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14
COMPROMISOS, AVANCES Y DESAFÍOS CON EL DESARROLLO SOSTENIBLE:
DFHUFDUVH D FHUR KDFLD \ PDODULD
DXQTXH HQ DPERVFDVRVVH REVHUYDQ WDVDV
WRGDYtD DOWDV HQ SURYLQFLDV HVSHFtÀFDV
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WXULVPR\ODLQPLJUDFLyQKDLWLDQD5HVSHFWRD
ODWXEHUFXORVLVVHUHÁHMDQPHMRUtDVDXQTXH
OD UHODWLYDPHQWH DOWD LQFLGHQFLD SHUVLVWH
,JXDOPHQWHOD WDVDGH IHFXQGLGDGHQWUHODV
DGROHVFHQWHV HV UHODWLYDPHQWH DOWD HQ OD
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/RV DYDQFHV HQ PDWHULD GH VDOXG VH LUiQ
UHÁHMDQGR HQ OD PHGLGD HQ TXH HO QXHYR
PRGHOR GH DWHQFLyQ SULPDULD VH YD\D
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VDOXG \ HGXFDFLyQ VLVWHPDV GH YLJLODQFLD
HSLGHPLROyJLFD PiV HIHFWLYRV PD\RUHV
QLYHOHV GH FXPSOLPLHQWR GH SURWRFRORV GH
VDOXG\XQIRUWDOHFLPLHQWRGHODDUWLFXODFLyQ
LQVWLWXFLRQDOHQHOVHFWRU/RDQWHULRUWDPELpQ
LPSOLFDUi GH FDUD DO IXWXUR LQFUHPHQWDU HO
JDVWR S~EOLFR HO FXDO VH KD PDQWHQLGR HQ
PHQRVGHOGHO3,%
ODS 3. Se registran progresos en la
cobertura de salud, aunque con menor
impacto en la calidad de los servicios, por
lo que deben continuarse y ampliarse los
esfuerzos para lograr salud y bienestar
en la población. /D WDVD GH PRUWDOLGDG
PDWHUQDHVDOWD SRUHQFLPDGHSRUFDGD
PLO QDFLGRV YLYRV \ VH KD PDQWHQLGR
HOHYDGD SRU XQ ODUJR SHUtRGR GH WLHPSR /D
PRUWDOLGDGHQWUHQLxDV\QLxRVGHPHQRVGH
DxRVKDGHFOLQDGRDXQTXHOHQWDPHQWH/D
PRUWDOLGDGQHRQDWDO HQQLxDV\QLxRVGH
GtDVGHQDFLGRDRPHQRV VLJXHHOHYDGD\HV
OD TXH H[SOLFD SULQFLSDOPHQWH OD PRUWDOLGDG
HQ OD LQIDQFLD $O PLVPR WLHPSR OD WDVD HV
SDUWLFXODUPHQWH HOHYDGD HQ ODV SURYLQFLDV \
HQORVKRJDUHVPiVSREUHV\DTXHOORVHQORV
TXHODPDGUHWLHQHPHQRUHVFRODULGDG
En materia de incidencia de epidemias, los
UHVXOWDGRVHYLGHQFLDQSURJUHVRVLPSRUWDQWHV
HQ 9,+6,'$ ORV QXHYRV FDVRV SRGUtDQ
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0.0035930690000000004,
0.0070174979,
0.019328232900000002,
-0.023609628900000002,
0.0007429634,
-0.016561158,
0.004198797000000001,
-0.0114262346,
-0.0191905685,
-0.0168502554
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"country": "dom",
"file_id": "sdg-03/vnr-report-dom-2018-es-7.pdf",
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|
En 2017 y 2018 la razón de mortalidad materna (indicador
3.1.1) fue superior a 100 muertes por cada 100 000 nacidos vivos, mientras en 2019 disminuyó a 94.8, cifra equivalente a 25
puntos porcentuales de distancia de la meta mundial al año
2030 (menos de 70 por cada 100 000 nacidos vivos). En 2020 la
razón de mortalidad materna aumentó a 126 por cada 100 000
nacidos vivos.
La elevada tasa de mortalidad materna no se corresponde
con la proporción de partos con asistencia de personal sanitario
especializado (indicador 3.1.2), la cual se ha mantenido cercana
al 100 %. Esto revela la necesidad de prestar mayor atención al
conjunto de factores que inciden en la calidad del servicio.
a. Evolución de los
indicadores
ODS 3: SALUD Y BIENESTAR Poner fın a las muertes maternas prevenibles forma
parte de la Estrategia Global para la Salud de la Mujer, el
Niño y el Adolescente (2016-2030), alineado a los ODS.En
la República Dominicana las complicaciones asociadas al
embarazo y el parto fıguran entre las principales causas de
muerte de las mujeres en edad reproductiva; acarreando
un enorme costo social y económico para las familias, las
comunidades y la sociedad en general.
Por su lado, para 2030, la meta 3.7 (acceso a salud sexual
y reproductiva) plantea garantizar el acceso universal a
servicios de salud sexual y reproductiva, incluidos la planifıcación familiar, información y educación, y la integración
de la salud reproductiva en las estrategias y los programas
nacionales. El Ministerio de Salud Pública, a través de la
División Materno Infantil y Adolescentes, ha asumido la
compra de los métodos anticonceptivos desde el año 2010 y
los mismos están accesibles de manera gratuita para la población en la red pública de servicios, además de que están
siendo ofertados a bajo costo en algunas farmacias del Programa de Medicamentos Esenciales (PROMESE).
Según la ENHOGAR 2018 el porcentaje de adolescentes
sexualmente activas que utiliza algún método anticonceptivo es de 69.8 %, esta es una de las variables que se asocian
a que el país se ubique entre los que reportan mayor proporción de embarazos en adolescentes, el 19 % de las mujeres de 15 a 19 años de edad, ha estado alguna vez embarazada, cifra que aumenta a 23.7 % en la zona rural.
La razón de MORTALIDAD materna
se mantiene ALTA, a pesar de que
casi la totalidad de los PARTOS
cuenta con asistenciade personal
sanitario especializado.
La tasa de muertes EVITABLES
en la población menor de cinco años
registrada en 2019 debe DISMINUIR
3 puntos(10.7 %) para ALCANZAR
la META mundial al año 2030
(25 por mil nacidos vivos),
mientras que la MORTALIDAD neonatal
necesita DISMINUIR7.5 puntos
(38.5 %) para ALCANZAR
la META global
(12 por mil nacidos vivos).
104.4
94.8
107.1
126.0
GRÁFICO 11. Tasa de MORTALIDAD materna
por 100000 nacidos VIVOS, 2017-2020
Fuente: Ministerio de Salud Pública.
Sistema Nacional de Vigilancia Epidemiológica (SINAVE)
130
120
110
100
90
80
70
60
2017 2018 2019 2020
27 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
Poner fın a las muertes evitables de menores de cinco años
es una de las metas del ODS 3 (salud y bienestar), que propone
lograr que al 2030 la tasa mortalidad en menores de 5 años (indicador 3.2.1) sea reducida al menos a 25 por cada 1000 nacidos
vivos y la tasa de mortalidad neonatal (indicador 3.2.2) a 12.
La tasa de mortalidad en menores de cinco años fue calculada para el año 2019 en 28.0 por cada 1,000 nacidos vivos y la
tasa de mortalidad infantil en 23.5. El nivel de estas dos tasas
está muy determinado por la mortalidad neonatal, la cual fue
19.5 (Gráfıco 12).
Por su parte, se estimó que en 2020 las infecciones de VIH en
poblaciones clave fueron de 445 hombres que tienen sexo con
hombres (HSH), 284 trabajadoras sexuales (TRSX) y 212 personas transgénero (trans). Mientras que el número de nuevas
infecciones en migrantes fue 1 917, de las cuales el 41.8 % correspondió a población masculina y 58.2 % a población femenina.
El porcentaje de niños infectados por VIH a través de la
transmisión infantil, incluyendo período de lactancia, aumentó en los últimos años. Dicho porcentaje pasó de 11.6 % en 2017
a 17.3 % en 2020.
La cobertura de las personas que viven con VIH (PVVIH)
en tratamiento con antirretrovirales (TARV), aumentó de 43.6
en 2017 a 50.1 en 2020, según el último informe de estimaciones
y proyecciones de prevalencia del VIH y carga de enfermedad
publicado por el Ministerio de Salud Pública y Asistencia Social
(gráfıco 16).
A partir del informe de ONUSIDA, República Dominicana
Estimaciones nacionales de VIH 1990-2019, el SISDOM 2018-
2019 reporta una estabilidad en la tasa de incidencia de VIH, la
cual pasó de 0.33 por 1 000 habitantes en 2017 a 0.32 en 2020.
El número de nuevas infecciones de VIH en 2020 fue estimado en 3 422 casos (1 765 población masculina y 1 657 femenina),
equivalente a 3.05 nuevas infecciones por cada mil habitantes
(indicador 3.3.1). De estas nuevas infecciones, 3.6 % (123 casos)
correspondió a niños, niñas y adolescentes (0-14 años), 14.6 %
(499) a jóvenes de 15-24 años y 90.6 % (3 101) a personas de edad
entre 15 y 49 años.
Algunos indicadores
muestran PROGRESO hacia la meta
de ERRADICAR el VIH/SIDA,
la tuberculosis, la malaria y otras
enfermedades tropicales (meta ODS 3.3),
pero otros se ENCUENTRANestancados o
marchan a un ritmo lento.
GRÁFICO 12. Tasa de MORTALIDAD neonatal,
infantil y en menores de cincoaños
(MUERTES POR CADA 1000 NACIDOS VIVOS), 2019
GRÁFICO 13. Número de NUEVAS infecciones
por el VIH,por sexo y edad, 2020
Fuente: UNICEF, a partir de estimaciones del grupo interagencial de Naciones Unidas
Fuente: ONUSIDA, a partir de Estimaciones y Proyecciones de Prevalencia de VIH y Carga
de Enfermedad (2020).
30
25
20
15
10
5
0
19.5
Neonatal
23.5
Infantil
(Menores de 1 año)
28.0
Menores
de 5 años
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
-
3,422
Total
1,765
Masculino
1,657
Femenino
3,299
15 años
y más
3,101
15 años
49 años
499
15 años
24 años
123
0 año
14 años
28 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
Las estadísticas disponibles sobre la incidencia de la tuberculosis (indicador 3.3.2) en el período de implementación de la
Agenda 2030 muestran resultados diferenciados por fuente.
Según estimaciones de la OMS, en 2017 la incidencia por 100
mil habitantes fue 45 y 42 en los años 2019 y 2020. Mientras
que las mediciones del Ministerio de Salud Pública indican que
en dichos años las tasas fueron 38, 35 y 24, respectivamente.
La tasa de mortalidad asociada a la tuberculosis fue de 2.9
por 100 000 habitantes en 2017 y de 3.2 en 2019. En este último año, los casos de fallecimiento por tuberculosis estuvieron concentrados en el Distrito Nacional (9.2 fallecidos por
100 000 habitantes), La Romana (7.8), La Vega (4.9), Puerto
Plata (4.8), El Seibo (5.4) y Elías Piña (4.7)[10], territorios con
distintos niveles de concentración poblacional y pobreza. En
el Distrito Nacional, con mayor densidad poblacional y más
bajos niveles de pobreza se registró la tasa más alta de mortalidad asociada a tuberculosis, mientras que Elías Piña, con
mayor tasa de pobreza tuvo más baja mortalidad atribuida a
dicha enfermedad.
10 MEPyD. SISDOM 2018-2019.
La malaria y el dengue, DOS
enfermedades tropicales que registraron
ALTAS TASAS de incidencia en 2019. Cada
cierto TIEMPO surgen BROTES de dengue
que AFECTAN de manera especial a la
población en condiciones de pobreza de
determinados territorios.
La incidencia de la TUBERCULOSIS
se mantiene relativamente ESTABLE.
En 2019 se concentró en 6 DE LAS 32
provincias del país.
En 2019, la tasa de incidencia de la malaria fue 12.7 por
100 000 habitantes, tasa mucho más alta que el promedio
registrado en los últimos años; por ejemplo, fue equivalente al triple de la tasa de 2017 y más del doble de la de 2018
(gráfıco 16).La última vez que dicha tasa superó el valor de
10 fue en 2011, cuando alcanzó 16.1[11]. Al mismo tiempo, la
tasa de mortalidad asociada a dicha enfermedad aumentó a
0.04 por 100 000 en 2019, cuadruplicando la mortalidad de
los dos años previos.
Los datos revelan que la incidencia de la malaria es más elevada en determinadas provincias. En 2019 fue particularmente
muy alta en el Distrito Nacional (35.2 por 100 000 habitantes)
y en las provincias Santo Domingo (26.0) y San Cristóbal (21.2).
11 En el año anterior (2010) fue 25.1, lo que evidencia que dicha tasa
tiene una alta variabilidad, según muestran los datos publicados
por SISDOM correspondientes al periodo 1988-9019. El valor más
alto fue registrado en 2005 (41.6).
GRÁFICO 14. Porcentaje de la población del total
ELEGIBLEque vive con VIH y que está
en TARV, 2017-2020
GRÁFICO 15. Tasa de INCIDENCIA de
tuberculosis por 100000 habitantes, 2017-2020
43.6
38 38
48.4
35 50.1 50.1
24
52
50
48
46
44
42
40
40
35
30
25
20
15
10
5
0 Fuente: Ministerio de Salud Pública y Asistencia Social. Informe de estimaciones y
proyecciones de prevalencia de VIH y carga de enfermedad, 2019
Fuente: ONE. Elaborado por el Ministerio de Salud Pública,
a partir del sistema de cohorte
2017
2017
2018
2018
2019
2019
2020
2020
29 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
El dengue alcanzó una tasa de 194.8 por cada 100 000 habitantes en 2019, muy superior a las tasas de 2017 (13.4) y 2018
(15.4), como puede observarse en el gráfıco 19. El último brote
de esta enfermedad ocurrió en 2015, con una tasa de 170.3 por
100 000 habitantes[12]. El dengue afecta con intensidad muy
distinta a las poblaciones de las diferentes áreas territoriales.
En el caso del referido brote, en todas las provincias la tasa de
incidencia fue alta, pero se destacan San José de Ocoa (tasa de
655 por cada 100 000 habitantes), Barahona (460), Independencia (342.1) y Valverde (330.4).La tasa de letalidad promedio
nacional fue 0.26 % en 2019, cerca del triple de la tasa de 2017
(0.10 %) y cuatro veces la de 2018 (0.06).
12 En 2010 y 2013 hubo grandes brotes de dengue, cuyas tasas
de incidencia fueron 122.6 y 168.3, respectivamente. Durante el
período 1994-2019, los años de menor incidencia fueron 1996 (8.1)
y 2017 (13.4). Ver SISDOM 2018-2019.
Entre las metas del ODS 3 sobre salud y bienestar se encuentran reducir a la tercera parte la mortalidad prematura
mediante la prevención y promoción de la salud mental (meta
3.4), prevenir y tratar el abuso de sustancias adictivas (meta
3.5) y reducir a la mitad el número de muertes y lesiones causadas por accidentes de tráfıco (3.6). De los cinco indicadores
de estas metas, se dispone de información sobre tres de ellos,
como se muestra a continuación.
La tasa de suicidio (indicador 3.4.2) ha estado entre 5.7 y 6.3
por cada 100 000 habitantes en el período 2017-2019, con una
notable diferencia entre hombres y mujeres. En los hombres, la
tasa en dicho período ha sido alrededor de 10 y en las mujeres
alrededor de 2 (gráfıco 18). La mortalidad por accidentes de
tránsito (indicador 3.6.1) es extremadamente alta en el país; en
2019 fue de 30.9 fallecidos por cada 100 mil habitantes, mientras que en 2020 se registró una tasa de 26.0; 44.9 hombre y 7.0
mujeres (gráfıco 19).
3.9
2017
4.7
2018
12.7
2019
GRÁFICO 16. Tasa de Incidencia de MALARIA
(PALUDISMO) por 100000 habitantes, 2017-2019
FUENTE: MEPyD. SISDOM 2018-2019
14
12
10
8
6
4
2
0
por 100000 habitantes, 2017-2019
30 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
En otro orden, sobre el consumo de sustancias adictivas, la
ONE reporta que el consumo de alcohol en adultos (indicador
3.5.2) en 2018 fue 7.1 litros por persona, dato obtenido a partir
del informe básico de salud 2019 de OPS/OMS,
Importante ver la variación que han tenido las causas de
muertes en el país. El VIH/SIDA pasó de ser la quinta causa de
muerte en 2009 a ocupar la posición número 15 en el 2019, con
una reducción de un 39,4 % en el periodo. A su vez, y a pesar de
una reducción del 12.8 %, los desórdenes del periodo neonatal
se mantienen como la tercera causa de muerte. Por su parte,
enfermedades no contagiosas como la diabetes y la cirrosis han
pasado a ser la cuarta y quinta causa de muerte respectivamente; posiblemente vinculado a temas de malnutrición y consumo
excesivo de bebidas alcohólicas[13].
13 http://www.healthdata.org/dominican-republic
GRÁFICO 19. Tasa de mortalidad por
ACCIDENTES de tránsito (FALLECIDOS POR CADA
100 000 HABITANTES), por sexo, 2018-2020
GRÁFICO 18. Tasa de mortalidad por SUICIDIO por cada 100 000 habitantes, por sexo, 2017-2020
Total Hombre Mujer
Total Hombre Mujer
5.7 5.7
9.3
2.0 2.0
6.3
10.6
5.9
10.1
1.7
9.5
1.9
2017
29.3
51.6
7.0
2017
2018
7.6
30.9
54.3
2018
2019
26.0
44.9
7.0
2019
2020
12
10
8
6
4
2
0
60.0
50.0
40.0
30.0
20.0
10.0
-
Fuente: ONE: Elaborado con la base de datos de suicidios del OSC-RD, a partir proyección poblacional.
Fuente: SNU-OPS, a partir del Observatorio de Seguridad Vial del INTRANT.
TABLA 1. Comparativo 10 principales causas
de muerte en el país 2009-2019
2009 2019 Variación %
2009-2019
Enfermedades del corazón 1 1 41.7%
Accidente cerebrovascular 2 2 33.7%
Muerte neonatal 3 3 -12.8%
Diabetes 6 4 43.6%
Cirrosis 9 5 65.7%
Accidente de tránsito 4 6 10.2%
Enfermedades renales 10 7 29.9%
Infecciones respiratorias 7 8 -1.0%
Violencia 8 9 6.9%
Hipertensión 11 10 25.0%
VIH 5 15 -39.4%
Fuente: Elaboración propia en base a datos de Institute for Health Metrics and Evaluation:
http://www.healthdata.org/dominican-republic
31 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
Avanzar hacia el acceso universal a los servicios de salud
sexual y reproductiva (meta ODS 3.7) y la cobertura sanitaria
universal (3.8) son metas de extraordinaria importancia en el
marco del ODS 3 (salud y bienestar). Respecto al embarazo en
adolescentes, el informe de seguimiento al PNPSP 2017-2020
señala que la tasa de embarazo en adolescentes registró una reducción de 3.2 puntos porcentuales de 2015 a 2019, al pasar en
dicho período de 27.2 % a 24.0 %[14].
Por otro lado, el avance hacia la meta ODS 3.8, referente al
logro de la cobertura sanitaria universal, se mide a través de la
cobertura de los servicios de salud esenciales (indicador 3.8.1)
y la proporción de la población con grandes gastos sanitarios
por hogar como porcentaje del total de gastos o ingresos de los
hogares (3.8.2). Ante la falta datos sobre estos dos indicadores,
se ha estimado pertinente presentar la información disponible
de proporción de la población afıliada a seguro de salud. Si bien
este indicador tiene el alcance de los dos indicadores globales
citados, la ampliación de la cobertura del seguro de salud contribuye a mejorar el acceso al servicio de salud, sobre todo de la
población de menores ingresos, al mismo tiempo que disminuye el gasto de bolsillo de la familia.
En tal sentido, como muestra el siguiente gráfıco, en el año
2017 el 73 % de la población estaba afıliada al Seguro Familiar de
Salud, proporción que aumentó a 95 % en 2020, especialmente
por la iniciativa gubernamental puesta en marcha en el último
cuatrimestre de 2020 para aumentar en 2 millones el número
de afıliados al Régimen Subsidiado a través del Seguro Nacional de Salud (Senasa).
Al cierre del año 2020, de los 9.96 millones de personas
con seguro familiar de salud, el 42.3 % corresponde a población afıliada a través del Régimen Contributivo (aportes de
asalariados y empresas) y el 57.7 % al Régimen Subsidiado.
El 49.8 % de la población afıliada es masculina y el 50.2 %
población femenina.
14https://mepyd.gob.do/publicaciones/Plan-Nacional-Plurianual-del-Sector-Publico-Actualizacion-2019, pág. 48.
Entre2017 Y 2019,
las TRES cuartas parte de la población
ESTABAafiliada a Seguro Familiar
de Salud, proporción que aumentó a
95 % en 2020.
La ESCASA financiación
ha sido un importante CUELLO
de botella para el AVANCE
en materia de SALUD.
Uno de los medios para lograr el ODS 3 (salud y bienestar) lo
constituye la meta 3.c: aumentar considerablemente la fınanciación de la salud y la contratación, el perfeccionamiento, la
capacitación y la retención del personal sanitario.
El personal médico requerido para el desempeño adecuado de las funciones es bajo. En 2019 la densidad de personal sanitario (indicador 3.c.1) del Ministerio de Salud era
de 10.8 personal médico y 3.9 enfermeros(as) por 10 000
habitantes (gráfıco 21).
GRÁFICO 20. Porcentaje de la población
AFILIADA al Seguro Familiar de Salud. 2017-2020
120%
100%
80%
60%
40%
20%
0%
Fuente: Elaborado con información del Consejo Nacional de la Seguridad Social
https://www.cnss.gob.do/transparencia/index.php/estadisticas/informes-estadisticosdel-sdss/category/731-estadisticas-trimestrales-sdss
73.3 %
2017
75.7 %
2018
76.8 %
2019
95.3 %
2020
32 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
Los avances en materia de salud requieren de un aumento
sustancial de la fınanciación. Esto es un requerimiento de primer orden para mejorar la calidad de la provisión de los servicios, disponer de personal salud sufıciente y adecuado nivel de
profesionalización, un modelo de atención primaria consolidado y fortalecido, sistemas de vigilancia epidemiológica más
efectivos y un fortalecimiento de la articulación institucional
en el sector, entre otros aspectos señalados en los cuales se observan amplios espacios de mejora.
En el período de implementación de la Agenda 2030, el promedio del gasto público en salud se ha mantenido por debajo
del 2 % del PIB. El nivel más alto tuvo lugar en el año 2020, en
el cual, en el marco de las medidas para mitigar los efectos de
la pandemia de Covid-19 el presupuesto del Gobierno central
en salud fue equivalente a 2.3 % del PIB, un incremento de 0.6
puntos porcentuales, equivalente a 35.3 %.
b. Principales medidas
de política vinculada
a la salud y el bienestar
Durante el período 2017-2020, el Informe de seguimiento al
PNPSP recoge una serie de acciones que se han implementado
destinadas a garantizar el acceso a salud y promover el bienestar de la población, entre las cuales se pueden citar:
a.-Desarrollo de la red pública de salud y de redes privadas,
articuladas por niveles de atención;
b.-Fortalecimiento de los servicios de salud colectiva relacionados con los eventos de cada ciclo de vida;
c.-Fomento de estilos de vida saludables en la población vulnerable y en pobreza extrema;
d.-Aseguramiento de la provisión de servicios de salud mental de calidad a la población que lo requiera;
e.-Impulso al aseguramiento universal garantizando la sostenibilidad fınanciera, calidad, equidad, oportunidad, pertinencia, efıciencia de costos y expansión de la canasta de
prestaciones del Plan Básico de Salud;
f.-Fortalecimiento de las regulaciones, mecanismos y acciones que garanticen la afıliación y una efıcaz fıscalización
del pago al Sistema Dominicano de Seguridad Social por
parte de empleadores públicos y privados;
g.-Articular los programas asistenciales vigentes en salud,
e iniciar la puesta en marcha de las pensiones del régimen
subsidiado.
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
Fuente: Elaborado con información de la DIGEPRES https://www.digepres.gob.do/
estadisticas/gastos/ *No incluye el gasto destinado a agua potable.
1.8%
2017
1.6%
2018
1.7%
2019
2.3%
2020
GRÁFICO 21. Personal MÉDICO Y
ENFERMEROS (AS) del Ministerio de Salud
Pública por 10000 habitantes, 2017-2019
GRÁFICO 22. Gasto público en SALUD
del Gobierno central (% DEL PIB), 2017-2020*
Médico Enfermeros (as)
10.8
3.9
2019
11.3
3.1
2017
14.5
3.6
2018
16
14
12
10
8
6
4
2
0
Fuente: MEPyD. SISDOM 2018-2019.
33 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
Entre las acciones para el fortalecimiento institucional se
encuentra la aprobación, en 2019, de la Ley 397-19 que crea el
Instituto Dominicano de Prevención y Protección de Riesgos
Laborales (IDOPPRIL), la cual establece el proceso de disolución del Instituto Dominicano de Seguros Sociales (IDSS).
Esto tiene implicaciones positivas importantes en términos
de protección de los trabajadores y trabajadoras y reforzamiento institucional del sistema de seguridad social, con una
integración para avanzar hacia una única red de proveedores
de servicios públicos.
En materia de prestación de servicios de salud colectiva, las
acciones para mejorar los indicadores priorizados en el sistema
se enfocaron en áreas tales como:
a.-Prevención y atención integral a personas
viviendo con VIH;
b.-Programa Ampliado de Inmunización;
c.-Salud materno-infantil;
d.-Prevención y control de la tuberculosis;
e.-Programa de control de desnutrición;
f.-Prevención y control de enfermedades
producidas por vectores;
g.-Promoción y educación para la salud.
El citado informe resalta el aporte de los servicios del 9-1-1,
como complemento al funcionamiento de la red de servicios
de salud, que tiene por objetivo establecer e implementar las
normas, estrategias y políticas requeridas para el desarrollo
de los procesos de atención de urgencias y emergencias médicas. De igual manera, se refıere al Programa de Medicamentos
Esenciales mediante el cual, a través de la red de Farmacias del
Pueblo, se facilita el acceso a compra de medicamentos a las familias más pobres, así como a la identifıcación de una estrategia para implementar el Seguro Familiar de Salud en el primer
nivel de atención del sistema, tanto el régimen contributivo,
como el subsidiado.
La presente gestión de gobierno tiene el objetivo de garantizar el acceso a salud universal de la población dominicana, con los recursos fınancieros requeridos para la ejecución
de programas de salud pública preventivos y aplicación de un
modelo de gestión hospitalaria efıciente, con recursos humanos competentes y comprometidos. Para el alcance de este objetivo, las intervenciones de política comprenden las siguientes
acciones, entre otras:
a.-LA SALUD como derecho.
» Incorporar al 100 % de la población dominicana, así
como la extranjera que resida legalmente en el país,
en el Sistema Dominicano de Seguridad Social
» Distribuir de manera efectiva los medicamentos a
través del Plan Nacional de Medicamentos e Insumos.
» Mantener la cobertura en el Programa Nacional de
Medicamentos Antirretrovirales (ARV) y los insumos
necesarios para evitar la transmisión materno infantil.
» Establecer Farmacias del Pueblo cercanas a las unidades de atención primaria (UNAP´s)
» Fortalecer los programas de promoción, prevención
y control (salud colectiva) para reducir el impacto de
enfermedades prevenibles.
» Establecer una red hospitalaria público-privada que
responda a los distintos niveles de atención distribuida en el territorio
» Fortalecer la atención a las personas con enfermedades catastrófıcas.
» Disminuir las muertes de recién nacidos y de niños
menores de cinco años.
» Disminuir las enfermedades tropicales transmitidas
por el agua y otras afecciones transmisibles.
b.-SERVICIOS DE SALUD para garantizar
el derecho de la mujer
» Incorporar la perspectiva de género en la oferta
de los servicios públicos de salud, así como ofrecer
prioritariamente las necesidades de los grupos más
vulnerables.
» Ejecutar programas de salud para la mujer, así como
protocolos adecuados en función de los grupos vulnerables.
» Fortalecer los servicios de salud sexual y reproductiva.
c.-GARANTIZAR RECURSOS materiales y
financieros para la salud
34 INFORME NACIONAL VOLUNTARIO 2021 l
CRECIMIENTO con equidad y respeto al medioambiente.
|
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{
"country": "dom",
"file_id": "sdg-03/vnr-report-dom-2021-es-5.pdf",
"language": "es",
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|
»SALUD y bienestar (ODS 3). En el ámbito del
derecho a la salud, los principales indicadores de
cobertura muestran reducidos avances y aún se
tienen retos de calidad del servicio. La tasa de
mortalidad materna se mantiene alta. También
merece especial atención la tasa de muertes evitables en la
12
población menor de cinco años. La escasa fınanciación ha
sido un importante cuello de botella para el avance en materia de salud. Hasta el año 2019, alrededor del 75 % de la población disponía de seguro familiar de salud, cobertura que
mejoró en 2020, cuando aumentó a 95 %.
|
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[
3
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{
"country": "dom",
"file_id": "sdg-03/vnr-report-dom-2021-es-6.pdf",
"language": "es",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2021
}
|
123
Objetivo 3.
Garantizar una vida sana y promover el bienestar para todos en todas las edades
La universalidad y gratuidad en los servicios de salud, establecida como parte de la Constitución 2008, ha marcado un hito en la búsqueda de la salud y el bienestar de la población ecuatoriana. En los últimos años el país ha
registrado avances destacables en cuanto al acceso a servicios e infraestructura para la atención sanitaria, así
como en la reducción de tasas de mortalidad y la atención de enfermedades con un enfoque preventivo gracias
al fortalecimiento del primer nivel de atención y la búsqueda de casos de personas en riesgo en cada territorio.
A pesar de ello, persisten desafíos en esta área vinculados con la necesidad de trabajar en el fortalecimiento del
talento humano, la sostenibilidad del sistema, el cierre de brechas, el fomento a la investigación y la profundización de acciones en el marco de la salud sexual y reproductiva frente a problemas persistentes en la población.
En este sentido, son esenciales las acciones de fortalecimiento de la red pública integral de salud.
|
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|
38
3
39
Salud y Bienestar
Saliud y Bienestar
Garantizar una vida sana y
promover el bienestar para
todos en todas las edades
Visión de país
Ecuador avanzará en su garantía del derecho a la salud gracias a la promoción de hábitos de vida saludables,
orientados a la prevención de enfermedades. El país reducirá sus niveles de sedentarismo, mejorará los patrones de alimentación e incrementará la actividad física en todos los grupos, independientemente de edad. Esto
disminuirá los niveles de estrés y el número de muertes a causa de enfermedades cardiovasculares, diabetes,
sobrepeso, obesidad, entre otras. También se pondrá énfasis en combatir el consumo de drogas, alcohol y tabaco
(especialmente, en los adolescentes y jóvenes).
Diagnóstico de la situación actual
Para lograr un desarrollo integral de la población es fundamental garantizar una vida saludable y promover
condiciones de vida digna para todos. En los últimos años se han presentado avances significativos en las condiciones de bienestar de la población lográndose incrementos en la esperanza de vida, reducción de las tasas de
mortalidad o el control de enfermedades prevenibles. A pesar de ello, la Agenda 2030 de Desarrollo Sostenible
plantea ahora objetivos más ambiciosos enfocados en profundizar acciones para reducir brechas entre regiones
y grupos poblacionales.
En el país, el combate a la mortalidad materna, infantil y enfermedades no transmisibles como la diabetes ha
sido una constante en la agenda de política pública y un reflejo del nivel de desarrollo alcanzado. Para ello, se ha
trabajado en un conjunto de políticas que paulatinamente han permitido la reducción de los índices de mortalidad y el incremento en el acceso a servicios de salud, tendencia que ha ido de la mano con la de la región. Ecuador ha decido ir más allá. Así, desde 2008 el país ha apostado por un sistema nacional de salud universal a través
de la gratuidad en la atención sanitaria y el fortalecimiento de la atención primaria con enfoque preventivo.
Como parte del enfoque preventivo adoptado, se ha trabajado en la promoción del acceso a servicios de salud
para la prevención y control de las enfermedades no transmisibles como enfermedades del corazón, diabetes y
enfermedades cerebrovasculares, que en la actualidad representan las tres principales causas de mortalidad en
el país, con el 9,7%, 7,3% y 6,4% de las defunciones en el año 2016, respectivamente (INEC, 2016). Así, durante
los últimos años, el gasto público en salud como porcentaje del PIB pasó de 2% en 2014 a 3% en 2016 (SNI,
2017), incremento que se vio traducido en la provisión de infraestructura, equipamiento médico y aumento del
número de profesionales de la salud, lo que favoreció el aumento en la atención y servicios de salud.
Como parte de ello, se enmarca el trabajo realizado a favor del derecho a la salud sexual y reproductiva, con
un enfoque de equidad territorial y pertinencia cultural. Así, entre 2014 y 2016 la razón de mortalidad materna
se redujo de 49,2 a 39,7 muertes por cada 100.000 nacidos vivos (INEC, 2016), evidenciando que la atención
40
Gráfico 4. Razón de mortalidad materna (por cada 100.000 nacidos vivos)
Fuente: Instituto Nacional de Estadística y Censos (INEC) – Estadísticas Vitales.
2014 2015 2016
49,2
44,6
39,7
adecuada y oportuna puede salvar vidas. Para el seguimiento de esta problemática, el país viene trabajando,
desde el año 2008, en el fortalecimiento del registro estadístico de nacimientos y defunciones y, desde 2015, en
el fortalecimiento de la capacidad estadística nacional para el reporte de los ODS.
Complementariamente, se han realizado esfuerzos por incrementar los partos que son asistidos por personal de
salud. Desde 2017, Ecuador promovió y reconoció la importancia de la articulación de las parteras calificadas
como parte del modelo de atención integral de salud, facultándolas a brindar atención al momento del parto. Dicho
proceso ha sido acompañado por la Organización Panamericana de la Salud (OPS) y la Organización Mundial de la
Salud (OMS), principalmente en lo referente a la capacitación en temáticas de derechos, interculturalidad y salud
materna e infantil (OPS, 2017). Los datos evidencian que, entre 2014 y 2016, los nacimientos asistidos por personal de salud se han incrementado al 97% y se espera mantener este logro en los próximos años (INEC, 2016).
Gráfico 5. Nacimientos asistidos por personal de salud (porcentaje)
Fuente: Instituto Nacional de Estadística y Censos (INEC) – Estadísticas Vitales.
2014 2015 2016
95,0
94,4
96,9
Salud y Bienestar
41
Política pública
El derecho a la salud debe orientarse hacia la garantía en la cobertura y acceso universal, con especial énfasis en los grupos de atención prioritaria. Para ello, el país ha trabajado en la coordinación de una Red Pública
Integral de Salud que organiza y estructura los servicios, de manera que se mantenga una atención continua y
de calidad en todo el territorio. Se busca así fomentar la integralidad en la provisión de servicios, contar con cobertura nacional, garantizar su sostenibilidad y, de manera particular, enfocar el accionar hacia la prevención de
enfermedades y la promoción de la salud sexual y reproductiva. Así, las prioridades nacionales se han plasmado
en las siguientes políticas:
Tabla 3. Políticas del Plan Nacional de Desarrollo vinculadas con el ODS 3
Fuente: Secretaría Nacional de Planificación y Desarrollo (Senplades) – Plan Nacional de Desarrollo 2017-2021 “Toda Una Vida”.
Nro. Política PND
1.2 Generar capacidades y promover oportunidades en condiciones de equidad, para todas las personas a lo largo del ciclo de vida.
1.4 Garantizar el desarrollo infantil integral para estimular las capacidades de las niñas y niños, considerando los contextos territoriales; la interculturalidad; el género y las discapacidades.
1.5
Fortalecer el sistema de inclusión y equidad social, protección integral, protección especial, atención integral y el sistema de cuidados durante el ciclo de vida de las personas, con énfasis en los
grupos de atención prioritaria, considerando los contextos territoriales y las diversidades.
1.6 Garantizar el derecho a la salud, a la educación y el cuidado integral durante el ciclo de vida bajo
criterios de accesibilidad, calidad y pertinencia territorial y cultural.
1.7 Garantizar el acceso al trabajo digno y la seguridad social de todas las personas.
1.8
Garantizar el acceso a una vivienda adecuada y digna con pertinencia cultural y a un entorno seguro
que incluya la provisión y calidad de los bienes y servicios públicos vinculados al hábitat: suelo,
energía, movilidad, transporte, agua y saneamiento, calidad ambiental, espacio público seguro y
recreación.
5.1 Generar trabajo y empleo dignos fomentando el aprovechamiento de las infraestructuras construidas y las capacidades instaladas.
6.6
Fomentar en zonas rurales el acceso a servicios de salud, educación, agua segura, saneamiento
básico, seguridad ciudadana, protección social rural y vivienda con pertinencia territorial y de calidad; así como el impulso a la conectividad y vialidad nacional.
Salud y Bienestar
42
En relación al cumplimiento de este objetivo, se han definido los siguientes mecanismos:
• Lineamientos operativos para la implementación del Modelo de Atención Integral en Salud:
orientan el accionar integrado de los actores del sistema nacional de salud hacia la garantía de los derechos en salud, a través de la implementación del Modelo Integral de Salud Familiar Comunitario e Intercultural, bajo los principios de la Estrategia de Atención Primaria de Salud Renovada, que incluye la estrategia
de Promoción de la Salud.
• Plan Nacional de Reducción de la Mortalidad Materna y Neonatal: busca vigilar e investigar epidemiológicamente las causas de morbilidad.
• Iniciativa Ecuador sin Muertes Maternas: implementa unidades de salud de la Red de Cuidados Obstétricos y Neonatales Esenciales.
• Programa Ampliado de Inmunizaciones: provisión de inmunizaciones asegurando el acceso sin discriminación con énfasis en grupos de atención prioritaria. Para el país, la inmunización es una prioridad
política, un derecho y un bien público, expresado en el marco legal y la asignación presupuestaria.
• Proyecto de Tamizaje Metabólico Neonatal: cuyo objetivo es la prevención de la discapacidad intelectual y la muerte precoz en los recién nacidos.
• Plan Nacional de Salud Sexual y Salud Reproductiva: promueve la inclusión, la igualdad y el respeto
de los derechos en el marco de la salud sexual y reproductiva y prevención de embarazo en adolescentes.
• Tu bebé sin VIH - Hazte la Prueba: se enfoca en la eliminación de la transmisión materno-infantil de VIH
y sífilis congénita.
• Programa de Municipios Saludables: propicia la atención de aspectos que tienen alta incidencia en la
salud de la población y que son de competencia municipal, áreas verdes y recreación.
• Plan Nacional de Prevención Integral y Control del Fenómeno Socio Económico de las Drogas
2017-2021: constituye el marco dentro del cual se desarrollan acciones para reducir el consumo de las
Salud y Bienestar
drogas y afianzar un adecuado desarrollo del ser humano.
43
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Examen Nacional Voluntario 51
52 Examen Nacional Voluntario
Objetivo 3: Garantizar una vida sana y promover el
bienestar para todos en todas las edades
Visión de país
Para promover la salud y bienestar de la población al
2030, Ecuador impulsará la promoción de hábitos de vida
saludables, así como la garantía de la cobertura y calidad
de la salud. El país mejorará los patrones de alimentación,
desde los primeros años de vida, e incrementará la
actividad física en todos los grupos etarios.
Estas políticas estarán enfocadas a disminuir el número
de muertes a causa de enfermedades cardiovasculares,
diabetes, sobrepeso, obesidad, entre otras. También se
pondrá énfasis en combatir el consumo de drogas, alcohol
y tabaco, especialmente, en los adolescentes y jóvenes.
Avances en el desempeño de los indicadores del
ODS 3
De acuerdo con la Comisión Económica para América
Latina y el Caribe (Cepal), en la región se han logrado
avances en indicadores de acceso y resultado en salud
(Cepal, 2020). La razón de mortalidad materna (por cada
100.000 nacidos vivos) en el Ecuador, pasó de 49,16 en
2014 a 41,10 en 2018 (dato provisional).
En el caso de la mortalidad infantil, en 2017, por cada
1 000 nacidos vivos en América Latina y el Caribe se
registraron 14 muertes (Cepal, 2020). En Ecuador, la tasa
de mortalidad infantil (menores de un año), por cada
1 000 nacimientos, pasó de 8,5 a 10,1 (dato provisional),
entre 2014 y 2018. Mientras que las tasas de mortalidad
en niños menores de cinco años (por cada 1 000
nacidos vivos), en el 2014 fue de 11,0; y en 2018 (dato
provisional) se registraron 12,2 muertes de niños menores
de cinco años, por cada 1 000 nacidos vivos.
Los efectos de la obesidad y sobrepeso aumentan la
incidencia de enfermedades no transmisibles. Entre
2014 y 2018, la prevalencia de obesidad y sobrepeso
Ilustración 14. Razón de mortalidad materna por cada
100.000 nacidos vivos
Fuente: Instituto Nacional de Estadística y Censos (INEC) - Estadísticas
Vitales.
en niños de cinco a 11 años pasó de 31,3% a 35,4%,
respectivamente.
El embarazo en niñas y adolescentes es un problema de
salud pública que conlleva un impacto social, económico
y cultural, debido al vínculo entre pobreza, exclusión y
fecundidad temprana. En el país, la tasa específica de
nacimientos en mujeres adolescentes de 15 a 19 años
(por cada 1 000 mujeres adolescentes), entre 2014 y
2018 pasó de 72,3 a 69,3 (dato provisional).
En América Latina y el Caribe, la proporción de partos con
asistencia de personal de salud capacitado ascendió a
92,0%, en 2017 (Cepal, 2020). En el país, el derecho a
la salud se enfoca a los grupos de atención prioritaria,
en este sentido, la proporción de nacidos vivos con
asistencia de personal de la salud pasó de 95,05% en
2014, a 96,07% en 2018 (dato provisional).
La cobertura y calidad de la salud es posible con
la vinculación de médicos al sistema. La tasa de
profesionales de la salud por cada 10 000 habitantes
pasó de 21,3 en 2014, a 28,8 en 2018.
La salud, además de la prestación de servicios públicos
adecuados, requiere del esfuerzo de cada individuo,
familia o comunidad para alcanzar un nivel de bienestar.
El porcentaje de la población de 12 y más años que
realiza ejercicio o deporte en su tiempo libre, más de
3,5 horas a la semana, pasó de 12,2% a 10,1%, entre
2016 y 2018.
Por otro lado, a nivel nacional, la tasa de mortalidad
atribuida a las enfermedades cardiovasculares, el
cáncer, la diabetes o las enfermedades respiratorias
crónicas pasó de 186,5 muertes por cada 100 000
habitantes, en 2014, a 196,0 en 2018. La misma tendencia
ocurre en el área rural: en 2014, la tasa fue de 98,2 y pasó
Ilustración 15. Proporción de nacidos vivos con asistencia de
personal de salud (incluye parteras) - (Porcentaje)
Fuente: Instituto Nacional de Estadística y Censos (INEC) - Registro
estadístico de nacidos vivos.
Examen Nacional Voluntario 53
a 111.4 muertes, en 2018.
Se han identificado muertes por enfermedades que son
prevenibles si se mejoran los servicios de saneamiento. Al
2014, la tasa de mortalidad atribuida al agua no apta
para el consumo, el saneamiento en condiciones de
riesgo y la falta de higiene fue de 4,2 personas por cada
100.000 habitantes, mientras que en 2018 fue de 3,0.
Políticas públicas orientadas al ODS 3
El país orienta sus esfuerzos para el mejoramiento de la
calidad de vida de la población, mediante políticas públicas
integrales e integradoras relacionadas a la promoción de
la salud y prevención de enfermedad. El cuidado de la
salud y bienestar de la población constituyen una prioridad
para el Estado ecuatoriano, que ha implementado diversas
acciones que garanticen el derecho a una vida sana,
durante todo el ciclo de vida.
La Estrategia Médico del Barrio procura dar asistencia
médica primaria a grupos prioritarios y vulnerables de la
población, especialmente del área rural. Esta intervención
tiene una visión integral en salud (individual, familiar,
comunitaria e intercultural) y el propósito de identificar
oportunamente los riesgos que afecten la salud de la
comunidad. La intervención Las Manuelas garantiza
la atención integral de las personas con discapacidad y
la de sus núcleos familiares, protegiendo sus derechos
y su calidad de vida. La intervención Mis Mejores
Años -a través del componente denominado Estado de
Salud- continúa promoviendo un envejecimiento activo
y saludable de las personas mayores de 65 años; para
lograrlo, cuenta con un paquete de servicios orientado a la
atención y seguimiento de las personas adultas mayores,
vinculado a la “Estrategia de Atención Integral en Salud
(EIAS)”, con la identificación y seguimiento del estado
de salud de este grupo poblacional por parte de médicos
del primer nivel de atención y su evaluación anual por
parte de médicos especialistas. La intervención Misión
Ternura promueve la participación del Estado, gobiernos
autónomos descentralizados, sociedad, comunidad y
familia, en el desarrollo de acciones interinstitucionales
para la promoción del bienestar humano desde la gestación
y durante los primeros cinco años de vida de niños y niñas.
Como parte de esto, el componente “Atención Integral de
Salud con Ternura” pone énfasis en la atención en salud
durante el período de gestación, así como durante los
primeros 1 000 días de los recién nacidos.
Mediante Acuerdo Interministerial 0247- 2018, de 29 de
agosto de 2018, se expide la Política Intersectorial de
Prevención del Embarazo en Niñas y Adolescentes
(Pipena) 2018-2025, que contribuye al acceso universal a
información, educación integral de la sexualidad y servicios
de salud sexual y reproductiva; asimismo, a los sistemas
de protección y participación en el marco del ejercicio de
los derechos sexuales y derechos reproductivos para una
vida libre de violencia. Está Política establece el trabajo
coordinado de varias instituciones ejecutoras, como el
Ministerio de Salud Pública (MSP), Ministerio de Inclusión
Económica y Social (MIES), Ministerio de Educación
(Mineduc) y Secretaría Técnica del Plan Toda Una Vida
(Stptv); está última ejecuta la Misión Mujer, que tiene
como política la prevención del embarazo en adolescentes.
El Plan Nacional de Salud Sexual y Salud Reproductiva
2017 - 2021 desarrolla estrategias para garantizar la salud
sexual y salud reproductiva, promoviendo la inclusión, la
igualdad y el respeto de los derechos humanos. El Plan
Estratégico Nacional Multisectorial para la respuesta
al virus de la inmunodeficiencia humana (VIH)/sida e
infecciones de transmisión sexual (ITS) 2018 - 2022
brinda respuesta nacional al avance de la epidemia del
VIH contribuyendo, a la vez, con las metas establecidas
por la ONU en el marco de los ODS.
Existen otras iniciativas, entre las cuales se destaca el
Plan Decenal del Deporte, la Educación Física y la
Recreación 2018 – 2028, cuyo objetivo es fomentar
la actividad física y el buen estado de salud en toda la
población mediante el deporte, la educación física y la
recreación. Además, el proyecto Actividades Físicas,
Rítmicas y Recreativas, que desarrolla actividades
de bailoterapia, aeróbicos, deportes y actividades
recreativas dirigidos a niños, jóvenes, adultos, personas
con discapacidad y personas privadas de la libertad.
Adicionalmente, el Plan Nacional de Prevención Integral
y Control del Fenómeno Socio económico de las
Drogas 2017 - 2021, que enfatiza en la promoción de la
salud, basada en la prevención, diagnóstico, tratamiento,
rehabilitación, reducción de riesgos y daños, inclusión
social y reducción de las drogas.
Resultados de la gestión institucional
Mediante la implementación de la estrategia Médico del
Barrio se atendieron 726 431 pacientes vulnerables y
prioritarios a nivel nacional.
A través de la intervención emblemática Misión Ternura, se
atendieron a 287 801 niños y niñas menores de tres años
en servicios de desarrollo infantil integral (Modalidades:
Creciendo con nuestros hijos, Círculos de Cuidado,
Recreación y Aprendizaje, y Centros de Desarrollo Infantil).
En el marco de la Política Intersectorial de Prevención
del Embarazo en Niñas y Adolescentes 2018-2025, se
54 Examen Nacional Voluntario
sensibilizó a 3 872 adolescentes escolarizados de 30
colegios fiscales de las provincias de Esmeraldas y
Sucumbíos, y el cantón Tulcán. Además, se capacitó a
personal de salud, educación y Ministerio de Inclusión
Económica y Social (MIES). Asimismo, con el apoyo de
Unfpa y PMA se fortaleció la coordinación intersectorial
entre el Ministerio de Salud Pública, Ministerio de
Educación, y Ministerio de Inclusión Económica y Social.
Con el fin de atender a personas con VIH que acuden a
los servicios de salud, se capacitó a 76 251 profesionales
de salud en Derechos Humanos y VIH. Además, para
prevenir la discapacidad intelectual y muerte precoz del
recién nacido, a nivel nacional, se ha realizado el tamizaje
metabólico neonatal a un total de 536 740 niños.
Con la implementación del Plan Nacional de Prevención
Integral y Control del Fenómeno Socioeconómico de
las Drogas se han atendido a 919 038 usuarios de los
servicios de salud mental, uso y consumo de alcohol,
tabaco y otras drogas, a nivel nacional.
Mediante la implementación del Plan Decenal de Deporte
-de la Secretaría del Deporte- se fortalecieron las
actividades deportivas extraescolares, beneficiando a 9
414 estudiantes de edades comprendidas entre nueve a
17 años, en 181 centros educativos. Además, se activaron
2 330 puntos recreativos y se implementaron 100 escuelas
de iniciación deportiva. Asimismo, en 2019, el proyecto
Actividades Físicas, Rítmicas y Recreativas registró a 63
082 beneficiarios mensuales de estas actividades.
Evaluación de Política Pública
Estrategia Ecuador Sin Muertes Maternas
En el 2017, como ente rector de la planificación
nacional, la Secretaría Técnica de Planificación “Planifica
Ecuador” presentó los resultados de la evaluación de
la “Estrategia Ecuador Sin Muertes Maternas”, cuyo
objetivo fue identificar los inconvenientes operativos en
su funcionamiento. Se consideraron los siguientes ejes
de análisis: i) Mejoramiento de la calidad de atención.
ii) Sistema de vigilancia, información e investigación. iii)
Fortalecimiento de la planificación familiar. vi) Estrategias
comunitarias. v) Funcionamiento de redes y micro redes.
Los resultados de la Estrategia señalan que el promedio
más bajo registrado en los controles prenatales fue entre
las semanas de gestación 38 y 40, por lo que se recomienda
fortalecer el seguimiento a las mujeres gestantes hasta
el final del embarazo. Además, es importante fomentar y
generalizar la aplicación de las herramientas de captación
y seguimiento en territorio a las gestantes y puérperas.
Por otro lado, es indispensable reforzar y monitorear
la asesoría y acceso a métodos anticonceptivos,
especialmente posevento obstétrico, ya que al aumentar
a más de tres años el período intergenésico se convierte
en una de las estrategias más importantes y de mayor
éxito para mejorar el resultado de los partos, así como la
supervivencia materna y del recién nacido.
Además, se evidencia la necesidad de institucionalizar la
estrategia para asegurar su continuidad. Finalmente, ante
la existencia de gran cantidad de información dispersa,
heterogénea y subutilizada, se demuestra la necesidad de
centralizar la información en un solo sistema o plataforma
al interior del Ministerio de Salud.
Iniciativas impulsadas por varios actores
La iniciativa Salud y nutrición de la primera infancia
-impulsada por la Organización Mundial de la Salud (OMS)
y la Organización Panamericana de la Salud (OPS)- tiene
como objetivo implementar modelos intersectoriales que
operen las actuales políticas públicas, orientadas a la
reducción de la desnutrición, promoviendo el desarrollo
temprano de la primera infancia en población rural y urbana;
asimismo, que permita facilitar la institucionalización de
los procesos y escalamiento de intervenciones y buenas
prácticas a otros territorios del país.
El Grupo de Investigación One Health, de la Universidad
de las Américas, ha desarrollado un proyecto de salud
pública y animal enfocado al diagnóstico y prevención de
enfermedades infecciosas como tuberculosis, neumonía
y enfermedades zoonóticas, con énfasis en la población
infantil e indígena.
El proyecto Mejoramiento de la salud de grupos de
población en situaciones de vulnerabilidad en América
Latina y el Caribe, ejecutado por la OMS y la OPS, busca
mejorar la capacidad de respuesta de los servicios de
salud, a fin de lograr una atención integral y continua de
gestantes, recién nacidos y niños menores de cinco años.
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{
"country": "ecu",
"file_id": "sdg-03/vnr-report-ecu-2020-es-7.pdf",
"language": "es",
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|
Examen Nacional Voluntario 113
ODS 3-Salud y bienestar
La política pública ha enfocado sus acciones en el
tema de la salud sexual y reproductiva de la población,
destacándose en el Plan Nacional de Reducción de la
Mortalidad Materna y Neonatal, y en el Plan Nacional de
Salud Sexual y Reproductiva. La implementación de estos
planes ha permitido obtener avances en la reducción de la
mortalidad materna y en la tasa específica de nacimientos
en mujeres adolescentes entre 15 a 19 años de edad,
principalmente.
Con el fin de combatir la desnutrición crónica, Ecuador
ha realizado un trabajo coordinado entre las instituciones
involucradas en la atención de niñas y niños. Desde el
Ministerio de Salud se promueve la lactancia materna
en los establecimientos del Sistema Nacional de Salud.
En coordinación con el Ministerio de Trabajo, se emitió la
normativa que promueve la lactancia materna en el sector
privado, incidiendo en el aumento de la prevalencia de la
lactancia materna exclusiva en los primeros 6 meses de
vida.
114 Examen Nacional Voluntario
En la reducción de la problemática relacionada a la salud
y el bienestar de la población ecuatoriana, en 2018, el
país registró un avance en la atención en salud de calidad
a través de la incorporación de más profesionales al
sistema de salud público.
A pesar de los progresos registrados en cobertura,
calidad y acceso a los servicios de salud, así como en
la implementación de acciones relacionadas a la salud
sexual y reproductiva de la población, el país continúa con
el desafío de reducir la mortalidad infantil, a través del
acceso de las mujeres a la atención de calidad por parte
de médicos.
Ante este escenario, es indispensable coordinar
acciones con las entidades públicas involucradas en la
implementación de programas y proyectos de planificación
familiar, orientación sexual y protección de los derechos
de mujeres, niñas y adolescentes.
Otro desafío a tomar en cuenta es el fomento de hábitos
saludables durante el ciclo de vida de las personas,
ello implica adoptar a la salud preventiva como política
de Estado, para reducir la mortalidad a causa de
enfermedades crónicas transmisibles y evitar problemas
derivados de una inadecuada alimentación.
Asimismo, el acceso al agua y saneamiento es
indispensable para la erradicación de enfermedades
prevenibles como el cólera, paludismo, entre otras, por ello
es fundamental implementar acciones interinstitucionales
coordinadas en los diferentes niveles de gobierno.
Finalmente, el país en materia de salud y bienestar deberá
enfocar sus esfuerzos en la reducción de la desnutrición
crónica, para ello se requiere contar con un adecuado
seguimiento y atención a la población vulnerable por
parte del sistema de salud pública, de manera coordinada
con las entidades involucradas en la erradicación de la
desnutrición.
|
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[
3
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{
"country": "ecu",
"file_id": "sdg-03/vnr-report-ecu-2020-es-8.pdf",
"language": "es",
"locality": null,
"size": "m",
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}
|
Examen Nacional Voluntario 7
ODS 3 - Salud y bienestar
La garantía de la cobertura y calidad de la salud, así
como la mejora de los patrones de alimentación desde
los primeros años de vida son los principales logros que
han permitido reducir la mortalidad. Con el fin de prevenir
el embarazo en adolescentes, se implementó la Política
Intersectorial de Prevención del Embarazo en Niñas
y Adolescentes; sin embargo, es necesario fortalecer
las acciones interinstitucionales para precautelar los
derechos de mujeres, niñas y adolescentes.
|
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[
3
] |
{
"country": "ecu",
"file_id": "sdg-03/vnr-report-ecu-2020-es-9.pdf",
"language": "es",
"locality": null,
"size": "s",
"type": "vnr",
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|
28 Progress Towards Goals and Targets
Indicators SDG
target Type Value 2030
Target Change
Maternal mortality
ratio (per 100,000
live births)
3.1 3 33 2016 <70
Under-fve mortality
rate (per 1,000 live
births)
3.2 3 27 2014 18
Neonatal mortality
rate (per 1,000 live
births)
3.2 3 14 2014 8
Tuberculosis incidence
(per 100,000 people) 3.3 1 13,000 2016 N/A
Suicide mortality
rate 3.4 3 52 2015 N/A
Death rate due to
road traffc injuries
(per 100,000
population)
3.6 3 13.2 2016 8
S'G GRRG +HDOWK DQG WHOO%HLQJ
Egypt’s 2014 constitution affrms 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. It also specifes that the
state shall allocate at least 3 percent of the
Gross National Product (GNP) to the health
sector on an annual basis. In alignment with
this, the SDS prioritizes the development of the
health sector as an integral aspect to achieving
sustainable development, based on the notion
of investing in human capital. One of the main
aims of the strategy is developing the health
insurance system to increase the percentage
of citizens covered from 58 percent8 to 100
percent by 2030.
The Government of Egypt works persistently
on improving the health services provided to
its citizens, despite being constrained by the
availability of fnancial resources, a growing
8 Ministry of Health database, 2013.
population, and the need for better governance.
The progress made in the era of the Millennium
Development Goals with respect to maternal
and child mortality rates refects the efforts
being exerted in that regard. Additionally,
Egypt’s experience in treating hepatitis C
has become a renowned success story and a
model for other countries. The participation of
different stakeholders in providing health care
in Egypt especially to low- and middle-income
citizens is also remarkable. All these efforts,
as outlined below in more detail, indicate that
Egypt is making huge progress in achieving the
national and international health goals, while
acknowledging the need to compound these
efforts to reach its targets.
Signifcant Decrease in Maternal and
Child Mortality Rates
The decrease in the maternal mortality ratio
from 174 per 100,000 live births in 1992/93 to
Table 4: SDG 3 Indicators
Egypt's Voluntary National Review 2018 29
33 in 2016 refects a signifcant improvement
in health outcomes in the country. This
improvement can be partially attributed to
the increase in the percentage of women who
received antenatal health services, and the
percentage of births attended by a health care
provider.
Similarly, the under-fve mortality rate was
reduced from 81 deaths per thousand live
births in 1995 to 27 deaths per thousand in
2014, a decrease of 66 percent. The infant
mortality rate also dropped from 60 deaths
per thousand live births in 1995 to 22 deaths
per thousand in 2014.
Hepatitis C: A Challenge Turned into a
Success Story
Egypt formerly had one of the world’s highest
prevalence rates of hepatitis C. However, in
2015, the country began a battle to eradicate
the disease over the next fve years, and since
then, more than 1 million patients have been
cured, and 15 million people will be surveyed
and treated every year over a period of three
years. Egypt will therefore be free of the
virus by the end of 2020. The success of
the eradication plan relies on producing the
required medication locally, and the price of
hepatitis C treatment for each person dropped
from $900 in 2014 to less than $200 in
20169. In addition, at the end of 2016 the “Ibda
Binafsak” (“Start with Yourself”) initiative was
launched, which aims to detect patients with
hepatitis C in public organizations.
9 World Health Organization (http://www.who.int/
mediacentre/news/releases/2016/world-hepatitisday/en/).
CSR Allocated to Provide Health
Services
The role of the private sector in providing
aid for vulnerable groups in Egypt through
their corporate social responsibility (CSR)
programs has grown over the past decade.
Corporate social responsibility activities
cover a wide range of groups, including
poor people, people with disabilities, people
living in informal settlements and deprived
areas, orphaned children, and children living
or working on the street. Several hospitals
that serve thousands of patients every year
depend on both CSR and citizens’ donations
to provide the resources for quality health
care to vulnerable groups. The Magdi Yacoub
Foundation and the Children’s Cancer
Hospital (57357) are notable examples.
The Children’s Cancer Hospital (57357)
works to prevent cancer through research
and education, and provides quality
healthcare free to children with cancer. The
hospital, which offers its services on an
equal opportunity basis, depends on charity
and donations.
The Magdi Yacoub Foundation has
established an international medical center
of excellence offering free state-of-the-art
services for children with heart problems.
Through its medical complex located in
Aswan, less-privileged children receive the
highest international standards of medical
care.
|
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|
30
Source: MOHP/ CAPMAS
Improvements in Key Health
Indicators
49.0
45.9
43.6
43.4
42.8
2015
2016
2017
2018
2019
8.9
9.7
7.7
6.9
6.8
2015
2016
2017
2018
2019
Maternal
Mortality Ratio
Death due to road
traffic injuries
Source: MPED
Indicator Previous Progress
(3.2.1) Under 5 Mortality Rate (per 1000 live births) 20.3 2015 20.4 2019
(3.2.2) Neonatal Mortality Rate (per 1000 live births) 6.8 2015 7.5 2019
Hepatitis C Yearly Reported Cases 8,746 2017 4,194¯ 2019
(3.1.1) Maternal Mortality Ratio (per 100,000 live births) 49.0 2015 42.8 ¯ 2019
(3.6.1) Death rate due to road traffic injuries (per 100,000 people) 8.9 2015 6.89 ¯ 2019
(3.8.1)
proxy Number of Insured People (million) 51.1 2015 56.9 2019
Family Out of Pocket Health Expenditure on Average 9.9% 2018 10.4% 2020
SDG 3: GOOD HEALTH & WELLBEING
(1) PROGRESS TOWARDS THE GOAL
Egypt afrms the universal right to high quality healthcare, and
the GoE has, in turn, worked towards building and maintaining an
inclusive and efective healthcare system that guarantees highquality healthcare services and promotes overall wellbeing. Since
then, key national health indicators have either:
- improved, such as:
• Maternal mortality rate (from 45.9 in 2016 to 42.8 in 2019),
• Death rates due to road trafc injuries (from 8.9 in 2015 to 6.8
in 2019),
• Healthcare coverage (number of insured people grew from 51.1
million in 2015 to 56.9 million in 2019).
- maintained the progress or remained largely the same:
• Under-5 mortality rates (at 20.4 in 2019 which is already below
the 2030 target of 25),
• Neonatal mortality rates (increased to 7.5 in 2019 but still below
the 2030 target of 12),
• Suicide rates (remaining at 0.1 per 100,000 inhabitants).
As for epidemics and disease-specifc indicators, Egypt had
noteworthy progress by 2020 (per 100,000 inhabitants) such as
Malaria incidence rate dropped to Zero, Tuberculosis incidence rate
reached 12, Hepatitis B incidence rate was at 1.78, and HIV incidence
rate at 2.77. Source: MOHP/ CAPMAS
6.8 6.6 7 7.2 7.5
20.3 19.6 19.5 20 20.4
2015 2016 2017 2018 2019
Ne onatal Under 5 Years
Infant Mortality Rates
31
(2) GOVERNMENT EFFORTS TOWARDS DISEASE CONTROL &
WELL-BEING PROMOTION
(2.1) Government Initiatives Towards Disease Control
In 2015, Egypt ranked amongst the highest countries in the world
in Hepatitis C virus infections. Recognizing the enormous health,
social, and economic burden of the disease, the “100 Million Health
Initiative” was launched in 2018 with the sole target of eliminating
the Hepatitis C epidemic. The initiative proved successful with 2019
having over a 50% decrease in newly reported Hepatitis C cases
from before the initiative in 2017 after screening almost 60% of the
population and more than 4 million patients received the required
treatment free of charge.
Since then, the “100 Million Health” initiative has expanded to
encompass other chronic diseases such as diabetes, hypertension,
stunting, and obesity. Sub-initiatives were launched under the same
umbrella focusing on other pressing health issues such as:
• The “Supporting Egyptian Women Health” initiative aiming
at performing checkups for 28 million women across Egypt
to screen for breast cancer, general reproductive health, and
chronic diseases.
• The “Newborns Health” initiative with around 95.8% of
newborns receiving the required medical care in 2020.
(2.2) The Family Development Strategy
Population growth rates have been marginally slowing down
dropping from 2.62% in 2017 to 1.79% in 2019, with fertility rates
dropping from 3.4 in 2017 to 2.9 in 2020. However, population
growth remains a challenge for well-being. Consequently, the
“Family Development Strategy” was set with fve pillars targeting
women from 15 to 45 years. Emphasis was laid on enabling access to
safe family planning and reproductive health services which led to
an increase in the use of safe family planning methods from 58.8% in
2014 to 62.5% in 2020.
(2.3) An Inclusive Healthcare System for All
In addition to initiatives and strategies, the GoE seeks to institutionally
develop the healthcare system and increasing accessibility. In 2019,
56.9 million Egyptians had medical insurance coverage up from 51.1
million in 2015. Egypt started tackling the issues of health coverage
by launching the new Comprehensive Health Insurance Program to
be implemented on six phases from 2018 to 2032 aiming to provide
medical insurance to the entire population by then.
(2.4) Improving Efciencies
The “Ending the Waiting Lists” initiative, launched in 2018, is
concerned with ending long waiting lists of surgeries for patients in
critical conditions, nearly 700 thousand surgeries on the waiting list
were performed since its initiation.
Source CAPMAS
3,659
5,087
1,508
3,570
1,108
3,086
Female Male
2017 2018 2019
New Reported Hepatitis C Cases
During the Year
Egypt’s response to this 3-decade-long
public health challenge demonstrates a
strong political will and commitment by the
Ministry of Health and Population. We are
proud to support the country’s rapid scaleup of free HCV testing, treatment, and
follow-up care for all people in need. It
provides a bright example of the
fundamental principles for universal health
coverage, to achieve health for all.
Dr Jean Jabbour, WHO representative for
Egypt | Mar 30, 2019
Pillars of the
Family Development Strategy
Economic
Empowerment
Services
Intervention
Cultural, Educational,
and Media
Intervention
Digitization
Legislative
Intervention
32
(3) CHALLENGES OF HEALTH AND WELLBEING IN EGYPT
One of the challenges facing healthcare in Egypt is the increase in cost, as out of pocket health expenditure on average for
Egyptian families increased from 9.9% in 2018 to 10.4% in 2020. A more pressing challenge, however, is the low density of healthcare
workers, as the number of doctors and nurses in Egypt were 1.2 doctors and 2.2 nurses per 1000 citizens in 2019, below the global
average of 1.5 doctors and 3.4 nurses.
(4) PARTNERSHIPS FOR BETTER HEALTH AND WELLBEING
Examples of Partnerships: Sawiris
Foundation for Social Development
• Supporting the Hepatitis C campaign in
cooperation with the Tahya Misr Fund,
providing testing and treatment to more than
125,000 beneficiaries in 2019 with a budget
of ~USD 11.5 million with a focus on the
governorate of Luxor.
• Sponsoring 135 liver transplant operations in
2019 under the “supporting liver transplant”
initiative with a cost of ~USD 0.85 million. 19.2 47.1 1920 49.3 20.4 18.8 46.1 19.7
Egypt LMICs MENA
2019 2020 (COVID) 2020 (No COVID)
Effect of COVID:
Under 5 Mortality Rate
7.5
26.33
11.28
7.38
27.09
11.44
7.28
25.63
11.05
Egypt LMICs MENA
Neonatal Mortality Rate
Source: Pardee Center for International Future Studies
(2021), Denver University
Horizon 2030 Projections
By 2030: Business
as Usual
With SDG
Push
NEONATAL
MORTALITY RATE 5.98 5.28
UNDER-5
MORTALITY RATE 15.7 14.3
The civil society plays a key role in supporting the betterment of
health and wellbeing in Egypt through many initiatives that spanned
before and throughout the COVID-19 pandemic usually in partnership
with the Ministry of Health and Population. Many of those initiatives
have a focused approach, zooming in on a key issue in which NGOs
sometimes have better access to the population most in need.
Other initiatives provide strong support to government programs
already on ground.
(5) COVID-19 IMPACT & GOVERNMENT RESPONSE
Egypt has already achieved the target for under-5 mortality rates
(U5MR) of below 25 per 1,000 live births reaching 19.2 in 2019. Egypt’s
U5MR dropped to 19.0 in 2020 due to the pandemic as opposed to
18.8 under a No-Covid scenario. Similarly, Egypt achieved the target
for neonatal mortality rates (NMR) of below 12 per 1,000 live births,
reaching 7.5 in 2019 with the pandemic causing a slowdown in
progress (reaching 7.4 rather than 7.3 in 2020).
While the efects of the pandemic on nationwide health indicators
were mercifully moderate, still urgent government policies were
crucial to maintaining the wellbeing of the population. In March
2020, partial lockdowns and travel restrictions were implemented,
university hospitals and public university dorms were converted
to quarantine locations by early April. The GoE also issued a ban
on exports of medical and protective equipment, as well as all
medicines without a strategic reserve of six-month supplies. Further
rapid response policies aimed to avoid the critical overwhelming of
the healthcare sector such as:
• A 100% budget increase for the Ministry of Health and Population
was allocated for 2020/2021 than the previous fscal year.
• More than USD 319 million additional allocations were set for
providing basic supplies and medical equipment.
• USD 1 billion was set aside as emergency funding in support of
the diferent initiatives by the Ministry of Health.
• A 75% increase in the infection compensation for doctors and
nursing staf with a budget of USD 144 million.
Egypt is committed to ensuring good health and wellbeing for all
its citizens and developing the resilience of its healthcare sector.
As a result of a strong evidence-based policy push, NMR has the
potential to reach a rate of 5.28 and U5MR to reach 14.3 by 2030.
|
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Eritrea and the 2030 Agenda 33
4.1 Sustainable Development Goal 3
Good health and general well-being are fundamental
requisites for sustainable development. SDG 3 seeks
to ensure health and well-being for all, at every stage
of life. It addresses the range of major health priorities,
including reproductive, maternal, and child health;
communicable, non-communicable, and environmental
diseases; UHC; and access for all to safe, effective,
quality, and affordable vaccines and medicines. SDG 3
also calls for more research and development, greater
levels of health financing, and strengthened capacity of
all countries in health risk reduction and management.
Globally, there have been significant strides made,
particularly in terms of increasing expectancy and
reducing some of the most common causes of child
and maternal mortality. Worldwide progress has also
been achieved on increasing access to clean water and
sanitation, as well as reducing malaria, tuberculosis,
polio, and the spread of HIV/AIDS. At the same time,
however, an abundance of challenges remains and the
world is significantly off-track in numerous areas. Major
disparities both between and within countries persist,
while there are a range of different persistent and
emerging health issues. Overall, global efforts will need
to be substantially scaled up, inequities eliminated, and
progress must be significantly accelerated if SDG 3 is to
be achieved.
4.2 Eritrea’s progress on
Sustainable Development Goal 3
Indicator 3.1.1: Maternal mortality ratio
Indicator 3.1.2: Proportion of births attended by
skilled health personnel
Considerable progress has been made in improving
reproductive, maternal, newborn, child, and adolescent
health. The MoH estimates that the maternal mortality
ratio dropped from 998 per 100,000 live births in 1990 to
752 in 2002, 486 in 2007, 228 in 2015, and 184 in 2019
– an overall reduction of 82 percent during the period
1990-2019.5
Success is driven by several factors, including:
expansion of infrastructure to historically under-served
regions; strengthening community health promoters
and the supervisory role of village health committees;
development of maternity waiting homes; improving
access to transport for emergency cases; increasing
the number of staff with lifesaving skills; increasing the
number of facilities that can provide comprehensive
emergency newborn and obstetric care services; and
strengthening maternal-perinatal death surveillance and
response.
It is projected that the country is likely to achieve
the SDG target of reducing maternal mortality ratio to
70 per 100,000 live births by 2030. However, there is
Target 3.1: By 2030, reduce the global
maternal mortality ratio to less than 70
per 100,000 live birth.
Figure 4.1 - Maternal mortality ratio
5 EDHS 1997; EPHS 2013; Ghebrehiwet and Morrow 2006; MoH 2021
34 Eritrea and the 2030 Agenda
great need to strengthen and expand interventions that
improve the health and well-being of mothers during and
after pregnancy.
In addition, there has been steady improvement with
regard to the proportion of births attended by skilled
health personnel. In 2019, the proportion of births
attended by skilled health personnel was approximately
71 percent, a significant increase from 62 percent in
2017. Moreover, the percentage of pregnant women
attending at least one antenatal care visit has increased
to 98 percent, and more mothers and newborns are now
receiving postnatal care within two days of childbirth.6
Indicator 3.2.1: Under-five mortality rate
Indicator 3.2.2: Neonatal mortality rate
Between 1990 and 2020, the neonatal mortality rate
was reduced by 49 percent, from 35 deaths per 1,000
live births to 18, while the under-five mortality rate was
reduced by 75 percent, from 153 to 39. The average
exponential annual rate of reduction for under-five
mortality between 1990 and 2020 is estimated at 4.5
percent, which is among the fastest in the world.7
At present, neonatal mortality in Eritrea accounts for
about 43 percent of under-five deaths and 60 percent
of infant deaths, suggesting that continued reductions in
infant and under-five mortality will be largely contingent
upon further improvements in neonatal mortality.
Importantly, plans are in place to begin providing more
holistic and comprehensive health care for children
based on integrated management of neonatal and
childhood illnesses in communities and facilities around
the country, as well as improving the quality of care in
the peripartum period by strengthening health worker
skills in early essential newborn care and scaling up
access to neonatal intensive care.
Indicator 3.3.1: Number of new HIV infections per
1,000 uninfected population, by sex, age, and key
populations
Through sustained implementation of high-impact
interventions and a well-coordinated multi-sectoral
approach, notable success has been achieved in halting
the spread of HIV and sustaining a decline in prevalence
and incidence. From 2005 to 2020, HIV prevalence
declined from 1.1 percent to 0.6 percent, while the
incidence rate declined from 0.43 per 1,000 population
to 0.1. Across the same period, AIDS-related deaths
fell from 1,400 to 270. Importantly, HIV testing is nearly
universal among pregnant women (around 95 percent),
and the mother to child transmission rate is estimated to
be 1.8 percent. Between 2003 and 2020, the percentage
of pregnant women testing positive declined from 2.5 to
0.2, while positive tests dropped from 4.3 to 0.3 among
those in the general population voluntarily seeking
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-5 mortality to at least
as low as 25 per 1,000 live births
Figure 4.2 - Neonatal and under-five mortality rates
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
Image 8: Maternal and childhood care
6 MoH 2019a ; MoH 2020
7 UN IGME 2021
Eritrea and the 2030 Agenda 35
testing. These notable measures of progress position
Eritrea to apply for validation and ultimately certification of
elimination of mother-to-child transmission of HIV.
Recent epidemiological studies indicate that although
HIV prevalence and new infections are decreasing
among the general population, several key groups,
including women engaged in CSW, long-distance
truck drivers, and the incarcerated, remain particularly
vulnerable and disproportionately affected. Collectively,
these population groups account for about 21 percent of
HIV-positive cases. In 2019, prevalence among women
in CSW was 14.8 percent, among long-distance truck
drivers was 4.3 percent, and among the incarcerated
was 1.4 percent.8
Indicator 3.3.2: Tuberculosis incidence per 100,000
population
There were 2,873 tuberculosis (TB) cases (including
HIV-associated TB) in 2020, for an incidence rate of
81 per 100,000 population, and 74 cases of multidrugresistant (MDR) TB, for an incidence of 2.1 per 100,000.
The number of notified cases of TB decreased from
2,242 in 2016 (equivalent to 66.5 per 100,000) to 1,616
(45.6 per 100,000) in 2020, with an average annual rate
of reduction of approximately 6 percent. 28 cases of
MDR TB were notified, an increase from 17 in 2019.9
In 2020, treatment coverage was 55 percent, while
the treatment success rate was 92 percent – up from 89
percent in 2016. High treatment success rate contributes
significantly to reducing transmission, complications,
and mortality.10
Indicator 3.3.3: Malaria incidence per 1,000
population
Malaria has been a long-standing challenge and the
risk of malaria remains moderate to high within large
swathes of the country. However, over the years the
country has made major inroads against the disease.
Through the combination of an array of control and
prevention interventions, which has included the
mass distribution of long-lasting insecticide-treated
nets, indoor residual spraying, drainage and larval
source management, effective case management
and surveillance, and strong community mobilization,
awareness, and reception, the national malaria burden
has been significantly reduced.
In 2021, there were 6 deaths due to malaria, a drop
from 23 in 2016 and 405 in 1998. Between 1998 and
2016, malaria incidence dropped significantly, declining
from 157 to 34 cases per 1,000 people. Following further
reductions to 18 cases per 1,000 in 2018, there has
been a slight increase in cases in recent years, to 30
cases per 1,000 in 2020. Despite the recent small rise in
cases, the country is transitioning from pre-elimination
towards elimination of malaria, with the long-term goal of
ultimately eliminating and preventing the reintroduction
of malaria by 2030.
Indicator 3.3.4: Hepatitis B incidence per 100,000
population
Although monitoring and service programs have only
been initiated recently, routine surveys shed critical light
on hepatitis B prevalence among key population groups.
Between 2015 and 2019, prevalence among antenatal
care attendants dropped from 3 to 2.6 percent. For the
same period, hepatitis B prevalence dropped from 1.8 to
1.5 percent among women in CSW, increased from 2.4
to 2.9 percent among long-distance truck drivers, and
fell from 4.7 to 3.7 percent among the incarcerated.11
The 2021 World Health Statistics report estimates
hepatitis B surface antigen prevalence among children
under 5 years at about 1.02 percent for 2019.12
Figure 4.3 - Malaria incidence per 1,000 at risk
Image 9: Malaria prevention and control
8 MoH 2019b; MoH 2019c
9 NTLCP 2020; WHO 2021a
10 NTLCP 2020; WHO 2021a
11 MoH 2019c
12 WHO 2021b
36 Eritrea and the 2030 Agenda
Indicator 3.3.5: Number of people requiring
interventions against neglected tropical diseases
Considerable efforts have been made to control,
eliminate, and eradicate neglected tropical diseases
(NTDs). Several multi-year national master plans have
been developed, while various interventions have been
employed, including mass drug administration (MDA)
in high burden areas, vector management, veterinary
public health, and water, sanitation, and hygiene.
The National NTD Program conducted annual
sentinel site surveys for schistosomiasis and soiltransmitted helminthiasis in 29 schools among
the 91 schools that have moderate prevalence for
schistosomiasis. Findings from successive surveys
showed significant reduction of prevalence in the
majority of the surveyed schools. Comparing the
mapping study results of 2014 and 2015, out of the 29
surveyed 48 percent of the schools showed decreasing
prevalence, 35 percent showed zero prevalence, and
the remaining 17 percent showed increasing prevalence.
These results indicate the need for additional
prevention and control strategies, such as snail control,
environmental sanitation, raising community awareness,
and MDA.
The 2021 World Health Statistics report estimates the
number of people requiring interventions against NTDs
at 427,112 for 2019.13
Indicator 3.4.1: Mortality rate attributed to
cardiovascular disease, cancer, diabetes or chronic
respiratory disease
Non-communicable diseases (NCDs) have become
the leading cause of morbidity and mortality among
hospital and health centre inpatients. In recent years,
the number of deaths from cancer, diabetes, and
cardiovascular diseases (CVDs) has increased, while
the number of deaths from chronic respiratory diseases
(CRDs) has remained constant. Specifically, between
2015 and 2021, the number of deaths due to CVDs
increased from 139 to 396, the number of deaths due to
diabetes increased from 60 to 101, the number of deaths
from cancers increased from 23 to 49, and deaths from
CRDs has remained at 10.14 However, the 2021 World
Health Statistics Report estimate for the probability of
dying from any of cancer, diabetes, CVDs, and CRDs
between age 30 and 70, which stands at nearly 27
percent, is greatly overestimated.15
These trends and developments indicate a shift in the
national disease burden from communicable diseases to
NCDs, associated with a variety of different factors, such
as diet, lifestyle, and behaviors. Sustained efforts and
further work will be required in order to reduce major
modifiable risk factors, both develop and implement
effective legal frameworks, and orient the health system
through people-centered health care.
Indicator 3.4.2: Suicide mortality rate
The estimated suicide mortality rate remains relatively
low. However, recent years have witnessed a modest
increase, from about 1.85 per 100,000 population in
2015 to approximately 3.67 in 2021. This upward trend is
closely associated with and driven by a number of
factors, including improved reporting and monitoring
mechanisms. While the overall estimates for Eritrea are
modest, the importance of mental health and access to
psychosocial support, particularly for youth, is a key
component of Eritrea’s comprehensive health care
package.
Indicator 3.5.1: Coverage of treatment interventions
(pharmacological, psychosocial and rehabilitation
and after-care services) for substance use disorders
Indicator 3.5.2: Alcohol per capita consumption
(aged 15 years and older) within a calendar year in
litres of pure alcohol
Comprehensive and accurate data on coverage of
treatment interventions for substance use disorders
and alcohol consumption is unavailable. However, from
2015 to 2020 the number of diagnoses and treatment
Target 3.4: By 2030, reduce by one
third premature mortality from noncommunicable diseases through
prevention and treatment and promote
mental health and well-being.
Figure 4.4 - Deaths from major non-communicable
diseases
Target 3.5: Strengthen the prevention
and treatment of substance abuse,
including narcotic drug abuse and
harmful use of alcohol
13 WHO 2021b
14 MoH 2021
15 WHO 2021b
Eritrea and the 2030 Agenda 37
of alcohol-related mental disorders increased from 14
to 21, while the number of diagnoses and treatment of
substance abuse-related mental disorders increased
from 95 to 245. Overall, alcohol- and substance abuserelated mental disorders are estimated to comprise
about 10 percent of all diagnosed and treated mental
disorders.
The 2021 World Health Statistics Report estimates
the alcohol per capita (≥ 15 years of age) consumption
at 2.1 litres of pure alcohol.16
Indicator 3.6.1: Death rate due to road traffic injuries
Deaths due to road traffic injuries remain relatively
low and have declined compared to previous years. In
2021, the death rate due to road traffic injuries recorded
in health facilities was approximately 2.8 per 100,000
population, a considerable drop from 3.95 in 2015. While
recent trends have been influenced by the reduced
overall traffic due to COVID-19-related national lockdowns, continued and long-term reductions will require
a multifaceted approach and range of preventative
interventions.
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
The MoH estimates the contraceptive prevalence
rate for modern methods among all women aged 15-
49 years at about 13.5 percent in 2019. For 2021, the
UNFPA estimates the unmet need for family planning
among all women aged 15-49 years at 18 percent,
while among women 15-49 years that are married or
in a union it is estimated at 29 percent. As well, it is
estimated that the proportion of demand satisfied with
modern methods among all women aged 15-49 years is
32 percent. These estimates suggest that the potential
for rapid uptake and a large impact is large.17
Indicator 3.7.2: Adolescent birth rate (aged 10-14
years; aged 15-19 years) per 1,000 women in that
age group
The adolescent fertility rate (births per 1,000 women
aged 15-19 years) has decreased considerably over the
years, dropping from 88.6 per 1,000 women aged 15-19
years in 2000 to 55.7 in 2015 and 48.9 in 2019. The
long, extended decline can be attributed to a number of
closely interlinked factors, such as investments in the
human capital of women and girls, the rising age at
marriage and better protection of women’s and girls’
rights, increased educational and economic
opportunities for young women, and progressive
changes in traditional social customs.
Indicator 3.8.1: Coverage of essential health
services
Indicator 3.8.2: Proportion of population with large
household expenditures on health as a share of total
household expenditure or income
The national health policy aims to maximize the
health and well-being of all citizens at all ages and seeks
to ensure equity and access to essential health services
at an affordable cost, utilizing primary health care as
a key strategy and consistent with universal health
coverage (UHC) principles.
Since 2016 a wide set of interventions, including the
Essential Health Care Package, have been developed
and implemented to expand access and improve care
for all. Modest progress is being registered towards
achievement of UHC, as illustrated by improvements on
the UHC service coverage index. In 2019, it was 54.9,
an increase from 47.6 in 2016.18
Target 3.6: By 2020, halve the number
of global deaths and injuries from road
traffic accidents
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 programmes
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
Figure 4.5 - UHC service coverage index
16 WHO 2021b
17 UNFPA 2021
18 WHO 2021c
38 Eritrea and the 2030 Agenda
Health service continues to be heavily subsidized,
with patients required to make only nominal payments
(which are wholly waived in cases of financial
need). Many essential health services are provided
completely free of charge, including all public and
preventive services, such as immunization and growth
monitoring, pre- and post-partum care, nutrition and
supplementation, and health education. All patients with
chronic diseases and other disorders, such as TB, HIV/
AIDS, hypertension, diabetes, and mental disorders,
among others, are provided with free care and
prescribed medications.
Importantly, accessibility, the expansion of health
infrastructure, and human resource development
have also been areas of major focus, with the country
constructing and renovating many hospitals, health
centres, health stations, and clinics, as well as
considerably increasing the number of doctors and
health professionals. There are now 335 health facilities
distributed across the country (comprising hospitals,
health centres, health stations, and clinics) – a nearly
fourfold increase from 1991. At present, approximately
80 percent of the population lives within a 10 km radius
of a health facility and 70 percent within a 5 km radius,
representing major improvements from just a few
decades ago.19
Indicator 3.9.1: Mortality rate attributed to household
and ambient air pollution
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)
Indicator 3.9.3: Mortality rate attributed to
unintentional poisoning
The 2021 World Health Statistics Report estimates
the age-standardized mortality rate attributed to
household and ambient air pollution at 173.7 per
100,000 population for 2016. As well, the mortality
rate attributed to exposure to unsafe water, sanitation,
and hygiene services is estimated at 45.6 per 100,000
population for 2016, while the mortality rate from
unintentional poisoning is estimated at 3.3 per 100,000
population for 2019.20
Notable improvements are being made in expanding
access to safe, clean water and basic sanitation.
