years
of age) use modern family planning methods. The
Czech Republic’s family policy goals include the prevention of infertility and improving the fnancial availability of assisted reproduction.
41
dence are the increased occurrence of physical
and chemical carcinogens, which also pollute
the environment, and lifestyle changes. Healthcare in the Czech Republic has high quality in
this area. The diagnosis of cancerous tumours
and the overall quality of medical care is high. In
relation to the improved diagnostics, one cause of the higher number of reported cancerous
tumours may also be the nationwide state oncological screening programmes. Mammographic
screening was ofcially launched in the Czech
Republic in 2002, cervical screening in 2008, and
screening for colorectal cancer in January 2009.
As well as skin tumours, tumours of the large intestine and the rectum are typical for the Czech
Republic.
Unfortunately, an unhealthy lifestyle (insufcient exercise, stress, high alcohol consumption
and smoking) contributes to the occurrence of
non-infectious disease as well as age. Solutions
include public campaigns and an emphasis on
physical activity with at least moderate exertion
for children, and promotion of a healthy lifestyle.
The implementation of programmes to support
health (food labelling, the promotion of exercise
as an integral lifestyle element) and the aforementioned screening programmes are priority
areas of the Health 2020 programme and include the Health 2030 strategic framework, a basic
health policy strategy in the Czech Republic for
the next decade. Although these programmes
are more efective in the long term and considerably cheaper than subsequent treatment,
the implementation of these programmes faces
a lack of funds.
Strengthening oncology
During the Covid-19 pandemic, only urgent health care was provided and preventive examinations and check-ups for oncological patients were
limited. This may subsequently be refected in
an increasing incidence of tumours, their more
advanced state, and higher treatment costs.
The Czech Republic wants to prevent a long-
-term impact from the pandemic in this area,
particularly with regard to the aging population. Using reforms and investments, it plans to
contribute towards increasing the resilience of
the oncological prevention and care system. In
compliance with national and European strategies, attention will be devoted not only to primary and secondary prevention, but also to health
literacy.
The overall investment costs are estimated at
around EUR 394 million (National Recovery Plan).
Tobacco control
31.5% of the population aged 15 years and over
were tobacco users in 2018, and this number is
slowly falling. A law prohibiting smoking (with
the exception of hookahs) in restaurants and
bars came into efect in 2017. The excise duty
rates on tobacco products were also increased. A further increase in excise duties on tobacco products is foreseen in the next three
years to ensure they do not become more affordable. The new National Strategy to Prevent
and Reduce Damage Linked to Addictive Behaviour 2019–2027 and its action plan focus on tobacco control, among other things.
Youths´ point of view
22% of young people stated that they smoke
(or otherwise use tobacco) (practically) every
day.
A clearer view of the world
The DOT Glasses project helps people with poor
eyesight in developing countries. Thanks to adjustable glasses frames and a radically simplifed
lens concept, 90% of the population can now
enjoy sufciently good eyesight. Over a million
poor people will have access to better healthcare by 2022 thanks to glasses. The fnal price of
these glasses is around USD 3 to USD 5.
|
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24
SDG 3: Ensure healthy lives and promote well-being for all at all
ages
Good health is an objective of, a prerequisite for and a result of sustainable
development. Respecting, promoting and guaranteeing good health is a
human rights obligation. One central factor in this is ensuring that all people have access to affordable health care of an acceptable standard (universal health coverage
or UHC).
National challenges
The German health system is often seen at international level as an example to be followed in
order to achieve universal health coverage. The concept of prevention, which is integral to the
goal, is the priority of Germany’s health policy. The Preventive Health Care Act, adopted in
mid-2015, steps up health promotion and preventive health close to the citizens, i.e.in schools,
pre-school childcare facilities and at the workplace, while the services offered by health insurance schemes in order to detect and diagnose diseases at an early stage are being further
developed, and the interplay between health promotion in the workplace and occupational
health and safety are being improved. The environmental policy of the German Government
also serves to protect the population from harmful influences in the environment in the form of
chemicals, contamination of air, soil or water, and noise pollution.
Global responsibility
At global level, Germany is working for the following in particular:
• A global health policy and the strengthening of health systems, especially the fight
against the spread of transnational health hazards. The framework for inter-ministerial work
is provided by the German Government’s strategy entitled Shaping Global Health – Taking
Joint Action – Embracing Responsibility. The road map Healthy Systems – Healthy
Lives, initiated jointly by Germany and the World Health Organization, is an important
measure.
• Improving international crisis management when epidemics strike, partly by supporting structural reforms (UN High-level Panel on the Global Response to Health Crises)
and developing solutions to address the risk of global pandemics (e.g. the World Bank’s
Pandemic Emergency Financing Facility) and contributions to the WHO emergency funds.
• Strengthening the World Health Organization in its overarching and coordinating role
in global health architecture. Germany is the third largest contributor to the regular budget.
• Health and environmental protection in bilateral and multilateral cooperation.
25
Support for other countries
In cooperation with developing countries, the targets that build on the Millennium Development Goals are still the priority fields of action (“unfinished business” of the MDGs, including improving maternal and child health, ensuring access to sexual and reproductive health
services and realising reproductive rights, as well as eradicating and fighting communicable
diseases). Within the framework of negotiations and international initiatives, the German Government is actively involved, for instance, in efforts to promote a rights-based approach to
family planning and maternal health, comprehensive sexuality education and access, especially
for young people, to sexual and reproductive health services, to better link sexual and reproductive health services and HIV/AIDS work, and in the field of sexual orientation and gender
identity (SOGI). Comprehensive sexuality education (CSE) is a central concern of the German
Government. This should include age-appropriate explanations of human rights, sexuality,
gender equity, partnerships and sexual and reproductive health on the basis of scientifically
founded and value-free information.
• The Initiative on Rights-based Family Planning and Maternal Health supports partner countries in efforts to increase the use of modern contraceptive methods, and helps ensure that no birth is unwanted and that every birth is attended by health professionals.
• The German Government aims, with the help of Gavi, The Vaccine Alliance, to vaccinate
300 million more people by 2020, and to save 8 million lives and prevent 300 million new
infections with the projects financed by the Global Fund to Fight AIDS, Tuberculosis and
Malaria (GFATM).
• Research activities on neglected and poverty-related diseases are being clustered, coordinated with G7 partners and the necessary data is being made available.