Through significant investments and a range of
interventions, nationwide access to clean water is
approximately 85 percent, whereas it was 13 percent in
1991. Importantly, the rural-urban gap is steadily being
bridged, with access to water in urban areas rising
from 30 percent to 92 percent and in rural areas from
7 percent to above 70 percent. Additionally, access to
water has also improved in schools, with greater than
50 percent of all schools now having access to safe,
clean water service, which is much greater than in
previous years. In health facilities, increased access to
clean, safe water has promoted infection prevention and
control, supported healthy deliveries, and helped reduce
neonatal mortality risk.
Similarly, access to basic sanitation and hygiene
facilities has been expanded. Whereas in 1991 about
12.8 percent of households had access to toilets or
latrines, at present about 33 percent of all households
do. Additionally, greater than 67 percent of the country’s
schools have toilets or latrines, while about 77 percent
of villages nationwide have been declared to be “open
defecation free”. Notably, there are also greater levels of
public awareness of good hygiene practices and their
role in reducing the spread of disease.
To consolidate improvement and build upon
progress, the country has undertaken a number of
initiatives, including development of the One WASH
Strategy and One WASH Investment Plan for 2019-2030,
monitoring and improving water safety and quality at
different levels, public education campaigns, and
investment in expanding infrastructure.
Image 10: Health laboratory technicians
Target 3.9: By 2030, substantially
reduce the number of deaths and
illnesses from hazardous chemicals
and air, water and soil pollution and
contamination
Target 3.a: Strengthen the
implementation of the World Health
Organization Framework Convention
on Tobacco Control in all countries, as
appropriate
19 MoH 2020
20 WHO 2021b
Eritrea and the 2030 Agenda 39
Indicator 3.9.1: Mortality rate attributed to household
and ambient air pollution
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)
Indicator 3.9.3: Mortality rate attributed to
unintentional poisoning
The 2021 World Health Statistics Report estimates
the age-standardized mortality rate attributed to
household and ambient air pollution at 173.7 per
100,000 population for 2016. As well, the mortality
rate attributed to exposure to unsafe water, sanitation,
and hygiene services is estimated at 45.6 per 100,000
population for 2016, while the mortality rate from
unintentional poisoning is estimated at 3.3 per 100,000
population for 2019.20
Notable improvements are being made in expanding
access to safe, clean water and basic sanitation.
Through significant investments and a range of
interventions, nationwide access to clean water is
approximately 85 percent, whereas it was 13 percent in
1991. Importantly, the rural-urban gap is steadily being
bridged, with access to water in urban areas rising
from 30 percent to 92 percent and in rural areas from
7 percent to above 70 percent. Additionally, access to
water has also improved in schools, with greater than
50 percent of all schools now having access to safe,
clean water service, which is much greater than in
previous years. In health facilities, increased access to
clean, safe water has promoted infection prevention and
control, supported healthy deliveries, and helped reduce
neonatal mortality risk.
Similarly, access to basic sanitation and hygiene
facilities has been expanded. Whereas in 1991 about
12.8 percent of households had access to toilets or
latrines, at present about 33 percent of all households
do. Additionally, greater than 67 percent of the country’s
schools have toilets or latrines, while about 77 percent
of villages nationwide have been declared to be “open
defecation free”. Notably, there are also greater levels of
public awareness of good hygiene practices and their
role in reducing the spread of disease.
To consolidate improvement and build upon
progress, the country has undertaken a number of
initiatives, including development of the One WASH
Strategy and One WASH Investment Plan for 2019-2030,
monitoring and improving water safety and quality at
different levels, public education campaigns, and
investment in expanding infrastructure.
Target 3.a: 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 2021 World Health Statistics Report estimates
the age-standardized prevalence of current tobacco use
among persons aged 15 years and older at
approximately 7.2 percent for 2018.21
Indicator 3.b.1: Proportion of the target population
covered by all vaccines included in their national
programme
Indicator 3.b.2: Total net official development
assistance to medical research and basic health
sectors
Indicator 3.b.3: Proportion of health facilities that
have a core set of relevant essential medicines
available and affordable on a sustainable basis
Tremendous strides have been made with regard
to national vaccination. In 1991, only 6 vaccines were
administered to children, with an overall coverage
rate of less than 10 percent. However, the national
routine vaccination schedule has steadily grown and
now provides an array of vaccines to protect against
a variety of serious or potentially fatal diseases. At
present, the proportion of the target population covered
by all vaccines included in the National Immunization
Programme (NIP) is nearly 100 percent, with more than
95 percent fully immunized for their age.
Under the oversight of the MoH and the NIP, a total
of 295 health facilities in the country provide routine
vaccination services 6 days per week. In addition,
vaccination service is provided at 450 outreach sites
nationwide, while nomadic groups and those residing
in extremely remote or difficult to reach areas receive
service through the “Reach Every District” approach,
along with mobile health units and mass vaccination
campaigns organized in close cooperation with
community coordinators, volunteers, and local contacts.
Presently, a total of 12 vaccines are administered to
young children, with coverage rates of approximately 95
percent or higher.
The 2021 World Health Statistics Report estimates
the total net official development assistance to medical
research and basic health sectors per capita at $US7.16
for 2019.22 The 2013-2017 national health research
agenda has been updated, helping to bring it more in
Target 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
Image 11: Safe drinking water supply in the community
21 WHO 2021b
22 WHO 2021b
40 Eritrea and the 2030 Agenda
line with the WHO’s protocols and guidelines. Between
2016 and 2021, approximately $US50 million was
received from the Global Fund and GAVI Alliance
grants, of which about 0.5 percent was allocated to
development and health research.
The 2021 World Health Statistics Report estimates
the domestic general government health expenditure
as a percentage of general government expenditure at
approximately 2.4 percent for 2018.23
The National List of Medicines, the Standard
Treatment Guidelines, and the National Formulary
collectively aim to satisfy the priority health care
needs of the population, with due regard to disease
prevalence and public health relevance, evidence of
efficacy and safety, and comparative cost-effectiveness.
Procurement, storage, and distribution of all medical
and pharmaceutical supplies is overseen by the
Pharmaceutical Corporation of Eritrea, a parastatal
organization. Supplies are subsequently distributed
to health facilities throughout the country. Availability
of essential medicines in public health facility, zonal
medical warehouses, and private pharmacies is
estimated at 82, 93, and 61 percent, respectively, while
availability in hospitals is estimated at 87 percent, health
centres 85 percent, and health stations 73 percent.
Health service and medicines are heavily subsidized,
with fees wholly waived in cases of financial need, while
many essential services are provided free of charge. All
individuals with chronic diseases and other disorders,
such as TB, HIV/AIDS, hypertension, diabetes, and
mental disorders, among others, are provided with free
care and prescribed medications.
Indicator 3.c.1: Health worker density and
distribution
Expanding the health workforce remains a key area
of national focus and investment. The government
covers the full costs of education, training, and salaries
for all health workers, and there are no recruitment
ceilings or constraints. In recent years, the national
health workforce has grown by 3 to 4 percent annually;
in 2021, it was a total of 11,068, comprising 56
percent skilled health professionals and 44 percent
administrative and support staff.
The number of doctors has been increased from 100
in 1997 to 291 by 2021. Across the same period, the
number of dentists rose from 6 to 59, nurses from 625
to 1,474, assistant nurses from 1,220 to 2918, dental
therapists from 11 to 165, pharmacists and pharmacy
technicians from 97 to 486, laboratory technicians from
99 to 517, radiologists from 28 to 132, physiotherapy
technicians from 6 to 140, and specialized doctors from
5 to 74. Importantly, distribution is also being improved,
with more health workers now serving in rural areas and
historically under-served communities. Accordingly,
in 2021 per 10,000 population the density of medical
doctors, nursing and midwifery personnel, dentists
and dental therapists, pharmacists and pharmacy
technicians stand at 0.8, 12, 0.6 and 1.3 respectively.
Despite the considerable progress, however,
shortages remain, and there is a relatively low density of
doctors and dentists, as well as a small number of
specialized health professionals (e.g., intensive care
nurses, psychiatrists, psychologists, etc.). Importantly,
Eritrea continues to invest in training professionals, while
also working to push forward cooperation with
international organization and various partners for local
capacity-building.
Indicator 3.d.1: International Health Regulations
(IHR) capacity and health emergency preparedness
As a signatory to the International Health Regulations
(IHR 2005), Eritrea remains committed to improving
health security and it has taken tangible steps to
develop, strengthen, and maintain core public health
and emergency preparedness capacities. In 2017, the
first National Action Plan for Health Security (NAPHS,
for 2017 to 2021) was developed, with a focus on
implementing the IHR and strengthening capacity to
detect, assess, report, and respond to public health
events. After the inaugural NAPHS was reviewed and
evaluated, the new NAPHS for 2022 to 2026 was
developed with an aim to enhance public health core
capacity and further strengthen the health system.
Eritrea annually conducts and submits IHR selfassessment reports, consistent with World Health
Assembly guidelines and requirements. The overall IHR
core capacity index score was 71 percent 2015. After
dropping for a period of several years it has begun
climbing again, reaching 57 percent in 2020.
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
States
Target 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
23 WHO 2021b
Eritrea and the 2030 Agenda 41
Indicator 3.d.2: Percentage of bloodstream
infections due to selected antimicrobial resistant
organisms
Consistent with its endorsement of the 2015 Global
Action Plan on Antimicrobial Resistance (AMR), Eritrea
is working to tackle threats from AMR. A national action
plan for AMR, embracing the “One Health” approach,
has recently been established and put into place.
Developed by a multi-sector committee comprising
multiple ministries and other stakeholders, the action
plan aims to promote appropriate and effective use of
antimicrobials in human and animal health, strengthen
prevention and control measures, and raise public
awareness and knowledge.
In addition, infection and prevention control (IPC)
guidelines have been finalized, with IPC committees
found in all hospitals, while laboratory and surveillance
capacities continue to be enhanced. Both indicator and
event-based systems have been established and are
functioning at all levels, while zoonotic surveillance, food
safety, and security initiatives are conducted through
collaboration between the MoH and the Ministry of
Agriculture (MoA).
Of note, the National Health Laboratory, which
monitors and collects data on common bacterial
infections, is moving towards greater standardization,
coordination, and quality management. The percentage
of bloodstream infections due to selected AMR
organisms has tended to vary by year, while of the
Escherichia coli and Staphylococcus aureus isolated
between 2017 and 2021, a large percentage was
resistant.
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[
3
] |
{
"country": "eri",
"file_id": "sdg-03/vnr-report-eri-2022-en-1.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2022
}
|
134
SDG 3. Ensure healthy lives and promote well-being for all at all ages. In order to promote health
and wellbeing, the Government of the Balearic Islands has approved the Strategy for Care for
Chronic Conditions, enabling comprehensive, coordinated care for chronic patients and their
families. The Healthy Eating and Active Living Strategy, the Early Colorectal Cancer Detection
Programme, and the Early Breast Cancer Detection Programme have all continued to receive
support. In addition, actions have been undertaken aimed at prevention, and at acquisition of
healthy habits in centres of education.
|
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[
3
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{
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"file_id": "sdg-03/vnr-report-esp-2018-en-5.pdf",
"language": "en",
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|
SPAIN – VOLUNTARY NATIONAL REVIEW REPORT 40
3. Ensure healthy lives and promote well-being for all at all ages
SDG 3 seeks to ensure healthy living and to promote universal well-being, an objective that is
closely related to the previous one. In view of the fact that the diseases causing the death of
SPAIN – VOLUNTARY NATIONAL REVIEW REPORT 41
most Europeans are the result of poor diet, an appropriate healthcare system must incorporate
the necessary measures to promote a type of diet that prevents these diseases, as discussed in
the previous section.
In fact, health is one of the areas where multiple interactions among the SDGs are reflected.
Urban pollution is an example of a situation producing negative impacts on health. An example
from the opposite perspective is the promotion of sports, both as an element of physical activity
related to a healthy lifestyle and, also as an educational and cultural space that has an
important impact on gender and integration issues. From everyday practice to high-level
competition, sport occupies a transversal space in today’s society, affecting areas such as
health, education, culture, gender issues and integration. Sustainable development must take
this reality into account and make good use of the possibilities offered.
In Spain, public health is defined under current legislation (Act 33/2011, of 4 October, on public
health) as the set of activities organized by all levels of public administration, with the
participation of society in general, to prevent disease and to protect, promote and restore
human health, both individually and collectively, through therapeutic, sectoral and cross-cutting
actions. Public health occupies a central place in the 2030 Agenda, as human health is a public
good to be sought because of its intrinsic value, and also as a means to achieve other objectives.
The World Health Organization, at its 70th World Health Assembly in 2017, presented the
Secretariat Report on Progress in the Implementation of the 2030 Agenda for Sustainable
Development, as incontrovertible evidence of the incorporation of this Agenda into the
planning frameworks, processes and functions that correspond to this body.
Spain’s Health Ministry has expressed its willingness to contribute to mainstreaming the
contents of the 2030 Agenda in the field of public health and to help achieve the progressive
implementation of the “health in all policies” goal, seeking to act not only in disease prevention
but also in promoting individual and collective health within the healthiest possible
environment. It has been affirmed that the definition made of public health should integrate all
the dimensions of the 2030 Agenda: social, economic, environmental and governance. These
dimensions are determinants of the population’s health (in addition to the biological concept
and the focus adopted within the healthcare services). Therefore, in the health sector, these
dimensions should all be addressed as a natural and harmonious part of public policies
regarding health care. In addition, social well-being must be taken into account, with special
concern for particularly vulnerable areas of the population such as persons with disabilities and
the elderly.
Furthermore, measures should be adopted to prevent and respond appropriately to disabilities,
reducing their impact on individual health, and promoting quality of life and integration into the
activities of society. Moreover, the need for preventive measures should not be limited to
individual interventions. The social sphere exerts a decisive influence on the life of individuals,
and so interventions in this area must also adopt a collective scope, and therefore address a
much more extensive and heterogeneous environment. Hence, disease prevention activities
must be focused on the entire life cycle, from before birth until the end of life, and should be
considered indispensable in all areas of human existence, including the family, education,
SPAIN – VOLUNTARY NATIONAL REVIEW REPORT 42
employment, health care, leisure activities and much more. But in addition, preventive
measures must be given a global component, to ensure their presence in the spaces that impact
on the social collective, such as awareness-raising campaigns on the importance of living a
healthy lifestyle (in areas such as avoiding tobacco and alcohol, taking exercise and consuming a
healthy diet), of consumption in general and of environmental conditions.
In consequence, the overall aim of the Strategy for the promotion of health and for disease
prevention in the National Health System, which was approved by the Inter-territorial Council of
the National Health System (CISNS) on 18 December 2013, is to promote the health and wellbeing of the population by fostering healthy environments and lifestyles and the avoidance of
injuries. This Strategy provides an opportunity to integrate and coordinate health promotion
and disease prevention efforts at all levels and among all the sectors and stakeholders involved.
The Strategy includes actions focused on populations, on specific environments and on factors
to be addressed. With regard to populations, an initial phase of the Strategy prioritizes attention
for children (aged under 15) and for persons aged over 50. In interventions aimed at health
promotion and disease prevention, it is emphasized that actions should be integrated,
addressing not only the main health/risk factors and their interactions, but also the different
contexts in which each population lives. Thus, for the population aged under 15, education and
community contexts have been identified as priority areas for intervention, in addition to health
care. On the other hand, for the population aged over 50, the main aspects addressed
correspond to health care and the community.
The factors targeted in this Strategy are those considered most important from the standpoint
of approaches to chronicity, such as healthy eating, physical activity, the consumption of
tobacco and alcohol, emotional well-being and the safety of the environment (e.g., accident
prevention). This approach represents an advance in comprehensive health intervention,
strengthening primary disease prevention and health promotion, reinforcing interventions in
universal primary care and promoting and coordinating community interventions in different
environments (health, social, educational and community), with a view to reducing premature
mortality from non-communicable diseases to minimal levels.
Other collaborative strategies, too, have been approved by CISNS, to improve the approach
adopted towards problems of public health. All of these interventions are based on the
fundamental principles of comprehensiveness, scientific evidence, cohesion, participation,
evaluation, health-in-all-policies and fairness.
Spain has always argued that policies regarding illegal drugs should be applied under a balanced
approach, in which actions to reduce demand (prevention, treatment and reinsertion) are
combined with those to limit supply (targeting manufacturing and trafficking, related money
laundering, and international judicial and police cooperation). There is a self-evident
relationship between this aspect of SDG 3 and SDG 16. One of the factors addressed in
international policies on the drug problem, and which is incorporated into the Spanish Strategy
on Addictions, is that of gender issues, taking into account the special situation of female
consumers. Therefore, there is also an interrelation with SDG 5. Moreover, in view of the
SPAIN – VOLUNTARY NATIONAL REVIEW REPORT 43
overriding importance of education as an instrument of prevention, especially among the
young, SDG 4 must also be considered as a point of reference.
The Spanish government is committed to maintaining the universal, public and charge-free
nature of the health system, and to guaranteeing its sustainability. To do so, current legislation
and regulations are constantly reviewed, seeking to optimize the provision of public health
services. Appropriate updating of the portfolio of healthcare services has led to the
incorporation of new techniques and preventive, diagnostic and therapeutic procedures, as well
as the elimination of those which have become obsolete. The creation of a Spanish network of
agencies to assess the technologies and benefits of the National Health System is a significant
contribution to enhancing the quality, fairness, efficiency and cohesion of the system.
Finally, the health problems of the twenty-first century related to demographic, socioeconomic,
environmental, epidemiological and technological changes will require health and social welfare
personnel to adapt themselves to providing integrated, people-centred social services
throughout the attention process. Accordingly, importance should be granted to expanding
scientific research and to improving the technological capacity of industrial sectors, worldwide
but especially in developing countries, thereby encouraging innovation and greatly increasing
the number of R&D personnel and levels of public and private spending in this regard by 2030.
R&D&i policies are viewed as fundamental supports to the definition, development and
application of health and social policies. Therefore, the 2017-2020 National Plan for Scientific
and Technical Research and Innovation seeks to encourage R&D&i activities, as a necessary
response to new challenges arising in areas of society such as health, demographic change and
well-being. The R&D&i activities funded under this Plan are expected to contribute to
unprecedented advances in scientific and technological knowledge in the field of biomedical
research, in public research organizations, in the business sector and in the National Health
System.
Finally, making all levels of the health system more inclusive and accessible to persons with
disabilities will also reduce inequalities and unmet health needs (WHO World Report on
Disability, 2011).
|
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[
3
] |
{
"country": "esp",
"file_id": "sdg-03/vnr-report-esp-2018-en-6.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2018
}
|
ESPAÑA - INFORME EXAMEN NACIONAL VOLUNTARIO 140
ODS 3. Garantizar una vida sana y promover el bienestar de todos a todas las edades. Con el
objeto de promover la salud y el bienestar el GOIB ha aprobado la Estrategia para la Atención de
la Cronicidad que permitirá una asistencia integral y coordinada a los pacientes crónicos y sus
familias. Se siguen impulsando la Estrategia de alimentación saludable y vida activa, el Programa
de Detección Precoz de Cáncer de Colon y Recto., el Programa de detección precoz del Cáncer
de Mama. También acciones dirigidas a fomentar la prevención y la adquisición de hábitos
saludables en los centros escolares.
|
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|
ESPAÑA - INFORME EXAMEN NACIONAL VOLUNTARIO 41
3. Garantizar una vida sana y promover el bienestar de todos a todas las
edades
El ODS 3 tiene como objetivo garantizar una vida sana y promover el bienestar de todos a todas
las edades. Se trata de un objetivo estrechamente relacionado con el anterior. Si tenemos en
cuenta que las enfermedades que conducen a la muerte a la mayor parte de europeos son
consecuencia de una mala alimentación, el mejor sistema sanitario no puede eludir las medidas
necesarias para un tipo de alimentación que prevenga estas enfermedades, tal y como se ha
tratado en el apartado anterior.
En efecto, la salud es uno de los ámbitos donde se reflejan múltiples interacciones entre los
ODS. La contaminación urbana es uno de los ejemplos de los impactos negativos. Desde la
perspectiva contraria, por ejemplo, impulsar la práctica deportiva como elemento de actividad
física ligada a una vida saludable y, al mismo tiempo, como espacio educativo y cultural tiene un
impacto importante en temas de género e integración. Desde la práctica deportiva a la alta
competición, el deporte está ocupando un espacio transversal en las sociedades
contemporáneas. Afecta a la salud, la educación, la cultura, los temas de género y los temas de
integración. El desarrollo sostenible debe tener en cuenta esa realidad y aprovecharla en su
beneficio.
La salud pública se define, en nuestra normativa vigente (Ley 33/2011, de 4 de octubre, General
de Salud Pública) como el conjunto de actividades organizadas por las AAPP, con la participación
de la sociedad, para prevenir la enfermedad así como para proteger, promover y recuperar la
salud de las personas, tanto en el ámbito individual como en el colectivo y mediante acciones
sanitarias, sectoriales y transversales. La salud pública ocupa un papel inequívoco en la Agenda
2030 en tanto la salud de las personas es un bien a alcanzar por el valor que representa en sí
mismo, a la vez que un medio para alcanzar otros objetivos.
La Organización Mundial de la Salud (OMS), con ocasión de la 70ª Asamblea Mundial de la
Salud, celebrada en 2017, presentó el Informe de la Secretaría relativo a los Progresos en la
Aplicación de la Agenda 2030 para el Desarrollo Sostenible, lo que evidencia, sin duda, la
ESPAÑA - INFORME EXAMEN NACIONAL VOLUNTARIO 42
incorporación de esta Agenda a los marcos de planificación, los procesos y las funciones que le
son propias a esta Organización.
Desde el Ministerio de Sanidad, Consumo y Bienestar Social (MSCBS) existe una voluntad de
trabajar con el enfoque de transversalización de los contenidos de la Agenda 2030 en el campo
de la salud pública y la implementación progresiva del marco de acción de “salud en todas las
políticas”, ya que no solo hay que actuar en la prevención sino también en la promoción de la
salud individual y colectiva en entornos lo más saludables posibles. La propia definición de salud
pública debe integrar todas las dimensiones de la Agenda 2030 – social, económica,
medioambiental y gobernanza. Estas tres dimensiones, se conforman también como
determinantes de la salud de la población (además de la biológica y la propia de los servicios
sanitarios) por lo que, desde el sector salud, se han de contemplar de modo natural y armónico
en las políticas públicas sanitarias. Todo ello sin olvidar el bienestar social de todos, y
especialmente de aquellos segmentos de población especialmente concernidos como el de las
personas con discapacidad y las personas mayores.
Asimismo, es necesario promover las medidas de prevención e intensificación de
discapacidades, reduciendo el impacto sobre la salud de la persona, su calidad de vida y su
integración en las actividades de la sociedad. La necesidad de instaurar medidas de prevención
no puede reducir sus límites a las intervenciones individuales. Teniendo en cuenta la influencia
decisiva del conjunto social sobre la vida del individuo, resulta indispensable la intervención con
acciones de alcance colectivo, lo que significa ocuparse de un ámbito mucho más extenso y
heterogéneo. De este modo, las actividades de prevención se han de extender, en el tiempo, a
todo el ciclo vital de las personas, incluso desde antes del nacimiento y hasta la vejez, y ha de
entenderse que son indispensables en cada uno de los ámbitos en los que se desenvuelve la
vida: familiar, educativo, laboral, sanitario, de ocio,… Pero también las medidas preventivas han
de tener su componente global, haciéndose presentes en los espacios que representan un
impacto en el colectivo social, como los de sensibilización sobre la importancia de llevar un
estilo de vida saludable (evitar el tabaco y el alcohol, hacer ejercicio, procurar una alimentación
sana) y de consumo en general o los de las condiciones medioambientales.
Así, la “Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud”,
aprobada por el Consejo Interterritorial del Sistema Nacional de Salud (CISNS) el 18 de
diciembre de 2013, tiene, como objetivo general, el fomentar la salud y el bienestar de la
población promoviendo entornos y estilos de vida saludables y potenciando la seguridad frente
a las lesiones y es una oportunidad de integrar y coordinar los esfuerzos de promoción de la
salud y prevención entre todos los niveles, sectores y actores implicados.
El desarrollo de esta Estrategia contiene acciones por poblaciones, por entornos y por factores a
abordar. Con relación a las poblaciones, en la primera fase se priorizaron para la acción la
infancia (menores de 15 años) y los mayores de 50 años. En las intervenciones dirigidas a la
promoción de la salud y prevención es importante actuar de forma integrada, no sólo
abordando en conjunto los principales factores de salud/riesgo y sus interacciones, sino
también los diferentes entornos vitales de cada población. Así, para la población menor de 15
años, se han identificado como entornos prioritarios de intervención, además del sanitario, el
ESPAÑA - INFORME EXAMEN NACIONAL VOLUNTARIO 43
educativo y el comunitario. En la población mayor de 50 años se abordan el entorno sanitario y
el comunitario.
Los factores que se contemplan en esta Estrategia corresponden a aquellos que tienen mayor
importancia, desde el punto de vista del abordaje de la cronicidad, como son la alimentación
saludable, actividad física, consumo de tabaco y consumo de riesgo de alcohol, sumando
también el bienestar emocional y la seguridad del entorno con el objetivo de prevenir lesiones
no intencionales. Esto permite avanzar en la intervención integral en salud, afianzando las
intervenciones en prevención primaria y promoción de la salud, reforzando estas intervenciones
en atención primaria con carácter universal y promoviendo las intervenciones comunitarias y su
coordinación en los diferentes entornos (sanitario, social, educativo y comunitario), previéndose
conseguir una reducción de la mortalidad prematura por enfermedades no transmisibles a
niveles mínimos.
Además, existen otras Estrategias, aprobadas por el Consejo Interterritorial del Sistema
Nacional de Salud (CISNS), que colaboran a la mejora del abordaje de estos problemas de salud.
Todas estas intervenciones se hacen siempre en base a los principios rectores de integralidad,
evidencia científica, cohesión, participación, evaluación, salud en todas las políticas y equidad
España ha defendido siempre que la política de drogas ha de mantener un enfoque equilibrado,
en el que tengan tanta relevancia las actuaciones de reducción de la demanda de drogas
(prevención, tratamiento y reinserción) como las de reducción de la oferta (fabricación y tráfico,
blanqueo de capitales ligado con el mismo o cooperación judicial y policial internacional). En
este sentido es innegable la relación con el ODS 16. Una de las vías que sigue la política de
drogas, a nivel internacional y que se recoge ampliamente en la Estrategia Nacional sobre
Adicciones (ENA), es el enfoque de género, dada la especial situación de la mujer consumidora.
Por ello también hay interrelación con el ODS 5. Y, dada la gran relevancia que tiene la
educación como una de las principales herramientas de prevención, en especial entre los más
jóvenes, hay que aludir al ODS 4.
Mantener el carácter universal, público y gratuito del sistema sanitario, así como garantizar su
sostenibilidad, es uno de los objetivos del gobierno de España revisando la legislación y
normativa vigentes de manera que contribuyan a la consecución de este carácter universal de la
sanidad pública. La actualización de la cartera de servicios ha permitido incorporar nuevas
técnicas y procedimientos preventivos, diagnósticos y terapéuticos, así como retirar aquellas
que han quedado obsoletas. La creación de la Red Española de Agencias de Evaluación de
Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud contribuye al incremento de
la calidad, equidad, eficiencia y cohesión del mismo.
Finalmente, los problemas sanitarios del siglo XXI relacionados con los cambios demográficos,
socioeconómicos, medioambientales, epidemiológicos y tecnológicos exigirán que el personal
sanitario y social esté adaptado a la provisión de servicios de salud y sociales integrados y
centrados en las personas a todo lo largo del proceso asistencial, por lo que parece importante
aumentar la investigación científica y mejorar la capacidad tecnológica de los sectores
industriales de todos los países, en particular los países en desarrollo, entre otras cosas,
fomentando la innovación y aumentando considerablemente, de aquí a 2030, el número de
44
personas que trabajan en investigación y desarrollo por millón de habitantes y los gastos de los
sectores público y privado en investigación y desarrollo.
Las políticas de I+D+i se configuran como elementos fundamentales de apoyo para la definición,
el desarrollo y la aplicación de las políticas sanitarias y sociales. Por lo tanto, el Plan Estatal de
Investigación Científica y Técnica y de Innovación 2017-2020 fomenta las actividades de I+D+i
para dar respuesta a un reto de la sociedad como es la salud, el cambio demográfico y el
bienestar. Las actividades de I+D+I financiadas por el Plan Estatal han contribuido a los avances
sin precedentes que ha experimentado el conocimiento científico y tecnológico en materia de
investigación biomédica en nuestro país, tanto en organismos de investigación públicos como
en el ámbito empresarial y del Sistema Nacional de Salud.
Además, lograr que todos los niveles de los sistemas de salud existentes sean más inclusivos y
que los programas de salud pública sean accesibles a las personas con discapacidad también
permitirá reducir las desigualdades y las necesidades no satisfechas en la esfera de la salud
(Informe mundial discapacidad OMS 2011).
|
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|
20
6.3 Goal 3. Ensure healthy lives and promote well-being for all in
all age groups
Estonia's goals and the situation in general
Estonia's healthcare system may be considered effective in the EU as well as the global context.
More than 90% of the population is covered by health insurance, meaning that most of the
population has access to healthcare services. One of the government’s priorities is to improve
public health. The target of the government’s action plan is to increase healthy life years from birth
to 59.2 years in the case of men, and 64.4 years in the case of women. Regarding life expectancy,
the targets are 74.5 years in the case of men, and 83.6 years in the case of women. Also one of the
21
targets of the Government is to decrease the number of fatal accidents, poisonings and trauma to
65 deaths per 100 000 people.
The biggest goals 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. Also in order to prevent diseases, health related
behaviour needs to be promoted and use of addictive substances decreased.
Indicator Current
situation
Target
Life expectancy in years (separately for men and women)
(SBA; EGAP, SE indicators)
Men 72.3
Women 81.5
(2014)
Men 74.5
Women 83.6
(2019)
Healthy life years (without limitations) at birth (separately
for men and women)
(SBA; EGAP, SE indicators)
Men 53.1
Women 57.1
(2014)
Men 59.2
Women 64.4
(2019)
Fatal accidents, poisonings and trauma per 100,000
people.
(SBA)
71
(2014)
65
(2019)
Per capita use of alcohol (litres of absolute alcohol per
year per person)
(Green Book on Alcohol Policy)
8.7 litres
(2015)
<8 litres
(2019)
Measures and activities
Developments in the field of health are mapped out in the Population Health Development Plan
2009-2020, approved by the Government of Estonia. Effectiveness is an important factor in the
Estonian healthcare system, the purpose of which is to improve the indicators of public health,
improve the quality of the healthcare system and guarantee the optimal use of the resources of
health insurance.
In order to guarantee the accessibility of high-quality health services for the whole population,
taking into consideration the demographic trends and sustainable use of resources the target is to
network (promote cooperation between) the county hospitals with the regional hospitals. In order
to improve the accessibility of primary health services, health-care centres are being created,
consolidating primary health care services and their support services.
The effectiveness of providing health-care services and the cost savings are supported by the ehealth strategy, the purpose of which is to create a well-cooperating network of primary level esolutions and services based on them by 2025. The final goal is to more effective use of the
healthcare, labour market and social services systems’ resources and improve the satisfaction of
the service users. As an example, the e-ambulance service is ready and in use. In the patient portal
the patients are able to see their treatment bills.
In 2015 the research, development and innovation strategy 2015-2020 of the Estonian health-care
system, Putting science and innovation at the service of health-care, was completed, generating a
common understanding on how research, development and innovation can more effectively
support the goals of the Estonian health-care system. Among other things the development of
personal medicine is targeted and a pilot project on the development of personal medicine is being
prepared.
22
Important political measures from the perspective of public health are described in the Green Book
on Alcohol Policy and in the Green Book on Tobacco Policy. The Green Book on Nutrition and
Exercise is being completed, the purpose of which is to shape an integrated and long-term policy
on preventing problems stemming from unhealthy nutrition (including preventing obesity). The
purpose of alcohol policy is to reduce the social, economic and health damages resulting from the
abuse of alcohol, Also, to guarantee a supportive environment for the growth of children and youth,
and make the living environment safer for all. Social campaigns titled Let’s drink less by half and
Passive drinking have been organised.
The target of the Green Book on Tobacco Policy is to reduce the health damage caused by tobacco
and to prevent the accessibility of tobacco by minors. The aim is to decrease the number of daily
smokers to 18% by 2025 and the number of smokers to 24% by 2025.
Measures against HIV and AIDS are coordinated within the framework of the Public Health
Development Plan. 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.
From the NGO sector, programs such as the Good Deed Foundation and a donation environment
founded by Swedbank - I love to help - through which it is possible to support various relief
organisations deserve mention. It is possible to donate to the AIDS Information and Support Centre
to support the prevention of drug addiction as well as rehabilitation. In addition many different
organisations operating in the health sector have been supported.
The purpose of the Healthy Estonia Foundation is to help shape health behaviours and decrease
the number of preventable deaths in Estonia. To facilitate this, health-awareness is being promoted
through discussion and dialogue.
Estonian cities have, since 1999, co-operated in order to introduce and implement the ideas and
principles behind the healthy cities movement, contributing to the achievement of health and wellbeing amongst all age groups in cities and counties. In order to promote and implement the
principles of healthy city living in Estonia, in 2002 13 local governments founded an NGO called the
Network of Healthy Cities. Systemic implementation of the WHO healthy cities benchmarks (health
indicators, health services indicators, environmental indicators, social and economic indicators) in
the monitoring of local situations, and in raising the awareness of decision-makers, are important
input factors for knowledge-based planning of local development.
Estonians are willing to help people who are in need for health reasons. As an example, the
Christmas Tunnel TV show, aired by the Estonian Public Broadcasting network, is a charity
programme collecting donations for different hospitals and health organisations for the purpose of
improving the quality of medical aid through the purchase of better medical equipment.
The international student organisation AIESEC is organising a six-week project, the purpose of
which is to find solutions to the problems of drug and alcohol abuse and promote healthy lifestyles
in the local communities. The target group of the project is high-school students and young people
aged 18-25.
23
In the period 2011-2015 Estonia supported the advancement of health-care in the developing
countries with almost 2.6 million EUR through its development cooperation. In the period 2016-
2020 Estonia will continue the implementation of bilateral projects in order to improve the
accessibility of health-care services and improve the competence and capacity of health-care in its
partner countries. In addition Estonia will continue to co-finance healthcare projects and
supporting organisations with voluntary donations in cooperation with international organisations,
the WHO as well as UNICEF.
|
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Review of the implementation of the UN 2030 Agenda in Estonia 21
5.3. GOAL 3. ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
Share of overweight
population
50,7%
Ensure healthy lives
and promote well-being
for all at all ages
Estonian healthcare management can be
considered effective in both the European and
global contexts. 95% of the population is covered
by health insurance, which means that the majority
of the population has access to health care.
Improving public health is a government priority.
The Government has submitted the National
Health Plan for 2020–2030 to the Riigikogu for
discussion, which sets the goal of increasing the
average life expectancy of Estonians by 2030
to 78.0 years for men and 84.0 years for women
and the number of healthy years to 62.0 for men
and 63.0 for women. The government wishes to
have it approved this year. The life expectancy
of the Estonian population has grown strongly
in recent decades, but unfortunately, we do not
have such a trend in terms of a healthy life expectancy. Therefore, when implementing the development plan, it is defnitely important to ensure
that the number of healthy life years grows faster
than the life expectancy, i.e. that people would
GOAL 3
Life expectancy
78,4
years
Healthy life years
54,2
years
Number of fatal
accidents per
100,000 inhabitants
60,4
live most of their lives without restrictions due to
health problems.
In addition to the above-mentioned goals, the
National Health Plan 2020–2030 aims to reduce
health inequalities (between genders, regions,
and levels of education). By the end of the
National Health Plan, it is desired to achieve
that by 2030, the life expectancy in no county is
shorter than the Estonian average and that the
life expectancy of people with basic education
does not lag behind the life expectancy of
people with higher education by more than six
years.
In order to ensure health and well-being, it is also
important to engage in prevention activities.
The prevention of diseases and injuries and the
early detection of diseases help to increase the
quality of life of people, as a disease detected
at an early stage is usually treatable, and the
person retains activity and ability to work.
ESTONIA’S GOALS AND
GENERAL SITUATION
22 Review of the implementation of the UN 2030 Agenda in Estonia
INDICATORS
2016
Latest known
status
(year)
3.1. Life expectancy 77,8 78,4
(2018)
3.2. Healthy life years 57 54,2
(2018)
3.3. Share of overweight population, %
52 50,7
(2018)
3.4.1. Number of fatal accidents
per 100,000 inhabitants
65 60,4
(2018)
3.4.2. Number of fatal accidents
at work per 100,000 inhabitants
2 1,1
(2018)
3.5.1. Deaths preventable by
treatment
2468 2390
(2018)
3.5.2. Preventable deaths 3158 3176
(2018)
3.6. Deaths due to chronic diseases per 100,000 under 65 years
of age
156 156
(2016)
3.7.1. HIV infection per 100,000
inhabitants
17,4 13,5
(2019)
3.7.2. Infection with tuberculosis
per 100,000 inhabitants
12,7 9,2
(2018)
3.7.3. Infection with acute hepatitis B per 100,000 inhabitants
0,6 0,3
(2018)
3.7.4. Infection with chronic hepatitis B per 100,000 inhabitants
1,3 1,2
(2018)
3.7.5. Infection with acute hepatitis C per 100,000 inhabitants
1,1 0,4
(2018)
3.7.6. Infection with chronic hepatitis C per 100,000 inhabitants
15,4 9,6
(2018)
3.8. Number of suicides per
100,000 inhabitants
14 14,1
(2018)
3.9.1. Primar morbidity rate of
mental and behavioural disorders
per 100,000 inhabitants
1956 1986
(2018)
3.9.2. Mental and behavioural
disorders caused by psychoactive substances per 100,000
inhabitants
232 242
(2018)
3.10. Alcohol consumption per
inhabitant aged 15 and over, litres
of 100% alcohol
10,2 10,1
(2018)
3.11. Tobacco consumption
among 16–64-year-olds, %
21 17
(2018)
5.3.1 CENTRAL GOVERNMENT
LEVEL
Since 2016, health centres have been built
or renovated to improve the availability of
primary health care services. Within the
framework of the project, it is planned to renovate
58 primary health centres across Estonia by 2023.
To date, 25 centres have started operating. With
the new centres, the choice of primary health
care services for the patient expands. The team
of health centres to be created consists of family
physicians and nurses. In addition, physiotherapists, nurses and midwives, and, if necessary,
other specialists will work in health centres. The
frst county health centre will also be established,
which is a modernised general hospital.
At the end of 2017, the government approved
the National HIV Action Plan for 2017–2025,
with the help of which the state is taking
important steps to stop the HIV epidemic. The
aim of the HIV Action Plan is to bring the number
of new infection cases to the average level of the
European Union, i.e. less than 100 cases per year.
The availability of treatment and harm reduction
services for HIV-positive people and drug
addicts has also been expanded – the number
of treatment places will be increased, and a new
centre for treatment and rehabilitation services
for adolescents will be established in East-Viru
County.
In the feld of e-health, amendments to the
Act on Narcotic Drugs and Psychotropic
Substances and Precursors thereof entered
into force at the end of 2019, based on which
the collection of personalised data for the drug
treatment register (drug treatment database)
started in such a way that entries in the register
of the same person can be linked to data already
collected in other national databases (e.g.
population register, tuberculosis register, causes
of death register, etc.). Above all, it makes it
possible to protect the life and health of an
addicted person by improving the quality of
drug treatment services and by creating opportunities for linking treatment data to assess the
effectiveness of existing treatment. The quality
MEASURES AND ACTIVITIES
Review of the implementation of the UN 2030 Agenda in Estonia 23
of the data necessary for the development of
health policy and the analyses performed on the
basis of them will also improve (e.g. the possibility to evaluate the effectiveness of treatment,
diagnostics, and treatment, analyse the occurrence of drug addiction in Estonia, etc. will
improve).
In order to ensure better access to health care
services and the sustainability of the health care
system, the Government of the Republic decided
in 2017 to gradually expand the income base
of the Estonian Health Insurance Fund, which
will help to reduce the fragmentation of health
care fnancing. The extra funds provide an opportunity to shorten the waiting list for treatment,
improve the availability of health care services as
well as the continuity and quality of treatment.
From 2020, for example, dental care benefts
for adults, ambulance services, reimbursement
of infertility treatment costs, fnancing of substitution fees for family physicians, HIV medicines,
immunisation preparations, and the cost of
emergency care for uninsured persons and other
costs were transferred from the state budget to
the budget of the Estonian Health Insurance
Fund.
As additional fnancial measures, an additional
system of benefts for medicinal products
was established in 2018, and people with an
increased need for treatment began to be
reimbursed for medicines at a higher rate than
before. Also, from July 2017, dental care became
much more accessible as a dental beneft
was introduced for adults that was previously
absent. Dental benefts for pensioners, pregnant
women, mothers of children under one year of
age, and people with an increased need for
treatment were also increased. The change
reduced people’s annual spending on improving
oral health. Dental care for all insured persons
under the age of 19 continues to be free of
charge, and the state pays for unavoidable dental
care to uninsured people from the budget of the
Estonian Health Insurance Fund.
In 2018–2019, changes to the immunisation
plan came into force, including the vaccination
of 12-year-old girls against papillomavirus
(HPV), and an infant combination vaccine was
introduced to protect against six pathogens
(diphtheria, tetanus, pertussis, polio, haemophilia B infection, and hepatitis B virus). Vaccination of girls against HPV is important, as the
primary incidence and mortality of cervical
cancer in Estonia is one of the highest in Europe.
Vaccination of girls aims to reduce the prevalence of HPV infection, the resulting pre-cancerous conditions, the incidence of cancer, and
to prevent cancer-related health care costs and
mortality. As a result of the change that came
into force in 2019, it is possible to receive free
infuenza vaccinations outside the home for recipients of round-the-clock general care services
and recipients of round-the-clock special care
services.
From the point of view of alcohol policy, amendments to the Advertising Act entered into
force in June 2018 which signifcantly restrict
alcohol advertising. In addition to the previous
restrictions, the amendment completely banned
outdoor alcohol advertising and advertising
on social media and further restricted alcohol
advertising on television, radio, and magazines.
The purpose of amending the Advertising Act
is to protect public health, reduce the social,
economic, and health damage caused by
alcohol consumption, and ensure a supportive
environment for the growth and development for
children and young people. In addition, restrictions on the display of alcoholic beverages
entered into force in June 2019. This means
that alcoholic beverages must be placed in the
store separately from other goods so that the
consumer does not inevitably come into contact
with them.
In order to better prevent minors from starting
smoking and using other similar products,
to reduce the number of daily smokers in
Estonia and thus the health risks, harms, and
costs associated with smoking, the Tobacco
Act has been amended in recent years: the
packaging and labelling of tobacco products
were regulated, including the obligation to
include pictorial warnings, the requirements for
nicotine-containing electronic cigarettes were
supplemented, cross-border distance sales
of tobacco and related products was banned,
tobacco display and branding at the point of
sale was restricted, compositional and purity
requirements for nicotine-free liquid were established, favours other than tobacco were banned
in e-cigarettes, a requirement to request a
document when selling a tobacco product was
introduced, and police offcers were given the
24 Review of the implementation of the UN 2030 Agenda in Estonia
right to carry out control purchases to monitor
compliance with the ban on sales to minors.
In 2019, a nationwide digital registry was
introduced in Estonia in all hospitals of the
Hospital Master Plan, which makes it easier for
people to fnd an appointment with a medical
specialist. A nationwide digital registry does
not automatically shorten waiting lists, but it
does increase transparency and eliminate the
possibility of double bookings. The innovative
solution gives people the freedom to book
appointments from one place without having
to call different healthcare facilities or use the
healthcare provider’s appointment booking
environment. By the end of 2019, a total of 32
healthcare providers, including 20 hospitals in
the Hospital Master Plan, had joined the national
digital registry solution; by spring 2020, the
number of health care providers who had joined
the solution has increased to 45.
The completed drafts of the National Health Plan
2030 and the Development Plan for Agriculture
and Fisheries until 2030 set the joint target to
reduce food-related risks to human life and
health, including strengthening national food
safety monitoring, raising consumer awareness,
and improving the country’s capacity to provide
early warning of health risks. The measures put
in place will work together to reduce deaths
and morbidity from hazardous chemicals and
contaminated water and food.
In 2017, the road safety programme for
2016–2025 was approved, which focuses on
ensuring road safety as a whole and the aim of
which is to reduce the average number of road
deaths in Estonia by at least 50% in 2012–2014.
This means that instead of the current 82 fatalities, the average number of people killed in
traffc between 2023 and 2025 would not exceed
40, and the number of seriously injured would
not exceed 330 people per year on average.
Estonia does not yet have a separate national
mental health policy, but the Green Paper
on Mental Health, which will be completed in
spring 2020, will help fll this gap. The document
to be discussed in the Government deals with
the prevention of mental health problems and
the provision of treatment processes in a coordinated manner.
FOTO: LIINA NOTTA
Review of the implementation of the UN 2030 Agenda in Estonia 25
To support the mental health of families with
children, it is planned to create and expand
various services and counselling programmes
for conscious family planning, the birth of
healthy children, protection of maternal health,
and early intervention. In addition to parenting
programmes that help develop parenting skills,
there are also relationship support programmes
to prevent divorce and intimate partner violence.
As it is best for children to have both parents
involved in their upbringing, a national family
mediation system is being developed. The
aim is to achieve better cooperation between
separated parents and to facilitate the conclusion
of agreements based on the welfare of children
on matters concerning the organisation of a
child’s life, both out of court and at an early stage
during court proceedings. The use of family
mediation as an alternative to court proceedings
has had a positive effect in many countries and is
often free of charge for families. Estonia has also
set the goal that the corresponding service be
as widely available to families as possible.
To promote physical activity, a support
programme for regional health sports centres
was established in 2019, which aims to improve
the quality of services and mobility conditions
in at least one health sports centre in each
county to ensure high-quality opportunities
for all residents to engage in physical activity
and engage more people in physical activity.
As a result of the programme, the proportion
of people who move regularly will increase, it
will have a positive effect on people’s health
behaviour, and it will increase people’s potential
life expectancy.
Fiscal measures have also been promoted to
support people’s healthy lifestyles. In 2018,
an incentive was applied to employers to
reimburse more employees’ sports expenses
and certain health-promoting services, such as a
doctor’s appointment with a rehabilitation doctor
or a doctor’s appointment with a physiotherapist. In 2018, the method of calculating coaches’
salaries and labour costs was also changed. In
order to increase the physical activity of children
and young people and thus ensure good health,
there is a need for educated people who know
and want to instruct young people, even outside
of physical education classes.
5.3.2 ACTIVITIES OF
NON-GOVERNMENTAL
ORGANISATIONS
The mission of the Estonian Mental Health and
Well-Being Coalition (VATEK) is to increase the
awareness of the entire population about the
importance and signifcance of mental health and
the possibilities of promoting and maintaining it.
VATEK started its activities in 2012, and by now,
it has become a strong umbrella organisation
uniting nearly 60 organisations in the feld of
mental health, being a spokesperson and partner
in the feld of mental health for the Ministry
of Social Affairs. VATEK’s action plan includes
a mental health fair as a major annual event,
supported by thematic mental health workshops
in the counties. The fair is dedicated to World
Mental Health Day on 10 October and focuses
on the annual theme announced by the World
Mental Health Federation (WMHF).
The non-proft organisation Head Matters
deals with the promotion of mental health,
prevention of problems, early intervention, and
reduction of stigma in Estonian society. In 2017,
the campaign “Listening to man” was implemented. The issue is important because statistically, men seek less help than women, but they are
subject to different stereotypes and attitudes. In
2018, the depression awareness campaign “Black
Snow” took place. In addition, in 2018–2019,
Head Matters focused on the development of
mental health frst aid knowledge and skills in
society through training.
To facilitate the movement, the Estonian
Health Trails Foundation has been established,
which has signifcantly expanded its activities
in 2017–2019. The aim of the foundation is to
ensure the availability of the network of health
trails for the majority of the Estonian population
for year-round free exercise. At present, there
are approximately 100 outdoor health trails and
more than 50 indoor health trails in Estonia.
In 2017–2019, the foundation has signifcantly
increased the capacity to produce artifcial snow
across Estonia, contributed to the training of
trail maintenance personnel, paid attention to
informing and communicating with people, and
collecting statistics on the use of health trails to
reach more people with even better trails.
26 Review of the implementation of the UN 2030 Agenda in Estonia
“Physically active schools” is a programme in
which, since 2016, under the leadership of the
University of Tartu’s Research Group of Physical
Activity for Health, solutions have been sought
in cooperation with schools on how to make
school days more mobile and bring more joy
of movement to each student. To date, more
than 100 schools across Estonia have joined the
programme.
In 2019, the Ministry of Social Affairs selected
strategic partners in the feld of mental health for
two years, which were non-proft organisation
Head Matters, the Estonian-Swedish Mental
Health and Welfare Coalition, the Estonian
Youth Mental Health Movement, Minutes
of Stillness, and the Centre for Gambling
Addiction.
In addition, the Ministry of Social Affairs, in cooperation with the Ministry of the Interior, has strategic
partners operating in the feld of children and
families. These are Valuing Life and Estonian
Association of Big Families. Valuing Life brings
together organisations that support the mental
health of families and children.16 In cooperation,
16 Estonian Women’s Associations Roundtable, Estonian Women’s
Shelters Union, NGO Crisis Programme for Children and Youth,
“No Kids in the Middle”, Association of Mediators, Pro Familia,
NGO Vaiter, NGO Hingekeel, NGO Unekool.
the foundation offers evidence-based training in
support of relationships and mental health (PREP),
a crisis programme for young people and children,
and the programme “No Kids in the Middle”.
5.3.3 INTERNATIONAL
DEVELOPMENT
COOPERATION
Health care is one of the priority areas of
Estonian development cooperation. One of
the longest-term international development
cooperation partnerships in ensuring health care
has been the project “Supporting the development of the Moldovan health insurance
system” (2011–2019) between the Estonian
Health Insurance Fund and the Moldovan Health
Insurance Fund. In the course of this project, the
development of the Moldovan health insurance
system was supported through the sharing of
Estonia’s theoretical and practical experience.
Within the framework of the project, 10 study
sessions were held for the target group, which
also included a project summary visit. The
training sessions focused on organisational development, performance management, healthcare
fnancing (pricing, budget planning, contracting,
FOTO: HARIDUS- JA TEADUSMINISTEERIUM / AIVO KALLAS
Review of the implementation of the UN 2030 Agenda in Estonia 27
case-based remuneration system), benefts of
medicinal products, EU health insurance, and IT
solutions.
Due to Estonian expertise in the feld of e-services, e-services have also been developed in
partner countries. For example, in the project
“Development of e-services for the primary
health care system in Belarus” (2016–2017),
which was implemented by Estonian Help
Centers to fnd out the possibilities for further
development of e-services for the primary health
care system in Belarus. On this basis, a primary
medical counselling service was prepared. The
overall goal of the project was to improve the
quality of life of the people of Minsk and Gomel
oblasts in Belarus by giving them better and
faster access to primary health care.
On the topics of e-health, the project “Consultation on the introduction of e-health in
Ohmatdit and preparation of standard guidelines” of Praxis Centre for Policy Studies
(2018–2019) was also successful. At Ohmatdit,
the largest children’s hospital in Ukraine,
management was advised, and guidelines were
prepared for the implementation of e-medicine
solutions, from e-document management to
e-registration and e-patient card solutions.
In health care, development cooperation also
pays attention to prevention. For example,
in its project “Development of prevention
in health care” (2017–2018), NGO ProDia
aimed to improve the health behaviour and
timely treatment of Moldovan residents. New
approaches to health prevention were developed
and tested and implemented for the Moldovan
population. At the same time, needs analyses
were conducted, and recommendations and
evaluation methodologies were developed,
e-solutions for prevention were tested, and
training seminars were organised for family
physicians and personnel managers as well as
civic associations and other target groups.
As a preventive action, the Estonian Sexual
Health Association focused on improving
the knowledge and skills of Moldovan young
counsellors in sex education, targeting different
target groups (students, parents, teachers, etc.)
in the project “Improving the availability of sex
education through the development and implementation of multifunctional online platformbased training in Moldova” (2018–2019). An
online platform and training materials were set
up to train the trainers. Teaching methodologies
and materials were developed in cooperation
with Moldovan partners.
Project activities in the feld of health promotion
also take place outside the Eastern Partnership
countries. For example, for the last three years,
under the leadership of Estonian Doctors Help
the World, Estonian doctors have operated on
patients with various surgical pathologies in the
Meru County hospitals in Kenya and instructed
local medical staff inside and outside of the
operating room. Within the framework of the
Mondo follow-up project for the promotion of
women’s and girls’ health education in northern
and eastern Afghanistan (2019–2020), NGO
Mondo, in cooperation with the Tallinn Health
Care College, will continue educational development cooperation to promote women’s
health in northern and eastern Afghanistan. The
aim is to improve the curriculum and teaching
materials of medical schools, to train midwives
in e-learning, who, in turn, provide health
education in girls’ schools, and to improve
health awareness among the local population in
the Jowzjan Province. Cooperation will continue
with the Afghan Midwifery Association to align
local curricula with the national community-based midwifery education programme. In the
Nangarhār province, the education of children of
returning war refugees will also continue to be
supported with the help of a local partner.
|
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3
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{
"country": "est",
"file_id": "sdg-03/vnr-report-est-2020-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
44
3. Ensure healthy lives and promote well-being for all at all ages: It has been proclaimed in the constitution of the
FDRE that government has the obligation to allocate ever increasing resources to provide to the public health,
education and other social services. The national health sector policy, strategy, plan and program of the government
have threfore, emanaeted from this constitutional provision and they are focusing on preventive rather than curative
health services to addresse critical issues and problems of the health sector in Ethiopia. With the main objective of
ensuring easy access to and quality of basic health services for all Ethiopian citizens, the Ethiopian government has
made massive investment in expanding health infrastructure and building the human capital in the health sector.
Health Extension Program has been operatonal and rolled out to all rural and urban areas of the country for effective
implementation of the national health sector policy by deploying about thirty eight thousand trained health extension
workers. Accordingly, the national health services coverage reached 98 % through expanding health institutions,
training, and deploying sufficient human resources and increasing health service accessebility. Maternal and infants
health has improved significanrly with reduced maternal mortality rate per100,000 live births to 420 in 2014/15 while
that of under five child mortality rate declined to 64/1000 live births in the same period. Incidences & spread of
communicable diseases have been restrained and life expectancy has shown tremendous progress. Healthy and
productive labor force is thus availed for the economy to maintain its accelerated pace and achieve the goal of
eradicating poverty in all its forms by 2030.
|
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[
3
] |
{
"country": "eth",
"file_id": "sdg-03/vnr-report-eth-2017-en-5.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2017
}
|
ETHIOPIA VNR 2022
71
The health policy of Ethiopia aims to provide a comprehensive
package of health services and improve equity and quality health
services. The policy has been implemented through successive
National Health Sector Development Plans (HSDPs I-IV)) since
1997. Following the conclusion of HSDP-IV in 2015, two health
sector transformation plans (HSTP-I & II) have been developed
and HSTP-II (2020/21 - 2024/25) is being implemented. The
Ethiopian National Healthcare Quality Strategy (NHQS) aims
to align key stakeholders across prioritized interventions that
help drive large-scale improvement in quality-of-care delivery.
The Ethiopian health sector has a strong community health
program through the health extension program (HEP) which
delivers cost efective basic services to all Ethiopians, mainly
women and children. Other initiatives have been developed
and implemented to enhance the fnancial risk protection in
accessing essential health services. These include high-impact
interventions free of charge through an exemption program;
subsidization of more than 80% of the cost of care in public
health facilities; implementation of community-based health
insurance (CBHI) schemes; and full subsidization of the very
poor through fee waivers for both health services and CBHI
premiums. The healthcare fnancing strategy has been revised
to achieve the goal of universal health coverage in the country.
GOAL 3 – HEALTH AND WELLBEING
5.8.
MINISTRY OF PLANNING AND DEVELOPMENT
72
The share of government budget allocated to the health
sector increased from 7.8% in 2015/16 to 10.5% in 2020/21,
below the 15% target of the Abuja Declaration. Households
covered under the CBHI program increased in the last six years.
Between 2020/21 and 2021/22, CBHI benefciary households
increased by 9.2% and reached 9.5 million in 2021/22. In
2020/21, development partners disbursed around US$87.2
million to the sector to support SDGs implementation in the
sector.
Ethiopia has made progress in reducing mortality rates of
both maternal and children, especially those under-fve years
of age. Under-fve mortality rate decreased from 67 deaths
per 1000 live births in 2015/16 to 59 in 2019/20 while maternal
mortality rate marginally declined to 401 in 2019/20 (Figure 5).
With this pace, the under-fve mortality rate will remain well
above the 2030 target of 25 which requires accelerated eforts
in implementing interventions that aim to reduce under-fve
mortality. The number of children dying within 28 days of birth
slightly increased from 29 to 30 deaths and it will remain above
the 2030 target of 12 if the current continues going forward.
Similarly, death rate from road trafc accidents declined from
61.4 to 33 deaths per 10,000 vehicles.
5.9.
5.10.
Table 5: Progress Summary – SDG 3
ETHIOPIA VNR 2022
73
Overall, health outcomes improved but the progress has been
sluggish or even worsened in some indicators. In addition, the
COVID-19 pandemic, internal confict, drought, desert locusts,
and price hikes might have reversed the gains registered so far.
There has been extensive damage to health facilities across
Northern Ethiopia, from health posts to hospitals, substantially
impairing service delivery and putting lives at risk. While
there are no estimates yet of excess morbidity and mortality
caused by the combined impact of crises, the reduction and
or absence of vital services – immunization, maternal and
child health (MCH), disease surveillance and management,
COVID-19 vaccination, and treatment – can be expected to
have had serious efects.
5.11.
Figure 5: Mortality Indicators
Source: Ministry of Health
Table 6: Other Health Indicators
Source: Ministry of Health
|
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[
3
] |
{
"country": "eth",
"file_id": "sdg-03/vnr-report-eth-2022-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
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}
|
283Stakeholder consultation – Synopsis report
Main achievements:
Some targets of SDG 3 have been achieved for indicators including life expectancy at birth, gap in life expectancy at birth among
regions, population with good or very good perceived health, etc. Moreover, the EU launched several initiatives in response to the
COVID-19 crisis to support partner countries in addressing both the short-term and long-term effects of the pandemic. The role
of research, science and innovation and the quick mobilisation of vaccines during covid was certainly a major achievement for the
EU. The setting up of the Health Emergency Preparedness and Response (HERA) isa welcome step forward, as is the reinforced role
of the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC). The Europe’s
Beating Cancer Plan is also a milestone to ensure the availability of high-quality, accessible healthcare infrastructure and effective
support systems for patients’ physical and mental well-being. The adoption of the new EU Global Health Strategy is very timely
and will help provide guidelines for the coming years in acomplex environment and reaffirm the EU’s leading role in global health.
Challenging areas where further action is required:
The COVID-19 pandemic had a huge impact on health and care systems all over the EU. Health systems were not ready to face
the pandemic and have not been reinforced or reformed after the covid crisis. Overall, the progress on SDG 3 is too slow and there
are still challenges to reducing inequalities within the EU in health and access to healthcare. Action is required to:
▶ Address the intellectual property rights for vaccines and other treatments by introducing a temporary TRIPS waiver to be
able to ensure that access to the vaccination remains a public good and that developing countries also have access to them.
▶ Address issues with privatisation in health systems (including health data space) and lack of access to affordable healthcare.
▶ Promote decent working conditions for the care and health workforce, including informal carers; update the Action
Plan for the Health and Care Workforce in the European Union to guarantee integrated health workforce planning and
forecasting.
▶ Address health inequalities, which have become even more evident with the pandemic. While the “eave no one behind”
principle should guide action, the pandemic has shown that unbalanced power dynamics and economic interests prevail
over global solidarity.
▶ Give a larger role to the European Parliament, regional authorities and CSOs in the Health Emergency Preparedness and
Response (HERA), and strengthen the participation of civil society and social partners in the European Medicines Agency
(EMA) and the European Centre for Disease Prevention and Control (ECDC).
SDG 3: Ensure healthy lives and promote wellbeing for all at all ages
|
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|
110
Ensure healthy lives and promote well-being for all at all ages
Government’s assessment
3.1 Finland’s maternal mortality ratio is below the
target set.
3.2 In Finland, mortality among newborns and children under
5 years of age is at a very low level and declining.
3.3 No epidemics of AIDS, tuberculosis or malaria exist in
Finland and the spread of hepatitis, communicable
diseases has been prevented.
3.4 Finland has succeeded in reducing premature mortality
from non-communicable diseases while also promoting
mental health and wellbeing.
3.5 Alcohol use has particularly declined among young
people in Finland. The number of drug-related deaths has
increased.
3.6 The number of deaths from road traffic accidents has
declined, but not halved yet. The numbers of injuries
reported to the police have decreased.
3.7 Ensuring universal access to sexual and reproductive
healthcare services by 2030 is not yet reached, but
the situation is reasonable. An ongoing pilot project of
provides contraception free of charge for people under
the age of 25.
3.8 Finland provides health and social services and social
security with universal coverage. The reform aims to
improve the quality and availability of primary services.
Access to medicines and vaccines is ensured for the whole
population.
3.9 There are very few deaths and illnesses from hazardous
chemicals or air, water and soil pollution or contamination
in Finland.
FINLAND HAS SUCCEEDED in guaranteeing high-quality
public health care for the entire population. Access to primary
health care and specialized medical care is guaranteed
regardless of the patient's or client's ability to pay. Finland has
managed to reduce significantly pre-mortem deaths caused by
non-communicable diseases through efficient prevention and
treatment.
Finland has successfully increased awareness of mental
health promotion and mental disorders and reached a broad
consensus on the measures to launch, while also preparing
a National Mental Health Strategy for 2020–2030. Suicide
mortality is declining in Finland. Finland has successfully
reduced smoking, especially among younger age groups.
A specific challenge for Finland is to bring down the
numbers of other causes of premature mortality, including
accidental and violent causes of death, alcohol-related
mortality, and suicides. Mental health problems are a growing
public health challenge. Obesity became a key public health
challenge among both men and women between 2012 and
2017.
Finland’s challenge is that problems with health, safety
and wellbeing only tend to accumulate for some individuals.
Bringing down the overall burden of premature mortality
would require the capacity to also influence other causes of
death (external causes, alcohol-related mortality, and suicides).
Special attention should be paid to narrowing the differences in
mortality between socio-economic groups.
In addition, Finland has challenges with access to services,
which is manifested in terms such as regional differences in
availability and waiting times. The reforms of health and social
services and social security are among the key national policy
initiatives, which are being prepared and implemented in
different areas and at different levels.
Global responsibility. Finland is very active in operations
under the World Health Organisation (WHO) and supports
strengthening the European Union’s role in the field of
global health. Among other things, Finland supports the
implementation of the WHO Framework Convention on
Tobacco Control in all countries as required.
Finland supports the research and development of vaccines
and medicines for communicable and non-communicable
diseases that primarily affect developing countries. We also
endorse the Doha Declaration on the WTO Agreement on
Trade-Related Aspects of Intellectual Property Rights (TRIPS
Agreement). The agreement guarantees access to affordable
essential medicines and vaccines and affirms the right of
developing countries to use to the full the flexibilities included
in trade agreements on intellectual property rights. Finland
works actively to ensure that all countries have the capacity for
early warning, risk reduction and management of national and
global health risks.
Key national policy initiatives
Over the 2017–2018 period, Finland implemented a package of
key government projects, including the key projects to promote
career opportunities for people with partial work ability and to
foster health and wellbeing and reduce inequalities, the reform
of home care and informal care, and the programme to address
reform in child and family services. The previous Government
prepared an administrative reform of health and social services,
which is still ongoing. The reforms address the shortcomings
and new challenges identified in the benefit and service
systems.
111
Ensure healthy lives and promote well-being for all at all ages
Civil society’s assessment
TREND: NEGATIVE
FINLAND’S CHALLENGE IS that funding for global health
efforts has decreased in the past few years although health
has traditionally been a key focus for Finland. It is particularly
alarming that Finland no longer funds the UN Programme on
HIV/AIDS, UNAIDS. Finland has special expertise in health-care
development, and development cooperation in the health
sector is proven to have an impact. Global health competence is
also a safeguard as Finland prepares for global health threats.
Finland’s health service system is among the least equitable
in Europe. There are significant inequalities in health and wellbeing. The uneven geographical distribution of health care
resources reinforces inequality in access to care. There have
been attempts to reform the service structures during several
government terms but these attempts have been unsuccessful.
The number of elderly people in Finland continues to
increase, with the number set to reach 1.5 million in 2030. There
are not enough measures promoting health and well-being
targeted at older persons.
The investment in sexual health in Finland decreased. The
only government authority that coordinated the promotion
of sexual and reproductive health, the Seli unit of the Finnish
Institute for Health and Welfare (THL), was abolished.
The Finnish Medical Society Duodecim and medical
specialist societies produce evidence-based current care
guidelines on significant diseases with an impact on national
health and on their prevention, treatment and rehabilitation.
Due to declining funding, they can no longer produce new
guidelines or maintain all current ones.
The Alcohol Act of 2017 increased the availability of alcohol.
Alcohol-related causes explain one fifth of differences in
mortality by social group among Finnish men and one sixth
among Finnish women. Medicine shortages have drastically
increased over the past ten years and they have partially
led to extended supply shortages of some vitally important
medicines. Households’ share of health-care expenses is greater
in Finland than in other Nordic countries or in the EU on
average. In Finland, psychotherapies and other psycho-social
treatment methods are part of the public sector health services,
but their availability is poor.
Finland has succeeded in highlighting sexual and
reproductive health in its development policy and in actively
defending them and the associated rights in the EU. Finland has
highlighted the rights of the disabled as an overarching theme
of development policy and finances the UN Partnership to
Promote the Rights of Persons with Disabilities, which is mainly
executed by non-governmental organisations, particularly
disabled people’s organisations.
The Programme of Prime Minister Sanna Marin’s Government
highlights the narrowing of health and well-being gaps through
high-quality health and social services as one of its goals, while
highlighting preventive health policy and health-promoting
taxation. The Programme pledges to secure necessary care and
treatment also for all undocumented migrants. If enacted in
law, this would be a significant step in realising a fundamental
human right.
The Programme also proposes to trial free contraception
for everyone under the age of 25, which is significant for the
sexual health and equality of young people. The Tobacco Act
has reinforced the policy on tobacco and created nicotinefree living environments. Smoking has decreased throughout
the population, especially among young people. Finland
has published a national mental health strategy and suicide
prevention programme for 2020–2030 and launched the
preparation of a child strategy that will extend beyond one
government term of office.
Finland must
• invest in implementing the Government Programme so that
it can secure equal health and social services for everyone
• make global health a development policy priority and
restore the level of funding to what it was before the
spending cuts
• promote access to health services especially among those in
vulnerable situations both in Finland and globally.
Organisations participating in this assessment: Finnish
Development NGOs Fingo, EHYT Finnish Association for
Substance Abuse Prevention, the Finnish Association of People
with Physical Disabilities, Physicians for Social Responsibility
– Finland, MIELI – Mental Health Finland, SOSTE Finnish
Federation for Social Affairs and Health and the Family
Federation of Finland.
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26 | VOLUNTARY NATIONAL REVIEW • FIJI’S PROGRESS IN THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS
SDG 3: GOOD HEALTH AND
WELL-BEING
Ensure healthy lives and promote well-being for all at all
ages
Overview
The 2013 Constitution of the Republic of Fiji mandates
that the Fijian Government works to realise the right to
good health and well-being for every Fijian. The National
Development Plan (NDP) has explicitly integrated a
number of SDG 3 targets and indicators which include:
• reducing the maternal mortality ratio to less
than 39.2 or less than 8 deaths by 2021;
• reducing the perinatal mortality rate to less
than 9 per 1,000 total births by 2030;
• reducing the infant mortality rate to less than 8
per 1,000 live births by 2030;
• reducing the under 5 mortality rate to less than
8 per 1,000 live births by 2030;
• reducing the neonatal mortality to less than 5
by 2021;
• reducing the prevalence rate of tuberculosis to
less than 77 per 100,000 population by 2021;
• reducing the total number of confrmed HIV
cases to less than 900 by 2021;
• reducing premature mortality due to noncommunicable diseases (NCDs) (<70 years) to
less than 20% by 2030; and
• reducing the prevalence of diabetes to less than
30% by 2030.
The NDP proposes to achieve these targets through
strengthening and implementing integrated programmes
for maternal and child health, expanding the
immunisation programme, strengthening the integrated
management of childhood illnesses, and improving
reproductive health.
At the sectoral level, the Ministry of Health and Medical
Services (MoHMS) has developed a National Strategic
Plan for 2016-2020. The Plan has two main strategic
pillars. The frst of which focuses on the delivery of
health services to the population through reducing the
risks of NCDs, improving maternal/child health and
reducing communicable diseases and the second, aims
to strengthen systems to improve overall health sector
performance by expanding access to primary health
care, cultivating a more motivated health workforce to
improve productivity, improving standards of evidencebased policy planning and implementation, developing
health infrastructure, and securing sustainable fnancing.
For some of the priority areas, MoHMS has developed
targeted strategic plans, including a National Wellness
Policy, the NCDs Strategic Plan, and the Climate Change
and Health Strategic Action Plan.
Governance and Service Delivery
Fiji’s health care services are delivered through a wellestablished health system, based on quality primary
care. The three-tiered structure provides integrated
services at primary, secondary and tertiary levels,
and includes government, private and traditional care
providers. The MoHMS is responsible for developing
health policies and managing the overall system.
Primary and public health are administered through four
Divisional level offces, which in turn are broken down
into 19 subdivisions. Actual health care services are
provided through a hierarchy of nursing stations, health
centres, sub-divisional hospitals, divisional hospitals
and specialised hospitals. Divisional hospitals provide
tertiary care and also function as national domestic
referral centres.
Major Health Indicators
Maternal and Child Health
At the end of 2017, Fiji’s maternal mortality ratio of 35.6
per 100,000 live births live births fell considerably under
the global maternal mortality ratio of 90 per 100,000
live births. The maternal mortality ratio has reduced
from 59.47 per 100,000 live births in 2012 to 35.6 in
2017. However, trends in recent years indicate that there
remains a need to raise greater awareness on maternal
child health care and tackling issues that would continue
to help reduce maternal mortality.
VOLUNTARY NATIONAL REVIEW • FIJI’S PROGRESS IN THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS | 27
Under 5 and Infant Mortality
Countries globally are aiming to reduce neonatal
mortality to at least 12 per 1,000 live births and under-5
mortality to at least 25 per 1,000 live births and, in Fiji,
signifcant progress has been made in recent years to
prevent deaths of newborns and children under 5 years
of age. Nevertheless, statistics indicate the need for
more progress to further improve the infant and under-5
mortality rates. Fiji’s infant mortality rate stood at 16.4
per 1,000 live births in 2017 compared to 15.9 per 1,000
live births in 2012. The under-5 mortality rate stands at
20.8 per 1,000 live births in 2017 compared to 21.0 per
1,000 live births in 2012. Progress has been steady, but
it must accelerate, through substantial improvements to
the quality of antenatal and perinatal services.
Non-Communicable and Communicable Diseases
A growing concern contributing to the substantial share
of disease and mortalities in Fiji is premature mortality
resulting from NCDs. The burden of NCDs continues
to place signifcant demand on health resources. The
number of confrmed cardiovascular cases is on the
rise. It should be noted that this increase is largely in
part to improvements in diagnostics, referrals, and
cardiovascular interventions such as angiograms.
Admissions for cardiovascular diseases have increased
from 35 per 1000 admissions in 2013 to 59 in 2017 and
a leading cause for this is rheumatic heart disease.
Mortality due to diabetes has decreased. However,
cancer mortality has increased. Overall the rates of
mortality relating to cardiovascular, cancer, diabetes
and chronic respiratory disease has reduced from 4,455
in 2012 to 4,120 in 2017.
Diabetes continues to be one of the major factors in
the increase in the number of patients seeking dialysis
treatment. The Fijian Government has invested in
purchasing dialysis machines for the three dialysis
centers located at the main divisional hospitals: CWMSuva, Lautoka and Labasa.
Poor nutrition is also a contributing factor in the increase
in NCDs. Preventative measures are being undertaken to
address the issue through advocacy for healthy eating
habits, physical activity and other lifestyle changes.
In terms of communicable diseases, Pneumonia and
Leptospirosis account for the greatest number of deaths
in Fiji. TB case notifcations have increased over the last
5 years from 201 in 2012 to 363 in 2017. This increase
can be also attributed to improvements in the case
detection rate and increased efforts in TB programs.
The current incidence rate for Fiji is 49 per 100,000.
At the end of 2018, a total of 927 cases of HIV have been
reported. The UNAIDS’s Fiji Country snapshot report in
2016 found that only 259 people who were confrmed
HIV cases were receiving antiretroviral therapy (ART)
treatment.
The incidence of Hepatitis B has reduced from 37.41
per 100,000 population in 2014 compared to 12.5 in
2017. In Fiji, Hepatitis B immunisations are part of the
immunisation schedule for infants under 18 months
which are free and available to all newborns in Fiji.
Frequent infectious disease outbreaks have been
reported with some pathogens showing multi-drug
resistance. This has limited access to effective
antimicrobials treatment for patients. Fiji is also taking
a holistic and multi-sectoral approach to address the
emergence of multi-drug resistance to ensure the
sustainable access of effective antimicrobials treatment
for patients.
In terms of suicide, an average of 67 people committed
suicide between 2012 and 2017. Family disputes and
relationship problems are the most common contributing
factors for individuals to attempt or commit suicide.
The MoHMS in partnership with stakeholders and other
organisations are working towards creating awareness
on suicide prevention and mental health. For example,
efforts are currently undertaken by the MoHMS and the
World Health Organisation on primary health care and
school-based support for mental health issues.
Opportunities for Collaboration
The epidemic of NCDs that has plagued the nation
requires both curative treatment and preventive actions.
This challenge needs to be overcome through actions
that target all aspects of the health system, including
governance, health workforce, health fnancing, essential
medicines and technologies, health information system,
as well as health delivery. Ultimately, the most viable
option for combating NCDs is continuing to focus efforts
on prevention and primary healthcare.
There are opportunities to reduce child mortality
rate further by tackling the root causes relating to
demographics, health system, health service delivery
and patients’ health seeking behaviours. A similar
approach should be taken to deliver good quality sexual
and reproductive health services throughout the country.
Some progress has been made over the years to increase
the fnances available for health. Government fnancing
remains the dominant source of funds accounting for
28 | VOLUNTARY NATIONAL REVIEW • FIJI’S PROGRESS IN THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS
approximately 64% of total Current Health Expenditure
(CHE) in 2016. Large public investment in health
means that out-of-pocket (OOP) expenditure for health
remains relatively low at 21% of total CHE compared
to 15% in 2015. Thus, to better track catastrophic
health expenditure, the MoHMS in collaboration with
the National Statistics Offce and the World Health
Organisation, will look into strategies to reduce the
burden of out-of-pocket spending for households.
The Ministry’s ability to fulfl its core functions largely
depends on the extent to which their workforce (in terms
of numbers, cadres, skill levels, distribution, and other
metrics), meet the health needs of the population. The
strategic objective is to have a productive, motivated
health workforce with a focus on patient rights and
customer satisfaction. A review for doctor’s cadre was
undertaken this year which was largely to better align
doctor’s positions to address the needs of the Ministry.
While progress has been made on the recruitment of
new doctors and nurses, the challenge is to ensure that
health services for all patients are addressed at all health
facilities. The health service coverage is extensive and
free for all patients which signifes Fiji’s commitment to
prioritise equitable health outcomes and risk protection.
There is greater accessibility of services for the poor,
which is a priority in terms of service delivery. This issue
has been further strengthened through a decentralization
of services for general outpatients to the health centres
in the subdivisions, which has brought services closer
to peri-urban and rural populated areas thus improving
accessibility.
In January 2019, the Fijian Government formalised
a public private partnership agreement in its quest to
increase private sector participation in improving the
effciency and level of health services made available
in Fiji. Aspen Medical from Australia was the winning
bidder under this new arrangement and will fully take
over operations at the Lautoka and Ba hospitals by early
2020. The project will not only signifcantly improve
access to specialist services available in the country
but also reduce the cost of overseas patient referrals
due to services such as clinical services, admitted acute
care, non-admitted care, and emergency care.
|
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|
39
40
SDG 3: Good Health and Well-Being
Ensure Healthy Lives and Promote
Well-being for All at All ages
Fiji’s priority targets for SDG 3 are:
Target 3.1 – By 2030, reduce the global maternal mortality ratio to less than 70 per
100,000 live births
Target 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
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
Target 3.4 - By 2030, reduce by one third premature mortality from non-communicable
diseases through prevention and treatment and promote mental health and wellbeing
Target 3.5 - Strengthen the prevention and treatment of substance abuse, including
narcotic drug abuse and harmful use of alcohol
Target 3.6 - By 2020, halve the number of global deaths and injuries from road trafc
accidents
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 programmes
Target 3.8 - Achieve universal health coverage, including fnancial risk protection,
access to quality essential health-care services and access to safe, effective, quality
and affordable essential medicines and vaccines for all
Target 3.c - Substantially increase health fnancing and the recruitment, development,
training and retention of the health workforce in developing countries, especially in
least developed countries and small island developing States
Maintain
Accelerate
Reverse
Not Assessed
Goal 3 3.1 Maternal Mortality
3.2 Child Mortality
3.3 Communicable Diseases
3.4 NCD & Mental Health
3.5 Substance Abuse
3.6 Road Traffic Accidents
3.7 Sexual & Reproductive Health
3.8 Universal Health Coverage
3.9 Health Impact of Pollution
3.a Tobacco Control
3.b R&D for Health
3.c Health Financing & Workforce
3.d Management of Health Risks
41
It is imperative that Fiji accelerates progress towards achieving this SDG. Targets 3.1, 3.4, 3.8, 3.a, and 3.c require
accelerated progress if Fiji is to meet these targets by 2030. However, there has been regression in Targets 3.2, 3.3, 3.5,
3.6, 3.7, 3.9, and 3.b. Target 3.d, unfortunately, could not be measured.
Maternal Health
Fiji has made remarkable progress in Skilled Birth Attendance (SBA), Total Contraceptive Prevalence Rate (CPR), and
Adolescent Birth Rates (ABR) over the last three decades. The SBA increased from 98% in 1990 to 100% in 2021, CPR
rose from 29% in 2009 to 36% in 2021, and ABR decreased from 36% in 2007 to 31% in 2021.
However, despite this progress, an independent review conducted in 2019 by Fiji’s Obstetrics and Gynaecology Clinical
Service Network, Ministry of Health and Medical Services (MHMS), and the United Nations Population Fund (UNFPA)
revealed an MMR of 86/100,000 live births, surpassing the SDG target of 70/100,000 live births. This underscores the
need for focused attention on improving the quality of maternal and newborn health services, particularly in hard-toreach rural areas and for marginalized girls and women in the country.
To address this, Fiji has made signifcant efforts to provide transportation logistics for women in labor and ensure that
the majority of births in the country are attended by skilled birth attendants, including midwives, nurses, and doctors.
Fiji has made efforts to provide transportation for women in labor and to ensure that nearly all birhts occur in the
presence of competent birth attendants. Currently, 87% of all deliveries in Fiji take place in six facilities: Colonial
War Memorial Hospital (CWMH) in Suva, Lautoka, Labasa, Nadi, Sigatoka, and Nausori Hospitals. Referral rates for
complications from SHD to DH are high, constituting between 22% to 34% of all deliveries in each division. Deliveries
at DH have increased since 2003, and CWMH and Lautoka Hospital are operating beyond capacity. However, access to
quality maternal healthcare remains a challenge for women residing in the hard-to-reach maritime areas.
Children’s health
The neonatal mortality rate in Fiji has seen a signifcant increase, rising from 9.3 per 1000 births in 2017 to 22.2 in 2021.
One possible reason for this increase is that while the number of deaths has remained relatively stable, there has been
a decline in the number of births, which impacts the calculation of the mortality rate.
42
The under-5 mortality rate in Fiji has experienced a signifcant increase, nearly doubling over a six-year period, from
16.6 deaths per thousand live births in 2015 to 32.2 in 2021. This comes after showing positive signs of decline from a
fgure of 21 deaths per thousand live births in 2012.
Combatting Communicable Diseases
As a tropical country, Fiji is susceptible to several
diseases that are endemic to tropical regions. These
include Dengue, Leptospirosis, Typhoid, Tuberculosis,
and Lymphatic flariasis.
Dengue is a painful and debilitating disease that
can have serious consequences. While most cases
recover within approximately a week, there are
instances where the disease can be fatal. It is primarily
transmitted by infected mosquitoes. At times, the
number of infections can reach epidemic levels. For
instance, in the years 2013-2014, Fiji experienced
over 15,000 confrmed cases of Dengue. During
such periods, the government implements spraying
campaigns to control the population of mosquitoes
carrying the disease.
The WISH Fiji surveys conducted across 29
communities revealed that the incidence of Dengue
cases, totalling 60 reported cases over three years,
was associated with various factors. These factors
include a lack of effort to control standing water
(including water in containers) and overgrown
vegetation around houses, the presence of mosquito
larvae within households, the number of people in
households and their relative wealth, the proximity
of swamps, the frequency of fooding and the extent
of food-prone areas in the watershed, as well as the
presence of highly erodible soil and pathways for its
entry into creeks through road crossings.
The WISH-Fiji Project
The WISH-Fiji project, initiated in late 2018, is a
proof-of-concept research program supported by the
Australian DFAT and Bloomberg Philanthropies. It
receives backing from the Fiji Ministry of Health and
Medical Services. The project’s objective is to evaluate
ecosystem-based and health system interventions in
fve sub-catchments in Fiji to address the prevalence
of three diseases: typhoid, leptospirosis, and dengue.
The research group involved in the project comprises
members from the University of Sydney, Edith Cowan
University, Fiji National University, and the Wildlife
Conservation Society. Collaborative partnerships
have been formed with the Fiji Ministry of Health and
Medical Services, the Fijian National Drinking Water
Quality Committee, WHO, and UNICEF.
The project team aims to develop and implement
practical approaches that integrate water quality
monitoring, assessment of water-related diseases,
and interventions in the areas of water safety,
sanitation, and catchment management. The primary
focus is on implementing proactive measures to
prevent, detect, and respond to water-related diseases
in Fiji, emphasizing upstream solutions.
The project’s objectives include establishing multisectoral planning and implementation processes to
mitigate the risks of water-related diseases, providing
a model for water-related disease control in the region,
and generating crucial evidence to inform policy
development not only in Fiji but also in other Pacifc
Island Countries.
43
Leptospirosis is a bacterial disease that can infect both humans and animals, and it is a common infection in Fiji. In
February 2022, the Fiji Ministry of Health reported 179 confrmed cases of leptospirosis following a period of heavy
rains and fooding in the country. Among the reported cases, 73 were from the Western Division, 65 from the Central
Division, 38 from the Northern Division, and 3 from the Eastern Division. Unfortunately, 14 deaths were recorded among
these cases. The majority of those affected were males between the ages of 20 and 49.
In early 2023, there was a signifcant increase in leptospirosis cases in the Northern provinces of Macuata and Bua.
Between January 1st and February 26th, the Ministry of Health and Medical Services reported 171 cases, and an
additional 50 cases were recorded in the following week. In response to this surge, the Ministry of Health actively
conducted awareness and advocacy campaigns in the Northern division to emphasize the importance of adhering to
preventive measures for leptospirosis.
Typhoid is an exclusively human, fecal-orally transmitted, systemic disease caused by infection with the bacterium
Salmonella enterica subspecies enterica serovar Typhi (S. Typhi). Among Pacifc countries, Fiji has the highest infection
rate, which has been steadily increasing every year since 2005. Typhoid in Fiji is typically seasonal and is associated
with prolonged heavy rainfall and tropical cyclones. It has also been recognized that socio-cultural and behavioral
factors play a role in the transmission of typhoid.
Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis. While the bacteria primarily affect the
lungs, they can also target other organs like the kidneys, spine, and brain. TB is both curable and preventable, but
without proper treatment, it can be fatal. In recent years, TB rates have remained stable, with fewer than 100 cases
reported annually. Since the year 2000, there has been an improvement in the detection of TB cases, and the treatment
rate has remained relatively consistent.
Lymphatic flariasis (LF) ) is a parasitic disease transmitted by mosquitoes that can cause signifcant morbidity in
humans. In Fiji, LF is caused by the thread-like flarial worm, Wuchereria bancrofti. The Ministry of Health’s Lymphatic
Filariasis Programme focuses on two main pillars: transmission control through Mass Drug Administration (MDA) and
Morbidity Management and Disability Prevention. These pillars aim to eliminate lymphatic flariasis in Fiji, with the goal
of reducing the prevalence to less than 1% by 2030.
Signifcant progress has been made in reducing the national prevalence of LF in Fiji. The prevalence decreased from
16.6% in 2000 to 9.5% in 2007. However, the disease has not been completely eradicated in Fiji.25 In response to the
9.5% prevalence in 2007, two rounds of national MDA were implemented between 2008 and 2009. Due to limitations
in human and fnancial resources, surveys and MDA were then conducted in four hotspot islands representing Fiji’s
four divisions. These islands include Serua (Central) with a prevalence of 28.4% (2022 Sentinel survey), Malolo Island
(Western) with a prevalence of 15.9%, Taveuni (Northern) with a prevalence of 7.7%, and Rotuma (Eastern) with a
prevalence of 15% (the last three determined through a 2019 Sentinel survey).