The present draft of the National Sustainable Development Strategy 2016 envisages that national sustainability indicators and goals/measures concentrate on: (a)
premature mortality; (b) smoking rate; (c) obesity; (d) pollutants in the air; (e) exposure to
particulate matter.
|
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|
40
SDG 3
Ensure healthy lives and
promote well-being for
all at all ages
Premature mortality (women)
Premature mortality (men)
Smoking rate among adolescents
Smoking rate among adults
Obesity rate among children and adolescents
Obesity rate among adults
Emissions of air pollutants
Share of the population with increased exposure to PM10
Germany’s contribution to pandemic prevention and response
world-wide
Source: Sustainable Development in Germany – Indicator Report 2021
Improving the health of all people on Earth is a central concern of the 2030 Agenda. Good
health is a goal of sustainable development but also its prerequisite and result. Monitoring,
promoting and providing for it is a human rights obligation. The crucial requirement in this
context is universal health coverage or UHC, i.e. access for everyone to affordable healthcare of appropriate quality.
The COVID 19 pandemic has shown what drastic effects such an outbreak and the accompanying strain on health services can have on all areas of life – on public and private life as
well as economic activity. In this respect SDG 3 is connected not only to SDG 2 (no hunger),
SDG 6 (drinking water and sanitation) and SDG 13 (climate action) but also to all the other
goals.
German Voluntary National Review to the HLPF 2021 41
Pursuit of the 17 SDGs in, by and in partnership with Germany | SDG 3
Relevant indicators and exemplary
trends
In the German Sustainable Development Strategy,
SDG 3 is covered by nine indicators in three
categories:
• Health and nutrition: Premature mortality
among women and men, smoking rates among
adolescents and adults, the obesity rate among
children and adolescents and the obesity rate
among adults;
• Air pollution: Emissions of air pollutants and
share of the population with excessive exposure
to PM10
1
;
• Global health: Germany’s contribution to global
pandemic prevention and response.
The last of these listed indicators is examined
below by way of an example; it is intended to
depict Germany’s willingness to assume increasing
responsibility in the international effort to combat
the pandemic worldwide. The indicator covers
expenditure and pledges made by Germany for
global pandemic prevention and response programmes. It excludes programmes designed to
contain the COVID-19 pandemic (see the paler
part of the green column for 2020 seen in the
graph).
Germany’s pledges for global healthcare funding,
that is to say for global pandemic prevention and
response programmes, particularly in countries of
the Global South, have been continuously increased over the past few years. The aim is to raise
Germany’s contribution to global pandemic
prevention and response substantially from its
2019 level in the period up to 2030.
42
Pursuit of the 17 SDGs in, by and in partnership with Germany | SDG 3
Context, challenges and core
activities since 2016
Application of the prevention principle and
reinforcement of healthcare systems are priorities
of German health policy both at home and abroad.
The German healthcare system is regarded
internationally as a model for universal coverage in
the event of illness. Both the statutory and the
private health insurance schemes offer their
members reliable protection covering all essential
health services. Nonetheless, the effectiveness of
the healthcare system in Germany must be
continuously reviewed and re!ned. The same
applies to other key areas, such as the development and qualitative improvement of healthcare.
The COVID 19 pandemic, moreover, has shown
that vital importance attaches to the upgrading of
the public health service, which is an indispensable
pillar of the healthcare system. The COVID 19
pandemic is likely to pose formidable challenges
for healthcare systems, both worldwide and
within Germany, for some time to come.
The reinforcement of global players in the !eld of
health, particularly the WHO, and of national
healthcare systems in partner countries is a key
objective of Germany’s international activities,
which are described in the Global Health Strategy
of the German Government. At the heart of the
German Government’s international cooperation
in the health sector is its contribution to ensuring
that universal basic healthcare is also available to
the poorest people.
In Germany:
• Enhancing prevention and health literacy,
especially digital health literacy, in everyday life
and protecting public health: The Prevention
Act (Präventionsgesetz) raises the standard of
prevention and health promotion, especially in
schools, child daycare centres and workplaces,
by means of services provided by the health
insurance funds and services for the early
detection of diseases.
• The Protection against Measles Act (Masernschutzgesetz), adopted in 2020, stipulates that
proof of adequate vaccination against measles
or of immunity to measles must be presented
for all those who are looked after in communal
facilities or who work there.
• Strengthening the public health service: The
adoption of the 2020 Pact for the Public Health
Service provided for measures to upgrade the
human, technical and digital resources of the
county or district health authorities.
• Strengthening the health service infrastructure,
especially its digital infrastructure: A Future of
Hospitals Act (Krankenhauszukunftsgesetz) was
adopted in 2020, particularly with a view to
expanding the digitalisation of hospitals and
improving their IT security.
German Voluntary National Review to the HLPF 2021 43
Pursuit of the 17 SDGs in, by and in partnership with Germany | SDG 3
• Digitalisation of the healthcare system to
improve the quality of urban and rural medical
care and to meet the challenges of demographic
change: A system of electronic patient !les is
being introduced; from 2021, health insurance
funds are to make it available to all their
members.
• Implementation of the National Reduction and
Innovation Strategy for Sugar, Fats and Salt in
Processed Foods: Processed foods are to contain
fewer calories and fats and less sugar and salt.
This strategy is focused clearly on ready-made
products, particularly those that are designed to
appeal to children and adolescents.
In the global context and in
cooperation with partner countries:
• Closer coordination of global health players and
reinforcement of national health systems: A
joint initiative was launched by Germany,
Norway and Ghana for the preparation of a
Global Action Plan for Healthy Lives and
Well-being for All (SDG 3 GAP), which was
adopted by the World Health Organization
(WHO) together with 11 other multilateral
organisations in 2019. Following the accession
of the ILO at the start of 2021, a total of 13
organisations are now involved.
• Germany also supports the activities which the
United Nations has announced for the 2021-
2030 Decade of Healthy Ageing being run by
the WHO.
• Strengthening global health players: Germany is
a reliable partner to many multilateral health
organisations, particularly the WHO, Gavi, the
Vaccine Alliance, and the Global Fund to !ght
AIDS, Tuberculosis and Malaria (GFATM). In this
vein, Germany was able to increase its funding
for the WHO from EUR 181 million in 2016-
2017 to EUR 313 million in 2018-2019. The
funds provided to !ght the pandemic bring the
total for 2020 up to EUR 564 million. Similarly,
the funding for the GFATM was raised from
EUR 210 million in 2016 to EUR 350 million in
2020. Other important international partners
with which Germany cooperates are the United
Nations Population Fund (UNFPA), the Global
Financing Facility (GFF) and the International
Planned Parenthood Federation (IPPF), to
which the German Government is providing
aggregate funding of about EUR 190 million in
2020 and 2021.
• Stepping up multilateral cooperation on the
basis of the One Health approach: Germany has
been doing this by initiating the establishment
of the One Health High Level Expert Panel to
advise the WHO, the FAO, the World Organisation for Animal Health (OIE) and the United
Nations Environment Programme (UNEP) and
by supporting its work.
44
Pursuit of the 17 SDGs in, by and in partnership with Germany | SDG 3
• Global access to and global distribution of
vaccines, especially in the context of the COVID
19 pandemic:
ACT Accelerator: Germany is a founding
member of the Access to COVID-19 Tools (ACT)
Accelerator and its second-largest donor. The
Accelerator is a global platform for the development of COVID-19 vaccines, therapies and
diagnostics.
COVAX: Germany actively supports the United
Nations’ COVID-19 Vaccines Global Access
(COVAX) initiative, the aim of which is to obtain
reasonable prices, especially for poorer countries, through bulk ordering and to distribute
vaccines worldwide. Germany is providing the
COVAX facility with EUR 1.08 billion to procure
vaccines for the world’s 92 poorest countries as
part of a total allocation to the ACT Accelerator
of about EUR 2.2 billion.
• Bolstering research and development for
vaccines against pathogens that may cause
epidemics: Germany plays an active role in the
international CEPI initiative (Coalition for
Epidemic Preparedness Innovations) and is providing it, as part of the aforementioned ACT
Accelerator allocation, with a total of EUR 350
million for 2020 and 2021.
• Initiative on Rights-based Family Planning and
Maternal Health: In this initiative, Germany
helps to ensure that the right conditions are
created in 21 partner countries for the avoidance of unwanted pregnancies and for professional medical assistance at births. Another
priority is access to comprehensive sexuality
education, especially for adolescents and young
adults, to empower them to take independent
informed decisions about their health and to
protect women and girls effectively from
unwanted pregnancies. Since 2016, the German
Government has made resources amounting to
about EUR 480 million available for this
initiative in its development cooperation
budget.
German Voluntary National Review to the HLPF 2021 45
Pursuit of the 17 SDGs in, by and in partnership with Germany | SDG 3
Lessons learned, areas requiring
action and anticipated priority areas
• Pandemic prevention and preparedness measures require constant improvement.
• Health system structures require further
modernisation through innovation and digitalisation.
• The care system needs to be improved and
reinforced.
• There is a need to keep building capacity for the
manufacture of vaccines and other important
pharmaceutical products in Germany, Europe,
and developing and newly industrialised
countries.
• Research into vaccines, medicines, treatments
and diagnostics has to be accelerated in Germany and Europe.
• There is a need to strengthen global health
entities and improve their capacity for cooperation.
• There is a need to strengthen global health
structures with due regard to the lessons
learned from COVID-19, particularly by
advancing the proposal for an international
treaty on pandemic prevention and preparedness with a view to building national, regional
and global capacity for greater resilience in the
face of future pandemics.
• Investment is needed to improve pandemic
prevention and preparedness, particularly by
strengthening the political, !nancial and
institutional position of the World Health
Organization to enhance its response capability.
• There is a need to make more use of the One
Health approach nationally, regionally and in
the context of international cooperation, since
human and animal health and environmental
factors are closely intertwined.
• National health systems must be continuously
strengthened to guarantee access to essential
services, including sexual and reproductive
services, and the exercise of reproductive rights,
even in crises, as these are prerequisites for
stability, welfare and global health.
• Access to preventive measures of sexual and
reproductive health, including comprehensive
sexuality education, and to related rights must
be maintained.
• There is a need for more dovetailing of multilateral and bilateral activities as well as for an
extension of cooperation among all key players
in the health system– the public sector, the
private sector and the academic community.
|
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52
Les cibles de l’ODD3 sont alignées à environ 72% avec les axes et les objectifs prioritaires du PND
« Djibouti ICI » 2020-2024. Huit cibles opérationnelles et quatre cibles de mise en œuvre sont
priorisées dans le PND « Djibouti ICI ». La tendance globale affichée est une amélioration modérée
ave des défis majeurs.
En matière de santé, les investissements importants mobilisés auprès des partenaires du
développement ont permis de renforcer le système national de santé, d’améliorer la santé
reproductive, de réduire la mortalité maternelle et infantile et de stabiliser la prévalence du VIH,
grâce à l’expansion des services de santé reproductive de qualité.
➢ Les objectifs et les axes stratégiques du PNDS
Le PNDS 2015-2019 avait 6 objectifs principaux, à savoir : i) assurer davantage de participation et de
transparence dans la gouvernance pour un système de santé plus équitable et plus performant ; ii)
garantir l’accès universel à des services de santé de qualité pour répondre aux besoins de la
population ; iii) adapter le financement et l’utilisation des ressources financières aux besoins du
système de santé ; iv) développer et valoriser les ressources humaines en fonction des besoins du
système de santé ; v) améliorer la disponibilité, l’accessibilité, l’usage rationnel des médicaments et
la qualité des moyens de diagnostic ; vi) renforcer le système national d’information sanitaire pour
améliorer l’appui à la prise de décision, la surveillance, le suivi-évaluation du PNDS.
Ces six objectifs s'articulent autour de 4 axes stratégiques qui sont i) la lutte contre la mortalité
maternelle, néonatale et infanto-juvénile ; ii) la lutte contre le paludisme, le VIH/sida, la tuberculose,
iii) la lutte contre les maladies non transmissibles et iv) le renforcement du système de santé.
La budgétisation du PNDS 2015-2019, avec l’outil « OneHealth » a été réalisée avec l’appui de l’OMS.
Les orientations stratégiques du nouveau Plan National de Développement Sanitaire (PNDS) 2020-
2024, lancé en mars 2020, visent à accélérer les progrès vers la couverture sanitaire universelle afin
de réaliser les priorités et les objectifs retenus dans la vision Djibouti 2035 et le PND « Djibouti ICI »
2020-2024. Les orientations stratégiques du nouveau PNDS 2020-2024, s’attèlent d’atteindre les
cibles des objectifs de développement durable liés à la santé, grâce à un cadre de performance
propice qui fixe les cibles en matière de réduction de la morbidité, de la mortalité et de la
malnutrition, l’augmentation des couvertures effectives des interventions à haut impact et aussi le
renforcement des piliers du système de santé à tous les niveaux.
Lancement le 18 mai 2022, d’un symposium sur la santé dont l’objectif général est d’organiser des
consultations publiques à travers des ateliers thématiques dans le but d’identifier les réformes
nécessaires pour atteindre la couverture de santé universelle à Djibouti.
Lancé à travers tout le pays, ce symposium permettra de conduire une analyse approfondie du
système de santé de Djibouti en matière de couverture sanitaire universelle, de lutte contre les
maladies transmissibles et non transmissibles, et également la préparation des réponses aux
urgences sanitaires.