25 World Health Organisation - https://apps.who.int/neglected_diseases/ntddata/lf/lf.html
26 https://www.aidsdatahub.org/country-profles/fji
HIV/AIDS
As of 2022, there were approximately
1,400 people living with HIV in Fiji. Out of
this number, 647 individuals, or 45%, were
receiving antiretroviral therapy (ART).26
According to UNAIDS estimates, new HIV
infections have increased by 129% in Fiji
since 2010. The Ministry of Health and
Medical Services aims to reduce and prevent
new infections while also addressing the
treatment gap.
Starting from 2024, Fiji plans to re-engage
with the Global Fund, although there may still
be funding gaps that need to be addressed.
Fiji’s intention is to introduce PrEP, point-ofcare testing, and community-based/led HIV
programming, aligning with the 2021 HIV
political commitments.
NEW INFECTIONS
<200
PEOPLE LIVING WITH HIV
1400
PEOPLE ON ART
(45% ART COVERAGE)
647
AIDS RELATED DEATHS
<100
44
COVID-19
The frst case of COVID-19 was reported in Fiji on March 19, 2020. From March 2020 to January 2023, there were
68,771 confrmed cases of COVID-19 in Fiji, resulting in 883 deaths.27 The vaccination campaign for COVID-19 in Fiji has
been successful, with 99% of the population aged 12 and above receiving the frst dose and 89% receiving the second
dose. Additionally, as of mid-February 2023, 170,867 individuals received a booster dose, and 29,208 received a second
booster dose.28 The economic impact of COVID-19 is discussed in another section of this report.
Combatting Non-Communicable Diseases
Non-communicable diseases (NCDs) have been a serious problem in Fiji. Approximately 800 people in Fiji require
dialysis every year, and diabetes affects 15.8% of Fiji’s population, with 60% of those admitted to the hospital being
diabetic.29
The prevalence of NCDs in Fiji and the Pacifc region has reached crisis levels. The most recent NCD STEPS survey in Fiji
has revealed alarming trends of increasing levels of risk factors, unhealthy behaviors, and NCDs. This has highlighted
the urgent need for a comprehensive response involving all stakeholders to address this crisis. In 2015, a Fiji NCD
Strategy was developed to tackle the problem.
The strategy focuses on a multisectoral approach, improved service delivery through the integration of prevention,
early diagnosis, and treatment at all levels of primary healthcare, enhanced monitoring and evaluation, and capacity
building to deliver these services effectively.
Recently, the Ministry of Health has developed a Wellness Strategic Plan 2023–2030, which outlines an ambitious
yet achievable approach to reducing preventable NCDs and related conditions in Fiji. The plan is based on a logical,
results-driven framework that aligns with national, regional, and global wellness and NCD plans. It aims to achieve
economic, social, and health objectives by addressing barriers, challenges, and defcits while capitalizing on strengths
and opportunities. The plan provides fexibility to adapt to evolving external circumstances and focuses on three
priorities: wellness promotion and disease prevention, clinical treatment and management for individuals with NCDs,
and foundational systems and enabling support to create efcient and effective operations.
27 World Health Organization Covid19 Data - https://covid19.who.int/region/wpro/country/fj
28 Fiji Ministry of Health
29 Dr Eddie McCaig speaking at the National Economic Summit, April 2023.
Treatment Gap People on ART PLHIV
1,300
1,200
1,100
960
880
800
720
650
580
530
470
420
370 330 290
220 190 150 170 130
250
794
506 434 352 274 202 222 160 165 195 0 0 0 0 11 20 28 36 50 63 79 96
764
748
686
658 598 525
485 420
434 391
320 357
294 262 209 230
120 150 170 190
2000
0
500
Number
1000
1500
People living with HIV, people on ART and treatment gap,
2000 - 2020
2005 2010 2015 2020
45
Addressing Mental Health
Mental health has traditionally been a taboo
subject in Fiji, with individuals suffering from
mental illness often hesitant to seek help.
The country’s main mental care institution,
St Giles Hospital, provides care for all
mental patients regardless of the level of
care they require. Empower Pacifc, a CSO,
offers counseling services to individuals
experiencing challenging, stressful, and
psychologically traumatic experiences.
One positive development in Fiji is the
decrease in the suicide mortality rate, which
dropped from 3.8 per 100,000 population in
2017 to 0.9 in 2021.
Engaging in physical exercise and sports
plays a signifcant role in reducing the
incidence of NCDs and promoting better
mental health. In the 2030 Agenda preamble,
the UN recognizes sport as a crucial driver
of sustainable development and peace,
empowering women, youth, individuals,
and communities.30 Fiji has a strong
sporting culture, and many Fijians have
successful careers as professional athletes,
particularly in rugby, with several playing for
prominent international clubs. Sports also
contribute to other SDGs, such as quality
education (SDG4), gender equality and the
empowerment of women and girls (SDG5),
sustainable cities and communities (SDG11),
peacebuilding, accountable and inclusive
institutions (SDG16), and partnerships for
the goals (SDG17).31
30 https://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_RES_70_1_E.pdf
31 https://www.un.org/en/chronicle/article/role-sport-achieving-sustainable-development-goals
Tobacco Use
The Ministry of Health and Medical Services in Fiji has been actively engaged in tobacco prevention and control efforts.
Their primary objective is to enhance the overall health of the population by reducing tobacco use and addressing the
associated social, economic, and health disparities. To achieve this, the Fiji Tobacco Strategic Plan for the years 2023
to 2030 has been developed, which outlines eight major strategies and corresponding activities aimed at achieving a
30% reduction in tobacco use.
The major strategies identifed in the plan encompass various aspects of tobacco control, including:
1. Addressing tobacco industry interference.
2. Enhancing governance, infrastructure, and capacity building.
3. Regulating advertising, promotion, and sponsorship related to tobacco.
4. Promoting alternative crops to tobacco farming.
Empower Pacifc
Established in 2014, Empower Pacifc is an organization
dedicated to maximizing the potential of communities
through collaborative efforts with the government and
other community agencies. Their goal is to provide a
comprehensive model of professional health services,
encompassing various programs that enhance the health
and well-being of their clients. Additionally, Empower Pacifc
facilitates opportunities for learning, income generation, and
personal growth. One notable initiative of Empower Pacifc
is the management of a helpline, which offers assistance
to individuals in need of support to address mental health
issues.
NI KO GADREVA MO
ROGOCI, LIFELINE ENA
ROGOCI IKO.
Crisis Support Line
Toll Free | 24 hours a day
132 454
WHEN YOU NEED TO
TALK, WE’RE HERE TO
LISTEN
46
5. Ensuring tobacco products are less affordable and accessible.
6. Expanding cessation services to support individuals in quitting tobacco use.
7. Implementing effective tobacco control policies.
8. Conducting communication and promotional campaigns to raise awareness
Access to Sexual and Reproductive Health
Although CPR was increasing in Fiji, the high rate of unmet needs for family planning (FP) remained a concern.
Approximately 26% of women of reproductive age (15-49 years) who wished to avoid pregnancy were not using a
modern contraceptive method. To address this issue, the Fiji Ministry of Health and Medical Services, in collaboration
with UNFPA, has been actively working to strengthen in-service training for FP health workers, including at the nursing
station level, to ensure universal access to FP/SRH services.
In 2022, the Ministry successfully trained 82 health workers in FP, utilizing the updated WHO Family Planning curriculum.
The training program was designed with a human rights and client-centered approach, aiming to equip health workers
with the skills to provide comprehensive family planning counseling, including the provision of various contraceptive
methods, such as long-acting reversible contraceptives (LARCs). It also focused on screening women and girls at risk
of gender-based violence, offering basic counseling and referrals, and delivering quality services to individuals with
disabilities. The Ministry’s objective is to have at least one fully trained staff member available in all health facilities,
ensuring youth-friendly and disability-inclusive family planning services. Currently, 39% of health facilities have received
training using the updated curriculum.
To improve the overall quality of FP/MH/SRH services, including client feedback, the Ministry of Health, in collaboration
with its partners, has developed a Sexual and Reproductive Health supportive supervision tool. This tool will be
implemented to provide on-the-job mentoring and supervision for trained health workers.
The Ministry of Health also oversees a Family Health program, which focuses on managing, implementing, monitoring,
and evaluating programs related to Child Health, Maternal Health, HIV/STIs, Reproductive Health, and Gender.
Furthermore, the Reproductive & Family Health Association of Fiji (RFHAF) has been operating in Fiji since 1996.
The organization plays a crucial role in supporting reproductive and sexual health issues, advocating for the rights of
individuals, families, high-need groups, and the broader community.
Health Coverage
Fiji’s Universal Health Coverage (UHC) service coverage index has shown improvement, reaching 61 in 2019 compared
to 56 in 2010. The UHC Index measures the average coverage of essential services, including reproductive, maternal,
newborn, and child health, infectious diseases, non-communicable diseases, and service capacity and access. The
index is measured on a scale from 0 (worst) to 100 (best), indicating the level of coverage achieved.
Health workers
Health workers play a crucial role in Fiji’s health system and are considered its backbone. The country has tertiary
education institutions that train medical, dental, and nursing professionals. However, the demand for health professionals
remains a persistent challenge as these professions are highly sought after in overseas markets. Currently, Fiji has
3,056 nursing positions.
In 2022 alone, 807 nurses (26% of the total) resigned from the Health Ministry, highlighting the need to address retention
and workforce stability. The Ministry recognizes the importance of having well-supported, appropriately compensated,
and capable healthcare professionals who are compassionate and caring. Finding inclusive and consultative solutions
to this ongoing problem is crucial.32
32 Minister of Health’s speech in Parliament (15 February 2023).
|
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18
GUIDELINES
Maintain a high level of healthy, long life expectancy and well-being
Achieve universal health coverage and easy access to healthcare
Eradicate environmental health risk inequalities
Work to end the major epidemics (HIV/AIDS, tuberculosis and malaria)
Achieve equal access for all to healthcare and health services
CHALLENGES AND ACTIONS
IN FRANCE
The French social security system was founded in 1945
to “ensure that everyone should have the means
required to support themselves and their family in
decent conditions, in all circumstances.” The “means
required” cover: health insurance, occupational injuries
and diseases, pensions and family benefits. To ensure
the sustainability of the French health system, the
government is currently making savings to restore the
balance of the social security accounts, optimising
hospital expenditure, reducing the price of medicine
and promoting generic drugs. For the future, France
needs to take up two major challenges: equal access to
healthcare nationwide and the ageing of the French
population whose life expectancy at birth stood at 85.1
years for women and 79 years for men in mainland France
in 2015 (INSEE). This entails preparing for new needs and
new forms of intergenerational solidarity and their
financing. France also needs to scale up its disabled persons
policy with work on accessibility, vulnerability and inclusion
in society.
INTERNATIONALLY
France has a proactive international health policy. It has
made sexual and reproductive health one of its
priorities. Some €500 million were allocated to the
Muskoka Initiative from 2011 to 2015, reducing
maternal, newborn and child mortality. In 2016, France
again earmarked €10 million for this initiative.
France also works on building the capacities of national
health systems to increase their resilience to crises, a
weakness tragically illustrated by the Ebola epidemic in
2015. This work concentrates mainly on ten Frenchspeaking African countries and Haiti. To this end, France
funds an array of projects to improve health security
and actively participates in research with Aviesan and
the REACTing consortium. On the UN High-Level
Commission on Health Employment and Economic
Growth set up by the United Nations in March 2015 and cochaired by the President of the French Republic, France also
plays a driving role in thinking on human healthcare
resources. Universal health coverage, the cornerstone of
health for all, is a key French priority. France supports the
UHC 2030 project at the highest level in the multilateral
organisations.
France’s international health solidarity is based on a
partnership approach in keeping with SDG 17. It works with
a range of players, its operators such as the French Agency
for Development (AFD) and Expertise France, and civil
society. France recognises in particular the leading role
played by NGOs in the Ebola virus epidemic in 2012, from
alerting the international community through caring for
patients on the ground to prevention and follow-up.
ENSURE HEALTHY LIVES AND PROMOTE
WELL-BEING FOR ALL AT ALL AGES
From 1995 to 2012, healthy life expectancy rose
from 62.4 to 63.8 years for women and from 60 to
62.6 years for men
Eurostat
19
REGIONAL HEALTHCARE PACT Launched in December 2012,
the Regional Healthcare Pact offers incentives to young
doctors to establish their practices in underserved areas.
It is also designed to develop healthcare infrastructures
such as multidisciplinary health centres and healthcare
clusters.
GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA France is the number two contributor to the Global Fund to
Fight AIDS, Tuberculosis and Malaria, to which it has just
renewed its pledge of €1.08 billion for the next three years. It
is the leading contributor to UNITAID, providing over half of
the organisation’s funds. It supports the Global Alliance for
Vaccines and Immunization (GAVI). In total, France
channels over €500 million a year into these three bodies.
THE 3RD NATIONAL
ENVIRONMENTAL HEALTH PLAN for
2015 – 2019 is designed to reduce
the impacts of environmental
factors on health and the
inequality of exposure to these
impacts: air and water pollution,
effects of pesticides on health,
endocrine disruptors, noise, waves,
nanomaterials, etc. In 2015, France
banned bisphenol A from food
containers and is working to scale
up the regulations on pesticides.
THE HEALTH ACT Three strands structure the health
system’s modernisation: innovation for prevention
(health education, information campaigns and
screening), innovation for local healthcare (system of
direct payment by insurers for medical treatment, local
medical treatment and the public hospital service) and
innovation to increase patients’ rights and safety
(confidentiality, drug safety, abortion and digital
modernisation). Also of note is the creation of the
French Public Health Agency.
PROTECTION FOR ALL
The Universal Healthcare System
(PUMA) now guarantees
healthcare cost coverage to
everyone working or living in
France, without the need for any
particular formalities.
ROAD SAFETY
Road fatalities in mainland France fell from 17,000 a year in the early 1970s
to 3,500 a year in 2015. Measures have been adopted to reduce speeds
and harmonise legislation at European level to roll back the number of
deaths from 3,000 to 2,000 by 2020.
THE HEALTHCARE INNOVATION INVESTMENT FUND, has a budget of
€340 million to assist sector entrepreneurs with their projects and
promote the spread of healthcare innovations. In addition,
public and private research bodies work together on the
Strategic Advisory Board on the Health Industries (CSIS) to
disseminate innovations and monitor antibiotic resistance.
HEALTH AND CIVIL SOCIETY
A 30-year associationbusiness partnership
responds to humanitarian
emergencies with pooled
funds and emergency kits
containing new, locally
appropriate healthcare
products.
|
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18
ORIENTATIONS
Maintenir une espérance de vie et un bien-être élevés par une santé optimale
Assurer une couverture santé pour tous et un accès aux soins simplifié
Lutter contre les inégalités face aux risques pour la santé liés à l’environnement
Œuvrer à l’éradication des grandes pandémies (sida, tuberculose, paludisme)
Permettre un accès universel et équitable aux soins et aux services de santé
ENJEUX ET ACTIONS
EN FRANCE
Créée en 1945, la Sécurité sociale « est la garantie
donnée à chacun qu'en toutes circonstances il disposera
des moyens nécessaires pour assurer sa subsistance et
celle de sa famille dans des conditions décentes ». Par «
moyens nécessaires », il est entendu: assurance
maladie, réparation des accidents du travail et des
maladies professionnelles, retraites et prestations
familiales. Pour assurer la pérennité du système de
santé français, le gouvernement poursuit actuellement
le rétablissement des comptes sociaux par des
économies portant sur l’optimisation de la dépense
hospitalière, sur la baisse du prix des médicaments, ou
encore sur la promotion des médicaments génériques.
Pour l’avenir, la France doit relever deux défis majeurs :
l’égalité de l’accès aux soins dans les territoires et le
vieillissement de la société française dont l’espérance de vie
à la naissance atteint en 2015, en France métropolitaine,
85,1 ans pour les femmes et 79 ans pour les hommes,
(INSEE). Il s’agit d’anticiper les nouveaux besoins et les
nouvelles formes de solidarité intergénérationnelle ainsi
que leurs financements. En outre, la France doit amplifier sa
politique en faveur des personnes handicapées, à la fois en
matière d’accessibilité, de vulnérabilité et d’inclusion dans
la société.
A L’INTERNATIONAL
La France mène une action volontariste en santé
internationale. Elle a fait de la santé sexuelle et
reproductive une de ses priorités. Environ 500 millions €
ont été consacrés à l’initiative Muskoka entre 2011 et
2015, qui a permis de réduire la mortalité maternelle,
néonatale et infantile. En 2016, la France a renouvelé
son engagement à hauteur de 10M d’euros.
La France œuvre également au renforcement des
systèmes de santé nationaux pour accroître leur
résilience aux crises, une défaillance dramatiquement
illustrée par l’épidémie d’Ebola en 2015. C’est
notamment le cas dans dix pays d'Afrique francophones
et en Haïti. La France finance donc de nombreux projets
afin de renforcer la sécurité sanitaire et participe
activement à l’effort de recherche au travers d’Aviesan
et du consortium REACTing. A travers la commission de
haut niveau sur l’emploi en santé et la croissance
économique créée par les Nations unies en mars 2016 et
co-présidée par le Président de la République, elle joue
aussi un rôle moteur dans la réflexion sur les ressources
humaines en santé. . En outre, la couverture santé
universelle, pierre angulaire d’une santé accessible à tous,
est au cœur des priorités françaises. Ainsi, la France porte le
projet UHC 2030 au plus haut niveau au sein des
organisations multilatérales.
La solidarité internationale en santé de la France repose sur
une approche partenariale, en cohérence avec l’ODD 17.
Elle associe une diversité d’acteurs, ses opérateurs comme
l’AFD ou Expertise France tout comme la société civile. Elle
reconnaît en particulier le rôle de premier plan joué par les
ONG dans l’épidémie de maladie à virus Ebola en 2015,
allant de l’alerte de la communauté internationale, à la
prise en charge des patients sur le terrain en passant par la
prévention et le suivi.
PERMETTRE A TOUS DE VIVRE EN BONNE SANTE ET
PROMOUVOIR LE BIEN-ETRE DE TOUS A TOUT AGE
Entre 1995 et 2012, l’espérance de vie en bonne
santé est passée de 62,4 à 63,8 ans (femmes) et de
60 à 62,6 ans (hommes)
Eurostat
19
PACTE TERRITOIRE-SANTE, Lancé en décembre
2012, le pacte territoiresanté propose des
mesures d'incitations
pour l'installation des
jeunes médecins dans les
territoires déficitaires. Il
agit aussi sur le
développement des
infrastructures de soin
comme les maisons ou
les pôles de santé.
LE FONDS D’INVESTISSEMENT
INNOVATION EN SANTE, doté de 340
millions d’euros, vise à
accompagner les entrepreneurs
du secteur dans leurs projets et
permettre la diffusion de
l’innovation santé. De plus,
recherche publique et privée
collaborent au sein du conseil
stratégique des industries de santé
(CSIS) : diffusion de l’innovation,
veille sur l’antibiorésistance.
FONDS MONDIAL DE LUTTE
CONTRE LE SIDA, LA
TUBERCULOSE ET LE
PALUDISME La France est le deuxième
contributeur au fonds
mondial de lutte contre le
sida, la tuberculose et le
paludisme, auquel elle
vient de renouveler son
engagement de 1,08 Mds
d’euros pour les trois
prochaines années. Elle est
le premier à UNITAID, où
elle apporte plus de la
moitié des financements.
Elle soutient l’alliance pour
la vaccination et
l’immunisation (GAVI). Au
total, plus de 500 millions €
par an sont consacrés par
la France à ces trois
dispositifs.
LE 3EME PLAN NATIONAL SANTE
ENVIRONNEMENT 2015 – 2019 vise à
réduire les impacts des facteurs
environnementaux sur la santé et
les inégalités d’exposition à ces
impacts : qualité de l’air et de
l’eau, effets des pesticides sur la
santé, perturbateurs endocriniens,
bruit, ondes, nanomatériaux… La
France a interdit dès 2015 le
bisphenol A dans les contenants
alimentaires et agit pour étendre
les réglementations des produits
phytosanitaires.
LOI SANTE Trois axes
structurent la
modernisation du système
de santé : innover pour
mieux prévenir (éducation
à la santé, campagnes de
sensibilisation, dépistages),
innover pour mieux soigner
en proximité (tiers-payant,
médecine de proximité,
service public hospitalier)
et innover pour renforcer
les droits et la sécurité des
patients (confidentialité,
sécurité des médicaments,
accès à l’IVG et
modernisation numérique).
Enfin, l’Agence nationale
de santé publique a été
créée.
PROTECTION DE TOUS
Désormais, la protection universelle
maladie (PUMA) garantit à toute
personne qui travaille ou réside en
France la prise en charge des frais
de santé, sans démarche
particulière à accomplir.
SECURITE ROUTIERE
La mortalité routière en France métropolitaine est passée de 17 000 à 3500
tués par an entre le début des années 70 et 2015. Pour passer de 3000 à
2000 tués par an d’ici à 2020, des mesures de réduction des vitesses ou
encore d’harmonisation de la législation au niveau européen sont
adoptées.
SANTE ET SOCIETE CIVILE
Pour les cas d’urgence
humanitaire, depuis 30
ans un partenariat
association-entreprise
permet de fédérer les
dons et de mettre à
disposition des kits
d’urgence de produits
de santé neufs adaptés
au terrain.
|
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{
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}
|
| 37
Priority Targets
The FSM has prioritized five targets to
ensure healthy lives and promote wellbeing at
all ages. The Department of Health Services in
each State has the primary responsibility for
curative, preventive and public health services.
Under the leadership of DHSA, the targets were
reviewed and aligned to the Healthy Islands
Framework (52 indicators), and the Framework
for Sustainable Health Development in the
FSM, 2014-2024.Targets 3.1, 3.3, 3.4 and 3.7
are selected for discussion.
Selected Target Assessment and Progress
The principles of the national and state
Constitutions in FSM affirm the right to
healthcare for all citizens21. A National Health
Summit was held in August 2014 that unified
numerous national and state-level policies,
programs, projects, plans and strategies to
improve health sector development.
An outcome of this Summit was a
national strategic framework that affirms the
right to healthcare for all citizens, guided by the
following principles:
That health is a human right;
That health is integral to national
development;
That health requires sustainable resources
and financing;
That health requires effective leadership
and governance; and,
That health requires multi-sector integrated
approaches and partnerships.
Importantly, the FSM has as one of its
six major goals to “ensure universal access to
essential healthcare services”.
FSM remains a low HIV-prevalence
country. The national HIV program is persistent
in its contact investigation and placing people
21Framework for Sustainable Health Development in the
FSM, Health Summit Communiqué, August 2014.
Target 3.1
Reduce the maternal mortality ratio.
Target 3.2
End preventable deaths of newborns and
children under 5.
Target 3.3
End the epidemics of AIDS, tuberculosis,
malaria and neglected tropical diseases, and
combat hepatitis, water-borne diseases and
other communicable diseases.
Target 3.4
Reduce by 1/3 premature mortality from
non-communicable diseases through
prevention and treatment and promote
mental health and well-being.
Target 3.7
Ensure universal access to sexual and
reproductive health care services, including
for family planning, and the integration of
reproductive health into national strategies.
SDG 3: GOOD HEALTH AND WELL BEING
VOLUNTARY NATIONAL REVIEW | 38
living with HIV on Anti-Retroviral treatment
within a month of diagnosis so HIV transmission
can be reverted. Hepatitis B is decreasing
amongst the younger subset of the population;
however, there is an increased incidence in
older age groups.
The incidence rate of tuberculosis (TB)
in FSM was has dropped between 16.9/10,000
population in 2012 to 9.8/10,000 in 2018. The
highest rates are seen in the states of Chuuk
and Pohnpei and then followed by Yap State.
MDR-TB22 has been declining in country
and is now contained with almost no cases for
this reporting. TB incidence rate is declining
very slowly and this is due to people seeking
medical consultation in the late stage of the
disease spectrum, and possibly likely due to
disease discrimination in the communities.
Awareness of the disease is a
continuous part of program activities, as is
continues support to State Public Health
Programs to visit communities’ in-situ.
In terms of people requiring
interventions against leprosy, one of the
neglected tropical diseases (NTDs) 23 , FSM’s
22Multidrug-resistant TB (MDR TB) is caused by an
organism that is resistant to at least isoniazid and
rifampin, the two most potent TB drugs.
23NTDs are a diverse group of communicable and less
well-known diseases that prevail in tropical and subtropical climates in 149 countries (WHO). Affecting the
world’s poorest people, NTDs impair physical and
cognitive development, contribute to mother and child
illnesses and death, and make it difficult to farm and
earn a living and limit productivity in the workplace
(CDC).
most recent complete report is in 2017, where
the New Case Detection Rate (NCDR), or
prevalence rate (PR), was 137/100,000
population.
The FSM is considered to be one of only
three countries in the Pacific Islands that have
not reached the WHO goal of elimination: PR of
< 1/10,000 population. Despite continuous
contact investigation for family contacts,
people are not seeking medical consultation in
the early stages of these preventable diseases.
However, the data and progress on
SDG3 – or lack thereof – is not for lack of a
systematic and coordinated effort. On the
contrary, the FSM spends more on Health as a
percentage of GDP than any other PIC24.
24Government expenditure on health made up around
20.6 per cent of total government expenditure, which,
according to NMDI data, is the highest figure in the
PICTS group.
VOLUNTARY NATIONAL REVIEW | 39
As of 2015, around 80 per cent of health
funding went to programs at the state level;
only 20 per cent was spent at the national level.
Around 65 per cent of state-level health
funding is allocated to curative services, with 15
per cent going to overseas referral costs, 10 per
cent to public health and prevention and 10 per
cent to administration.
Climate Change and Health is a growing
concern within the Federation25. This is
particularly true for water-, vector- and foodborne diseases. This is an emerging trend and
more effort will need to be made within the
FSM to address, adapt to and mitigate not only
the environmental effects of Climate Change,
but also the serious human health effects, both
physical and mental.
25The FSM Department of Health & Social Affairs
(DoHSA), along with the National Designated Authority
(NDA), is currently putting a proposal to the Green
Climate Fund (GCF) entitled, “Increasing Resilience to
the Health Risks of Climate Change in the FSM.”
As such, the FSM has developed a
Climate Change and Health Action Plan
(NCCHAP), which aims at mainstreaming
climate change considerations into activities for
the health sector and health considerations
into the activities of other sectors.
In relation to Target 3.1, skilled birth
attendance is estimated to be 85%. Maternal
mortality ratio declined significantly from
161/100,000 live births in 2010 to 43/100,000
live births in 201626.
The contraceptive prevalence rate
(CPR), in Federated States of Micronesia
increased from 49.5% in 2009 to 51.3% in 2017,
while the fertility rate decreased from 3.5 to
3.13 children per woman (FSM 2017
Reproductive Health Needs Assessment).
The FSM took swift action to respond to
COVID-1927 to thwart the entry of the virus into
FSM, enforcing strict travel bans into and out of
26According to the FSM National Health Sector Key
Performance Indicators & SDG Annual Scorecard- 2016.
27President H.E. David W. Panuelo declared a national
Public Health Emergency Declaration on 31 January
2020.
VOLUNTARY NATIONAL REVIEW | 40
the four primary ports of entry – be sea and by
air. The development of the National COVID-19
Response Framework has also been a
collaborative effort to respond to the
pandemic.
There was also a commendable swift
response of the DoHSA during the first quarter
of 2020 to a measles outbreak in the Pacific
during which a national measles immunization
campaign was held to protect children under
five, adolescents, frontline first responders,
travelers and other adults.
The national measles immunization
campaign resulted in overall immunization full
protection coverage against measles of 84% of
children under the age of five years28,29.
According to the latest national
estimates, summarized in the 2016 State of the
World’s Children (SOWC) dataset, the underfive child mortality rate in FSM stands at 31
deaths per 1,000 live births as of 2015, which
represents a 38 per cent reduction since 1990.
Challenges
Non-Communicable
Diseases (NCDs) remain a
vast and pervasive issue
for the FSM, accounting
for more than 70% of
deaths3031.
According to estimates provided by the
Institute of Health Metrics, the leading causes
of premature death in FSM in 2010 were
28Approximately 73% of the FSMs population has
received the Measles, Mumps and Rubella (MMR)
vaccine, according the DoHSA data.
29At National level, the FSM DoHSA conducted
integrated de-worming and vitamin A supplementation
into the national measles immunization campaign,
achieving about 68% coverage of children under the age
of five. This heralds the resuscitation of mass vitamin A
and de-worming campaign after a gap of more than five
years and deserves more support.
3082% of the population consumes less than five
combined servings of fruits and vegetables per day; 73%
of the population is overweight, with 43% being obese.
31Obesity and overweight appear to be a particular
problem among the female population of FSM: 75 per
cent of females are considered overweight compared
with 64 per cent of males; and 44 per cent of females are
considered obese compared with 31 per cent of males.
Reaching the hard-to-reach; the
national measles immunization
campaign January 2020.
VOLUNTARY NATIONAL REVIEW | 41
NCDs 32 . The disease burden of NCDs has
increased rapidly, with FSM witnessing almost
epidemic rises in diabetes (81 per cent change
since 1990) and chronic kidney disease (63 per
cent change)33.
NCDs account for more than 80% of
referrals for off-island medical treatment,
adding a huge financial burden on the
healthcare system in FSM (FSM MiCare data).
The table below shows the incidence
percentage-wise for each State34.
32Diabetes: 8 per cent of years of life lost; stroke: 7.5 per
cent; ischemic heart disease: 7.4 per cent; cirrhosis: 2.4
per cent; and chronic kidney disease: 2.4 per cent.
33Situation Analysis of Children in the FSM 2017
(UNICEF).
34FSM has made noteworthy progress in combating
tobacco use which is a major risk factor of NCDs,
including implementation of innovative measures to
protect vulnerable populations from second-hand smoke
exposure by prohibiting smoking in cars with minors
present. In 2019, the FSM completed its third national
Global Youth Tobacco Survey, demonstrating a
commitment to monitoring the impact of interventions
on the health of young people in the FSM.At the national
level, the FSM has drafted tobacco control legislation
High perinatal mortality 35 signifies
suboptimal quality of maternal and newborn
care and requires urgent attention. Findings of
the Health Facility Readiness and Services
Availability Assessment conducted in 2018
highlighted that while almost all facilities
reported family planning services availability,
only 27% of the facilities were ready to provide
family planning services.
Health care coverage in regard to
providing medical insurance remains an issue36.
71% of the population remains without
insurance, with Chuuk (79.7%) and Yap (75.2%)
with the highest rates of non-coverage.
and its enactment is imperative to strengthen alignment
with the WHO FCTC and protect health and the
environment.
35 Perinatal definition....
36 A 2018 survey throughout the FSM revealed that
71.3% of respondents said they did not have health-care
coverage. Of the total, 70.3 % of the males did not have
health-care coverage and 72.3% females lacked healthcare coverage. Compounding this, the data also showed
that female respondents are more likely to have poor
health than male respondents.
VOLUNTARY NATIONAL REVIEW | 42
Immunizations of important vaccines
against deadly diseases37for children remain
too low on average across the FSM, at 65%.
Although overall progress is being made,
additional public health outreach efforts are
needed to protect the population, especially
young children.
There is a lack of data on many health
and nutrition issues, including over and under
nutrition, mental health, micro-nutrient
deficiency, and accessibility rates to health care
services for outer island communities. These
are data that we will need to begin to quantify,
track and monitor.
37Diphtheria, tetanus , whooping cough, hepatitis B,
measles, mumps, rubella and polio are the main
vaccines.
Way Forward
Keeping COVID19 and other such
pandemic infections out of the FSMs many
islands is no small task. Small Island Developing
States (SIDS) are both perfectly suited to
isolating themselves from a pandemic, and at
the same time, extremely susceptible to the
threats that a pandemic poses. At this point in
time it is clearly evident that the FSM – and the
rest of the Pacific – must remain focused on
COVID19 responses and in working with the
multiple bi-lateral and multi-lateral programs
related to and available for this response.
With nearly 24% of the population
currently under the age of 15, women and men
of reproductive age represent a growing,
significant proportion of the population, and
there is a need to ensure access to Sexual
Reproductive Health (SRH) services including
Family Planning (FP) services38,39
An unhealthy society is a society at risk.
A pandemic such as COVID-19 exposes this as
starkly as humanly possible. NCDs such as
obesity, heart disease, diabetes, hypertension,
cancer and chronic obstructive pulmonary
disease (COPD) are the leading cause of
mortality and morbidity, and more than half of
the population is at high risk of developing
them. Continuing positive pressure by Public
Health officials acting in concert with farmers,
women’s and youth groups must be ensured.
38FSM MDG Status Report 2010.
39Department of Health and Social Affairs, Family
Planning Annual Reports, 2007-2011.
VOLUNTARY NATIONAL REVIEW | 43
In addition, Public Health officials in
coordination with civil society actors must be
even more proactive to address and eliminate
NTDs, and to maximize required immunizations
for all ages, particularly the young.
More holistic and integrated
approaches to tackling health problems
through multi-sector initiatives – cross-aligning
multiple SDGs in Agriculture, Tourism and
Fisheries–to improve mental and physical wellbeing must be prioritized.
Some relevant SDG3 documents in FSM are:
National Strategic Plan for the Prevention
and Control of NCDs in FSM 2013-2017
FSM NCD Risk Factors STEPS Report 2008
UNICEF Situation Analysis of Children in FSM
2017
National Climate Change and Health Action
Plan 2018
WHO Country Cooperation Strategy for FSM
2018–2022 (WHO)
FSM COVID-19 Response Framework 2019
FSM Comprehensive Cancer Control Plan
2019-2024
FSM Youth NCD Risk Factors 2017
FSM Behavioral Risk Factor Surveillance
System Report 2018
National Strategic Plan of Action for the
Prevention and Control of NCDs in the FSM
2019-2024
FSM National Health Sector Key
Performance Indicators & SDG Annual
Scorecard- 2016
FSM 2017 Reproductive Health Needs
Assessment
Health Facility Readiness Assessment 2018
FSM Youth Policy 2019
FSM COVID-19 Situation Report SITREP 2020
Framework for Sustainable Health
Development in the FSM 2014-2024
Pohnpei State Highlight
|
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[
3
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{
"country": "fsm",
"file_id": "sdg-03/vnr-report-fsm-2020-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
25
La Santé est au cœur du développement du Gabon. Dans le PSGE, elle constitue l’un des facteurs
contribuant à la constitution d’un capital humain de qualité. Elle couvre plusieurs pathologies qui font
l’objet de programmes spécifiques. Elle a nécessité la réalisation ou la remise à niveau de plusieurs
formations sanitaires et a vu l’ouverture de plusieurs spécialités, notamment en cancérologie,
Sur la cible 3.1 relative au taux de mortalité maternelle, dont l’objectif est de 70 pour 100 000 naissances
vivantes en 2030, le Gabon se situait à 519 décès pour 100 000 naissances vivantes en 2000 pour passer
à 316 en 2010 (EDSG 2000 et 2012). Selon les estimations de l’OMS, ce taux serait de 261 en 2015 et
de 252 en 201713. Cette cible semble à la portée du Gabon d’ici 2030.
Sur la cible 3.2 qui vise, d’ici à 2030, à « éliminer les décès évitables de nouveau-nés et d’enfants de
moins de 5 ans », le taux de mortalité néo-natale est passé de 30 pour 1000 naissances vivantes en 2000
à 26 pour 1000 naissances vivantes en 2012 (EDSG 2000 et 2012). La cible pour 2030 étant de 12 1000
naissances vivantes en 2030 pour la mortalité néonatale et de 25 pour 1000 naissances vivantes en ce
qui concerne les enfants de moins de 5 ans.
De plus, l’analyse spatiale du taux de mortalité infantile chez les pauvres en 2012 montre que Libreville
et Port-Gentil présentent un taux de 41 naissances vivantes, alors que le taux de Mortalité juvénile est de
16 pour 1000 et le taux de mortalité des moins de 5 ans de 56 pour 1000 naissances vivantes.
Pour les autres zones urbaines, la Mortalité infantile est de 43 pour 1000 naissances vivantes et la
Mortalité juvénile de 30 pour 1000 naissances vivantes et la mortalité des moins de 5 ans de 72 pour
1000 naissances vivantes. En Zones rurales, on a enregistré un taux de mortalité infantile de 48 pour
1000 naissances vivantes ; un taux de mortalité juvénile de 32 pour 1000 naissances vivantes ; un taux
de mortalité des moins de 5 ans de 79 pour 1000 naissances vivantes.
Graphique 3: Mortalité infantile en milliers (par sexe) / Santé sexuelle et procréative
Mortalité infantile en milliers (par sexe) Santé sexuelle et procréative
13 EDS 2012 pour les données entre 2000 et 2012. Bases des données internationales pour les autres années.
PERMETTRE A TOUS DE VIVRE EN BONNE SANTE ET PROMOUVOIR LE BIEN-ETRE DE TOUS A
TOUT AGE
26
Sources : DGS, Enquête Démographique et de Santé Gabon 2000 et 2012 (EDS), OMS et auteur
La demande de planification familiale satisfaite par les méthodes modernes provenant des femmes de
15 à 49 ans, qui était de 26,6% en 2000, est passée à 52,2% en 2020, soit une augmentation de 25,6%.
En dynamique, on constate qu’elle est en augmentation depuis 2000 à la suite de nombreuses
campagnes de sensibilisation, d’une plus grande couverture en structures adéquates et de la forte
scolarisation des femmes qui les amènent à adapter leur vie familiale aux réalités économiques et
sociales actuelles.
Le taux de fécondité des adolescentes pour 1000 femmes de la tranche d’âge de 15-19 ans est passé de 144 naissances pour
1000 femmes, selon les données de l’ESDG 2000 à 114 naissances pour 1000 femmes selon l’EDSG 2012. Il y a donc une
baisse tendancielle de 30 naissances pour 1000 femmes.
L’épidémie du sida et d’autres maladies infectieuses régressent, mais la vigilance doit rester de mise
surtout dans les tranches d’âges de 14-24 ans et 15-49 ans chez les jeunes filles et femmes en ce qui
concerne de nouvelles infections à VIH.
L’indice de couverture sanitaire universelle, qui englobe la gamme complète des services de santé
essentiels de qualité, qu’il s’agisse de la promotion de la santé, de la prévention, des traitements, de la
réadaptation et des soins palliatifs, s’inscrit à la hausse depuis 2000, passant de 29% en 2000 à 49% en
2017.
Au total, sur la base de l’évolution des indicateurs analysés, l’ODD3 semble à portée d’atteinte d’ici
2030. L’indice de couverture sanitaire universelle est en amélioration continue et va se poursuivre. Mais
le Gouvernement peut amplifier ces tendances moyennant des efforts pour renforcer les infrastructures
de santé, former et motiver les personnels, doter les structures sanitaires en médicaments,
accroitre l’offre de soins de santé primaire et renforcer la viabilité financière de la CNAMGS.
0
10
20
30
40
50
60
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
MOYENNE MASCULIN FEMININ
117 115 113,6
91
0
20
40
60
80
100
120
140
0
10
20
30
40
50
60
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
Taux de natalité chez les adolescentes (pour 1 000 femmes
âgées de 15 à 19 ans)
Demande de planification familiale satisfaite par les méthodes
modernes en % de femmes de 15 à 49 ans
GARANTIR L’ACCES DE TOUS A DES SERVICES D’ALIMENTATION EN EAU
ET D’ASSAINISSEMENT GERES DE FAÇON DURABLE
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GHANA’S 2019 VNR REPORT 29
Good Health and Well-being
Ensure Healthy Lives and
Promote Well-Being For
All At All Ages
Indicator 3.1.1: Maternal mortality ratio
The indicator on maternal mortality is measured with both survey and institutional data. Data from
maternal health survey indicates that maternal deaths have declined from 580 per 100,000 live
births in 2007 to 310 per 100,000 live births in 2017 (Figure 4.3.1). This is consistent with trends
using institutional data which shows a decline from 224 per 100,000 live births in 2007 to 147 per
100,000 live births in 2017 (Figure 4.3.2). In 2017, 97 percent of pregnant women visited a skilled
health personnel for antenatal care at least once, 85 percent at least four times and 26 percent at
least eight times.
Regional disaggregation of institutional maternal mortality shows that maternal deaths worsened
in 2017 in Ashanti, Eastern, Greater Accra and Upper East regions but improved in the other six
regions with Brong Ahafo, Upper West, Central and Western regions attaining the medium-term
target of less than 135 per 100,000 live births.
The Government of Ghana is committed to reducing maternal deaths by making reproductive health
services available to all women of childbearing age. For instance, the National Health Insurance
Scheme (NHIS) was reviewed in 2016 to provide universal guarantee package of maternal and child
healthcare. The possession of the NHIS card is no longer necessary to access primary healthcare
for pregnant women. In addition, emergency services are being revamped with the provision of
ambulances for all districts.
Figure 4.3.2: Institutional maternal mortality, 2007-2017 (per 100,000 live birth)
0
100
200
300
400
500
600
700
2007 2017
Figure 4.3.1: Maternal mortality ratio survey,
2007 & 2017 (per 100,000 live births)
Source: GSS, GMHS 2007 and 2017 Source: MOH, Holistic Assessment of Health Sector Programme of
Work, various years
Figure 4.3.2: Institutional maternal mortality, 2007-2017 (per 100,000 live birth)
224
200
170 163
195
152 155
144 142
152 147
200 7 200 8 200 9 201 0 201 1 201 2 201 3 201 4 201 5 201 6 201 7
Key issues relating to reducing maternal mortality include addressing concerns on adolescent fertility
and improving coverage of family planning services. Young mothers are at increased risk of sickness
and death and are more likely to experience adverse pregnancy outcomes. They are also more likely
to be constrained in their ability to pursue educational opportunities than young women who delay
childbearing. Intermittent Preventive Treatment (IPT) for malaria and HIV counselling is being promoted
upscaled to cover all pregnant women.
Indicator 3.1.2: Proportion of births attended by skilled health personnel
The percentage of deliveries attended by health personnel trained in providing lifesaving obstetric care,
including giving the necessary supervision, care and advice to women during pregnancy continue to
improve with an increase from 73.7 percent in 2014 to 79.9 percent in 2017 (Figure 4.3.3). With the
exception of Ashanti Region which recorded a decline – from 86 percent to 82 percent – all the other
regions improved (Figure 4.3.4). Mothers with higher levels of education and income are more likely to
be supervised by skilled health providers.
30 GHANA’S 2019 VNR REPORT
Figure 4.3.3: Proportion of births attended by
skilled health personnel, 2003-2017 (%)
Figure 4.3.4: Proportion of births attended by skilled health
personnel by geographical areas, 2004-2017 (%)
Source: GSS, GDHS (2003, 2008, 2014); MICS
2017
Source: GSS, GDHS 2014; MICS 2017
Figure 4.3.3
47.1
58.7
73.7
79.0
2003
GDHS
2008
GDHS
2014
GDHS
2017
MICS
80
73
93
69
79
82
86
60
94
83
75.3
72
92.1
66.3
67.2
86.3
79
36.4
84.6
63.7
Western
Central
Greater Accra
Volta
Eastern
Ashanti
Brong Ahafo
Northern
Upper East
Upper West
2014 2017
Measures to increase coverage of supervised delivery have focused on: producing and equitably
distributing midwives; enhancing access to CHPS compound in deprived areas; improving access
to obstetric emergency services; training on the use of partograph which promotes confdence,
reducing prolonged labour, caesarean sections and intra-partum stillbirths; and training of health
workers including midwives in safe motherhood skills, abortion care, lactation management, and
Jadelle insertion and removal.
Indicator 3.2.1: Under-fve mortality rate
Since 2003, the likelihood of a child dying before reaching age 5 has been declining in Ghana
reaching 56 per 1000 live births in 2017 (Figure 4.3.5) . Similar trend was observed across all regions
and socio-economic characteristics – sex, urban and rural areas (Figure 4.3.6).
Child health interventions contributing to the improvement in under fve mortality rate include:
implementing the Child Health Policy and Child Health Strategy; sustaining the Expanded
Programme on Immunization (EPI) for children; enhancing the use of insecticide-treated nets (ITNs);
improving malaria case management in health facilities; and scaling up the Integrated Management
of Childhood Illnesses (IMCI) programme.
Figure 4.3.5: Trends in under-5 mortality rates,
2003-2017 (per 1,000 live births)
Source: GSS, GDHS (2003, 2008, 2014); MICS 2017
Figure 4.3.6: Trends in under-5 mortality rates by regions, sex and
locality, 2014-2017 (per 1,000 live births)
Source: GSS, GDHS 2014 and MICS 2017
111
80
60 56.0
2003
GDHS
2008
GDHS
2014
GDHS
2017
MICS
0 20 40 60 80 100 120
Western
Central
Greater Accra
Volta
Eastern
Ashanti
Brong Ahafo
Northern
Upper East
Upper West
Male
Female
Urban
Rural
2014 2017
GHANA’S 2019 VNR REPORT 31
Indicator 3.2.2 Neonatal mortality rate
The number of children dying within 28 days of birth has declined from 43 per 1, 000 live births
in 2003 to 27 deaths per 1, 000 live births in 2017 (Figure 4.3.7). Between 2014 and 2017, all
regions recorded similar declines except Ashanti, which recorded an increase from 42 deaths
per 1, 000 live births in 2014 to 52 deaths per 1, 000 live births in 2017 (Figure 4.3.8). In 2014,
the highest mortality rates occurred among children of women in the highest wealth quintile and
highest education attainment, while in 2017 the highest mortality occurred among children of
women in the lowest quintile and lowest education.
Figure 4.3.7: Neonatal mortality rate,
2012 – 2017 (per 1,000 live births)
Source: GSS, GDHS (2003, 2008, 2014); MICS 2017
Figure 4.3.8: Neonatal mortality rate by region, 2014 &
2017 (per 1,000 live births)
Source: GSS, GDHS 2014 and MICS 2017
43
30
29
27.0
2003
GDHS
2008
GDHS
2014
GDHS
2017
MICS
Figure 4.3.5:
0 10 20 30 40 50 60
Western
Central
Greater Accra
Volta
Eastern
Ashanti
Brong Ahafo
Northern
Upper East
Upper West
2014 2017
Indicator 3.3.1: Number of new HIV infections per 1,000 uninfected population, by sex, age
and key populations
The 2017 sentinel report estimates HIV prevalence rate in Ghana as 1.67 percent, representing a
decline from 1.70 percent recorded in 2016. The number of estimated new HIV and AIDS infections
has not recorded signifcant reduction from 2013 to 2017. Indeed, new infections increased from
2013 to 2015 but declined from 19.57 in 2015 to 19.1 in 2017 (Figure 4.3.9).
Greater Accra and Ashanti Regions have the highest number of HIV population for all age groups
while Upper East and Upper West have the lowest. Moreover, Greater Accra and Ashanti regions
have the highest new HIV infections whilst Upper West has the least. For all regions, new infected
persons were mostly females (Figure 4.3.10).
32 GHANA’S 2019 VNR REPORT
Figure 4.3.9: New HIV infections, 2013-2017 (per 1,000
uninfected population)
Figure 4.3.10: New HIV infections for all age groups by
region, 2017 (per 1,000 uninfected population)
Source: Ghana Aids Commission, National and Sub-National HIV and AIDS Estimates and Projections, 2018 Report
4.54 4.34 4.34 3.86
2.56
5.3 5.36 5.44 5.54
5.56
19.25 19.28 19.57 19.43
19.1
2013 2014 2015 2016 2017
0-14 15-24 All
Western
Central
Greater Accra
Volta
Eastern
Ashanti
Brong Ahafo
Northern
Upper East
Upper West
Female Male
Prevention of mother-to-child transmission and coverage of pediatric antiretroviral therapy remain
low as stigma and discrimination continue to hamper uptake of services. In 2016, Ghana adopted
the “Treat-All” policy which makes every People Living with HIV (PLHIV) eligible for treatment and
this is expected to increase PLHIV on Anti-Retroviral Therapy (ART). To accelerate action towards
ending HIV and AIDs epidemic, government adopted a 90-90-90 strategy in 2017 which is aimed
at ensuring that by 2020 all 90 percent of PLHIV will know their status, 90 percent of all people with
diagnosed HIV infection will receive sustained ART and 90 percent of all receiving ART will have viral
suppression.
Indicator 3.3.2: Tuberculosis incidence per 100,000 population
Tuberculosis incidence is measured with total case notifcations in a year per 100,000 population. The
incidence rate declined from 49.38 per 100,000 population in 2016 to 46.34 per 100,000 population
in 2018 (Figure 4.3.11).Progress towards TB control is monitored by the TB Treatment Success Rate,
which is the percentage of all registered new tuberculosis cases in a given year that successfully
completed treatment. Ghana has achieved the international target of having TB treatment success rate
Figure 4.3.11: Tuberculosis incidence, 2016-2018 (per 100,000 population)
Source: MOH, Holistic Assessment of Health Sector Programme of Work, 2018
of 85%. However, the treatment
success rate has remained almost
stagnant over the years.
To sustain the gains made, the
National TB Control programme
is implementing various strategies
including the Directly Observed
Treatment Short-course (DOTS)
across the 5 tier health system of
Ghana. The DOT programme involves ensuring regular drugs supply, building capacity for TB treatment, and directly supervising
treatment among others. By WHO defnition Ghana has achieved 100 percent DOT coverage and
is currently in the maintenance stage of DOT expansion.
GHANA’S 2019 VNR REPORT 33
Indicator 3.3.3: Malaria incidence per 1,000 population
Figure 4.3.12: Malaria incidence rate, 2015-2018
(per 1000 population)
Source: MOH, Holistic Assessment of Health Sector
Programme of Work, 2018
Figure 4.3.13: Death rate due to road trafc injuries,
2012-2018 (per 100,000 population)
Source: MOH, Holistic Assessment of Health Sector
Programme of Work, 2018
The malaria incidence declined from 2015 to 2016
but has been increasing since then, reaching 185.4
cases per 1,000 population in 2018 (Figure 4.3.12).
A total of 11,027,087 uncomplicated suspected
malaria cases were reported in 2018, out of which
92 percent were tested. About 54 percent of
the cases tested were confrmed either through
microscopy or rapid diagnostic test. The use of
insecticide-treated nets (ITNs) is being promoted
to help reduce the incidence of malaria among
high risk groups.
Malaria is the number one disease burden
evidenced from both burden of disease and
outpatient hospital data. As part of eforts to
Figure 4.3.13
10.54
11.24
8.08 7.62
4.41
7.19
7.95
2012 2013 2014 2015 2016 2017 2018
address this problem, Ghana, on 1st May 2019 introduced the world’s frst vaccine for malaria
(RTS,S or Mosquirix). This vaccine is being introduced as a pilot from 2019 to 2021 in 6 of the
16 administrative regions of the country. The lessons learnt will inform the rollout to all the other
regions. We believe this intervention will add up to our other interventions to help reduce the burden
of malaria in Ghana.
Indicator 3.6.1: Death rate due to road trafc
injuries
Deaths due to road accident injuries remain a
major development concern. Number of deaths
generally declined between 2013 and 2016, but has
since been on the rise, increasing from 4 deaths
per 100,000 population to 8 deaths per 100,000
population in 2018 (Figure 4.3.13).
A new Road Safety Strategy (2018-2020) and Action
Plan are being implemented to reduce the levels of
road trafc fatalities and injuries. The action plan
focuses on promoting safe use of public transport
Malaria is the number one disease burden evidenced from both our Burden of Disease and our
outpatient hospital data. As part of eforts to address this problem, Ghana, on 1st May 2019
introduced the world’s frst vaccine for malaria (RTS,S or Mosquirix). This vaccine is being introduced
as a pilot from 2019 to 2021 in 6 of the 16 administrative regions of the country. The lessons learnt
will inform the rollout to all the other regions. We believe this intervention will add up to our other
interventions to help reduce the burden of malaria in Ghana.
Box 4.3.1 Piloting the Malaria Vaccine
systems; implementing an integrated speed management programme; ensuring use of safer
vehicles; promoting greater responsibility, dedication, commitment and sense of urgency from
relevant stakeholders; and developing knowledge, skill and behaviour of all road users. The
mandate of the NRSC has been strengthened with the passage of the National Road Saftey
Authority Act, which transforms the NRSC into an Authority.
34 GHANA’S 2019 VNR REPORT
Adolescent birth rate has declined from 76 percent in 2014 to 75 percent in 2017(Figure: 4.3.15).
In reaping the demographic dividend for national development, eforts are in place to coordinate
the implementation of the Ghana Family Planning Costed Implementation Plan, 2016-2020 and
awareness creation intervention.
Government’s strategy is to expand access to and improve the quality of healthcare for all socioeconomic groups through a Universal Health Coverage (UHC) policy. Investments have been made
in quality, reliable, sustainable and resilient health infrastructure, such as expansion of CommunityBased Health Planning Services (CHPS) compounds, upgrade of existing hospital facilities and
construction of new health infrastructure.
Eforts to achieve the goal of the UHC policy
include bridging equity gaps in access to
healthcare; ensuring sustainable healthcare
fnancing arrangements that protect the poor;
and improving governance, management and
efciency in health service delivery. Others were
improving access to quality service delivery
and quality mental health services; improving
maternal, child and adolescent healthcare; and
preventing and controlling non-communicable
diseases (NCDs) and neglected tropical
diseases (NTDs).
Despite these interventions, access to health
services has generally declined especially
in rural areas of the country (Ghana Living Standards Survey Round 7). Huge imbalances in
geographical access to quality healthcare; inadequate and inequitable distribution of critical staf,
increased cost of healthcare delivery, and poor quality of healthcare services prevail.
Figure 4.3.15
116
88
74 66
76 75
1993
GDHS
1998
GDHS
2003
GDHS
2008
GDHS
2014
GDHS
2017
MICS
Indicator 3.7.1 Proportion of women of
reproductive age (aged 15-49 years) who have
their need for family planning satisfed with
modern methods
In general, access to modern family methods
continue to increase with the proportion of women
age between 15-49 years having their family
planning needs met increased from 22 percent in
1998 to 42 percent in 2017 (Figure 4.3.14)
Indicator 3.7.2: Adolescent birth rate (aged 10-
14 years; aged 15-19 years) per 1,000 women in
that age group
Figure 4.3.14: Proportion of women of reproductive age
(15-49 years) with met needs for modern family planning
methods, 1998-2017(%)
22 25.2 23.5 26.7
42
199 8
G DHS
200 3
G DHS
2008
G DHS
201 4
G DHS
2017
M I C S
Source: GSS, GDHS Various Editions, MICS 2017
Selected Government Interventions under Goal 3
1. Free primary healthcare services for pregnant women;
2. Enhancing access to CHPS compound in deprived areas;
3. Improving access to obstetric emergency services;
4. Training of health workers including midwives in safe motherhood skills, abortion care, lactation management,
and Jadelle insertion and removal;
5. Implementing the Child Health Policy and Child Health Strategy;
6. Expanded Programme on Immunization (EPI) for children;
7. Promoting the use of insecticide-treated nets (ITNs);
8. Improving malaria case management in health facilities;
9. Scaling up the Integrated Management of Childhood Illnesses (IMCI) programme;
10. Adoption of the 90-90-90 strategy for HIV;
11. Introduction of new malaria vaccine (RTS,S or Mosquirix) in 6 of the 16 administrative regions of the country;
12. Revamping of emergency service with the provision of ambulances to all districts
13. Implementation of the Medical Drone Delivery Service
14. Upgrading of existing health facilities and construction of new health infrastructure
15. Provision of post-crash response centres along major highways
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{
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|
GHANA 2022 VNR 27 SUSTAINABLE DEVELOPMENT GOALS
GOAL 3 ENSURE HEALTHY LIVES AND PROMOTE WELLBEING FOR ALL AT ALL AGES
Indicator 3.1.1: Maternal mortality ratio
Maternal deaths have declined from 580
per 100,000 live births in 2007 to 301 per
100,000 live births in 2021 (Figure 8). The
slow pace of maternal death decline makes
it diffcult for the country to achieve the
SDGs target of 70 deaths per 100,000 live
births by 2030.
Similarly, maternal deaths recorded at
health facilities have reduced since 2007
to 109 per 100,000 live births in 2020 and is
projected to reach 62 per 100,000 live births
in 2024 (Figure 9). In Ghana, institutional
maternal mortality rate grossly understates
the situation among the population,
however, it refects the improvement in
maternal care at health facilities.
Strict adherence to maternal health
protocols and guidelines, and the
implementation of maternal death audit
recommendations has contributed to the
reduction.
Figure 8: Maternal mortality ratio, 2007, 2010, 2017
and 2021, (per 100,000 per live births)
Figure 9: Institutional Maternal Mortality, 2016 - 2024
(per 100,000 live births)
Indicator 3.1.2: Proportion of births
attended by skilled health personnel
Skilled birth coverage improved from 55.5
percent in 2016 to 59.1 percent in 2019 but
declined to 58.7 percent in 2020 (Figure
10). This reduction was largely due to the
reluctance of expecting mothers to visit
health facilities for fear of contracting
COVID-19. The country recorded a
midwife to women in fertility age (WIFA)
population ratio of 1:560 in 2020, surpassing
the national target of 1:710. However, to
achieve universal skilled birth attendance,
additional measures must be put in place
to ensure an average annual increase of 4
percent between 2021 and 2030.
GHANA 2022 VNR 28 SUSTAINABLE DEVELOPMENT GOALS
A marginal increase was recorded in the
proportion of mothers who made at least
4 antenatal care visits and proportion of
mothers and children receiving post-natal
care within 48 hours after delivery between
2016 and 2020. The worsening situation
of frst antenatal care visit since 2016 was
reversed in 2020 (Figure 10). The increase
in postnatal care is attributed to increased
awareness of staff and community
members about postnatal care schedule
and its importance.
Figure 10: Antenatal, postnatal, and skilled delivery coverage, 2016 – 2020, (%)
Table 6: Under 5 mortality rate and malaria case fatality, (2016 - 2021)
Indicator 2016 2017 2018 2019 2020 2021
Institutional under 5 mortality rates - - - 55 50 45
Institutional Under Five Malaria Case
Fatality 0.32 0.20 0.16 0.02 0.02 0.12
Source: Holistic Assessment of the Health Sector, 2021; and Ministry of Health 2022 Programme Based
Budget
Indicator 3.2.1: Under-fve mortality rate
Child death prior to the attainment of age
5 has been declining since 2016. Offcial
survey results show a decline from 111 per
1,000 live births in 2013 to 56 per 1,000 live
births in 2017 against the SDG target of 25
per 1,000 live births.
Facility level information also shows a
declining trend from 55 to 45 per 1,000 live
births between 2019 and 2021, representing
a 3 percent average annual reduction over
this period. Institutional under 5 malaria
case fatality has continued to improve most
especially between 2016 and 2019. However,
the rate marginally deteriorated from 0.02
in 2019 to 0.12 in 2021 (Table 6).
Penta-3 immunization coverage has been
sustained above 90 percent level since 2016.
Factors such as inadequate and aging
cold chain equipment and logistics, and
inadequate numbers and mix of relevant
staff have been consistently identifed to
affect the rate of childhood immunization.
Seven regions have exceeded the 100
percent target, while Volta and Greater
Accra Regions had less than 80 percent
coverage in 2020 (Figure 11). These wide
GHANA 2022 VNR 29 SUSTAINABLE DEVELOPMENT GOALS
regional disparities observed show the
need for continuous investments in EPI
alongside targeted based allocation of
funds to address existing challenges in the
underlined regions.
Figure 11:Penta 3 immunisation coverage by region, 2020(%)
Indicator 3.2.2 Neonatal mortality rate
The proportion of children dying within 28
days of birth as recorded at health facilities
declined from 8.4 per 1,000 live births in
2017 to 7.3 per 1,000 live births in 2019
Figure 12). The rate increased marginally
to 7.4 per 1,000 live births in 2020 partly
due to COVID-19 but improved to 7.0 deaths
per 1,000 live births in 2021. To achieve the
national target of 4.8 deaths per 1,000 live
births would require an average annual
reduction of 0.24 deaths per 1,000 live
births.
Figure 12: Neonatal mortality rate, 2016 - 2021, (per
thousand live births)
Indicator 3.3.1: Number of new HIV
infections per 1,000 uninfected
population, by sex, age and key
populations
There was a decline in new HIV infections
from 20,323 in 2016 to 17,580 in 2020, while
Person Living with HIV (PLHIV) increased
by 18 percent from 2016 to 347,605 in 2020
(Figure 13). HIV incidence has also declined
over the same period, indicating some
progress with the prevention of onward
transmission of HIV.
Figure 13: Number of PLHIV, new infections, and new
infections per 1000 uninfected population, 2016-2020
The rate of new infections declined from
0.71 per 1,000 in 2016 to 0.57 per 1,000
uninfected population in 2020. HIV deaths
increased from 13,534 in 2016 to 14,275 in
2018 but declined in 2020 to 9,957.
HIV prevalence among adults is projected
to have declined marginally from 1.7
percent in 2019 to 1.69 in 2020.
GHANA 2022 VNR 30 SUSTAINABLE DEVELOPMENT GOALS
PLHIV receiving antiretroviral therapy (ART)
increased by 36 percent, from 153,901 (2019)
to 208, 811 (2020). This high increase in
ART treatment for PLHIV shows massive
investments in the control of HIV/AIDs in the
country. There was a signifcant increase in
access to ARVs among pregnant women as
a proportion of recipients increased from
50 percent in 2016 to 87 percent in 2019 but
declined to 80 percent in 2020 (Figure 14).
Figure 14: The proportions of PLHIV on ART and
infected pregnant women receiving ARVs, 2016-
2020, (%)
Ghana could not achieve any of the set
targets for the 90-90-90 programme by
the 2020 end date. The coverage for HIV
persons knowing their status stood at 74
percent in 2020.
In addition, HIV positive persons on ART
reduced marginally from 61 percent to
60 percent between 2019 and 2020. The
highest gains in 2020 was with the HIV
diagnosed persons on ART with viral
suppression, which increased from 41
percent in 2019 to 74 percent in 2020.
Indicator 3.3.2: Tuberculosis incidence
per 100,000 population
The number of new Tuberculosis (TB) cases
reduced by 2,159 between 2019 and 2020,
translating into a reduction in TB incidence
from 48.5 per 100,000 population in 2019 to
40.2 per 100,000 population in 2020 (Figure
15), which is far above the target of ending
the epidemic of TB by 2030.
Figure 15: Tuberculosis incidence per 100,000
population, 2016-2020
Indicator 3.3.3: Malaria incidence per
1,000 population
The worsening malaria situation between
2016 and 2018 has since been reversed.
Malaria incidence has improved to 186 per
1,000 population in 2020, after a peak of
341 per 1,000 population in 2018(Figure
16). The promotion of test, treat, and
track (T3) malaria strategy; distribution of
insecticide treated nets; improved malaria
case management and supply of malaria
Rapid Diagnostic Tests (RDTs) at all service
delivery sites have contributed to this
improvement.
Figure 16: Malaria incidence per 1000 population,
2016 - 2020
Indicator 3.4.1: Mortality rate attributed to
cardiovascular disease, cancer, diabetes
or chronic respiratory disease
In the past few years, non-communicable
diseases (NCDs) have become one of
the leading causes of death, becoming
a public health threat. Deaths from noncommunicable diseases increased by 12
percent from 2018 to 2020 suggesting
that Ghana is not on track to achieve the
SDG target by 2030. Available data shows
GHANA 2022 VNR 31 SUSTAINABLE DEVELOPMENT GOALS
that cardiovascular diseases were among
the top 10 leading causes of deaths in the
country (Figure 17).
Deaths due to respiratory diseases
increased from 3,195 in 2018 to 4,526 in 2020
with pneumonia accounting for the largest
share of these deaths. Hypertension was
responsible for 2,978 deaths in 2020.
Figure 17: Number of deaths from non-communicable diseases by cause of death, 2018 - 2020
Indicator 3.7.1 Proportion of women of
reproductive age (aged 15-49 years)
who have their need for family planning
satisfed with modern methods
Ghana Maternal and Health Survey
estimated Contraceptive Prevalence Rate
(CPR) to be 30.8 percent for married women
in 2017 (compared with 22.2% in 2014)
and 38.4 percent for unmarried women
(compared with 31.7% in 2014).
Family planning (FP) acceptor rate peaked
at 39.8 percent in 2019 but declined to 29.6
percent in 2020 (Figure 18). This decline can
be attributed to shortage in commodities
arising from the COVID-19 restrictions.
Poor access to quality FP services,
characterised by few skilled providers and
inadequate commodities that give the
client little or no choice of methods of
family planning, contributes to high levels
of unmet need in the country.
Figure 18: Trend in family planning acceptor rate,
2016-2020, (%)
Indicator 3.c.1 Health worker density and
distribution
Doctor to population ratio has improved
consistently from 2016, reducing the case
burden of patients on a doctor over the
period. This improvement, however, falls
short of the WHO minimum recommended
threshold of one doctor to 1,000 population.
The nurse to population ratio has
improved signifcantly between 2016 to
2020, exceeding the WHO minimum
recommended threshold of one nurse to
1,000 population (Figure 19).
GHANA 2022 VNR 32 SUSTAINABLE DEVELOPMENT GOALS
Figure 19: Doctor and nurse to population ratios, 2016
- 2020
Indicator 3.d.1 International Health
Regulations (IHR) capacity and health
emergency preparedness
Ghana is a party to the International Health
Regulation designed to help protect all
States from the international spread of
diseases. The core capacities required are
legislation and policy, coordination and
partnership, surveillance, preparedness,
response, laboratory, risk communication,
points of entry, human resources, logistics
and other resources (WHO, 2016).
Some achievements under the IHR include:
1. Establishment of a National IHR Focal
Point located at the Disease Surveillance
Department of Ghana Health Service (GHS)
2. Regular monitoring of progress of
implementation of the IHR by the WHO
Secretariat
3. Ghana has adapted the Second Edition
IDSR Guidelines which also promotes IHR
(2005) implementation
4. Development of IHR Website
5. Training of staff at designated Points of
Entry on IHR Core capacity requirements
1 This refers to death from any cause
Effect of COVID-19 on access and delivery
of health services
The restriction of movements, fear on the
part of health workers and clients, stigma
and misinformation about COVID-19
affected healthcare delivery as many
routine services were suspended. As a
result, Outpatient Department (OPD)
attendance, childhood immunization and
all-cause deaths1
performed below their
respective targets.
COVID-19 also highlighted the unequal
distribution of healthcare facilities in
the country, showing concentration of
healthcare infrastructure in Accra, Kumasi,
and few other cities. Government increased
investment in medical laboratories,
particularly those capable of conducting
PCR test from 2 to 16 nationwide in 2020.
The change in government priority in favour
of saving lives instead of investments in
other sectors of the economy resulted in
an unanticipated expenditure of GH¢17.7
billion (or 4.6% of GDP) in 2020.
Assessment of recovery from the
Pandemic
The early response and the interventions
introduced led to recovery in most of
the key service indicators towards the
end of 2020. A remarkable progress was
observed for maternal and child health
indicators. Considerable improvements
were also recorded in access to quality
healthcare through expansion of services
to the peripherals, increased recruitment
of health personnel, and improved NHIS
active membership.
Comparison of the Household and Job
Tracker Surveys (waves 1 and 2) shows that
efforts to reverse the impact of COVID-19
had yielded positive results (Table 7).
GHANA 2022 VNR 33 SUSTAINABLE DEVELOPMENT GOALS
Table 7: Health impact of COVID-19, 2020
Variable Wave 1 – June 2020 Wave 2 – September 2020
Proportion of households that could not buy medicine 10.9% 10.9%
Proportion of households that needed healthcare and
were able to access it
93.9% 95.7%
Proportion of children missing vaccinations 29.4% 20.6%
Source: Household and Jobs Tracker Survey, 2020
Innovative interventions for accelerating attainment of SDG 3
Interventions being implemented by the government towards the attainment of SDG 3
include the following:
S/n Key Interventions Remarks
1. Establishment and expansion of Medical Drone Delivery Services
• To improve Rural Healthcare, the Ministry of Health in partnership with
Zipline established four Drone Centres in Omenako in the Eastern region,
Mpanya in the Ashanti region, Vovsi in the North East region and Sefwi in
the Western North region; to leverage technology to eliminate stock outs,
cold chain breakages and accelerate emergency response, in 2020.
• By the end of September 2020, 79,000 products to 925 health facilities in
deprived areas were delivered.
2. Reproductive, Maternal,
Newborn, Child and Adolescent Health and Nutrition (RMNCAHN) Strategic
Plan
• In 2021, a comprehensive Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAHN) Strategic Plan aimed at ensuring increased and equitable access to high quality RMNCAHN services for
all by 2030 was launched.
• Related policies and plans under the various components of RMNCAHN
implementation include:
o The National Child Health Policy and Child Health Strategy (2017-2025)
o The National Newborn Health Strategy and Action Plan (2019 – 2023)
3. Vaccine Development Programme
• A comprehensive strategy has been put in place for the establishment of a
National Vaccine Institute to lead in the domestic production of vaccines.
The frst phase of commercial production is expected to start in January
2024.
4. Health Infrastructure Development
• Government has launched a programme to address infrastructure shortcoming in the health facilities. The Agenda 111, is being implemented. This
comprises:
o standard 100-bed district hospitals for 101 districts without hospitals;
o six new regional hospitals for each of the six new regions;
o the rehabilitation of the Effa-Nkwanta Hospital in the Western Region;
o one new regional hospital for the Western Region; and
o three psychiatric hospitals for each of the three zones of the country,
i.e., North, Middle and Coastal.
Emerging issues
1. Increase in government expenditure on
health
2. High incidence of non-communicable
diseases
3. Urgent need for local vaccine production
4. Urgent need for Ghana Centre for
Disease Control (CDC)
5. High doctor to population ratio
6. Unequal distribution of health facilities
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[
3
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{
"country": "gha",
"file_id": "sdg-03/vnr-report-gha-2022-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
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|
Goal 3. Ensure healthy lives and promote well-being for all at all ages
Introduction
Although The Gambia registered significant achievements of improved access to basic health
services across the country, Primary Health Care (PHC) substantially deteriorated overtime and
is no longer adequately serving the population. There is considerable growth in NonCommunicable Diseases (NCDs), high Out of Pocket Expenditures for healthcare, serious
challenges relating to maternal and women’s health, and skilled health personnel are inadequate.
To address these issues and other challenges, government will make major efforts to revitalize
the Primary Health Care system, by building, re-orienting and re-aligning the health system in
the Gambia towards UHC, with an emphasis on PHC, and maintaining effective systems to
ensure improved financial protection and affordability for the most vulnerable populations,
including women, children and the youth while intensifying focus on quality and equity.
Four main outcomes are to be achieved during the next 4 years focusing on reducing maternal,
newborn mortality, reducing the burden of communicable and non-communicable diseases, and
ensuring that the country has appropriately skilled health personnel in place. The weak health
governance and partnership framework will also be addressed, as well as enhanced nutrition and
Water, Sanitation and Hygiene (WASH) outcomes.
Childhood Mortality
This is another area in which the country has not made progress. As shown in Figure 4.8 below
both under five and neonatal mortality increased between 2013 and 2018.
Figure 4.8 Under five and neonatal mortality
Source: GDHS 2013 and MICS 6 2018 U9G86A#8O!G68B
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Skilled attendance at delivery
Attendance of births by skilled workers has been a success story for the country’s primary health
care programme and now even though the concept of Traditional Birth Attendants (TBAs) has
been discontinued and now they are called Community Birth Companions (CBCs) , transitioning
them into escorts for women giving birth has ensured that a lot of women give birth at health
facilities. As shown in Figure 4.9 below, the proportion of births attended by skilled health
personnel has been increasing since 2013; from 57.2% in 2013 to 82.7% in 2018.
Figure 4.9: Proportion of women attended by skilled health personnel
Source: GDHS 2013, IHS 2015/16 and MICS 6 2018
Figure 4.10 below shows map of The Gambia showing under five mortality rate by LGA. The data shows
that under five mortality has decreased in all the LGAs except in Kantaur and Janjangbureh, which are the
poorest regions in the country according to 2015/2016 IHS. A significant decrease has been observed in
Base from 92/1000 to 62/1000
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|
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3
] |
{
"country": "gmb",
"file_id": "sdg-03/vnr-report-gmb-2020-en-3.pdf",
"language": "en",
"locality": null,
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|
42
5.2.3 Goal 3: Health
As a strategic priority in the NDP, the government is committed to putting in place
efforts to strengthen quality health service delivery for reduction of maternal, newborn, infant, child morbidity and mortality, and improvement in adolescent and youth
health. Also, in the National Health Sector Strategic Plan (2021-2025), the government
commits to improving health services in the country and reducing maternal mortality
to improve health status of the population.
Maternal Mortality
In 2019-20 maternal mortality ratio (MMR) for The Gambia is 289 maternal deaths per
100,000 live births. The estimated pregnancy-related mortality ratio (PRMR) is
320(GDHS, 2019-20) deaths per 100,000 live births; that is, for every 1,000 births in the
country, about three women die during pregnancy or within 2 months of the end of a
pregnancy from any cause including accidents or violence. In 2013 GDHS, the
43
pregnancy-related mortality was 433 deaths per 100,000 live births. Overall, there
appears to be a downward trend in the PRMR7 since 2006-13.
Trends in Childhood Mortality Rates
Child mortality estimates are presented in Figure 2. In the latest GDHS, infant and
under-5 mortality rates for the 5-year period before the survey are 42 and 56 deaths
per 1,000 live births, respectively. The neonatal mortality rate is 29 deaths per 1,000
live births. At these mortality levels, about 1 in 18 children in The Gambia does not
survive to their fifth birthday. In The Gambia, infant, under-5 and neonatal mortality
levels have increased since 2013. Under-5 mortality has slightly increased from 54 to
56 deaths per 1,000 live births. Infant mortality has increased from 34 to 42 deaths per
1,000 live births. Neonatal mortality has increased, from 22 to 29 deaths per 1,000 live
births. Child mortality (deaths of children between ages 1 and 5) decreased slightly
from 20 to 15 deaths per 1,000 live births.
Skilled attendance at delivery
The government has promoted the presence of a skilled attendant at every delivery in
the country and major accomplishments were registered. Ensuring institutional
deliveries increase the chances of skilled birth attendance and ensures that many of
the interventions known to save the lives of women are properly implemented. At
the national level, the percentage of births with skilled assistance during delivery
increased from 57% in 2013 to 84% in 2019-20. Achievements are in part due to
community birth companions (formerly Traditionally Birth Attendants) not being
allowed to assist delivery but rather s escort women in labour to the nearest health
facility.
7 Includes deaths up to two months after birth irrespective of the cause of death.
22
12
34
20
54
29
13
42
15
56
Neonatal mortality Postneonatal mortality Infant mortality Child mortality Under-5 mortality
Figure 2: Deaths per 1,000 live births for the 5-year period before the survey
GDHS 2013 GDHS 2019-20
44
The country has also registered improvement in uptake of family planning services.
The proportion of women of reproductive age (15–49) who have their need for family
planning satisfied with modern methods increased from 37.6% (MICS 6, 2018) to
41.3% (GDHS, 2019-20).
Malaria as a communicable disease is a major public health problem and one of the
leading causes of morbidity in the country. Figure 4 shows the incidence of malaria
per 1000 population in the country. The data shows a significant reduction in the
prevalence of malaria over the previous years. However, from 2019 to 2020, the
prevalence slightly increased from 23.2 to 30.6 per 1000 population.
Source: Health Services Report
The government through the National Malaria Control Programme (NMCP) has
significantly invested in malaria control and prevention including the mass
distribution of Long-Lasting Insecticide Nets (LLINs). On routine basis, the
distribution of LLINs is done across the country. Also, the regions with high
prevalence of cases are targeted for routine Indoor Residual Spraying (IRS).
Furthermore, malaria case management, community sensitization and related
programs were scaled up to control the disease.
57.20%
82.70% 83.80%
GDHS, 2013 MICS 6, 2018 GDHS, 2019-20
Figure 3: Proportion of women attended by skilled health personnel
75.6
34.7
40.6
23.2
30.6
2015 2016 2017 2018 2019 2020
Figure 4: Malaria Incidence per 1000 population
|
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55
ODD 3
Permettre à tous de vivre en bonne santé et promouvoirle
bien-être
Le profil épidémiologique est caractérisé par la prédominance des maladies transmissibles et non
transmissibles avec l’émergence de nouvelles maladies, accentuée par les conditions
défavorables du milieu et la prédominance des comportements à risque comme le tabagisme,
alcoolisme, consommation de drogue et pratiques sexuelles à risque. Tous ces facteurs
déterminants jouent aussi en interaction avec la présence d’une alimentation déséquilibrée. Ce
profil est également aggravé par un système de santé déficient qui n’arrive pas à donner des
réponses favorables aux exigences de la population.
Selon les chiffres du Ministère de la santé publique, le taux de mortalité maternelle qui était de
560/100000 en 2015,105 a augmenté à 667/100000 en 2021,
106 dû à l’impact du COVID-19, aux
grèves générales à la fonction publique, la fragilité du système national de santé.107 D’autre part,
dans le MICS6/2019,
108 la mortalité infantile était de (35‰).
Le système de santé est composé de trois niveaux. Un niveau central avec 11 régions sanitaires
au niveau régional et 114 aires sanitaires en périphérie (le niveau le plus proche des
communautés), définies sur la base de critères géographiques et couvrant une population
comprise entre 5 000 et 12 000 habitants. Cependant, malgré cela, 66% de la population vit
toujours à plus de 5 km des structures de soins de santé primaires. Le secteur de la santé est
composé d’un secteur public et d’un secteur privé lucratif et non lucratif. Vu la complexité de la
santé, le Ministère de la santé a adopté une approche pour tenir compte, dans sa planification
et coordination avec les bailleurs de fonds, des déterminants socioéconomiques en regroupant
tous les secteurs du développement qui mènent des activités de sensibilisation pour une
meilleure implication de tous.
Le Système d’Information Sanitaire (SIS) qui accompagne ce plan est affecté par l’insuffisance du
personnel compétent dans la gestion des données, et l’implication du secteur privé lucratif
demeure très limitée. Les mesures sont en cours pour renverser la tendance y compris l’inclusion
du DHIS_2 au niveau de la totalité des régions sanitaires du pays, ainsi que sa mise en échelle au
niveau des structures de soins. Le gouvernement est en train d’élaborer son nouveau Plan
National de Développement Sanitaire (2023-2030) de façon à réorganiser le système de santé
qui sera apte à fournir des services de santé inclusifs et intégrés pour sa population.
Comme le gouvernement n’est pas en mesure de pouvoir couvrir la totalité des frais de mise en
œuvre de ce plan seul, il a été fait un alignement graduel de l’aide externe par certains bailleurs
de fonds, en attendant l’organisation d’une table-ronde pour mobiliser les ressources
manquantes. Le financement de la santé dépend principalement de l’appui externe qui
représente plus de 90% du budget d’investissement. Dans cet appui externe, 24% vient des
partenaires internationaux et 68% imputés aux paiements directs par les ménages, laissant ainsi
105 https://apps.who.int/iris/bitstream/handle/10665/170250/9789240694439_eng.pdf?sequence=1&isAllowed=y 106 https://apps.who.int/iris/bitstream/handle/10665/342703/9789240027053-eng.pdf 107 Rapport du Ministère de la Santé publique, 2021. 108 https://stat-guinebissau.com/MICS6_Relatorio_SFR_GB_Versao_3_YC_KI30.pdf
Cibles pour laquelle il manque des données
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.
56
la contribution de l’Etat à peine de 8%.
109 La contribution de l’Etat se limite au paiement des
salaires et quelques petites interventions. Un essai sur les Comptes Nationaux de Santé en 2019
n’a pas encore vu ses activités institutionnalisées. Les budgets gouvernementaux et la corruption
ont impacté les salaires qui sont en outre à l’origine d’un environnement de travail inadéquat,
qui engendre le non-paiement des salaires des médecins, infirmiers et autres praticiens
médicaux.
110 Compte tenu de cela, le secteur de la santé reste fortement dépendant de l’aide
internationale, limitant la capacité des infrastructures des établissements de santé et
l’équipement hospitalier,
111 et réduisant la soutenabilité du financement de ce secteur afin
d’assurer le droit à la santé pour toutes et tous.
La situation des ressources humaines pour la santé est caractérisée par un manque de
spécialistes, aggravé par une grande disparité dans leur distribution entre les différentes régions
et structures sanitaires et à l’intérieur d’une même structure, avec une forte concentration sur
Bissau, la capitale. Cette carence porte préjudice dans la gestion des programmes. L’absence
d’une politique de développement des ressources humaines, exprimée entre autres par
l’inexistence d’un plan de carrière au sein des catégories professionnelles de santé contribuant
aussi à des faibles productivités des différents services de santé. La faible capacité d’absorption
des nouveaux professionnels de santé, par le Ministère de la Fonction Publique, bloque le
processus de recrutement du personnel.
La politique visant l’implication des communautés dans la prise des décisions se heurte à des
difficultés organisationnelles. Actuellement, l’Etat s’organise dans une stratégie communautaire
en mettant 50 familles sous la responsabilité d’un agent de santé communautaire en vue de
faciliter la mise en œuvre des 16 pratiques familiales et d’hygiènes dans les différentes familles.
Le système de santé dépend considérablement de l’appui des agents de santé communautaires.
Cependant la pérennité de cette stratégie dépend des financements externes pour la
rémunération et le paiement des déplacements des agents de santé communautaires.
L’Indice Synthétique de Fécondité (ISF) est de 4,9 enfants par femme en âge de procréer (15-49
ans), qui a baissé à 4,3%, en 2018-2019. L’ISF est de 5,3 enfants en milieu rural contre 2,7 pour
le milieu urbain. Le taux de fécondité est passé de 106% chez les 15-19 ans (MICS 2014), a 84 en
2019. Pour 2019, le taux de fécondité en milieu rural est de 119%, ceci est caractéristique du fait
que la vie procréative des femmes commence tôt et se termine assez tardivement. Les
principales causes étant le mariage et les rapports sexuels précoces surtout chez les jeunes filles
en mariage intergénérationnel et le faible taux de prévalence d’utilisation des méthodes
contraceptives. En outre, la situation des mutilations génitales féminines (MGF) empire avec un
taux de prévalence chez les filles âgées de 0 à 14 ans passant de 49,7% à 52,1%, en 2018-2019.112
Par ailleurs, 41,8% des femmes âgées de 15-49 ans acceptaient la violence de leurs partenaires,
en 2014, cette proportion a baissé à 36,4%, en 2018-2019.
En RGB, l’accès aux soins médicaux, à la nourriture et à l’eau potable reste précaire. La malaria,
la tuberculose, le choléra, la malnutrition, les maladies infectieuses et respiratoires, les diarrhées
et le VIH/SIDA continuent d’être répandus à travers le pays, contribuant à un taux de mortalité
infantile élevé. La malnutrition chronique a reculé, le taux étant passé de 32% en 2010 à 28% en
2014 et à 27,7%, en 2018-2019. Une régression a été enregistrée en matière d’allaitement
exclusif au sein, dont le taux est passé de 65% en 2010 à 53% en 2014, pour remonter à 59,3%,
en 2018-2019. La prévalence du VIH, qui s’établit à 3,3%, est la plus élevée d'Afrique de l'Ouest.
La prévalence du VIH chez les filles et les femmes âgées de 14 à 24 ans est de 4,2%, soit trois fois
plus que chez les garçons et les hommes de la même tranche d’âge. Seuls 33% des 44000
personnes vivant avec le VIH reçoivent un traitement antirétroviral. Dans quatre régions, les
109 Comptes Nationaux de Santé, 2015-2017, 2022. 110 Joào & Handem, 2011. 111 Idem. 112 MICS 2018-2019.
57
Centres de récupération nutritionnels (CRN) ont testé les enfants pour la séropositivité et leur
nombre a augmenté entre 2015 et 2017. Il est estimé à 5,3% la population séropositive âgée de
15 à 49 ans, faisant du taux de la RGB, le second taux le plus élevé en Afrique de l’Ouest.113 Le
Secrétariat National de Lutte contre le SIDA (SNLS) et le Conseil National du SIDA (GAC) ont
accompli des progrès considérables pour gérer et coordonner la réponse nationale à l’épidémie
au cours des dernières années.
Avec l’initiative du partenariat pour la santé « H4+ », la gratuité des soins en faveur de la femme
enceinte et des enfants de moins de 5 ans a commencé sa mise en œuvre. Parallèlement,
l’initiative pour la santé des mères et des enfants de l’Union Européenne (PIMI) soutient la
gratuité dans les régions non couvertes par l’initiative « H4+ », en plus de programmes soutenus
par le Fonds Mondial (accès aux médicaments et produits pharmaceutiques et de laboratoire
pour les 3 maladies cibles) et aussi du soutien de GAVI pour l’immunisation des enfants.
Comme opportunités, le pays dispose :
1. Des mécanismes pour améliorer la gestion des fonds provenant des différentes sources.
2. Existence d’un Comité de coordination pour le secteur de la santé (CCSS) peu fonctionnel.
3. D’autres mécanismes pour la coordination des ressources des partenaires, tels que le CCM
pour les ressources du Fonds Mondial et CCIA pour les ressources du GAVI.
4. L’adhésion du pays aux initiatives internationales de santé : UHC2030 (IHP+), HHA, H4+.
5. Le cadre de concertation des partenaires mis en place pour l’appui à la réponse à la
pandémie de COVID-19 et qui a permis la mise en place en cours du Groupe de Coordination
des Partenaires Santé.
Le taux de mortalité infantile est inquiétant est symbolique à la fois de la pénurie généralisée
d’hôpitaux et d’installations de soins adéquats, et de la persistance d’un haut niveau de
malnutrition, qui est un défi de santé publique attribué à l’insécurité alimentaire. A travers le
pays, 78 centres de réhabilitation nutritionnelle ont été installés mais ils ont eu très peu de
succès. Les facteurs limitants incluent l’impact négatif de la volonté des parents d’amener leurs
enfants dans ces centres et ces derniers qui perdent la trace de leurs patients avant la fin de leur
traitement.
114
Au-delà d’un financement insuffisant, le système de santé du pays a un accès limité à
l’équipement et aux médicaments nécessaires, mettant davantage la pression sur son personnel
surchargé. Il y a seulement 1,7 médecin pour 10 000 personnes, ce chiffre baisse encore pour les
pédiatres: 3 pour environ 720 000 enfants âgés de moins de 15 ans.