Permettre à tous de vivre en bonne santé et promouvoir
le bien-être de tous à tout âge
53
262
256 256
247 246
248
235
240
245
250
255
260
265
2012 2013 2014 2015 2016 2017
Graphique n°8 : Taux de mortalité maternelle pour 100
000 naissances vivantes.
72 70 67 65 63 61 59 58
0
10
20
30
40
50
60
70
80
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Graphique n°9 : Taux de mortalité des enfants
de moins de 5 ans pour 1 000 naissance vivantes
❖ Cible 3.1 : D’ici à 2030, faire passer le taux mondial de mortalité maternelle au-dessous de 70
pour 100 000 naissances vivantes
L’enquête sur la santé de la mère et des enfants (EDSF/PAPFAM), réalisée en 2012 sur le territoire
national, a permis de situer le taux de mortalité maternelle à 383 décès pour 100 000 naissances
vivantes.
Les estimations internationales montrent que ce taux a baissé de 15% entre 2012 et 2017 (graphique
ci-dessous).
En
2012, 87,4 % des accouchements ont été assistés par du personnel de santé qualifié, contre 75 % en
2002, soit une hausse de 12,4 points de pourcentage.
La santé maternelle et néo-natale étant une préoccupation majeure, le gouvernement a adopté en
octobre 2021, une nouvelle stratégie nationale d’accélération de la réduction de la mortalité
maternelle et néo-natale, élaborée avec l’appui des partenaires comme l’OMS, UNICEF, UNFPA,
ONUSIDA, OIM, UNHCR, AFD mais également les principales sections, antennes et institutions
publiques axées sur la mère et l’enfant, dont la Direction de la Santé du corps des forces armées
Djiboutiennes. L’objectif de cette stratégie nationale est de réduire de ¾ le taux de mortalité
maternelle et de 2/3 le taux de mortalité des enfants de moins de 5 ans.
❖ Cible 3.2 : D’ici à 2030, éliminer les décès évitables de nouveau-nés et d’enfants de moins de
5 ans, tous les pays devant chercher à ramener la mortalité néonatale à 12 pour 1 000
naissances vivantes au plus et la mortalité des enfants de moins de 5 ans à 25 pour
1 000 naissances vivantes au plus
Le nombre de décès de nouveau-nés et des enfants de moins de 5 ans a été réduit. Ce nombre est
passé de 127 décès d’enfants de moins 5 ans pour 1 000 naissances vivantes avec un taux de
54
36.4
35.5
34.8
33.9
33.2
32.4
31.7
30.5
30
31
32
33
34
35
36
37
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Graphique n°10: Taux de mortalite néonatale pour 1 000
naissances vivantes
mortalité infanto-juvénile de 122 ‰ chez les garçons et 132 ‰ chez les filles en 2002 à 68 décès
d’enfants de moins de 5 ans pour 1 000 naissances vivantes avec un taux de mortalité infantojuvénile de 75 ‰ chez les garçons et 61 ‰ chez les filles en 2012.
De même, moins d’enfants décèdent avant d’atteindre un mois comme l’indique le taux de mortalité
néonatale qui était 45 décès pour 1 000 naissances vivantes (48,6 ‰ chez les garçons et 41,4 ‰ chez
les filles) en 2002 et qui a baissé en 2012 en affichant 36 décès pour 1 000 naissances vivantes (37 ‰
chez les garçons et 35 ‰ chez les filles).
Graphique n°11 : Taux de mortalité des enfants de moins de 5 ans et taux de mortalité néonatale
pour 1000 naissances vivantes
Source : EDSF-PAPFAM 2002 & 2012
❖ Cible 3.3 : D’ici à 2030, mettre fin à l’épidémie de sida, à la tuberculose, au paludisme et aux
maladies tropicales négligées et combattre l’hépatite, les maladies transmises par l’eau et
autres maladies transmissibles
Le nombre de nouvelle infection au VIH est de 0,57 pour 1 000 personnes séronégatives.
55
L’incidence du paludisme a augmenté sur la période 2015-2018, c’est-à-dire que le nombre de
nouveaux cas paludéens a augmenté considérablement en passant de 13,8 nouveaux cas pour 1 000
habitants exposés au risque de paludisme en 2015 à 35,2 ‰ en 2018. À l’opposé, l’incidence de la
tuberculose a diminué au fil des années ; elle est passée de 367 personnes souffrant de la
tuberculose pour 1 000 personnes exposées au risque de la tuberculose en 2015 à 224 ‰ en 2020.
Par ailleurs, l’incidence de l’hépatite B se situait à 600 cas pour 100 000 habitants en 2015 et en
2018, on dénombre 110 561 personnes pour lesquelles des interventions contre les maladies
tropicales négligées sont nécessaires à Djibouti.
Graphique n°12 : Incidence de la tuberculose pour 100 000 habitants
Source : WHO Global Tuberculosis Report 2020
❖ Cible 3.4 : D’ici à 2030, réduire d’un tiers, par la prévention et le traitement, le taux de
mortalité prématurée due à des maladies non transmissibles et promouvoir la santé mentale
et le bien-être
En 2019, selon les estimations de l’OMS, le taux de mortalité attribuable aux maladies
cardiovasculaires, au cancer, au diabète ou aux maladies respiratoires chroniques est évalué à 22 %
et le taux de mortalité par suicide à 9,6 décès pour 100 000 habitants.
❖ Cible 3.6 : D’ici à 2020, diminuer de moitié à l’échelle mondiale le nombre de décès et de
blessures dus à des accidents de la route
En 2017, le taux de mortalité due aux accidents de la route est estimé à 23,5 décès pour 1 000
habitants. Ce taux est resté au même niveau que l’année 2015 (23,9 ‰).
❖ Cible 3.7 : D’ici à 2030, assurer l’accès de tous à des services de soins de santé sexuelle et
procréative, y compris à des fins de planification familiale, d’information et d’éducation, et
veiller à la prise en compte de la santé procréative dans les stratégies et programmes
nationaux
En 2012, moins d’un quart (22 %) des femmes âgées de 15-49 ans ont déclaré avoir utilisé des
méthodes modernes de planification familiale. Cette proportion, qui a doublé depuis 2002 (10,5 %),
demeure faible et montre clairement que l’utilisation des moyens contraceptifs modernes à des fins
de planification familiale touchent uniquement une minorité des femmes en âge de procréer.
Par ailleurs, il faut noter qu’en 2012, le taux de fécondité chez les adolescentes âgées entre 15 et 19
ans était de 20,6 ‰ adolescentes du même groupe d’âge.