115 Les mécanismes de
gouvernance de la protection sociale ont besoin de renforcement de capacités, vue la faiblesse
des ressources humaines, des outils de gestion, ainsi que l’absence d’un cadre de
réglementation, et d’un plan stratégique et opérationnel à moyen terme pour la protection
sociale de base et non contributive.
L’accessibilité financière des services de santé existants est un frein majeur à l’accès à la santé
de base pour une grande partie de la population. Il y a une absence notoire de dispositifs de
protection financière contre le risque maladie, que ce soit pour les travailleurs de l’économie
moderne et leurs familles (qui constituent néanmoins une faible proportion de la population)
mais aussi et surtout pour la majorité de la population issue de l’économie informelle.
Pour assurer une vie saine à tous les citoyens, en 2020, lors de la révision par le Conseil des droits
de l’homme, la RGB s’est engagée à mettre en œuvre un grand nombre de recommandations
liées à la santé notamment (119.107) qui vise à renforcer la législation en matière de santé et la
mise en œuvre des politiques et des directives visant à améliorer l’accès, en particulier des
113 UNICEF 2021 114 UNICEF, 2021. 115 UNICEF, 2021.
58
personnes handicapées, des femmes et des jeunes aux services de soin de sante). Il sera aussi
essentiel de surmonter les défis des ressources humains ainsi que des infrastructures
insuffisantes et dégradées, des centres de traitements spécialisés presque inexistants, sans
oublier la forte dépendance de l'aide étrangère pour assurer le maintien des stocks de
médicaments/matériels, y compris la chaîne du froid, entre autres besoins du secteur.
A. Situation et tendances
L’objectif 3 de permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à
tout âge, poursuit 13 cibles dont neuf de résultats (3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9) et
quatre de moyens de mise en œuvre (3.a, 3.b, 3.c, 3.d).
Tendance des résultats de l’ODD 3
Des neuf cibles de résultats de l’ODD 3, huit sont centrées sur les personnes et une porte sur
l’ensemble de la société (3.8).
Résultats centrés sur les personnes
Cible 3.1 : D’ici à 2030, faire passer le taux mondial de mortalité maternelle au-dessous de 70
pour 100 000 naissances vivantes
La situation de la mortalité maternelle demeure préoccupante car malgré une tendance générale
à la baisse, l’atteinte de la cible semble encore hors de portée. Les données disponibles indiquent
qu’en 2017, il y avait en moyenne 667116 décès de femmes pour 100 000 naissances vivantes.
Cette situation était prévisible si l’on sait qu’une part importante des naissances se passent en
dehors de toute assistance médicale, et en 2019, la proportion d’accouchements assistés par du
personnel de santé qualifié n’était encore que de 53,8%.
Figure 7.8 : Evolution de la mortalité maternelle
Source : UNDESA (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 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.
La mortalité des enfants demeure encore parmi les plus élevée au monde, malgré une tendance
à la baisse. Pour l’année 2020, sur 1 000 naissances, 35 enfants mourraient avant d’avoir atteint
1 mois, 51 mourraient avant l’âge d’un an et 77 mourraient avant d’atteindre l’âge de 5 ans.
116 21072_WHS 2021 (who.int)
0
200
400
600
800
1 000
1 200
1 400
2000 2005 2010 2015 2016 2017
Taux de mortalité maternelle (pour 100.000 naissances
vivantes)
59
Figure 7.9 : Evolution de la mortalité des enfants
Source : UNDESA (2021)
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
La tendance générale des infections à VIH est à la baisse mais demeure une préoccupation
particulière chez les femmes qui contractent beaucoup plus le virus pour toutes les années. En
2020, pour 1 000 personnes séronégatives de 15 à 24 ans, il y avait 1,03 nouvelles infections;
chez les femmes, il y avait 1,48 nouvelles infections pour 1 000 femmes séronégatives. Pour la
même année, lorsqu’on considère la tranche d’âge de 15 à 49 ans, on a respectivement 1,23
nouvelles infections pour 1 000 personnes séronégatives dans l’ensemble et 1,6 chez les
femmes.
Figure 7.10 : Evolution des nouvelles infections à VIH, par âge et sexe
Source : UNDESA (2021)
La situation de la tuberculose est stagnante depuis 2005: le taux d’incidence est à 361 pour
100 000 habitants. Pour le paludisme, le taux d’incidence qui était de 94,8 pour 1 000 habitants
en 2005 est descendu à 56,7 en 2017 avant de remonter à 88,9 en 2020.
0.0
50.0
100.0
150.0
200.0
2000 2005 2010 2015 2016 2017 2018 2019 2020
Taux de mortalité (pour 1 000
naissances vivantes)
Mortalité des enfants
Taux de mortalité des enfants de moins de 5 ans
Taux de mortalité des enfants de moins d'un an
Taux de mortalité des enfants de moins d'un mois
0.00
0.50
1.00
1.50
2.00
2.50
3.00
2015 2016 2017 2018 2019 2020
Nombre de nouvelles infections à VIH pour
1 000 personnes séronégatives de 15-24 ans
ENSEMBLE FEMMES HOMMES
0.00
0.50
1.00
1.50
2.00
2.50
3.00
2015 2016 2017 2018 2019 2020
Nombre de nouvelles infections à VIH
pour 1 000 personnes séronégatives de
15-49 ans
ENSEMBLE FEMMES HOMMES
60
Figure 7.11 : Evolution du taux d’incidence du paludisme
Source : UNDESA (2021)
Les informations sur l’hépatite B ne sont disponibles que pour les enfants de moins de 5 ans. La
prévalence de l’antigène de surface de l’hépatite B chez ces enfants est passée de 2,12% en 2015
à 2,39% en 2018 pour redescendre à 2,11% en 2020.
Le nombre de personnes pour lesquelles des interventions contre les maladies tropicales
négligées sont nécessaires a connu une baisse considérable au cours des dernières années. De
1 731 541 personnes en 2015, il est descendu à 1 232 549 en 2019, soit une baisse de 29% sur la
période.
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 bienêtre.
Il y a une légère baisse du taux de mortalité attribuable à des maladies cardiovasculaires, au
cancer, au diabète ou à des maladies respiratoires chroniques, mesuré pour les personnes âgées
de 30 à 70 ans, passant de 26,1% en 2015 à 24,9% en 2019. Ce taux est un peu plus élevé chez
les hommes de la même tranche d’âge, passant de 29,1 à 27,4%; chez les femmes, il est passé de
24 à 23%. En outre, il y a une très légère baisse du suicide: pour 100 000 décès; 7,2 y sont
attribuables en 2015 contre 7 en 2019. Le taux de suicide est plus important chez les hommes,
de 10,5 en 2015 et 10,2 en 2019 pour 100 000 hommes décédés. Chez les femmes, le taux est de
4,1 pour 100 000 femmes décédées en 2015 et 3,9 en 2019.
Cible 3.5 : Renforcer la prévention et le traitement de l’abus de substances psychoactives,
notamment de stupéfiants et d’alcool.
La prévalence sur 12 mois des troubles liés à la consommation d’alcool, pour 2018-2019, à raison
de (9,7% pour les femmes) et (15,4% pour les hommes). Elle est principalement observée chez
les hommes parmi lesquels le taux de prévalence est de 2%; chezles femmes ce taux est de 0,1%.
En termes de quantité, la consommation d’alcool (en litres d’alcool pur) par habitant (âgé de 15
ans ou plus) a crû de 5,2 litres en 2015 à 5,5 litres en 2019. Elle est beaucoup plus importante
chez les hommes qui ont consommé en moyenne 8,8 litres d’alcool pur en 2015 et 9,3 en 2019.
Cependant, il y a aussi une légère hausse de consommation chez les femmes qui sont passées
d’une quantité moyenne de 2 litres en 2015 à 2,1 en 2019.
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
Le taux de mortalité lié aux accidents de la route a légèrement augmenté, passant de 32,1 décès
pour 100 000 habitants en 2015 à 32,2 en 2019. Il est beaucoup plus important chez les hommes
où il est estimé à 43,4 en 2015 et 44 en 2019. Pour les femmes, ce taux a légèrement baissé de
21,3 en 2015 à 21 en 2019.
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
2005 2010 2015 2016 2017 2018 2019 2020
Incidence du paludisme pour 1 000 habitants
61
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.
La proportion de femmes en âge de procréer (15 à 49
ans) qui utilisent des méthodes modernes de
planification familiale est de 60% en 2019. Cette
proportion était de 55,7%, en 2014, et a baissé à 20,6%,
en 2018-2019. En outre, la procréation par les
adolescentes est importante. Chez les adolescentes,
respectivement 1,6 pour 1 000 âgées de 10 à 14 ans et
84 pour 1 000 de 15 à 19 ans ont donné naissance à un
enfant 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, la situation de mortalité attribuable à la pollution de l’air dans les habitations et à la
pollution de l’air ambiant est la suivante :
En termes brut, pour 100 000 décès, 87 sont attribués à la pollution de l’air dans les
habitations et 38 à la pollution de l’air ambiant (108 pour les deux types de pollution);
En termes normalisés selon l’âge, pour 100 000 décès, 169 sont attribués à la pollution de
l’air dans les habitations et 78 à la pollution de l’air ambiant (215 pour les deux types de
pollution).
Le taux de mortalité attribuable à l’insalubrité de l’eau, aux déficiences du système
d’assainissement et au manque d’hygiène (accès à des services WASH inadéquats) est estimé à
35,3 pour 100 000 décès en 2016. Le taux de mortalité attribuable à un empoisonnement
accidentel est en légère hausse, allant de 2,2 pour 100 000 décès en 2015 à 2,3 en 2019. Il y a eu
une stagnation chez les hommes à 3 sur la période et une hausse chez les femmes de 1,5 à 1,7.
Résultats à l’échelle de la société
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
Le niveau de couverture sanitaire universelle (CSU) est faible et en détérioration au cours des
dernières années. L’indice de couverture des services de CSU qui était de 38% en 2015 a connu
une légère baisse à 37% en 2019. Les données disponibles montrent que les ménages contribuent
en grande partie directement à leurs dépenses de santé. En 2010, 0,95% des ménages utilisaient
plus de 25% de leurs dépenses dans la santé et 6,26% le faisaient à plus de 10%. A noter une
expansion du secteur sanitaire privé au cours des dernières années, à travers une prolifération
de cliniques privées et pharmacies, souvent sans contrôle ou supervision publiques.
Processus et moyens de mise en œuvre spécifiques à l’ODD 3
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.117
La RGB subit les effets néfastes du tabagisme, où chaque année, plus de 430 de ses habitants
sont tués par des maladies causées par le tabac. Pourtant, plus de 1 000 enfants (10-14 ans) et
117 Guinea-Bissau - Tobacco Atlas
62
67 000 de jeunes et d’adultes continuent de consommer du tabac chaque jour. En 2015, pour les
jeunes et les adultes, 11,4% des hommes (soit environ 61 400 hommes) consommaient du tabac,
contre 1% des femmes (soit 5 500 femmes). Parmi les enfants de 10 à 14 ans, 0,9% des garçons
consommaient quotidiennement du tabac, en 2015, contre 0,18% des filles.
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.
La couverture vaccinale en 3 doses de diphtérie-tétanos-coqueluche (DTC3) qui était de 86% en
2015 a connu une baisse jusqu’à 76,9% en 2018-2019. La proportion de la population cible ayant
accès à la 3e dose conjuguée contre le pneumocoque (PCV3) a fait un bond de 10% en 2015 à
83% en 2016 avant de retomber aussi à 76% en 2018-2019.
L’aide publique au développement consacrée à la recherche médicale et aux soins de santé de
base fluctue autour de 20 millions de dollars au prix constant de 2019. Son plus haut niveau en
termes nets a été atteint en 2018 où il était de 24 millions.
Figure 7.12 : Evolution de l’accès aux vaccins et de l’aide publique au développement pour la recherche
médicale et la santé de base
Source : UNDESA (2021)
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.
La couverture en personnel de santé en 2020 se présente comme suit :
3 dentistes pour un millions d’habitants.
791 infirmiers et infirmières pour un million d’habitants, ce personnel étant à 67%
constitué de femmes.
7 pharmaciens et pharmaciennes pour un million d’habitants.
196 médecins pour un million d’habitants, dont 31% de femmes.
B. Défis futurs, risques, opportunités et actions d’accélération
B1. Défis futurs et risques
✓ Le financement soutenable du secteur de la santé au vu de la réduction de l’espace
budgétaire.
-
100
2015 2016 2017 2018 2019 2020
Taux d'accès aux vaccins
Proportion de la population cible ayant accès
à 3 doses de diphtérie-tétanos-coqueluche…
-
50
2015 2016 2017 2018 2019
Aide publique au développement aux
secteurs de la recherche médicale et de la
santé de base (millions de dollars
constants des États-Unis en 2019)
Décaissement net décaissement brut
63
✓ L’insuffisance de personnel spécialisé.
✓ L’insuffisance de structures sanitaires adéquates.
✓ Équipements modernes insuffisants aux plans quantitatif et qualitatif.
✓ La gouvernance du secteur de la santé.
✓ L’accessibilité et l’offre de services de santé de qualité.
✓ La fréquentation des établissements sanitaires.
✓ La préparation et la réponse aux urgences sanitaires (épidémies, pandémie, etc…).
✓ Manque de contrôle de qualité des médicaments vendus sur le marché
✓ Mauvaise conservation des médicaments et vaccins
✓ Faible disponibilité de médicaments dans certaines régions, y compris d’occasionnelles
ruptures de stocks d’antirétroviraux
✓ Coût élevé des médicaments, limitant l’accès des populations vulnérables
✓ Fort recours aux tradipraticiens et aux médicaments traditionnels.
B2. Opportunités
✓ Existence du plan national de développement sanitaire (PNDS3).
✓ Disponibilité des partenaires techniques et financiers pour soutenir le Plan National de
Développement sanitaire.
B3. Actions d’Accélération
✓ Présenter au comité des droits économiques, sociaux et culturels son premier rapport
sur l’application du Pacte International relatif aux droits économiques, sociaux et
culturels, notamment son article 12
✓ Mise en œuvre effective du troisième plan national de développement sanitaire.
✓ L’amélioration de la gouvernance et de la redevabilité.
✓ La conception et la mise en place d’un dispositif de couverture de santé universelle
(recommandation 119.109 de l’examen périodique universelle en 2020).
✓ L’augmentation des allocations budgétaires pour le secteur sanitaire.
✓ Renforcer la législation sur la santé et la mise en œuvre de politiques et de directives
visant à améliorer l’accès à la santé services de soins, en particulier des personnes vivant
avec des handicaps, des femmes et des jeunes,
✓ Bâtir un système de financement des soins de santé capable de réduire les obstacles
financiers d’accès à la santé, et promouvoir une utilisation efficace des ressources
économiques
✓ Prévoir la décentralisation des services de santé sexuelle et de reproduction au niveau
local, y compris en étendant les services de protection du personnel du Ministère de la
santé, de la famille et de la famille et de Cohésion sociale dans les régions.
|
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[
3
] |
{
"country": "gnb",
"file_id": "sdg-03/vnr-report-gnb-2022-fr-3.pdf",
"language": "fr",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2022
}
|
69
Informe Nacional Voluntario
ODS 3. Alcanzar este objetivo en 2030, supone adoptar
mecanismos de protección social con un sistema de seguro
universal de la salud y la mejora de servicios de base como
la alimentación, la nutrición, el acceso al agua potable,
la higiene y el saneamiento. Esta serie de acciones son
prioritarias para las zonas rurales y periféricas. El desarrollo
de un plan integrado para la supervivencia y el desarrollo
del niño, nutrición, agua y saneamiento y el VIH/SIDA, son
igualmente necesarios para alcanzar el ODS.
Es importante aumentar rápidamente y mantener a un
nivel elevado la cobertura de vacunación de por lo menos
90% para las enfermedades prevenibles por la vacunación,
privilegiando la estrategia Alcanzar Cada Distrito (ACD) a
nivel nacional y el reforzamiento de la prevención de la
transmisión del VIH de la madre al hijo (PTMH).
70
Alcanzar este objetivo supone también la intensifcación
de los servicios de consultas prenatales y postnatales, el
reforzamiento de los recursos humanos y materiales, así
como la puesta en marcha de los cuidados obstétricos de
urgencia en los diferentes centros de salud y hospitales. Es
igualmente necesaria la elaboración de un sistema efcaz
de colecta, de análisis, de difusión y de actualización de las
estadísticas sanitarias.
|
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|
63
Informe Nacional Voluntario
ODS 3. Salud y Bienestar
En Guinea Ecuatorial se han logrado grandes progresos
en cuanto al sector salud y bienestar poblacional. La
realización de la encuesta Demográfca de Salud en
64
2011 ha permitido disponer de indicadores esenciales
para conocer los progresos en materia de salud,
sobre todo en la mortalidad materna, infantil, de las
enfermedades contagiosas como el VIH, la tuberculosis,
malaria y otras enfermedades transmisibles. Por ello,
es clave realizar encuestas regulares que contribuyan a
identifcar y abordar las disparidades persistentes y los
avances alcanzados.
La fgura a continuación muestra el número de personas
que requieren intervenciones contra enfermedades
tropicales desatendidas (indicador 3.3.5). Se observa
una importante caída luego de 2015, lo cual habla de una
mejora en el desempeño en materia de salud.
Figura 11. Indicador 3.3.5 Número de personas que
requieren intervenciones contra enfermedades tropicales
desatendidas.101
Fuente: UNSTATS
Con respecto a los hábitos de consumo de la población, la
siguiente fgura (indicador 3.5.2) muestra el consumo de
alcohol per cápita entre la población mayor de 15 años. Se
observa una caída en el consumo luego de 2015, lo cual es
deseable ya que el consumo de alcohol incide tanto en la
prevalencia de enfermedades, lesiones y otras condiciones
de salud, como en los desórdenes y sus resultados en las
personas.
Figura 12. Indicador 3.5.2 Consumo anual de alcohol per
cápita entre la población mayor de 15 años.102
Fuente: UNSTATS
Otro de los indicadores al respecto de este ODS es la
proporción de mujeres en edad reproductiva que tienen
su necesidad de planifcación familiar satisfecha con los
métodos modernos (indicador 3.7.1103). Según datos
de la EDSGE-1 2011, dicha proporción es de 20,7%, lo
cual revela que gran parte de las mujeres no acceden a
estos métodos de planifcación familiar, lo cual tiene
consecuencias en otros aspectos de la vida de las mujeres.
Por su parte, si bien la tasa de fecundidad adolescente
(indicador 3.7.2) se redujo luego del año 2000, muestra
una tendencia creciente luego de 2005.
Figura 13. Indicador 3.7.2 Tasa de natalidad adolescente
por cada 1000 mujeres (15 a 19 años).104
Fuente: UNSTATS
65
Informe Nacional Voluntario
En cuanto a la oferta de servicios de salud, un indicador
relevante corresponde a la cantidad de médicos por
cada de 10000 personas (indicador 3.c.1). De acuerdo
con datos del Observatorio Mundial de la Salud, este
indicador en Guinea Ecuatorial es de 4 médicos, es
decir un número modesto105. Por su parte, según datos
de la OCDE, luego de 2011 la asistencia recibida para
investigación médica y los sectores básicos de salud
(indicador 3.b.2) se redujo, lo cual puede haber tenido un
impacto en la calidad de los servicios ofrecidos.
Figura 14. Indicador 3.b.2 Asistencia ofcial recibida
para investigación médica y sectores básicos de salud
(millones de dólares constantes de 2018).106
Fuente: UNSTATS
En el censo de población 1994, Guinea Ecuatorial fguraba
entre los países que poseen una tasa de mortalidad
materna más elevada de África, con una tasa de 352
por 100.000 nacidos vivos. El escaso acceso, utilización
y calidad de los cuidados obstétricos y neonatales de
urgencia, la defciencia del sistema de referencia y de
contrarreferencia, la escasa capacidad operacional de
los programas de sensibilización de las mujeres sobre
sus derechos en materia de sexualidad y reproducción
en general y de los riesgos relacionados a la maternidad
en particular, el funcionamiento defciente del sistema de
información sanitaria y de vigilancia epidemiológica de
la mortalidad materna y neonatal, entre otras, también
fguraban como causas profundas de la mortalidad
materna que han constituido el fundamento la elaboración
y adopción por el Gobierno de la hoja de ruta para acelerar
la reducción de la mortalidad materna y neonatal en
2008. Las causas indirectas de muertes maternas siguen
siendo provocadas por la anemia, el paludismo durante el
embarazo, la malnutrición y el VIH/SIDA.
En los últimos años, la tasa de mortalidad materna
(indicador 3.1.1) se ha reducido de una manera signifcativa.
Las inversiones del Gobierno, la asistencia sanitaria y el
fortalecimiento de los servicios de planifcación familiar
han sido los factores determinantes para la disminución
de la mortalidad materna. La mortalidad materna (número
anual de muertes femeninas por cada 100,000 nacidos
vivos) en Guinea Ecuatorial ha disminuido en los últimos
años, se ha pasado de 344 en 2005 a 301 en 2017107.
Figura 15. Indicador 3.1.1 Tasa de mortalidad materna
por cada mil nacidos vivos en Guinea Ecuatorial
Fuente: UNSTATS
La mortalidad infantil registró una disminución en los
últimos años. De acuerdo con la EDS GE 2011, en el
periodo 2007-2011, la tasa de mortalidad para los menores
de 5 años (indicador 3.2.1) pasó de 113 muertes a 81.2
muertes por cada 1.000 nacidos vivos en el 2018 108.
Si bien, según especialistas, el paludismo sigue siendo
unas de las principales causas de la muerte en Guinea
Ecuatorial, el gobierno creó el Programa Nacional de
Lucha contra el Paludismo (PNLP) afectado al Ministerio
de Sanidad y Bienestar Social y está siendo apoyado por
66
la ONG Medical Care Development International (MCDI)
para la implementación de intervenciones de control del
paludismo en la Isla de Bioko y en la Región Continental.
Su prevalencia se ha logrado reducir del 82% en 2012 a
28% en 2013.
Por su parte, Guinea Ecuatorial es uno de los países
con mayor número de casos de tuberculosis en la zona
de África Occidental, con una tasa de incidencia de la
enfermedad sensible de 172 casos por 100.000 habitantes.
Se ha creado en el Ministerio de Sanidad y Bienestar Social
el Programa Nacional de Lucha contra la Tuberculosis, sin
embargo, entre el 2015 y el 2016 el número de casos de
las diferentes tipologías de tuberculosis aumentó. Para
luchar contra la Tuberculosis, el Gobierno, a través del
Ministerio de Sanidad y Bienestar Social, ha incrementado
el número de unidades públicas o privadas acreditadas
para su diagnóstico y tratamiento de forma gratuita. Se
han adquirido tratamientos mejores para las formas graves
de Tuberculosis y se ha implementado en todo el país el
GeneXpert, una herramienta moderna capaz de detectar
las formas resistentes de la Tuberculosis.
El VIH/SIDA (indicador 3.3.1) en Guinea Ecuatorial es
una de las principales causas de morbi-mortalidad en
la población. De acuerdo con información brindada por
INEGE, los estudios de prevalencia en la población de
15-49 años han mostrado un incremento de las tasas
de infección entre 1989 (1,1%) y 1997 (3,48%), la cual
se mantiene elevada en 2004 (3,2%), y se confrma con
los datos de la EDSGE-1 2011, que revela un aumento
signifcativo de esta prevalencia en un 93,7%, siendo
6,2%, signifcativamente superior en mujeres (8,3%) que
en hombres (3,7%). En los últimos años el número de
infecciones se ha incrementado, situándose en un 5,3%,
en 2020, frente al 3,2% del 2004.
|
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|
THE INCORPORATION OF THE SDGs IN THE NATIONAL FRAMEWORK 43
Ensuring universal access to quality health care services (SDG 3)
Closely linked to tackling poverty and social exclusion, is the access to quality health services,
because, as the World Health Organisaton underlines, poverty and social exclusion are the main
determinants of health, which, in its turn, then afects the above causal factors. In this directon,
Greece has combined in one natonal priority the fght against poverty and social exclusion with
universal access to quality health services. At the same tme, the formaton of health policies
based on the percepton of health as a social good and right, is in line with the 2030 Agenda and
the Natonal Growth Strategy, whereby investng in health, is a basic requirement for safeguarding human dignity, combatng poverty and inequalites, ensuring social cohesion and advancing economic development. Improving populaton’s health leads to increased productvity and
reduced healthcare and rehabilitaton costs. In view of the above, it should be noted that the
Ministry of Health has already developed policies that contribute to the efectve implementaton of SDGs and has taken important initatves on new legislaton, strategies and innovatve
programmes, such as those mentoned below.
Special atenton is also given to gender equality in health care, as is evident in the Natonal
Acton Plan on Gender Equality 2016-2020 (NAPGE), prepared by the General Secretariat for
Gender Equality (GSGE), Ministry of Interior, where one of the strategic objectves set for the
period 2016-2020 is the eliminaton of gender inequalites in health, including the integraton of
a gender perspectve in health care policies and the eliminaton of gender stereotypes in health
services for special populaton groups.
Free access to the public health care system and healthcare for uninsured citzens (SDG 3.8)
With the adopton of law 4368/2016 and a Joint Ministerial Decision, free access to the public
health system is allowed for the uninsured citzens and vulnerable social groups, in terms of nursing and medical care. Free access is ensured by minimising bureaucracy. As regards the contributon in pharmaceutcal spending, a new system of income criteria is introduced in order to relieve
the vulnerable social groups. Also, through a healthcare card issued by the hospitals, refugees,
irrespectve of their legal status, who need systematc medical care and live in the country, are
covered.
Achieving universal access to quality health care services requires, inter alia, the development throughout the territory of an upgraded and modernised primary health care network.
44 HELLENIC REPUBLIC I VNR 2018
The Ministry of Health introduced law 4486/2017, which ensures the organisaton and operaton of the Decentralised Regional Health Units, providing integrated primary health care
services, to all age groups of the populaton. These units do not restrict their services only in
the management of diseases, but extend them to health promoton, preventon, systematc
monitoring of patents’ health, physical rehabilitaton and social reintegraton, taking into account that, from an integrated health care perspectve, the disease is not just a biological
phenomenon, as it has serious social implicatons. With a view to the unhindered access of
patents with serious diseases to all high-cost and innovatve therapies, an integrated mechanism for the evaluaton and compensaton of pharmaceutcal products, which ensures scientfcally sound, cost-efectve and equitable access to safe, efectve and innovatve medicines,
as well as the sustainability of the Natonal Health System, law 4512/2018 was adopted.
In the context of dealing with refugee and migratory fows, the Ministry of Health cooperates
with other competent ministries and bodies for the protecton of human rights and the optmal
treatment of extraordinary circumstances. In this directon, it has given priority to protectng the
health of refugees, migrants and the entre populaton of the country, through organising mass
vaccinatons, exceeding 30,000, with the help of UNICEF, WHO, the EU and various NGOs, and in
line with the recommendatons of the Natonal Immunisaton Commitee.
Promoton of mental health and well-being (SDG 3.4)
The psychiatric reform is implemented through the “PSYCHARGOS” Programme, which aims at
shifing the provision of health services from an “asylum treatment” to a “community care” perspectve. Law 4461/2017 initated the administratve reform of the mental health system, placing
emphasis on decentralisaton, democratc functoning, and strengthening the human resources
of the system. In order to achieve the improvement of the quality of mental health services, a
Quality Assessment Body for mental health units has been set up, and staf training actons are
being implemented.
With law 4316/2014, the Natonal Observatory for Dementa and Alzheimer’s disease was established, in order to support the natonal policy of combatng the disease and protectng the rights
of patents and their families. Within the scope of this Observatory, a Natonal Acton Plan on
Dementa-Alzheimer has been developed.
It is worth mentoning that among the actons aimed at the social reintegraton of people with
chronic mental disorders, the Social Mental Health Cooperatves were introduced, an innovatve
form of social entrepreneurship, in which people with mental health problems as well as healthy
people are engaged in professional actvites. These Cooperatves have been assessed as a best
practce for socio-economic reintegraton at European level.
Increase in health fnancing and recruitment of health workforce (SDG 3.c)
The share of public health expenditure was increased from 4.7% of GDP in 2015 to 5.1% in 2016
and 2017. Medical and care staf was recruited at health insttutons in which a signifcant shortage had been found. In order to address the issue of inequalites of access to and provision of
health services, artcles 39, 40 and 41 of law 4368/2016 regulate issues related to the mobility of
doctors in the Natonal Health System (NHS), while incentves are set for doctors who ofer their
services in the arid and insular regions of the country.
|
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[
3
] |
{
"country": "grc",
"file_id": "sdg-03/vnr-report-grc-2018-en-1.pdf",
"language": "en",
"locality": null,
"size": "m",
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}
|
44
Promoton of mental health and well-being (SDG 3.4)
The psychiatric reform is implemented through the “PSYCHARGOS” Programme, which aims at
shifing the provision of health services from an “asylum treatment” to a “community care” perspectve. Law 4461/2017 initated the administratve reform of the mental health system, placing
emphasis on decentralisaton, democratc functoning, and strengthening the human resources
of the system. In order to achieve the improvement of the quality of mental health services, a
Quality Assessment Body for mental health units has been set up, and staf training actons are
being implemented.
With law 4316/2014, the Natonal Observatory for Dementa and Alzheimer’s disease was established, in order to support the natonal policy of combatng the disease and protectng the rights
of patents and their families. Within the scope of this Observatory, a Natonal Acton Plan on
Dementa-Alzheimer has been developed.
It is worth mentoning that among the actons aimed at the social reintegraton of people with
chronic mental disorders, the Social Mental Health Cooperatves were introduced, an innovatve
form of social entrepreneurship, in which people with mental health problems as well as healthy
people are engaged in professional actvites. These Cooperatves have been assessed as a best
practce for socio-economic reintegraton at European level.
Increase in health fnancing and recruitment of health workforce (SDG 3.c)
The share of public health expenditure was increased from 4.7% of GDP in 2015 to 5.1% in 2016
and 2017. Medical and care staf was recruited at health insttutons in which a signifcant shortage had been found. In order to address the issue of inequalites of access to and provision of
health services, artcles 39, 40 and 41 of law 4368/2016 regulate issues related to the mobility of
doctors in the Natonal Health System (NHS), while incentves are set for doctors who ofer their
services in the arid and insular regions of the country.
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[
3
] |
{
"country": "grc",
"file_id": "sdg-03/vnr-report-grc-2018-en-2.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2018
}
|
44 HELLENIC REPUBLIC I VNR 2018
Promoton of mental health and well-being (SDG 3.4)
The psychiatric reform is implemented through the “PSYCHARGOS” Programme, which aims at
shifing the provision of health services from an “asylum treatment” to a “community care” perspectve. Law 4461/2017 initated the administratve reform of the mental health system, placing
emphasis on decentralisaton, democratc functoning, and strengthening the human resources
of the system. In order to achieve the improvement of the quality of mental health services, a
Quality Assessment Body for mental health units has been set up, and staf training actons are
being implemented.
With law 4316/2014, the Natonal Observatory for Dementa and Alzheimer’s disease was established, in order to support the natonal policy of combatng the disease and protectng the rights
of patents and their families. Within the scope of this Observatory, a Natonal Acton Plan on
Dementa-Alzheimer has been developed.
It is worth mentoning that among the actons aimed at the social reintegraton of people with
chronic mental disorders, the Social Mental Health Cooperatves were introduced, an innovatve
form of social entrepreneurship, in which people with mental health problems as well as healthy
people are engaged in professional actvites. These Cooperatves have been assessed as a best
practce for socio-economic reintegraton at European level.
|
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[
3
] |
{
"country": "grc",
"file_id": "sdg-03/vnr-report-grc-2018-en-3.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2018
}
|
45
Reducing maternal and child mortality (SDG 3.1, 3.2)
According to the latest available data of the Hellenic Statstcal Authority (2015), the rato of neonatal mortality in Greece is 2.83 per 1,000 live births, the deaths of children up to 4 years is 4.5
per 1,000 live births and the maternal mortality index is 3 per 100,000 live births. Hence, SDG 3.1
and 3.2 have already been reached.
Considering the above, the Greek government, and especially the Ministry of Health, must overcome important challenges, related mainly to budgetary constraints. In this directon and in order to achieve SDG 3 and its targets, policies will be pursued with a view to: (i) ensuring and
improving the quality, efciency and efectveness of health services, with partcular emphasis on
primary health care services; (ii) using statstcal data for the implementaton of evidence-based
policies tackling the most important diseases (cancer, diabetes, childhood obesity, hypertension,
coronary artery disease, diabetes mellitus); (iii) cooperatng with the EU Member States to reach
afordable and socially acceptable prices for innovatve medicines; (iv) ensuring transparency in
the healthcare procurement system, aimed at ratonal allocaton of available fnancial resources.
|
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HELLENIC REPUBLIC I VNR 2022 62
SDG 3: Ensure healthy lives and promote well-being for all at all ages
63
Healthy life years at birth by sex
Assessment of progress in relevant SDG indicators
• Healthy life years have been steadily increasing for both sexes, from 64 in 2015 to 66 in 2019.
However, the number of remaining years that a person of specific age is expected to live without
any severe or moderate health problems still remains below pre-crisis levels (67 years).
• Despite the multi-year economic crisis and the outbreak of the pandemic, the percentage of people
with self-perceived health as “good” or “very good” has risen slightly over a decade, from 75.7% to
78.6%.
• Smoking prevalence remains a significant problem, as the percentage of the population aged 15+
years who report tobacco smoking every day fluctuated around 40% over the past decade.
• Apart from a minor setback regarding HIV, the standardized death rate due to tuberculosis, Human
Immunodeficiency Virus (HIV) and hepatitis by type of disease remained very low, and even decreased slightly from 2012 (1.6) to 2018 (1.45).
ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
HELLENIC REPUBLIC I VNR 2022 64
Key challenges
In the aftermath of the economic crisis, the Greek health system was already facing serious challenges,
which the outbreak of the pandemic only exacerbated. Compared to other European countries, public spending for Health in Greece has been relatively low, because of the economic crisis during the
previous decade, particularly concerning long-term care. Investment and institutional reforms in the
health sector progress, yet slowly-but steadily- due to the pandemic, especially in important areas such
as primary care, whereas access to complementary services is a priority. It is evident that the public
health system is in need of further organizational reforms to ensure its resilience, starting with more
efficient prevention, more accessible primary and at home/outpatient care, particularly with an aging
population and a relatively low rate of long-term care workers. The pandemic also revealed weaknesses
in the mental health system that called for both ad hoc and long-term solutions. Moreover, the insular
and remote mountain communities face chronic difficulties in accessing the full spectrum of public
health services, such as specialist doctors and specialized laboratory centres.
Main policy initiatives and measures
• In 2019, the National Public Health Organization was established, which is responsible for promoting health, preventing chronic diseases, and reducing the burden of non-communicable diseases. It has issued guidelines for the administration of antiretroviral therapy and treatment of opportunistic infections in adults and adolescents with HIV infection. SDG 3.2
• In order to promote healthcare quality and patient safety, a Health Quality Assurance Agency,
responsible for quality assurance of health services, was established in 2020. With a view to adopting a Common Assessment Framework for hospitals, the HQAA has already issued directions for
specific standards for patient identification and patient file management. It has also developed an
operational plan for safe hospital operation under emergency situations. At the same time, training
is conducted for medical personnel, regarding quality issues and prevention of disease control protocols. SDG 3.8, 3.c
• The National Vaccination Programme, targets specific and vulnerable groups of the population,
minors and adults, migrant populations and populations at risk. In 2021, three new digital services
were launched: the Child and Adolescent Vaccination Register, the Pupil Health Registry and
the Children’s Digital Health Booklet. In 2022 universal vaccination of boys and girls against the
Human Papillomavirus (HPV) in order to meet the target set by the WHO and to eliminate HPV (and
the cancers it causes) by 2030 was introduced. Boys and girls aged 9 to 18 will now be vaccinated
against HPV free of charge, whereas previously the vaccine was only free for girls. SDG 3.2, 3.4
• As part of an information campaign, material from the Global Alliance for Breastfeeding Action was
promoted in health care facilities and other places where breastfeeding can be encouraged. Institutional interventions took place regarding the operation of “breastfeeding areas” in health structures
under the supervision of the Ministry of Health (hospitals and health centres), in structures under
the supervision of the Ministry of Culture (museums and sports facilities) and in workplaces for
breastfeeding working mothers. “Human Milk Banks” in public hospitals became operational. Moreover, use of breast milk substitutes for new-borns for acceptable medical reasons or with the written
consent of the mother, was strongly encouraged. SDGs 3.4, 1, 4, 8, 5
65
• A 5 year National Action Plan for Public Health was introduced in 2020, which includes the
National Prevention Programme “Spiros Doxiadis”. The Programme focuses on prevention of
behavioural and environmental factors, such as tobacco use and poor dietary habits related to mortality rate as well as on the early identification and effective prevention of diseases. An extensive
screening programme has been launched, focusing on the early detection of common Non-Communicable Diseases in the general population. It is estimated that more than 50% of unidentified cases
of cancer will be detected thanks to the mass screening program and more than 4 million diagnostic procedures will be performed by 2025. More specifically, the actions consist of free of charge
screening tests for cervical cancer, breast cancer (an SMS has been sent initially to 1,300,000
women to have a free mammogram and have their results examined by a doctor), colorectal cancer,
abdominal aortic aneurysm and cardiovascular risk assessment (National Plan for the treatment
of Vascular Strokes in specialized centres throughout the country sets procedures that ensure the
treatment of patients within a few hours after the occurrence of the stroke), which are the most
common non communicable diseases linked to mortality rates. SDG 3.4
• A National Childhood Cancer Registry was established in 2020. Registration of minor patients
and data gathered from different sources will gradually feed into a mechanism to assess the demand
for health services and provide scientific staff with the necessary information to manage and monitor specific patients throughout the country. SDGs 3.2, 3.4
• A rigid approach towards tobacco use has been followed since 2019, in accordance with the WHO
Framework Convention on Tobacco Control. The legislative and regulatory framework for Tobacco
Control was amended, banning tobacco use in all indoor and specific outdoor public spaces, and
foreseeing extensive controls. A 4-digit telephone line (1142) is available for citizens to report violations of legislation and seek information or help to quit smoking. Smoking Cessation Clinics were
upgraded, along with the introduction of the relevant regulatory framework of operation. The Ministry of Health, in cooperation with the responsible supervising bodies and services, has been implementing since 2018 actions and interventions to raise awareness and inform the student population
on the hazards of tobacco use. In addition, information materials, such as posters and table tabs on
prohibition of tobacco and related products, have been distributed across public areas and offices.
SDG 3.a
• In order to address the increased hospitalization needs that were exacerbated during the Covid-19
pandemic, the total number of available Intensive Care Unit (ICU) public beds was significantly
increased. In February 2020, there were 565 ICU public beds in Greece with no availability for potential hospitalization of COVID-19 cases. As of February 2022, Greece has 1,343 operational ICU
beds, of which 704 are dedicated to COVID-19 patients. SDGs 3.3, 3.8
• Implementation of the program “No One Alone in the Pandemic” (2021), a psychological support
program through teleconsultation, for Covid-19 patients who are hospitalized or are in quarantine at
home, for their family members and for the health staff of Hospitals (providing support for anxiety,
depression, and suicidal behaviour). In the context of the program, hospitalized Covid-19 patients
are provided with tablets in order to counter the negative effects of quarantine. A 5-digit telephone
helpline (10306) provides tele-counselling and support from qualified professionals addressed to
the general population, free of charge and on a 24-hour basis. The range of services provided include psychiatric care to patients with mental illness, psychological support to children, families and
health personnel, as well as social support to the adult population with mental health issues. The line
has incorporated new features in order to support children, adolescents and their families, as well
as fire- or earthquake-stricken citizens. Meanwhile, ad hoc initiatives have also been carried out to
address emergencies that act as stressors for the affected population. SDG 3.4
ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
HELLENIC REPUBLIC I VNR 2022 66
• The institution of Family Doctor and the Primary Health Care structures have been established
since 2017 for the provision of essential health care services, such as medical and dental care,
reproductive health and care of the mother and child, and the implementation of vaccination programs. Furthermore, the population coverage was expanded, through Local Health Groups that will
also operate as family medical groups. Primary health care facilities played a leading role in the management of the pandemic, as sampling points. They also provided home or remote medical services,
by operating Special Mobile Health Teams (SMHTs) to serve mountainous and remote areas and to
vaccinate vulnerable groups and people with mobility difficulties. SDG 3.8
• In order to support the inhabitants of mountainous and remote regions, a new preventive healthcare
programme, “Prevention at Home” was introduced in 2020. The Programme makes possible, on
the one hand, medical examinations at home for the inhabitants of the above regions who belong to
vulnerable groups of the population and, on the other hand, the automated dispatch of the results to
contracted practitioners using information and communication technologies. SDGs 3.8, 1.4, 10.2
• A National Mental Health Committee, consisting of specialized - distinguished scientists in the
mental health field, was established in 2021 with a mandate to design a mental health strategy,
which will lead to a new 10-year National Action Plan for Mental Health. Funding of mental health
and addictions programs was increased by 62% in 2021 for strengthening the mental health facilities
and services and the development of new ones throughout the country, aiming to provide care to all
population groups. SDG 3.4
• In recent years, efforts have been made to further develop programs for the prevention, damage reduction, detoxification and social rehabilitation of users. A significant new initiative is the establishment, in 2021, of a safe drug consumption space, specially designed to reduce risk and prevent
overdose among socially marginalized, usually homeless, adult users. SDG 3.5
• The National Central Health Procurement Authority was reorganized in order to rationalise expenditure for a sustainable health care system. A 30% target for centralization of procurement has
already been achieved, resulting in the procurement of higher quality materials and better health
services; a new target of 40% has been set for 2022. In addition, structural measures to reduce
clawback have been taken since 2019, setting yearly reduction targets up to 2025. In this direction,
incentives were introduced for pharmaceutical companies, offsetting clawback with R&D expenditure. SDG 3.8
• As regards the problem of bloodstream infections due to selected antimicrobial-resistant organisms,
the National Action Plan (2019-23) for the Treatment of Microbial Resistance in Greece was
published in 2019. The Action Plan was developed in the framework of One Health in collaboration
with the Ministry of Rural Development & Food and the Ministry of Environment & Energy. In parallel, from 2020, the National Programme for the prevention and control of hospital-acquired
infections and antimicrobial resistance is being implemented in cooperation with donors and
stakeholders. SDGs 3.d., 2, 17.17
• A series of measures have been taken to prevent the West Nile virus and malaria epidemics, as
well as to avoid outbreaks due to imported cases of dengue, chikungunya or Zika. Attention is being
paid in order to avoid area designation as malaria-endemic by the World Health Organization (WHO).
SDG 3.3
• Regarding protection of public health from major-accident hazards involving dangerous substances, consultation of all competent authorities is taking place. The consultation seeks to update the
institutional framework, aiming at more effective control for the prevention of the occurrence of
a major accident and at the clarification of response procedures after a major accident occurs, in
order to minimize its consequences. SDG 3.9
• To enhance informed decisions regarding sexual relations, contraceptive use and reproductive
67
healthcare, a series of awareness-raising and information activities and interventions on sexual
and reproductive health have taken place since 2020, with topics such as contraception in adolescence, sexually transmitted infections, sex education for boys, sex education for girls, and relationships in adolescence. SDGs 3.7, 5.6
• Another important type of facility is the Day Centre for Psychological Support of People with Oncological Diseases, which has already been established. Also in 2021 a pilot program of Psychogeriatric Support for the promotion of health and the prevention of mental disorders of the elderly, with
emphasis on depression, which is an important risk factor for dementia was established in Aiginiteio
University Hospital (pilot phase with island regions, such as Tinos, Syros and Andros, and remote
areas, such as Evros and Xanthi). SDG 3.4
• Development of a tele-psychiatry network, in the form of an integrated digital outpatient clinic
(prescription services, consultations, issuance of certificates) for the remote support of adults and
minors in remote areas. Implementation has already started in the Greek islands of Kastelorizo and
Symi while similar units will be developed in border islands and mountainous areas shortly afterwards. SDG 3.8
• The Government adopted a new National Strategic Plan for Road Safety 2021-2030, which introduces the Safe System Approach and the long-term Vision Zero road fatalities by 2050. The quantitative targets of the Greek Road Safety Strategic Plan are aligned with the EU targets of reducing the
number of fatalities and serious injuries in crashes by 50% by 2030. SDGs 3.6, 11.2
• A new legislative framework promoting Road Safety and aiming at reducing the level of road traffic fatalities and injuries through managing the interaction between speed, vehicles, road infrastructure and road-user behaviour in a holistic manner, came via law 4850/2021. Next steps include the
re-evaluation and updating of the educational material for the assessment of the candidate drivers
as well as the revision of the Highway Code, taking into account the international experience. SDGs
3.6, 11.2
• Traffic education and road safety for children and youth is fundamental for the national goal of reducing the number of road accidents, and this is done via the “e-Drive Academy” platform and the
introduction of a road safety course in all the primary schools of the country. SDGs 3.6, 4.7, 11.2
• The Ministry of Citizen Protection has signed a Memorandum of Understanding with the Organisation Against Drugs (ΟΚΑΝΑ), which provides for the development of common actions and training
programs in the field of prevention, treatment, harm reduction and social reintegration for drug
users. SDG 3.5
• As regards access to public health services by residents of remote areas and small islands, particularly in emergencies, patient airlift services to city hospitals are provided by both the NHS and
the military. Health care services are also provided in military hospitals for family members of Armed
Forces personnel and all citizens. Air medical evacuation flights across the country and abroad are
carried out by the Ministry of Defence supplementary to the Ministry of Health. SDGs 3.4, 3.6, 3.8
ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
HELLENIC REPUBLIC I VNR 2022 68
Forthcoming initiatives
• As part of the National public health Prevention Program “Spyros Doxiadis” and with the main goal
of reducing risk factors for public health and the indirect relief of hospitals, a series of initiatives are
planned as follows: the National Program for the Promotion of Physical Exercise and Healthy
Nutrition, is scheduled to begin in 2022, the prenatal screening for 270,000 pregnant women and
perinatal screening for 270,000 new-borns is planned over the next 3 years, and the alcohol prevention programme (estimated benefit to around 291,000 young people in the 14-24 age group)
will unfold in the next years. SDG 3.2, 3.4, 3.5
• A set of mental health structures and services will be rendered operational by end 2022, for
patients with dementia and Alzheimer’s disease, patients with autism, patients in the age group
of children, adolescents and young adults, for the support of employed and unemployed people,
migrants and refugees. A series of projects aiming to promote mental health will be financed under
the Recovery and Resilience Plan (RRP); for instance, the development of new mental health facilities and services aimed at ensuring citizens’ access across the country and the implementation of
actions related to addressing the adverse effects on the mental health of the population due to the
pandemic (totalling amount € 55 million - Start of implementation: 2022). SDG 3.4, 3.8
• In the context of the National Strategic Reference Framework 2021-27 the following objectives of
the ongoing psychiatric reform will start to be implemented in 2022: abolition of institutional care,
development of community care and promotion of social integration of people with psychosocial
disability, improvement of the quality of mental health services and development of tele-psychiatric
services and home care. SDGs 3.4, 3.8
• Supply of two mobile health clinics (June 2022) that provide age assessment and essential health
services to unaccompanied children. SDG 3.8
• The national digital infrastructure is under way to support oncology patients throughout their
interaction with the healthcare system. SDG 3.8
Best practice example
Early Intervention Units in Psychosis - SDG 3.4
Every year around 3,500 young children are expected to experience a first episode of psychosis following which they will be intense users of inpatient or outpatient mental health
services of the National Health System (NHS). Within the framework of the psychiatric
reform, prevention and treatment structures are being set up since 2021 with emphasis
on regional Greece. New types of Mental Health Units, under the name “Early Intervention
Units in Psychosis”, aim at the preventive detection and treatment of the most severe forms
of mental disorder, in order to minimize the long-term effects and to prevent or reduce the
relapse rates. They also improve the functionality of young patients and their occupational,
educational and social integration. Short-stay facilities for patients with autism have been
established throughout Greece, as well as distance learning psychoeducation and support
programs for their family or caregivers (in cooperation with non-profit organizations) have
been created.
Best practice example
Early Intervention Units in Psychosis
SDG 3.4
Every year around 3,500 young children are expected to experience a first episode of psychosis following which they will be intense users of inpatient or outpatient mental health
services of the National Health System (NHS). Within the framework of the psychiatric
reform, prevention and treatment structures are being set up since 2021 with emphasis
on regional Greece. New types of Mental Health Units, under the name “Early Intervention
Units in Psychosis”, aim at the preventive detection and treatment of the most severe forms
of mental disorder, in order to minimize the long-term effects and to prevent or reduce the
relapse rates. They also improve the functionality of young patients and their occupational,
educational and social integration. Short-stay facilities for patients with autism have been
established throughout Greece, as well as distance learning psychoeducation and support
programs for their family or caregivers (in cooperation with non-profit organizations) have
been created.
69
• The development of National Registers and Codifications, the Central Data Repository and the
universal implementation of the Individual Electronic Health Record will create a unique network
for the exchange of information between doctors and patients, protecting personal data and ensuring medical confidentiality. A strategic plan for interoperability in health services will be finalised by
the end of 2022. SDG 3.8
• Two new services, which will be supported by digital technology and telemedicine, are to be introduced in the near future. These are the “home care” and “hospital at home” programmes, which
bring health services from hospital to home. In order to promote equitable health coverage and access to quality essential health-care services, 8 reference sites will be established by Q2/2025 so
as to provide hospital at home services. In addition, a national registry for patients treated through
home care will be set up. SDG 3.8
• A substantial reform in Primary Healthcare is in full progress; following the newly introduced legislative framework, 60 local health units will be rendered operational within 2022, while more health
units will be upgraded in terms of infrastructure and equipment. SDG 3.8
• Adopt measures and actions aimed at implementing the new National Strategic Plan for Road Safety
2021-2030. SDG 3.6
ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
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21
GUYANA VOLUNTARY NATIONAL REVIEW 2019
PROGRESS ON GOALS AND TARGETS
Context and Key Achievements
Public health care as priority, must be provided fairly and
equitably to all citizens regardless of economic status,
geographic location, ethnicity or lifestyle. There are three
key values that characterise the Guyana health service: (i)
“health as a human right” - recognising the rights of citizens
to enjoy good standards of living, health and well-being;
(ii) “equity” - universal access is provided to all regardless
of gender, socio-economic status or geography; and (iii)
“solidarity” - with health as a priority, all citizens must engage
in the delivery of good health services, especially to the
poor and disadvantaged. From as far back as the 1990’s the
Government took the strategic policy decision to promote
primary universal health care as the most effective investment
and the mechanism for promoting good health and reducing
the incidence of disease and illness.
Currently, the public health sector is guided by the Health
Vision 2020 – the national plan to achieve ‘Health for All in
Guyana’. Vision 2020 draws on various target strategies such
as the Nutrition Strategy, Maternal, Neonatal, Adolescent
and Family Health Strategy and the Disability Prevention
and Management. Currently, the health authorities have
undertaken to conduct an end-period evaluation of Vision
2020 with a view to commencing work on the next sector
strategy, which will be framed within the principles of the
Green State Development Strategy: Vision 2040. The next
strategy is also envisaged to incorporate the dimensions of
resilience and climate change responsiveness.
Key health indicators for Guyana have generally shown an
improvement over the years. Life expectancy has increased
from 66.8 years in 2010, to 68.2 years in 2017. Between 94
to 96 percent of all births have been attended by skilled
health personnel over the period 2015 to 2018 (SDG Target
3.1). Additionally, immunisation coverage has consistently
remained high ranging between 96 and 98 percent between
2015 and 2018 (SDG Target 3.b). Further, Guyana, being a
tropical country, is susceptible to vector borne disease. The
incidence of malaria – the most prominent vector-borne
disease – per 1,000 has fuctuated during this period between
13 and 21.7, with the hinterland being more susceptible,
especially in remote and mining areas.
Health care in Guyana is fnanced primarily by central
government, with support from international development
partners. Total public health expenditure as a percentage of
the national budget increased from 9.8 percent in 2015 to 12.0
percent in 2018; however, health expenditure as a percentage
of GDP was about 4.2 percent in 2018, up from 3.3 percent
in 2015. Though slightly lower than the CARICOM average of
6.7 percent and also under the PAHO/WHO recommended
target of 6 percent of GDP. For the health sector, drugs and
medical supplies account for the one of the largest shares
of expenditure which is magnifed by the signifcant cost of
transporting these supplies to the far-fung health facilities in
the hinterland.
Capital investments are an important component of public
health expenditure. Between 2015 and 2018, this expenditure
category has increased from 5 percent to 7 percent as a share
of total public health expenditure. Infrastructural upgrades
of health facilities have been undertaken across the country,
including at hinterland locations such as Paramakatoi and
Port Kaituma and at district hospitals in Diamond, Suddie and
Bartica. The national referral hospital – Georgetown Public
Hospital Corporation – has also upgraded its maternity ward
facilities and the operating theatres and beneftted from
new equipment including a mammography machine and CT
scanner. Nevertheless, signifcant defcits exist, particularly in
the hinterland.
As was under the MDGs, improving maternal mortality
remains a major bottleneck for Guyana’s health care system.
The maternal mortality for the country was recorded at 133
per 100,000 live births in 2017, up from 112 in 2015 (SDG
Target 3.1), while neonatal mortality declined from 20.4 per
1,000 live births to 18.6 over the same period (SDG Target
3.2). Government has undertaken to improve the quality
of maternal facilities across the countries, adding beds
to maternal units in hospitals as well as maternal waiting
homes. The Maternal and Child Health Programme is also
endeavouring to strengthen community engagement and
implement behavioural change strategies in select regions.
Guyana recognises the importance of achieving this particular
target, especially given the near stagnant population growth,
and is committed to prioritising initiatives that will see a
drastic improvement in maternal and child health, ensuring
no woman dies giving birth.
Within the past years, the disease profle of Guyana has
changed. The country currently is in an epidemiological
transition, with non-communicable diseases (NCDs) being
the major cause of morbidity and mortality since 2004. In
2015, NCDs accounted for 70 percent of all deaths with
SUSTAINABLE DEVELOPMENT GOAL 3:
ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
22
GUYANA VOLUNTARY NATIONAL REVIEW 2019
PROGRESS ON GOALS AND TARGETS
cerebrovascular disease (stroke) being the leading cause
of death, followed by ischemic heart disease, neoplasms,
diabetes and hypertension. Non-communicable diseases
are the main contributor to the burden of disease, with an
estimated annual economic burden of US$221.5 million in
direct and indirect costs, and accounted for 46.9 percent of all
Disability Adjusted Life Years lost in 200012. Notwithstanding,
opportunities can be found to establish partnerships for the
provision of critical health care services.
The Guyana Cancer Society has partnered with government
and is fully invested in the aspirations of the SDGs and has
aligned its programme with the goal of promoting healthy
lives and well-being. Its programmes include outreach and
advocacy, screenings, and community support systems,
particularly for survivors. A major achievement, thus far, is
the screening of over one thousand women within the past
fve years. Additionally, Government has enacted a Tobacco
Control Act (2017) in an effort to control and reduce the
health-related impacts of tobacco consumption, which may
include cancer, heart-attack and stroke, among others.
Guyana also has a signifcant burden of communicable
diseases – with Human Immunodefciency Virus (HIV), infuenza
and pneumonia being the sixth and ninth leading causes
of death, respectively, in 2012 and 2015. Notwithstanding,
the country has made important strides to address diseases
such as tuberculosis (TB), malaria and HIV, among others. In
2018, Guyana signed on to the “Treat All” Policy – the global
standard for responding to the HIV epidemic – as HIV continues
to pose a public health challenge with the incidence of this
disease having increased from 113 per 100,000 population in
2015 to 161 in 2017 (SDG Target 3.3).
Guyana has also undertaken to resuscitate its directly
observed treatment, short-course (DOTS) to address the
slight resurge in tuberculosis (TB) related mortality which has
increased from 9 per 100,000 population to an estimated
10.7 in 2018 (SDG Target 3.3). Improved detection, treatment
and monitoring continue to be required in order to restrain
any further deaths from TB. Additionally, mental health has
emerged as a national issue over the last few years, as Guyana
has ranked among the countries with the highest rates of
suicide in the world at 24.6 per 100,000 population (2017)
(SDG Target 3.4). This is the third major cause of death in the
15 – 44 age group. A mental health unit and a support hotline
have been established, and the unit has facilitated mental
health training for health professionals across the country to
improve the awareness and detection of mental health issues.
12 Taken from the Non-Communicable Prevention and Control Strategy (2013)
In any health sector, a major input for the delivery of quality
services is a well-trained healthcare workforce. For Guyana,
the number of physicians per 10,000 population has
declined from 14.1 in 2015, to 13.5 in 2018 (SDG Target
3.b), notwithstanding continued efforts to ensure that every
administrative region is equipped with specialist services and
accompanying personnel, including surgeons, gynaecologists
and paediatricians. Guyana continues to value its bilateral
partnerships with countries including Cuba and China, which
allow Guyanese to beneft from training in medicine overseas.
Additionally, investments have continued to support the
country’s nursing schools – located in Georgetown, New
Amsterdam and Linden - and the School of Medicine at the
University of Guyana which has the capacity to produce about
30 doctors and train 20 post graduate doctors annually.
Challenges, Emerging Issues and Addressing
the Way Forward
Notwithstanding substantial efforts by Guyana to analyse the
problems as well as identify and cost solutions to improving
maternal health via a MDG Acceleration Framework (MAF),
fnancing and technical support were not forthcoming as
expected. As such, maternal health outcomes have not
improved at the pace that is desired. In 2016, work commenced
on the decentralization of maternal services, especially to
Regions 1, 7, 8, and 9, as a targeted programme aimed at
improving maternal and child health, which is expected to
improve the related outcome indicators by 2020.
Critical to improving health outcomes, including that of
maternal health, is the effective management of drugs
and medical supplies. Supply chain management of these
items have been inadequate with reports of shortages
persisting across the country. The lack of systems for effective
procurement, distribution and tracking remain and requires
additional support.
The inadequacy of supply of qualifed medical professionals
also adds pressure to the public health system. Currently, the
national referral hospital is the only public medical facility most
suited to treat high-risk patients. Furthermore, for hinterland
patients this presents an exacerbated challenge as they must
travel to the national referral hospital, in Georgetown, on their
own by river fown by emergency charter fight (medevac).
Over the past ten years, expenditure on emergency medical
evacuations from the hinterland to national referral hospital
on the coast has doubled. Additionally, in some non-highrisk instances, where the specialist or equipment may not
be available in a region, a patient must make the often
arduous journey to the national referral hospital. This results
23
GUYANA VOLUNTARY NATIONAL REVIEW 2019
PROGRESS ON GOALS AND TARGETS
in overcrowding at the national referral hospital in many
instances and places added fnancial burden and risk on
patients.
Key to the issue of adequate staffng is the quality of
remuneration of health professionals. Guyana intends to
review and revise the general wage level for health sector
workers with a view to attracting and retaining them. However,
retention in the hinterland and remote riverrain communities
will likely remain a challenge until connectivity, quality of life
and cost of living improve in those areas.
For effective decisions to be taken and programmes
implemented in health and other sectors, data is paramount.
While the health sector is more advanced with regard to the
breadth of data generated, it is not suffciently modernised or
effcient in collection and production – there is still an absence
of a national integrated health information system. Data
systems strengthening remains an area of priority, especially
as data analysis and dissemination tends to be in response to
ad hoc requests from donors and other partners.
Predictability of development fnancing also features as
a multi-sectoral challenge. Recognising that access to
concessional and other donor funding will remain critical, at
least in the immediate medium term, the continued reduction
in predictable and timely fnancial support by development
partners will impact Guyana’s ability to effectively plan and
implement its programmes and provide public services. It is
expected that the elaboration and costing of Guyana’s Vision
2040 will serve to more effectively channel donor support,
though this requires active collaboration by all stakeholders.
Lessons Learned
In light of the challenges facing the public health sector,
emanating from various facets of service provision, improved
coordination must be prioritised, along with building and
sustaining human resources for health, while improving health
information systems nationally. Piecemeal interventions,
including limited reach in rural and hinterland regions with
reduced capacities, and especially with contracted donor
support, have adversely impacted the sustainability of the
gains made in the sector. Therefore, management of the
sector, including donor interactions, must be done in a
holistic, concerted and strategic manner.
Given the changes to the disease profle of Guyana, public
education on health and nutrition is even more critical to
positively affect the choices each individual makes, especially
in a world of proliferating unhealthy fast-food chains and
sugar-sweetened beverages. Every citizen should be aware
of the impacts of their life choices, from decisions on regular
check-ups, to how often one exercises, to what food they
consume and to what information one consumes, especially
from sources without offcial medical training and expertise.
Indicator 2012 2013 2014 2015 2016 2017 2018
Crude Birth Rate (per 1,000 persons) 18.2 18.5 19.8 17.6 17.8 17.9 18.1
Neonatal Mortality Rate (per 1,000 live births) 21.8 21.4 20.9 20.4 20.0 18.6 16.7
Infant Mortality Rate (per 1,000 live births) 24.1 24.9 23.3 22.9 23.4 19.9 18.7
Under 5 Mortality Rate (per 1,000 live births) 26.7 25.9 23.9 24.3 25.1 21.5 19.1
Table 4 - Neonatal, Infant and Child Mortality Rates for Guyana, 2012-2018, Ministry of Public Health, Statistical Unit
|
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[
3
] |
{
"country": "guy",
"file_id": "sdg-03/vnr-report-guy-2019-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2019
}
|
1.3. Vida sana y bienestar
El ODS 3, se propone garantizar una vida sana y promover el bienestar para todos en todas
las edades. Las metas de la AD-ODS son las siguientes; reducir la tasa de mortalidad
materna; disminuir las muertes evitables de recién nacidos y menores de 5 años; poner fin a
las epidemias del SIDA, tuberculosis, malaria y enfermedades tropicales desatendidas y
combatir la hepatitis y otras enfermedades transmisibles; reducir el número de muertes y
lesiones por accidentes de tránsito; garantizar el acceso universal a los servicios de salud sexual y
reproductiva; y, facilitar el acceso a medicamentos y vacunas esenciales.
Algunas estimaciones del Banco Mundial muestran leves mejoras en algunos indicadores de salud, tales
como la tasa de mortalidad materna, la mortalidad en menores de 5 años y neonatal. Además, como se
puede observar en cuadro 5, la tasa de fecundidad en mujeres de 15 a 49 años, tuvo una baja significativa,
mientras que el porcentaje de mujeres entre 15-19 años, que alguna vez estuvo embarazada, continúa
siendo alta16. Por otra parte, es importante prestar atención al número de muertes por eventos de tránsito
(por 100,000 habitantes), ya que presenta aumentos sostenidos a lo largo del periodo.
14 PCM 86-2018
15 http://www.investhonduras.hn/alianza-para-el-corredor-seco/
16 Estos indicadores serán actualizados por la Encuesta Nacional de Demografía y Salud (ENDESA) 2019, todavía en revisión y edición.
Cuadro 5. Dimensión Social, Indicadores del ODS 3
Indicador 2015 2016 2017 2018 2019
3.1.1 Razón de mortalidad materna por 100,000 nacidos vivos1 67.0 65.0 65.0 65.0 ND
3.1.2 Cobertura de parto institucional2 83.0 ND ND 83.0 ND
3.2.1 Tasa de mortalidad en el menor de cinco años por 1,000 nacidos vivos1 19.5 18.8 18.2 17.6 ND
3.2.2 Tasa de mortalidad neonatal por 1,000 nacidos vivos1 10.7 10.3 9.9 9.6 ND
3.4.1 Tasa de muertes por eventos de tránsito por 100,000 habitantes2 15.5 16.1 16.8 17.9 18.6
3.5.2 Tasa global de fecundidad en mujeres de 15 a 49 años2 2.9 ND ND 2.5 ND
3.5.3 Porcentaje de mujeres de 15 a 19 años que alguna vez estuvo embarazada2 24.0 ND ND 23.0 ND
Fuente:/1Base de datos del Banco Mundial, 2
SESAL.
La Secretaría de Salud (SESAL), como entidad rectora del sector tiene entre sus pilares prioritarios:
Modelo de Gestión Descentralizada de Servicios de Salud del Primer y Segundo Nivel, para
ampliar y mejorar acceso, cobertura, eficiencia y calidad de los servicios de salud17.
Política Nacional de Salud Materno Infantil, que comprende: programas de vacunación; estrategias de
Atención Integral al Niño en la Comunidad; Estrategia de Atención Integral a las Enfermedades
Prevalentes en la Infancia, Estrategia de Reducción de la Mortalidad Materna; y vigilancia
epidemiológica para reducir la incidencia de enfermedades prevenibles y la mortalidad.
18
Política Nacional de Género en Salud19 y Estrategia Nacional de Género en Salud.
Plan Estratégico de la Malaria, con estrategias diferenciadas por estratos, promoviendo el manejo
integrado de vectores, fortaleciendo la cobertura y calidad de servicios de diagnóstico y el tratamiento.
20
Plan Estratégico Nacional en VIH y SIDA, que focaliza en: prevención en las poblaciones en riesgo;
servicios de atención integral; y eliminación de la discriminación relacionada al VIH.
21
|
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[
3
] |
{
"country": "hnd",
"file_id": "sdg-03/vnr-report-hnd-2020-es-5.pdf",
"language": "es",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2020
}
|
11. ODS 3. Con base en información del Banco Mundial, se observan leves mejoras en algunos indicadores
de salud, tales como la tasa de mortalidad materna, mortalidad en menores de 5 años y mortalidad
neonatal, aunque por otra parte es importante prestar atención al indicador de las muertes por eventos
de tránsito (por 100,000 habitantes), y sus causas, ya que presenta aumentos sostenidos a lo largo del
periodo. A través de la Secretaría de Salud, se trabaja en áreas como: gestión descentralizada de los
servicios de salud, Plan Nacional de Salud Materno Infantil, Plan Estratégico de la Malaria y Plan
Estratégico Nacional de Respuesta al VIH y SIDA, entre otros.
|
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{
"country": "hnd",
"file_id": "sdg-03/vnr-report-hnd-2020-es-6.pdf",
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|
25
Goal 3.
Ensure healthy lives and
promote well-being for all
at all ages
25
26
Suicide rate per 100,000 population
Source: Croatian Bureau of Statistics (Indicator 3.4.2)
0,00
5,00
10,00
15,00
20,00
25,00
1999.
2000.
2001.
2002.
2003.
2004.
2005.
2006.
2007.
2008.
2009.
2010.
2011.
2012.
2013.
2014.
2015.
2016.
2017.
2018.
2019.
2020.
2021.
Under-5 mortality rate per 1,000 live births
Source: Croatian Bureau of Statistics (Indicator 3.2.1)
9,2
8,4
7,4 7,2
6,6 6,1 6,4
5,4
6,1
5,2 5,3
4,4
5,2 5,6
5,0 4,9 5,0 5,0
4,5 4,7 4,6
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0
9,0
10,0
Death rate due to road trafc accidents per 100,000 population
Source: Eurostat (Indicator 3.6.1)
0
2
4
6
8
10
12
14
16
18
27
Accessibility, quality and efciency of healthcare are the fundamental values of contemporary
healthcare systems, and they are at the centre of all refections regarding the next steps in the
development of Croatian healthcare. All challenges Croatia has been faced with for quite some time
are expected to further intensify in this decade. These primarily relate to improving health outcomes
and achieving a balance between fnancial possibilities and rising costs related to new and more
advanced treatment methods resulting from technological and scientifc advances, as well as to an
increased demand for healthcare services due to an ageing population.
Quality and accessibility of healthcare
The outbreak of the COVID-19 pandemic proved to be a challenge not only for economic and social
resilience, but also for the Croatian healthcare and social welfare systems. Accessibility, quality and
efciency of healthcare are the fundamental values of contemporary healthcare systems, and they
are at the centre of all refections regarding the further development of Croatian healthcare.
According to Eurostat, the number of healthy life years at birth in 2020 for Croatia was 59.6 for
women and 57.5 for men, which shows an increase by one year when compared to 2018. However, in
these terms, Croatia still ranks signifcantly below the European Union average (64.5 for women and
63.5 for men). Life expectancy at birth in Croatia has increased by nearly four years in the last ffteen
or so years. However, due to the COVID-19 pandemic, all European countries recorded a decrease in
life expectancy in 2020 and 2021 (from 77.8 to 76.7 years of age in Croatia, 79.9 for women and 73.7
for men, respectively).
With the aim of improving the healthcare system and health outcomes for the population, the National
Health Development Plan for the period 2021 to 2027 was developed and adopted. The National
Plan supports the implementation of the National Development Strategy 2030 through the planned
improvement of the healthcare system and health outcomes as key priorities in the development of
Croatia by 2030. The priority areas for development are the promotion of health and prevention of
disease, prevention and control of infectious and mass chronic non-infectious diseases, as well as
injuries and invalidity, protection of vulnerable and specifc social groups within the population, and
monitoring of environmental factors afecting health, all of which will enable Croatia to signifcantly
contribute to the achievement relevant sustainable development goals in cooperation with various
actors and the society as a whole.
The National Recovery and Resilience Plan 2021–2026 foresees the implementation of the “Healthcare”
component which includes fve reforms and 24 investments, with the estimated investment value
of EUR 340.2 million. The implementation of the planned reforms and investments will ensure an
accessible, functional and efcient public healthcare system which provides quality healthcare
services on all levels of healthcare and throughout Croatia.
Maternal and child health, sexual and reproductive health
Perinatal healthcare and children’s healthcare are carried out based on expert guidance and healthcare
schemes within the framework of compulsory health insurance. In Croatia, maternal mortality ratio
was 0–5 per 100,000 live births, infant mortality ratio around 3 per 1,000 live births, overall infant
mortality ratio around 4 per 1,000 live births, while mortality of children under 5 years of age was 4.2
per 1,000 of live births. Around 95% of toddlers and children of pre-school age participate in primary
healthcare through preventive check-ups and vaccinations. Several national screening processes
are also implemented, regarding hearing, a spectrum of metabolic and hereditary conditions, as
well as eyesight. For the purpose of comparing perinatal health among European countries, Croatia
also participates in the Euro-Peristat Network, aimed at planning and further improving healthcare
for pregnant and post-partum women, as well as newborns. Numerous civil society organisations
also contribute to promoting children’s health. A reduction in neonatal, infant and under-5 mortality
rate is particularly signifcant in marginalised groups, such as the Roma population, where activities
are carried out in order to ensure better antenatal healthcare and healthcare at delivery for Roma
women, as well as preventive healthcare for Roma infants and children, as foreseen in the National
Roma Inclusion Plan 2021–2027.
28
Through the implementation of activities included in Croatia’s National Programme “Living Healthy”,
aimed at promoting sexual and reproductive health, education is provided to third-year high school
students in all counties regarding the protection of sexual and reproductive health, as well as
responsible sexual behaviour.
Infectious diseases
The epidemiological situation as regards infectious diseases in Croatia has been maintained at a
relatively favourable level for years. Thanks to a systemic and very thorough implementation of
vaccination programmes in Croatia, situation regarding vaccine-preventable diseases (tetanus,
mumps, whooping cough, measles) is also very favourable and their incidence is low, while certain
diseases have been completely eradicated, with the exception of sporadic imported cases (diphtheria,
poliomyelitis, rubella). Tuberculosis incidence in Croatia in 2021 was 4.1 per 100,000 citizens, placing
it among countries with a low tuberculosis incidence for fve consecutive years. However, potential
risk factors (migration, transport, tourism, etc.), as well as the incidences of emerging diseases, still
require on-going and intense anti-epidemic and preventive actions. The newest infectious disease
threats are the COVID-19 pandemic which started in 2019, monkeypox, the epidemic of hepatitis A in
children, and invasive group A streptococcal infections.
Thanks to measures included in the National HIV/AIDS Prevention Programme (being implemented
since 1993), HIV/AIDS have been maintained at low levels (one of the lowest in Europe) ever since the
frst recorded incidences.
There are continuous activities aimed at strengthening the public health domain as regards a rapid
and quality diagnosis of infectious diseases. New diagnostic methods are being introduced with the
aim of diagnosing imported, emerging and re-emerging infectious diseases, new sampling procedures
are being developed, and studies are being carried out.
Preventing non-infectious diseases and promoting mental health
Through the implementation of activities included in Croatia’s National Programme “Living Healthy”,
continuous eforts are being made in order to create stimulating environments, as well as to inform,
educate and raise awareness among citizens of all age groups regarding the positive aspects of
healthy lifestyles: physical, mental and sexual health. In order to ensure a comprehensive approach,
this national programme is divided into fve components: Health education, Health and physical
activity, Health and nutrition, Health and the work place, Health and the environment. In the period
between 2016–2023, the activities were carried out with co-fnancing from the European Social Fund,
through a project with the same name – Living Healthy.
With the aim of stimulating healthy lifestyles, maintaining and improving life-long health, and
preventing obesity and other chronic non-infectious diseases, activities aimed at promoting physical
and mental health are regularly carried out. It is important to note that the frst action plan for the
prevention of obesity is currently in development, and it is aimed at resolving this public health issue.
A comprehensive national programme for the prevention and control of chronic non-infectious
diseases is being prepared, and it will cover all important public health issues related to chronic noninfectious diseases, with a particular focus on cardiovascular diseases. The objective of the programme
is to reduce the number of avoidable premature deaths by one third by 2030, in accordance with the
sustainable development goals. Eforts are continuously made in the areas of preventing disease and
promoting health, as well as early diagnostics and treatment in accordance with guidelines.
In 2020, the Croatian Parliament adopted the National Cancer Strategic Framework until 2030. In line
with the recommendations of the European Commission, Croatia introduced two programmes for
early cancer detection back in 2006 and 2007 – National Breast Cancer Early Detection Programme
and National Colorectal Cancer Early Detection Programme. Croatia also implements a National Lung
Cancer Screening and Early Detection Programme, and a national programme for the prevention and
early detection of melanoma is in the works. The National Cervical Cancer Early Detection Programme
is currently being re-organised and it will be re-introduced when ready. Based on a global initiative
29
for a reduction in avoidable vision impairment launched by the World Health Organisation, a National
Prevention Programme for Early Detection of Vision Impairment in Children was introduced in 2016.
In late 2022, the Government adopted the Strategic Framework for Mental Health until 2030. The
Strategic Framework is specifcally aimed at preserving and improving mental health, prevention and
early detection of mental health issues, increasing availability of efcient psycho-social interventions,
all the while respecting human rights, as well as protecting mental health in the community through
establishing mobile units. Special attention is given to protecting mental health of children and young
persons. Data regarding the suicide rate in Croatia show that the suicide rate in Croatia in 2019 was
14.32%, and that it increased to 15.03% in 2021, but looking at the period of the previous ten and
more years, Croatia recorded a trend of decrease in the suicide rate.
Addiction prevention
In February 2023, the National Strategy on Combatting Addiction for the period until 2030 was
adopted, defning priorities, specifc objectives, and measures related to addiction and behavioural
addictions (alcohol, tobacco, drugs, gambling, internet). Priorities and specifc objectives identifed
in the National Strategy support the implementation of the ffth strategic objective of the National
Development Strategy 2030 (Healthy, Active and High-Quality Life), as well as the related priority
areas of public policies. The vision set out in the National Strategy includes a decrease in demand for
and availability of illegal addictive substances, an improvement in health and safety of citizens, and
a decrease in health and social risks and harm associated with addiction and behavioural addiction.
Education activities in the area of addiction prevention are carried out continuously, and they are
aimed at experts developing and implementing prevention programmes.
Health, healthy habits and active lifestyles through sports
Croatia is one of the countries which have recorded a signifcant reduction in physical activity among
citizens in the last few years, which was further compounded by work and sports restrictions and a
decrease in free movement of citizens due to the COVID-19 pandemic.
Through the activities included in the National Programme “Living Healthy”, eforts are being made in
order to create stimulating environments, as well as to inform, educate and raise awareness among
citizens of all age groups regarding the positive aspects of healthy lifestyles: proper nutrition and
physical activity aimed at preventing obesity.
In 2019, the National Sports Programme 2019–2026 was adopted, which includes measures and
activities aimed at promoting and supporting sports activities from the earliest age, from recreational
to high-level and professional sports. The National Sports Programme 2019–2026 defned the overall
objective of improving health-oriented physical exercise and increasing promotional values of sports
through a series of measures and activities aimed at encouraging sports and recreation activities at
the state and local level, as well as at increasing the number of participants who pursue daily physical
activities so as to preserve their health. Education campaigns and promotion activities on the national
and local level, as well as co-fnancing of programmes promoting health-oriented physical exercise,
will be used to promote programmes and projects aimed at incorporating physical activity into the
daily life for the purpose of preventing diseases and improving and preserving health. From the
beginning of the implementation of the National Sports Programme in 2019 to the end of 2022, 445
programmes have been co-fnanced, in the total amount of EUR 6 million. In 2022 the new Sports Act
was adopted, developping all types of sports, recreational, amateur and professional, with continued
investment into sportsplayers, trainers and infrastructure.
Reduction in the number of road trafc accidents
During 2022, the number of trafc accidents increased by 3.5% when compared to 2021. However,
despite the increased number of trafc accidents, the number of persons who died in these accidents
in 2022 decreased by 5.8% when compared to 2021. In 2022, there were 275 deaths, or 17 fewer
persons to lose their lives than in 2021, when 292 deaths were recorded.
30
In 2021, the Government adopted the sixth National Road Safety Plan for the period 2021– 2030which
is in line with the global and European road safety trends and has the goal of achieving a 50% decrease
in the number of deaths from trafc accidents and the number of major road trafc accidents.
Environment and health
In late 2019, Croatia adopted the National Air Pollution Control Programme for 2020–2029. The
Programme is the main instrument for air pollution control management which European Union
Member States use in order to ensure that their emission reduction commitments are achieved.
During 2019 and 2020, Croatia participated in the project “AIRQ – Expansion and Modernisation of
the National Network for Continuous Air Quality Monitoring”, which enabled the acquisition of 6 new
air quality measurement stations and the upgrade of 18 existing ones. This contributed to achieving
the necessary conditions for efcient control and management of air quality in the entire territory, as
well as pre-conditions for implementing appropriate air protection measures.
With the aim of drawing the public’s attention and raising awareness, the web-portal “Air Quality
in the Republic of Croatia” was developed, and it uses the Air Quality Index to present the current
state of air quality using real-time data. If citizens are expected to participate in the monitoring, they
need to be provided with timely, easily accessible and user-friendly information. Citizens can only
participate in the formulation and mainstreaming of air protection policies and take appropriate
measures, including changes to their own behaviours, if they are well-informed and educated. This
is also a way to try and encourage citizens to introduce changes to their every-day lives, thus directly
contributing to improving air quality and their own health.
|
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3
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{
"country": "hrv",
"file_id": "sdg-03/vnr-report-hrv-2023-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
15
In recent years, the importance of staying
healthy has become the centre of the current
thinking on healthcare. Disease prevention
builds on the promotion of taking
responsibility on the individual and social
levels and the health-conscious thinking of
the public. This view serves as a compass
for a better, higher quality, and
consequently happier life.
In Hungary, as a result of general
improvements, the infant mortality rate
dropped to under 5 per mille in 2011 and to
3.9 per mille by 2016, presenting the lowest
ratio ever measured in official population
statistics by the Hungarian Central
Statistical Office. Hungary is the only
Member State of the European Union that
provides children and citizens with
vaccinations for a wide range of infectious
diseases as part of a compulsory and statefunded system. The country has created a
compulsory vaccination system against the
most common and most severe childhood
infections in this climate, and consequently,
due to the high level of coverage, these
diseases have been eradicated.
In order to prevent cardiovascular diseases,
which make up the highest percentage of
premature deaths, new regulations were
introduced in 2013, as a result of which an
80% decrease in the ratio of foods with high
trans fatty acid content was observed by
2014. As part of the measures against
tumorous diseases, which are the other
major cause of premature deaths in
Hungary,
- a vaccination has been introduced
against human papillomavirus
(HPV) infection for 7th graders;
- a screening system has been
developed for breast and cervical
cancer;
- health promotion offices have been
set up to contribute to decreasing the
number of cardiovascular and
tumorous diseases, as well as to
improve attitudes and habits having
an impact on health preservation.
In addition, the prevention and discouraging
of alcoholism and drug consumption are
also important. In the interest of reducing
excessive alcohol consumption, an alcohol
protocol has been compiled for health
promotion offices with the aim of helping
screen for alcohol addiction, and platformspecific alcohol consumption prevention
programs have been introduced for schools,
communities, and workplaces. State
funding of drug prevention and treatment
programs has also increased, and a
Ensure healthy lives and promote well-being for all at
all ages
16
previously unavailable service has appeared
in the area of child and youth addictology
care: three providers were set up in 2015 to
ensure the rehabilitation of drug addicts
aged 10-16. With the purpose of decreasing
smoking and protecting non-smokers,
regulations concerning tobacco products
have become stricter. As a result of these
measures, indoor pollution has decreased
considerably and the number of adult
smokers and everyday smokers both
dropped from 30.2% in 2000 to 25.8% in
2014.
In 2017, an Act on expanding state support
for in vitro fertilisation and reinforcing the
state-funded institutions providing artificial
insemination was adopted, as a result of
which more state-funded institutions have
started to provide infertility treatments.
Funding for the necessary medications has
increased considerably, and the
procurement of the medical technical
devices and instruments used in the process
has also become state subsidized.
Hungary is committed to improving the
health situation of the country. One of its
major objectives is continuously to improve
the overall health of the population. In
addition to efforts intended to further
prevention, the Government also aims to
improve the recovery chances of patients, so
even more indebted healthcare institutions
have been kept under state maintenance,
which guarantees a more efficient and safer
operation on the long term.
The Government has also renewed the
hospital infrastructure. In many hospitals,
the buildings have been renovated and the
equipment has been modernized, mainly in
disadvantaged rural areas in order to
compensate for the territorial inequalities in
the care system. In the period between 2007
and 2013, significant funds were spent on
the implementation of healthcare
developments from available development
sources. The healthcare infrastructure was
undergoing unprecedented development,
with healthcare investment amounting to
EUR 1.5 billion. The basic objective of this
period was to reinforce and restructure the
infrastructural background of healthcare
and make the public healthcare service
system suitable to give adequate responses
to the major public health challenges of our
age by using EU support efficiently.
For the purpose of increasing access to
healthcare, a program focusing on the
reduction of waiting lists has been
completed. As a result, the number of
patients on the waiting list decreased from
70,000 in 2012 to less than 28,000 in the
first half of 2018.
Hungary has reinforced the primary care
provided by general practitioners both in
function and in funding. Since 2015, a
“group practice” program – as part of a
community development process – has been
operating involving local Roma
communities. Within the framework of this
program approximately 36,000 people,
including nearly 10,000 members of the
Roma minority, have attended screenings
for more than 20 parameters and related
lifestyle counselling. Moreover, a Digital
Immune Stimulation Program was initiated
in May 2017 in order to ensure a healthier
online environment for young people and to
facilitate utilising the opportunities
provided by the online world more
consciously and conscientiously.
Hungary also puts specific emphasis on
improving air quality to promote a healthy
environment. In this context, a nationwide
Intersectoral Action Program for the
17
Reduction of Particulate Matter (PM10) has
been developed to further reduce PM10
pollution in a 2011–2030 timeframe. The
estimated budget of this program is approx.
2.5 billion EUR. By the end of 2016, the
Government spent more than 504 million
EUR on the implementation of the PM10
program. The largest investments have
happened in the transportation sector and
the energy efficiency and green investment
sector, for example the improvement of the
Hungarian Air Quality Network within the
relevant Operational Programs.
Furthermore, particular attention is paid to
implementing important elements of
chemical safety. The country plays an active
role promoting education on the risks of
chemical use, and it also focuses on the
identification of the dangers and the risks of
hazardous materials in order to determine
the rules for safe use, as well as restrictions
and prohibitions, if necessary. In addition,
online access to information on the current
rate of air pollution and pollen load is freeof-charge for every citizen.
According to the World Health
Organization industrially contaminated
sites are one of the most significant risk
factors for human health, so reducing the
human and ecological risks of these sites is
essential in order to ensure a healthy
environment. Consequently, the National
Environmental Remediation Program was
established in 1996 for the identification,
assessment, and remediation of
contaminated land and groundwater. Data
on the identification, registration, and
technical classification of all contaminated
sites are stored in the National
Environmental Information System.
Financing the clean-up of contaminated
sites is generally guided by the “polluter
pays principle”. In cases when this is not
applicable, funds are allocated from the
government budget or financed through the
EU Cohesion Fund. Most of the
contaminated historical sites are managed
by the state and financed by the national
budget. More than 45 sites were managed
within the framework of the Remediation
Program, using approximately 95 million
EUR between 2015 and 2017.
Hungary is committed to the wellbeing of
all at the global level as well. As part of its
international development strategy, the
country therefore promotes the achievement
of universal health coverage and providing
access to quality essential health-care
services and medicines in indigent regions.
In line with this commitment, financial
assistance has been provided by the country
for medical supplies (e.g. 470,000 EUR to
the St. Joseph Hospital in Erbil, Iraq) since
2015, funding has been provided for
psycho-sociological programs (e.g. 30,000
EUR in Lebanon), and reconstructed
hospitals (e.g. 169,000 EUR in Aleppo,
Syria) were provided.