❖ Cible 3.8 : Faire en sorte que chacun bénéficie d’une couverture sanitaire universelle,
comprenant une protection contre les risques financiers et donnant accès à des services de
santé essentiels de qualité et à des médicaments et vaccins essentiels sûrs, efficaces, de qualité
et d’un coût abordable
56
L’indice de couverture des services de santé essentiels est passé de 44 en 2015 à 47 en 2017. En
d’autres termes, 47 % de la population bénéficiait d’une couverture des services de santé essentiels
en 2017. La proportion de personnes qui vivent dans ménages engageant plus de 25% de leurs
dépenses totales en santé est estimé à 0,62 % en 2012 et à 0,26 % en 2017.
❖ Cible 3.9 : D’ici à 2030, réduire nettement le nombre de décès et de maladies dus à des
substances chimiques dangereuses et à la pollution et à la contamination de l’air, de l’eau et
du sol
En 2016, l’OMS a estimé le taux de mortalité attribué à l'eau insalubre, à l'assainissement insalubre
et au manque d'hygiène à 31,3 décès pour 100 000 habitants et en 2019, le taux de mortalité
attribué aux intoxications non-intentionnelles à 2,5 décès pour 100 000 habitants.
❖ Cible 3.a : Renforcer dans tous les pays, selon qu’il convient, l’application de la Conventioncadre de l’Organisation mondiale de la Santé pour la lutte antitabac
La prévalence de la consommation actuelle de tabac chez les personnes âgées de 10 ans ou plus était
située à 12,1 % en 2002. Cette prévalence a atteint 17,3 % en 2017 et les personnes les plus
concernées par la consommation de tabac sont celles dont leur âge était compris entre 30 et 59 ans
(30,2 % chez les 30-39 ans, 34,7 % chez les 40-49 ans et 35,1 % chez les 50-59 ans).
❖ Cible 3.b : Appuyer la recherche et le développement de vaccins et de médicaments contre les
maladies, transmissibles ou non, qui touchent principalement les habitants des pays
en développement, donner accès, à un coût abordable, aux médicaments et vaccins essentiels,
conformément à la Déclaration de Doha sur l’Accord sur les aspects des droits de propriété
intellectuelle qui touchent au commerce (ADPIC) et la santé publique, qui réaffirme le droit
qu’ont les pays en développement de tirer pleinement parti des dispositions de cet accord qui
ménagent une flexibilité lorsqu’il s’agit de protéger la santé publique et, en particulier,
d’assurer l’accès universel aux médicaments
En 2020, l’UNICEF a estimé à 62 % la proportion de nourrissons survivants recevant une première
dose de vaccin anti rougeoleux (MCV1) et à 70 % la proportion de nourrissons survivants ayant reçu 3
doses de diphtérie-tétanos-coqueluche (DTC3). Ces taux ont baissé par rapport aux années
antérieures.
Par ailleurs, selon l’OCDE, le montant total de l'aide publique au développement alloué aux secteurs
de la recherche médicale et de la santé de base a été le plus conséquent en 2016 (soit 11 millions de
$ US). À partir de 2017, ce montant a commencé à diminuer en passant à 8 millions de $ US en 2018
et à 4 millions de $ US en 2019.
❖ Cible 3.c : Accroître considérablement le budget de la santé et le recrutement, le
perfectionnement, la formation et le maintien en poste du personnel de santé dans les pays
en développement, notamment dans les pays les moins avancés et les petits États insulaires en
développement
En 2020, le pays comptait 1,54 médecins et 5,07 infirmiers pour 10 000 habitants et 10,74 sagefemmes pour 10 000 femmes en âge de procréer.
❖ Cible 3.d : Renforcer les moyens dont disposent tous les pays, en particulier les pays en
développement, en matière d’alerte rapide, de réduction des risques et de gestion des risques
sanitaires nationaux et mondiaux
Le degré de préparation aux urgences sanitaires s’est affaibli car cet indicateur est passé de 37 % en
2018 à 32 % en 2019.
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|
61 |
SDG 3: Good Health and Well Being
Ensure healthy lives and promote well-being for
all at all ages
The Dominica-China Friendship Hospital is a state-of-the-art health care facility that has also been built to
be resilient, but importantly to provide specialized health care services that bring tertiary level health care to
Dominica. Health services include among others, intensive care, oncology, a Brenda Strafford Foundation
Eye Care Centre, ophthalmology, fully equipped labs, dialysis units and modern and start of the art medical
equipment and machines of the same level of sophistication that exists in China.
A Snapshot of Our Progress to Achieving SDG 3
Life Expectancy at Birth 78.2 years (highest in the
Caribbean)
Life Expectancy at Birth (men) 74.2 years
Life Expectancy at Birth (Women) 80.3 years
Number of inhabitants over 100 years
old
23 (July 2021); highest
number of centenarians per
capita in the world
62 |
Infant Mortality Rate 30.9 per 1,000 live births
(2017)43
Diabetes prevalence rate 11.7% (% of population ages
20 – 79)
Hypertension Prevalence Rate 32.1% (2017)
Incidence of HIV/AIDS 0.26 cases per 1,000
population (2016)
% Males that are Overweight 35% (close to LAC average)
(2017)44
% Females that are Overweight 30% (better than LAC
average) (2017)45
Number of Operational Health
Centers
47 (2017)
Doctors per 1,000 Population 1.1 (2017)46
Nurses per 1,000 Population 6.4 (better than LAC average)
(2017)47
% Women Attending at Least 4
Antenatal Visits During Pregnancy
85% (better than LAC
average)48
Health Spending Per Capital US$636 (2017)49
Health Care Costs as a % of GDP 4.2 (2019) 50
Dominica’s Resilience Targets… towards the world’s 1st climate
resilient small island developing state
• No more than 5% of schools and healthcare facilities severely
damaged or destroyed by an extreme weather event
According to the Human Development Index 2020, Dominica ranked first in life expectancy in the
Caribbean and also has the highest number of centenarians per capita in the Caribbean. Life
expectancy at birth is 78.2 years, which is a good indicator of the quality of life of the people of a
country. Dominica also gave birth to the oldest person ever to live in the world – a women that
lived to 128 years.
43 https://data.unwomen.org/country/dominica 44 OECD, World Bank. 2020. Health at a Glance: Latin America and the Caribbean 2020 45 Ibid 46 Ibid 47 Ibid 48 Ibid 49 Ibid 50 https://www.statista.com/statistics/952542/dominica-health-expenditure-share-gdp/
63 |
Dominica is committed to achieving universal health care for all its citizens. There is access to
primary and secondary health care and with the Dominica China Friendship Hospital, Dominicans
now have access to a tertiary health care facility that includes specialized health services. Primary
care services are provided at no cost with some groups receiving health care at no cost – the poor,
pregnant women, seniors above 60 years, and children below 18 years old. The health sector is
guided by the National Strategic Plan for Health 2009-2019. The Ministry of Health seeks to protect
and expand universal access to a high-quality health system that includes strong, adequately
funded infrastructures for health promotion, disease prevention and health protection as well as
increased resource mobilization for health programmes. Focus continues to be placed on
strengthening the governance of Dominica’s health system to support the development of a
resilient health system which meets the population’s needs. This involves providing world-class
health facilities across the island as part of its thrust to provide optimal health care and delivery
of health services for the population. In fact, as of May 2021, Dominicans can access lifesaving
heart surgery at the Cardiology Department of the Dominica China Friendship Hospital, which is
partly staffed by Dominican surgeons. The Government has been focused on delivering to its
population 12 new SMART health centres and 2 new hospitals and the overall modernization of
the health infrastructure on the island.
The Marigot Hospital also is another new and modern hospital
Several health policies have been drafted in recent years, along with implementation plans which
focuses on:
64 |
● Providing an adequate and motivated workforce equipped to provide quality health
services. It is important to note that the system is affected by the emigration of nurses.
● Strengthening the institutional structure of the health and social services system
● Maintaining health services that respond to the needs of the population both at primary
and secondary care level.
● Improving the health and quality of life of selected vulnerable individuals and groups in the
population.
● Managing communicable and non-communicable diseases through early detection and
prevention.
The Ministry of Health has in place an integrated electronic information system, the Dominica
Integrated Information Systems for Health (DIISH). All 47 primary health care centers are linked to
this network, which allows them to back up information locally and use it off-line.
Notwithstanding the high life expectancy at birth, Dominica is impacted like several other
Caribbean countries by the high incidence of non-communicable diseases (NCDs). NCDs including
diabetes, hypertension, heart diseases, cancers and strokes are the leading causes of mortality,
morbidity and illness and represent over 50 percent of deaths. For example, between 2013 and
2017, more females were diagnosed with diabetes than males at a ratio of 2:1, and more males
had amputations due to diabetes compared to females in the 50 – 59 age group and the over 70
age group51. In 2014, diseases of the circulatory system (hypertension, heart disease) were
responsible for 44 percent of deaths and neoplasms (cancers), 18 percent. These two groups of
causes account for almost two-thirds of all deaths in the country. To control and better address
NCDs, the Government has embraced a Health in All Policies approach. The disease burden
affected by a country can be measured by two indicators – Years Lived with Disability (YLD) and
Disability-Adjusted Life Years52 (DALYs), with one DALY being one lost year of healthy life. NCD in
Dominica cause 61.4 percent of all disability- adjusted life years (DALYs) and 52.9 percent of all
years lived with disability (YLDs)53.
Maternal mortality has been at one to zero deaths for several years, with three deaths between
2010 and 2015. Quality antenatal care is available to all women, and all births are attended by
skilled health personnel. Vaccinations are almost universal.
Following Hurricane Maria, damage to the health sector was US$10.9 million. Princess Margaret
Hospital, Roseau, the only referral hospital in the health care system, sustained severe damage
with 15 percent of its buildings totally destroyed, leaving 53 percent able to function. Central
medical stores lost the majority of medical supplies due to water damage, although most
51 Experts from Speech by Prime Minster Roosevelt Skerrit, available at:
https://caribbean.loopnews.com/content/diabetes-high-blood-pressure-5th-leading-cause-death-dominica
52 A Disability Adjusted Life Year (DALY) is the sum of years of potential life lost due to premature death and the
years of productive life lost due to disability compared to a standardized life expectancy.
53 PAHO. 2019. The Burden of Mental Disorders in the Americas, Country Profile: Dominica
65 |
medications were spared. Bed capacity was decreased by 95 beds. Medical equipment such as
fluoroscopy, portable x-ray and all blood bank equipment were damaged and destroyed.
Transformational Initiatives – Building Back Better… From Vulnerability to
Resilience
Making Health Care Facilities Smart
The Government has recently started to build Smart Health Care Centres and has 5 such facilities
completed across the island. SMART Health Facilities completed in 2019 have already begun to
provide benefits including savings of about US$40,000 per annum due to solar installations and
water conservation. The country can also boast of having the first off-grid solar powered health
facility in La Plaine.
SMART Retrofitted Health Centre in Grand Bay
The SMART facilities embody resilience, sustainability and are environmentally sound and have
the following characteristics:
Resilient and Safe facilities
have:
Sustainable Facilities: Environmentally Sound
and Green Facilities are
characterized by:
● Sound Roof and Foundation
● Improved Security and Signage
● Reduce Downtime
● Have Resilient Structures
● Reduce Operating Costs
● Water Efficiency
● Waste Minimization and
Management
66 |
Resilient and Safe facilities
have:
Sustainable Facilities: Environmentally Sound
and Green Facilities are
characterized by:
● Secured Equipment and Fuel
Storage
● Protected and Efficient Doors
and Windows
● Good Drainage
● Back-up Power
● Water Reserves
● Disaster Management Plans
● Comprehensive Maintenance
Planning Disability Access
● Improve Safety
● Meet and Exceed Patient
and Staff Satisfaction
● Embody EnvironmentallySound Operations
● Have Improved Emergency
Care and Services for the
Community
● Pollution Prevention
● Rainwater Harvesting
● Alternative Power using
Renewable Energy
● Efficient Lighting and
Cooling
● Improved Indoor Air
Quality
A Review of the SDG Targets under Goal 3 and Dominica’s Progress
This dashboard shows at a snapshot how Dominica is progressing with respect to the
achievement of the SDG targets under Goal 3: Good Health and Well-being.
SDG Targets Goal #3 – Good Health and Well-being Dominica’s
Progress
By 2030, reduce the global maternal mortality ratio to less than 70 per
100,000 live births
By 2030, end preventable deaths of newborns and children under 5 years of
age, with all countries aiming to reduce neonatal mortality to at least as low
as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per
1,000 live births
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected
tropical diseases and combat hepatitis, water-borne diseases and other
communicable diseases
By 2030, reduce by one third premature mortality from non-communicable
diseases through prevention and treatment and promote mental health and
well-being
Strengthen the prevention and treatment of substance abuse, including
narcotic drug abuse and harmful use of alcohol
By 2030, ensure universal access to sexual and reproductive health-care
services, including for family planning, information and education, and the
integration of reproductive health into national strategies and programmes
67 |
SDG Targets Goal #3 – Good Health and Well-being Dominica’s
Progress
Achieve universal health coverage, including financial risk protection, access
to quality essential health-care services and access to safe, effective, quality
and affordable essential medicines and vaccines for all
By 2030, substantially reduce the number of deaths and illnesses from
hazardous chemicals and air, water and soil pollution and contamination.