To foster the prevention of noncommunicable diseases, with the financial
support of the Ministry of Foreign Affairs
and Trade, a project to assist the prevention
and the early detection of breast cancer was
implemented in Albania in 2015. One of the
most prominent results of the project is that
it has presented the risk factors for
developing breast cancer, the most affected
age groups and target groups, and the
methods and importance of selfexamination in detail. Furthermore,
healthcare training is in the IDC activities of
our country, too. The main goal of a training
program being carried out in Ethiopia is to
improve the living conditions of people
residing in Ethiopia’s region with severe
leprosy. This program aims to provide a
two-day professional training course for 50
healthcare workers to learn the basic
information about the early symptoms of
leprosy, healing, complications,
psychological assistance, and home care of
the illness.
|
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32
3.4.3 Goal 3. Ensure healthy lives and promote well-being for all at all
ages
Efforts taken to ensure healthy lives and promote well-being for all at all
ages are; reducing maternal and infant mortality, controlling communicable and
non-communicable diseases, promoting reproductive health, improving The
National Health Insurance (Jaminan Kesehatan Nasional/JKN) coverage, health
personnel, medicines and vaccines. The Voluntary National Review (VNR) for
Goal 3 covers the trend and analysis, challenges and improvement measures,
innovation and key efforts, emerging issues and lessons learned.
1. Trend and Analysis
a. Maternal Mortality Rate (MMR)
One of the main efforts put forward by the government is by ensuring that
every childbirth happened at the health facility. Indonesia Demographic and
Health Survey (IDHS) shows the increase of childbirths at the health facilities
from 46% (2007) to 63.20% (2012).
National Socio-Economic Survey (Survei Sosial Ekonomi
Nasional/Susenas) shows the increases to 77.60% (2015) and 79.70% (2016).
The proportion of childbirths assisted by professional health personnel based on
IDHS also increased from 73% (2007) to 83% (2012). At the end of MDGs
implementation (2015), the MMR has reduced from 346 (Population Cencus/SP
2010) to 305 per 100,000 live births (Intercensal Population Survey/SUPAS
2015), which constitutes 2.40% annual reduction rate (ARR). The RPJMN target
of 306 per 100,000 live births in 2019 has been achieved. However, MMR global
target of less than 70 per 100,000 live births in 2030 can only be achieved with
ARR of 9.50%. Therefore, new commitments and breakthroughs are needed.
Figure 3.19.Trend of Indonesia Maternal Mortality Rate
Source: Various publications
The Maternal
Mortality Rate has
decreased yet
strong efforts are
needed to achieve
the SDGs targets
•
400 IDHS, 2012
350 334 346
300 307 305
IDHS, 2002 SUPAS, 2015
250
200 IDHS, 2007
150
100 • 102
MDGsTarget
50
0
1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
33
The Study of Maternal Mortality Verbal Analysis (Ministry of Health,
2012) reveals that the main causes of the maternal mortality are still dominated
by hypertension in pregnancy, hemorrhage infection and other accompanying
diseases (heart and kidney). Other factors that also affect were maternal health
condition before pregnancy, access to and quality of health services, as well as
the socio-cultural factors. Most of deaths basically could be prevented among
others through the improvement of the Family Planning Program and the
reduction of early marriage.
b. Mortality Rate of Infant, Under-five and Neonatal
The Infants Mortality Rate (IMR) and Under-five Mortality Rate (U5MR)
continue to decrease but been stagnant since 2007. The Neonatal Mortality Rate
(NMR) is also stagnant during the same period. The 0.50% ARR of NMR causes
the difficulty to achieve the SDGs target of 12 per 1,000 live births in 2030. It
requires ARR of 3.00% to achieve such target. Cause of deaths based on the
Sample Registration System (SRS) of 2014 (which was carried out in 128
districts) are low birth weight (38.80%), asphyxia (26.50%) and congenital
malformation (12.70%). The highest infant and neonatal mortality rates are at
the low-income group, 52 and 29 per 1,000 live births respectively.
c. Complete Basic Immunization
The data of IDHS and Basic Health Research (Riskesdas) shows that the
complete basic immunization coverage4
is continuously increasing. However,
there are disparities in the coverage between region, economic status and
domicile. The highest coverage is in Yogyakarta Province (83.10%) and the
lowest is in Papua Province (29.20%). Meanwhile, the coverage in urban
4
The complete basic immunization in IDHS is defined as the percentage of children at the age of 12-23
months who receive immunization of BCG, measles, and three times for DPT and polio. Meanwhile,
according to Riskesdas is if children at the age of 12-23 months have obtained all types of immunization,
namely one time HB-0, one time BCG, three times DPT-HB, four times polio, and one time measles
immunization.
68
57
46
35 34 32
97
81
58
46 44 40
32 30
22 20 19 19
0
20
40
60
80
100
120
1991 1994 1997 2002/2003 2007 2012
IMR U5MR NMR
Figure 3.20. Trend of IMR, U5MR and NMR in Indonesia
Source: IDHS, BPS-Statistics Indonesia
The trend of
complete basic
immunization
coverage of
children at the age
of 12-23 months
continue increasing
IMR, U5MR and
NMR have
decreased but
stagnant since 2007
.Ill
·---------........ ___ ,•~----•..-------.i.1'.
-+-
- ..........
34
(64.50%) is higher than rural (53.70%). Based on economic status, the coverage
of the wealthiest group (67.80%) is higher then the poorest group (39.50%).
However, there are still 32.10% of children at the age of 12-23 months
who obtained incomplete immunization and 8.70% who did not obtain
immunization at all. Based on region, the percentage of
unimmunized/unvaccinated children is highest in Papua Province (36.60%) and
lowest in Yogyakarta Province (1.10%), while the percentage of children with
incomplete immunization is highest in Maluku Province (48.60%) and lowest in
Yogyakarta Province (15.70%). Based on economic status, the percentage of
children with incomplete immunization (39.70%) and
unimmunized/unvaccinated (20.80%) at the poorest group is higher compared
to the wealthiest group (27.90% and 4.30% respectively). The percentage of
children at the age of 12-23 months who lived in rural and obtained incomplete
immunization (34.70%) and never obtained immunization (11.70%) is also
higher compared to children in urban areas (29.60% and 5.80% respectively).
The data of the Ministry of Health presents that districts/municipalities that
achieved 80% of complete basic immunization are also increasing from 71.20%
in 2013 to 80.70% in 2016.
d. Trend of Communicable Diseases
1) HIV-AIDS
The trend of HIV/AIDS cases has increased yet it is still below 0.50%. The
prevalence of HIV reaches 0.37% in 2016. Meanwhile, the AIDS case rate is at
28.45/100,000 population in 2016, varies from the lowest in West Sulawesi
Province (0.09/100,000 population) and the highest in Papua Province
(416.91/100,000 population). However, AIDS cases have already reached the
household level where the AIDS cases at present infant. Therefore, the
government commits to control the HIV prevalence below 0.50% among others
through the sustainable comprehensive services at the districts/municipalities to
provide HIV/AIDS service to the community, as well as the Prevention Mother
to Child Transmission (PMTCT) program. The AIDS case fatality rate (CFR)
decreased from 13.55% (2005) to 1.11% (2016). The number of people living
Figure 3.21. Trend of Complete Basic Immunization
Source: IDHS (2002-2012), Riskesdas (2007-2013)
52.0
59.0
66.0
41.6
53.8
59.2
0.0
20.0
40.0
60.0
80.0
2002 2007 2010 2012 2013
IDHS Riskesdas
Percentage (%)
The HIV
prevalence is
controled below
0.5% and ARV
treatment has
increased
Percentage of
complete basic
immunization of the
poorest group is
lower compared to
the wealthiest
group
• •
35
with HIV and AIDS who received the Antiretroviral (ARV) treatment has
increased from 2,381 (2005) to 77,748 (2016).
Figure 3.22. Total HIV-AIDS cases in Indonesia, 2005-2016
Source: Disease Prevention and Control Surveillance Report, Directorate General of Disease
Prevention and Control, Ministry of Health *Latest update: 31 December 2016
2) Tuberculosis (TB)
Based on TB prevalence survey, the prevalence of TB with the
microscopic method has decreased from 331 (2006) to 263 (2015) and 257 per
100,000 population (2016). Government will continue efforts to reduce TB
prevalence and achieve the RPJMN target of 245 per 100,000 population in
2019.
3) Malaria
Based on the Annual Paracite Incidence (API), malaria morbidity rate has
decreased from 1.75 (2011) to 0.85 per 1,000 population (2015). In 2016, there
were 247 districts/municipalities that have received the malaria elimination
certificate and in the phase of free malaria transmission. These
districts/municipalities have implemented specific strategies based on the
regional endemicity stratification, namely: (1) acceleration strategy in the East
Indonesia region focusing on medical treatment at all health facilities, active
case finding and the use of long lasting insecticidal nets (LLIN); (2)
intensification strategy in the focus area outside East Indonesia region by
emphasizing on the risk groups; and (3) elimination strategy in areas with API<1
per 1,000 population (low endemic) focusing on surveillance and early
detection, as well as active case finding.
4) NeglectedTropicalDiseases (NTDs)
The number of provinces with leprosy elimination has increased from 20
provinces (2014) to 23 provinces (2016) as the result of strong leprosy
controlling effort. The government aims to achieve leprosy elimination in all
provinces in 2019. Meanwhile, the mass drug prophylaxis against filariasis was
carried out in several regencies since 2002. The achievement of mass drug
859
7,195 6,048
10,362 9,793
21,591 21,031 21,511
29,037
32,711 30,935
41,250
5,239
3,680 4,828 5,298 6,744 7,470 8,279 10,862 11,741
7,963 7,185 7,491
s.d
2005
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016*
HIV Cases AIDS Cases
The TB prevalence
has decreased yet
strong efforts to
achieve the target
are needed
The malaria
morbidity rate has
declined and the
specific strategies
based on the
regional endemicity
stratification being
implemented
The total number of
districts/
municipalities with
leprosy and filariasis
elimination has
increased
• •
36
prophylaxis against filariasis during the period of 2006-2012 is less than 50%
and has increased to 71.40% in 2016. The total number of
districts/municipalities with filariasis elimination has increased from 8 in 2014
to 17 in 2015 and 22 in 2016. The government has a committment to eliminate
filariasis in 2020 by continuously increasing the mass drug prophylaxis against
filariasisat districts/municipalities with Filariasis endemic. In addition, the
government has targeted to eradicate Schistosomiasis in 2019.
e. Non-Communicable Diseases (NCDs)
The prevalence of hypertension is 25.8% (nearly 40 million population of
18 years of age and above) and the prevalence of diabetes mellitus (DM) is
6.90% based on Riskesdas of 2013. Meanwhile, the obesity prevalence in 2013
is 15.40% (around 23.5 million population) which is increasing from 10.3% in
2007. The NCDs affect all group of population however the poorest group has
higher prevalence and it increased more rapidly. The stroke prevalence at the
poorest group increased from 7.70 (2007) to 13.10 (2013) and it is the highest
compared to other groups. Therefore, preventing and overcoming NCDs needs
to be a pro-poor policy.
Smoking, aside from unbalanced diet and lack of physical activities,
contributes to the increase of NCDs prevalence in Indonesia. Riskesdas shows
that the proportion of population of 15 years of age and above who are smoking
and chewing tobacco has increased from 34.20% (2007) to 36.30% (2013).
Around 26.10% of the population lack of physical activities and 93.50% of the
population of 10 years of age and above lack of consuming fruits and vegetables
(2013). Meanwhile, Riskesdas 2007 shows that 4.60% of the population
consumes alcohol, whereas 0.60 % consumes up to the hazardous level
according to the WHO standard. Global School Health Survey (GSHS) suggests
that 4.40% of children at the secondary level consume alcohol. The issue of
alcohol consumption should also obtain more attention in the future.
f. Reproductive Health
Figure 3.23. Total Fertility Rate in Indonesia, 1981-2012
Source: IDHS 2012
The total fertility rate (TFR) has been stagnant for the last decade, at
around 2.60 children per 1,000 women. Strong efforts are needed to achieve the
RPJMN target of 2.3 children per 1,000 women in 2019. Meanwhile, the age
specific fertility rate (ASFR) of women at the age of 15-19 years has decreased
from 51 (2007) to 48 births per 1,000 women (2012). However, ASFR is still
3.2
3.0
2.9 2.8
2.6 2.6 2.6
2
2.5
3
3.5
1987 1991 1994 1997 2002-03 2007 2012
TFR has been
stagnant for the last
decade
The NCDs
(Hypertension, DM,
obesity) prevalence
has increased
The NCDs risk
factors among
others smoking
behavior, alcohol
consumption, lack
of physical
activities, and
unbalanced diet
have increased
• • •
37
high compared to the RPJMN target around 38 births per 1,000 women in 2019.
Higher ASFR lead to higher risk of maternal mortality and stunted children.
Therefore, comprehensive reproductive health services for adolescent, including
education, information, and communication (EIC), as well as increasing the age
of first marriage are needed.
The improvement of reproductive health services contributed to an
increase in contraceptive prevalence rate (CPR) of all methods from 61.40% in
2007 to 61.90% in 2012 (IDHS). Furthermore, based on Susenas, the CPR
decreases from 61.98% to 59.98% during 2013-2015. The use of short-term
contraceptive method is still dominant, where the drop out rate is still quite high.
This condition contributes to the stagnancy of TFR for the last 10 years.
Figure 3.24. Trend of the Contraceptive Prevalence Rate (CPR)
Source: IDHS
g. National Health Insurance (Jaminan Kesehatan Nasional/JKN)
Coverage
To provide health services to all citizens, the total number of population
covered by JKN continues to increase. Up to 31 December 2016 there were
171.9 million participants (66.50%). The JKN target in 2019 is 95% of the total
population. Partnership with health facilities has increased to provide a more
comprehensive health services, shown by the increased of the first level health
facility from 18,644 (January 2015) to 20,708 (December 2016) and the
advanced level health facility from 1,727 to 2,068. Nevertheless, the
implementation of the universal health coverage (UHC) needs to be directed to
address the equity of health services between region, including access to facility
and health personnel as well as the improvement of quality health facilities.
The expansion of JKN coverage contributes to the decrease of the unmet
need of health service which is the percentage of the population with health
complaints that disrupted their daily activities but do not seek treatment. The
unmet need of health service decreased from 9.9% in 2006 to 4.3% in 2016. The
unmet need of health service in rural is slightly higher compared to urban due to
the difference in the availability of facilities and health personnel.
49.7
54.7
57.4
60.3 61.4 61.9
47.1
52.1
54.7 56.7 57.4 57.9
30
35
40
45
50
55
60
65
1991 1994 1997 2002/03 2007 2012
Percentage (%)
Any Method Modern Method
The expansion of
JKN coverage
contributes to the
decrease of the
unmet need of
health service
The total number of
population covered
by JKN continues
to increase
•:.::=- ----::-:!~::::;-~· ===·:· =====·
~ -ill™ . : ill ill ill
--- -
38
Figure 3.25.Percentage of Unmet Need of Health Service, 2006-2016
Source: Susenas, BPS-Statistics Indonesia
h. Health Personnel
The total number of community health centers (Pusat Kesehatan
Masyarakat/Puskesmas) with minimum five types of health personnel, namely:
public health staff, environmental health staff, nutritionist, pharmacist, and
health analyst, has increased yet still below annual target (2015 and 2016).
Table 3.4. Ratio of Health Personnel per 100,000 Population in 2016
Source: Ministry of Health
By the end of 2016, there are only 1,264 Puskesmas which met the standard of
health personnel. The availability of doctors and specialists at hospitals has also
shown an improvement. Utilization of health personnel at health facilities has
also increase over the years. However, the Ministry of Health in 2015 reported
that the distribution of health personnel in Java Island is the largest (46.76%),
followed by Sumatera (26.30%), Sulawesi (9.41%), Kalimantan (7.79%), Bali
and Nusa Tenggara (5.96%), and Maluku and Papua (3.78%).
i. Medicine and Vaccine
The percentage of medicines and vaccines availability at the Puskesmas
has increased from 75.50% (2014) to 79.4% (2015) and 81.57% (2016). To
ensure the availability of medicines and vaccines, government is optimizing
spending through state budget as well as utilizating the Special Allocation Fund
(Dana Alokasi Khusus/DAK) that increased by 20% in 2016. Additionally, drug
supervision has increased to guarantee the quality and safety of medicines. By
9.9
7.8 7.6
8.3
7.3
6.3 6.0
5.0 5.2 4.6 4.3
8.7
6.2 6.2 7.0 6.3 5.2 5.7
4.3 4.6 4.2 3.9
10.9 8.9 8.9 9.5 8.4 7.3 6.3 5.7 5.8 5.1 4.8
0.0
2.0
4.0
6.0
8.0
10.0
12.0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Indonesia Urban Rural
Percentage (%)
Type of
Health Staff
National
Rate
Lowest
Rate
Highest
Rate
Doctor 45 10 (West Sulawesi) 170 (DKI Jakarta)
Specialist 13.6 2.8 (NTT) 70.6 (DKI Jakarta)
Nurse 170 38 (East Java) 453(Aceh)
Midwife 162 47 (North Kalimantan) 501 (Aceh)
The availability of
health personnel at
health facilities has
increased yet the
distribution remains
challenging
The availability of
medicines and
vaccines at
Puskesmas has
increased, including
the drug
supervision
• • •
39
the end of 2016, the percentage of medicines that met the requirements has
reached around 98.55%.
2. Challenges and Improvement Measures
The challenges and improvement measures for Goal 3: Ensure Healthy
Lives and Promote Well-being for All at All Ages including maternal mortality
rate, mortality rate of infant input under-five and neonatal, communicable
disease, non-communicable disease, reproductive health, national health
insurance coverage, heath personal and medine and vaccines, as well as data and
information are follows:
a. Maternal Mortality Rate (MMR)
1) Improvement of knowledge of pregnant woman on the importance of
pregnancy examination and delivery assistance at health facilities; 2)
Improvement of quality maternal services, including human resources
competency, health facility, and hospital with comprehensive emergency
obstretic and neonatal care (PONEK); 3) Improvement of quality maternal
health services referral system; 4) Formulation of regulations that support the
optimizing of maternal health services; and 5) Improvement of reproductive
health education, information, and communication (EIC) as well as the services
for women and girls.
b. Mortality Rate of Infant, Under-five and Neonatal
1) Improvement of knowledge on parenting; 2) Improvement of the quality of
child health services, including human resources competency, health facility
with basic emergency obstretic and neonatal care (PONED), and hospital with
PONEK; 3) Improvement of the quality of health services, to prevent perinatal
and neonatal deaths; 4) Improvement of the role of integrated service post
(Posyandu) role; and 5) Improvement of health promotion and education,
particularly on immunization and its benefit to community.
c. Communicable Diseases
1) Expansion of compulsory screening for pregnant woman to detect HIV/AIDS;
2) Expansion of the TB molecular rapid test at all hospitals to enhance the
finding of new TB cases; 3) Improvement of systematical approach to prevent
Multi Drug Resistance (MDR), including to seek the new medical treatment; and
4) Improvement of logistics, human resources and financing for HIV/AIDS
(ARV, reagent and diagnostic kit) and TB along with the expansion of screening
at pregnant woman and use of TB molecular rapid test.
d. Non-Communicable Diseases
1) Outreach to 2/3 of NCDs patients who do not know that they suffer from
NCDs including the standardization of medical treatment; 2) Promotive and
preventive approaches in controlling the NCDs risk factors; and 3) Improvement
of human resources quantity and quality, as well as the health service
infrastructures in line with the increase of NCDs patients.
e. Reproductive Health
1) Improvement of gross enrollment rate for women (12 years’ compulsory
education) to prevent early marriage; 2) Improvement of the use of long-term
The challenges for
health development
include
improvement of
knowledge and
awareness, quality
of health services,
facilities and
personnel, as well
as data and
information and
regulation
40
contraception method; and 3) Improvement of reproductive health education,
particularly for school-age children.
f. National Health Insurance (JKN) Coverage
1) Expanding the JKN coverage of informal and formal workers; 2) Expansion
of partnership between Social Security Administrative Body for health (Badan
Penyelenggara Jaminan Sosial Kesehatan/BPJS) and private first level health
facilities; and 3) Improvement of access to quality health facilities and
personnel.
g. Health Personnel
1) Improvement of quality health personnel through the competency test and
accreditation of health education; 2) Improvement of the engagement of health
professional organizations and education institution associations to enhance
health personnel competency and professionalism; 3) Development of the health
personnel placement scheme, particularly for the underdeveloped, border and
island areas.
h. Medicines and Vaccines
1) Improvement of self-sufficiency in the production of drug raw materials; 2)
Improvement of the rational drug use; and 3) Strengthening drug supervision to
prevent the circulation of false drugs and vaccines.
i. Data and Information
The improvement of the quality of health data and information, particularly the
development of birth and mortality data collection system for monitoring and
evaluation achievement of health development, including data collection for
narcotic, phsycotropica and addictive substance and traffic accidents.
3. Innovation and Key Efforts
1) Several efforts to reduce MMR and IMR, including: 1) Service
Delivery Insurance (Jaminan Persalinan/Jampersal), which is a
program commenced since 2011 to provide free service to pregnant
woman from poor families. Along with the implementation of JKN, the
scope of Jampersal has been adjusted to cover cost for shelter, operational
cost, health personnel, and transportation costs; 2) Strengthening the
blood transfusion unit at sub-national level, including the improvement
of quality technical staff, as well as the infrastructures; and 3) Planned
Generation (Generasi Berencana/Genre) is the program to reduce ASFR
through the reproductive health education for teenagers in the preparation
of family life.
2) Communicable diseases: 1) HIV/AIDS screening for pregnant woman
and ARV treatment for key population, pregnant woman, TB and hepatitis
patients with HIV positive; and 2) Improvement TB diagnostic using
molecular rapic test.
The innovations for
communicable
diseases are
HIV/AIDS
screening, ARV
treatment and TB
diagnostic using
molecular rapid test
The innovations to
reduce MMR and
IMR are Jampersal
program, blood
transfusion unit
and planned
generation
41
3) Non-communicable diseases, namely: the enactment of Presidential
Instruction (Inpres) No. 1 of 2017 concerning Healthy Lifestyle
Community Movement (Gerakan Masyarakat Hidup Sehat/Germas),
which is a cross-sector movement to improve healthy lifestyle of the
community supported by the availability of infrastructures as well as
improvement of healthy environment. One example is the regional based
integrated elderly care post for NCDs (Pos Pembinaan
Terpadu/Posbindu), schools and work places, as well as the
implementation of free smoking areas (Kawasan Tanpa Rokok/KTR)
through the sub-national regulation.
4) Integration of maternal and child health indicators, communicable
diseases (HIV/AIDS and TB), and non-communicable diseases
(hypertension, DM and mental disruption) into the Minimum Service
Standard in health sector.
5) National Health Insurance (JKN), namely: 1) the enactment of Law
Number 40 of 2004 concerning National Social Security System (Sistem
Jaminan Sosial Nasional/SJSN) as a basis of JKN; 2) Increase of total
number of health facilities in partnership with BPJS-Health; 3) Simplify
the premium payment mechanism through thousands of outlets and online
system; and 4) application of the performance based capitation to
encourage the preventive and promotive health efforts.
6) Health personnel: 1) mandatory work for specialists (Wajib Kerja Dokter
Spesialis/WKDS), specialist education program (Program Pendidikan
Dokter Spesialis/PPDS), special assignment of team based (Nusantara
Sehat) and individual based health personnel to fulfill the need of health
personnel particularly for the underdeveloped, border and island areas; 2)
health personnel registration system as a control system for professional
practices and the record of health personnel distribution, conducted by
three independent institutions, namely the Indonesian Health Personnel
Council (Majelis Tenaga Kesehatan Indonesia/MTKI), Indonesian
Medical Doctor Council (Konsil Kedokteran Indonesia) and the National
Pharmacy Council (Konsil Farmasi Nasional); 3) the establishment of
Independence Accreditation Agency for Health Higher Education
(Lembaga Akreditasi Mandiri Pendidikan Tinggi Kesehatan/LAM
PTKes), which accredits all health science study programs intended to
improve the quality of health education institutions.
7) Medicines and vaccines: 1) application of the e-catalogue to guarantee
transparency in the procurement of drugs and health equipments; and 2)
formation of vaccine research consortiumaiming at producing new
vaccines in accordance with Indonesia diseases characteristics such as TB
and Dengue.
8) Develop the integrated referral system and telemedicine to reduce the
number of referrals and to fulfill specialist services which are not available
in some areas.
9) Application of the sample registration system (SRS) for recording the
deaths and the causes of deaths as basis to develop National Civil
Registration and Vital Statistic (CRVS), as well as the application of
The innovation for
NCDs is through
Germas
42
CRVS in several districts/municipalities (Solo, Pekalongan, Gorontalo,
and Yogyakarta).
10) The family oriented approach health service, which is the health
services by Puskesmasthat integrates the individual and community health
efforts with the family as the target. The health service is provided by
visiting families in the work area of the Puskesmas.
4. Emerging Issues
Emerging issues on goal 3: ensure healthy live and promote well-being for
all of all ages related to increase risk factors of the non-communicable disease
and use operational drugs are follows:
a. Increase Risk Factors of the Non-Communicable Disease
Due to rapid urbanization of population to large cities, there is a tendency
of increasing unhealthy lifestyle, such as lack of physical activities, unbalanced
diet and smoking behavior. These conditions contribute to the increase of
prevalence of hypertension, high blood glucose, high blood fat, as well as
obesity, which increases the prevalence of heart and vascular disease, chronic
obstructive lung disease, and various types of cancer which are the main causes
of deaths (WHO, 2013). The poor group will face the risk of catastrophic
spending for NCDs and decrease in productivity, which ultimately worsen
theirpoor condition.
Indonesia is also experiencing the escalation of NCDs. The Riskesdas
shows the increase of stroke prevalence from 8.3 per mil in 2007 to 12.1 per mil
in 2013. In addition, 61% of the total deaths were caused by cardiovascular,
cancer, diabetes and chronic obstructive lung disease. There is also high
prevalence of infants with low birth weight (10%) and short-born (20%), as well
as the high stunting at under-five (37.2%) in Indonesia (2013). They need to
obtain more attention due to the potential of increase risk factor ofNCDs at the
adulthood. The financial burden of the government and community will increase
due to the increase of NCDs. Therefore, controlling the NCDs risk factors should
be given more attention from the government in the future.
b. Rational Use of Drugs
The increase of access and availability of medicine in the community poses
the challenge of rational use of drugs. According to WHO, the use of drugs is
rational when the patient receives medications in accordance with their clinical
needs, during an adequate period and at lowest cost to them and their
community. However, the requirements for rational use drugs are often not
adhered to. Drugs are prescribed and provided incorrectly, ineffectively and
inefficiently coupled with the problem of obtaining essential drugs. Based on
2016 National Health Indicators Survey (Survei Indikator Kesehatan
Nasional/Sirkesnas), the rational use of drugs at the Puskesmas is only 64.4%.
Therefore, rational use of drugs should become the focus intervention to prevent
the inappropriate drugs that may jeopardize patients and result in increased
antibiotic resistance (Anti-Microbial Resistance). The efforts to increase the
community trust toward the quality health services, is also needed.
Emerging issues for
the health are the
increase risk factors
of noncommunicable
diseases and the use
of rational drugs
43
5. Lessons Learned
In implementing goal 2, Indonesia learned a number of lessons as follows:
a. JKN as a Reform in the Health Service System
The JKN is the form of government responsibility in providing health
service to the community to reduce the financial constrains of the population to
access health services, shown by the decrease of unmet need of health services.
With the principle of “no one left behind”, everyone is required to have health
insurance, where the premium of the poor is borned by the government. Due to
JKN, there is an increase in motivation to improve the quality and the provision
of comprehensive health services to the community. In addition, JKN is an
opportunity for the government to use the state health budget more effectively
and efficiently. The government has more flexibility to allocate budget for
community health, such as for promotive and preventive efforts.
b. Cross Sectoral Approach
The efforts to improve the community health need a cross-sectoral
approach. Typically, the health development closely related to the intervention
only dealt by health sector. However, the experience of the Government of
Indonesia in controlling various community health problems (i.e. NTDs, NCDs
risk factors), showed that the engagement of other sectors has very important
roles. For instances, basic infrastructure development such as water and
sanitation sectors dealt by the public works, and environmental management
(contamination control and waste management) dealt by environmental sector,
provided significant contribution in determining the success of the health
development. Therefore, the cross-sectoral role is strongly needed for the health
development in the future.
Learning for the
health development
includes JKN as the
health service
reformation and
need of cross-sector
approach
|
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{
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"file_id": "sdg-03/vnr-report-idn-2017-en-3.pdf",
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|
200
4.2.3 Goal 3. Good Health and Well Being
Efforts taken to ensure healthy lives and promote well-being for all at all ages are;
reducing maternal and infant mortality, combating communicable and noncommunicable diseases, promoting reproductive health and improving The National
Health Insurance (Jaminan Kesehatan Nasional/JKN) coverage.
A. Trend Analysis
a. Maternal Mortality Rate (MMR)
At the end of MDGs implementation (2015), the MMR has been reduced from 346
(Population Cencus/SP 2010) to 305 per 100,000 live births (Intercensal Population
Survey/SUPAS 2015), which constitutes 2.40% annual reduction rate (ARR). The national
target of 306 per 100,000 live births in 2019 has been achieved. However, MMR global
target of less than 70 per 100,000 live births in 2030 can only be achieved with ARR of
9.50%. Therefore, new commitments and breakthroughs are needed.
201
Figure 111. Trend of MMR
Source: Various publications
b. Mortality Rate of Infants, Under-fives and Neonatals
The Infants Mortality Rate (IMR) and under-fives Mortality Rate (U5MR) continue
to decrease. Policy innovation and acceleration are needed to achieve global target in
2030 to reduce NMR to at least as low as 12 per 1,000 live births and U5MR to at least as
low as 25 per 1,000 live births.
Figure 112. Trend of IMR, U5MR and NMR
Source: IDHS, BPS-Statistics Indonesia
c. Communicable Diseases
The trend of non-communicable diseases in Indonesia shows a tendency to decline
from year to year. HIV prevalence in the adult population was maintained below 0.5%, at
the level of 0.33% (2018). The decline in the incidence of tuberculosis (TB) showed a
promising development of 319 incidents per 100,000 population (2017) from 338 per
100,000 population (2011). The malaria illness trend based on API (Annual Paracite
Incidence) decreased from 1.75 (2011) to 0.84 per 1000 population (2018). Malaria has
been eliminated in half of the country’s districts (285 districts) in 2018.
97
81
58
46 44 40
32
68
57
46
35 34 32
24
32 30
22 20 19 19 15
0
20
40
60
80
100
120
1991 1994 1997 2002/2003 2007 2012 2015
AKBa AKB AKN
202
Figure 113. Trend of Communicable Diseases
Source: Global TB Report and Disease Prevention and Control Surveillance Report, Directorate General of Disease
Prevention and Control, Ministry of Health
d. Non-Communicable Diseases (NCD)
1. Risk Factors of Non-Communicable Diseases
Based on Basic Health Research (Riskesdas), the prevalence of hypertension at
population 18 years old and above increased from 25.8% (2013) to 34.1% (2018). During
the same period, the obesity prevalence at population 18 years old and above increased
from 15.4% to 21.8%. Smoking, aside from unbalanced diet and lack of physical activities,
contributes to the increase of NCDs prevalence in Indonesia. The proportion of 18 year
olds and below who are smoking increased from 7.2% to 9.1%.
Figure 114. Trend of Risk Factors of Non-Communicable Diseases
Source: Riskesdas 2013-2018, Sirkesnas 2016
e. Reproductive Health
1. Contraceptive Prevalence Rate (CPR)
The improvement of reproductive health services contributed to an increase in
contraceptive prevalence rate (CPR) of all methods from 49.7% in 1991 to 63.6% in 2017
according to Indonesia Demographic and Health Survey (IDHS).
338
335
332
329
325
322
319
300
310
320
330
340
2011 2012 2013 2014 2015 2016 2017
incidence of tuberculosis per 100.000
population
1.75 1.69
1.38
0.99
0.85 0.84
0.99
0.84
0
0.5
1
1.5
2
2011 2012 2013 2014 2015 2016 2017 2018
Annual Parasite Insidence/API
7.20 8.80 9.10
25.80
32.40 34.10
15.40
20.70 21.80
0.00
10.00
20.00
30.00
40.00
2013 2016*Sirkesnas 2018
Smoking ≤18yo Hypertension ≥18yo Obesity ≥18yo
203
Figure 115. Trend of the Contraceptive Prevalence Rate
Source: IDH
2. Fertility Rate
The total fertility rate (TFR) has reduced from 2.6 in 2012 to 2.4 children per 1,000
women in 2017. Strong efforts are needed to achieve the national target of 2.3 children
per 1,000 women in 2019. Meanwhile, the age specific fertility rate (ASFR) of women at
the age of 15-19 years old decreased from 51 (2007) to 36 births per 1,000 women
(2017).
Figure 116. Trend of TFR and ASFR
Source: IDHS, BPS
f. Universal Health Coverage
1. JKN Coverage /Jaminan Kesehatan Nasional
To provide health services to all citizens, the total number of population covered by
JKN continues to increase. Up to 31 December 2018, 78.7% of the population have already
enrolled to JKN.
49.7
54.7
57.4
60.3 61.4 61.9 63.6
47.1
52.1
54.7
56.7 57.4 57.9 57.2
30
35
40
45
50
55
60
65
70
1991 1994 1997 2002/03 2007 2012 2017
All Method Modern Method
3 2.9 2.8 2.6 2.6 2.6 2.4
67
61 62
51 51 48
36
0
10
20
30
40
50
60
70
80
1991 1994 1997 2002/03 2007 2012 2017
TFR ASFR
204
Figure 117. Trend of JKN Coverage
Source: BPJS-Health
2. Unmet Need of Health Services
The expansion of JKN coverage contributes to the decrease of unmet needs for
health services, which is the percentage of the population with health complaints that
disrupted their daily activities but do not seek treatment. The unmet needs for health
services decreased from 9.9% in 2006 to 4,91% in 2018.
Figure 118. Percentage of Unmet Needs for Health Services
Source: Susenas, BPS-Statistics Indonesia
B. Challenges
a. Mortality Rate of Maternals, Infants, Under-five and Neonatals
The challenges ahead are: 1) improving the quality of basic and referral health
services, as well as maternal and neonatal emergencies including competency of human
resources (HR), facilities, Health Centers (Puskesmas) capable of Basic Emergency
Neonatal Obstetric Services (PONED) and hospitals capable of Comprehensive Emergency
Obstetric Neonatal Services (PONEK); 2) improvement of reproductive health services’
quality for maternal, bride and groom to be, as well as adolescents; 3) increasing maternal
61.55
66.50
71.80
78.40
50.00
60.00
70.00
80.00
2015 2016 2017 2018
JKN Coverage
9.9
7.8 7.6
8.3
7.3
6.3 6
5 5.2
4.66 4.33
5.26 4.91
0
2
4
6
8
10
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Unmet Need of Health Service
205
knowledge on antenatal care and parenting; 4) increasing the role of the community
through Desa Siaga, the Maternity Planning and Prevention Complication Program
(Program Perencanaan Persalinan dan Pencegahan Komplikasi/P4K) and Integrated
Health Posts (Posyandu); and 5) health education and promotion, including benefit of
immunization.
b. Communicable Diseases
The challenges for ending infectious disease epidemics are: 1) scaling up proven
interventions for preventing and controlling HIV/AIDS, TB, and malaria such as voluntary,
conseling, and testing (VCT) to reduce under-reporting of HIV/AIDS cases; the use of TB
Molecular Rapid Test methods to improve the findings of new TB cases, and the use of
insecticide-treated bed nets to prevent malaria transmission, 2) increasing screening
coverage especially for high risk group; 3) increasing effective drug treatment, including
prevention of Multi Drug Resistance (MDR); and 5) increasing logistical needs, human
resources and funding for HIV/AIDS, TB and malaria.
c. Non-Communicable Diseases (NCD)
Challenges to reduce morbidity and mortality due to NCDs include: 1) improving
screening coverage for NCD; 2) reducing unhealthy lifestyles such as smoking, unhealthy
diets, and lack of physical activity; 3) providing regulation to prevent NCD such as
increasing the national tobacco excise, imposing ban on cigarette advertisements, and
reducing consumption of sugar, sodium, and fat; 4) improving urban environments to
encourage physical activity; and 5) increasing the quantity and quality of human
resources as well as health care facilities as the number of NCD prevalence increases.
d. Reproductive Health
The challenges ahead are: 1) increasing women’s education participation to prevent
early marriage; 2) increasing the use of Long-Term Contraceptive Methods (MKJP); and
3) improving reproductive health education, especially for school-age children.
e. Universal Health Coverage
The future challenges are: 1) expanding membership of JKN especially informal
sectors and workers; 2) improving supply side readiness through encouraging greater
cooperation between BPJS-Health and the private health facilities; and 3) improving
adequate management of JKN.
C. The Way Forward
Based on the Government Annual Work Plan, the policy directive for health is as
follows: (1) accelerating the fulfillment of access to quality maternal, child, adolescent and
elderly health services; (2) improving access and quality of family planning and
reproductive health services; (3) accelerating the improvement of community nutrition;
(4) improving disease control and environmental health; (5) improving access to quality
basic health services; (6) improving access to quality referral health services; (7)
increasing the availability, affordability, equity and quality of pharmaceuticals and
medical devices; (8) increasing the effectiveness of drug and food supervision; (9)
increasing the availability, distribution and quality of health human resources; (10)
206
strengthening the Healthy Life Style Movement (Gerakan Masyarakat Hidup
Sehat/Germas); (11) strengthening management and research, as well as health
information systems; (12) strengthening the implementation of the SJSN in the health
sector; and (13) increasing the effectiveness of health financing.
The policy directive in the framework of family planning development, are: (1)
strengthening access to equitable and quality family planning and reproductive health
services, both in the SJSN Kesehatan and Non-SJSN Kesehatan; (2) strengthening access to
equitable and quality family planning and reproductive health services, both in the SJSN
Kesehatan and Non-SJSN Kesehatan; (3) strengthening population management
institutions (including elderlies) and effective family planning.
|
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14
SDG 3: Good Health and Well-Being | Ensure Healthy Lives and Promote Well-Being for
All at All Ages
India has made significant strides in improving various health indicators. The country’s strategy in health
is focused on providing essential services to the entire population, with a special emphasis on the poor and
vulnerable groups.
Specific Targets under the National Health Policy, 2017
0
10
20
30
40
50
60
70
80
Infant Mortality Rate Under-5 Mortality Rate
Reduction in Infant & Child Mortality Rates (Per 1,000 Live Births)
2005-06 2015-16
Women and Children
•Reduce Infant Mortality Rate to
28 by 2019
•Reduce Maternal Mortality
Ratio to 100 by 2020
•Reduce NeoNatal Mortality to
16 by 2025
•Reduce Under-Five Mortality
to 23 by 2025
•Completey immunize 90% of
newborn children by 2025
•Immunize all unimmunized and
partially immunized children
against vaccine-preventable
diseases by 2020
•Enhance skilled birth
attendance to more than 90%
by 2025
•Increase antenatal care
coverage to 90%
Communicable Diseases
•Achieve the global target of
90:90:90 for HIV/AIDS by
2020
•Eliminate Kala-Azar by
2017, Lymphatic Filariasis in
endemic pockets by 2017 &
Leprosy by 2018
•Achieve & maintain a cure
rate of more than 85% in
new sputum positive TB
patients; and reduce
incidence of new cases to
reach elimination status by
2025
Non-Communicable Diseases
•Reduce premature mortality
from cardiovascular diseases,
cancer, diabetes & chronic
respiratory diseases by 25%
by 2025
15
Improving the health status of women and children
India has developed a roadmap, the ‘India New-born
Action Plan’ for achieving the targets outlined in the
global ‘Every New-born Action Plan’ by 2030, five
years before the global deadline. Other flagship
initiatives include ICDS, Rashtriya Bal Swasthya
Karyakram (a child health screening and early
intervention programme) and JSY.
A number of initiatives in this space are leveraging
technology for improving the health indicators of
women and children. For instance, ANMOL
(Auxiliary Nurse Midwives Online) is a tablet-based
application launched by the Ministry of Health &
Family Welfare for enabling Auxiliary Nurse
Midwives to electronically enter and update data for
beneficiaries in their jurisdictions. Similarly,
digitization of ICDS centres is facilitating real-time
monitoring of service delivery across the country.
Progress Made in the Areas of Family Planning, Maternal Health & Child Health
43.5
62
78.2
91.9
55.3
78.4
58.8
81.1
0 10 20 30 40 50 60 70 80 90 100
2005-06
2015-16
Improvements in the vaccination coverage of children between 12-23 months (%)
Received Measles Received DPT Received BCG Fully immunized
Government of India launched Mission
Indradhanush (rainbow program) in 2014
for covering children who are
unvaccinated or partially vaccinated. The
Mission aims to ensure full immunization
of children up to two years & pregnant
women.
16
Preventing Communicable Diseases
Under the National Vector Borne Disease Control Programme, prevention and control of six diseases has
been prioritized, including Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-Azar and
Lymphatic Filariasis. Additionally, the government has launched a National Strategic Plan recently with
the objective of eliminating TB by 2025. A new medication, Bedaquiline, has also been launched for
tackling drug-resistant TB. Further, the Integrated Disease Surveillance Programme provides early warning
signals for initiating timely action in response to health challenges in the country.
Reducing the Burden of Non-Communicable
Diseases
A National Programme for the prevention of noncommunicable diseases including cancer and
cardiovascular ailments is focused on promoting healthy
lifestyles in collaboration with a range of stakeholders
including civil society and the media. A National NonCommunicable Diseases Cell has been established along
with 36 and 318 Cells at the state and district levels
respectively. In addition, 71 Cardiac Care Units and 61
Day-care Centres for Chemotherapy have been set up in
various districts across the country. The government has
also launched a mobile health initiative, mDiabetes, for
creating awareness about the illness.
2.7
2.2
Total Fertility Rate (children per woman)
2005-06 2015-16
37
51
A Minimum of 4 Antenatal Care Visits
(% of last births in the past 5 years)
2005-06 2015-16
38.7
78.9
2005-06 2015-16
Increase in Institutional Deliveries Under Janani Suraksha Yojana (%)
ASHA Soft - An Online Monitoring &
Payment System
A web-based software has been launched
in the state of Rajasthan with the objective
of ensuring timely and transparent
payments to community health workers.
Use of the software has also improved the
entry of beneficiary data in the Pregnancy
& Child Tracking Systems. The initiative
has been rolled out across all districts in the
state covering 4,700 community health
workers.
17
As heart diseases affect a large number of people in the country, the government has taken steps to ensure
the availability of coronary stents at affordable prices. Further, the National Dialysis Services Programme
has been launched for patients with renal diseases. Recognizing the significant burden of mental health
issues, the Indian Parliament has recently passed the Mental Healthcare Bill, which decriminalizes suicide
and protects the property rights of patients.
Ensuring access to basic health facilities for all
The National Health Mission provides flexible financing to state governments for improving infrastructure
facilities at the district and sub-district levels. The
Mission was allocated INR 267 billion (USD 4 billion)
in 2017-18 making it one of the largest centrally
sponsored schemes of the Government of India.
Additionally, the government has launched a National
Health Protection Scheme for giving financial
assistance to families that are below the poverty line
and have lost their primary wage earners. Such
families will be provided with a health insurance cover
to the tune of INR 100,000 (USD 1,563). For ensuring
the availability of adequately trained doctors, the
government is creating an additional 5,000
postgraduate seats per year. Additionally, steps are
being taken to transform the regulatory framework for
medical education and practice in the country.
Success Stories in Health: Kerala & Tamil Nadu
The state of Kerala has had an excellent track record in the provision of healthcare. Recently, the state
government has launched an initiative called Aardram for revamping the public health system and
providing more patient-friendly services. Alongside health promotion and prevention, there is also a
focus on strengthening facilities at the secondary and tertiary levels. The initiative will aim to ensure
that at least one hospital in every district is equipped to provide super specialty services. Kerala, despite
its achievements in the health sector, is not resting on its laurels given the changing epidemiology in
the state and the emergence of new challenges like lifestyle diseases.
Similarly, Tamil Nadu has made tremendous progress despite spending only around 1% of its GDP
on health. The achievements have been underpinned by a well-functioning network of primary health
care centers with monthly performance monitoring, rapid scale-up of the immunization programme, a
reliable supply of essential drugs as well as a successful community health worker scheme.
Index for Spurring Improvements in
Health
Ministry of Health & Family Welfare and NITI
Aayog are spearheading the Health Index
initiative. The Index has been developed to
monitor state-level performance on various
health indicators. The objective is to encourage
states to improve their data collection systems
as well as health outcomes. The Index
comprises indicators pertaining to processes,
governance systems and outcomes in the
health sector.
18
Traditional and Alternative Systems of Medicine
A Ministry of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) was
establised in 2014 for promoting indigenous and alternative systems of healthcare in India. There are
currently 0.8 million registered AYUSH practitioners in the country who practice traditional Indian
medicine as a complement to modern medicine. There is also a vast infrastructure for AYUSH in the
country with 3,277 hospitals and 24,289 dispensaries. Further, several initiatives have been undertaken
at the state-level for integrating AYUSH with healthcare initiatives. In Tamil Nadu, for instance, a pilot
project was implemented for delivering AYUSH services as part of the nutrition scheme. The
programme achieved positive results in the form of a reduction in the infant and maternal mortality rates
as well as anemia among girls.
The practice of Yoga originated in India thousands of years ago. It promotes wellness and prevents
psychosomatic disorders. Given the immense popularity of Yoga across the world, the Indian Prime
Minister moved a draft resolution, endorsed by 175 member states, for celebrating the International Day
of Yoga. Since 2015, International Yoga Day is celebrated across the globe on 21st June every year.
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{
"country": "ind",
"file_id": "sdg-03/vnr-report-ind-2017-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
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|
India has made remarkable progress in providing
universal access to afordable healthcare solutions with special emphasis on groups in situations of vulnerability. An array of initiatives,
primarily under the National Health Policy, 2017,
have been instrumental in achieving considerable progress in several areas – improving child
and maternal health, reducing mortality, raising
life expectancy and strengthening the defense
against major communicable diseases. As the
largest supplier of vaccines and generic drugs,
India is widely acknowledged as the ‘pharmacy
of the world’. Globally, maternal mortality has
fallen by almost 50 per cent since 1990 and
measles vaccines have averted nearly 15.6 million
deaths since 2000. On the other hand, the risk of
death from non-communicable diseases remains
high at 18 per cent. Challenges persist in the
battles against HIV/AIDS, malaria and tuberculosis. The global pandemic COVID-19 has thrown
open India’s health systems to multifarious challenges, which the country is combating with
ground-breaking synergies among industry, civil
society and diferent levels of the government.
India’s focus primarily has been on universalising
preventive healthcare, ensuring primary healthcare afordability and ramping up modern medical infrastructure. Special interventions have
been rolled out for improving the health status of
women and children, and for preventing communicable and non-communicable diseases.
Universal Health Protection and Afordable
Healthcare
The launch of the world’s largest health protection programme, Ayushman Bharat and its two
components, facilitate inclusive health care
to at-risk communities. Health and Wellness
Centres (HWC), provide comprehensive primary
health care (1,50,000 HWCs are planned to be
set up by 2022, of which 39,039 are already
functional); Pradhan Mantri Jan Aarogya Yojana
provides health cover to 100 million vulnerable families up to INR 500,000 (USD 6,666.7)
per family per year for secondary and tertiary
hospitalisation. Since its implementation in
2018, Ayushman Bharat has reached close to
10 million beneficiaries, who have benefitted
from cashless treatment worth INR 134 billion
(USD 1.8 billion). About 61.4 million women
have accessed services of HWCs accounting for
54 per cent of the total footfalls. Out of the 1393
Health Benefit Packages (HBP) under PMJAY,
116 are female centric, 64 are only for males and
1213 are common for both.
With a significant increase in access to Statesupported healthcare, the out of pocket expenditure (OoPE) as a percentage of total health
expenditure has declined from 64.2 per cent in
2013-14 to 58.7 per cent in 2016-17. The Pradhan
Mantri Jan Aushadhi Pariyojana, under which
quality medicine is supplied at afordable prices,
has played a big role in reducing the OoPE of
patients. In addition, availability of free drugs
and a basket of diagnostic services at the district
and sub-district levels across the country under
the Free Drugs Service initiative has also helped
significantly in cutting down OoPE. Hastening
the pace towards universal healthcare, India aims
to increase primary healthcare expenditure from
the current level of 52.1 per cent to two-thirds
of total public health expenditure. These initiatives, in conjunction with Ayushman Bharat,
have made unprecedented strides in providing
afordable healthcare to the poor and vulnerable
in the true spirit of ‘Leave No One Behind’. 45
INDIA’S MARCH FORWARD: PROGRESS ON THE SDGs
SDG 3
GOOD HEALTH AND WELL-BEING
Ensure healthy lives and promote well-being
for all at all ages
India has made significant progress in
providing universal access to afordable
healthcare solutions.
Enhancing Medical Infrastructure
India has a doctor-population ratio of 1:1456,
against the WHO benchmark of 1:1000. To
address the challenge of shortage of doctors,
India has embarked on an ambitious programme
for upgrading health infrastructure - from district
hospitals to medical colleges. Since 2014, 141 new
medical colleges have been sanctioned and with
an increase in the intake capacity of medical
students.
Reducing Maternal Mortality Ratio
India has reduced Maternal Mortality Ratio (MMR)
by 6.15 per cent - from 130 in 2014-16 to 122 in
2015-17, which puts it on track to achieve an MMR
of less than 70 by 2030. The implementation of
the Reproductive, Maternal, Newborn, Child and
Adolescent Health (RMNCH+A) strategy, with
interventions across the life stages of women
and children, and focus on addressing inequitable healthcare delivery for groups in situations of
vulnerability, has had a profound impact on the
maternal health situation. NHM has also led to the
creation of a million strong workforce of frontline workers - Accredited Social Health Activist
(ASHA) directly involved in preventive, promotive
and service delivery activities.
Further, institutional deliveries doubled between
2005-06 and 2015-16 from 39 per cent to
79 per cent, increasing by 21 percentage points in
urban and by 46 percentage points in rural India.
A record of 94.3 per cent of all reported deliveries in India in 2019-20, took place at a health
institution. Key initiatives under maternal health
including Janani Suraksha Yojana (conditional
cash transfer for institutional delivery), Dakshata,
LaQshya (quality of care around child birth) have
played a huge role in this improvement.
Reducing Neonatal and Under Five Mortality
Infant Mortality Rate (IMR) declined from 37 to 32
between 2015 and 2018. Under-5 Mortality Rate
has declined, as well, in recent years, from 43 in
2015 to 37 in 2017. The reduction has been more
for girls (by 13.3 per cent) than for boys (by 10 per
cent). Neonatal mortality rate also declined by 8
per cent from 25 to 23 during this period.
The percentage of children aged 12-23 months
who have received all basic vaccinations
increased from 44 per cent in 2005-06 to 62
per cent in 2015-16. The coverage of immunization in children aged between 9-11 months has
increased by about 3.1 percentage points, from
88.66 per cent in 2016-17 to 91.76 per cent in
2018-19. The progress is largely attributed to the
Integrated Child Development Services (ICDS)
Scheme, one of the world’s largest programmes
which provides an integrated package of services
for the holistic development of children, and
Mission Indradhanush, a focused initiative for
universalising immunization.
FACILITIES 2018 (in number) Percentage Increase from 2014
SC/PHC/CHC 1,89,784 3.87
Government Hospital
(rural and urban areas, including CHC) 25,778 26.95
AYUSH Hospital and Dispensaries 31,986 7.58
Medical Colleges 539 35.43
Nursing Personnel 29,66,375 13.13
Pharmacists 11,25,222 69.42
Doctors (Modern System)* 9,23,749 23.64
AYUSH Doctors 7,99,879 8.60
Notes:
1. SC: Sub Centre; PHC: Primary Health Centre; CHC: Community Health Centre;
AYUSH: Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy
2. * Assuming 80 per cent of registered doctors are available
Table 2. Healthcare Infrastructure and Human Resource
46
INDIA VNR 2020 SUSTAINABLE DEVELOPMENT GOALS
Eliminating Communicable and
Non - Communicable Diseases
The National Vector Borne Disease Control
Programme (NVBDCP) leads India’s fight against
communicable diseases such as polio, malaria,
TB and lymphatic filariasis. India achieved poliofree status in 2014. Among the 11 most malaria-afected countries globally, India showed a
continuous reduction in reported cases during
2016-18 - 60 per cent in 2016-17 and 51 per
cent in 2017-18. As far as lymphatic filariasis
is concerned, there has been steady progress
in terms of reduction in infection levels below
the threshold in 37 per cent of all districts. An
‘accelerated plan’ is being implemented to make
India free of lymphatic filariasis by 2021. With
respect to TB, India has been able to improve
notification of cases, which grew by 16 per cent
in 2018. At the same time, there has been a
decline in the incidence of cases (per 100,000
population) from 217 cases in 2015 to 204 cases
in 2017 – a decline of 6 per cent, thereby consistently moving towards complete elimination of
TB by 2025. The emphasis on water and sanitation, especially through the Swachh Bharat
Mission, has had an appreciable dent on spread
of communicable diseases.
India, with the third largest HIV incidence in
the world, has 2.14 million people living with
HIV. While the HIV prevalence in India stood
at 0.22 per cent in 2017 (0.25 per cent among
males and 0.19 per cent among women), new HIV
infections per 1000 uninfected people declined
by 12.5 per cent, from 0.08 in 2015 to 0.07 in
2017, primarily attributable to the National AIDS
Control Programme (NACP).
India is among the first few countries to set
specific targets and indicators to bring down
the burden of NCDs based mortality by 25 per
cent by the year 2025. India’s response to NCDs
has been robust with the expansion of National
Programme for Prevention and Control of
Cancer, Diabetes, Cardiovascular Diseases and
Stroke (NPCDCS) to the entire country. The
Mental Healthcare Act came into being in 2017,
which has adopted an entitlement approach to
delivery of mental healthcare and services, which
also improved the awareness on mental health.
47
INDIA’S MARCH FORWARD: PROGRESS ON THE SDGs
UNDER-5
MORTALITY RATE
IMPROVED TO
37
in 2017 from
43 in 2015
MATERNAL
MORTALITY RATIO
REDUCED TO
122
in 2015-17 from
130 in 2014-16
AYUSHMAN
BHARAT
HEALTH AND
WELLNESS CENTRES
BY 2022
1,50,000
HEALTH INSURANCE
FOR 100 MILLION
FAMILIES
INR
5,00,000
per year
Monitoring Progress at the National and Sub-national levels
While measuring the country's performance on the SDG India Index and Dashboard, for SDG 3 and its
disaggregated eight national indicators, the overall Index Score for the country is 61, and ranges between
29 and 82 for the States, and between 50 and 71 for the UTs, on a scale of 0-100 This indicates that the
distance to target covered so far by India in Good Health and Well Being remains 61, with a significant
variation among the sub-national units.
Available in 11 languages, this app augments
the initiatives of the Government to contain
the risks of COVID-19 and share the best
practices. It is the world's fastest-growing
mobile application with more than 100 million
installations on the Google Play Store, just
weeks after its launch on April 2, 2020. It now
brings online medical consultations (call and
video), Home Lab Test and e-Pharmacy.
AAROGYA SETU
Aarogya Setu is a COVID-19 tracking mobile
application developed by Government of
India which enables people to self-assess the
risk of the Corona Virus infection based on their
interaction with others, using cutting edge
Bluetooth technology and algorithms based on
artificial intelligence.
YSR AAROGYASRI SCHEME
Towards achievement of universal health
coverage for BPL families, whether defined in
terms of financial protection or access to and
efective use of healthcare, the Government
of Andhra Pradesh is implementing the
YSR Aarogyasri Health Insurance Scheme. The
aim of the scheme is to provide Universal
Health Coverage to BPL families. The scheme
has established a demand-side mechanism that
mobilises and channels additional public
financing to health, introduced an explicit
benefits package, pioneered cashless care and
fostered public private partnerships.
good practices
11
LANGUAGES
100
MILLION USERS
48
INDIA VNR 2020 SUSTAINABLE DEVELOPMENT GOALS
As the world’s second-most populous country, India faces a number of challenges in the
health sector.
{ Afordability and the cost of healthcare:
The private sector is a significant player
in healthcare. Paucity of regulation in the
private sector and the consequent variation in quality and cost of services continues to be a challenge. Although healthcare
ofered by the public sector comes at low
or no cost, it is often not the first choice
on account of perceived unreliability and
indiferent quality.
{ Health workforce density: India has one of
the lowest densities of healthcare personnel. Though the number of physicians,
nurses and midwives per 10,000 population increased by about 1.7 per cent, from
35.8 in 2015 to 36.4 in 2016, marking progress, India continues to persevere towards
further improvement in this area.
{ Lack of Health Awareness: While health
awareness has spread considerably, major
gaps still remain. Areas that particularly
require attention include child and adolescent health, sexual and reproductive healthcare, food and nutrition, lifestyle aspects,
geriatric morbidity and care, and mental
health. Causes are diverse-inadequate
preventive care and patient counseling in
the health delivery system, lower public
priority to health concerns and weaker links
between education and health.
The health system has geared up with exemplary
resilience to manage the COVID-19 pandemic,
with efective containment, treatment, surveillance and tracking systems, as is evident in the
way in which India has been managing the crisis.
The response of the public health system across
the country and the services of frontline workers
have been diligent with implementation of efective strategies for containment, tracking, testing
and treatment to keep the crisis from flaring.
Significant strides have been made in increasing
life expectancy and reducing the threats associated with child and maternal mortality. However,
further impetus is required to fully eradicate a
wide range of diseases and address diferent
persistent and emerging health issues.
India has a rich tradition of alternative medicine,
which needs to be researched and tapped into
as a part of the mainstream healthcare system.
The Government has proposed to set up an
Ayurveda hospital in each district with the assistance of the Ministry of Ayush (Ayurveda, Yoga &
Naturopathy, Unani, Siddha and Homoeopathy).
Leveraging technology is transforming the
public health scenario in India. It is, for example,
connecting remote areas with national centers
of excellence or patients in villages with doctors
in hospitals in urban areas through measures
like tele-medicine. Technology can further break
distance barriers, by providing swifter solutions
through better diagnostics and e-payment
services, thereby truly universalising access to
the best of diagnostics, tele-medicine and other
healthcare services.
There are ample opportunities for the private
sector to support health promotion and disease
prevention activities under public–private partnerships and through corporate social responsibility initiatives. Engaging the private sector in
a creative and positive manner as partners for
health action coordinated by the government,
can go a long way in addressing health challenges in the next decade and beyond.
Challenges and Way Forward
49
INDIA’S MARCH FORWARD: PROGRESS ON THE SDGs
The health system has geared up with
exemplary resilience to manage COVID-19
pandemic, with efective containment,
treatment, surveillance and tracking
systems, as is evident in the way in which
India has been managing the crisis.
• •
|
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[
3
] |
{
"country": "ind",
"file_id": "sdg-03/vnr-report-ind-2020-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
SDG 3: Good Health and Wellbeing
Forty-fve per cent of the VNR consultation participants noted the damaging impact of
COVID-19 on their mental health. The waiting times for Child and Adolescent Mental
Health Services need urgent improvement, and healthcare facilities need to be established
in rural areas and in disadvantaged communities to meet the growing needs of young people.
Community-based primary care needs to become a priority, to reach those most vulnerable,
who might be scared to speak about their struggles or to approach a healthcare practitioner
in the frst instance. It is noted that educators and youth workers cannot and should not be
everything to every young person, but having the necessary tools to ensure the immediate
safety of the young person, and being able to signpost them to reliable, effective, and nonjudgmental services is essential.
Increasing and improving existing service provision is a necessity to BBB while LNOB. This
spans healthcare and mental health services, transport links, and working conditions. The
adequacy of services provided by local government during the pandemic, compared to
during our recovery is problematic for young people. Small business grants, amenities in
underserved communities, and clean green spaces were all welcome advancements as a result
of COVID-19-19, but they seem to have decreased in importance for the government since
the lockdowns were lifted. Gabrielle, 16, notes that not all youth groups were able to function
because of funding cuts both during and after the pandemic: “This affects young people around
the country as they have nowhere to go to socialise and feel isolated and distant. This lack
of facilities for young people has caused them to rely more on their phones to socialise with
others, but phones and social media can be damaging to young people’s mental health”.
Along with capacity, skills, and confdence building, youth services evoke a sense of collective
responsibility, especially amongst young people considered most vulnerable. It is for these
reasons that prior to the 2022 National Budget, NYCI presented over 3,000 signatures of
71
young people to the government, calling for increased, fundamental investment.11 73% of
NYCI’s member organisations reported increased deprivation in their communities as a direct
result of living costs, and challenges remain in terms of electricity, shelter, and food. Increasing
governmental fnancial support for youth work organisations would enable underserved
communities to beneft from their life-changing and life-saving services, ensuring that no one is
left behind.
“My mental health went downhill during the pandemic, and I fell into an extremely dark
place. Over the course of the lockdown, I was placed on an urgent waiting list for multiple
public mental health services. These waiting lists were too long and I was waiting over a
year, or have yet to be called for some of them. I am still feeling the effects of this after the
pandemic. My self-image, confdence and social skills have been ripped apart” – Emma,
17
72
|
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[
3
] |
{
"country": "irl",
"file_id": "sdg-03/vnr-report-irl-2023-en-2.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2023
}
|
45
SDG 3: Ensure Healthy Lives and Promote Well-being
Under the National Health Policy 2014-2023, the Ministry of Health "provides
comprehensive and inclusive healthcare to all individuals and at the highest quality
through the efficient use of available resources" (xiii). By expanding decentralization of
health sector governance, strengthening the MOH supervisory role and engaging
stakeholders(xiv), compared to 73% in 2014 and 62% in 2016.
Available data show that 63% of the Iraqi population had access to primary
health care in 2017 (xv).
Life expectancy in Iraq is 73.6 years (75.6 years for women and 71.7 years for
men), (xvi) about 3.6 years higher than 2011 level (69.0 years) (xvii).
46
Table (5): Life expectancy at birth 2014-2018 (year)
Year Males Females Total
2014 67.7 70.9 69.3
2015 71.0 74.9 73.0
2016 71.3 75.2 73.4
2017 71.5 75.4 73.6
2018 71.7 75.6 73.6
Source: Ministry of Planning, Central Bureau of Statistics, Directorate of Population Statistics
and Manpower
In recent years, 17 comprehensive immunization campaigns have been
conducted, which kept Iraq polio-free for the past three years, after
documenting the first such cases for decades in 2014. These campaigns
managed to reach out to 89% of the targeted children in the three
immunization rounds of 2017 (xviii).
Based on various data sources, Iraq has achieved a significant reduction in
under-five mortality rates since its rise in the 1990s by sanctions when more
than 60 children per 1000 live births (xix), ranging from 22-26 children per 1000
live births for the years 2014-2018 with the measurement of double crisis
conditions (xx). While neonatal deaths were 14 children per 1,000 live births in
2018 (xxi).
6.3% of births in Iraq were handled by non-specialized persons in 2017.
Maternal mortality was 36 deaths per 100,000 live births (xxii), slightly below
the 2015 rate of 36.2, and slightly higher than in 2013 before the double crisis,
when it reached 30.1 percent by 2014 (xxiii).
The main maternal mortality causes in Iraq are postpartum hemorrhage
(20.6%), and pregnancy difficulties and dystocia (6.8%) due to non-skilled
midwives and most births in poor and remote areas are handled by midwives
due to traditions.
Chronic diseases account for 43% of all adult deaths. According to WHO,
overweight and obesity are the leading cause of chronic diseases in Iraq.
Overweight is expected to rise among both men and women over the coming
decade. However, 80% of heart diseases and about 40% of cancer and diabetes
cases can be prevented through healthy diets, regular physical activity and
avoiding bad habits such as smoking (xxiv)
.
47
Figure (13): Births conducted by non-specialized staff (2011-2017)
Source: MoP, CSO, Sustainable development for better empowerment of women and
girls, Baghdad, 2018, p 21.
Over the past decade, violence has been the leading cause of death in Iraq, where
201,876 people lost their lives as a result of terrorist acts (xxv)
. Traffic accidents
caused 21557 deaths during the period 2007-2016 (xxvi)
. In 2017, the trafficrelated death rate was 1.4 persons in 30 days per 100,000 people (according to
the standardized lifetime rates).
|
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[
3
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{
"country": "irq",
"file_id": "sdg-03/vnr-report-irq-2019-en-2.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2019
}
|
Iraq Second Voluntary National Review Report 2021
National Committee for Sustainable Development 57
There are still significant disparities and challenges in health services, especially after
2014 and the occupation of some provinces by terrorist groups. Complete and
comprehensive health coverage varies across the country. In addition, the health system
often focuses on curative services more than preventive and primary care.(11) Conflict,
crises and displacement have undermined primary care, especially reproductive health
services and vaccination, and exacerbated the spread of diseases and the social crisis.
The Health System and the COVID-19 Crisis
The COVID-19 crisis imposed more pressure on the health system due to increased
demand for health services in a context of poor human and material resources and weak
infrastructure. Although the system does not meet International Health Regulations
requirements, especially those related to responding to health risks and epidemics, an
evaluation conducted in 2019 to monitor the availability of 531 therapeutic and lifesaving pharmaceuticals showed that 12% of essential medicines were entirely available
in health institutions, including life-saving medicines and those used to treat common
cases, while half of medicines were not available in hospitals and health centers
throughout 2018.(12)
According to the 2020 SDG report, health worker density per 10,000 people was low and
did not change enough during 2016-2019. For example, the doctor density per 10,000
people in 2019 was 9, compared to 52 in Austria, 49 in Norway, 43 in Switzerland,
Germany, and Sweden, 30 in the United Kingdom, 26 in the United States, 25 in Japan,
and 19 in Turkey, according to 2019 data.(13) The crisis has imposed more challenges in
meeting patients’ needs, whether related to COVID-19 or other issues. These are due to
poor human, material, and financial resources, and the inadequacy of health buildings,
especially hospitals and health-care centers. The Ministry of Health responded to the
health crisis by intensifying efforts and mobilizing its material and human resources to
serve patients, despite the lack of resources (see Figure 12).
The concentration of expenditure on the operational side and neglect of the investment
side have narrowed the chances for keeping pace with increased demand for health
services and improving quality standards.
Iraq Second Voluntary National Review Report 2021
National Committee for Sustainable Development 58
Figure 12: Ministry of Health Measures to Respond to the COVID-19
Pandemic in 2020
The Decline in Reproductive Health Services During the Pandemic
According to a rapid survey on the impact of the COVID-19 pandemic on reproductive
health services, the response to the pandemic posed additional challenges for women (see
Figure 13). Reproductive health services have significantly declined due to the transfer
or absence of health staff. Some services have continued, such as maternity halls,
operating rooms, and women’s lobbies, except in some provinces that closed maternity
halls for about a month. The pandemic in general impacted the reproductive health
services provided to women by health institutions.
Iraq Second Voluntary National Review Report 2021
National Committee for Sustainable Development 59
Figure 13: The Pandemic’s Impact on Reproductive Health Services Provided by
Health Institutions
Source: COSIT et al., The Rapid Survey on the Impact of the COVID-19 Pandemic
on Reproductive Health Services in Iraq, November 2020, p. 10.
Iraq’s national health policy (2014-2023) is committed to investing in community
participation and volunteer support for emergency preparedness with an emphasis on
building human capacity and sustainable integrated systems. During the health crisis, the
volunteers of the Iraqi Red Crescent contributed to awareness-raising in communities and
schools on mitigating the risks of COVID-19, and maintaining good health and protecting
others. A team of local volunteers reached more than 400 families inside the Saad Camp
for IDPs in Diyala Province to provide personal protective equipment such as gloves and
sanitizers.
The Iraqi Ministry of Health, in cooperation with the World Health Organization (WHO),
launched the awareness-raising campaign "Your Health Is Important" in the heavily
populated, high-risk areas of Dhi Qar, Maysan, Basra, Wasit, and Sulaymaniyah. Around
650 community volunteers, including the community police working under the
supervision of WHO’s implementing partners, the United Iraqi Medical Society and
Ministry of Youth and Sports, supported the campaign. The teams distributed more than
360,000 information, education, and communication materials, and personal protective
equipment to approximately 5 million people in the five provinces.
The Ministry of Health of the Kurdistan Region of Iraq mobilized more than 400 local
community volunteers to reach a population of over 800,000 people and conducted
several community awareness-raising campaigns on the importance of wearing a mask,
maintaining physical distancing, and practicing good hand hygiene Volunteers were
trained and mobilized to deliver a package of supplies containing masks and educational
materials such as flyers, banners, posters, and other visual items. To strengthen the health
sector, the Ministry of Health and the Joint Coordination and Monitoring Center
|
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"country": "irq",
"file_id": "sdg-03/vnr-report-irq-2021-en-2.pdf",
"language": "en",
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"year": 2021
}
|
30
Ensure healthy
lives and promote
well-being for all
at all ages
General good health and well-being are important factors in achieving the
goals of sustainable development. In recent years, major steps have been
taken to improve people’s life expectancy, for example, by reducing maternal
and infant mortality and preventing the spread of disease. However, plenty of
work remains to be done to ensure the health and well-being of a larger portion
of mankind than now enjoy these privileges.
The most recent OECD Health Report states
that healthier lifestyles, higher incomes and
better education, together with better health
services, have contributed to increasing
average lifespans in recent decades.17 The life
expectancy of Icelanders is among the highest
in the world and about three of every four
adults (74%) in Iceland considered themselves
in good or very good health in 2017.18
Maternal and infant mortality and
access to healthcare in the feld of
sexual and reproductive health
Maternal mortality is a rare occurrence in
Iceland and its frequency is among the lowest
in the world.19 Pregnancy and maternity care is
provided solely by qualified healthcare professionals and the entire cost of checkups and care during pregnancy and maternity and neonatal care is paid from the
public purse. Infant mortality in Iceland is among the lowest in the world, and deaths
of young children due to accidents have been reduced in recent years with increased
emphasis on prevention of children’s accidents.20 Comprehensive infant and child
care is provided at primary healthcare centres with the aim of supporting the health
and development of children from birth to six years of age.
The public has good access to contraception and information and education on
sexual health in primary healthcare centres and from gynecologists. However, it is
17 OECD, 2017, Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris.
18 The Directorate of Health, October ࠀ߿ࠁ8, Heilsa og líðan Íslendinga ࠀ߿ࠁ7 - Framkvæmdaskýrsla
(Health and Well-being of Icelanders 2017 - Implementation Report).
19 WHO, 2015, Trends in Maternal Mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World
Bank Group and the United Nations Population Division.
20 UNICEF, 2018, Every Child Alive: The urgent need to end newborn deaths. See also this report’s
Appendix.
MAIN CHALLENGES:
• Changing demography of
the population
• Supply of and access to
resources and services by
region
• Chronic diseases that can be
linked to lifestyle
• Supply of new drugs and
overuse of antibiotics
• Healthcare expenditure
• Recruiting healthcare
personnel
31
urgent to place still more emphasis on prevention and counselling on contraception
to prevent unplanned pregnancies. Particular attention must be paid to younger
women and women who are disadvantaged in society. The birth rate among young
mothers has been declining rapidly over the past decades: in 2017 there were 5.9
births per 1,000 women in the age group 15-19. The average age women giving birth
for the first time has been rising and is now 27.8 years.21
Eradication of epidemics and reduction in premature deaths
Iceland has generally managed to keep infectious diseases to a minimum. The Chief
Epidemiologist for Iceland monitors the communicable disease situation and can
respond within the limits permitted by law. The epidemiologist’s office gathers data
on the epidemiology of communicable diseases and forwards this to the European
Centre for Disease Prevention and Control (ECDC) and the World Health Organisation
(WHO) in a non-personally identifiable form.
In Iceland, epidemiology of sexually transmitted diseases has long been similar to
that of neighbouring countries, however, in recent years there has been an increase
in syphilis, HIV and gonorrhea in Iceland as elsewhere. Emphasis has been placed
on those groups who are more exposed to infection. Actions to address this trend
include increasing access to condoms, facilitating addicts in obtaining clean needles
and the establishment of a professional board on sexual health.
The International Health Regulation (IHR) became a binding international
agreement in 2007 and Icelandic legislation takes this into account. The scope of
the Communicable Disease Prevention Act was expanded in 2007 and now covers
diseases that can cause epidemics and threaten the common good. The Act provides
an important framework for swift and effective action against a wide variety of
threats in Iceland. Legislation on toxins and pollution is also very comprehensive and
provides good protection against pollution and hazardous substances. Enforcement
of the law is the responsibility of various public bodies, such as the Environment
Agency, the Consumer Agency, health committees of local authorities and the
Administration of Occupational Safety and Health.
In 2017, the number of premature deaths in Iceland was 422 per 100,000 inhabitants.22
Efforts are underway on health promotion and prevention efforts against premature
deaths. The work covers a broad spectrum of health risks and influencing factors,
21 Statistics Iceland, ࠁ5 May ࠀ߿ࠁ8, Frjósemi aldrei verið minni en árið ࠀ߿ࠁ7) Fertility never lower than
in 2017).
22 See Appendix.
“Illegal drugs, prescription drugs and alcohol.
People don’t realise how extensive usage of these is
among teenagers. If you want any of these, it’s so
easy to get it. We must stop this together by
promoting education and prevention.”
Helgi Rafn Bergþórsson, 15 years old
Leave
no one
behind
Leave
no one
behind
32
such as alcohol, tobacco and drug prevention, nutrition counselling, exercise,
mental health and dental care, as well as violence and accident prevention.
Screening for cervical and breast cancer has a long history in Iceland and efforts
are constantly directed at increasing the participation of women in the screenings.
There are also plans to start screening for colon and rectal cancer. In March 2019, the
Screening Council delivered its opinion to the Directorate of Health on the location,
management and implementation of screening for cancer in Iceland, and the next
task of the Council is to review the arrangements for specific screenings.
Ensuring adequate staffing in the healthcare system has been a challenge that could
affect the development of disease diagnosis and treatment unless the necessary
personnel can be recruited. In 2016, a four-year mental health policy was adopted
focusing on preventive measures and early intervention. 23 Work is underway on
implementing this policy and a project manager for suicide prevention has been
appointed in accordance with an action plan to reduce suicide in Iceland.24
The government also participates in a two-year pilot project on the establishment
and operation of multidisciplinary reception and support remedies for young people
aged 12-25 years, which will provide individualised and trauma-responsive service.
The goal is to improve services for children and young people and ensure that
they receive assistance as soon as possible. This pilot project is undertaken on the
initiative of and, in collaboration with, Bergið Headspace, and is modelled on similar
remedies in Australia and Denmark. The project will also work in close cooperation
with schools, primary healthcare and other parties in children’s immediate
environment.
Access to healthcare services, essential medicines and vaccines
All citizens have access to healthcare services and treatment in hospital is without
charge to the patient. In recent years, the rules on patients’ cost contribution for
outpatient healthcare have been altered to reduce the expenses of persons requiring
extensive healthcare services and pharmaceuticals, and a ceiling set for payments
for such. Charges for visits to primary healthcare centres are low and none for
children, the disabled and the elderly. School nurses work in all compulsory schools
in Iceland.
Vaccinations for children are paid for by the public health service and vaccines are
also accessible to all citizens at an affordable price. Dental care for children under 18
years of age is free of charge. Adults need to pay for their dental expenses, but the
health service covers part of dental expenses for the elderly and the disabled.
Access to psychological services through primary healthcare has been increased,
but psychological services by self-employed psychologists are only subsidised for
children. Wage earners, however, have access to grants from their trade unions to
23 Althingi, 145th Legislative Assembly 2015-2016, Four-year Policy and Action Plan for Mental Health,
338th Agenda item, Parliamentary Resolution 28/145.
24 Starfshópur um sjálfsvígsforvarnir (Working Group on Suicide Prevention), April ࠀ߿ࠁ8, Action Plan
for Reducing Suicide in Iceland. Conclusions of working group.
Leave
no one
behind
Leave
no one
behind
Leave
no one
behind
33
cover psychological and dental expenses. Sufficient public health service and mental
care for persons with disabilities needs specific attention.
One of the major healthcare challenges is to provide the population with sufficient
supply of essential medicines and ensure their quality and safe use. Antibiotic
resistance, arising from overuse of antibiotics, is one of the greatest health threats
facing humanity.
Prevention and treatment for use of illegal intoxicants and
reduction of traffc accidents
In Iceland, comprehensive preventive work is directed at the main health risks
and influencing factors. Iceland ratified the World Health Organisation (WHO)
Framework Convention on Tobacco Control in 2005, and has adopted a policy on
prevention of alcohol and drug abuse that extends to the end of 2020. The state
has a monopoly on the sale of alcoholic beverages and current legislation prohibits
the sale, provision or supply of alcohol to persons under 20 years of age. Significant
progress has been made in reducing the use of alcohol, illegal intoxicants and
tobacco among young people in Iceland, and the use of these substances is now on
average the lowest in Europe.25 Alcohol consumption in Iceland is below the average
of OECD countries, at 7.5 litres of pure alcohol per person aged 15 years and older in
2015.26 There is good access to treatment options for intoxicant abuse for adults, but
remedies for young people and those with compound problems, i.e. mental health
and drug problems or developmental and drug abuse problems, need improvement.
Traffic fatalities have been low in the last decade, averaging 15 per year.27 With such
a low number, each accident strongly influences the statistics, which explains the
considerable fluctuations from one year to the next. The average over each five-year
period is therefore considered instead of individual years. It should be noted that,
due to increasing tourism, annual mileage driven on Icelandic roads has increased
by 40% over a period of five years, with an impact on the rate of accidents.
Every year, road safety is actively promoted in Iceland through the implementation
of a traffic safety plan, which is used in allocating funding for important road
works aimed at traffic safety. The police carry out specific speed and drunk-driving
supervision and the Icelandic Transport Authority has specifically focused education,
promotions and campaigns.
International actions
Iceland’s international development cooperation emphasises improving
living conditions and increasing opportunities for people with stronger social
infrastructure, including improved access to basic healthcare services. Efforts are
being made to achieve this through bilateral development cooperation,
25 European Monitoring Centre for Drugs and Drug Addiction, 2016, ESPAD Report 2015: Results from
the European School Survey Project on Alcohol and Other Drugs.
26 OECD, 2017, Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris.
27 See Appendix.
Leave
no one
behind
34
appropriations to civil society organisations and contributions to international
institutions.The Icelandic government has emphasized public health in Malawi
with the aim of decreasing maternal mortality. Its support has included the
construction of waiting homes for expecting mothers in rural areas of Mangochi
District. Additionally, a district maternity ward with a waiting home has been
established, as well as newborn care and family planning units. In addition, the
referral system has been supplemented by eleven new ambulances, so that in the
event of an emergency or high-risk birth on the rural wards, it is easier to respond
in time. Around 80% of women in the district now have access to a maternity
ward with good facilities for mothers, newborns and their families. With these
increased attention to maternal and newborn health, Mangochi district has seen
the reduction of incidence of maternal mortality by 37% over the past decade.28
In Malawi, the government and partners have also managed to reduce the incidence
of child mortality by 49% from 2010 to 2015.29 Iceland has funded a number of
activities by local health authorities to combat neonatal and infant mortality in
Mangochi District. This includes reinforcement of health care services in the most
rural areas, which are provided by nearly 600 Health Surveillance Assistants who
have received training in recent years.
According to a UNICEF report of 2018, despite the fact that Malawi is one of the
poorest countries in the world, the country has shown considerable success in terms
of neonatal and infant mortality. This is thanks to increased access to quality health
care for expectant mothers. In 2000, more than half of women in Malawi gave birth to
their children without the help of trained healthcare professionals such as midwives
and doctors, but in 2016, the rate of childbirth assistance had risen to 90%. This
led to a decrease in the incidence of infant mortality from 41 in 1,000 births in 2000
to 18 out of 1,000 births in 2017.30 In 2018, Iceland also provided humanitarian aid
to UNICEF in Syria and to Syrian refugees in neighbouring countries and to the UN
Population Fund (UNFPA) in Yemen at year-end 2018, to reduce infant and maternal
deaths in countries where the situation is dire.
Iceland supported UNFPA in Yemen at year-end 2018, which includes funding
caesarean sections and other important services that reduce neonatal death. Iceland
also supports UNICEF healthcare programmes in Palestine and, among other things,
funded an evaluation in 2018 of a project that Iceland supported in 2011-2015 for
home-based check-ups for infants, which showed the project’s positive effects in
reducing maternal and infant mortality.
In February 2018, the Minister for Foreign Affairs signed an agreement with UNFPA
for Iceland to support the Agency’s mission in Syria. UNFPA’s efforts in Syria in 2016
have enabled two million Syrian women to be granted access to life-saving health
services in Syria, Egypt, Iraq, Jordan and Turkey. Iceland’s international development
cooperation also places strong emphasis on sexual and reproductive health and
rights. In 2017, Iceland tripled its core contribution to UNFPA, whose role is to
28 National Statistics offce Malawi, Demographic and Health Survey ߿ࠀ߿ࠁ and ࠀ߿ࠁ5/ࠀ6.
29 National Statistics offce Malawi, Demographic and Health Survey ߿ࠀ߿ࠁ and ࠀ߿ࠁ5/ࠀ6.
30 UNICEF, February 2018, Every Child Alive: The urgent need to end newborn deaths.
35
ensure sexual and reproductive health and rights in developing countries. This
supports the creation and implementation of projects aimed at eradicating poverty,
providing ready access to contraception, making giving birth safe and reducing HIV
transmission. Important aspects of these activities include the rights of mothers
and children to primary healthcare, infant health protection, the distribution of
contraceptives and sexual and family education. A further support to district health
authorities in Mangochi will be provided by UNFPA this coming year by offering
family planning services to reduce the number of premature childbirths among
young girls, fistula operations and centres for survivors of gender-based violence.
In international work, there is also a strong emphasis on the importance of
prevention, cure and treatment of neurological disorders, especially spinal cord
injury. Particular efforts have been made to increase Nordic cooperation in this area
with the aim of facilitating research in the field. At UN level, the Icelandic government
has drawn particular attention to the issue in connection with road safety and noninfectious diseases.
Health-promoting Community
and the SDGs
Health-promoting Community (HSAM) is a holistic, interdisciplinary program
managed by the Directorate of Health in collaboration and consultation with
local authorities and other stakeholders. Its primary goal is to support communities in creating an environment and conditions that promote healthy
lifestyles, health and well-being of all residents. This is consistent with SDG
3, good health and well-being, and fits in well with the key focus of the SDGs,
that no one should be left behind in their implementation.
SDG target 3.4
From the signing
with Árborg
municipality
in May 2019.
Municipalities
themselves take
the initiative
of becoming a
Health-promoting
Community. In
May 2019, 86% of
the population
lived in a Healthpromoting
Community.
|
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[
3
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{
"country": "isl",
"file_id": "sdg-03/vnr-report-isl-2019-en-6.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
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}
|
63 VOLUNTARY NATIONAL REVIEW | ICELAND 2023
Ensure healthy lives and promote
well-being for all at all stages
Goal 3
Civil society’s assessment
Aflið - Organisation Against Sexual and Domestic Abuse, Kynheil - Association for Sexual and
Reproductive Health, Iceland Touring Association, Icelandic Red Cross, Medical Students’ Public
Health Association, MS Society of Iceland, National Olympic and Sports Association of Iceland,
Icelandic Public Health Association, and Hugrún - Organisation for Mental Health Education
participated in this assessment.
Iceland’s overall challenge is to ensure equal access to primary health care for all, especially
those in vulnerable positions. Inequalities exist at various levels, as reflected in a lower health
expenditure per capita than the EU average, uneven geographical distribution of health care services, and lack of health care professionals. While the majority of people in Iceland report being
in good health, chronic illnesses and the prevalence of behavioural risk factors still cause premature mortality. This calls for Iceland to develop a more holistic view on health for all age groups.
Iceland should work more purposefully with non-governmental organizations to promote and prioritise holistic public health. This includes ensuring equal access to all forms of indoor and outdoor
exercise to support mental, social, and physical health for everyone at all stages of life. Successful
pilot projects, such as the use of exercise cards and health-promoting receptions at public health
care services, should be scaled up by focusing on equal participation and well-being for all.
Iceland needs to improve the provision of comprehensive sexuality education at primary and
upper- secondary school level in relation to global guidelines and recommendations. In cultivating optimal sexual health and well-being, Iceland also needs regular assessment and surveillance
regarding the implementation of such education.
The government should put more e!ort into promoting positive awareness and understanding of
mental health to decrease stigma and facilitate access to e!ective mental health services for all.
This includes improving policies and legislation, school- and work-based programmes, and caregiver support. A mental health action plan is already in progress. It is crucial to finalize, approve,
and implement the plan as soon as possible.
Iceland has been successful in preventing adolescent substance use through an evidence-based
intervention model. However, there are signs of backsliding that demand that more attention
be paid to the overall health and well-being of young people, in particular those in vulnerable
positions due to socio-economic status, background, or abilities.
With respect to global e!orts, Iceland should continue to promote basic health care services as
part of its ODA in relation to its vision of SDG 3. Emphasis should be placed on supporting mothers and children, including advancing sexual and reproductive health rights. A good example is
Iceland’s participation in the joint UNFPA-UNICEF Programme working towards the elimination of
female genital mutilation.
Recommendations to the Government
Iceland should:
• invest more in holistic approaches to health and wellbeing, including health promotion
and disease prevention methods at all stages of life.
• raise public awareness of health literacy and its importance.
• implement health impact assessments.
• ensure continuous comprehensive sexuality education in Icelandic primary and
upper-secondary schools.
• implement and monitor a mental health action plan.
• ensure an appealing work environment for health care professionals to ensure basic
services for all.
• guarantee equal access to all forms of health care services across geographical regions
and irrespective of people’s background, abilities, or orientations.
|
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|
Goal 3 – Ensure healthy lives and promote well-being for all at all ages
!e priorities of the health sector are driven by the strategies outlined in Vision 2030
Jamaica under the national outcome, ‘A Healthy and Stable Population’ and are closely
aligned with the health-related SDGs and other internationally agreed development
frameworks. Health services are provided by a combination of the public and private
sectors, as well as non-governmental organizations (NGOs).
Jamaica is at an advanced stage of the demographic transition, characterized by
the following: a decline in the 0–14 age group; and an increase in both the working
age population (15–64 years) and dependent elderly age group (65+ years). !is
structure impacts social and economic development particularly as it relates to
provision of and access to health care services.