Substantially increase health financing and the recruitment, development,
training and retention of the health workforce in developing countries,
especially in least developed countries and small island developing States
Strengthen the capacity of all countries, in particular developing countries,
for early warning, risk reduction and management of national and global
health risks
National Strategies, Opportunities and Future Directions to 2030
The priorities of the Health Sector can be summarized in five core priorities as follows:
1. Strengthening the health system to advance universal health coverage and access ensuring
appropriate legislation and policies
2. Reducing morbidity and mortality due to communicable diseases including new and
emerging communicable diseases
3. Reducing the burden of chronic NCDs including mental health and substance abuse
4. Achieving optimal family health through one’s life course
5. Strengthen health emergencies and disaster management and reducing environmental
threats and risks
To advance the achievement of SDG 3, the Government of Dominica in partnership with its citizens
and development partners will operationalize these priorities as follows:
● Review current health policies, strategies and legislation and reassess Primary Health Care
services and conduct a re-evaluation of the human resource strategy of the health services
● Build upon the Smart Hospital Initiative to ensure that health care facilities are climate
smart and promote the use of affordable technology and equipment
● Establish an entity to drive the climate resilience and health agenda
● Pursue the digitization of health data and encourage data sharing to inform plans of other
development sectors
● Continue assessments on the impact of climate change on vector ecology and biology,
water and water related conditions and include climate sensitive diseases and conditions
in the national disease surveillance system to gauge the impact of climate variability on
disease incidence and distribution
● Increase capacity of laboratory facilities to examine for and detect disease-causing
pathogens
● Develop an early warning system for climate sensitive diseases
68 |
● Increase outreach and health campaigns and provide opportunities to building capacity of
health service personnel surveillance, environmental monitoring, vector control,
psychosocial support
● Complete review of solid waste management systems and technologies, including a focus
on plasma incineration and promotion of waste to energy
● Encourage greater involvement of the private sector in the provision of affordable health
care
Dominica ranks first in life expectancy in the Caribbean and has the highest number of
centenarians per capita in the Caribbean. Photos L-r Mrs. Meonette Bannis celebrated her 106th
birthday on April 27. 2022 and Mrs. Angela Cuffy turned 105 on May 24th, 2022. Dominica is
organic and green and credits its consumption of local foods to the longevity of its population.
|
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[
3
] |
{
"country": "dma",
"file_id": "sdg-03/vnr-report-dma-2022-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2022
}
|
146
“Frisk i Naturen”
The “Summer in Nature 2020” agreement between
the Government, the Social Liberal Party, the Socialist People’s Party, the Red-Green Alliance, and The
Alternative allocates funding for “Frisk i Naturen”,
a partnership between the Danish Environmental
Protection Agency and SIND – the Danish Association for Mental Health – to help mentally vulnerable
people get outside and enjoy nature. This initiative
is linked to target 3.4 on promoting mental health.
|
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|
22 - Statistical follow-up on the 2030 Agenda - Denmark
Goal 3: Ensure healthy lives and promote well-being for all
at all ages
By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live
births
Indicator 3.1.1
Maternal mortality ratio
There are major variations from one year to the next, since the number of women
who die in connection with pregnancy and birth is very low. In the last ten years, 16
women in total have died in connection with pregnancy or birth. Being well below
the maximum limit, Denmark thus meets the maternal mortality ratio target of a
maximum of 70 deaths per 100,000 live births.
Indicator 3.1.2
Proportion of births attended by skilled health personnel
According the Danish Health Data Authorities, Denmark does not compile continuous and official statistics about
births with assistance from health care professionals. However, the authorities estimate that the figure is very
high.
100%
By 2030, end preventable deaths of newborns and children under 5 years of age,
with all countries aiming to reduce neonatal mortality to at least as low as 12 per
1,000 live births and under‑5 mortality to at least as low as 25 per 1,000 live births
Indicator 3.2.1
Under‑5 mortality rate
The under-5 mortality rate has been very stable over the last ten years. All of the
years, the rate was below five children per 1,000 live births. Being well below the
maximum limit, Denmark thus meets the under-5 mortality rate target of a
maximum of 12 deaths per 1,000 live births.
Target 3.1
Target 3.2
Statistical follow-up on the 2030 Agenda - Denmark - 23
Indicator 3.2.2
Neonatal mortality rate
The neonatal mortality rate for infants within the first 28 days of their lives has been
very stable for the last decade. All of the years, the rate was approximately three
children per 1,000 live-born children. Being well below the maximum limit,
Denmark thus meets the neonatal mortality rate target of a maximum of 25 deaths
per 1,000 live births.
By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne diseases and other communicable
diseases
Indicator 3.3.1
Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations
The share of new HIV infections was at a stable level throughout the period.
Target 3.3
24 - Statistical follow-up on the 2030 Agenda - Denmark
Indicator 3.3.2
Tuberculosis incidence per 100,000 population
There is a decreasing trend in the incidence of tuberculosis over the period.
Indicator 3.3.3
Malaria incidence per 1,000 population
According to Statens Serum Institut (SSI), approximately 80-100 new cases of malaria are recorded in Denmark
each year. These are due to travelling in malarious areas. 100%
Indicator 3.3.4
Hepatitis B incidence per 100,000 population
After a period from 2011-2017 with a Hepatitis B incidence of 4.5-5.4 per 100,000
persons there is a decrease in 2018 to 2.8.
Statistical follow-up on the 2030 Agenda - Denmark - 25
Indicator 3.3.5
Number of people requiring interventions against neglected tropical diseases
In general, neglected tropical diseases are non-existent in Denmark. The diagnosed diseases are found among
foreign travellers or returning tourists. 0%
By 2030, reduce by one third premature mortality from non-communicable diseases
through prevention and treatment and promote mental health and well-being
Indicator 3.4.1
Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
Over the last ten years, the mortality rate attributed to cardiovascular disease,
cancer, diabetes or chronic respiratory disease has dropped by 13 per cent. In 2009,
the rate was 585 per 100,000 persons, and in 2019, it had dropped to 508 per
100,000 persons. The aim is to reduce this by one third by 2030. In this way,
Denmark has made some progress towards this aim.
Target 3.4
26 - Statistical follow-up on the 2030 Agenda - Denmark
Indicator 3.4.2
Suicide mortality rate
The suicide mortality rate has been at a very stable level in the last ten years. All of
the years, the rate was in the range of 10 to 12 per 100,000 persons.
Strengthen the prevention and treatment of substance abuse, including narcotic drug
abuse and harmful use of alcohol
Indicator 3.5.1
Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare
services) for substance use disorders
According to the Danish Health Authorities, continuous and official statistics are not compiled on the coverage of
treatment interventions for alcohol and substance use disorders in Denmark. n/a
Indicator 3.5.2
Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol
The figure shows a decline in the consumption of alcohol by Danish citizens above
the age of 18, from 10.6 litres per persons in 2009 to 9.5 litres per person in 2019.
I.e. a reduction of 1.1 litres per person over a period of ten years. Especially from 2011
to 2012, there was a large drop in the alcohol consumption which was, most likely,
due to rather large increases in the tax rates for beer and wine.
Target 3.5
Statistical follow-up on the 2030 Agenda - Denmark - 27
By 2020, halve the number of global deaths and injuries from road traffic accidents
Indicator 3.6.1
Death rate due to road traffic injuries
In the last ten years, the death rate due to traffic injuries declined by 38 per cent. In
2009, the rate was 5.5 cases per 100,000 persons, and in 2019, it had dropped to 3.4
cases per 100,000 persons.
By 2030, ensure universal access to sexual and reproductive health-care services,
including for family planning, information and education, and the integration of
reproductive health into national strategies and programmes
Indicator 3.7.1
Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning
satisfied with modern methods
Denmark does not compile continuous and official statistics on women’s need for family planning. However, all
citizens in Denmark have access to free medical assistance and abortion as well as free access to modern
contraception against payment.
100%
Target 3.6
Target 3.7
28 - Statistical follow-up on the 2030 Agenda - Denmark
Indicator 3.7.2
Adolescent birth rate (aged 10-14 years; aged 15-19 years) per 1,000 women in that age group
The share of adolescent women aged 15-19 who have had a child in the last ten years
has declined by 69 per cent. In 2010, the share was 3.6 per 1,000 women, and in
2020, it had dropped to 1.1 per 1,000 women.
Achieve universal health coverage, including financial risk protection, access to
quality essential health-care services and access to safe, effective, quality and
affordable essential medicines and vaccines for all
Indicator 3.8.1
Coverage of essential health services
Denmark does not compile continuous and official statistics on essential health care services (the fourteen tracer
interventions). However, all citizens in Denmark have free access to essential health care services. 100%
Indicator 3.8.2
Proportion of population with large household expenditures on health as a share of total household
expenditure or income
Denmark does not compile continuous and official statistics in accordance with the methodology of the indicator.
However, Statistics Denmark estimates – on the basis of the National Household Budget Survey – that few people,
if any, pay more than 10 per cent of their household expenses or income on health care services.
0%
By 2030, substantially reduce the number of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and contamination
Indicator 3.9.1
Mortality rate attributed to household and ambient air pollution
The mortality rate due to air pollution is currently available for 2016-2018 and is
73.5 cases per 100,000 persons.
Target 3.8
Target 3.9
Statistical follow-up on the 2030 Agenda - Denmark - 29
Indicator 3.9.2
Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe
Water, Sanitation and Hygiene for All (WASH) services)
Denmark does not compile continuous and official statistics on the mortality rate directly attributable to unsafe
water or unsafe sanitation. However, Statistics Denmark estimates – on the basis on statistics from the World
Health Organisation and Global Health Observatory – that very few people, if any, die as a direct consequence of
unsafe water or unsafe sanitation.
0%
Indicator 3.9.3
Mortality rate attributed to unintentional poisoning
The mortality rate attributed to unintentional poisoning has been at a very stable
level in the last ten years. All of the years, the rate was between 3.5 and 5.3 per
100,000 persons.
30 - Statistical follow-up on the 2030 Agenda - Denmark
Strengthen the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries, as appropriate
Indicator 3.a.1
Age-standardized prevalence of current tobacco use among persons aged 15 years and older
The prevalence of smoking is at a similar level for men and women, though 1-2 per
cent point higher for men except in 2011 and 2012. There was a marginally
decreasing tendency from 2011 to 2014. Since 2016, there was an increase especially
for men.
Support the research and development of vaccines and medicines for the
communicable and non‑communicable diseases that primarily affect developing
countries, provide access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement and Public Health,
which affirms the right of developing countries to use to the full the provisions in the
Agreement on Trade-Related Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide access to medicines
for all
Indicator 3.b.1
Proportion of the target population covered by all vaccines included in their national programme
Generally, the proportion covered by vaccines is high and above 90 per cent. This is
not the case for HPV, which furthermore decreased from 2015 and is only 60 per
cent in 2018. The proportion covered by measles vaccination decreased from 2016
and was 78 per cent in 2018. This is expected to be due to some groups’ scepticism
about this particular vaccination.
Target 3.a
Target 3.b
Statistical follow-up on the 2030 Agenda - Denmark - 31
Indicator 3.b.2
Total net official development assistance to medical research and basic health sectors
The figure shows the net Official Development Assistance (ODA) from Denmark to
the medical research and basic health sectors. The large decline from 2015 onwards
is primarily due to a large fall in the basic health care category, which is defined as
basic and primary health care programmes, paramedical and nursing care
programmes, supply of drugs, medicines and vaccines related to basic health care,
and activities aimed at achieving universal health coverage. The large decline in ODA
to medical research and basic health sectors is mainly due to less public sector aid,
but also less aid from NGOs and civil society is a significant factor in the decline.
Indicator 3.b.3
Proportion of health facilities that have a core set of relevant essential medicines available and
affordable on a sustainable basis
Note that there may be health factors creating periods of peak demand during which the stock of medicine may
be insufficient. 100%
32 - Statistical follow-up on the 2030 Agenda - Denmark
Substantially increase health financing and the recruitment, development, training
and retention of the health workforce in developing countries, especially in least
developed countries and small island developing States
Indicator 3.c.1
Health worker density and distribution
In Denmark, there is an even distribution of health workers throughout all regions. Waiting time may occur for
certain types of hospital treatment, and some municipalities occasionally experience a shortage of doctors, but in
case of acute need, everybody can be referred to immediate medical audit.
Strengthen the capacity of all countries, in particular developing countries, for early
warning, risk reduction and management of national and global health risks
Indicator 3.d.1
International Health Regulations (IHR) capacity and health emergency preparedness
According to the WHO, the average value for 13 core capacity indicators from 2010-2017, is 90 per cent in
Denmark. 100%
Target 3.c
Target 3.d
|
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{
"country": "dnk",
"file_id": "sdg-03/vnr-report-dnk-2021-en-12.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2021
}
|
36
COMPROMISOS, AVANCES Y DESAFÍOS CON EL DESARROLLO SOSTENIBLE:
SDG 3. Progress in health coverage is
recorded, although with less impact on the
quality of services, so efforts to achieve
health and wellbeing in the population
must be continued and expanded. Maternal
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[
3
] |
{
"country": "dom",
"file_id": "sdg-03/vnr-report-dom-2018-es-6.pdf",
"language": "es",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2018
}
|
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