28 JAMAICA VOLUNTARY NATIONAL REVIEW REPORT
Over the period under review, there have been major advances in health care
delivery, resulting in increased e)ciency and access. !ese included but not limited
to: (i) Development of a 10-Year Strategic Plan for the health sector; (ii) a health
*nancing assessment for formulation of a dra+ National Health Insurance Plan (iii)
advancement in the process of universal health coverage; (iv) infrastructural
improvements; (v) implementation of the Programme for the Reduction of Maternal
and Child Health (PROMAC); (vi) promotion of healthy lifestyle practices aimed at
reducing non-communicable diseases (NCDs) (vii) increased e,orts to end the
epidemic of HIV/AIDS; (viii) initiatives to reduce global deaths and injuries; and
(ix) ensuring universal access to sexual and reproductive health-care services.
!e advancements made have been largely through government interventions and
partnerships with the Diaspora, charitable organizations locally and overseas, and
International Development Partners (IDPs).
Over the period of review, the priority initiatives undertaken by the Health Sector
include:
• Formulation of a 10-year Strategic Plan – A 10-year Strategic Plan 2017 2027
was designed to provide overarching strategic direction, consistent with the
country’s commitment to advance universal access to health, universal health
coverage and Vision 2030 Jamaica. !e plan seeks to establish an integrated
service delivery framework as well as development of an operating tool for early
detection of NCDs.
• Achievement of universal health coverage and Health Financing – !e GOJ
partnered with PAHO to identify options and recommend strategies and actions
to improve and strengthen health *nancing, equity and e)ciency and delivery
of health-care services towards universal health for all. A national forum was
held in December 2016 under the theme, “Health Financing toward Universal
Health in Jamaica: International and Policy Options.” Feasible options on health
*nancing alternatives with an emphasis on the National Health Insurance (NHI)
Scheme was the main highlight and it was recommended that an integrated
phased approach be taken to implementation of the scheme and that the bene*ts
should be applied through the National Health Fund. Currently, approximately
20.0 per cent of the population is covered by health insurance. In this regard, a
National Health Insurance Plan was dra+ed through a consultative process,
which will form the framework for transitioning to universal insurance coverage
for the population.
• Reduction of Maternal and child Mortality – Improving the health and
wellbeing of women and children and infants is an important health goal in
Jamaica’s national development planning framework. A Programme for the
Reduction of Maternal and Child Mortality (PROMAC) funded by the European
G O A L S A N D TA R G E T S 29
Union began implementation in 2013 to address the challenges being faced in
attaining MDGs 4 and 5. PROMAC focuses on (i) Newborn and emergency
obstetric care; (ii) Quality primary health services and referral systems; (iii)
health workers training and research; and (iv) support to health seeking
behaviour of the target population and the role of civil society. Several actions
undertaken include: constructing high dependency units, increasing the cadre
of specialized skilled health workers2 and conducting baseline research on the
causes and risk factors pertaining to premature births and distribution of
midwives bags for maternal and child care at the community level.
• Reduction of premature mortality from non-communicable diseases(NCDs)
– !e strategic priorities for the reduction and control of NCDs are guided by
the National Strategic and Action Plan for the Prevention and Control of NCDs
in Jamaica 2013–2018. !e goal of the Plan is to reduce the burden of preventable
morbidity and disability and avoidable premature mortality due to noncommunicable diseases and injuries by 25.0 per cent by 2025. In support of the
Plan, several interventions have been undertaken addressing: risk reduction and
health promotion management of the disease, improving surveillance and policy
development advocacy, governance and capacity building.
• Substance abuse prevention – Jamaica became party to the WHO Framework
Convention on Tobacco Control (FCTC) in 2005, this action supports the goal
for the strengthening of treatment and prevention of substance abuse and
harmful use of alcohol. !e Public Health (Tobacco Control) Regulation, 2013
covers only some of the articles of the FCTC (smoke free spaces and graphic
health warnings on cigarette packs). Work undertaken by the National Council
on Drug Abuse and other agencies has had some impact including the
implementation of substance abuse prevention programmes, primary treatment
and public awareness initiatives. One important strategy in prevention and
control of tobacco usage has been a commitment to enact comprehensive tobacco
control legislation in alignment with the FCTC, which covers important articles
such as tobacco advertising, promotion and sponsorship (targeting youth).
• Promoting Mental Health and well-being – Using the Mental Health in All
Policy approach Jamaica has progressed with the formulation of a dra+ National
Mental Health Policy as well as implementation of the Mental Health Action Plan
2013–2020. Community mental health service is a key component of the plan.
High-level multi-stakeholder discussions advanced with the objective to
undertake a public health approach, developing mental health systems of care
and fostering stronger collaboration and greater accountability for commitments
towards community mental health.
2. Skilled health care workers including, doctors and nurses in critical care, neonatology and maternal
foetal medicine.
30 JAMAICA VOLUNTARY NATIONAL REVIEW REPORT
• Promotion of healthy lifestyle practices – A Programme to promote a healthy
lifestyle and protect against non-communicable diseases, through a physical
activity initiative, “!e Jamaica Moves Programme for Schools Community and
Workplaces” was implemented. It encourages appropriate health check, physical
activity and healthy eating habits including the limitation of sugar intake.
° Increased e#ort to end the epidemic of HIV/AIDS – Addressing the issues
of HIV and AIDS are high on the country’s development agenda. Jamaica
has an estimated HIV prevalence of 1.7 per cent among the general
population. Based on both modelled estimates and the case-based
surveillance data, it is estimated that 30 000 persons are currently living with
HIV in Jamaica with approximately 12.0 per cent being unaware of their
status. Approximately 12 000 adults and children have received antiretroviral
treatment contributing to increasing viral suppression rates and decreasing
mother to child transmission rates. !e national HIV/AIDs response uses a
multi-sectoral approach to reduce HIV incidence. !e framework for
HIV/AIDS response is focused on prevention, treatment, care and support,
enabling environment, empowerment and governance. Funding for the HIV
response was supported through agreements with donor agencies such as
Global Fund, United States Agency for International Development (USAID)
and the World Bank. !e Government of Jamaica has supported the
engagement of civil society organizations in HIV service provision and
substantial interventions in reaching key a,ected populations. !e
advancements made in the delivery of HIV services have been in large part
due to the partnerships with and commitment of several CSOs.
° Achievements and advances in the care of people living with HIV/AIDS
included: the integration of HIV/AIDS services of the national HIV/AIDS
programme into the National Family Planning Board; the development of
the dra+ National Integrated Sexual Health Strategic Plan; establishment of
a National HIV/AIDS-Discrimination Reporting and Redress System,
development of the National HIV Workplace Policy; and the commissioning
of several research to clarify issues for evidence based practice. Prevention
strategies have proven successful in the most at risk populations (MARPs)
in the continued *ght against HIV/AIDS, however, challenges remain.
° Issues remain largely in the areas of reducing vulnerability to HIV/AIDs,
stigma and discrimination that have not been su)ciently addressed. !e
vehicles for the spread of HIV in Jamaica are primarily among heterosexuals,
youth and speci*c target groups such as men who have sex with men (MSM)
and commercial sex workers (CSW) and are in0uenced by cultural and
behavioural issues and must be carefully monitored in reducing the epidemic.
Advocacy for resources have been based on generalized populations,
G O A L S A N D TA R G E T S 31
however, strategic investments have shi+ed to speci*c target groups such as
MSM, CSW and inmates among others.
° With support from the Global Fund and UNAIDS, Jamaica has conducted a
HIV Transition Preparedness Assessment to examine the country’s readiness
to move from donor support to national sustainability for the response to
ending AIDS.
• Reduce global deaths and injuriesfrom road tra$c accidents – !e legislative
framework to support this target was advanced with the dra+ing of a new Road
Tra)c Act (2018). !is will be supported by the following policies and plans:
!e National Road Safety Policy (2004), National Transport Policy (2007) and
the National Strategic Plan and Action Plan for the Prevention and Control of
Non-Communicable Diseases (2013–2018). !ere are over 300 collisions
involving fatalities annually. Accidents and injuries are among the main causes
of visits to accident and Emergency units in public hospitals across the island,
approximately 85 per cent of these injuries were classi*ed as unintentional and
the remainder intentional. One of the major concern is that most cases of
accidents and injuries falls in the 20–64 years age group. Injuries mainly included
motor vehicle accidents, accidental lacerations, blunt injuries and stab wounds.
!ere is need for a multi-sectorial approach in addressing the impact of
accidents, with the Ministries of National Security, Education, Health and
Transport and Works.
• Ensuring universal access to sexual and reproductive health-care services –
!e adolescent SRH programme in Jamaica issupported by the National Strategic
Plan for Adolescents and Pre-adolescents 2011–2016 and the Integrated Strategic
Framework for the Reduction of Adolescent Pregnancy in the Caribbean
(UNFPA and Caribbean). !e strategic plan guides health promotion strategies
for adolescents, programmatic activities of the MOH, MOEYI and the NFPB,
while building partnerships and reorientation of the health services towards an
adolescent-friendly approach (see additional details in chapter 5).
Other signi*cant e,orts include:
• Government’s collaboration with development partners to conduct a HIV
adolescent country assessment called the “All In” initiative revealed a 0.1 per cent
prevalence of HIV among the cohort of girls and boys 10–14 years, this *nding
is a re0ection of reduction in the mother-to-child transmission of HIV.
• Increase in vaccination coverage in children 12 to 23 months with the *rst and
second doses of the Mumps, Measles and Rubella vaccine to 95.0 per cent.
• A project aimed at reducing waiting time at health facilities A 30.0 per cent
increase in drug subsidies for all pharmaceuticals and expanded reach for
32 JAMAICA VOLUNTARY NATIONAL REVIEW REPORT
individual bene*ts programme, such as the Jamaica Drug for the Elderly
Programme (JADEP).
Some of the challenges experienced in the sector include:
• !e lack of signi*cant resources in high dependency care for newborns, as well
as, external issues such as: indirect maternal deaths from complications of
chronic diseases such as hypertension, diabetes, obesity, sickle cell, cardiovascular
conditions and HIV impacted achievement of these targets.
• !e lack of a coordinated multi-sectoral approach aimed at addressing the
developmental impact of road tra)c accidents.
• Aged infrastructure
• A need for comprehensive national Sexual and Reproductive Health Policy and
Strategic Plan, which would speak to existing and emerging issues including safe
motherhood, in order to e,ectively address universal access to SRH services.
• E,ects of trauma on the health sector
• Increased personal responsibility for health, prevention and treatment of noncommunicable diseases and HIV/AIDS,
• Strengthening of rehabilitation services for vulnerable persons, including
children, the elderly, and persons with disabilities and those with mental health.
G O A L S A N D TA R G E T S 33
|
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"file_id": "sdg-03/vnr-report-jam-2018-en-3.pdf",
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|
42
Health and Well-being
Jordan has witnessed substantal achievements in all aspects related to ensuring the right to health and
a fulflling life. Life expectancy at birth has increased to 72.7 for males and 76.7 for females. Under-fve
mortality rates have dropped from 37 per 1,000 live births in 1990 to 21 per 1,000 live births in 2012.
Similarly, infant mortality rates have decreased from 34 to 17 over the same period, but with remaining
disparites where mortalites are higher among poorest households and in the Southern governorates.
Most deaths now occur in the frst month of life (the neonatal period); of the 17 per thousand deaths
recorded in 2012, 14 took place during the frst month of life. This requires focused atenton in the
coming years on the peri-natal period and on women’s health and reproductve health. The results of
the upcoming Demographic and Health Survey in late 2017 will shed more light on the trends to date.
The Government has set a target to reduce infant mortality (with a special focus on neo-natal mortality)
and under-fve mortality rates by two thirds to reach 6 and 7 per 1,000 live births respectvely by 2030.
Maternal health has greatly improved over the last decades and Maternal Mortality Rato is 19 per
100,000 live births based on a maternal mortality study conducted in 2008, while 99.6% of births are
atended by a qualifed birth atendant. Future improvement will depend on beter targetng of more
vulnerable cases, and a reducton in disparites in the quality of health care provided to all women of
child-bearing age.
As advancements are witnessed at the natonal level, concrete steps to improve sub-natonal data
gathering and strengthen administratve records and actve surveillance become even more important,
in order to improve the health and wellbeing of harder-to-reach populatons.
Jordan is currently implementng the Natonal Strategy for Reproductve Health/Family Planning (2013-
2018), through a close partnership between the Ministry of Health and other partners. The Strategy
outlines a comprehensive framework for reproductve health/family planning in order to ensure a
demographic transiton in the country by 2040. Jordan aims to reach a total fertlity rate of 2.1 per
women of childbearing age, to support changes in social and economic policies to atain the demographic
opportunity, and further strengthen available maternal and child health services.
43
In additon to further improving health services (especially in governorates), Jordan will be focusing
on strengthening civil registraton and hospital records to enable proper capturing and investgatng of
maternal and child deaths, while also striving to address their causes. The percentage of the populaton
in Jordan with health insurance is now 55% and 68% among Jordanians. “Jordan 2025” sets the target
at 95% in 2025, and the Government is aiming to reach 100% coverage by 2030. Within this context,
the Ministry of Health recently agreed to sign the Global Partnership Compact towards universal health
coverage. The Ministry of Health is also undertaking a health system governance review to support
the design of an efectve strategy in line with natonal goals and SDG3 in an efort to accelerate the
achievement of universal health coverage.
A health sector vulnerability assessment conducted in 2015 identfed the need for 2,886 additonal
hospital beds, 22 comprehensive health centres, and approximately 1,000 doctors and 2,000 nurses to
cope with the increasing pressure on the health system due to the Syria crisis. The Government is also
vigilantly ensuring that previous gains in polio and measles eradicaton are not compromised, especially
in light of polio outbreaks witnessed in Syria and Iraq over the past years. Several blanket immunizaton
campaigns have been conducted since 2011, covering all children in Jordan.
In recent years, Jordan has undergone a signifcant epidemiological transiton towards non communicable
diseases (NCDs) which account for three quarters of total deaths in Jordan. Furthermore, Jordan is also
experiencing a changing demographic profle, with increasing burden on natonal health care systems
and services with high costs of secondary and tertary care. Determinants of poor health and unhealthy
behaviors such as tobacco use (especially among youth) and inappropriate diets are becoming increasingly
prevalent in Jordan and are contributng to the increased incidence of NCDs.
In the coming years, Jordan will contnue placing a special focus on safeguarding its development gains
and further improving all of the health indicators. “Jordan 2025” has outlined key areas of focus, including:
improving the quality of health services, improving the insttutonal framework in the health sector,
developing an efectve health insurance system, strengthening partnerships and cooperaton, improving
educaton of medical professionals, and controlling the emergence or re-emergence of infectous
diseases. The SDGs related to health are mostly focused on primary healthcare and preventatve care
which will remain among the natonal health priorites. Jordan will also emphasize secondary and tertary
care, and natonal targets and indicators which have been set in natonal plans will be harmonized with
the SDG indicators. Finally, the government is currently implementng an e-health initatve, “Hakeem”,
to automate the public healthcare sector in Jordan. The initatve is intended to signifcantly transform
the health sector in Jordan and facilitate efcient, high-quality healthcare through the natonwide
implementaton of an Electronic Health Record soluton (EHR).
|
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{
"country": "jor",
"file_id": "sdg-03/vnr-report-jor-2017-en-3.pdf",
"language": "en",
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|
Jordan has been and still is a pioneer among
the countries of the region in ensuring that all
members in society enjoy healthy lifestyles
and for promoting well-being for all ages.
It has made signifcant strides in increasing
the values of average life expectancy at
birth, reducing child and maternal mortality,
reducing malaria, tuberculosis, polio, and
the spread of HIV. It should be noted that
the goal’s components intersects with the
different SDGs, including SDGs 1, 2, 5, 13 and 16.
SDG3: Good Health and Well-Being
Ensure healthy lives and promote well-being for
all at all ages
Recent years have also witnessed intensifed
efforts to prepare a set of strategies,
including the Ministry of Health’s Strategic
Plan 2018-2022, the Health Sector Reform
Plan 2018-2022, the National Reproductive
and Sexual Health Strategy 2020-2030, the
National Rehabilitation Strategy 2020-2024,
and the Health Plan for Emergency and
Crisis Response 2022-2023, with the aim of
strengthening efforts to achieve the desired
targets.
66 2nd Voluntary National Review
National efforts exerted to achieve
the goal
• Establishing a national system for
monitoring and responding to maternal
deaths with the aim of monitoring deaths
for women of reproductive age 15-49
years as soon as they occur, identifying
the causes and contributing factors
that led to death, and determining
recommendations and response to
prevent similar deaths.
• Providing free maternity and childhood
services and family planning in primary
health care centres, covering all regions
of the Kingdom through 524 health
centres. These centres provide maternal
care services during pregnancy and after
childbirth, childcare up to fve years of
age, family planning services, consultation
services and health education. Vaccination
services are also offered for expectant
mothers and children, in addition to
investigations into family violence.
• Preparation of a free national vaccination
programme for all children under 6 years
of age, residing in Jordan of different
nationalities.
• The medical sector provides a programme
to combat HIV/AIDS through prevention
of infection, detection of cases, free
laboratory examination and treatment
for the infected, and counseling via the
hotline on sexually transmitted diseases.
• Inclusion of community health clinic
services to promote healthy lifestyles in
143 clinics in order to reduce the spread
of non-communicable diseases (NCDs)
and reduce premature deaths resulting
from their complications. The ‘interactive
electronic monitoring’ project was
launched to monitor and track NCDs, in
addition to launching programmes to
control diabetes and control high blood
pressure.
Source: Ministry of Health
3.1.1 Maternal mortality ratio
2015
19
38.5
2020
• Launch of the National Reproductive and
Sexual Health Strategy 2020-2030, which
covered all components of reproductive
and sexual health and according to the
human life cycle, as well as a national
document for youth and adolescentfriendly sexual and reproductive health
information and services was launched
and applied in 5 centres. A draft national
plan was also prepared to implement
the commitments of the Nairobi Summit
2021-2030 and to reach zero indicators of
the unmet need for family planning, zero
maternal deaths and zero family violence
by 2030.
3.4.1 Mortality rate attributed
to cardiovascular disease,
cancer, diabetes or chronic
respiratory disease
2015
58.70%
83%
2020
Source: Ministry of Health
2nd Voluntary National Review 67
Challenges and risks facing the goal
• The re-emergence of infectious diseases.
• The typical transformation of diseases,
the increase in the rates of NCDs and the
consequent increase in the number of
patients and spending on them.
• Increasing demand for health services
with the increase in population and infux
of refugees, and the increasing cost of
health services and spending on them.
• Slow inclusion of the uninsured in
universal health insurance.
• The diffculty of attracting specialised
competencies and the loss of qualifed
technical competencies.
• Great efforts were made towards
achieving universal health coverage
through the segment of those covered
by civil health insurance, the introduction
of new categories of benefciaries from
social protection programmes and the
expansion of covered health services as
well. These are provided on the basis of
quality and fairness through partnership
with health service providers in the
private sector.
3.2.1 Under�5 mortality rate
2012
21
19
2018
Source: Ministry of Health
• Preparing a national nutrition strategy
2022-2030 guided by local nutrition
situation analysis and in line with the
regional nutrition strategy.
• Jordan adopted a policy to reduce
smoking, by providing free stopping
smoking services to all nationalities
through 26 clinics for stopping smoking
distributed in all governorates of the
Kingdom.
• Around 3400 public personnel were
employed in 2020, 75% of whom are
doctors and nurses.
• A national plan was prepared to preserve
the essential health services during
COVID-19 and beyond.
Al- Bashir Hospital for Specialised
Surgery, established as the frst
hospital specialised in thoracic,
vascular, catheter and heart surgery.
Since opening the hospital in 2021,
many chest and open heart surgeries
have been performed.
68 2nd Voluntary National Review
epidemiology and NCDs, as well as
activating the epidemiological monitoring
process by combating risk factors, the
early detection of NCDs, and activating
the detection of colon, prostate and
cervical cancer. Furthermore, work to
invest in awareness raising campaigns
targeting the public and further
engagement of CSOs to effectively tackle
NCDs and their risk factors, especially
tobacco use and obesity, in addition to
increasing awareness of nutrition and
healthy lifestyles.
• Assess expanding health insurance
coverage within the available resources
in light of the increasing demand for
health services, and to reach the goal of
universal health coverage.
• Focus attention on human capital by reassessing the existing system to improve
the recruitment of cadres, reduce
immigration and enhance performancebased incentives. Moreover, work to
improve the process of continuing
education, especially in the health feld
(residency and scholarships, and to
continue to provide necessary training to
all health cadres).
• Look into expanding the promotion of the
tobacco addiction treatment programme.
• Work to build a national health
information system to collect data from
all sectors, and that is categorised by sex
and geography.
• Consider moving with the amendments
to the Midwifery Law in Jordan to fll
the gaps in human capacities and speed
up achieving the desired health goals,
especially in remote areas.
• Look into increasing the health system's
resilience and the ability to prepare and
• Determinants of poor health such as
tobacco use, obesity and other unhealthy
behavior that are becoming increasingly
prevalent in Jordan and contribute to the
increase in the incidence of NCDs.
• The absence of an electronic monitoring
system for deaths of newborns and
children under the age of fve.
Recommendations and the way
forward
• Assess how to strengthen the
infrastructure, governance and service
delivery within primary health care as it is
the frst gateway to disease management
and achieving universal health coverage.
• Consider activating the neonatal
mortality monitoring committee and
add neonatal deaths under fve years of
age to the work of this committee, and
look to strengthening the use of new
technologies to ensure full registration of
these deaths.
• Identify how to support the
implementation of unifed comprehensive
package of health services, including
sexual and reproductive health services,
in addition to dealing with violence
against women and children.
• Support good maternal and newborn care
through the network of mother and childfriendly hospitals for all, with newborn
Intensive Care and Pediatric Units, the
promotion of breastfeeding, and access
to quality mental health services.
• Consider developing a national strategy
for NCDs that addresses governance,
prevention, health service provision,
countering and monitoring NCDs, in
addition to strengthening programmes
in the disciplines of infectious diseases,
2nd Voluntary National Review 69
respond to health emergencies through
the application of the International
Health Regulations and the expansion of
disclosure of all risks.
• Encourage the optimal use of the
infrastructure established during the
pandemic, including feld hospitals
and equipment, to improve the quality,
sustainability, and best use of services.
• Invest in promotional and preventive
health interventions at the societal level
through sustainable fnancial support.
Jordan is among the first countries to vaccinate refugees
against Covid-19
• Strengthen coordination and
collaboration between sectors and
relevant parties to harmonise initiatives
and reduce redundancy, while also
bolstering the health care system and the
governance in dealing with NCDs.
• Prepare a system linked to food monitoring
that contributes to formulating future
policies.
70 2nd Voluntary National Review
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{
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|
25
Priority Area 2
"Promoton of Health and Longevity"
Japan has a track record of achieving some of
the world's best health outcomes and greatest
longevity through its natonwide public health
insurance system over the last 50 years. It is
said that the healthy life expectancy of Japan
is 71.19 years for males and 74.21 years for
females (2013), estmated as the longest in the
world, though a large gap between average
healthy life expectancy and average total life
expectancy has been pointed as a challenge. The
extension of healthy life expectancy is important
for the reducton of the burden of nursing care
and for the healthy living of elderly persons. The
Government of Japan is implementng measures
to accelerate the rate of expansion of healthy
life expectancy exceed that of average life
expectancy, and to extend the average healthy
life expectancy by more than two years by 2025
with lifelong preventve care and support.
In internatonal cooperaton, Japan places
great importance on eforts in health and medical
care, which have direct links to the promoton
of human security. With a view to supportng
the achievement of the SDGs' health goals, in
September 2015, the Japanese government
formulated the "Basic Design for Peace and
Health (Global Heath Cooperaton as a guideline
for its global health poly)", to build a response
system for future public health emergencies,
similar to the outbreak of Ebola virus, and to
provide lifelong basic health services for all,
while utlizing Japan's knowledge, technology,
equipment, services and etc.
In additon, Japan set health as one of the
priority agendas at the G7 Ise-Shima Summit, in
May 2016 as well as at the Sixth Tokyo Internatonal
Conference for African Development (TICAD VI),
co-organized with Kenya in August 2016. At the
Ise-Shima Summit the G7 leaders agreed on the
importance of reinforcing the Global Health
Architecture in order to strengthen the response
to public health emergencies, promotng
26
Universal Health Coverage (UHC), which is the
key to responding to a wide range of health
issues including preparedness to public health
emergencies, and strengthening the response
to antmicrobial resistance (AMR). They also
announced the "G7 Ise-Shima Vision for Global
Health", elaboratng the directon of their
concrete actons. At TICAD VI, health was taken
as one of the "three pillars" of Africa’s contnued
development, and the partcipants agreed in the
Nairobi Declaraton, which upheld "promotng
resilient health systems for quality of life" to
solve the challenges having emerged from the
Ebola outbreak in Africa.
Furthermore, in July 2016, Japan launched the
"Basic principles of Asia Health and Wellbeing
Initatve" to establish a “new Asia” through the
realizaton of UHC* and a society of health and
longevity with sustainable economic growth.
Japan will make eforts to share the lessons
learned from its own experiences to other
Asian countries by building upon mutually
benefcial relatonships, not only by sharing their
representatve system such as community-based
integrated care system, but also by supportng
the overseas advancement of the private sector.
(1) Domestc Issues and Eforts
(Promoton of health and longevity)
Based on the Health Promoton Law, Japan
formulated the "Health Japan 21 (Second editon)"
in 2012, which sets various indicators and targets
for health for the next 10 years, in order to
extend the healthy life span of its populaton and
reduce health inequality through partnerships
with companies, private organizatons and local
governments.
(2) Internatonal cooperaton
(Strengthening internatonal response capacity
for public health emergencies)
In order to strengthen the global health
architecture to respond to cross-border public
health emergencies, Japan has actvely contributed
to the discussions at various internatonal
fora as well as to support the expansion of the
Emergency Response Department of the World
Health Organizatons (WHO) and their emergency
response actvites. In additon, the World Bank
launched the Pandemic Emergency Facility
(PEF), which is a fnancing mechanism to quickly
mobilize funds by using insurance mechanisms
at the tme of pandemic occurrence. Japan
actvely engaged in designing this mechanism
in partnership with the World Bank and WHO,
and commited fnancial contributons to the PEF
ahead of other countries in May 2016.
Furthermore, in order to strengthen the
global response mechanism, Japan supported an
initatve led by WHO and the UN Ofce for the
Coordinaton of Humanitarian Afairs (OCHA) to
formulate and utlize the Level 3 (L3) Actvaton
Procedures for Infectous Disease Events to
prepare for public health emergencies. All these
measures and contributons are stated in the
"G7 Ise-Shima Vision for Global Health" and have
been disseminated widely around the world.
Interventons against some kinds of infectous
diseases, like Ebola virus disease (EVD),
see litle demand at tmes of normalcy, but
become immediately necessary globally once
an outbreak occurs. Japan is supportng a new
partnership called the “Coaliton for Epidemic
and Preparedness Innovaton (CEPI)” which was
launched in January 2017 to promote internatonal
research and development in producing vaccines
for such diseases.
27
(Atainment of UHC through strengthening
health systems in developing countries)
UHC means that all people can access basic
health services when they need them at an
afordable cost. The achievement of UHC is
important from the viewpoint of correctng health
inequites and responding to the basic health
needs of all the people, and to help recipient
countries to cope with health and well-being
related issues by themselves. In May 2015, Japan
took the lead to include the promoton of UHC
into the “G7 Ise-Shima Vision for Global Health"
as one of its pillars, in order to contribute to
the preventon and preparedness against public
health emergencies. Also, at TICAD VI in August
2016, Japan, in partnership with the World Bank
and WHO, jointly announced a policy framework
for acton named “UHC in Africa” as one of “Japan
Brand”.
Ownership and leadership are indispensable
for ataining UHC in Africa. In this connecton,
Japan has partnered with Kenya, Senegal and
Ghana as model countries to extend cooperaton
in the areas of policy and insttutonal reform,
as well as human resources development in
individual policy priorites, so that such measures
may spread throughout the entre contnent.
In order to further promote UHC at the feld
level, Japan and the World Bank launched the
“Japan-World Bank UHC Initatve” in January 2017.
In order to follow the progress in the developing
countries, an internatonal conference named
“UHC Forum 2017” which is jointly organized by
the Government of Japan, the World Bank and
WHO as well as other organizatons, will be held
in Tokyo in December 2017.
In view of the ageing populaton in Asia, Japan
intends to contribute to building sustainable
social security systems in order to respond to
the rapid changes of the demographic structure
of the region, by sharing lessons and expertse
gained from its own experience. A host country
event on strengthening Health Systems and
Promotng UHC at the 50th annual meetng of the
Asian Development Bank (ADB) was held in the
city of Yokohama in May, and a memorandum of
understanding was signed between JICA and the
ADB in order to establish a strategic partnership
to strengthening health security and promote
UHC at the annual meetng, to name but a few
endeavors in this area. In July this year, the frst
Health Ministers Meetng on UHC and Ageing will
be convened under the framework of ASEANJapan cooperaton.
In response to the views refected in the 2030
Agenda adopted in September 2015, Japan has
addressed the importance of strengthening
mult-stakeholder partnerships on various
occasions, such as at a side-event during the UN
General Assembly meetng in September 2015,
the UHC Internatonal Conference in December
2015, the G7 Ise-Shima Summit in May 2016
and other internatonal conferences. To refect
the gaining internatonal momentum, the
Internatonal Health Partnerships for UHC2030
(IHP for UHC2030) was formed in June 2016,
building on the multlateral health partnership
under the Internatonal Health Partnership Plus
(IHP+).
[Case Study] Cooperaton toward Achieving
UHC in Africa
JICA signed an ODA loan agreement with
the governments of Kenya and Senegal
and is implementng fnancial cooperaton
necessary to achieve UHC for both countries.
28
(Promoton of the Asia Health and Wellbeing
Initatve)
In order to address ageing Asia, Japan launched
“The Asia Health and Wellbeing Initatves” which
provide Japanese knowledge and expertse on
long-term care and social welfare systems and
support long-term care and related business
providers’ overseas advancement. As a naton
at the forefront of ageing society, the Initatve
intends to train experts in long-term care in
Japan and return them to their countries to meet
the new business opportunites there through
circular migraton across the region.
In Kenya, JICA has supported the eforts of
the Government of Kenya to implement its
Health Insurance Subsidy Programs aiming
at increasing the number of poor households
receiving benefts from 0 to 420,000, and Free
Maternal Services to increase the number
of facility-based deliveries (from 44% to
65%) through the provision of free obstetric
services.
|
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[
3
] |
{
"country": "jpn",
"file_id": "sdg-03/vnr-report-jpn-2017-en-1.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2017
}
|
137
Goal 3
Target 3.8 (Universal Health Coverage) has become a policy priority for the international community, and
Japan's contribution is highly appreciated. There is a need to further improve international awareness of
its importance under the COVID-19 Pandemic. It is also highly commendable that Japan has been engaged
in international cooperation to overcome the COVID-19 Pandemic since the beginning of 2020 and has
been actively involved in the creation and funding of the ACT Accelerators and COVAX Facility.
On the other hand, in Japan, from the perspective of Target 3.8, the status of access to isolation and
medical facilities, including testing and contact tracing (active epidemiological surveillance), preventive
measures (masks, PPE), and methods and effectiveness of providing preventive messages, is inadequate.
In particular, it became clear that access to medical, welfare, and health services for foreign residents in
Japan is not well developed. At the same time, there is a need to further promote education and awareness
and correct understanding of the public medical insurance, social welfare, social security, and public
assistance systems, which support universal health coverage in Japan.
The importance of One Health (hygiene of humans, animals, and the environment) has been recognized,
and related efforts are being made by the national government and some local governments. Research on
planetary health is also underway, focusing on the relationship with global ecological changes.
In 2020, the number of suicides increased for the first time in 11 years due to the COVID-19 Pandemic.
|
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[
3
] |
{
"country": "jpn",
"file_id": "sdg-03/vnr-report-jpn-2021-en-5.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2021
}
|
100
Goal 3: Ensure healthy lives and promote well-being for all at all ages
Based on the Health Promotion Law, Japan formulated the "Healthy Japan 21 (Second Stage)" in 2012, setting
various health-related indicators and targets for the next 10 years, with the intension to extend healthy life
expectancy and reduce health disparities through cooperation among companies, private organizations, and local
governments. Although there have been improvements in the extension of healthy life expectancy and the
reduction of health disparities, further efforts are needed in some areas such as cardiovascular disease and diabetes.
With regard to smoking, various measures are being taken with the goal of "reducing the smoking rate among
adults (those who want to quit smoking will do so)" (target: 12%). In addition, the Health Promotion Law was
amended in 2018 to strengthen measures against second-hand smoking, such as specifying prohibited smoking
areas for each type of facility.
Average life expectancy and healthy life expectancy
Based on Fig. 1-2-6 in Annual Health, Labor and Welfare Report 2020.
Healthy life expectancy is the average number of years that a person can expect to live in full health.
Japan has one of the highest suicide rates in the world as a whole and is the highest among the G7 countries,
showing that not only physical health but also mental health is an issue. Based on the 2016 revision of the Basic Law
on Suicide Prevention and the actual situation of suicide in Japan, the Cabinet approved the "Outline of
Comprehensive Suicide Prevention Measures: Aiming to Realize a Society in which No One is Driven to Suicide" in
July 2017. In order to reduce the suicide rate to the current level of other developed countries, the Outline sets a
goal of reducing the suicide mortality rate by more than 30% compared to 2015 (from 18.5 per 100,000 population
in 2015 to less than 13.0) by 2026. Since then, the number of suicides has been decreasing, but after the COVID-19
Male Femal
50
60
70
80
90
Healthy life expectancy Average life expectancy
101
pandemic, the number of suicides increased in 2020 for the first time in 11 years, and the number of female suicides
in particular increased by 935 compared to the previous year. There are a variety of factors behind female suicides,
including health problems, economic and lifestyle problems, work problems, and family problems, which have been
exacerbated during the COVID-19 pandemic, and may have influenced the increase in female suicides. Japan will
continue to promote comprehensive measures with the aim of realizing a society where no one is driven to suicide.
Number of suicides per year
Based on “The status of suicides in 2020” by National Police Agency and Ministry of Health, Labor and Welfare. The unit of the values
is person.
The number of fatalities due to road traffic accidents, as mentioned in Target 3.6, was 5,039 in 2015 (4.0 per
100,000 population) but has been decreasing year by year to 3,819 in 2019 (3.1 per 100,000 population).
Number of fatalities in road traffic accidents
The number of fatalities due to road traffic accidents per 100,000 people.
Based on the Vital Statistics of the Ministry of Health, Labour and Welfare.
0
5000
10000
15000
20000
25000
30000
35000
1980 1985 1990 1995 2000 2005 2010 2015 2020
Male Female Total
|
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[
3
] |
{
"country": "jpn",
"file_id": "sdg-03/vnr-report-jpn-2021-en-6.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2021
}
|
3636
Goal 3
ENSURE HEALTHY LIVES AND PROMOTE
WELL-BEING FOR ALL AT ALL AGES
36
VOLUNTARY NATIONAL REVIEW OF THE
REPUBLIC OF KAZAKHSTAN
37
Figure 9.
Main health-care indicators
GOAL 3
Humanity is facing new challenges with environmental
degradation, sedentary lifestyles and unhealthy diets,
leading to an increase in chronic diseases. Under these
conditions, one of the most important tasks of
Kazakhstan's national policy is to improve the nation's
health.
The implementation of national health care reforms in
Kazakhstan has enabled the country to achieve significant
results under this SDG.
Over the last 18 years, life expectancy has increased by
7.75 years. From 2000 to 2018, maternal mortality in the
country decreased more than 4 times, amounting to 14.0
per 100,000 live births, while infant mortality decreased
almost 2.5 times, amounting to 8.03 per 1,000 live births.
However, these figures still lag behind the level achieved by
OECD countries; thus, this issue remains a problem.
Source: data from the Ministry of Health of the Republic of Kazakhstan
2000 2018 2000 2018 2000 2018
73.15 60.9
14
19.6
65.4 8.03
Life expectancy,
years
Maternal mortality (per
100 thousand live births)
Infant mortality (per
1000 live births)
3838
Kazakhstan has achieved good results in
minimising the incidence of primary
tuberculosis, reducing its level almost
threefold in the last 18 years. Kazakhstan is
also among the countries where HIV
prevalence is very low; 0.2% among people
aged 15-49 years.
A programme to prevent suicides among
minors was piloted in 2015, and implemented
in all regions in 2018. The number number of
suicides among adolescents in Kazakhstan
over the past 3 years has decreased by 30%.
Despite the positive dynamics, the leading
cause of death is related to circulatory system
diseases and malignant neoplasms.
One problem facing health care is the lack
of medical personnel. The measures taken
have improved the situation, reducing the
shortage of medical personnel by 36.8%, from
3,800 in 2014 to 2,400 in 2018. However, there
is a gap between the number of medical
personnel in urban and rural areas (in urban
areas, 56.8 per 10,000 population, in rural
areas, 16.1 per 10,000 population). At present,
there is a 4% shortage in total number of
medical personnel.
The basis of almost all health-care reforms
in Kazakhstan is the optimization of inpatient
care and the shift towards primary health care
(PHC).
A National Screening Programme is
currently in place to ensure the early
detection of diseases that are the main causes
of death and disability. In 2017, the age group
eligible for screening was extended to those
aged 70 years, while the frequency of
screening examinations and the coverage of
target groups have both been increased.
A disease management programme is now
being implemented in clinics, which relates to
the active involvement of a patient in
managing his/her disease by adhering to
treatment guidelines and regimen. The
programme currently covers three diseases:
diabetes, arterial hypertension and chronic
heart failure.
In order to reduce maternal and infant
mortality, an integrated model of medical
care in childbirth and childhood has been
introduced. International technologies have
also been implemented for perinatal care and
the integrated management of childhood
illness.
One of the achievements in maintaining
children's health is the development of
neonatal highly-specialized care. To date,
compared with 2010, the survival rate of
children with extremely low body mass
(under 1 kg) has increased 1.5 times.
The national immunization schedule
ensures the full immunization coverage of the
population, with vaccines administered by
qualified health professionals.
Work is also under way to automate the
drug supply system to ensure a timely and
uninterrupted drug supply is readily available
for the population. This includes introducing a
pricing system for all drugs, switching to
electronic prescriptions, and the provision of
support to domestic pharmaceutical
manufacturers.
VOLUNTARY NATIONAL REVIEW OF THE
REPUBLIC OF KAZAKHSTAN
39
The work on health-care digitalisation
continues. Digitalization reduces the number
of medical errors, improves the quality and
speed of service, as well as the quality of
management decision-making. The transition
to paperless, digital management of medical
records in health-care organizations is also
under way, with electronic health passports to
be introduced by 2020.
In order to increase funding in health care,
the introduction of a Compulsory Social
Health Insurance (CSHI) scheme by 2020 is
under way. The scheme will increase the
availability and quality of medical care, reduce
the level of informal payments, and increase
the social responsibility of citizens for their
health.
Today in Kazakhstan, fully-equipped
medical centres that meet international
accreditation standards have been
established, capable of providing highly
specialized care. Since 2012, organ
transplantation has been actively developed
in Kazakhstan. Nine centres for organ
transplantation of living and cadaveric donors
and three immunological tissue-typing
laboratories have been established in the
country. Heart, lung, and pancreas organ
transplants are now being performed in
Kazakhstan. Innovative technologies have
been actively introduced at the National
Research Cardiac Surgery Centre and, in 2017,
the Centre performed a unique surgery - a
fully-artificial heart implant.
To date, a network of cardiac surgery units
has been established to cover all regions of
the country, thus all patients can now receive
high-quality cardio surgery and cardiac
treatment.
Next steps to implement SDG 3:
improve disease prevention and
management;
further modernize medical and
pharmaceutical education and science, based
on the transfer of best practices and
standards through strategic partnerships
with leading foreign universities;
continue digitalization of data and
processes, which will increase the
accessibility, quality, safety and patientcentred nature of the health-care system.
ЦЕЛЬ 3
|
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Despite the progress in healthcare, there are still inequalities
in access to health services and especially during the
COVID-19 pandemic.
The installation represents a healthy person who sits in the
Lotus position with a blooming flower instead of a head.
The atmosphere of health is a screen made of metal frame,
the “walls” of which are flled with rags of fabrics soaked
in a essential oils succus. The mannequin holds a jar with
the words “WELL-BEING”.
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022 63
SDG 3.
Ensure healthy
lives and promote
well-being for
all at all ages
WHAT HAS CHANGED IN THREE YEARS:
Kazakh scientists have developed an
inactivated type of QazVac vaccine
to combat coronavirus infection.
Birth rate growth by 7.5%
(from 21.77 per 1000 births
in 2019 to 23.41 in 2021).
Decrease in infant mortality by 0.6%
(from 8.40 per 1000 births in 2019
to 8.35 in 2021).
Decrease in mortality from malignant
neoplasms by 7.7% (from 79.30
per 100,000 population in 2019
to 73.17 in 2021).
15% reduction in tuberculosis
mortality (from 2.0 per 100,000
population in 2019 to 1.7 in 2021).
Over a three-year period, the healthcare system of
Kazakhstan has withstood the enormous burden
associated with the global challenge – the control of
COVID-19.
2020 has been a turning point in all areas of life. The
coronavirus infection has changed the way people live
and has shown that healthcare is of the greatest value,
which requires constant attention and strengthening.
The Government of Kazakhstan has come together
to control COVID-19 and has done a lot of work to
restore the healthcare sector. In general, medicine in
Kazakhstan has experienced several qualitative changes
over the past 3 years, one of which was a confdent step
towards fnancial support for medical workers.
During the pandemic and in order to improve the image
and status of service, ability to respond to global and
national threats, powers of the Chief State Sanitary
Doctors at all levels were strengthened, the Law on
Biological Safety was approved.23
Since February 2021, more than 27 million doses of
COVID-19 vaccines have been delivered to the country.
The population has access to 5 types of vaccines,
including vaccines approved by the World Health
Organization. On November 22, 2021, revaccination
started.
During the coronavirus pandemic, the digitalization
of the healthcare sector was improved. In particular,
digital programs were created: the COVID-19 Control
Center, the Unifed Integration Portal (PCR research),
the Vaccination module, Ashyq mobile applications,
within the framework of the EAEU “I travel without
COVID-19”.
23 Law of the Republic of Kazakhstan No. 122-VII ZRK “On biological safety
of the Republic of Kazakhstan” dated May 21, 2022, https://adilet.zan.kz/
rus/docs/Z2200000122
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
64 VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022
The project “Dashboard of COVID-19 indicators” was implemented to monitor
indicators to stabilize the situation related to the spread of COVID-19. As part
of the automation of the process of collecting and recording the results of
laboratory tests for COVID-19, a Unifed data repository for PCR studies for
COVID-19 was created.
A centralized record of PCR tests for COVID-19, conducted by all laboratories,
regardless of the form of ownership, for epidemiological surveillance of the
infection throughout the country, has been provided. To date, 139 out of 165
laboratories have been integrated with the Unifed Integration Portal of the
RSE “National Center for Expertise” and work on integration continues.
The Government monitors the coverage of the population with preventive
vaccinations within the framework of the national vaccination calendar, and
ensures the optimal level of vaccination coverage of children of target ages
(more than 95%). In order to control and monitor the country’s vaccinated
population, the Vaccination module has been implemented, where information
on vaccinated citizens is entered into a single database. The Electronic
Vaccination Passport has been implemented in the eGov mobile application.
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022 65
A unifed republican database of medicines with access for the population (the
Database) has been created, developed by domestic IT developers of Medical
information systems with the support of National Chamber of Entrepreneurs
of the Republic of Kazakhstan “Atameken”. The database aggregates
data on pharmacies and distributors. Today, about 1,200 pharmacies and
8 distributors are connected.
Kazakhstan is one of the few countries where a domestic vaccine against
COVID-19 has been developed.
A signifcant contribution to control coronavirus infection during the
pandemic was made by the volunteer movement, which was reinforced
by the announcement of the Year of the Volunteer in Kazakhstan in 2020.
During the pandemic, representatives of volunteer organizations provided
special assistance to control coronavirus by organizing free hot meals for
medical personnel, purchasing expensive drugs, organizing the distribution of
medicines, and providing transport for medical workers. Individual volunteers
have provided support for healthcare workers by providing education for
their children, providing medical facilities with oxygen concentrates worth
KZT 450 million, and raising funds to purchase masks and gloves for doctors
involved in measures to control COVID-19.
To continue fnancial support and motivation of medical workers, since
October 1, 2021, new surcharges have been established for certain categories
of positions in the healthcare system for work in anti-epidemic measures
in the fght against COVID-19 coronavirus infection and risk of its infection
Kazakh vaccine QazVac
QazVac (QazCovid-in) was developed by
specialists from the Research Institute for
Biological Safety. QazVac is an inactivated
vaccine, purifed, concentrated, with the
addition of an aluminum hydroxide adjuvant.
The technology for the development of the
Kazakh vaccine has been time-tested, and all
its components are reliable, because tested
in the development of other vaccines.
The inactivated vaccine platform is well
known and safe.
Most people received all components earlier
as part of other vaccines. The only new
component is an inactivated virus.
The inactivated vaccine is considered
traditional, it is more effective, the technology
for its preparation is not so complicated,
and it is safer than other types of vaccines.
That is why Kazakh scientists chose an
inactivated type of vaccine to create QazVac
(QazCovid-in).
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
66 VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022
by risk groups: High risk in a 7-fold amount – KZT 123,879 of the basic
offcial salary (infectious hospitals); Medium risk in a 5-fold amount of BOS –
KZT 88,485 (laboratories); Low risk in a 3-fold amount of BOS – KZT 53,091
(others). This norm ensures equal pay for equal conditions of infection risk.
Reducing the Maternal Mortality Rate
The issues of protection of motherhood and childhood have an important
political signifcance, indicated both in international and national documents.
At the end of 2021, the total number of women of childbearing age increased
by 100,639 compared to the previous year and amounted to 4,646,646
people. Accordingly, there was an increase in the number of pregnant women
and childbirth, as well as the birth rate of children. Over the past 5 years, the
country has seen an increase in the birth rate by 7.2%; the number of children
born has increased by 15%. However, there has also been an increase in
the maternal mortality rate (MM). In 2021, compared to 2020, the maternal
mortality ratio increased by 22.6% and amounted to 44.71 per 100,000
live births (Figure 12). At the same time, the MM rate, excluding mortality
from COVID-19, was 13.4 per 100,000 live births, which is lower than the
MM rates before the pandemic (2018 – 13.9; 2019 – 13.7; 2020 – 15.9 per
100,000 live births).
In the structure of the causes of maternal death, extragenital diseases
accounted for 82%: the main share (86%) was occupied by pneumonia and
coronavirus infection, 14% were diseases of the cardiovascular, nervous,
endocrine systems, gastrointestinal tract and oncological diseases. The
greatest number of maternal losses was noted among multiparous (82%) and
in the postpartum period (85%). By age categories, women aged 30-35 years
prevail – 30%, in the active reproductive age (from 30 to 39 years) 55% died.
Mortality was higher among urban women – 64%, rural – 36%. In terms of
social status, the largest number was noted among housewives – 58%.
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022 67
Figure 12. Key indicators of the health care system
Also in 2021, there was an increase in the incidence of coronavirus
infection COVID-19 among women of childbearing age and pregnant women
by 2.5 times compared to 2020 (2021 – 26,050, in 2020 – 10,259). In
intensive care units, there were 2.4 times more pregnant women with severe
coronavirus infection. 61 patients with total lung disease were connected
to an extracorporeal membrane oxygenation (ECMO) machine, which is
4.5 times more than in 2020. Severely ill patients were not vaccinated.
The Ministry of Health of the Republic of Kazakhstan monitors and takes
systematic measures to reduce the mortality of pregnant women. One of
the measures was to conduct an analysis of each case of maternal death,
undertaken by an expert group including teaching staff from six medical
universities as well as two republican centers.
Other measures to reduce morbidity and mortality of pregnant women were
measures to increase coverage of pregnant women with individual and
interdisciplinary perinatal care, improvement of the standard of obstetric and
gynecological care organization, development and approval of the Roadmap
for Further Improvement of Medical Care for Pregnant and Maternity Patients
in Postpartum Period in the Republic of Kazakhstan for 2022-2025 and
others.24
24 According to the information system “Register of pregnant women and women of childbearing age”
Source: Ministry of Healthcare of the Republic of Kazakhstan
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
68 VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022
Reducing the mortality of newborns and children
under 5 years
In the republic, the infant mortality rate at the end of 2021 increased by
7.2% and amounted to 8.44 per 1,000 live births vs. 7.79 for the same period
in 2020. One of the reasons for the growth of the indicator was the high
congestion of the healthcare system during the pandemic.
To improve the health of children and reduce infant mortality, a number of
systemic measures are being implemented in the country. In particular, for the
timely detection of diseases and developmental disorders, 4.4 million children
were given preventive examinations, more than 900 thousand young children
were screened, and up to 90.7% of the child population was immunized
against 12 infectious vaccine-controlled diseases. 523 child development
rooms have been organized for counseling on issues of early childhood care.
In 2020, 877,869 children with 96 diseases were covered by free medicines.
As per the recommendation of UNICEF to support breastfeeding, 33 medical
organizations were awarded the status of “Baby Friendly Hospital”, and 85.6%
of children were exclusively breastfed.
Measures to reduce the epidemics of AIDS and tuberculosis
In the Republic of Kazakhstan, the HIV/AIDS epidemic control is one of the
priority areas of public health. The country is systematically implementing
measures aimed at reducing the spread of HIV infection and providing
universal treatment to all people in need who are living with HIV, in order to
fulfll the international commitment “Political Declaration on HIV and AIDS:
Ending Inequality and Setting the Path to Eliminate AIDS by 2030 year.” With
the adoption of the new Code of Public Health and other by-laws, legislative
regulation of the issues of prevention, diagnosis and treatment of HIV infection
has been ensured.
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022 69
Kazakhstan has had some success in preventing the spread of HIV infection.
All modern methods of treating HIV infection and the main drug regimens
recommended by WHO are used in the republic. Over the past 5 years, the
effectiveness of the treatment has increased from 59% to 84%. Signifcant
progress has been made in Kazakhstan in preventing mother-to-child transfer
of HIV infection and the risk of perinatal transmission has decreased from
1.5% in 2016 to 0.6% in 2020 (against the WHO recommendation of no more
than 2%).
It should be noted that the effectiveness of HIV/AIDS control is also associated
with adequate support from civil society. There are 39 non-governmental
organizations in the republic that are actively involved in the development,
implementation and evaluation of preventive measures and measures for
the care and support of people living with HIV/AIDS. The state provides for
annual budgetary fnancing as part of the social procurement.
Measures to improve the epidemiology of tuberculosis were carried out
in accordance with the Comprehensive Plan to Control Tuberculosis in
the Republic of Kazakhstan for 2014-2020. With the implementation of
the Comprehensive Plan, a signifcant improvement in all epidemiological
indicators has been achieved, the structure of anti-tuberculosis organizations
has been improved and reformed, and the latest world methods for detecting,
diagnosing and treating tuberculosis have been introduced. As a result of the
measures taken, there has been a decrease in incidence by 21.7% (2019 –
45.6 per 100 thousand population, 2020 – 35.7 per 100 thousand population)
and mortality by 5% (2019 – 2 per 100 thousand population , 2020 – 1.9 per
100 thousand population) from tuberculosis.
As a result of increased access to antiretroviral therapy, there has been a
halving of AIDS deaths from 16% per 100,000 people living with HIV in 2011
to 8% per 100,000 people in 2021.25
25 According to the Electronic Case Tracking System for HIV
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
70 VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022
Personnel policy in the healthcare system
In 2021, in order to develop the health workforce training system, a number
of measures were taken and amendments were made to the Decree of the
Government of the Republic of Kazakhstan dated February 7, 2008 No. 116
“On approval of the Rules for the appointment, payment and amount of state
scholarships to students in educational organizations”. As a result of this,
scholarships for medical students were increased (Figure 13).
Since 2021, the cost of grants for the training of medical workers has been
increased – 4,685 grants have been allocated according to the plan (the
number of grants allocated will increase annually and by 2025 will be more
than 5 thousand). In order to staff healthcare organizations with qualifed
personnel, the state provides resettlement benefts for young professionals
who go to work in rural areas, which in 2021 have been increased from
70 to 100 MCI. A transition to international standards for the training of
medical personnel is also envisaged (a mechanism has been developed
to amend the state compulsory standard of education in medical and
pharmaceutical specialties).
Special attention is paid to increasing the income of medical personnel.
Doctors and nursing staff are fully covered by salary increase. Therefore,
the salary increase affected more than 74 thousand doctors and more than
173 thousand nursing staff. Over the past 3 years, annual increase in the
average salary of a doctor is 30%:
Figure 13. Dynamics of increasing scholarships for students of medical universities, thousand tenge
Source: Ministry of Health of the Republic of Kazakhstan
ASSESSMENT OF SUSTAINABLE DEVELOPMENT GOALS ACHIEVEMENT IN THE REPUBLIC OF KAZAKHSTAN
VOLUNTARY NATIONAL REVIEW OF THE REPUBLIC OF KAZAKHSTAN 2022 71
Next steps on the SDG 3 implementation:
Implementation of the Laws “On biological safety of the Republic of
Kazakhstan”.
Adoption of the Law providing for professional liability insurance of
medical workers.
Adoption of the Health Development Concept until 2026.
Adoption of the Law on the transfer of the medical service of the
penitentiary system to the jurisdiction of the Ministry of Health of the
Republic of Kazakhstan.
Implementation of the National Project “Quality and affordable
healthcare for every citizen “Healthy Nation”.
– in 2019, the average salary of a doctor was KZT 189.3 thousand,
in 2020 it increased to KZT 246.1 thousand;
– in 2021, the increase amounted to KZT 320.0 thousand or 30%;
– in 2022, the increase amounted to KZT 415.9 thousand or 30%.
In general, the coronavirus pandemic has brought both barriers and
opportunities for the country. During the pandemic, pharmaceutical
companies not only restructured their work in the face of new restrictions,
but also worked to fnd medicines for COVID-19 and develop vaccines.
|
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Goal 3: Ensure Healthy Lives and Promote Well-being for all at all Ages
The health sector’s goal is, “to attain equitable, affordable, accessible and quality health care for all
Kenyan citizens” and thereby, reduce health inequalities while also reversing the downward
trend that has been seen in health-related outcome and impact indicators. The progress on
health goals is anchored on the Kenya Health Policy, 2014 - 2030 and the Kenyan Health
Sector Strategic and Investment Plan (KHSSP, July 2014 - June 2018) that have six policy
objectives and seven strategic objectives which provide the policy frame work to progress
towards attainment of vision 2030 goal for the health sector. The six policy objectives includes;
eliminate communicable diseases, halt and reverse burden of Non-communicable diseases,
reduce the burden of violence and injuries, provide essential health care ,minimize the exposure
to health risk factors and strengthen collaboration with sector providers.
Despite of the initiatives implemented during the MDGs period, maternal mortality ratio, and
infant and under five mortality remains unacceptably high at 362/100,000, 39 per 1000 live
births and 52 per 1000 live births respectively. Malaria incidence per 1,000 populations is 225.
The proportion of births attended by skilled health personnel is 61.8 which is an increase from
43 percent in 2011.Tuberculosis incidence per 1,000 populations was 90 in 2015.The overall
TB Treatment Completion Rate increased to 90% while TB treatment cure rate improved to
85%. Death rate due to road traffic injuries per 100,000 populations was 11 in 2014 before
increasing to 12 in 2015 and declining to 11 in 2016.
Currently, the number of new HIV infections per 1,000 uninfected is 146.According to the HIV
estimates report(2016) HIV preference rate realized a significant drop from 6.7% in 2003 to
5.9% in 2015. However, the prevalence rate among women at 6.3% remains higher than their
male counterparts at 5.5% in 2015. The number of new infections annually fell by 19% overll
23
and by 66% with regards to transmission from mother to child from 12,000 to 4,6000 between
2013 and 2016. The proportion of pregnant women, adults and children who tested positive
and were put on ARVs increased to 66% of those living with HIV and an estimated 580,000
deaths were averted by 2016 by scaling up ART.
The HIV and AIDS equity Tribunal was established in 2009, under section 25 of the HIV
prevention and Control Act of 2006. IT is the only HIV specific statutory body in the world
and it is granted powers of a subordinate court and has the broad mandate to “ear and
determine complaints arising out any breach of the provisions of HAPCA, excluding criminal
jurisdiction and may perform any other such functions as may be conferred upon if by HAPCA
or any other written law being in force. The tribunal has contributed to reducing HIV related
stigma and discrimination through various awards, and has presented an alternative avenue for
redress for HIV related human rights violations and has improved justice adjudication over
2000 cases. As the only judicial mechanism in the world specifically dedicated to the epidemic,
HIV and AIDS Tribunal of Kenya can serve as a possible model for replication in other
countries.
To mitigate this, the health sector has been rolling out several initiatives aimed at promoting
prosperity. They include: Comprehensive and Expanded Immunization programme that
includes pneumococcal vaccine for children to cover emerging diseases and ailments which has
led to a reduction in Infant and Child Mortality. Exclusive breast-feeding campaigns and
introduction of supplemental foods is geared towards reducing mortality rates. Mass
distribution of Long Lasting Insecticidal Mosquito nets has reduced the incidence of Malaria
especially among Lake Region communities. The increase on the proportions of birth assisted
by skilled health providers during delivery, health facilities deliveries and post-natal care are
also cited as factors that lowered both Child and Infant Mortality.
The HIV and AIDS equity Tribunal was established in 2009, under section 25 of the HIV
prevention and Control Act of 2006. IT is the only HIV specific statutory body in the world
and it is granted powers of a subordinate court and has the broad mandate to “ear and
determine complaints arising out any breach of the provisions of HAPCA, excluding criminal
jurisdiction and may perform any other such functions as may be conferred upon if by HAPCA
or any other written law being in force. The tribunal has contributed to reducing HIV related
stigma and discrimination through various awards, and has presented an alternative avenue for
redress for HIV related human rights violations and has improved justice adjudication over
2000 cases. As the only judicial mechanism in the world specifically dedicated to the epidemic,
HIV and AIDS Tribunal of Kenya can serve as a possible model for replication in other
countries.
Health Insurance Subsidy Programme (HISP), is an initiative aimed at contributing to better
quality of life, poverty alleviation and human development through meeting population health
needs; removal of financial barriers to health care and reduce incidences of catastrophic health
expenditures. This will be realized by consolidating and expanding social health subsidy
mechanisms with view to achieving Universal Health Coverage (UHC). This project targets
about 21,530 households of which 17,612 households have been registered to access health
services from the hospital of their choice.
24
Social Health Insurance is one of the most innovative and efficient ways of financing healthcare.
It has been recognized in the Kenya Vision 2030 as one of the pillars for Kenya to achieve
Universal Health Coverage. In this regard, government has been promoting reforms in the
National Hospital Insurance Fund (NHIF) to make it one of the key drivers for achieving
universal health coverage. The aim is to allow access to comprehensive health care for all
including vulnerable persons, orphans and the elderly. These recent reforms since 2013 have
included, changing the management structure at NHIF to make the institution more effective
and responsive to customer needs; reviewing the contributions of all members – after the
previous rates stagnated for over 20 years; expanding the benefit package to include in-patient
and out-patient cover, major and minor surgeries, cardiac conditions and chronic illness,
comprehensive cover for civil servants and disciplined forces and new packages related to
addressing non-communicable conditions and instituting strategies to enroll more members.
This has resulted in improved access to high quality comprehensive health care at subsidized
costs and enhanced access to healthcare by Kenyans particularly the vulnerable segments of the
society.
The Managed Equipment Service has allowed Medical facilities to acquire vital hardware as a
way to improve access to comprehensive Kenya Essential Package for Health (KEPH) services
by different constituents of Kenya’s population. Specifically, the project is set to contribute
towards acquisition of the requisite infrastructure and equipment to about 100 current Level 4
County Hospitals to the accepted norms and standards. Further these facilities will enable them
to provide a wide range of comprehensive health care services and provide prompt diagnosis of
non- communicable conditions. The government is also upgrading of health facilities in
informal settlements to increase access to vital health care services through a project that uses
mobile services to reach deep into these areas.
The Beyond Zero Campaign initiative by H.E. First Lady, Mrs. Margaret Kenyatta aims to end
preventable deaths among women and children and give new impetus to fight against HIV
through policy prioritization, resource allocation and improved service delivery. The campaign
seeks to leverage on the convening power of the First Lady for strengthening existing health
and community systems, mobilizing the contributions of private and public sectors and
development partners, catalyzing innovation and accelerating action by stakeholders and
political leaders and promote leadership and accountability at family, community and national
levels for the full implementation of Kenya’s HIV, maternal and child health commitments. The
achievements of the campaign include delivery of mobile clinics to all 47 county referral
hospitals in the country. By bringing health delivery closer to Kenya’s citizens, the mobile
clinics have been able to treat mothers and children who would otherwise have been obliged to
walk miles to seek treatment. This has contributed to a 66% drop in HIV infections from
mother to child between 2013 and 2016.
In addition to the above initiatives, health worker density and distribution per 100,000
populations has improved from 21 doctors and 165 nurses in 2014 and increased to 23 doctors
and 230 nurses in 2016 which support these initiatives.
At the sub national level, there are a number of innovative initiatives to address health at the
community level. These include;
25
Mother waiting home (KIROR): An initiative of West Pokot sub national Government. This is
a home outside their home and a home outside the health facility. The KIROR are facilities
constructed next to a health. Expectant mothers move to the KIROR a few days to their
expected day of delivery and are monitored during labour by the health personnel at the health
facility. This ensures that the expectant mothers do not have to travel long distances when in
labour. These facilities help in reducing congestion at the health facility while at the same time
getting prompt services of qualified personnel during delivery.
Kenya HIV and Health situation room: As part of the big data collaboration, this platform has
revolutionalized data management programme tracking and evaluation by bringing together
data from four(4) different agencies of Government in five(5) sub-system to provide easy to
interpret graphical representation of the HIV situation on health facility and community
services uptake, commodity supply that is allowing national and county managers to track
performance real-time. It is now being expanded to other reproductive maternal health
indicators.
The sub national Government of Embu has introduced the commodity exchange programme.
This starts with the formation of a county commodity security/Exchange team on WhatsApp
social platform. This commodity group has seen a lot of action since its inception. Sub county
pharmacists are always busy facilitating the collection of commodities and transferring them to
needy sites. It has become much easier to source commodities for sites that run out of essential
items and Priority program commodities.
Garissa County Health Management Team adapted the provision of MAMA kits to pregnant
mothers and incentives to Traditional Birth Attendants (TBAs) to improve skilled deliveries.
Reproductive Maternal Newborn, Child and Adolescent Health (RMNCAH) Project is a six sub
national initiative that focuses on improving maternal and newborn outcomes in six high
burden maternal mortality counties in Kenya2.The select counties contribute about 50% of
maternal deaths nationally. In those counties, a total of 507 additional health care facilities
received Managed NH equipment and are now providing Emergency Obstetric and New born
care (EmONC) services. The private sector has also made contribution to this goal as outlined
below.
The private sector contribution towards improving health care outcomes include a
KEPSA/UNICEF project aimed at improving maternal and infant nutrition through
sensitizing members of the private sector on the need to promote exclusive breastfeeding for
children by providing working mothers with a conducive working environment as well as
providing breaks for them to breastfeed their children. The project encourages businesses to
create mother and baby friendly spaces which includes the creation of a lactation station for
lactating mothers.
Mtiba- is a mobile health wallet for healthcare savings, payments and bonus schemes developed
by the private It allows individuals and organizations to distribute funds for healthcare to
people who rely on them. They can be sure that those funds will be used for healthcare only.
2 Mandera, Wajir, Turkana, Marsabit, Isiolo, Lamu, and Migori counties
26
And they know that their dependents are being treated at clinics that charge fair prices and
follow internationally recognized quality standards.
Private sector has also created the Pampers Mobile Clinic Program, providing free basic health
checks, health talks and products to mothers and their babies. The Pampers vaccine program
eliminates neonatal tetanus, a preventable disease that claims the life of 58,000 babies in
developing countries each year.
Another initiative involve offering a one-stop shop across six distinct healthcare services
namely: medical equipment supply, installation and after-sales service; construction of new
medical facilities or upgrade of existing facilities infrastructure; mobile clinics fabrication and
deployment; medical applications training; turnkey healthcare programs implementation
(PMO); and hospital information systems (HIS) and healthcare information technology (HCIT)
deployment
The Kenya government has a devolved system of government and has devolved health service
provision with the aim of improving health outcomes at the sub national and national level
because through improved health service delivery. One of the primary functions that the central
government has ceded to the sub national government through devolution is health service
delivery, where sub national Governments are responsible for delivery of a majority of health
services mainly primary level care and curative services.
To ensure the planning is properly done, counties are required to develop several plans. Each
sub national government must have:
a) An integrated development plan-This gives a roadmap for development in the county
over a five-year period.
b) Sector plans- Every sector in the county must also have a ten-year plan, explaining how
health, agriculture or water and sanitation will be managed.
c) Ten-year spatial plans –This explains how the county will manage land and
development across the entire county.
The Constitution and devolution laws, particularly the County Government Act, 2012 require
the involvement of residents in the preparation of all these plans.
Challenges
1. Health financing and purchasing of health care services still has a serious implication on
access and quality of health care;
2. Non-communicable diseases (NCDs) are exerting pressure to the health system. Despite
the awareness on the risk factors of NCDs, there has been no significant change on the
lifestyle amongst the general population. Cancer, hypertension, heart disease and
diabetes are rising and emerging as major health problems. Cancer alone is estimated
to cause 21,000 deaths annually;
3. Data unavailability especially on neglected tropical diseases (NTDs), cancer and
outbreak diseases.
27
4. Childbirth related conditions continue to pose significant challenges, especially
inadequacy of emergency services for delivery, under-utilization of existing antenatal
services and inadequate skills and competences of health workers in this area.
28
|
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[
3
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{
"country": "ken",
"file_id": "sdg-03/vnr-report-ken-2017-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2017
}
|
| SECOND VOLUNTARY NATIONAL REVIEW REPORT ON THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS - JUNE, 2020 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
4.3
ENSURE HEALTHY
LIVES AND PROMOTE
WELL-BEING FOR ALL
AT ALL AGES
Indicator 3.1.1: Maternal mortality ratio
In Kenya, maternal mortality is still high at 362 persons per 100,000 population according to 2014 figures. Antenatal coverage has
improved over the years with statistics indicating that the number of pregnant women who attended at least one ANC visit increased
from 44.3 per cent in 2011 to 66.6 per cent in 2019. Te number of pregnant women who had attended at least four antenatal visits
increased from 33.7 per cent in 2011 to 50.4 per cent in 2019.
Indicator 3.1.2: Proportion of births attended by skilled health personnel
Te proportion births attended by skilled health personnel in 2018 was 70.2 per cent, an increase from 61.8 per cent in 2014. Te
number of registered births increased by 22.9 per cent from 923,487 in 2017 to 1,135,378 in 2018. Skilled deliveries at a health facility
increased from 51 per cent in 2013/14 to 62.1 per cent in 2015/16 before declining to 60.1 per cent in 2017/18 and then increasing to
64.4 per cent in 2018/19.
Indicator 3.3.1: Number of new HIV infections per 1,000 uninfected population, by sex, age and key
populations
Te HIV incidence rate in Kenya was 1.4 persons per 1000 uninfected populations in 2016. Tis decreased to 1.3 persons in 2017 before
increasing again to 1.4 persons (1.3 males and 1.5 females) in 2018. Tis translates to about 140 new infections per uninfected population
of 1,000 or 36,000 new cases of HIV infection per year. Te incidence was higher among women (1.5) than men (1.3).
Indicator 3.3.2: Tuberculosis incidence per 1,000 population
Tuberculosis incidence per 1,000 populations was 181 in 2017. Te TB treatment success rate (TSR) has fluctuated between 85.6 per
cent in 2013 to a high of 89 per cent in 2014 and 82.5 per cent in 2018. Between 2016 and 2018, TB TSR consistently remained below
the recommended rate of 85 per cent. Figure 4-3 shows the TB Treatment Success Rate.
.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . JUNE, 2020 - SECOND VOLUNTARY NATIONAL REVIEW REPORT ON THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS |
43
Indicator 3.3.3: Malaria incidence per 1,000 population
Malaria incidences per 1,000 population was 87 in 2017 and declined to 80 in 2018 before increasing to 99
in 2019.
Indicator 3.4.2: Suicide mortality rate
The suicide mortality rate per 1,000,000 population dropped signifcantly from 9 persons in 2017 to 2 persons
in 2018.
Indicator 3.6.1: Death rate due to road traffic injuries
Death rate due to road traffc injuries per 100,000 population was 6 in 2017 before increasing to 7 in 2018
and 8 in 2019. The rising number of road traffc cases have exerted a huge burden on Kenya’s economy and
healthcare services. Road traffc injuries have a signifcant impact on the social and economic well-being of
individuals, their families, and society. Figure 4-4 shows the death rate due to road traffc injuries.
Figure 4-4: Death rate due to road traffic Injuries
Figure 4-3: TB treatment success rate
| SECOND VOLUNTARY NATIONAL REVIEW REPORT ON THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS - JUNE, 2020 .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
44
Indicator 3.c.1: Health worker density and
distribution
Te health worker density and distribution in the country per
100,000 population stood at 20 doctors, 170 nurses, 3 dentists
and 7 pharmacists in 2017. In 2019, it was 24 doctors, 182 nurses,
3 dentists and 7 pharmacist in 2018 and 25 doctors, 198 nurses, 3
dentists and 8 pharmacist.
Te country had 68,085 healthcare workers (HCW) in the public
sector as at November 2018 and 10,626 in private sector totalling
to 78,711 HCWs against a population of 47.5 million. Terefore,
Kenya has a HCWs to population ratio of 13/10,000 against
WHO’s recommended ratio of 23/10,000.
Te sector is also a priority under the Big Four Agenda. Te
priority is to achieve universal health coverage by ensuring all
residents of Kenya can access a primary care package. Tis will
help achieve SDG 3.
Challenges to Ensure Healthy Lives and Promote Well-Being
for All at All Ages
1. Health programmes remain heavily donor-dependent
2. Inadequate emergency services for delivery and underutilisation of existing antenatal services
3. Inadequate capacity for emergency and disaster preparedness
4. Low health insurance coverage in the country and high cost
of health services
5. Weak multi-sectoral coordination of programmes and
projects in the sector
6. Malaria remains one of the major causes of death especially
in children under five and pregnant women
Selected ongoing interventions to Ensure Healthy Lives and
Promote Well-Being
1. Te operationalisation of Kenya Health Professionals’
Oversight Authority to supervise and regulate health
workers in the country
2. Enhanced suppression of new HIV infections
3. Increased the number of GeneXpert machines and
introduced shorter-term regimen for management of drug
resistant TB
4. Insecticide-treated nets (ITNs); Indoor residual spraying
(IRS); entomological surveillance and insecticide resistance
monitoring in addition to case management
5. Beyond Zero Campaign
6. Scaling up UHC in all the counties with emphasis on
primary healthcare to ensure access to quality healthcare.
Strengthening supply chain systems, thereby improving
access to life-saving medicines and supplies, including family
planning commodities
7. Advocacy for sustainable financing of health programmes
from domestic resources. A gradual move away from donor
dependent financing of health.
8. Education/training, employment and appropriate
deployment of healthcare workers to address the human
resource for health challenge.
Emerging issues
1. Re-emergence of other diseases such as bird flu, dengue
fever, and chikungunya
2. Increased incidences of non-communicable diseases (NCDs)
such as hypertension, heart disease, diabetes and cancer
3. Emergence of co-morbidities between NCDs and HIV
4. COVID-19 pandemic.
Lessons learnt
1. A multi-sectoral approach is essential for successful
implementation of the health sector programmes and
projects
2. Effective surveillance and Cross-border collaboration and
partnership are critical in prevention and management of
infectious and communicable diseases
Best practice
Implementation of Linda Mama programme which intensified
the number of visits of ante natal and postnatal in the country in
addition to increase in the number of skilled deliveries in health
facilities.
|
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Voluntary National Review on the Implementation of the Sustainable Development Goals in the Kyrgyz Republic 47
PEOPLE, FAMILY AND SOCIETY
Ensure healthy lives
and promote well-being
for all at all ages
Goal 3.
I. Analysis of the current situation based
on the indicators for the goal
Healthcare is a priority area of the state policy in the
Kyrgyz Republic and the country has made certain
achievements in this regard.
Similar to other countries, the life expectancy of
women in the Kyrgyz Republic is higher than that of
men. In 2018, life expectancy at birth was 67.4 years
for boys and 75.6 years for girls. The difference in life
expectancy of boys and girls at birth is 8 years and
decreases with time.
Figure 17.
Life expectancy at birth by sex18 (2010, 2015–2018)
18 Social Trends in the Kyrgyz Republic: 2014–2018: NSC, 2019
One of four priority dimensions of the previous “Den
Sooluk” state health sector program (2012–2018)
was improving maternal and child health (including
reducing maternal mortality).
Girls Boys Both sexes
2010 2015 2016 2017 2018
67.4
75.6
65.3
73.5
69.3
70.6 70.9 71.1 71.3
66.7
74.8
67.0
75.1
67.2
75.4
48
The maternal mortality rate has been steadily
decreasing, down to 24.5 cases per 100 thousand
live births in 2018 as compared to 49.1 in 2012.
Due to the introduction of advanced technologies
for evidence-based perinatal care, there has been
a steady decrease in maternal mortality, indicating
that long term targets in terms of maternal mortality
reduction are achievable.
In 2018, 99% of all pregnant women made at least
one antenatal visit, 100% of deliveries were attended
by qualified health workers, and 96% of women
were visited by medical staff 2 days after delivery.
However, only 70% of all women received pregnancy
insurance.20
The Kyrgyz Republic was among the countries that
achieved MDG-4, reducing infant and child mortality
by two thirds as compared to 1990.21 The country
managed to reduce the neonatal mortality rate in
comparison with 2012 by 11% (2012: 14.6 per 1,000
live births; 2018: 13.0 per 1000 live births), and child
mortality by almost a quarter (2012: 23.4 per 1,000
live births; 2018: 17.6 per 1,000 live births). At the
moment, the state has ensured public access to
immunization, covering more than 95% of children.
As a result, the share of infant mortality from
infectious and parasitic diseases was about 2%.
Measures to promote and support breastfeeding
Figure 18.
Indicators of maternal, child (under fve years old) and infant mortality (under one year old) per 100,000
live births (2012–2018)19
19 The Multiple Indicator Cluster Survey (2018 Report): NSC, UNICEF
20 The Multiple Indicator Cluster Survey (2018 Report): NSC, UNICEF
21 UNICEF Global Progress Report “A Promise Renewed” 2015
22 AIDS Center data
increased breastfeeding rates from 41.1% in 2014
to 46% in 2018.
The epidemic of HIV/AIDS in the Kyrgyz Republic is
characterized as a low and concentrated epidemic.
As of January 1, 202022, there were 9,680 offcially
registered people with HIV, about 40% of whom are
undergoing antiretroviral therapy. For women, the
number of newly infected stabilized at a level of less
than 10, while for men this number grew signifcantly
from 9.8 in 2013 to 16 in 2018.
Tuberculosis incidence fell from 104.3 per 100,000
in 2012 to 83.0 in 2018. Mortality from tuberculosis
has been steadily decreasing, from 10.8 cases
per 100,000 people in 2012 to 5.8 cases in 2018.
Payment options for diagnosing and treating
tuberculosis at the Primary Health Care (PHC) level
and at specialized hospitals were reviewed. Clinical
cost-based groups for tuberculosis were identifed
and a new payment model for such services is being
implemented.
Despite the decline in mortality due to noncommunicable diseases over the past 20 years,
they are still responsible for 80% of all deaths in
the country. More than half of these (51.6%) are
associated with cardiovascular diseases. A road
map for optimizing assistance for acute myocardial
Maternal Infant (under one year old)
23.4 23.3 23.1 21.5 19.8 18.5 17.6
14.0 12.7 11.8 13.0 14.9 15.6 14.6
49.1
36.0
50.1
38.5
30.3 31.9
24.5
2012 2013 2014 2015 2016 2017 2018
Voluntary National Review on the Implementation of the Sustainable Development Goals in the Kyrgyz Republic 49
PEOPLE, FAMILY AND SOCIETY
23 Alcohol Taxation Policy in the Kyrgyz Republic WHO, 2017
24 http://www.stat.kg/ru/publications/kontrol-nad-oborotom-narkoticheskih-sredstv-psihotopropnyh-veshestv-i-ih-prekursorov-vkyrgyzskoj-respublike/
25 Offenses and the rule of law in the Kyrgyz Republic, NSC, 2019
infarction and stroke has been developed and is
being implemented in the country.
There is a steady tendency towards a reduction of
the mortality rate from cardiovascular diseases by
13.8%, amounting to 265.7 per 100,000 people at the
end of 2018. There is an increase in the mortality from
malignant neoplasms by 7.5%, amounting to 65.6 per
100,000 people at the end of 2018. Due to enhanced
preventive measures (introduction of pneumococcal
vaccine) and improved early detection and treatment,
the mortality rate from chronic respiratory diseases
has fallen by more than 37%, mainly among children
under the age of 5. At the same time, mortality rates
from neoplasms (cancer) and diabetes increased by
more than 10% and almost 38% respectively, over the
same period.
According to STEPS 2013 data, the percentage of men
who smoke (48.2%) is much higher than that of women
(2.7%). In 2006, the country enacted a law to protect
citizens’ health from the harmful effects of tobacco.
Smoking is prohibited in educational and healthcare
institutions, children’s leisure organizations, and some
public areas. The country has also introduced warning
labels on cigarette packages and a limited advertising
ban.
With regards to the prevention of alcohol
consumption, in 2014, the total per capita alcohol
consumption per year in the Kyrgyz Republic
amounted to five liters, which can be considered
relatively moderate compared to the average per
capita alcohol consumption in the World Health
Organization (WHO) European Region at 10.7 liters
per year.23 Measures which have been taken to reduce
the harmful consumption of alcohol include raising
taxes on alcohol for domestic products, restrictions
on the advertising of alcohol beverages, and a ban
on the sale of alcohol in public transport, government
offices, parks, city squares, children’s areas, and
educational, medical, sports and cultural institutions
and organizations, as well as the adoption of stricter
legislation on blood alcohol levels when driving
(maximum 0.3 g/l).
The primary incidence of drug addiction fell from 865
in 2009 to 269 in 2017. Per each 100,000 persons,
the rate fell from 16.1 to 4.3, or by a factor of 3.7.
The number of registered drug-addicts also decreased
from 10,417 in 2009 to 8,818 in 2017 (-1,599, -15.3%).24
Snapshot: To develop responsive mental health services, in close proximity to the place of
residence, in 2017–2018, a project piloting integrated services was offered to people with severe
mental disorders in 8 primary health care facilities. The results of the pilot project revealed
a decrease in hospitalizations by 51%, a decrease in length of hospitalizations by 52%, and a
decrease in treatment costs confrmed by 54.7% of the surveyed patients and 41% of the people
supporting them.
Suicide is one of the acute issues globally, with
suicide rates acting as an indicator of both public
mental health and social well-being. Compared to
2012, the rate of mortality due to suicide decreased
by almost 35%, and by 2018 amounted to 6.0 deaths
per 100,000 persons.
One of the leading causes of death from injuries in
the Kyrgyz Republic is from injuries due to traffc
accidents. In 2012–2018, mortality due to road traffc
accidents in the Kyrgyz Republic decreased by one
third, from 16.5 to 11 deaths per 100,000, with 812
deaths registered per year.25
50
26 The Multiple Indicator Cluster Survey (2018 Report): NSC, UNICEF.
27 https://vizhub.healthdata.org/sdg/
Addressing the issues of public sexual and
reproductive health, including among adolescents,
remains an important task. These include issues
of early motherhood and low awareness among
adolescents about healthy sexual and reproductive
behavior. In 2018, 38% of women of reproductive age
reported using up-to-date contraception methods.
Women in urban areas and women with higher levels
of education and income were more likely to use
modern birth control methods.26 The proportion of
women of reproductive age (15–49 years old) whose
family planning needs were met by modern methods
had increased to 67% in 2018 as compared to 42%
in 2014.
The total fertility rate in the Kyrgyz Republic is 3.9
births per woman. This rate is higher in rural areas
(4.4), for women with low levels of education (4.2),
and for those with lower education (4.5). In 2018,
the birth rate among adolescents (15–19 years old)
was 35.9 per 1,000 women – a decrease from 42.1
in 2012.
Achieving universal health coverage (UHC) is among
the country’s top priorities. The Kyrgyz Republic is a
member of the International Health Partnership for
UHC 2030 and is a signatory to the Global Compact
for progress towards universal health coverage. The
Institute for Health Metrics and Evaluation (IHME)
assessment index 2017 ranked the Kyrgyz Republic
at 68.6 (on a scale from 0 to 100).27
Mortality due to limited access to safe drinking
water, sanitation and hygiene in the Kyrgyz Republic
decreased from 2.8 in 2012 to 0.8 cases per 100,000
people in 2018.
Measures are being taken to address the growing
cost of medicines. Efforts are being made to improve
access of patients to pain medication for medicinal
purposes, primarily through the modernization of
legislation and digitization (electronic licensing
and prescription) training of medical staff and
palliative care practitioners. Three new laws on
regulating medicines and healthcare technologies
were introduced in 2017.28 Additionally, a national
list of essential medicines was revised in 2018 and
an initiative was suggested to update the price of
supplementary drugs, with a focus on medicines for
high-burden diseases.
One of the key factors in public access to highquality medical services is health care personnel.
The healthcare system of the Kyrgyz Republic suffers
from high staff turnover and a general shortage
of medical workers. This is exacerbated by a lack
of new medical personnel and is connected to
the sector’s low wages. As a result, there are not
enough medical personnel to meet public needs. In
2018 there were 2.2 doctors and 5.6 paramedical
workers per 1,000 people as compared to 2.4 and 5.7,
respectively, in 2012.
II. Challenges
Cross-cutting issues and approaches to addressing
public health protection are not sufficiently
considered.
(Target 3.1) Maternal mortality remains one of
the key development challenges. Despite the
achievements of recent years, there are still many
factors slowing down progress toward the goal of
signifcantly reducing maternal deaths.
(Target 3.2) Child health protection also suffers
from issues such as insufficient levels of
knowledge and practical skills among primary
health care providers and hospitals in terms
of managing the most common diseases and
provision of emergency prehospital and hospital
child care. These factors lead to excessive
medicalization, as well as inefficient treatment and
use of resources. Among other issues are the rise
of vaccine rejections due to religious beliefs and
a lack of parental awareness regarding childcare,
dangerous signs of illness (leading to late referrals
Voluntary National Review on the Implementation of the Sustainable Development Goals in the Kyrgyz Republic 51
PEOPLE, FAMILY AND SOCIETY
28 The Laws of the Kyrgyz Republic on “Drug Circulation”, “Circulation of Medical Products”, and the “Code of the Kyrgyz Republic
on Violations”
29 “Prevention and control of non-communicable diseases in Kyrgyzstan: The case for investment”, WHO Regional Offce for
Europe, 2017
to health-care providers) and proper infant and
child nutrition.
(Target 3.3) Despite the fact that the country
manages to keep the spread of HIV infection at a
fairly low level, there are a number of issues that can
negatively affect the situation:
- the high level of stigmatization and discrimination
of People living with HIV (PLWHIV) makes people
with a potential risk of HIV infection fear HIV testing
and surveillance, adding to the epidemic;
- lack of proper understanding of HIV infection is
also a social issue, rather than only a public health
issue.
The Kyrgyz Republic has made certain strides
in curbing the tuberculosis epidemic through the
implementation of health sector reform programs in
recent years, but some issues persist:
- inconsistency of the existing regulatory
framework for managing state funded public
procurement of medicines and laboratory diagnostic
services;
- factors beyond the control of the program, such
as poverty, living and work conditions of illegal
migrants.
(Target 3.4) NCDs account for 80% of all deaths in
the Kyrgyz Republic.
Premature mortality, morbidity and disability
associated with NCDs impede socio-economic
development. Estimated economic losses in the
Kyrgyz Republic related to NCDs account for
approximately 4% of the country’s annual GDP.29
Prevention of NCDs is one of the key functions
of the public health service, but the number and
competence of personnel in the health service do
not match either the current needs or those posed
by new challenges.
(Target 3.6) Timely emergency medical care in road
accidents saves lives and reduces disability rates.
In this regard, it is essential to establish organized
systems for integrated emergency medical care.
Efforts are being made to improve equipment in
ambulance systems. Financial and technical support
is required to upgrade emergency medical services
to meet modern standards and the needs of the
population. There is also an issue of low coverage
and access to emergency medical services for
residents of rural and remote areas.
(Target 3.7) Not enough attention is paid to the
reproductive health of men, related oncological
diseases and public awareness raising on these
topics.
(Target 3.8) A key element of health sector reform is
ensuring health service delivery following the UHC
requirements. This is the single payer system for
health services managed by the Mandatory Health
Insurance Fund (MHIF), and the State Guarantees
Program (SGP) with associated preferential drug
provision programs. This requires comprehensive
policy implementation in the health sector over a
long period and addressing such challenges as:
- limited access to quality primary health care
services, laboratory services and diagnostic
procedures in rural and remote areas;
- lack of adherence to international standards by
laboratories of the public health service affecting
the quality and effectiveness of the entire system of
public anti-epidemic efforts (as licensing standards
do not meet current requirements for the quality of
laboratory diagnostic services).
(Target 3.9) A hospital safety assessment conducted
in 2016–2017 revealed that 24% of hospitals receive
water from artesian wells, considered dangerous
for use in medical practice due to the high risk of
contamination.
(Target 3.c) Barriers to tackling human resources
issues in healthcare include lack of effective
intersectoral mechanisms for attracting and retaining
52
personnel in the regions, access to standards, clinical
guidelines and protocols, and medical equipment for
doctors in remote regions.
III. Next steps
- enacting new approaches for the prevention
of diseases, development of public health, and
improvement of interagency coordination in matters
of public health;
- further strengthening primary health care by
expanding the scope and quality of services,
including integrated approaches to service
provision, optimizing and rationalizing medical
service provision (including hospital networks),
modernizing inpatient care, and increasing support
for public-private partnership projects in the
healthcare sector;
- strengthening financing system, expanding
compulsory health insurance to reduce the State
Guarantees Program deficit, and ensuring adequate
coverage of essential health services and medicines
to ensure equal public access and financial
protection;
- introducing innovative information technologies
and e-health services (telemedicine, single
information networks, etc.);
- developing the National Program for protection
of sexual, reproductive, maternal and child health to
provide for the provision of reproductive, maternal
and childcare services throughout the course of
life, thereby enhancing the health of women and
children.
|
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[
3
] |
{
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"file_id": "sdg-03/vnr-report-kgz-2020-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
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|
CSDG 3:
Ensure healthy lives and promote
well-being for all ages
CAMBODIA’S VOLUNTARY NATIONAL REVIEW 2019
OF THE IMPLEMENTATION OF 2030 AGENDA 52
Progress
Health status of the people has improved through expansion and increased coverage of medical facilities together
with increased social health protection system and measures to improve fnancing of the sector. Developments
within the health sector as well as sectors with direct effects on health such as infrastructure, economic growth and
poverty reduction all play major roles in improving the life expectancy and living conditions of the people. Average
life expectancy increased from 61.9 years in 2000 to 68.7 in 2005 (with gender average for men at 66.7 years and
women at 70.7 years).
Achievements have been made towards reducing infant and maternal mortality, new HIV infection and AIDS related
deaths, caused by other communicable and non-communicable diseases and risk factors affecting the health of
the people. Maternal mortality decreased from 472 per 100,000 live births in 2005 to 170 in 2014. Likewise, infant
mortality decreased from 66 per 1,000 live births in 2005 to 28 in 2014. Major expansion has been made in the
number of available health centers and medical staff. The number of health centers increased from 1,105 centers in
2014 to 1,205 in 2018 and hospitals increased from 97 to 123. There is also better availability of private clinics and
pharmacies.
New HIV infections in Cambodia haves steadily declined from 2015 and Cambodia has already achieved its target
90-90-90 before 2020. This has been recognized by the United Nations as one among only seven other countries.
Challenges
Despite progresses and improvements, the health sector still faces a number of challenges in terms of both
epidemiology and the health system that require both short- and medium-term solutions.
Epidemiology: Infant and maternal mortality and under 5 mortality and prevalence of malnutrition is still high if
compared to other countries in the region. Lack of knowledge of sexual and reproductive health of adolescents
and youth and increased adolescent pregnancies were emerging issues. HIV prevalence remain high among key
population at risk to HIV infection such as entertainment workers, gay men and other men who have sex with men,
transgender women and people who inject drugs. Deaths from tuberculosis remain high, and high incidences of drug
resistance especially for the treatments of TB and malaria remains a clinical challenge. Non-communicable diseases
and growth in aging population will need to be accommodated with improved infrastructure and health service.
Alcohol and drug use, insecurity, urbanization, environmental deterioration, and climate change all pose threats to
the health of the population but require multi and inter-sectoral responses.
CAMBODIA’S VOLUNTARY NATIONAL REVIEW 2019 53 OF THE IMPLEMENTATION OF 2030 AGENDA
Health systems: Major challenges faced include: (1) health services quality remain inadequate due to limited resources,
specifcally, human resources, in term of the number of staff and specialists, and diagnostics and treatment ability; (2)
inadequate capacity of public health system to deal with diseases and health problems related to CDs, NCDs, mental
health, and provide public health emergency response to emerging/re-emerging infectious diseases pandemics, and
disasters, (3) investments on health infrastructure including technology and information system remains limited; (4)
inappropriate health care seeking of the population, especially in rural/remote areas i.e. delay in seeking care, selfmedication; and (5) the mushrooming of private clinics also poses managerial issues for the Ministry of Health.
Another challenge is related to a decline of funding to eliminate HIV/AIDS in Cambodia, where the preventative
programs have focused on the key population groups. The external fund support has been decreased and this is a
big concern for Cambodia to reach its 95-95-95 target in 2025.
Key Policies/Accelerating Strategies
The Health Strategic Plan 2016-2020 (HSP3) is MOH’s strategic management tool to guide the MOH and all health institutions
as well as concerned stakeholders to effectively and effciently use their available resources to translate health strategies
into action. The HSP3 renews a long-term vision of the health sector development and re-affrms the MOH’s commitment to
meeting the stated vision. It outlines the strategic framework for further strengthening operations in the entire health sector
(both public and private), to address priorities, and to ensure consistent application of strategies across program. The HSP3
also contains the framework for monitoring and evaluating progress and results of its implementation. The plan also aims
to mobilize adequate fnancial resources, inform fscal allocation, and guide development assistance in the health sector.
The National Strategic Plan for a Comprehensive and Multi-sectoral response to HIV/AIDS (2019-2023) is under
development while the sustainability roadmap which is the RGC’s 2013 seven-point policy on HIV/AIDS and the RGC’s
2019 policy circular 2013 are being implemented.
Table 11: Progress of CSDG 3
Sources: CSDG Framework and ministries
CAMBODIA’S VOLUNTARY NATIONAL REVIEW 2019
OF THE IMPLEMENTATION OF 2030 AGENDA 54
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3
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{
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"language": "en",
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|
Cambodia’s Voluntary National Review (VNR) 2023
Review of Progress, Challenges, and Policy Direction of CSDGs 39
CSDG 3: Ensure Healthy Lives and Promote Well-being for All Ages
Progress
ogress on CSDG-Despite the COVID of 23 71with 3 has been remarkable 19 pandemic, pr
indicators on track. Life expectancy has increased from 62 years in 2008 to 76 years in
2021/2022. Under five and neonatal mortality rates declined from 35 and 18, to 16 and 8 per
1000 live births between 2014 and 2021/22, respectively. During the same period, maternal
mortality declined from 170 to 154 per 100,000 live births.
The National AIDS Authority has prepared and launched the 5th National Comprehensive and
Multi-Sectoral Strategic Plan for HIV and AIDS (NSPV) 2019–2023. In 2022 there were an
estimated 1400 new HIV infections (0.08 per 1000 uninfected population). Cambodia is firmly
committed to achieving the 95-95-95 goal5
by 2025 and is performing well. Though under 95%
(86%) of the 76000 people estimated to be living with HIV at the end of 2022 knew their status,
99% of these were on antiretroviral treatment and 98% were virally suppressed. In 2021,
Cambodia transitioned out of the global list of 30 high burden countries for tuberculosis. Malaria
incidence has declined from 1.95 per 1000 population in 2019 to just 0.24 in 2022, and there
have been no reported malaria deaths since 2018.
Whilst an estimated half of the noncommunicable disease (NCD) related deaths (now 67%
deaths) were from cardiovascular disease (CVD), chronic respiratory disease, diabetes, and
cancer combined, the mortality rate from these four key NCDs in 30–70 year olds remains lower
than targets. Reductions in tobacco use have continued. Less movement during COVID-19
caused a reduction in road traffic accidents, and although they rose again in 2022 they remain
lower than targets. COVID-19 increased the need for mental health services. Cambodian people
with mental health problems who received examination/treatment at public health facilities
between 2015 and 2022 averaged 100,000/year.
The Health Equity Fund (targetting low-income families through a national identification
mechanism) had a 25% increase in members between 2019 and 2022. Membership of the
National Social Security Fund for Health Care (NSSF) (covering private sector workers and
current and ex civil servants and veterans) grew by 63% between 2019 and 2022. The use of
health services by low-income families under the Equity Fund programme between 2018–2022
included 14,164,131 outpatients (2,832,826 per year) and 814,665 hospitalized patients
(162,933 per year). Government health expenditure as a percentage of GDP rose dramatically
over the COVID-19 period to 2021 in line with the RGC’s strong response but fell again in
2022.
Challenges
There are many challenges for health systems in the short and long term. First, health and socioeconomic recovery from COVID-19 continues, and the risks of these public health emergencies
will continue to grow. These include risks of emerging and re-emerging infectious diseases,
zoonoses, food borne diseases, and antimicrobial resistance – along with public health risks
related to environmental changes including climate change and natural disasters.
5
In December 2020, UNAIDS released a new set of ambitious targets calling for 95% of all people living with HIV
to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral
therapy, and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025.
Cambodia’s Voluntary National Review (VNR) 2023
Review of Progress, Challenges, and Policy Direction of CSDGs 40
Table 8: Progress of CSDG 3
Second, rapidly increasing levels of NCDs make up the major proportion of death and disability
in Cambodia (60% combined in 2019). Mental health is a concern, with COVID-19 estimated
to have increased the prevalence of depression and anxiety by 25% globally but the proportion
of people receiving treatment and support in Cambodia remains lower than targets. An ageing
population in the future will need further NCD and chronic disease treatments, as well as
rehabilitation, care, and social support.
Despite progress, reproductive, maternal, child, and adolescent health and nutrition, as well as
major infectious diseases remain health concerns, with COVID-19 slowing progress in a number
of areas. Progress in maternal and child health indicators for people in remote locations and
Cambodia’s Voluntary National Review (VNR) 2023
Review of Progress, Challenges, and Policy Direction of CSDGs 41
vulnerable groups is lagging. Particular attention is required for these groups to ensure that no
one is left behind and to achieve the CSDGs. Family planning needs must be met with modern
methods. Rates of new HIV infections have stagnated requiring further action to achieve targets
of HIV elimination.
Coverage and quality/safety of health services have not yet met the expectations of the
Cambodian people, especially in district referral hospitals and health centers. Improvements in
physical infrastructure, staffing, and availability of medicines/medical equipment are needed to
achieve national standards.
In addition, the Ministry of Health and sub-national administrations must continue strengthening
regulatory capacity to ensure both private and public sectors abide by national laws/regulations,
standards, and professional codes.
Policies
The next National Health Strategic Plan aims to ensure the health and well-being of all people
in Cambodia in 2023 and beyond. This includes strengthening resilient health systems to
respond to growing public health threats, maintaining and improving essential quality services
built on a people-centered, integrated primary healthcare approach, and ensuring progress
towards universal health coverage. A focus on innovation including digital health; strong
institutions and partnerships; a healthy workforce fit for the future; high performing health
financing; and strong institutions and partnerships will enable achievement of strategic
priorities.
First, there is a need to improve the health condition of the general population by: reducing
morbidity and mortality due to NCDs; treating mental health conditions; improving sexual
reproductive health services; improving maternal, child and adolescent health services; and
eliminating and controlling major infectious diseases.
Second, there is a need to strengthen the resilience and modernization of the health system.
Third, we must ensure strong governance and regulatory mechanisms for the future of the health
system in Cambodia.
|
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{
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"file_id": "sdg-03/vnr-report-khm-2023-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
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}
|
SDG
024
03
GOOD HEALTH
& WELL-BEING
Life Expectancy at
Birth
Under Age 5 Mortality Government Expenditure
on Health
NCDs
of all deaths
75 yrs 9.8/1,000 5.39% 62%
SDG 3: Good Health & Wellbeing
Ensure healthy lives and promote wellbeing for all at all ages
Saint Kitts and Nevis recognizes that a healthy population is our greatest asset, and the public health of its citizens
is crucial in achieving sustainable economic growth.
Te Federation has already achieved some of the targets under SDG3 well ahead of 2030. In the last thirty years,
life expectancy at birth increased from 66 years to 75 years. Progress has been made in key areas such as childhood
immunization, antenatal care, and neonatal mortality rates. Te proportion of the target population with access
to 3 doses of diphtheria-tetanus-pertussis (DTP3) was 96.0 % in 2021. Te infant mortality rate per thousand live
births improved from 25.1 in 1990 to 12.3 in 202116. Te neonatal mortality rate fell from 14.6 deaths per 1,000
live births in 2000 to 9.8 deaths per 1,000 live births in 2021 . Further, 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.
16. htps://unstats.un.org/sdgs/dataportal/countryprofles/kna#goal-3
SDG
025 14
Indicator 2021 Close to, Better than or
Worse than Latin America
& Caribbean (LAC)
Countries Average
Life Expectancy at Birth (Female) 76.8 years Close to LAC
Life Expectancy at Birth (Male) 74.2 years Close to LAC
Neonatal mortality (per 1000 live
births), 2016
9.8 Better than LAC
Under Age 5 Mortality Rate (per
1,000 live births)
9 Better than LAC
Child Immunization (DT3) (%) 96.0 Better than LAC
Maternal Mortality Ratio 16.2 Better than LAC
Proportion of births attended by
skilled health personnel (%)
99 Better than LAC
Source: WHO Database, Health at a Glance, World Bank Development Indicators
ʹͳ
ǡ
ǡ ͳͶǤ
Ǥ
ǡ
ǡ
ǡ
ǡ
Ǧ
ȋȌǡ
Ǥ
Indicator 2021 Close to, Better than or
Worse than LAC
Countries Average
Hospital beds per 1,000 population 4.8* Better than LAC
Doctors per 1,000 population 2.7 Close to LAC
Nurses per 1,000 population 4.2 Better than LAC
Psychiatrists per 100,000 population 5.5 Better than LAC
Health Spending per capita (USD, ppp) 1442 Better than LAC
Out-of-pocket expenditure on health
(% of health spending)
48 Worse than LAC
Source: Health at a Glance: Latin America and the Caribbean 2020, * as at 2012
Source: WHO Database, Health at a Glance, World Bank Development Indicators
Source: Health at a Glance: Latin America and the Caribbean 2020 ( *as at 2012) 14
Indicator 2021 Close to, Better than or
Worse than Latin America
& Caribbean (LAC)
Countries Average
Life Expectancy at Birth (Female) 76.8 years Close to LAC
Life Expectancy at Birth (Male) 74.2 years Close to LAC
Neonatal mortality (per 1000 live
births), 2016
9.8 Better than LAC
Under Age 5 Mortality Rate (per
1,000 live births)
9 Better than LAC
Child Immunization (DT3) (%) 96.0 Better than LAC
Maternal Mortality Ratio 16.2 Better than LAC
Proportion of births attended by
skilled health personnel (%)
99 Better than LAC
Source: WHO Database, Health at a Glance, World Bank Development Indicators
ʹͳ
ǡ
ǡ ͳͶǤ
Ǥ
ǡ
ǡ
ǡ
ǡ
Ǧ
ȋȌǡ
Ǥ
Indicator 2021 Close to, Better than or
Worse than LAC
Countries Average
Hospital beds per 1,000 population 4.8* Better than LAC
Doctors per 1,000 population 2.7 Close to LAC
Nurses per 1,000 population 4.2 Better than LAC
Psychiatrists per 100,000 population 5.5 Better than LAC
Health Spending per capita (USD, ppp) 1442 Better than LAC
Out-of-pocket expenditure on health
(% of health spending)
48 Worse than LAC
Source: Health at a Glance: Latin America and the Caribbean 2020, * as at 2012
Public health services are delivered through a network of 21 health facilities at the primary, secondary, and tertiary
levels with 14 in St. Kitts and 7 in Nevis. Most parishes within the Federation have at least one health facility within
three miles of every household. Te health team at the primary level provides services such as medical clinics,
maternal and child health, community mental health, dental care, screening for non-communicable diseases
(NCDs), and prevention and control of communicable diseases.
SDG
026
Adequate access to health care is a function of several indicators including medical infrastructure availability
(number of hospital beds per 1,000 population), and human resources availability (doctors per 1,000 population,
nurses per 1,000 population, and psychiatrists per 100,000 population). Government expenditure on health in 2019
was estimated at 5.39 percent of GDP which is consistent with other Caribbean countries but below the average
of developed countries. Approximately 52 percent of health expenditure is funded through public sources while
the balance is via private spending, which includes out-of-pocket (OOP) payments and insurance disbursements.
Despite signifcant progress in the health sector, St. Kitts and Nevis faces several challenges, including a high
prevalence of non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and cancer due
largely to unhealthy diets and lifestyles; policy and legislation; human resources for health and infrastructural and
plant maintenance.
NCDs account for 62 percent of all deaths compared to 85 percent a decade ago. Te highest-ranking causes of
years lost due to premature deaths are neoplasm, cerebrovascular disease, and diabetes mellitus. Te burden of
chronic and age-related diseases increases along with the demand for quality healthcare, and this has led to an
upward trending healthcare expenditure. Te GoSKN has expressed concerns about the morbidity and mortality
associated with chronic NCDs attributed to tobacco use, limited physical activity, unhealthy diets, and the harmful
use of alcohol as some of the main lifestyle factors that are driving the upsurge of NCDs. Te consumption of
alcohol is about 8.9 litres per capita similar to the consumption pattern of countries in the Latin America and
Caribbean region but above the world average of 5.8 litres per capita 17.
Te overall strategic direction of the health sector is guided by the National Strategic Plan for Health (2017-2021)
which aims to provide equitable access to quality health services that are available and afordable to all users in the
Federation. To address the increasing incidence of NCDs, the Government launched the National Multi-Sectoral
Plan for the Prevention and Control of Non-Communicable Diseases in St. Christopher and Nevis (2018-2022).
Te NCD Plan defned 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. It targeted a 10 percent relative reduction
in preventable, premature deaths as a result of NCDs in St. Kitts and Nevis by 2021. An NCD Commission was
re-instated to coordinate and create an enabling environment for the promotion of health and wellness through
the prevention, control, and management of NCDs.
In 2017, St. Kitts and Nevis was certifed by the World Health Organization (WHO) for having eliminated motherto-child transmission (EMTCT) of HIV and Congenital Syphilis. Te Ministry of Health (MOH) adopted the
United Nations 90-90-90 targets, to measure interventions toward the global ambition of eliminating HIV by 2030.
Te targets are: 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed
HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy
will have viral suppression. As of end-2020, an estimated 185 individuals were living with HIV/AIDS, of which a
total of 60% (111) individuals were receiving anti-retinal treatment and 57% recorded a suppression in viral load.
17. htps://www.who.int/data/gho/data/indicators/indicator-details/GHO
SDG
027
GoSKN has strengthened its response to Mental Health. Since December 2016, it opened the Dr Arthur Lake
Mental Health Treatment Centre, increased the number of psychiatrists and mental health workers, and adopted a
community-based approach to deliver mental health services. Recently, especially during the COVID-19 pandemic
period, there have been increased mental health promotion and prevention campaigns through various media
platforms that seek to reduce the stigma and promote mental wellness and awareness among residents.
In the 2023 Budget address, GoSKN outlined its intent to increase public investments in health care toward the
PAHO benchmark of 6.0 percent of GDP through infrastructure upgrades, equipment purchases and additional
health personnel. In addition, the Budget signalled an intention to establish a National Health Insurance (NHI)
scheme following extensive public consultation.
COVID-19 and Health
Te COVID-19 reality brought unprecedented challenges and changes to everyday life. Te top priority of the
Government of Saint Kitts and Nevis was the health and protection of its citizens, as well as providing support to
cushion the social and economic fallout from the pandemic. Te Government implemented prompt public health
interventions, including non-pharmaceutical measures, and active contact tracing, with extensive and targeted
testing, which proved efective in controlling outbreaks. As of May 2023, 82.8% of the adult population in Saint
Kitts and Nevis had received their frst shot and 77.7% were fully vaccinated against COVID-19.
Dr. Arthur W. L. Lake Mental Health Day Treatment Centre
SDG
028
Bright Spots and Success Stories
• Te adoption of the Republic of China (Taiwan) sponsored Metabolic Disease Project aims to minimize
the incidence of NCD’s through the prevention and management of diseases such as heart disease, obesity,
hypertension, cancer, diabetes, hyperlipidemia by the reduction of associated risk factors. Te project has been
designed to run for four (4) years and will be a tremendous help in combating the efect of NCDs given the
closure of the Renal Clinic which has been a major success in helping to combat diabetes mellitus. Additionally,
the MOH was able to increase its trained staf compliment as graduates from the Stanford University Diabetes
Self-Management Programme were added to the cadre of trained personnel in 2020. Tey are equipped to
train others in self-care activities and can be utilized in the MOHs community outreach eforts to infuence
lifestyle change, screen, and detect new cases of Chronic NCDs and link those cases to management and care.
• Te reduction from 85 percent to the current average of 62 percent of NCD related deaths can be attributed
to the success of the Metabolic Screening Project and the overall Non-communicable Diseases programme
coordinated by the Ministries of Health in St. Kitts and Nevis. Over the period 2021 to 2022, the Metabolic
Screening Project recorded increases in the total screening exercises [79 in 2021 and 138 in 2022]; and the total
number of persons screened [4,053 in 2021 and 6,348 in 2022].
• Te SKN Moves initiative remained a linchpin in the fght to reduce adult and youth obesity. Te initiative
has taken root and has garnered the participation of multi-sectoral collaborators and participants since its
inception. Te GoSKN continues to implement several programmes to combat the challenges posed by noncommunicable diseases (NCDs). One such programme, SKN MOVES was launched on August 15, 2019, in
both St. Kitts and Nevis. SKN Moves is part of a
regional initiative Caribbean Moves adopted by
CARICOM in 2018 that encourages a lifestyle
change particularly by promoting good health
by focusing on three (3) main aspects: physical
activity, healthier diets, and knowing one’s health
status. Te national health education plan focuses
on the importance of diet and exercise which
should be routine practice to prevent and control
NCDs.
• Having eliminated the mother to child transmission of HIV and syphilis status the focus has shifed to
sustainability and the MOH continues to strengthen the prevention, management and control of HIV and
other sexually transmitted diseases. Continual eforts are being made to prepare a plan of action to guide the
2030 report on the 90/90/90 targets and to achieve the targets identifed by the United Nations. Tat is 90%
of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will
receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral
suppression. Statistics for 2020 show that over the past four (4) year period 2017-2020 approximately 185
individuals were living with HIV/AIDS. As of the end of 2020, a total of 60% (111) individuals were receiving
anti-retinal treatment and 57% recorded a suppression in viral load.
SKN Moves Walk, May, 2023
SDG
029
Te Joseph N. France General Hospital on St. Kitts was granted Baby-Friendly Certifcation afer meeting the ‘Ten
Steps to Successful Breastfeeding” which is the Global Standard against which maternal facilities are assessed and
accredited in October 2022. Te initiative was spearheaded by the Nutrition Surveillance Unit within the Health
Promotion Unit of the Ministry of Health. Activities are underway to have the Alexandra Hospital in Nevis BabyFriendly certifed.
Te MoH also has an ongoing collaboration with Stanford University Self-Management Programme which to
date has facilitated the training of forty-two (42) persons in the train-the-trainers workshops since its inception in
2015. In 2019 many of these persons delivered training to over 100 persons on how to better manage their NCD.
During the last fve years, PAHO provided technical assistance and support in key areas such as:
• Conducted consultancy to review legislation and draf a National Health Insurance and Security Act and
draf legislation to support the development of a Health Protection Scheme
• Combatting NCDs, cervical cancer prevention and development of control strategies
• Reviewing draf policy for Sugar Sweetened Beverages (SSB) taxation
• Strengthening of radiology services in St. Kitts and Nevis
• Workshop for healthcare professionals in Nevis to address mental health
|
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48 The Second Voluntary National Review Report on SDGs (VNR2) – 2023
SDG 3:
GOOD HEALTH
AND WELL-BEING
Ensure healthy lives and promote well-being
for all at all ages
119 As it was mentioned in the COVID-19 Section above, signifcant eforts were made to ensure equal and adequate access to quality health care for All.
120 State Audit Bureau (2020). Achievements of the State Audit Bureau towards achieve the Sustainable Development Goals – Annual Report, Twelfth Edition.
121 https://rho.emro.who.int/sites/default/fles/booklets/EMR-HIS-and-core-indicators-2020-fnal.pdf
Kuwait has recently witnessed a positive development in the
feld of health services and care (see section on COVID 19 and
Building Back Better119). It has enhanced the quality of health
services provided through numerous projects while keeping
up with the technical developments in this feld, boosting the
level and outreach of public health and ensuring highest and
advanced health care for all individuals120. Other signs of progress are seen in the dramatic decrease in trafc death rates
and the increase in surviving infants who received the two
WHO-recommended vaccines. The slight drawback, however,
is due to the increase of tuberculosis incidence from 25 per
100,000 in 2012 to 28 per 100,000 in 2017. Ofcial data on new
HIV infections and on age-standardized death rates due to
cardiovascular disease, cancer, diabetes, and chronic respiratory diseases in adults aged 7 to 30 years are rather lacking for
now while eforts are underway to close this data gap in near
future. With respect to TB, WHO 2022 reports a case incidence
rate of 17.1/100,000 in 2021 versus 18.8/100,000 in 2019121.
However, Kuwait’s current health system may still be facing a
few challenges, particularly in terms of the rising prevalence of
non-communicable diseases as a result of unhealthy diets, sedentary lifestyles and exposure to pollution, and the increasing
cost of health services. In addition, life expectancy at birth has
decreased in recent years and the prevalence of diabetes has
become one of the world’s highest, despite slight improvements in the most recent assessment. Attention will therefore
be required to improve the performance of the organizational structures considering the persistent challenges including
the inadequate structure of administrative organizations, the
competition between departments, the shortage of needed
The success of the national campaign to vaccinate against the Corona virus
by achieving herd immunity in the State of Kuwait
The Second Voluntary National Review Report on SDGs (VNR2) – 2023 49
specialists and the dependence on foreign experts, and the
limited health promotion laws, policies, and programmes.
Kuwait is working to secure cutting-edge medicines and technologies to hone the expertise of the health personnel and
enlist the needed specialists. The State of Kuwait is considering
further investment in information technologies with a view to
automating data and making it available for use throughout
the health system. As the current system emphasizes a treatment-oriented approach and puts a focus on infrastructure,
such as hospitals, there is a gap between the goal of improving
the health and well-being of the residents and the outcomes
resulting from the current system. Priority would therefore be
primarily given to ensuring good governance and planning,
validating policies with evidence-based measures of progress,
adopting a sustainable fnancial framework, nurturing new
technologies and knowledge industries, creating a modern
and comprehensive information system122 and enhancing the
health workforce123.
On SDG target 3.8 i.e., “achieve universal health coverage,
access to quality essential health-care services and access to
safe, efective, quality and afordable essential medicines and
vaccines for all”, Kuwait has a commendable record to show,
in partnership with a number of national and UN partners.
Furthermore, by virtue of funds received through private sector contributions, the International Organization for Migration
(IOM) procured and disseminated PPE kits for more than 4,000
vulnerable foreign laborers who continued to perform their
daily functions despite the associated health hazard. The support covered six governorates in the State of Kuwait, reaching
out to residents at government-run shelters and servicing female foreign workers in particular, together with psychosocial
support workshops124. An expatriate workers’ awareness campaign for the prevention of COVID-19 was also launched and
made available into 12 languages. (IOM, 2022).
In addition to the COVID-19 related government achievements, many eforts were deployed by non-government partners to fully meet SDG 3. For instance, the Women’s Cultural
and Social Society implemented several initiatives including
an awareness programme on Alzheimer (considering its relative high prevalence). A “Hope Club” (
including an awareness programme on A
A “Hope Club” ( يدان لملأا ( has
nother “Hope Fund” (
) has also
122 Worth noting in this context that Kuwait has recently piloted ICD-11 in Farwaniya hospital in partnership with WHO , thus being amongst the frst in the world
to do so, which paves the way for improving the quality of mortality and morbidity statistics.
123 KPPC, Policy Paper for the Health Pillar. Overview of Gaps, Challenges, and Way Forward in Kuwait National Development Plan 2015-2020, 2019; White Paper for
the Health Pillar National Health Policy Framework: Ensuring Healthy Lives and Wellbeing
124 International Organization of Migration (2021). IOM Kuwait Newsletter: A Year in Review. Retrieved from https://mailchi.mp/e68a34033f64/january-to-december-15749513?fbclid=IwAR2a83zvtu2gY5-RH8mEzN3WIRf_fJfa3VBafVHOQIOdCFLfBl8ywLomx3E
125 Women Cultural and Social Society, 2022
been providing moral and fnancial support to cancer patients
since 1987, and another “Hope Fund” (
) has also been providing moral and financial support
“Hope Fund” ( قودنص لملأا ( provid
As to the issue of overweight prevalence, the Women’s Cultural and
) providing
fnancial support to sick people with fnancial difculties. As
to the issue of overweight prevalence, the Women’s Cultural
and Social Society has set up an “AquaTots” swimming school
(the frst branch of a US-based school in the GCC) to provide
swimming lessons for boys and girls, aged between 6 months
and 12 years, and to persons with disabilities and the elderly.
The Society also set up a ftness center (Fitnessity), providing
ftness sessions to women and girls of all ages, in addition to a
number of awareness and sensitization sessions on health-related topics regarding breast cancer among others125.
On indicator 3.1.1, Kuwait has been recording a signifcantly
low maternal mortality ratio (MMR) between 2012 and 2020,
both for nationals and non-nationals. Despite the relative
dents in 2014 and 2019, 2020 recorded a near Zero (MMR).
As to births attended by a skilled health personnel, the indicators have recorded a near universal (more than 99.99 per
cent) rate between 2012 and up till 2020 for both, nationals
and non-nationals. The latest data recorded regarding indicators 3.2.1 and 3.2.2 can also be reported to have been
fully achieved given that the current records have signifcantly
Figure 15: Maternal Mortality Ratio / 100,000
Live Births by Nationality, 2012–2020. CSB of
Kuwait (2022). SDG 3 – Ensure healthy lives and
promote well-being for all at all ages.
50 The Second Voluntary National Review Report on SDGs (VNR2) – 2023
surpassed the target set for 2030126. As for most components
of targets 3.3, they are all on track to be achieved by 2030 as
per the CSB data in 2022. Indicator 3.3.3 is not relevant, since
Kuwait is free from Malaria, when only very minor imported
cases may be found, primarily among expatriates coming
from endemic areas. The same applies to indicator 3.2 (see
fgures below provided by CSB127).
Lending its support to the health sector as well, Al Eslah Society
launched in 2021 the “Compassion for the Treatment of Rheumatoid Patients” project, “Boshrakum Sclerosis” and the “Hope”
project for the treatment of cancer patients inside the State
of Kuwait. It equally launched its medical convoys and quality
projects outside and from Kuwait Convoys of eye operations
and medical clinics. In terms of curative health programs, Al Eslah Society spent 314,300 dinars on 213 patients with types of
cancerous tumors and sclerosis, with high costs that those who
benefted from were unable to cover their expenses128.
126 CSB of Kuwait (2022). SDG 3 – Ensure healthy lives and promote well-being for all at all ages
127 CSB of Kuwait (2022). SDG 3 – Op. cit.
128 Social Reform Association – Leadership Sustainability Report 2021
129 CSB of Kuwait (2022). SDG 3 – Ensure healthy lives and promote well-being for all at all ages
130 WHO, Monitoring health and health system performance in the Eastern Mediterranean Region 2021, 2022 Reports
As for target 3.4, the data provided refect a fairly stationary line. While indicator 3.5.2 is not applicable in Kuwait,
recent data show that indicator 3.5.1 has already been fully
achieved. Moving to target 3.6, i.e., “mortality rates due to
road trafc accidents”, recent data show a gradual decrease
over the years for both nationals and non-nationals with a
rate of 12.8/100,000 (2012) and 7.7/100,000 (2020) respectively,
whereas the target to be achieved by 2030 is 8.7/1000129. In
terms of target 3.7, both 1 and 2, recent data support the
prospects of full achievement in 2030. It is important to mention that the mortality rate associated with road trafc injuries
was estimated at 15.4/100,000 in 2021, as road trafc injuries
continue to pose a public health challenge in Kuwait130.
Figure 16: Under fve-mortality rate, CSB,
SDG3, 2022
Figure 18: TB Incidence Rate, CSB, SDG3, 2022
Figure 17: Neonatal Mortality Rate, CSB, SDG3,
2022
Figure 19: Number of People Requiring
Interventions against neglected tropical
diseases, CSB, SDG3, 2022
The Second Voluntary National Review Report on SDGs (VNR2) – 2023 51
Indicator 3.8.1, relates to the whole spectrum of health protection, promotion, prevention, treatment and care. Accordingly, and as per the records of the Ministry of Health, it is reported to be rather stationary131. Furthermore, mortality rates
due to unsafe WASH services or unintentional poisoning (target 3.9) are reported to be decreasing over the years, and the
target is reported to be on schedule to be achieved by 2030
in spite of a passing occasional dent (CSB SDG3, 2022). When
it comes to immunization prevalence, the fgures for Kuwait
are relatively high and are on track to be fully achieved by
2030 (indicator 3.b.1). The same observation applies to the
density and distribution of health workers, which have been
increasing throughout the years and are therefore on track to
be fully achieved by 2030 (indicator 3.c.1).
The State Audit Bureau lends consistent support to government eforts aimed at enhancing the quality of health care
services, through auditing and evaluating projects that are
designed to enhancing health services. This has been the case
in projects such as i)) the Natural Medicine Building Project;
ii) Kuwait Medical City Company; and iii) feld and monitoring
visits to diferent medical centers and hospitals132.
Of notable progress under SDG3 is the wide expansion of the
healthy cities’ initiative under the leadership of MOH healthy
131 CSB of Kuwait (2022). SDG 3 – Ensure healthy lives and promote well-being for all at all ages
132 State Audit Bureau (2020). Achievements of the State Audit Bureau towards achieve the Sustainable Development Goals – Annual Report, Twelfth Edition.
cities ofce and the WHO. Yarmouk City, Dhahiyat Abdullah
AlSalim and AlShamiya have all been designated as WHO
Healthy Cities and work multisectorally to sustain this designation. Other cities have registered to the national network and
working towards this designation.
Figure 21: Health Worker Density and
Distribution/1000 Population by Category and
Ownership, CSB, SDG3, 2022
Figure 20: Mortality Rate from Road Traffc,
Injuries/100 000 Population by National /
Non-National, CSB, SDG3, 2022
2012
0
5
10
15
20
2013 2014 2015 2016 2017 2018 2019 2020
Kuwaities Non-Kuwaities Total Linear (Total)
Yarmouk Healthy City The frst healthy city in Kuwait by World Health
Organization
|
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[
3
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{
"country": "kwt",
"file_id": "sdg-03/vnr-report-kwt-2023-en-4.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
22
23
3.1. Progress and challenges
Lao PDR has achieved the MDG target
of reducing its maternal mortality ratio
(MMR) by three-quarters from 1990
levels. Over the past two decades, MMR has
declined from 1,100 per 100,000 live births
in 1990 to around 220 in 2013 (estimated by
United Nations Agencies32) and 206 in 2015
according to the Lao Population & Housing
Census. Major hospitals can provide caesarean
services, and basic emergency obstetric and
newborn care services are available in every
district. Nonetheless, MMR is still high by any
standards.
Lao PDR has also made signifcant progress
in reducing under-fve and infant mortality.
In 2015, these had declined to half the levels
in 1990. The most recent survey shows that
in 2016/17, under-fve mortality rate has now
declined to 46 per thousand live births, which
is a signifcant achievement. Immunization
programmes have made good progress,
although still below the levels required to
induce herd immunity and reduce the threat
of outbreaks.
The high MMR is explained by the limited
coverage and inadequate quality of services,
poor nutrition, and low contraceptive use.
About 64 percent of births (2016/17) are
assisted by trained health personnel33 and
64.5 percent of deliveries take place in health
facilities (2016/17), which shows improvement
from the 2011/12 survey. Service quality and
referral systems need improvement. High
anaemia rates, low contraceptive use34 and
high fertility rates are also major contributors
to high maternal mortality. Among married
women and women in union, the unmet need
for modern contraceptives is still high (28
percent in 2016/17).
Adolescent pregnancy requires attention.
Despite achieving adolescent birth rate of
83 per 1000 live births (the national target
was 90), this rate remains one of the highest
in the region. The high adolescent birth rate
requires prioritizing the availability and use of
contraceptives, especially among unmarried
adolescents who still have diffculties in
accessing such services, despite the national
policy on birth spacing.35 The rate is highest
among adolescents with little or no education
or those living in areas without road access.
Disparities in maternal and child health
service coverage and outcomes are
pronounced. The lowest coverage levels are
in rural areas without road access, among
women with primary or no education, women
from the poorest households, and women
from ethnic communities living in remote
areas. The disparities are starkest between
poverty quintiles: in 2011/12, the richest and
poorest quintiles had up to 80 percentage
points difference in maternal health services
coverage. Mortality rates are much higher
among children from the poorest and/or most
remote households, and those born of mothers
with no education, adolescent mothers, and
mothers who are older (above age 34 years).36
HIV prevalence has been generally low. HIV
prevalence among female sex worker remains
stable (1 percent), but shows an increasing
trend in men having sex with men, from 1.6
in 2014 to 2.4 percent in 2017. The overall
knowledge on HIV remains low.37 Progress
on the three global targets for HIV treatment
scale-up beyond 201538 is constrained by
diffculties in reaching people living with HIV
(PLHIV) and referral to treatment. In 2017,
around 75 percent (11,876) of the estimated
PLHIV in Lao PDR knew their status and 47
percent of PLHIV were receiving antiretroviral
therapy, which is well below the global target.
Some 75 percent of those on antiretroviral
therapy had suppressed viral load.39
Lao PDR has achieved more than 90 percent
treatment rate of young children with
confrmed malaria40 but malaria resurgence
threatens its steady progress. From 2000 to
2011, malaria cases and deaths declined by
half. From December 2011, outbreaks with a
confrmed artemisinin-resistant strain led to
a sharp rise in cases and deaths. The demand
for forest products, infrastructure projects
near or in forested areas, and porous borders
heighten migration-related malaria risk. Bed
net coverage will need to improve: a 2016
survey in three high malaria burden provinces
found only 74.3 percent of children under age
fve using long-lasting insecticidal nets.41
TB treatment success rate is over 90 percent
and from 1990 to 2014, Lao PDR more than
halved the prevalence of all forms of TB. TB
incidence has also declined. However, mortality
due to TB does not show a declining trend.42
TB detection needs to be urgently improved:
around one-third of cases are detected and
the rest remain undiagnosed and untreated. 43
Non-communicable diseases (NCDs) and
injuries pose a growing threat. An estimated
48 percent of total deaths in Lao PDR in
2014 were due to NCDs.44 The World Health
Organization (WHO) has identifed adult risk
factors, among them a high rate of tobacco
24
use.45 An estimated 9 percent of total deaths
in the Lao PDR were attributed to injury.46
Road accident statistics show a rise of the
death rate from road accidents, from 8.6 per
100,000 in 2006 to 15.3 per 100,000 in 2015.47
The increase is largely associated with unsafe
road conditions, rapid expansion of roads,
the growth in the number of motorbikes and
vehicles, inexperienced motorists, and limited
capacity to enforce traffc laws and regulations.
Out-of-pocket spending has been a
dominant source of fnancing for health.
A persistently high level of out-of-pocket
spending (45 percent in 2016) remains a major
challenge for the country’s progress towards the
universal health coverage target. The country
is highly dependent on the Global Fund and
Gavi - the Vaccine Alliance - for the fnancing
of its immunization, malaria, tuberculosis (TB),
and HIV/AIDS program. Lao PDR entered the
accelerated transition phase of Gavi in 2017
and is now undergoing the transition process.
The country needs to accelerate progress
towards the universal health coverage target,
while effectively managing the transition from
external fnancing to more sustainable and
predictable fnancing.
Measurement issues: Systems to report on the
older (MDG) targets need review and those for
new SDG targets need further development.
Health information systems and the civil
registration and vital statistics system need
strengthening. Inadequacies in these systems
affect the quality of service data. Surveys such
as the Lao Social Indicators Survey provide a
useful countercheck of administrative data and
show substantial differences with health service
data on some indicators, such as immunization
and antenatal care. Improvement of country
monitoring systems will require identifying
and including SDG indicators that currently
lie outside existing administrative reports.
The established monitoring systems are not
yet equipped to monitor indicators specifc to
adolescent girls.
3.2. Looking forward
The Government of Lao PDR is prioritizing the
following strategies:
• Improving service accessibility,
availability and ensuring acceptable
quality. This includes expanding outreach
as well as improving the quality of services
at all levels.
• Accelerating health system reform.
The Ministry is prioritizing improvement
of health staff quality and availability,
especially in remote areas. Increased
and sustained levels of funding are also
necessary to fund health commodities
and accelerate interventions in poorer and
remote areas. Health education, sanitation
and other preventative health interventions
need to be stepped up. Management and
logistics systems for health supplies and
essential drugs need strengthening to
address frequent stock outs.48
• Addressing behavioural and other
factors impeding the response to HIV/
AIDS. These factors include cultural taboos,
diffculties in reaching the key high-risk
populations, and the mobility of young
migrant populations. The limited capacity
and coverage of health care services
constrain the integration of HIV testing and
treatment into the health care system.
• Stepping up efforts to combat malaria
with Greater Mekong Sub-region
partners. Lao PDR has committed to
achieving malaria elimination by 2030,49
together with China, Myanmar, Thailand,
and Viet Nam.
|
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34
SDG 3 – Good Health and Well-Being
(Ensure healthy lives and promote well-being for all at all ages)
35
Significant progress made against core health indicators.
Progress on the ten core indicators in the Health Sector Development Plan
Indicator ndic Source 2019 Source 2020 Target
1 Underweight prevalence 25.5 LCAAS 21.1 LSIS 20
2 Infant mortality rate 51 UN estimation 40 LSIS 30
57 Census
3 Stunting prevalence 35.6 LCAAS 33 LSIS 32
4 Under-five mortality rate 67 UN estimation 46 LSIS 40
86 Census
5 Maternal mortality rate 197 UN estimation 160
206 Census
6 Proportion of births attended by
trained health personnel
54 MoH: NHSR
2014-15
64.4 LSIS 80
7 Proportion of population using an
improved drinking water source
85.7 CEHWS 83.9 LSIS 90
8 Proportion of population using an
improved sanitation facility
69.3 CEHWS 73.8 LSIS 75
9 Vaccination coverage 79.5 MoH 66 LSIS 95
10 Health insurance coverage rate 32 MoH 71 MoH 80
Source: Ministry of Health – data provided for the 8th NSEDP review.
Health infrastructure and expansion
The Government have made concerted efforts to improve the facilities and services at all levels
with support from all partners. These include the following:
Village level. The number of Healthy Villages11 has grown to 5,676, representing 67% of
all the villages across the country. Some 84% of the 1,020 health centers across the country
are equipped to perform deliveries. Some 12% or 12 of the 103 health centers in the Three
Build districts have been upgraded. In total, 9% of all health centers in the country have
been upgraded to ‘small hospitals.
District level. There are now 135 district hospitals in 148 districts, compared to 127 in 2010.
Some 21.5% of these hospitals are able to provide comprehensive emergency obstetric and
neonatal care services, an improvement from 14% in 2015.
Provincial and central level. Of the 17 provincial hospitals (1,979 beds), two meet health
reform requirements (Houaphanh and Xiengkhouang province hospitals). Provincial
hospital personnel across the country have had their capacity upgraded in the use of medical
technology. Certain provincial hospitals are able to provide quality services equivalent to
that of some central level hospitals. At central level, there are five hospitals and 3 special
treatment centers.
HIV/AIDS trends. HIV prevalence has been generally low in Lao PDR. The HIV prevalence
among the reproductive-aged population (15-49 years) is estimated as 0.3%. While HIV prevalence
among female sex worker remains stable (1%), it is increasing in men having sex with men (MSM),
from 1.6% in 2014 to 2.4% in 2018. The overall knowledge on HIV remains low: comprehensive
knowledge about HIV prevention among women and men has not improved and has even
declined. There was an estimation of 780 new infections and about 500 AIDS-related deaths in
2019. HIV treatment and scale-up - Progress on the three global targets for HIV treatment scale-up
11 The Model Healthy Villages program was established by the Lao PDR Ministry of Health in 2011. It combines eight elements of primary health
care, including water supply, sanitation, village health volunteers, village drug kits, sleeping under mosquito nets, immunization, birth spacing,
breast feeding, antenatal care, risk case referrals, and birth and death reporting (Ministry of Health 2011). The Seventh Five‐ Year Health Sector
Development Plan (2011‐2015).
36
beyond 201512 is constrained by difficulties in reaching people living with HIV (PLHIV) and
referral to treatment. In 2019, 56% of PLHIV were receiving antiretroviral therapy (increased from
32% in 2015); and around 46% of those on antiretroviral therapy had suppressed viral load.
Malaria, and Tuberculosis control. Malaria - The utilization of insecticide-treated bed-nets
(ITNs) is on track: the recent survey conducted by the Ministry of Health in three high-malaria
burden provinces showed 1.6 people per net against the target of 1.5 people per net. The
percentage of children under age 5 sleeping under ITNs was 74.3% in 2016 (MoH data). The
mortality rate from malaria remains low (0.03 per 100,00013 in 2015 and 2019). Tuberculosis -
Treatment rate for TB cured under DOTS and others was 87% in the first six months of 2018 (in
2015 it was also 87%). TB detection needs to be urgently improved. TB detection rate has
improved from 37% in 2015 to an estimated 50% in 2019.14
Non-communicable diseases - A growing threat. Some 59.6% of all deaths for all ages in the
country were due to non-communicable diseases (NCD) in 2017. Coronary heart disease in Laos
reached 5,769 or 13.5% of total deaths, according to the latest WHO data published in 2017. WHO
has identified adult risk factors in Lao PDR, among them a high rate of tobacco use. The agestandardized NCD mortality rate per 100,000 population in 2016 was 780.6 (829.9 for males and
739.4 for females).15 The Ministry of Health has started NCD prevention and control with an
action plan for NCD 2014-2020, including through a holistic approach involving other sectors to
encourage physical activities and reduce the risk factors for NCDs at community level. Death from
injury. Injuries, estimated as 9% of total deaths in the Lao PDR, are mainly from road accidents.
Road accident statistics show a rise of the death rate from road accidents, from 14.2 per 100,000
in 2015 to 15.5 per 100,000 in 2016, 15 per 100,000 in 2017 and 14.12 per 100,000 in 2018. The
increase is largely associated with limited capacity to enforce traffic laws and regulations, unsafe
road conditions, and the growth in the number of motorbikes and vehicles.
Health systems during pandemic
The COVID-19 pandemic posed significant challenges to the health system in Lao PDR. Data
from health facilities compared to past years clearly shows a drop in use of essential health and
nutrition services, specifically for vulnerable population including mothers, newborns, children
and adolescents. The global social and economic crisis triggered by COVID-19 poses grave risks
to the nutritional status and survival of young children, with long term impact on human capital.
The COVID-19 pandemic is an opportunity for Lao PDR to build crisis-resilience through
strengthened and more systemic health and social protection measures for all. However,
this will require setting policies that ensure consistent consideration of reach to the most
vulnerable population groups, and reflect a core role for the private sector in making investments
in the development of Lao PDR’s human capital. Policies will prioritise critical interventions and
programmes along the life cycle, and recognise the need for coordinated multi-sectoral solutions.
Greater use of detailed disaggregated data to inform more targeted policies could help improve
efficiency in the increasingly resource-constrained environment. Digital connectivity is making it
technically possible to cost-effectively deliver more services remotely, but investments are needed
to ensure sustainability and equity in access.
Traumatic events such as COVID-19 and recent floods and disasters incurred in 2018 and
2019 can be a trigger for mental illness. The Government has paying great attention to mental
health of all citizens due to the recent impacts of the national disasters incurred in 2018 & 2019
and now the impact of COVID-19. During this recovery time, the Government is working with
12 The targets for the HIV treatment scale-up beyond 2015 are (i) by 2020, 90% of all people living with HIV will know their HIV status, (ii) by
2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and (iii) by 2020, 90% of all people receiving
antiretroviral therapy will have viral suppression. 13 From MDG reporting.
14 WHO global TB database. http://www.who.int/tb/country/data/download/en/ 15 WHO Global Health Observatory. http://apps.who.int/gho/data/view.main.2490
37
relevant partners to ensure sufficient number of skilled mental health staff which can respond to
a surge in demand when emergencies happen. The development of Lao PDR’s national guideline
will be an important step forwards in this. The guideline should make sure mental health services
are available to all who need them, both during times of peace and during emergencies. Recent
additional investments in this area are the toll-free Lao Women Union counselling helpline and
the newly established Lao Youth Union counselling helpline.
Safe drinking water and improved sanitation. The use of clean water has increased in the past
5 years from 69.9% in 2012 to 83.9% in 2018. There remain many mountainous and remote
provinces with lower coverage, and water sources may be prone to contamination from the
increasingly frequent floods. The use of improved sanitation facilities has increased significantly
from 56.9% in 2012 to 71% in 2018. The rate of open defecation has decreased from 37.9% in
2012 to 23.9% in 2018, but the practice is still a significant health risk. Flooding also poses risks
to sanitation facilities and sanitation in general. Estimated deaths/year attributable to unsafe water,
unsafe sanitation and lack of hygiene (diarrhea only) increased from 11 (2015) to 72 (2018).
Health protection and expenditure - Increased government spending. Many schemes have
been introduced to support universal health coverage, including health equity funds, free maternal
and child health services, and social health protection schemes. The total health expenditure per
capita has increased from US$29 (2011) to US$59 (2016). The total health expenditure as a
percentage of GDP has increased from 2.7% (2011) to 3% (2016) but then drop to 2.8% in 2018.
The general government health expenditure as a percentage of general government expenditure
has nearly doubled from 4.7% (2011) to 8.4% (2018), but still not yet reached the level endorsed
by the National Assembly. Out of pocket spending is still a concern, even though it has decreased
from 48.6% of total current health expenditures in 2011 to 45.1% in 2016. In term of Out of
pocket health expenditure per capita (US$) indeed increased from $25 in 2015 to $29 in 2018.
Greater efforts are needed for investing in primary health services, including sexual and
reproductive health, and nutrition services. Investments in Sexual and Reproductive Health
and Rights, as well as Nutrition, Maternal, Newborn, Adolescents and Child Health, can positively
impact human capital and macroeconomic performance. This will be particularly crucial for Lao
PDR’s young population to reap the possibility of the country's demographic dividend. The
Government will work with all partners to achieve a sustainable and efficient health financing
system. This will be built on a stable government budget, recognising anticipated donor transitions,
in close collaboration and coordination with development partners based on the Health Financing
Strategy. In working towards the achievement of universal health coverage by 2025,
implementation of the essential health service package will be prioritized, with service delivery
redesigned to be more resilient to disruptions during crises, and ensure equitable access to quality
healthcare. Policies will also be prioritized to protect gains in infant and maternal mortality, and
scale up family planning services, along with Lao PDR’s renewed commitments to International
Conference on Population and Development 25 (ICPD 25) during the 2019 Nairobi summit.
Careful consideration must be done to look at disaggregated data to identify and target
interventions to address disparities along with geographical location, age, sex, gender etc. For
example, in 2017, the adolescent birth rate at a national level was 83, compared to 42 in urban
areas, 95% in rural areas with road access, and 136 without road access.16 The 2020-2025 National
Plan of Action for Nutrition prioritizes the delivery of interventions and activities which address
the multifactorial determinants of stunting particularly the key proximal determinants of child
growth. Building resilience for the health system to respond to COVID-19 and prepare for future
public health emergencies, will include building systems for mental health and psychosocial
support for COVID-19 patients and other target groups. The Government is committed to
necessary steps to build the competence of the health workforce through long-term investment in
pre-service and in-service training.
16 LSIS II Survey (2018). https://lao.unfpa.org/en/publications/lao-social-indicator-survey-ii-2017-18-0
38
The execution of policies and plans still face many challenges due to limited capacity of
human resources, difficult terrain, dispersed population in remote areas, and lack of demand for
services. The disparities in health status and service coverage are, as in education, are determined
by (i) geography and access, (ii) by the level of education of the mother (in the case of maternal
and child health) or the household head (in the case of water and sanitation facilities), (iii) ethno
linguistic group (some groups are more remote than others or may have different cultural practices
that affect health), (iv) wealth of the household. An additional factor in child, infant and neonatal
mortality is the age of the mother: children born of mothers who are too young (below age 20) or
older (above age 35) have a higher probability of dying before the age of five. The disparities are
greater for certain indicators than others, meaning that for those indicators, the vulnerable groups
have much further to catch up.
|
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22
SDG 3
Good Health
Lebanon has consistently improved its
health system and registered relatively
favourable indicators, despite
internal challenges and external
shocks. The MoPH has developed
and implemented plans, aimed at
reaching the SDGs, which build on
past successes. Lebanon is controlling
and preventing disease outbreaks and
ensuring universal access to healthcare
services. The quality and coverage of
health services have been improving.
The number of women who die while
giving birth has reduced from 14 per
100,000 (2015) to 8.7 per 100,000
(2017). Neonatal mortality rates are
also very low at 4.3 per 1,000 (2017). More than 95 percent of births are attended by a
skilled healthcare professional (Figure 2).
Reproductive health services are accessible to nearly all Lebanese through a network of 213
primary healthcare centres run by the MoPH. Teenage pregnancy is not a critical issue in
Lebanon.
Outbreaks of tuberculosis, malaria,
hepatitis and AIDS are well contained
in Lebanon, if not non-existent. Malaria
and other tropical diseases are not
relevant in Lebanon. The tuberculosis
burden is low: incidence is estimated
at 16 per 100,000, prevalence is
estimated at 20 per 100,000, and
the mortality rate is estimated at 1
per 100,000. Tuberculosis comes
from exposure to different populations
through migration. Around half of the
reported tuberculosis cases over the
last three years have involved nonnationals, including displaced Syrians.
The completion of tuberculosis treatment
by Lebanese citizens is estimated to be
90 percent but only 50 percent for non-Lebanese. This is because non-Lebanese tend to leave
the country before they end their treatment.13
21
The Ministry of Agriculture 2015–2019 Strategy is based on principles of good governance. It aims to
develop the agriculture sector by ensuring food security and food safety, reducing poverty and rural–
urban migration, creating job opportunities, and increasing efficiency and sustainable use of natural
resources. Its specific objectives are:
1. to provide safe and good quality food.
2. to improve the contribution of agriculture to the economic and social development of the country
by raising agriculture’s share of GDP from four to six percent and reducing the current agriculture
trade deficit.
3. to promote the sustainable management of natural and genetic resources.
This is being implemented through eight courses of action, 30 components, and 104 area interventions.
The ministry’s strategic objectives are supported by other initiatives, such as the IDAL Agri-Plus
programme that provides agricultural export subsidies to local producers and other incentives to enhance
product quality and improve packaging, promotion and marketing. The Central Bank of Lebanon also
subsidises medium- and long-term agricultural loans and provides microfinance to enterprises with up to
four workers.
12 In addition the Ministry of Economy and Trade subsidises wheat and controls bread price
and the Ministry of Finance subsidises farmers planting tobacco.
SDG 3: Good Health
Lebanon has consistently improved its
health system and registered relatively
favourable indicators, despite internal
challenges and external shocks. The MoPH
has developed and implemented plans,
aimed at reaching the SDGs, which build on
past successes. Lebanon is controlling and
preventing disease outbreaks and ensuring
universal access to healthcare services. The
quality and coverage of health services have
been improving. The number of women
who die while giving birth has reduced from
14 per 100,000 (2015) to 8.7 per 100,000
(2017). Neonatal mortality rates are also
very low at 4.3 per 1,000 (2017). More than
95 percent of births are attended by a skilled
healthcare professional (Figure 2).
Reproductive health services are accessible to nearly all Lebanese through a network of 213 primary
healthcare centres run by the MoPH. Teenage pregnancy is not a critical issue in Lebanon.
Figure 2: Key SDG Target 3.1 and 3.2 indicators
Source: Ministry of Public Health
4.3
14
5.9
12.8
3.6
15.5
6.8
29.7
4.3
8.7 6.7
27.1
Lebanese
neonatal
mortality rate
(per 1000 live
births)
Lebanese
maternal
mortality rate
(per 100,000
live births)
Non-Lebanese
Neonatal
mortality rate
(per 1000 live
births)
Non-Lebanese
Maternal
mortality rate
(per 100,000
live births)
2015 2016 2017
22
utbreaks of tuberculosis, malaria,
hepatitis and AIDS are well contained in
Lebanon, if not non-existent. Malaria and
other tropical diseases are not relevant in
Lebanon. The tuberculosis burden is low:
incidence is estimated at 16 per 100,000,
prevalence is estimated at 20 per 100,000,
and the mortality rate is estimated at 1 per
100,000. Tuberculosis comes from
exposure to different populations through
migration. Around half of the reported
tuberculosis cases over the last three years
have involved non-nationals, including
displaced Syrians. The completion of
tuberculosis treatment by Lebanese
citi6ens is estimated to be 90 percent but
only 50 percent for non-Lebanese. This is
because non-Lebanese tend to leave the
country before they end their treatment.
13
The latest available data shows there were
108 new cases of HIBAIDS in 2016
compared with 113 in 2015. The HIBAIDS incidence stands at 2.47 per 100,000. hile this rate seems
higher than that of other Arab countries, it is mainly because of greater awareness and openess about the
subject that has led to higher reporting in Lebanon.
14
Food and waterborne diseases remain a challenge in
Lebanon. Food safety legislation was introduced in
2015, focusing on risk analysis. However, food safety
legislation is not well enforced by the various
concerned ministries.
Figure 3: Key ood and -aterorne diseases re&orted cases y year
Source: Ministry of Public Health
0
500
1000
1500
2000
2500
3000
2010 2011 2012 2013 2014 2015 2016 2017
Brucellosis Dysentery Food Poisoning
Hydatic Cyst Parasitic orms Typhoid Fever
iral Hepatitis A
ssuing ood sa ety "egis"ation
In 2015 Lebanon ratified a food safety law. The law is consistent
with the agriculture strategy and SDG targets 1.3 and 2.1. The
law aims to set the overall governance structure of the food
safety sector under the auspices of a public multi-stakeholder
entityGthe Food Safety Lebanese Commission. The law covers
all types of food, beverages and processed foods. It sets
requirements for food safety from farms, food transport and
display, through to tracking and recordkeeping. As soon as the
law was issued it was publicised by an awareness-raising
campaign that influenced food producers and consumers.
Members of the commission are still to be appointed.
Figure 2: Key SDG Target 3.1 and 3.2 indicators
Source: Ministry of Public Health
Figure 3: Key food and waterborne diseases reported cases by
year
Source: Ministry of Public Health
23
The latest available data shows there
were 108 new cases of HIV/AIDS in
2016 compared with 113 in 2015.
The HIV/AIDS incidence stands
at 2.47 per 100,000. While this
rate seems higher than that of other
Arab countries, it is mainly because
of greater awareness and openess
about the subject that has led to higher
reporting in Lebanon.14
Food and waterborne diseases remain
a challenge in Lebanon. Food safety
legislation was introduced in 2015,
focusing on risk analysis. However,
food safety legislation is not well enforced by the various concerned ministries.
After an upwards trend that reached its peak in 2007, the number of road deaths and injuries
in Lebanon have been declining steadily due to regular awareness campaigns (Figure 4).
Lebanon relies on various health
services, multiple delivery channels and
funding sources, to achieve universal
health coverage.15 The NSSF covers
around one-third of the population and
other funds are available to public sector
employees (such as the civil servants’
cooperative) and to those in national
military and security forces. Many
Lebanese also rely on private health
insurance, which provides financial
cover with variable levels of patient copay. The MoPH covers primary care
and hospitalisation at public and private
institutions for everyone else, which
amounts to around half the population.
This system has proved resilient to shocks
and ensured that every citizen has some
form of health insurance cover (indicator
3.8.2).16
The MoPH has a network of 213
primary healthcare centres across the
country, which provide services in
collaboration with non-governmental
organisations, the Ministry of Social
Affairs, and municipalities, patients can
see medical specialists at a reduced
cost and receive basic and chronic
disease medicationand vaccines
free Critical diseases such as cancer,
multiple sclerosis and others are fully
Figure 4: Crash, injuries and death rates due to car accidents)
indicator 3.6.1)
Source: Ministry of Public Health
23
After an upwards trend that reached its peak in 2007, the
number of road deaths and injuries in Lebanon have been
declining steadily due to regular awareness campaigns
(Figure 4).
Lebanon relies on various health services, multiple delivery
channels and funding sources, to achieve universal health
coverage.
15 The NSSF covers around one-third of the
population and other funds are available to public sector
employees (such as the civil servants’ cooperative) and to
those in national military and security forces. Many
Lebanese also rely on private health insurance, which
provides financial cover with variable levels of patient copay. The MoPH covers primary care and hospitalisation at
public and private institutions for everyone else, which
amounts to around half the population. This system has
proved resilient to shocks and ensured that every citi6en
has some form of health insurance cover (indicator 3.8.2).
16
The MoPH has a network of 213 primary
healthcare centres across the country, which
provide services in collaboration with nongovernmental organisations, the Ministry of
Social Affairs, and municipalities, patients
can see medical specialists at a reduced cost
and receive basic and chronic disease
medicationand vaccines free Critical diseases
such as cancer, multiple sclerosis and others
are fully covered by MoPH. More than 36
percent of these centres are accredited
internationally.
17 Almost 160,000 Lebanese used the primary healthcare centres in 2017, up 88 percent
from 2015.
18 Displaced Syrians also access the centres.
The public health system continues to face a number of challenges, including financial constraints,
understaffing (specifically an imbalance between medical doctors and nurses, paramedics, and
administrative staff), a focus on tertiary care and poorly regulated ambulatory care. Despite these hurdles,
Lebanon is committed to moving towards universal health coverage in line with the global engagement.
19
The commitment towards universal healthcare falls under MoPH’s Strategy 2025 that it launched in 2017.
The strategy’s central goal is universal health coverage and it is based on the principle of >health as the
right of each citi6en’. Its strategic goals are:
1. to modernise and strengthen MoPH’s executive and related administrations.
2. to improve collective public health through prevention and promotion throughout the life cycle of
each individual, and in all stagesBphases of life.
3. to make concrete steps towards universal coverage of high quality, safe and affordable healthcare
that prioritises the poor and vulnerable.
Figure ?: ras 1 in uries and deat rates due to car
accidents 7indicator 3.A.18
Source: Internal Security Forces Statistics
ntegrating SDG targets
MoPH has integrated SDG targets into its plans and strategies. It has
also set a baseline statistic for almost every SDG indicator and is in
process of setting its own specific indicator targets. MpPH has already
drawn up a planning framework and is implementing a series of
programmes that cover the main health topics under the SDGs.
Examples include the primary healthcare centres and reproductive
health programmes, the Mental Health 2015–2021 Strategy, the NonCommunicable Diseases Prevention and Control Plan Lebanon 2016–
2020, the National Tuberculosis Programme2017 and the InterMinisterial Substance se Response Strategy for Lebanon 2016–2021.
ntegrating SDG targets
MPH has integrated SDG targets in its plans and strategies. It has also
set the baseline statistics for almost every indicator of the SDGs, and is
in process of setting its own specific indicator targets. MPH has
already drawn up a planning framework and is implementing a series
of programs covering the main health topics under the SDGs. Examples
range from the primary healthcare centres and reproductive health
programs to work underway on the Mental Health 2015-2021 strategy,
the Non-Communicable Diseases Prevention and Control Plan Lebanon
2016-2020, the National Tuberculosis Programme - 2017, the InterMinisterial Substance se Response Strategy for Lebanon 2016-2021
and others.
Issuing food safety legislation
In 2015 Lebanon ratified a food safety law. The law is
consistent with the agriculture strategy and SDG targets
1.3 and 2.1. The law aims to set the overall governance
structure of the food safety sector under the auspices of a
public multi-stakeholder entity—the Food Safety Lebanese
Commission. The law covers all types of food, beverages
and processed foods. It sets requirements for food safety
from farms, food transport and display, through to tracking
and recordkeeping. As soon as the law was issued it
was publicised by an awareness-raising campaign that
influenced food producers and consumers. Members of
the commission are still to be appointed.
Integrating SDG targets
MOPH has integrated SDG targets in its plans and
strategies. It has also set the baseline statistics for almost
every indicator of the SDGs, and is in process of setting
its own specific indicator targets. MOPH has already
drawn up a planning framework and is implementing a
series of programs covering the main health topics under
the SDGs. Examples range from the primary healthcare
centres and reproductive health programs to work
underway on the Mental Health 2015-2021 strategy,
the Non-Communicable Diseases Prevention and Control
Plan Lebanon 2016-2020, the National Tuberculosis
Programme - 2017, the Inter-Ministerial Substance Use
Response Strategy for Lebanon 2016-2021 and others.
24
covered by MoPH. More than 36 percent of these centres are accredited internationally.17
Almost 160,000 Lebanese used the primary healthcare centres in 2017, up 88 percent from
2015.18 Displaced Syrians also access the centres.
The public health system continues to face a number of challenges, including financial constraints,
understaffing (specifically an imbalance between medical doctors and nurses, paramedics, and
administrative staff), a focus on tertiary care and poorly regulated ambulatory care. Despite
these hurdles, Lebanon is committed to moving towards universal health coverage in line with
the global engagement.19
The commitment towards universal healthcare falls under MoPH’s Strategy 2025 that it launched
in 2017. The strategy’s central goal is universal health coverage and it is based on the principle
of ‘health as the right of each citizen’. Its strategic goals are:
1. to modernise and strengthen MoPH’s executive and related administrations.
2. to improve collective public health through prevention and promotion throughout the life
cycle of each individual, and in all stages/phases of life.
3. to make concrete steps towards universal coverage of high quality, safe and affordable
healthcare that prioritises the poor and vulnerable.
4. to strengthen capacity and systems for timely, accurate and reliable epidemiological
surveillance intelligence for public health security and emergency preparedness and
response.
SDG 3 good practice: Reducing out-of-pocket health spending
The MoPH has been able to cut out-of-pocket spending by half, which has alleviated a heavy burden
on a large proportion of the Lebanese population. MoPH managed four challenges: improving the
quality of health services; containing the cost of healthcare and reducing its financial burden on
households; reorienting health services towards promotion and prevention, and ensuring universal
access to primary healthcare; and reducing the price and improving the quality of pharmaceuticals.
MoPH spent the last decade revamping the public sector’s primary health care network and upgrading
the quality of public hospitals. This included providing vaccines and essential drugs free of charge,
setting quality standards and clinical protocols, and ensuring a sufficient number of staff were trained.
MoPH also pushed for a rational use of medical technologies and medicines, and increased the
use of quality-assured generic medicines. It strengthened its leadership and governance functions
through accreditation systems for primary healthcare centers and hospitals, and used ‘performance
contracting’ with private and public hospitals for in-patient services at specified prices to ensure
hospital compliance. These combined and targeted measures resulted in increasing access to quasifree primary health services and essential medicines, shifted the focus from costly curative care to
preventive care, and widened access to quality pharmaceutical products at lower prices. As a result,
the proportion of households’ out-of-pocket spending on health services fell from 60 percent in 1998
to 32 percent in 2015, while public health indicators also drastically improved.
|
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47
GOAL 3: Healthy lives and promote well-being for all at all ages
Before the EVD crisis, Liberia’s health outcomes had been improving steadily since the end of the second
civil war in 2003. The 2013 Liberia Demographic Health Survey showed a 15 per cent decline in the underfive mortality rate (U5MR). By 2012, Liberia was among the first countries in Sub-Saharan Africa to achieve
its Millennium Development Goals (MDG) target of reducing U5MR to less than one-third of its 1990 level
(as of 2015, U5MR was estimated at 70 per 1,000 live births compared to 255 in 1990).
However, the EVD crisis led to a devastation of the already fragile healthcare system in Liberia and
severely constrained the ability of the Government to deliver key social services, including basic and
secondary health services, thereby leading to many preventable deaths. For example, measles vaccination
rates dropped from about 78% in January 2014 to 45% in January 2015. Similarly, health facility deliveries
decreased from 65% to 28%, while deliveries attended by skilled providers dropped from 61% to 31%.
Maternal mortality
As a result of ongoing efforts, the country’s maternal mortality ratio shows decreasing trends from 2010
(708) to 2013 (674) until 2014 (688). In 2015 (691) Liberia started to experience a rise again due to the
Ebola epidemic that cripples the country’s health system significantly. Notwithstanding, some gains have
been made since 2016 (661), as shown in the figure below
To date, Liberia has one of the highest
rates of maternal mortality in the world.
This is due to the causes of the recently
afflicted by civil conflict and an epidemic
of Ebola virus disease. However, the
government and development partners
have set ambitious national health targets
to improve maternal health reduce the
high prevailing maternal mortality ratio
and there have been some gains.
708
694
683 674
688 691
661 661
2010 2011 2012 2013 2014 2015 2016 2017
Figure...Liberia maternal mortality ratio
2010-2017
Maternal mortality ratio
48
About the characteristics of the women described in MDRs reported to NPHIL in 2017, 40 per cent of the
258 reported maternal deaths occurred among women 25–34 years old. 36 per cent were due to
hemorrhage, 11% to sepsis, 9% to hypertensive disorders, and 1.6% to obstructed labor. Over a quarter
of women who died had no formal education and various risk factors—including anemia, malaria, and
hypertension—were documented during ANC visits. Close to three-quarters of deaths occurred at a health
facility, while an additional 13% and 12% occurred in the community and en route to a health facility,
respectively. 29 per cent of reported deaths occurred within 24 hours after delivery, and only 44% of
women who died were documented to have been cared for by a professional/skilled birth attendant.
The proportion of births attended by skilled health personnel
A skilled medical professional assists majority of births (84%) in Liberia. This is a considerable increase
from the 2013 LDHS when a skilled provider attended only 61% of births. Assistance at delivery by a skilled
provider is more common in urban (89%) than rural (79%) areas. There is a good deal of variation between
regions and counties. Among regions, assistance at delivery is highest in North Central (92%) and lowest
in North Western (78%). In the counties, delivery by a skilled provider range from 51% in Gbarpolu to 97%
in Lofa.
As expected, there is a positive relationship between mother’s education and assistance at delivery; 81%
of women with no education are assisted by a skilled medical professional, as compared with 90% of those
with higher education. Assistance at delivery generally increases with increasing wealth, from 76% among
the poorest women to 94% among those in the highest wealth quintile.
Prenatal care from a skilled provider is important to monitor pregnancy and reduce morbidity and
mortality risks for the mother and child during pregnancy, at delivery, and during the postnatal period
(within 42 days after delivery). In Liberia, skilled providers trained to assist during delivery include doctors,
nurses, midwives, and physician assistants. Currently, 98% of mothers are receiving care from a health
professional at least once for their most recent birth in the last 5-year which is slightly higher than the
96% figure reported in 2013. Nevertheless, women with no education, those in the poorest wealth
quintile, and those living in Margibi, Sinoe, and Grand Kru counties are slightly less likely to report
receiving prenatal care from a skilled provider than other women. Overall, 87% of women had four or
more prenatal care visits, a large increase from 56% in the 2013 LDHS. Urban women were slightly more
likely than rural women to have had four or more prenatal care visits (89% and 85%, respectively). Among
the counties, the proportions of women with at least four prenatal care visits were lowest in Gbarpolu,
0
20
40
60
80
100
2007 LDHS 2013 LDHS 2019 LDHS
Birth attended by a skilled
providers
0
20
40
60
80
100
2007 LDHS 2013 LDHS 2019 LDHS
Birth occurred in a health
facility
49
Sinoe, and Grand Kru (72%-74%) and highest in River Gee and Bomi (93% each). The percentage of women
with four or more prenatal care visits generally increases with increasing education and wealth.
Under-five mortality rate
The government established a high-level national target of reducing under 5 mortality ratios to 57 per
1,000 live births by 2023. Ongoing interventions towards achieving this target include training vaccinators
to enhance immunization services, carrying out routine maintenance of cold-chain equipment, conducting
routine immunization outreach and periodic mass vaccination campaign, introducing new vaccines for
children & conducting regular supportive services, heightening VPD surveillance and neonatal death
surveillance, striving to achieve measles elimination status and MNTE, and improve immunization supply
chain management, training health workers especially female health workers on (IMNCI).
Presently, under-5 mortality is 93 deaths per 1,000 live births, which shows a slightly decreasing trend
from 94 deaths per 1,000 live births between 2013 and 2019. Most of the mortality occurs during the first
year of life, as the infant mortality rate is 63 deaths per 1,000 live births, while mortality between the first
and the fifth birthday is 33 deaths per 1,000 children. Mortality during the first month (neonatal mortality)
is higher than postneonatal mortality (37 deaths per 1,000 births versus 25 deaths per 1,000 births) and
accounts for 59% of overall infant mortality.
Comparing estimates from national surveys conducted at different predetermined points in time results
from the 2019-20 LDHS and the previous three LDHS surveys generally show a decline in child and under5 mortality within the range of 0-4 years preceding each respective survey. The data show an increase in
infant mortality since the 2013 LDHS; this increase is predominantly due to the rise in neonatal mortality
from 26 deaths per 1,000 children in 2013 to 37 deaths per 1,000 children in 2019-20.
Prevention and treatment of HIV, TB and Malaria
0
50
100
150
200
250
1986 LDHS 2007 LDHS 2013 LDHS 2019 LDHS
Under-5 mortality
0
50
100
150
200
1986 LDHS 2007 LDHS 2013 LDHS 2019 LDHS
Infant mortality
50
The Government of Liberia through the National AIDS Commission and the Ministry of Health and Social
Welfare, in partnership with implementing partners, international and national agencies, and nongovernmental and civil society organizations, has made steady progress in containing the spread of HIV
and mitigating the impact of the epidemic on the general population through the implementation
preventing new HIV infections (Clinical and Non-Clinical), preventing HIV in Key Populations (KPs), condom
promotion and distribution, treatment, care, and support for PLHIV, critical social and programmatic
enablers, rapid testing and awareness. Since 2010, two National HIV Strategic Framework (2010 – 2014
and 2015 -2020) has been developed for ensuring the successful coordination and management of the
national HIV response. Over the years, prevention activities, testing, and treatment services have been
scaled up and expanded to ensure universal access to HIV and AIDS services.
Liberia presently has a generalized HIV epidemic with the general population new infections decreasing
from 1900 in 2012 to 1600 2018. Though the impact of the epidemic continues to be significant, the
downward trend in the new HIV infections started since 2013 due to massive combine efforts by both
government and its development partners to stop the spread of the epidemic. In Liberia, the majority
living with HIV have access to antiretroviral therapy.
Knowledge of ways to reduce HIV transmission has proven to be vital in the fight against HIV/AIDS. The
involvement of multi-media and civil society organizations in the national response has increased the
public’s knowledge and awareness of HIV and AIDS with special emphasis focused on youth and key
populations. HIV prevention programs focus their messages and efforts on several important aspects of
behavior to avoid the spread of HIV. These include using condoms and limiting sexual intercourse to one
uninfected partner. 73 per cent of women and 83 per cent of men know that HIV can be prevented by
using condoms during sexual intercourse, and 79% of women and 85% of men say that limiting sexual
intercourse to one uninfected partner can reduce the chances of getting HIV. Overall, 66% of women and
77% of men know that both practices offer protection from HIV. Women and men age 15-19 have lower
levels of knowledge of these HIV prevention methods than people age 20 and older. Urban and rural
women have similar levels of knowledge about each of the prevention methods; however, urban men are
1400
1500
1600
1700
1800
1900
2000
2012 2013 2014 2015 2016 2017 2018
Newly infected Adults (ages 15+) and
childern (age 0-14)
In Liberia 2012-2018
0
10
20
30
40
2012 2013 2014 2015 2016 2017 2018
Antiretroviral therepy coverage (% of
people living with HIV)
in Liberia 2012-2018
51
more knowledgeable than their rural counterparts. TB treatment success rate has increased from 68 per
cent in 2015 to 76 per cent in 2016.
Malaria is endemic, and the entire population is
at risk of the disease. Children under five and pregnant women are the most affected groups. During the
period under review, the country’s malaria incidence has been on the rise since 2012 (307.903) and
reached a peak of 401.11 in 2017 before moving downward 361.504 in 2018.
However, the government is committed to ensuring that 80 per cent of the country’s population is
protected by malaria prevention measures by 2023. Between 2008–2018, approximately 11 million ITNs
were distributed in Liberia through campaigns, ANC services, and institutional deliveries. Moreover,
ongoing efforts through strong and sustained partnership are directed towards the implementation of
interventions that cut across intervention areas but bolster the achievement of malaria program results,
such as supply chain management, health information systems strengthening drug quality monitoring,
and scale-up IPT uptake to prevent malaria in pregnancy & provide special care to infected pregnant
mothers. Moreover, more service providers in malaria diagnosis and case management have been trained,
and the management and leadership of county health teams have been strengthened to oversee and
monitor malaria service delivery through updated national clinical standards, support for quality
improvement interventions, including regular supervision as well as clinical training, strengthening of the
health information system, and improved human resource management.
Liberia’s policy on malaria in pregnancy (MIP) is a three-pronged approach, consistent with WHO’s
recommendation to combat malaria in pregnancy. This approach consists of prompt and effective case
management of malaria and anemia, providing IPTp with sulfadoxine-pyrimethamine (SP) at every ANC
visit after the first trimester, and use of ITNs. Scaling up the implementation of IPTp was slowed during
the Ebola-virus disease (EVD) epidemic from 2014 to 2015, collective support has contributed to an
increase in ANC attendance and IPTp coverage. Results from the 2016 Liberia Malaria Indicator Survey
(MIS) indicate that almost all women (98 per cent) received ANC from a skilled provider for their most
recent birth and 79 per cent had the recommended four or more antenatal visits. The per centage of
women receiving two doses of IPTp 6 (IPTp2) increased from 45 per cent in the 2009 MIS to 55 per cent
in the 2016 MIS, and three doses of IPTp (IPTp3) doubled from 10 per cent in the 2009 MIS to 22 per cent
in the 2016 MIS.
Access to vaccines
0
100
200
300
400
500
2012 2013 2014 2015 2016 2017 2018
Incidence of malaria (per 100 popn at risk
2012-2018 Liberia
290
295
300
305
310
2011 2012 2013 2014 2015 2016 2017 2018
Incidence of tuberculosis (per 100,000
people)
2011-2018 Liberia
52
Overall, basic vaccination coverage among children age 12-23 months has improved since the 2013 LDHS,
rising 10 percentage points from 55% to 65%.
In Liberia, routine childhood vaccines include BCG vaccine (tuberculosis), DPT-HepB-Hib or pentavalent
vaccine (diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b), oral polio vaccine
or OPV (poliomyelitis), inactivated polio vaccine or IPV (poliomyelitis), pneumococcal vaccine, rotavirus
vaccine, measles vaccine, and yellow fever vaccine. In Liberia, the BCG vaccine is usually given immediately
after birth. A birth dose of the oral polio vaccine (polio 0) is given within 7 days after birth, while the first
two doses of the pentavalent, pneumococcal, rotavirus, and oral polio vaccines (excluding polio 0) are
given at approximately age 6 and 10 weeks. The third dose of the pentavalent, pneumococcal, and oral
polio vaccines are given at 14 weeks, at which time IPV is also given. The measles vaccination and yellow
fever vaccination are given at age 9 months.
To date, 65% of children age 12-23 months have received all basic vaccinations, while only 40% have
received all age-appropriate vaccinations. Six per cent of children age 12-23 months have not received
any vaccinations. Among children age 24-35 months, 31% have received all age-appropriate vaccinations.
Among children age 12-23 months, basic vaccination coverage is higher among boys than among girls
(67% versus 63%). Also, basic coverage is higher in urban than rural areas (66% versus 63%) and higher
among children whose vaccination card was seen than among those whose card was not seen (85% versus
28%). Basic vaccination coverage is lowest in the South Eastern A region (54%) and highest in the NorthWestern region (72%). By county, basic coverage is highest in Lofa (78%) and lowest in Sinoe (46%).
Coverage rates do not exhibit a strong relationship with either mother’s education or household wealth
other than being lowest among children in the poorest households. In the case of multi-dose vaccines,
coverage rates are highest for the first dose and decline for subsequent doses.
Family planning needs
The use of any contraceptive method by currently married women has more than doubled in the past 13
years, from 11% in 2007 to 20% in 2013 and 25% in 2019-20. The proportion of currently married women
who use modern contraceptive methods has also increased, from 10% in 2007 to 19% in 2013 and 24% in
2019-20.
0
20
40
60
80
All Basic vaccinations Age appropriate
vacinnations
Figure.. Basic vacinnations and age
appropriate vacinnations for childern
between 12-35 months
12-23 months 24-35 months
0
100
Sex Area Region County
Basic vaccination coverage (LDHS 2019-
2020)
Liberia
Boys Girls
Urban Rural
South Eastern Region North Western Region
Lofa Sinoe
53
One in four married women of reproductive age is using a method of contraception (25%). Almost all of
these women are using modern methods (24%), with only 1% using traditional methods. Injectables are
the most widely used method (14%), followed by implants (5%) and the pill (4%). In general, contraceptive
use among married women in Liberia increases once they have had at least one child. Use of any
contraceptive peaks at 28%-31% among currently married women age 20-34 before declining to 14%
among women age 45-49. While there is little variation in contraceptive use among married women
residing in urban and rural areas, the difference is more pronounced across regions. Women in SouthEastern B and South-Eastern A are more likely to use any method of contraception (43% and 38%,
respectively) than women in other regions (27% or less). By county, contraceptive use is highest among
women in Maryland (45%) and lowest among women in Margibi (18%). Contraceptive use initially
increases with educational attainment but drops off after women achieve some senior high schooling.
One in four married women have a met need for family planning (25%)—that is, they are currently using
a contraceptive method—and this has increased since 2013 when 20% of women had a met need for
family planning. The total demand for family planning among currently married women is 58%, and the
total demand satisfied is 43%; this demand is satisfied almost entirely by modern methods (41%).
Health Systems Strengthening
Community Health Assistance Program: Community Health Assistants (CHA’s) are delivering an
integrated and standardized service delivery package, which includes curative, preventive, promotive,
rehabilitative, and palliative services, to households located more than one-hour walk (more than 5km)
from the nearest health facility. Households located within 5km of a health facility, are receiving a tailored
package of services delivered by other community cadres. To date, 76.2 per cent or 2,904 of the overall
targeted 4,000 CHAs have been recruited, trained, and deployed in 13 counties. The CHA program is a
promising approach that can, potentially, change the narrative around health care delivery in Liberia.
Drugs and Medical Supplies: Enormous progress has been made in setting into place the institutional
framework for an effective supply chain management system. A temporary quality-testing lab will house
the Liberia Medicines and Health Products Regulatory Agency (LMHRA), while the construction of a new
testing lab that meets ISO standard is being planned. A new environmental health laboratory to test the
quality of drinking water to protect Liberians was dedicated and a centralized Health Care waste
management facility for the management of medical waste from major hospitals in Montserrado County
is under construction. The LMHRA is currently receiving and evaluating medicines and health products for
registration and Mass Drug Administration for the elimination and control is ongoing in all counties for
Onchocerciasis and Soil-transmitted helminths. Lymphatic Filariasis Mass Drug Administration is ongoing
0
50
2007 LDHS 2013 LDHS 2019 LDHS
Figure.. Unmet need, modern contraceptive use,
and percentage of demand satisfied with
modern methods
Unmet need
Modern contraceptive use (MCPR)
Percentage of demand satisfied with modern methods
54
in 13 counties except for Bomi and Gbarpolu. Schistosomiasis Mass Drug Administration is ongoing in 13
counties except for Rivercess and Grand Kru.
Diagnostic Services: Diagnostic capacity has improved over the years. Molecular diagnostic and
Microbiology techniques are up and running at the National Reference Laboratory (NRL), and Phebe and
Tappita hospitals. About 70 per cent of the laboratory infrastructure at JDJ hospital has been improved.
Notwithstanding, capacity for diagnostic is still limited due to a combination of infrastructure deficits,
inadequate human resource and technical capacities, and inadequate or lack of modern diagnostic
equipment.
Integrated Disease Surveillance and Response (IDSR): Post EVD outbreak, preventing and controlling
public health threats, and mitigating related risks are national priorities. Among several strategies put in
place to address threats is a functional public health surveillance system with an early warning system
that uses the IDSR platform. The system managed by the newly established National Public Health
Institute of Liberia (NPHI). Eleven of the 15 counties experienced disease outbreaks and humanitarian
emergencies with the most frequent being measles (20), Lassa fever (5), and pertussis (5). The high
frequency of measles outbreaks may be related to its endemicity and the high number of susceptible
children in the population. Recurring outbreaks of Lassa fever were also noted particularly in Nimba and
Bong counties. Two health-related emergencies involving flood and mudslides in Margibi
Response to disease outbreak: Liberia ranks the highest in the sub-region in terms of institutional
capacity to respond to any outbreak within 48 hours. The emergency response for a disease outbreak in
the country has significantly improved, ranking Liberia as having the best response system in the subregion as per the WHO recommended response time of an outbreak within the 48 hours. The National
Public health Institute has successfully detected and responded to 30 outbreaks covering Lassa fever,
meningitis, and measles. The National Reference Laboratory (NRL) of the institute increased its capacity
to test for 11 priority diseases and recently added the capacity to test for Buruli Ulcer for the first time in
Liberia. The laboratory is working towards getting an international accreditation in 12 months, which
will enable it to gain recognition in Africa.
Health systems capacities: To date, there are 736 clinics, 36 hospitals, and 57 health centers across the
country. Currently, the country’s health workforce is 16,064. Furthermore, the capacity of the health
workforce was significantly enhanced by routine training and specialties study for about forty medical and
master public health for 17 non-medical staff of the sector. Additionally, local scholarships were awarded
to 60 students of who 58 are studying Laboratory Science at the Mother Pattern College of Health Sciences
and two studying master’s in public health at the Cuttington University Graduate Program. The Ministry
of Health employed 1,318 Volunteers. The National Tuberculosis Reference Laboratory, 155 beds new
Redemption Hospital, Bo-Water Side Health Center and staff housing completed awaiting dedication, are
under construction, renovated12 health facilities (clinics) in Bomi, Montserrado, Bong and Monrovia and
ten counties already have installed 17 Gene expert Machines for rapid diagnosis of TB cases along with a
digital X-ray Computer-Aided Detection for Tuberculosis, which automatically screen people.
The government has committed significant resources to train, equip, incentivize and deploy CHAs to
deliver community-based FP/HBIMNC interventions and link communities to facilities, integrate and scaleup adolescent and youth-friendly services (AYFS) in all counties, improve maternal death surveillance and
response, provide and maintain ambulances to strengthen referrals networks for SGBV cases, ensure
essential lifesaving drugs and commodities are available in health facilities, improve basic amenities
(water, light/power, incinerators, placentas pit, and latrines) in all public health facilities with a focus on
IPC.
|
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30
4.3.Goal 3: Ensure healthy lives and promote well-being for all at all ages
3.1.1 Maternal mortality ratio
Table 8: Maternal mortality ratio in 2013 and 2019/2020
Indicator 2013 2019/2020
Maternal mortality ratio 1,072 per 100,000 742 per 100,000
Source: LDHS 2013 and LDHS 2019-2020
Liberia has made remarkable strides over the years in reducing maternal mortality ratio (MMR17) by 31
percent, from 1,072 per 100,000 in 2013 to 742 per 100,000 live births.18 The reduction in MMR is as a
result of improving access to quality maternal healthcare services; promoting knowledge on reproductive
health; and bolstering the capacity of local and national authorities to link community level care with
formal healthcare services. The Figure below mirrors the above table.
Figure 1: Trend in maternal mortality ratio
3.1.2 Proportion of births attended by skilled health personnel
The proportion of birth within the population that were attended to or assisted by a skilled provider is an
important quality marker as much as it does assure of reduce risk of adverse outcome for the mother and
unborn baby. The proportion of birth attended to by a skilled provider have increased overtime from 46.3
percent as was reported by LDHS 2007 to 84.4 percent in 2019-2020 (LDHS) and notably increased by 23.3
percent between the last two successive LDHS.
17 MMR is defined as women who died when pregnant, during delivery, or within 42 days of delivery or the
termination of a pregnancy, except when death was due to an accident or violence 18 Government of Liberia. Demographic Health Survey 2020
994 1072
742
0
200
400
600
800
1000
1200
1400
1600
LDHS 2007 LDHS 2013 LDHS 2019-2020
Per 100,000 live births
31
Figure 2: Proportion of birth assisted by skilled providers in Liberia
3.2.1 Under-five mortality rate
Table 9: Under-five mortality rate
Indicator 2007 2013 2019/2020
Under-five mortality rate 110 per 1000 live
births
94 per 1000 live
births
93 per 1000 live
births
Source: LDHS 2019/2020
The LDHS (2019-2020) found that under-5 mortality rate reduced from 110 per 1000 live births in 2007,
to 94 per live births in 2013, and 93 deaths per 1000 live births in 2019/2020. Child mortality decreased
from 43 to 33 deaths per 1000 live births. Existing data reveals that infant, child, and under-5 mortality
are lower in urban areas (57, 30 and 85 deaths per 1000 live births respectively) than in rural areas (69,
36 and 102 deaths per 1000 live births).
3.2.2 Neonatal mortality rate
Table 10: Neonatal mortality rate
Indicator 2013 2019/2020
Neonatal mortality rate 26 per 1000 live births 37 per 1000 live births
Source: LDHS 2013 and LDHS 2019-2020
The LDHS (2019-2020) indicates a worsening neonatal mortality rate at 37 per 1000 live births in
2019/2020, compared to 26 per 1000 live births in 2013.
57.9
46.3
61.1
84.4
0
10
20
30
40
50
60
70
80
90
Liberia (1986 DHS) Liberia (2007 DHS) Liberia (2013 DHS) Liberia (2019-20 DHS)
Proportion of births
Proportion of Births Assested by Skilled Provider, Liberia
32
3.3.1 Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations
Table 11: New HIV infections per 1,000 uninfected population, by sex, age, and key populations
Indicator: Number of new HIV infections per 1,000
uninfected population, by sex, age and key
populations
2013 2021
Men who have sex with men 19.8 37.9
Uniform service personnel 5.0 17.6
Female sex workers 9.8 16.7
People who inject drugs 3.0 14.4
Transport workers 4.8 9.6
Source: IBBSS 2021
HIV remains a major public health challenge in Liberia. In September 2021, the WHO released an
Integrated Biological and Behavioral Surveillance Survey (IBBSS) report on HIV/AIDS and other diseases.
The report revealed an increase in HIV prevalence in almost all the population groups, compared to the
2013 figures.
The IBBSS study found 37.9 percent (19.8 percent in 2013) HIV prevalence in men who have sex with men,
followed by transgender women with 27.6 percent (not included in 2013 IBBSS), uniformed service
personnel, 17.6 percent (5.0 percent in 2013), female sex workers, 16.7 percent (9.8 percent in 2013),
people who inject drugs, 14.4 percent (3.9 percent in 2013), transport workers, 9.6 percent (4.8 percent
in 2013), and inmates, 5.6 percent (not included in 2013 IBBSS). Only mobile traders and miners showed
slight declines in HIV prevalence from 4.5 percent in 2013 to 3.8 percent, and from 3.8 percent in 2013 to
3.0 percent, respectively.
It is likely that the increase in HIV prevalence is as a result of limited knowledge on prevention methods.
The LDHS (2020) found that, among women, there has been little change in knowledge of HIV prevention
methods since 2013. However, knowledge among men has increased. In 2013, 68 percent of men knew
that consistent use of condoms and limiting sexual intercourse to one uninfected partner can reduce the
risk of HIV, as compared with 77 percent in 2019-2020.
In 2021, the GOL trained 204 health professionals from 54 health facilities and 15 county health teams
and 300 other participants (students, teachers, and school administrators from 30 schools) to provide
pediatric HIV care and basic HIV/AIDS awareness/prevention, and life skills.
3.3.2 Tuberculosis incidence per 1,000 population
Table 12: Tuberculosis incidence per 1,000 population
Indicator 2017 2018 2019 2020
Tuberculosis incidence per 1,000
population
135 133 130 127
Source: World Bank. See link: https://data.worldbank.org/indicator/SH.TBS.INCD
33
From 2017 to 2020, the incidence of tuberculosis in Liberia reduced slightly. However, Liberia ranks as one
of the top 30 countries with high tuberculosis infection rates globally and is one of nine highly endemic
countries in the Africa. There are 370 health facilities that provide tuberculosis services in the country. In
2020, the National Tuberculosis Program confirmed and treated 6,990 patients and 7,446 patients in 2021,
representing an improvement in the treatment outcomes.19 The LDHS (2020) notes that knowledge of
tuberculosis is high in Liberia as 91 percent of women and 92 percent of men ages 15-49 who participated
in the survey said that they have heard of tuberculosis.
3.3.3 Malaria incidence per 1,000 population
Table 13: Malaria incidence per 1,000 population
Indicator 2017 2018 2019 2020
Malaria incidence per 1,000 population 392.3 383.2 369.6 358
World Bank: See link: https://data.worldbank.org/indicator/SH.MLR.INCD.P3?locations=LR
Malaria is endemic in Liberia and remains one of the foremost public health problems in the country,
which takes a toll on children under age 5 and pregnant women. Based on the data presented above, the
incidence of malaria has gradually reduced from 2017 to 2020. In part, this is due to the increasing use of
treated mosquito nets across the country.
As the LDHS (2019-2020) reports, several households are using mosquito nets to prevent malaria. Fiftysix percent of households in Liberia have at least one mosquito net, while 55 percent have at least one
insecticide-treated bed nets (ITN). Twenty-five percent of households have achieved full household ITN
coverage, meaning that there is at least one ITN for every two persons who slept in the household the
night before the LDH survey. The remaining households either have no ITNs (45 percent) or do not have
enough ITNs for all household members (30 percent). After increasing from 47% in 2009 to 62% in 2016,
ownership of ITNs dropped to 55% in 2019-2020.
Figure 3: Percent of households owning at least one insecticide-treated net
19 https://www.afro.who.int/countries/liberia/news/all-i-needed-was-love-care-and-treatment-my-journeytuberculosis-survivor
34
In addition to using ITNs, many women reported that they took preventive malaria drugs. Ninety percent
of women with a live birth in the 2 years before the survey reported taking one or more doses of fansidar
during their last pregnancy; 70 percent reported taking two or more doses, and 40 percent reported taking
three or more doses.
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[
3
] |
{
"country": "lbr",
"file_id": "sdg-03/vnr-report-lbr-2022-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2022
}
|
18 | Page
SDG 3:
Ensure healthy lives and promote well-being for all, at all ages
he Ministry of Health and Wellness has the constitutional responsibility for the regulation the health
sector in Saint Lucia. The Public Sector delivers healthcare services through 34 health centers, two
polyclinics, two district hospitals and one General Hospital and one parastatal hospital. All of which are
administered through public funds.
Saint Lucia’s citizenry is also served by a number of private primary care providers and one private
hospital. Non-Governmental Organizations and not for profit agencies also provide health care services
on island, with a focus on specific conditions or specific target groups, which limits the range of the
patients covered.
Saint Lucia faces challenges in the form of natural disasters and climate change, which have health
implications. Climate change leads to rising temperatures, changes in rainfall patterns, and more and
longer periods of extreme weather, with implications for water-borne and vector-borne diseases and food
security.
19 | Page
New and emerging diseases have begun to impact Saint Lucia’s health sector and in turn has highlighted
gaps in public health preparedness and response. Despite the increase in new and emerging diseases, noncommunicable diseases (NCDs) continue to be responsible for a growing burden of disease. Analysis of
claims data from the National Insurance Corporation (NIC), of which 70 percent of Saint Lucia’s
employed are active members, show that since 2009, the share of claimants paid for sickness benefits
have increased, as has the average amount of sickness benefit paid. This implies that there could be a
substantial productivity loss in the economy due to illness.
Against the backdrop of limited fiscal space, a double burden of disease, emerging new diseases, and a
service delivery system unable to adequately meet population needs, the Government of Saint Lucia has
initiated the process of health sector reform in the country. The government in collaboration with the
Word Bank Group intends to roll out an essential package of health services through a new unit (National
Health Insurance Unit within the Ministry of Helath) formed for this purpose.
The unit will also seek to develop and implement a national health financing mechanism to fund the
delivery of these services, while improving the efficiency and sustainability of current financing and
identifying new sources of revenue for the sector. The reform effort prioritizes the strengthening of the
primary level of care by introducing financial incentives to enhance service delivery at the primary health
care level, improve health infrastructure to ensure the primary health care level is properly outfitted to
provide the necessary care services stemming from the complexities of a double burden of disease, and
improving preparedness and response for public health emergencies through improvements in care
integration at the primary level.
The reform will have to take place with the appropriate alignment of Goal 3, in order to maximize the
benefits to people by achieving the set goals.
|
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-0.0238266326,
-0.039666537200000004
] |
[
3
] |
{
"country": "lca",
"file_id": "sdg-03/vnr-report-lca-2019-en-1.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2019
}
|
16
4 Implementation of the individual SDGs
Ensure healthy lives and promote
well-being for all people of all ages
Overall assessment
• Healthcare in Liechtenstein is of a high standard
• Healthcare services are available quickly and to everyone
• It was possible to stabilise rising costs in the healthcare sector, but that issue will remain
a challenge in the future
Situation in Liechtenstein
In general, healthcare provision in Liechtenstein is of high quality and availability is high.
All people resident in Liechtenstein have
unrestricted and equal access to health
services. For all residents there is mandatory
healthcare insurance (OKP), which ensures
the provision of healthcare services. Each
insured person pays a per-capita premium
and a contribution to costs. However, children aged under 16 are exempt from the
premium payment and contribution. Persons
aged between 16 and 20 pay half the premiums of adults aged over 20 and do not
have to pay a contribution. Adults with a
low household income receive a contribution
to their premiums and contributions.
With around 350 residents per practising
physician, the density of physicians is high
in international comparison. For necessary
care at home, the organisations “Familienhilfe Liechtenstein” and “Lebenshilfe Balzers”
350
300
250
200
150
100
50
0
2005
2007
1999
2009
2001
2011
2003
2013
2016
2006
2008
2000
2010
2002
2012
2015
2004
2014
Total Men Women
Statistical indicators
Mortality rate
up to age 65 per 100000 residents
Trend: No significant change Assessment: neutral
Source: Registry statistics (Zivilstandsstatistik),
Population statistics
17
4 Implementation of the individual SDGs
90
85
80
75
70
65
2005
2007
1997
2009
2001
2011
2003
2013
1999
2015
Men Women
Life expectancy at birth
in years
Trend: Increase Assessment: positive
Source: Eurostat
25
20
15
10
5
0
Men Women
2005
2007
1999
1997
1998
2009
2001
2011
2003
2013
2016
2006
2008
2000
2010
2002
2012
2015
2004
2014
Life expectancy at age 65
in years
Trend: Increase Assessment: positive
Source: Eurostat
provide services, also at short notice.
Primary inpatient care is provided by the
Liechtenstein National Hospital. However,
there are also additional agreements with
some 30 hospitals, clinics, treatment centres
and rehabilitation centres abroad, especially
in Switzerland. In terms of long-term care,
there are six care homes available in Balzers,
Triesen, Vaduz, Schaan, Eschen and Mauren.
The good healthcare provision is reflected
in the trends shown by statistical indicators.
Life expectancy has risen significantly in
the past 20 years and reached 84 years for
women and 80.6 years for men in 2015.
Life expectancy at age 65 also shows an
upwards trend.
In 2016, the leading causes of death in Liechtenstein were heart/cardiovascular disease
(34.5%), cancer (22.9%) and respiratory diseases (15.3%). The number of communicable
diseases that are required to be reported is
at a low level but fluctuates relatively strongly
due to the small number of cases. Until 2016
the number ranged from 78 to 149 cases.
Maternal mortality, child mortality and the
number of persons injured in road traffic
accidents are likewise very low.
The number of persons resident in Liechtenstein that are infected with HIV is recorded
in official statistics, but no epidemiological
evaluation is conducted due to the low number
of cases. The number of diagnosed HIV/Aids
cases has fluctuated since 2000 at around
0.8 to 1.2 cases per year on average.
18
4 Implementation of the individual SDGs
Challenges
Considerable challenges were posed by the
health costs per insured person, since these
costs were constantly increasing by 4%
per annum as a long-term average. Thanks
to measures implemented by the government
in terms of fees, and also an increase in
contributions, the costs per insured person
have been stabilised since 2013. That is a
considerable achievement in international
comparison. The current challenge is to
continue to keep costs stable.
General challenges can be identified with
respect to health-related behaviour. Numerous health problems are directly related to
(lack of) exercise, poor nutrition and obesity,
as well as the consumption of nicotine and
alcohol. There are certain challenges with
respect to the consumption of legal and
illegal drugs or abuse of medication, espe2005
2007
1999
1998
2009
2001
2011
2003
2013
2016
2006
2008
2000
2010
2002
2012
2015
2004
2014
600
500
400
300
200
100
0
Deaths and injuries from
road traffic accidents
per 100000 inhabitants
Trend: Decrease Assessment: positive
Source: National Police (Landespolizei), Government
Accountability Report (Rechenschaftsbericht der
Regierung), population statistics (Bevölkerungsstatistik)
2.5
2
1.5
1
0.5
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Total fertility rate
Average number of children per woman
Trend: No significant change Assessment: neutral Source: Registry statistics (Zivilstandsstatistik)
19
4 Implementation of the individual SDGs
cially among young people.
Measures
The state and local authorities offer numerous
preventive and health-promoting measures.
These includes free check-ups every five years.
In addition, women are invited to attend a
gynaecological screening every 2.5 years.
Furthermore, there are various briefings,
campaigns, projects and target group-specific or topic-specific measures. Awarenessraising campaigns in the fields of nutrition,
exercise, nicotine and alcohol have shown
that simple measures can achieve a great
deal in terms of public health.
450
400
350
300
250
200
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Trend 2001–2013: 4.02% growth per year
Costs per insured person, per month (mandatory insurance)
Trends in health costs
in CHF per insured person, per month
Trend: Stabilised since 2013 Assessment: positive
Source: Federal Health Authority cost monitoring (BAG Kostenmonitoring),
Ministry for Social Affairs (Ministerium für Gesellschaft)
|
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[
3
] |
{
"country": "lie",
"file_id": "sdg-03/vnr-report-lie-2019-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2019
}
|
72
SDG 3: Several respondents said the healthcare system
was very good, but many were concerned by the steady
rise in healthcare costs. Some respondents pointed out
deficits, such as in the psychosocial area, access for people
with disabilities, and housing and care for elderly people in
light of demographic change.
|
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"file_id": "sdg-03/vnr-report-lie-2023-en-5.pdf",
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|
15
SDG 3: Ensure healthy lives and
promote well-being for all at all ages
Situation in Liechtenstein
In general, healthcare provision in Liechtenstein is of high
quality and availability. This became particularly clear
during the COVID-19 pandemic, when the healthcare system remained fully functional at all times.
All Liechtenstein residents have unrestricted and equal access to health services. For all residents there is mandatory
healthcare insurance (OKP), which ensures the provision of
healthcare services. Each insured person pays a per-capita
premium and a contribution to costs. However, children
aged under 16 are exempt from the premium payment and
contribution. Persons aged between 16 and 20 pay half the
premiums of adults aged over 20 and do not have to pay a
contribution. As of 1 January 2023, insured persons who
have reached the regular pension age also no longer have
to pay contributions. Adults with a low household income
receive a contribution to their premiums and contributions.
The state supports healthcare through substantial subsidies from general taxation.
With around 315 residents per practising physician, the
density of physicians is high in international comparison,
especially as a large proportion of hospital services are provided in neighbouring countries. Primary inpatient care is
provided by the Liechtenstein National Hospital. However,
there are also additional agreements with 22 hospitals, clinOverall assessment
• Healthcare in Liechtenstein is of a very high standard and healthcare services are available quickly and to everyone.
• However, healthcare costs have stabilised at a very high level, which remains a challenge for the future. 1999 2001 2003 2005 2007 2009 2011 2013 2015
2017
2019
2020
350
300
250
200
150
100
50
0
Assessment neutral
The overall mortality rate up to age 65 has not
significantly changed.
Source: National Statistical Office – Sustainable development indicators
Desired development: Decrease
Trend: no significant change
Statistical indicators
Mortality rate
up to age 65 per 100,000 residents
Total Men Women
16
ics, treatment centres and rehabilitation centres abroad,
especially in Switzerland. In terms of long-term care, there
are six care homes available in Balzers, Triesen, Vaduz,
Schaan, Eschen and Mauren, along with a residential care
group in Triesenberg. For necessary care at home, the organisations “Familienhilfe Liechtenstein” and “Lebenshilfe
Balzers” provide services, also at short notice.
During the COVID-19 pandemic, no serious bottlenecks in
the health care system occurred. Liechtenstein also rapidly
set up testing facilities for the general public, in some cases free of charge, and always provided free vaccinations.
Liechtenstein also made an active contribution to the global fight against the pandemic by supporting COVAX, the
worldwide initiative to improve access to vaccines.
Liechtenstein’s good healthcare provision is reflected in
the trends shown by statistical indicators. Life expectancy
has increased significantly since the start of the survey. After a decline in 2020 influenced by the COVID-19 pandemic, it increased again in 2021, reaching 86.4 years for women and 81.6 years for men. Life expectancy at age 65 also
shows an upwards trend.
The main causes of death in Liechtenstein in 2021 were diseases of the cardiovascular system (including diabetes mellitus) at 31%, cancer at 26.6%, COVID-19 at 5.2% and other diseases of the respiratory organs at 4.8%. Maternal
mortality, child mortality and the number of persons injured in road traffic accidents were very low.
The number of cases of reportable infectious diseases has
fluctuated between 57 and 98 per year for some time –
COVID-19 infections not included. Since the start of the
COVID-19 pandemic, more than 21,000 people have tested
positive for SARS-CoV-2 (including multiple infections).
The number of persons resident in Liechtenstein that are
infected with HIV is recorded in official statistics, but no
epidemiological evaluation is conducted due to the low
number of cases. On average, there were 0.75 new HIV infections per year between 2010 and 2021.
Challenges
Considerable challenges are posed by the health costs per
insured person since these costs are increasing by 3% per
annum as a long-term average. Thanks to measures implemented in terms of fees, and also an increase in contributions, the costs per insured person began to stabilise in
2013. That is a considerable achievement in international
comparison. In 2021, however, the costs per insured person rose again by some 2% compared to the previous year,
and 2022 saw an overall cost increase of 6%. The current
challenge is to continue to keep costs stable.
General challenges can be identified with respect to
health-related behaviour. Numerous health problems are
directly related to lack of exercise, poor nutrition and obesity, and the consumption of nicotine and alcohol. There are
certain challenges with respect to the consumption of legal
and illegal drugs or abuse of medication, especially among
young people.
Measures
The state and local authorities offer numerous preventive
and health-promoting measures. These includes free
check-ups every five years. In addition, women are invited
to attend a gynaecological screening every 2.5 years. Furthermore, there are various briefings, campaigns, projects 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021
100
90
80
70
60
50
40
30
20
10
0
Assessment positive
Life expectancy at birth is increasing.
Source: National Statistical Office
Desired development: Increase
Trend: Increase
Life expectancy at birth
in years
Men Women
17
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
25
20
15
10
5
0
Assessment positive
Life expectancy at age 65 is increasing.
Source: National Statistical Office
Desired development: Increase
Trend: Increase
Life expectancy at age 65
in years
Men Women
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
600
500
400
300
200
100
0
Assessment positive
The number of road traffic injuries and fatalities
has declined.
Source: National Statistical Office – Sustainable development indicators
Desired development: Decrease
Trend: Decrease
Road traffic injuries and fatalities
per 100,000 inhabitants
and target group-specific or topic-specific measures.
Awareness-raising campaigns in the fields of nutrition, exercise, nicotine and alcohol have shown that simple measures can achieve a great deal.
In autumn 2021, the Association for Human Rights in Liechtenstein (VMR) and the Office of Public Health, in consultation with the Liechtenstein Medical Association, began offering intercultural interpreting services in doctors’
practices. The pilot project will run for two years from the
beginning of 2022 to the end of 2023 and will be free of
charge for patients and practices alike. This is another step
towards providing an accessible and inclusive healthcare
system for all.
In addition, road traffic campaigns such as #streetfluencer
highlight potential hazards to reduce the risk of accidents.
18
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
450
400
350
300
250
200
150
100
50
0
244.6 258.9 271.0
295.1 302.6 310.8 313.2 322.8 317.7
359.8 357.3 356.3 359.4 360.4 351.7 367.5 368.8 375.8
Assessment negative
The cost of mandatory health insurance for insured persons is increasing.
Source: National Statistical Office – Health insurers’ statistics
Desired development: Stable or decline
Trend: Increase
Cost of mandatory health insurance
per insured person, per month
Costs per insured person, per month Trend: 3.16% growth per year
|
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Sri Lanka Voluntary National Review on the Status of Implementing the Sustainable Development Goals 73
Current Status and Trends
Sri Lanka’s health system is well-known for
achieving outcomes such as, low maternal
and child mortality, and rising life expectancy.
However, emerging issues associated with the
rapid increase of Non Communicable Diseases
(NCDs) coupled with the swift rate of population
ageing and changes in diseases patterns have
contributed to transforming the healthcare
needs of the country.
Sri Lanka achieved the maternal mortality rate
global target under the SDGs (Target 3.1) more
than two decades ago (refer Figure 4.13). In
2015, Sri Lanka’s maternal mortality rate was
33.7 per 100,000 live births, which is well below
the SDG target of 70 per live births. Additionally,
the under-five mortality rate and the neonatal
mortality rates were 10 and 5.8 per 100,000 live
births, respectively.59 These mortality rates are
also lower than the relevant SDG target under
the SDGs (Target 3.2).
_____________
59 DCS (2017)
74 Sri Lanka Voluntary National Review on the Status of Implementing the Sustainable Development Goals
Sri Lanka’s performance with regard to
mitigating certain communicable diseases
(Target 3.3) such as Malaria and Tuberculosis
(TB) is also noteworthy. For example, in 2016
the World Health Organization (WHO) certified
Sri Lanka as a Malaria free country60; the
country’s TB incidence rate in 2015 was 65 per
100,000 population, with a mortality rate of
5.6 per 100,000 population compared to the
37 per 100,000 population in the WHO South
East Asian region as a whole.61 However, other
communicable diseases such as Dengue require
close attention. The incidence of Dengue has
increased from 142 cases per 100,000 population
in 2015 to 260 cases per 100,000 population in
2016.62 Moreover, the Demographic and Health
Survey (DHS) 2016 shows that only 33% of
women have comprehensive knowledge about
HIV AIDS; although Sri Lanka’s HIV prevalence
is below 1%, there has been an increase in the
reported HIV cases from 95 in 200963 to 285 in
2017.64 In fact, this is the highest number reported
in a year since the identification of the first HIV
infected Sri Lankan in 1987.
The rate of injuries and deaths attributed to
road accidents (Target 3.6) is also on the rise.
It is estimated that the average number of daily
deaths on road has increased from 6.6 in 2014 to
7.5 in 2015.65 The death rate due to road accidents
was 13.4 per 100,000 population in 2015.66
The entire population is covered by Sri Lanka’s
public health system (Target 3.8). However, more
than half of the total health expenditure in the
country is private expenditure, out of which 83%
is out-of-pocket payments by households.67
Gaps and Challenges
Sri Lanka faces a greater challenge in terms of the
threat posed by NCDs (Target 3.4), with 71% of
all annual deaths in Government hospitals being
due to chronic NCDs.68 Cardiovascular diseases,
cancer, diabetes, and chronic respiratory
diseases are the major NCDs that are burdening
the country’s population; in 2012, ischaemic
heart disease was the leading cause of death
among Sri Lankans.69 In addition, Chronic Kidney
Disease (CKD) has been recognized as an issue
of concern in the country.
Non-adherence to a proper referral system and
the shortage of facilities at primary healthcare
units have become challenges. These have,
resulted in secondary and tertiary care institutions
becoming overcrowded. The overcrowding and
long-waiting lists at Government facilities have
propelled patients to seek private healthcare,
increasing their out-of -pocket expenditure on
health.70
The quality of the country’s healthcare
sector needs further improvement in terms
of maintaining health standards in the areas
of infrastructure, equipment, healthcare sta!,
patient safety etc. With regard to ensuring
that no one is left behind (Target 3.8), GoSL
focuses its attention on improving the provision
of healthcare services to the estate sector
community where access to healthcare is lower
than the urban and rural sectors and reports low
levels of nutrition.71
Although Sri Lanka has achieved commendably
low national averages in maternal and child
mortality rates, considerable regional disparities
denote challenges that are yet to be overcome
in ensuring that no one is left behind (Targets
3.1, 3.2, and 3.8). Furthermore, there is much
scope for improving the access to sexual and
reproductive health-care services (Target 3.7):
Only 55.9% of women of reproductive age have
had their need for family planning satisfied with
modern methods.72 Issues such as the lack of
comprehensive sexual educational information
in school curricula, and the lack of adult
_____________
60 CBSL (2017), ‘Annual Report 2016’ Central Bank of Sri Lanka, Colombo
61 WHO (2017), ‘Bending the Curve, Ending TB: Annual Report 2017’. Available at http://apps.who.int/iris/bitstream/
handle/10665/254762/978929022584-eng.pdf?sequence=1&isAllowed=y
62 CBSL (2017)
63 MOH (2015), ‘Annual Report 2015: National STD/AIDS Control Programme’, Ministry of Health, Colombo
64 National STD/Aids Control Programme (2017), ‘Update : 4th Quarter 2017’, Department of Health Services, Colombo
65 Ibid
66 DCS (2017)
67 WHO (2015), ‘World Health Statistics 2015’, World Health Organization, Geneva
68 MOH (2012), ‘Annual Health Bulletin 2012’, Ministry of Health, Colombo
69 WHO (2017), ‘Sri Lanka: WHO Statistical Profile’. Available at http://www.who.int/gho/countries/lka.pdf?ua=1
70 PIP 2017-2020
71 Ibid
72 DCS (2017)
Sri Lanka Voluntary National Review on the Status of Implementing the Sustainable Development Goals 75
education on the subject as well as improving
attitudes towards sexual education need to be
addressed.73
In terms of communicable diseases (Target 3.3),
attention is required on eradicating/reducing
emerging and re-emerging diseases such as
dengue, rabies, HIV, leprosy, tuberculosis etc.
even though they have not posed a threat for
now.74 Additionally, the lack of awareness and
the lack of multi-sectoral coordination have been
identified as emerging issues, especially in the
case of Dengue; there is a need for improvement
in the identification of new cases.75
Among factors that are expected to contribute
to the increasing prevalence of NCDs (Target
3.4) are: Sri Lanka’s rapidly ageing population,
increasing prevalence of CKD, increasing
household income coupled with unhealthy food
habits, and the rise of alcohol and tobacco
consumption (Target 3.5).76 Furthermore,
given the rising incidence of CKD in farmingconcentrated areas – which points to the
possibility of chronic diseases resulting from
exposure to pesticides77 – it is necessary to focus
on reducing the number of deaths and illnesses
from hazardous chemicals and pollution (Target
3.9). These challenges need to be overcome in
order to gain ground on the fight against NCDs.
Way Forward
The quality of the country’s health sector needs to be further improved so that all emerging
issues can be attended to in a timely manner. It is necessary to strengthen the provision of
primary healthcare which would lead to reduction in private healthcare expenditure (and
out-of-pocket expenditure) as well as overcrowding at secondary and tertiary healthcare
facilities. In addition, there is a need to improve customer care at public hospitals and to
improve access to and perception of general public on mental health services.78 Reduction
of NCDs prevalence is essential given its impact not only on mortality and morbidity but
also on poverty and economic growth.
The Government is continuously focusing on developing infrastructure facilities, providing
essential drugs and services, and ensuring the systematic development of the current
health system. By developing a new Health Policy (2016-2025) and a Primary Healthcare
Policy, the Government has initiated the following reforms to overcome challenges in
ensuring universal health coverage:
1. Restructuring the primary healthcare system ensuring
easy access and early detection with related essential
services and a proper referral system to reduce the
overcrowding in specialized care hospitals.
_____________
73 Stakeholder input from the first thematic workshop
74 PIP 2017-2020
75 Stakeholder input
76 PIP 2017-2020
77 IPS (2016), ‘State of the Economy 2016’ Institute of Policy Studies of Sri Lanka, Colombo
78 Stakeholder input from the VNR Validation Workshop
76 Sri Lanka Voluntary National Review on the Status of Implementing the Sustainable Development Goals
2. Strengthening healthcare organizations, and the
provision and regulation of healthcare services not
only to deliver services e!ectively and e"ciently
but also to provide citizen-centred, quality care to
ensure patient satisfaction.
3. Developing a ‘citizen-centric, integrated healthcare
system’ which is a!ordable and sustainable, ensuring
continuous care for every patient by establishing
Primary Medical Care Units (PMCUs) for identified
populations.
4. Minimizing inequality and improving the quality and
safety of healthcare service delivery
The achievement of SDG 3 on good health and well-being is entwined with the achievement
of the other SDGs as well: high healthcare expenditure can neutralize the e!ect of poverty
eradication e!orts (SDG 1 & SDG 10); Poor performance in nutrition (refer section on
SDG 2) has negative impact on children’s physical and mental health and well-being
(SDG 2); education and awareness on disease prevention is a necessity to ensure a
sustainably healthy population (SDG 4); it is necessary to reduce mortality and morbidity
from environmental pollution through provision of clean water and sanitation (SDG 6) and
clean energy (SDG 7), as well as by promoting sustainable consumption and production
patterns (SDG 12); innovations for resource mobilization from the private sector is
essential to reduce the Government’s healthcare expenditure burden (SDG 8); the quality
of healthcare infrastructure needs to be improved (SDG 9); urban planning should focus
on cleaner, safer, and healthier living in terms of housing, transport and access to green
spaces (SDG 11); steps should be taken to insure against risks to health from climaterelated hazards and disasters (SDG 13); sustainable management of life below water (SDG
14) and life on land (SDG 15) is essential to ensure the safety of food supply and access
to healthy diets; it is necessary to identify and address the detrimental e!ect of conflicts
and violence on both mental and physical well-being (SDG 16); SDG 17, finally, provides for
the societal structures based on good governance and coherent macro-economic policy
background which allow people to thrive and lead healthy lives.79
_____________
79 Based on https://unsdglk.socialcops.com/
|
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|
SDG 3. ENSURE
HEALTHY LIVES AND
PROMOTE WELLBEING
FOR ALL AT ALL AGES
KEY CHALLENGES
Ageing population
Rising health care costs, underfunding of the health sector
Shortage of human resources in the health sector
Rapid and effective management of emerging crises
INPROGRESS OF KEY INDICATORS PER TARGET
3.1. In Lithuania, no deaths due to pregnancy, childbirth and post-partum conditions were
recorded by 2020 the target is considered achieved.
3.2. Lithuania maintains low mortality rates for newborns and children under 5 years of age
(respectively, 2.2% in 2018, 2.1% in 2021, and 0.8% in 2018, 0.7% in 2021.
3.3. Prevention and treatment measures and restrictions during COVID19 have contributed
to reducing the incidence of communicable diseases: The number of newly diagnosed HIV
positive people has fallen from 5.7 in 2018 to 3.9% in 2021, the incidence of tuberculosis has
also decreased 32.9% in 2018 and 19.6% in 2021, malaria 0.2% in 2018, 0.1% in 2021,
hepatitis B 0.5% in 2018, 0.3% in 2021.
3.4. However, the pandemic has contributed to an increase in premature mortality from
some non-communicable diseases: Mortality from diseases of the circulatory system has
increased 782.5 in 2018 and 820.3 in 2021 per 100 000 inhabitants), diabetes mellitus 18.8
in 2018 and 25.4 in 2021 per 100 000 inhabitants). It should be noted that mortality due to
malignant neoplasms reduced 286.6 in 2018, 275.9 in 2021 per 100 000 inhabitants),
respiratory diseases 49.6 in 2018 and 37.9 in 2021 per 100 000 inhabitants) and suicides
24.4 in 2018, 20.2 cases per 100 000 inhabitants).
3.5. The measures taken to control and prevent alcohol consumption are insufficient:
Consumption of legal alcoholic beverages has increased 11.2 litres of absolute alcohol per
person aged 15 and over in 2018 and 12.1 litres in 2021.
3.6. Although road accidents caused by intoxicated persons remain a problem (in 2018,
there were 344 road accidents caused by intoxicated persons, in 2021 333, the overall
road mortality in the country is decreasing (in 2018 8, in 2021 6.6 deaths per 100 000
inhabitants).
(continued on the next page)
37
INPROGRESS OF KEY INDICATORS PER TARGET (continued):
3.7. The number of under-age giving births in the country is falling 11.2 live births per 1 000
women aged 1519 in 2018 and 6.6 in 2021. However, there is still a need to focus more on
reproductive health education.
3.8. The country's public health coverage index is improving 67 in 2017 and 70 in 2019.
3.9. Deaths due to accidental poisoning are decreasing in Lithuania 3.6 deaths per 100
000 inhabitants in 2018 and 2 in 2021. However, deaths from diarrhea, intestinal worms and
diseases caused by malnutrition increased slightly 2.2 deaths per 100 000 inhabitants in
2018 and 2.4 in 2021.
3.a. The measures taken to control and prevent tobacco consumption are insufficient:
tobacco products are on the increase 1,164 cigarettes per 100,000 inhabitants in 2018 and
1,233 in 2021, as well as the use of electronic cigarettes.
3.b. The country has seen an increase in total net official development assistance for
medical research and basic health services: €5.1 thousand in 2018 and €3.3 million in 2021.
3.c. The number of health workers in the country has changed: a slight decrease in the
number of doctors 49 per 10,000 inhabitants in 2018, 46.9 in 2021, an increase in the
number of nurses and midwives (in 2018 there were 81.5 per 10 000 inhabitants, in 2021
82.1.
3.d. In Lithuania, the average level of application of the 13 International Health Regulations
IHR has increased (from 82% in 2018 to 85% in 2020.
More information on (in)progress for specific indicators is available here.
SDG 3. ENSURE
HEALTHY LIVES AND
PROMOTE WELLBEING
FOR ALL AT ALL AGES
38
SDG 3 IMPORTANCE IN THE LITHUANIAN CONTEXT
Promoting public health is both a national priority and a
priority of the country's SDGs. This goal aims to strengthen
physical and mental health for all age groups, promote healthy
lifestyles and ensure quality and accessible health care, while
measuring progress includes indicators on morbidity,
mortality, lifestyles, preventive measures and access to health
care for different groups in society.
PROGRESS IN THE INTERNATIONAL CONTEXT
In Lithuania, the health status of the population has been
improving steadily for several years: Between 2010 and 2019,
life expectancy in Lithuania increased at the fastest rate in the
EU (by 2019, life expectancy in Lithuania increased by more
than four years, from 72.1 to 76.5 years). However, this
improving trend was strongly affected by the impact of
COVID19, with 17% more deaths recorded in 2020 than in
2019, resulting in a reduction in life expectancy of 1.4 years
compared to 2019. The pandemic could also slow progress in
disease prevention by disrupting the implementation of
priority programmes for the early detection of chronic and
oncological diseases. In response to the negative impact of
COVID19, the government adopted a Plan of Measures to
Reduce the Economic Incentives and Consequences of the
Transmission of the Coronavirus COVID19, which provided
the resources needed for the effective functioning of health
and public protection systems.
It also aims to improve the efficiency and resilience of the
health system to shocks: Strengthening the capacity to
respond to emerging challenges, restructuring the
organisation of ambulance services, improving human
resource competencies, restructuring the hospital network by
further strengthening primary health care, developing
outpatient services and introducing innovative services based
on digital health system solutions. It is foreseen to pay special
attention to improving the quality of health care services by
developing new requirements for the provision of services,
improving the system for registering patients for medical
consultations, improving the monitoring of the activities of
medical institutions and the assessment of the quality of
services provided, and modernising the infrastructure of
health care services. It should be noted that in Lithuania,
health care is financed by the compulsory health insurance
fund PSD, which covers the costs of health care for almost
the entire population (around 98%, thus ensuring access to
health care for the absolute majority of the population. The
planned and implemented health system transformation
measures will ensure a more rational use of the PSD fund and
increase the coverage of services to the population.
It should be noted that in the NCCMA, in pursuit of SDG 3
progress, it is foreseen to strengthen the system for informing
the public about climate change and its threats to human
health. The monitoring and forecasting of indicators (pollen in
the air, phenological observations, etc.) will be implemented
and improved, prevention of diseases that may arise and
spread as a result of the effects of climate change will be
carried out, the design of infrastructure, residential and nonresidential buildings will be based on an assessment of the
change in meteorological conditions due to climate change.
The NCCMA is anchored in the prevention of heat waves
through the development of green infrastructure elements in
urbanised areas and the development of inter-agency
cooperation.
OVERVIEW OF INPROGRESS
Lithuania has already successfully achieved the goal of
reducing maternal mortality, and from 2020 the absolute
achievement of target 3.1 is recorded 0 deaths per 100,000
live births were recorded, and the proportion of births
attended by skilled health personnel was 100%. In 20182021,
the mortality rate of newborns and children under the age of
five remains low – throughout the period analysed, the
mortality rate of children 04 years) is less than 1 case /1,000
inhabitants of the respective age, and of newborns 3 cases
/1,000 live births 027 days) (target 3.2. In order to maintain
these positive trends, neonatology in Lithuania is being
consistently strengthened, which is considered to be a
decisive factor when all the necessary assistance for the
smallest premature and most difficult newborns is
concentrated in several institutions. According to the best
practices of foreign countries, regionalised care for mothers
and newborns creates positive conditions for better survival
rates.
FIGURE 17. HEALTHY LIFE EXPECTANCY IN YEARS IN LITHUANIA AND THE EU, 2018-2020.
Source: EUROSTAT, 2023.
STRATEGIC AGENDA
Improving public health and ensuring healthy lifestyles is one
of the country's strategic objectives – the NPP sets the goal of
reducing the gap in average life expectancy between men and
women to 5.2 years by 2030 and increasing the average
expected healthy life expectancy to 62.6 years for men and 65
years for women. In addition to the above goal, the plan also
aims to strengthen the emotional resilience of society by
improving suicide and addiction rates; encourage the
population to maintain and improve their health through
lifestyle and behaviour change; develop a responsible attitude
to health by increasing physical activity and participation in
sports activities among children and adults; improve the
quality of health services to increase the effectiveness of
treatment interventions and improve health outcomes; and
reduce avoidable mortality.
39
The country attaches great importance to the prevention and
treatment of communicable diseases (target 3.3. The
epidemiological situation is expected to improve between
2018 and 2021 The number of newly diagnosed HIV-positive
people has decreased (from 5.7 new cases in 2018 to 3.9
cases per 100 000 inhabitants in 2021 the incidence of
tuberculosis (from 32.9 new cases in 2018 to 19.6 cases per
100 000 inhabitants in 2021, incidence of acute viral hepatitis
B (from 0.5 cases per 100 000 population in 2018 to 0.3 cases
per 100 000 population in 2021. This has been influenced by
the development of low-threshold services for the
management of HIV infection, ensuring effective treatment of
HIV disease in all persons diagnosed with this infection. An
important role in improving the epidemiological situation of
tuberculosis is played by the updated tuberculosis treatment
algorithms in accordance with the recommendations of the
World Health Organisation WHO, the network of DOTS rooms
developed and the social support provided in the whole
country. The incidence of hepatitis B has decreased as a
result of the country's hepatitis B vaccination policy. COVID
19, which started with partially restricted health services and
potentially fewer diagnosed cases, but also with limited
contact between members of the public, which partially
reduced the risk of infection, is likely to have contributed to
the improvement in rates. Although a number of challenges
remain in the management of communicable diseases,
Lithuania has been able to ensure adequate diagnosis and
treatment of imported tropical diseases (e.g. malaria, dengue
fever), information, vaccination and chemoprophylaxis for
travellers to endemic areas, and chemoprophylaxis for malaria
(the number of new cases of malaria has fallen from 0.3 to
0.01 per 100 000 population).
Reducing premature mortality from noncommunicable
diseases remains an important goal (target 3.4. It should be
noted that the structure of the causes of death of the
Lithuanian population is unchanged for many years and there
are still three main causes of death: diseases of the
circulatory system, malignant tumours and external causes of
death. The mortality rate of the population from diseases of
the circulatory system remains high and is almost twice as
high as the average for EU Member States. In order to reduce
the morbidity and premature mortality of the population from
diseases of the circulatory system, oncological diseases, etc.,
projects are actively implemented to encourage residents to
adjust their lifestyles by reducing the prevalence of risk
factors, to encourage residents to participate in prevention
and early diagnosis programmes, to strengthen the
development of secondary and/or tertiary level outpatient
personal health care services for persons suffering from the
aforementioned diseases. The projects implemented also aim
to improve the infrastructure necessary for the provision of
health services and to improve the qualifications of health
professionals. Information campaigns are also be carried out
to encourage the public to take care of their health, adopt a
healthy lifestyle and have regular health checks.
Strengthening mental health and well-being is also important
for Lithuania (target 3.4. Progress in the provision of the
following services is monitored: from 2020, Lithuania have
mobile crisis teams that can arrive on site or provide remote
support in the event of a major mental health crisis; the skills
and competences of the employees of the municipal health
centres are strengthened, and the priorities set for these
institutions are aimed at training the residents of the selfgovernments on the issues of basic suicide prevention.
Between 2017 and 2021, 20,177 people were trained to
recognise signs of suicide risk, respond appropriately and
refer or provide psychological first aid. In 2022, the framework
for supporting people at risk of suicide was updated and
comprehensive measures is implemented to improve access
to support. A public communication campaign on suicide
prevention has also been launched to reduce negative public
attitudes towards the phenomenon. The country's strategic
goal of no more than 17.5 suicides per 100,000 inhabitants in
Lithuania in 2025 will be achieved on current trends.
FIGURE 18. INCIDENCE OF COMMUNICABLE DISEASES (NUMBER OF CASES PER 100
000 POPULATION).
Source: State Data Agency, 2023.
Lithuania is rigorously developing a national immunisation
programme, focusing on target groups (target 3.b.1. From
2018, an updated list of vaccines and target risk groups
provides the basis for strengthening the prevention of
communicable diseases. The vaccination of the population
with COVID19 ensured the wide availability of this vaccine
through vaccination centres, pharmacies, as well as mobile
teams that carry out vaccinations in non-medical facilities, etc.
More than 70% of the population was vaccinated with one of
the registered COVID19 vaccines in the initial programme,
and about 30% of the population was vaccinated with a
booster dose.
FIGURE 19. SUICIDE MORTALITY IN LITHUANIA, PER 100 000 NUMBER OF DEATHS BY
SUICIDE PER 100 INHABITANTS
Source: State Data Agency, 2023.
40
In order to achieve positive changes in the reduction of
chronic diseases, the fight against harmful habits is important
(targets 3.5 and 3.a). The following WHO-recommended
alcohol control measures entered into force in Lithuania in
2018 reducing the hours of sale of alcohol, increasing the age
limit for purchasing, consuming and possessing alcoholic
beverages by up to 20 years, banning alcohol advertising (by
establishing an exhaustive list of information that may be
published at points of sale and on retailers' websites),
improving the procedure for assessing alcohol consumption
habits, and providing and monitoring brief interventions for
alcohol users in 2020, which allows for improving the provision
of support services for people with harmful alcohol
consumption habits. Changes to the legislative framework
between 2020 and 2022 have been introduced to strengthen
the control and availability of tobacco, tobacco products and
related products, and to strengthen the capacity of health
professionals to provide tobacco risk assessment and
smoking cessation support services, and to increase the
supply and availability of smoking cessation support services;
The Action Plan to improve the availability and quality of
treatment and harm reduction services for addictive disorders
20212024 is endorsed. However, these measures are not
sufficient and additional attention needs to be paid to the
prevention of alcohol and tobacco consumption and to
increasing the availability of help for addicts of all ages: This is
also justified by the increasing consumption of alcohol by the
population since 2019 11.1 litres of absolute alcohol per
inhabitant aged 15 and over in 2019, 12.1 litres in 2021 and the
still stable high prevalence of tobacco consumption 1 145
tobacco products per inhabitant aged 15 and over in 2019
(cigarettes), 1 233 in 2021 and the increasing use of
electronic cigarettes (especially among young people).
Therefore, a number of national and regional measures are
planned for the period 20222030, financed with EU support,
to develop prevention, quality and effectiveness of the use of
psychoactive substances.
Lithuania has achieved good results in managing public health
emergencies (target 3.d.1. The average rate of
implementation of international health rules in Lithuania in
2021 is 82%, compared with 75% for countries in the WHO
European Region. The country's strengths include the legal
framework, management of health emergencies, food safety
and radiation protection, but there is still room for
improvement – infection prevention and control and
strengthening human resources. The main measures to be
applied in 20182022 are the preparation of legal acts for the
prevention and management of emergencies, risk assessment,
preparation of training programmes and training of
professionals.
THE CHALLENGES AHEAD
While the overall trends for the SDG 3 indicators are positive,
it is important to remember that Lithuania's health policy faces
long-term challenges: Inadequate financing of health care,
lack of human resources, ageing population both in Lithuania
and in the EU.
The challenge of an ageing population contributes to a higher
demand for health services and an increase in health care
costs. COVID19 has contributed to these challenges and has
had a significant impact on the achievement of health policy
goals. It should be noted that the pandemic has highlighted
gaps in the resilience of the health system: The health system
needs to be prepared to respond quickly and effectively to
emerging crises, to be able to respond rapidly to changes and
to manage them effectively, both in terms of assessing the
available infrastructure and the competence of professionals.
During the pandemic, the health system faced a shortage of
specialists and resources, the implementation of early
diagnosis and prevention programmes for chronic diseases
was disrupted, and 26% of the country's population reported
refusing medical care during the pandemic. The impact of the
energy crisis is also exceptional, when financial resources that
could be used to improve the quality or accessibility of health
services have to be allocated to cover the increased prices of
energy resources.
CONCLUSIONS AND PROPOSALS
Lithuania's progress towards SDG 3 from 2018 can be
considered medium and sufficient to achieve the goal. The
country is taking action to prevent communicable and noncommunicable diseases, control and prevent tobacco and
FIGURE 20. ABSOLUTE ALCOHOL CONSUMPTION OF THE LITHUANIAN POPULATION.
Source: State Data Agency, 2023.
Lithuania also aims to reduce the number of deaths and
injuries in road traffic accidents (target 3.6. Since 2018, there
has been a decrease in mortality due to injuries caused by
road traffic accidents, from 8 deaths per 100,000 inhabitants
in 2018 to 6.6 deaths in 2021. This is due to a complex set of
measures: both various social advertisements, preventive
information, more active police operations, improved road
infrastructure, as well as residents' choice to use newer,
smarter and safer vehicles. Maintaining such positive trends in
the future requires continued joint efforts of all institutions and
road users, responsible behaviour, care and respect for each
other on the road.
82% 75%
IN LITHUANIA IN THE EUROPEAN
REGION
THE AVERAGE CAPACITY TO
IMPLEMENT INTERNATIONAL HEALTH
RULES IS
41
alcohol use, strengthen the emotional resilience and physical
health of the population, and encourage people to maintain
and improve their health through lifestyle and behavioural
changes.
Actions are also taken to improve the quality and accessibility
of health services, with the aim of increasing the effectiveness
of interventions and improving outcomes by reducing
avoidable mortality.
However, the measures in place in the country are not
sufficient to achieve high progress towards the goal, which is
hampered by the country's long-term health challenges:
Inadequate funding for health care, a shortage of human
resources in the health sector and an ageing population, both
in Lithuania and in the EU. The COVID19 pandemic
contributed to these challenges and had a major impact on
the achievement of health policy goals, highlighting gaps in
the resilience of the health system.
GOOD PRACTICE
In order to improve the management of health threats and risk factors, in
20182021 the EU-funded project “Implementation of Health
Preservation Measures in Target Areas” No 08.4.2ESFAV62801
0001 established and expanded the network of defibrillators and
tourniquets was established and expanded in target areas, and more
than 6,000 Lithuanian residents were trained in first aid. After the
training, the majority of participants who agreed to become emergency
responders pledged to provide first aid to a victim in an emergency upon
receiving a signal.
To save lives, and with cardiovascular disease the leading cause of
death worldwide, first aid and defibrillation must be given as soon as
possible. In countries where defibrillation has been achieved within the
first 3 minutes of clinical death, the survival rate has increased by 75%,
so the establishment and expansion of this network in Lithuania is
considered an important step in the healthcare system.
In the future, in order to achieve the goals set in the country's
strategic documents, it will be necessary to increase the
sustainability and resilience of the health system to external
threats, to strengthen intersectoral cooperation, to improve
coordination of the activities of all health system stakeholders,
and to implement measures that contribute to a more efficient
and rational use of available resources. To strengthen public
health, we must continue to focus on increasing the emotional
resilience and physical activity of the country's population,
and on strengthening primary and preventive health care.
Equally important for public health is the need to mitigate the
adverse effects of climate change on human health, which
also requires the successful implementation of other SDGs.
Source: Pexels.
42
|
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[
3
] |
{
"country": "ltu",
"file_id": "sdg-03/vnr-report-ltu-2023-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
16 LE LUXEMBOURG EN TRANSITION
Dans les pages qui suivent, nous passons en revue l’état d’avancement de quelques ODD clés pour
le Luxembourg dans sa mise en œuvre de l’Agenda 2030.
Bonne santé et bien-être
En dépit de la crise sanitaire liée
au Covid-19, le niveau de santé et
de bien-être de la population du
Luxembourg connait globalement
une évolution positive, par rapport à un niveau déjà élevé. De
réels progrès sont observés, par exemple, à travers la baisse
du taux de suicide, du recours aux psychotropes ou encore
des accidents de la route. La proportion du nombre de fumeurs continue en revanche à augmenter (26% en 2020).
|
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52 53
Health in All Policies
For many years WHO has provided technical
support to the Ministry of Health based on a
Cooperation Agreement on priorities in the Latvian health sector.
For more information, see Section 5 Initiatives and partnerships for SDG implementation
Source: Ministry of Health
Air quality monitoring is the responsibility of
the national authorities, but local governments
and businesses also monitor the quality of air
and pollution levels. Local governments must
respond when non-compliance with air quality
standards has been identified. Although overall air quality in Latvia is good, there is much
to do to mitigate pollution in the capital city
Riga. The most significant pollution source in
the city centre is vehicles, not industry. Riga’s
air is polluted by small dust particles known as
PM10, which exceed maximum permissible annual concentrations. However, since 2007, the
number of days when permissible levels of PM10
particles exceed the limit has dropped by about
half.
Maternal and child health has been given special attention in the past seven years
through additional testing methods for pregnant women, improved service availability, and
the setting of ultrasound test standards. Publicly funded infertility treatment programmes
and confidential analysis of maternal mortality
have been introduced. Unfortunately, maternal
deaths are still being registered annually. The
situation was particularly alarming in 2015,
when the maternal mortality rate was 55.2 per
100,000 live births. In absolute terms, those
were 12 cases, 8 of which pregnancy-related. As
regards the childrens’ health, perinatal mortality is decreasing, but remains relatively high in
3
Ensure healthy lives and
promote well-being for
all at all ages
Affordable and effective health care is one of
the most important challenges that Latvia has
faced over the last decade. According to Eurostat, out of pocket expenditure comprises
42.07 % of total expenditure for health services,
one of the highest levels in the EU. The health
care budget was significantly increased in last
two years with the explicit aim of improving
the availability of health care services by reducing waiting periods for publicly financed
secondary outpatient services, diagnostics and
reimbursable medicines. One immediate result
- on average, waiting periods for medical services have been reduced by 25 % in 2017.
The main national health goal is to increase the average number of healthy life years,
as well as to reduce potential years of life lost
by 30 % from 2014 to 2030. To achieve this, the
government is concentrating on several areas,
including reducing premature mortality from
cardiovascular disease, which is three times
higher for men than for women. Because there
is no significant progress in reducing premature mortality due to malignant tumors, the
government has developed a “green corridor”
for early diagnostics and timely treatment of
cancer patients. A comprehensive policy to
improve nutrition and physical activity is currently being implemented. In the future, more
action is to be taken to reduce the number of
suicides and curtail mortality from cardio vascular diseases, especially among men.
The high premature mortality rate among
men is largely due to lifestyle habits, namely
the prevalence of smoking and harmful alcohol consumption. Regular smokers account for
25.6 % of the working age population (50.5 %
of men and 21.6 % of women), while 61.5 % of
men and 28.4 % of women aged 15-64 partake
in harmful alcohol consumption. In order to
reduce the prevalence of consumption of addictive substances, the excise tax on tobacco
products and alcoholic beverages has been
repeatedly raised in recent years, and restrictions have been imposed on the advertising,
distribution and availability of tobacco, other
smoking products and alcoholic beverages. To
continue decreasing substance abuse, future
policy should not only focus on lowering consumption and restricting availability, it should
also substantially improve addiction treatment
and rehabilitation services, providing access
to a broader range of therapies and improving
their effectiveness.
The Addiction Treatment
Centre
Some prison inmates have unhealthy habits,
including abuse of alcohol, narcotics and/or
psychotropic substances, and have committed
crimes under the influence of these substances.
Prisoners with addictions are not always able to
fully participate in the resocialisation process,
which often determines how successfully the
person will integrate into society after serving
the sentence. The Addiction Treatment Centre,
built with the help of the Norwegian Government Financial Instrument, was established in
Olaine Prison in October 2016. Owing to two
addiction treatment programmes and new infrastructure, prisoners now are serving their
sentences in therapeutic communities, where
the personnel use special mentor-contact principles. The Centre is a reminder that imprisonment is not revenge, but a way of helping offenders understand how to live on their own without
committing crimes.
Source: Ministry of Justice
The situation in Latvia is of heightened concern
regarding the spread of HIV and AIDS. In 2015,
Latvia had the second highest growth rate of
newly diagnosed HIV cases in the EU, 3.5 times
higher than the EU average. Latvia also has the
highest growth rate of newly diagnosed AIDS
cases in the European Union. In response, the
availability of medicines for HIV and AIDS treatment has been improved over the last year, and
more hepatitis C patients are receiving new generation medications and appropriate treatment
at earlier stages of that contagious disease. To
ensure a systematic approach, the government
approved a plan in late 2017, further restricting
the spread of HIV, sexually transmissive diseases, hepatitis B and C.
SDG
54 55
Healthy Local Governments
and Schools
The National Healthy Local Government Network unites 112 of 119 Latvian local governments that implement health promotion and
prevention activities in Latvia’s four priority
health care areas – cardio-vascular, oncology, maternal and child care, and mental health
(2017 data). 105 educational institutions have
joined the Health Promotion School Network
and integrate health promotion activities into
the school’s daily schedule. Although most local governments have insitutionalised health
activities, nation-wide data is not available on
municipal budget allocations toward health
promotion.
Source: Latvian Association of Local and
Regional Governments, Ministry of Health
comparison to other EU countries. Issues of reproductive and sexual health have not been addressed systematically in existing health policy.
The plan until 2020 emphasises public awareness raising on sexual and reproductive health
as well as the availability of government funded
birth control for women at risk of poverty and
social exclusion.
Investing public finances in health
promotion and disease prevention is less costly
than battling the consequences. Ttreating the
illnesses, and long-term investments ensure
long-term gains. National and local health
workers are promoting healthy lifestyles and
disease prevention in four priority health
areas by concentrating on nutrition, physical
activities, substance abuse, process addiction,
sexual and reproductive health, and mental
health. Special attention is paid to people
at risk of poverty, as well as territorial and
social exclusion. One future policy option to
increase the timely availability of health care
for pregnant women and children could be to
compensate public transport costs to medical
institutions for those at risk of social exclusion.
SDG
|
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[
3
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{
"country": "lva",
"file_id": "sdg-03/vnr-report-lva-2018-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2018
}
|
Good health and
well-being
Affordable and efficient healthcare is one of the major challenges of
the last decade. It is important that people take care of their health
and that the state improves the availability and quality of health care
services. Latvia plans to increase the number of doctors and nurses
and reduce waiting times, especially for children. High premature
mortality, mainly among men, is largely caused by smoking, alcohol use,
and external causes (namely, road accidents, suicides, drowning, and
risky behaviours). In the coming years, special attention will be paid
to psychological and emotional well-being, reducing the risks of crises,
and providing timely support to avoid crisis. At the global level, Latvia
donates Covid-19 vaccines to partner countries both bi-laterally and
through the COVAX mechanism.
Data source: CDPCL
IMPLEMENTATION AND ACHIEVEMENTS SDG 3
6480
6140 5972 5926 5798 5547 5391 5405 5241
4871 4842
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
0
1000
2000
3000
4000
5000
6000
7000
Potenciāli zaudētie mūža gadi līdz 64 g. v., uz 100 000 iedzīvotājiem
POTENTIAL YEARS OF LIFE LOST 100,000, TOTAL, PER 100 000
INHABITANTS AGED 064
40
ASSESSMENT OF PROGRESS
3.1 Progress in maternal mortality due to
pregnancy-related causes is variable and still
higher than the European average.
3.2 Child mortality up to five years of age has
declined in the last 10 years.
3.3 The incidence of infectious diseases in
Latvia has decreased significantly in recent
years, with the exception of certain diseases
and new infections such as Covid-19.
3.4 Premature mortality from external causes
has decreased, but Latvia is still among the EU
countries with the highest suicide rates.
3.5 Absolute alcohol consumption among
people of working age has fallen but is still
higher than the EU average.
3.6 The generation born after 2000 is replacing
the traditional use of tobacco products
with a variety of nicotine-containing and
non-nicotine-containing products, mainly
electronic smoking devices.
3.7 The number of people killed in road traffic
accidents has not changed significantly, but the
decrease in the number of road traffic injuries
is significant.
3.8 The total number of abortions and induced
abortions is decreasing, and the number of
adolescents giving birth is decreasing.
3.9 The availability of national coverage of
health care services and medicines has slightly
improved.
3.10 Hazardous chemical and air, water and
soil pollution and contamination have been
declining in the long term. However, recent
trends are levelling out upward, and ammonia
emissions are increasing.
Key actions
– Health promotion and disease prevention
measures are implemented at national and
local levels in relation to healthy nutrition,
physical activity, substance abuse and
process-addiction, sexual and reproductive
health, and mental health.
– From 2022, state-funded vaccination against
HPV is also available for boys, and pregnant
women and adolescents can receive the
vaccine against whooping cough. During the
Covid-19 pandemic, the entire population
could receive a free vaccine against seasonal
flu.
– In 2021, the salaries of doctors and functional
specialists increased on average by 25%
compared to 2020.
– Attracting doctors, their assistants, nurses,
nursing assistants, etc. and specialists to
work outside cities in the regions.
41 IMPLEMENTATION AND ACHIEVEMENTS SDG 3
Latvia in the world
By joining the Developed Countries Initiative,
Latvia has donated, both bilaterally and
through the COVAX mechanism, Covid-19
vaccines to partner countries, thus promoting
the vaccination of the world's population
and overcoming the effects of the pandemic.
In 2021, Latvia donated to seven partner
countries – 326 thousand vaccines doses in
total.
– Prices of medicines included on the list
of reimbursable medicines and patients’
co-payments for reimbursable medicines
decreased.
– Improved access to services for oncology
patients.
– Wider range of available services to support
psycho-emotional health, including to reduce
the effects of Covid-19.
– New-born screening was improved for early
detection of congenital diseases.
IMPLEMENTATION AND ACHIEVEMENTS SDG 3 Photo: Unsplash
42
COMMITMENTS AND CHALLENGES SDG 3
Key future actions
In order to continue improving health, Latvia
undertakes:
– to improve the mental health of the
population and to strengthen the emotional
and psychological resilience of the
population in various crisis situations;
– to develop guidelines and recommendations
for schools for the prevention of violence and
bullying, as well as raise public awareness on
actions to reduce bullying at schools;
– to improve the availability of health care
services in oncology;
– to provide successive assistance for
reintegration of persons with alcohol and
drug addiction;
– to develop new standards for patient care
and models for GP practices;
– to improve the availability of dentistry;
– to determine the compensation procedure
in cases when a person is suffering from
serious or moderate damage to their health
or life due to side effects from the Covid-19
vaccine.
New policies
– Public Health Guidelines for 2021–2027
(draft).
– A new remuneration model for human
resources involved in the provision of health
care services (requires government decision)
and a new human resource strategy in the
health sector.
– Plans to: improve conditions and treatment
in the areas of mental health, oncology, and
rare diseases; prevent and contain the spread
of HIV, sexually transmitted infections, and
hepatitis B and C.
– Plan on Improvement of Prevention and
Health Care Activities to Reduce the
Prevalence of Alcohol and Drug Use for
2023–2025.
– Action Plan to Reduce the Spread of
Antimicrobial Resistance for 2023–2027.
Challenges
– Highlighting health-promotion and diseaseprevention measures with a special focus on
groups at higher risk of premature incapacity
or death.
– Giving a more prominent role in disease
prevention to GP practice teams by involving
nurses.
– Need for a clearer link between investment
and health care outcomes.
– Addressing addiction to nicotine-containing
and nicotine-free products, mainly
e-cigarettes.
– Addressing addiction arising from the
growing use of ICT.
– Digitisation of health care data and
improvement of compatibility and quality,
including improvement of health care ICT
management.
43
Good practice
INCLUSIVE
– To ensure the availability of health care
outside the capital Riga, additional funding
is provided for employing doctors, their
assistants, ergotherapists, physiotherapists,
nursing assistants, nurses, midwives, dental
hygienists, and dental assistants in the
regions; the transfer of GP practices to new
doctors is ensured when the previous doctor
retires.
– Guidelines and recommendations for schools
on the prevention of violence and bullying,
as well as public awareness activities, are
being planned.
– Remote doctor consultations are provided,
and from the summer of 2020, pharmacies
are allowed to supply medicines to the
general population, including prescription
medicines. This is especially important for
people with no access or difficult access to
a pharmacy, including in rural and lesspopulated areas, as well as for persons who
are unable to leave their homes and cannot
use the help of an authorised person to
purchase medicines.
COMMITMENTS AND CHALLENGES SDG 3
REFORM OF THE NURSING PROFESSION
In order to improve health services and to
reduce understaffing, the country introduced
the General Care Nurse profession in 2022.
Training is now university based. The previous
two-stage education system for obtaining
nursing qualifications, as well as the rigid
retraining process, was abolished. The role of
nurses has changed significantly by entrusting
the nurses with broader competencies and
the independence to diagnose patient-care
problems, give counselling, and provide,
evaluate and analyse the quality of patient
care. This reform is in accordance with
recommendations by the European Federation
of Nurses Association.
PATIENT OPINIONS
A national PREM platform has been
established in Latvia. PREM (Patient Reported
Experience Measures) gathers information
on patients' views of their experience while
they are receiving care. PREM strengthens
patient-centred health care and can be used to
follow up on patient feedback, identify patient
priorities, and focus on general experiences
such as staff attitudes and the hospital
environment rather than on the experience
related to a particular disease. As a result,
practical aspects of care, such as waiting
times and communication between doctor and
patient, can be improved.
44
At present, all clinical university hospitals and some regional and specialised
hospitals are measuring patient experience using a platform developed for sending
patients questionnaires and retrieving data. Although the PREM platform is being
introduced at different speeds in the hospital system, the most important thing is
that Latvian hospitals are beginning to systematically take into account the views of
patients to improve patient care.
MORE LIGHT!
Kalāči, the memorial museum of Latvia’s talented 19th-century poet Eduards
Veidenbaums, is launching a series of activities called More Light! to reveal the
potential of art in improving the mental health and well-being of young people. The
museum is partnering with the local youth community to set up a new permanent
exhibition in the poet's family home that reveals the poet’s talents and aspirations,
troubled relationships with his family and friends, fragile health, ideas on democracy
and equality and, of course, his innovative poetry. In collaboration with Norwegian
theatre artist Morten Brunn, young people act, resolve conflicts and develop their
socio-emotional skills in creative drama workshops. In summer, artists in residence
from Latvia and Norway will join young people to create works of art inspired by the
museum's collection and local cultural history relevant to the youth of today.
Photo: Youth at Kalāči.
45 COMMITMENTS AND CHALLENGES SDG 3
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Examen National Volontaire de la mise en œuvre des ODD 4545
Permettre à tous de vivre en bonne santé
et promouvoir le bien-être de tous à tout âge
La santé et le bien-être des populations constituent l’une des fnalités de toute stratégie
de développement et composent une thématique centrale dans le programme mondial de
développement durable. Elle est en interaction directe ou indirecte avec tous les autres ODD,
dans la mesure où elle constitue, à la fois, une résultante pour certains objectifs et une cause pour
certains d’autres. Grâce aux efforts déployés dans ce domaine, le Maroc a réalisé des avancées
considérables, mais il demeure encore affronté à un ensemble de défs et c’est ainsi qu’il engage
de nouvelles stratégies pour y faire face.
Etat d’avancement
La santé maternelle et infantile
Le taux de mortalité maternelle a baissé de 112 décès pour 100 000 naissances vivantes en 2010
à 72,6 en 2018. Le progrès a été plus marqué en milieu urbain qu’en milieu rural, puisque ce taux
s’établit en 2018, respectivement, à 44,5 et 111,1 décès pour 100 000 naissances vivantes.
Graphique 4 : Taux de mortalité maternelle pour 100 000 naissances vivantes
Source : Ministère de la Santé et Haut-Commissariat au Plan
Cette baisse est due au développement des services de santé offerts à la femme, notamment la
généralisation de la gratuité de tous les services liés à l’accouchement au niveau des hôpitaux
publics. Ainsi, la proportion d’accouchement assistée par un personnel de santé qualifé a augmenté,
entre 2011 et 2018 de 73,6% à 86,6% au niveau national, de 92,1% à 96,6% en milieu urbain et de
55% à 74,2% en milieu rural.
Quant à la mortalité néonatale, elle a baissé, au cours de la même période, de 21,7 à 13,56 décès
pour 1 000 naissances vivantes. Le taux de la mortalité infanto-juvénile a été réduit de 30,5 à 22,2
pour 1 000 naissances vivantes et celui des enfants de moins d’un an de 28,8 à 18 pour 1 000
naissances vivantes.
227
112
72,6
2003 2011 2018
Graphique 4 : Taux de mortalité maternelle pour 100.000
naissances vivantes
46 Examen National Volontaire de la mise en œuvre des ODD
Graphique 5 : Taux de mortalité néonatale et infanto-juvénile
pour 1 000 naissances vivantes entre 2003 et 2018
Source : Ministère de la Santé
Lutte contre les maladies transmissibles
Sur le plan épidémiologique, le Maroc a mis en œuvre une stratégie de riposte aux maladies
transmissibles, notamment le VIH-sida, la tuberculose et le paludisme.
Au niveau du VIH, les dernières estimations de l’épidémie réalisée par le Ministère de la Santé et
l’ONUSIDA montrent que le nombre de nouvelles infections au VIH reste faible dans la population
générale, à raison de 0,03 pour 1 000 personnes séronégatives en 2019.
Concernant la tuberculose, l’incidence annuelle toutes formes confondues, a baissé, entre 2015
et 2018, de 101 cas à 99 cas pour 100 000 habitants. Un plan stratégique national antituberculeux
2018-2021 a été mis en place pour réduire de 40% à l’horizon 2021, le nombre de décès liés à cette
maladie.
Pour le paludisme, le Maroc n’a détecté, depuis l’année 2005, aucun cas autochtone, mais il
enregistre une moyenne de 450 cas importés.
S’agissant de l’hépatite virale B, l’incidence a baissé de 12 cas en 2016 à 11 cas pour 100 000 en
2019.
Maladies non transmissibles (MNT), santé mentale et traumatismes
La transition épidémiologique que le Maroc a connue s’est traduite par un poids de plus en plus
lourd des maladies non transmissibles (MNT) sur le système national de santé en particulier les
cancers, le diabète, les maladies cardiovasculaires et les maladies respiratoires chroniques. En 2018,
le taux de mortalité attribuable à ces maladies a atteint 12,4%.
Le taux de mortalité par suicide a baissé de 4,8 pour 100 000 habitants en 2015 à 2,9 en 2016. Sur
les 1 014 cas de suicide enregistrés en 2016, 613 sont des femmes (60,4%).
27
21,7
13,56
47
30,5
22,16
2003 2011 2018
Mortalité néonatale Mortalité infanto-juvénile
Graphique 5: taux de la mortalité infanto-juvénile
pour 1000 naissances entre 2003 et 2018
Examen National Volontaire de la mise en œuvre des ODD 4747
Prévention et traitement de l’abus de substances psychoactives
Par rapport à la santé mentale, une place prioritaire a été accordée au développement de l’offre de
soins psychiatriques à travers la mise en fonction de 9 services de psychiatrie intégrés au niveau des
hôpitaux de 9 provinces, l’achat de médicaments psychotropes et la couverture des interventions
thérapeutiques pour les troubles liés à la toxicomanie (suivi d’environ 25 700 patients en 2018
contre 15 168 en 2016).
La consommation d’alcool a augmenté, selon l’OMS, de 0,69 litre par habitant (âgé de 15 ans ou
plus) en 2016 à 0,74 litre en 2018.
Décès et blessures des accidents de la route
La prévention des accidents de la circulation routière est une préoccupation réelle au Maroc et des
efforts importants ont été déployés à cet effet. Ainsi, le taux de mortalité lié aux accidents sur la
voie publique pour 100 000 habitants est passé de 11 décès en 2016 à 9,37 décès en 2019.
L’objectif des pouvoirs publics est de ramener ce taux à 5,6 décès pour 100 000 habitants à l’horizon
2025. Ainsi, la nouvelle stratégie nationale de sécurité routière 2017-2026, vise à réduire le nombre
de décès par accidents de la route de 25% à l’horizon 2021 et de moitié et à l’horizon 2026.
Accès de tous à des services de soins de santé sexuelle et procréative
La réduction signifcative de la mortalité maternelle pourrait être expliquée, en particulier, par
l’amélioration du suivi de la grossesse, l’accouchement en milieu surveillé et l’amélioration de la
qualité de prise en charge.
La proportion des femmes ayant bénéfcié des consultations prénatales qualifées, a évolué de 11
points entre 2011 et 2018 pour atteindre 88,5%, tandis que celle des accouchements assistés par
un personnel qualifé a augmenté de 73,6% en 2011 à 86,6% en 2018.
La part des femmes non célibataires âgées de 15 à 49 ans utilisant une méthode contraceptive a
progressé de 67,4% en 2011 à 70,8% en 2018.
Le taux de natalité chez les adolescentes (15 à 19 ans) a, par ailleurs, baissé de 32 naissances pour
1 000 adolescentes en 2011 à 19,4 en 2018.
La couverture sanitaire universelle
L’adoption en 2002 du Code de Couverture Médicale de Base (CMB) et la mise en place en 2005
de la composante assurance maladie obligatoire (AMO) pour les salariés et un régime d’assistance
médicale pour les économiquement démunis (RAMED) depuis 2012, a permis d’atteindre un taux
de couverture médicale de 68,8% de la population marocaine en 2019 contre 52% en 2015.
La couverture a été élargie en 2015 aux étudiants non couverts à travers la mise en place d’une
assurance maladie obligatoire (AMO) de base au proft des étudiants de l’enseignement supérieur
public et privé pour une population cible de 288 000 étudiants. Consécutivement, 232 083 étudiants
ont été immatriculés.
Cette couverture est basée sur le principe de la gratuité et une gestion dématérialisée via un portail
électronique qui permet aux étudiants le suivi de leurs demandes d’inscription au régime de l’AMO
(http://cme.enssup.gov.ma).
48 Examen National Volontaire de la mise en œuvre des ODD
Par ailleurs, les étudiants ont accès gratuitement aux services de soins offerts par 21 centres
médicaux universitaires.
Le taux de couverture médicale de la population marocaine est appelé à s’améliorer avec
l’adoption de trois décrets d’application spécifques à la couverture médicale des travailleurs nonsalariés, notamment les sages-femmes, les kinésithérapeutes et les Adouls et par la couverture,
incessamment, des indépendants non-salariés exerçant une activité libérale.
Par ailleurs, le Maroc accorde une importance particulière aux Anciens Résistants et Anciens
Membres de Libération et leur consacre un programme de généralisation de la couverture médicale
et d’accès aux services sanitaires essentiels.
S’inscrivant dans la mise en œuvre de la stratégie nationale de migration, le Maroc accorde une
attention à la couverture médicale des migrants, en situation régulière et les réfugiés. Dans ce
cadre, plus de 23 758 migrants, ont bénéfcié, en 2019, de l’accès à l’ensemble des programmes
nationaux de santé publique, de soins de santé primaire et d’urgence.
Réduction des décès et maladies dus à l’insalubrité de l’eau et aux défciences du système
d’assainissement et au manque d’hygiène
Le taux de mortalité attribuable à l’insalubrité de l’eau, aux défciences du système d’assainissement
et au manque d’hygiène (accès à des services WASH inadéquats) est de 1,9 décès par 100 000
habitants en 2019.
Réduction des décès dus à la pollution de l’air ambiant
Le taux de mortalité attribuable à la pollution de l’air ambiant est de 28 décès par 100 000 habitants
en 2019 (source : étude réalisée par le Ministère de la Santé réalisée en 2019).
Renforcement de la lutte antitabac
Afn de lutter contre la consommation de tabac, le Maroc avait signé, en 2004, la « Conventioncadre pour la lutte antitabac » que l’OMS a adopté en 2003. En 2017, les résultats de l’enquête
nationale sur les facteurs de risques des maladies non transmissibles (MS, 2017) montrent que
13,4% des Marocains âgés de 18 ans et plus fument du tabac. En 2018, plus de 11% des marocains
de 15 ans et plus consomment du tabac. Le Maroc prévoit une réduction de la consommation de
tabac chez cette catégorie de population d’environ 20% à l’horizon de 2029.
Accès aux vaccins et aux médicaments
Le Maroc fait partie des pays pionniers qui se sont engagés pour assurer à tous les enfants une
protection maximale contre les risques de morbidité et de handicap liés aux maladies infectieuses.
Grâce au Programme National d’Immunisation, le Maroc a pu conserver des taux de couverture
vaccinale très élevés. Ainsi, la proportion des enfants âgés de 12-23 mois complètement vaccinés
s’est améliorée de 90,9% en 2011 à 94,5 en 2018.
Examen National Volontaire de la mise en œuvre des ODD 4949
Défcit en ressources humaines
Malgré sa baisse, le défcit en ressources humaines suffsantes reste l’un des défs majeurs du secteur
de la santé. La densité médicale a augmenté de 6,7 pour 10 000 habitants en 2017 à 7,2 en 2019
et celle paramédicale de 8,5 en 2017 à 8,9 pour 10 000 habitants en 2019. Pour combler ce défcit
en personnel médical et paramédical, le Maroc a créé des postes budgétaires au proft du Ministère
de la Santé ainsi qu’aux centres hospitaliers universitaires. A cet égard, 11 894 ont été créés au titre
des trois dernières années (2017, 2018 et 2019) ainsi que 4 000 postes additionnels au titre de la
loi de fnances 2020.
A noter que la problématique liée aux ressources humaines du secteur de la santé, ne peut être
résolue à travers le renforcement des effectifs, mais en veillant à la performance du personnel et à
une meilleure répartition d’utilisation des effectifs dans le cadre de la réfexion engagée pour une
refonte globale du système de la santé.
En effet, c’est la performance du nombre du personnel utilisé qui dépend en majeure partie, la
qualité des soins dispensés et le bon fonctionnement des structures de santé.
Pour la mobilisation du fnancement nécessaire du système de la santé, l’Etat s’est engagé fortement
dans le fnancement du secteur de la santé, et ce dans le but de garantir une meilleure offre de soins
au citoyen. Le budget total (hors CE) dédié au Ministère de la Santé est passé entre 2015 et 2019
de 13,096 millions de dirhams à 16,331 millions de dirhams, soit un taux d’accroissement annuel
moyen d’environ 3,5 %.
A noter que ledit budget a été augmenté à la loi de fnances 2020 à 18,669 millions de dirhams soit
une évolution de plus de 14,3% par rapport à l’année 2019.
A ces crédits s’ajoutent les montants additionnels mobilisés, pour accompagner la mise en œuvre
du RAMED (plus de 8,03 milliards de dirhams depuis 2014) ainsi que les dons des pays du Conseil
de Coopération du Golfe pour fnancer les projets de construction et d’équipement des CHU et la
mise à niveau des hôpitaux publics (8 milliards de dirhams).
De même, un effort budgétaire important est consenti au niveau de la mise à niveau des hôpitaux.
Ainsi et à partir de 2016, un programme de mise à niveau des infrastructures hospitalières a été mis
en place et doté d’une enveloppe annuelle de 1 milliard de dirhams à partir de l’année 2016.
Pour faire face aux défs du secteur, le budget qui lui est consacré a augmenté de 42% entre 2015
et 2020, passant, respectivement, de 13,1 à 18,6 milliards de dirhams.
Cadre juridique de la réduction et de la gestion des risques sanitaires
Au Maroc, la législation est favorable à la protection de la santé et la réduction des risques,
particulièrement en ce qui concerne la sécurité sanitaire des aliments, la salubrité de l’environnement
(pollution de l’air et de l’eau, gestion des déchets, radiations nucléaires et produits chimiques),
la santé et la sécurité au travail, la sécurité routière et la sécurité des patients en matière de
médicaments et de transfusions sanguines. Elle est alignée dans une large mesure sur les priorités
et engagements régionaux et mondiaux notamment au règlement sanitaire international (2005).
50 Examen National Volontaire de la mise en œuvre des ODD
Dans ce contexte, plusieurs stratégies et programmes environnementaux ont été mis en place
pour protéger l’environnement et la santé des populations et ce dans le cadre d’une approche
partenariale et concertée.
Principaux défs
A côté des avancées réalisées, il reste des défs à relever pour progresser vers l’atteinte des ODD
relatifs au domaine de la santé. Ils sont, notamment, les suivants :
- La dotation du secteur de la santé en ressources humaines suffsantes et qualifées ;
- La réduction des disparités régionales en termes de disponibilité de certains spécialistes
tels que les cardiologues et les endocrinologues (plus de 50% exercent sur l’axe RabatCasablanca) ;
- L’accélération de la réduction des décès évitables et de certaines morbidités liées aux
déterminants sociaux tels que la pauvreté et le niveau d’instruction des parents.
- L’amélioration de la connaissance du statut sérologique et l’extension de l’offre de services
de prise en charge du VIH ;
- La mobilisation du fnancement nécessaire au système de santé. La dépense globale du
secteur ne dépasse pas 5,8% du PIB et son budget général atteint à peine 5,86% du budget
général de l’État (Déclaration d’Abuja préconise 15% et l’OMS 10%). Ceci permettrait
d’alléger la charge des dépenses sanitaires sur les ménages qui supportent directement,
selon les Comptes Nationaux de la Santé 2015, plus de la moitié (50,7%) des dépenses
de santé. A cet égard, la mobilisation du fnancement au système de la santé doit être
accompagnée par une amélioration de l’effcacité d’allocation des dépenses de santé en
veillant à promouvoir l’effcience, éliminer le gaspillage et prendre des mesures concrètes
pour optimiser les ressources, accroître la soutenabilité et la redevabilité dans le secteur de
la santé ;
- Le développement du Système d’information sanitaire pour assurer un suivi régulier des
causes des décès et renseigner les indicateurs des ODD (les données de 13 indicateurs sur
27 ne sont pas disponibles) ;
- L’amélioration de la gouvernance du système de santé à travers, notamment, des partenariats
et la mutualisation des efforts de l’ensemble des acteurs du système ;
- L’extension de la couverture médicale de base.
Examen National Volontaire de la mise en œuvre des ODD 5151
Stratégies et programmes
Dans le domaine de la santé, le Plan Santé 2025 constitue le cadre stratégique global permettant
de répondre aux défs identifés. Il est décliné en un certain nombre de stratégies et programmes
dont :
- Politique nationale intégrée de la santé de l’enfant à l’horizon 2030 ;
- La Stratégie nationale d’élimination des décès évitables des mères et des nouveau-nés :
«Toute mère et tout nouveau-né comptent » ;
- Stratégie Nationale de Nutrition 2011-2019 ;
- Stratégie de prévention de la réintroduction du paludisme au Maroc vise le dépistage et de
la prise en charge précoce et gratuite des cas importés ;
- Stratégie multisectorielle de prévention et de contrôle des Maladies Non Transmissibles
2019-2029 ;
- Stratégie nationale de promotion de la santé mentale des enfants, des jeunes et des
adolescents ;
- Plan Stratégique National de lutte contre le VIH 2017-2021 ;
- Politique Pharmaceutique Nationale» pour l’accès équitable aux médicaments essentiels à
un prix abordable ;
- Plan National de Riposte contre les Bronchiolites Virales Aiguës du nourrisson vise à
standardiser la prise en charge des nourrissons et fxer les modalités de leur prise en charge
durant la saison automno-hivernale ;
- Plan national 2020-2029 de prévention et de contrôle du cancer ;
- Plan national multisectoriel de santé mentale 2020- 2030 ;
- Plan national d’accélération de la mise à niveau des urgences 2019-2021 ;
- Programme de la Surveillance de la Grossesse et de l’Accouchement (PSGA) qui
vise l’élaboration du paquet d’interventions essentielles conformes aux nouvelles
recommandations de l’OMS ;
- Programme National d’Immunisation qui vise à atteindre une couverture vaccinale uniforme
supérieure ou égale à 95% à tous les niveaux, à obtenir, avec les autres pays de la région,
la certifcation de l’éradication de la poliomyélite, de maintenir l’élimination du Tétanos
Néonatal et d’éliminer la rougeole et contrôler le Syndrome Rubéole Congénitale vers 2020 ;
- Programme national de lutte contre la tuberculose visant à réduire de 40% le nombre de
décès à l’horizon 2021 ;
- Programme National de Planifcation Familiale pour répondre aux besoins encore non
satisfaits ;
- Stratégie nationale de la sécurité routière 2017-2026 ;
- Programme de l’impulsion du capital humain des générations montantes, volet santé
maternelle et infantile, de la 3ème phase de l’INDH.
52 Examen National Volontaire de la mise en œuvre des ODD
Evolution des indicateurs de l’ODD 3
Cibles Code
ind. Indicateurs 2010 2011 2014 2015 2016 2017 2018 2019
Valeur
cible
2030
3.1 D’ici à 2030,
faire passer le
taux mondial de
mortalité maternelle
au-dessous de
70 pour 100 000
naissances vivantes
(n.v)
3.1.1 3.1.1 Taux de
mortalité maternelle
112 - - - - - 72,6 - < 70
3.1.2 3.1.2 Proportion
d’accouchements
assistés par du
personnel de santé
qualifé
- 73,6 - - - - 86,6 - 100
3.2 D’ici à 2030,
éliminer les décès
évitables de
nouveau-nés et
d’enfants de moins
de 5 ans, tous
les pays doivent
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
3.2.1 3.2.1 Taux de
mortalité des enfants
de moins de 5 ans
- 30,5 - - - - 22,16 - 12
3.2.2 3.2.2 Taux de
mortalité néonatale
- 21,7 - - - - 13,56 - 7
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
3.3.1 3.3.1 Nombre
de nouvelles
infections à VIH pour
1000 personnes
séronégatives,
par sexe, âge et
principaux groupes
de population
- - - - - - - 0,03 0
3.3.2 3.3.2 Incidence de la
tuberculose pour
100 000 habitants
- - - 101 - - 99 - 30
3.3.3 Incidence du
paludisme
autochtone pour
100 000 habitants
0 0 0 0 0 0 0 0 0
Incidence du
paludisme importé
pour
100 000 habitants
0 0 0 0,013 - - -- 0 0
3.3.4 3.3.4 Incidence de
l’hépatite B pour
100 000 habitants
- - - - 12 - - 11 0
Examen National Volontaire de la mise en œuvre des ODD 5353
3.3.5 3.3.5 Nombre de
personnes pour
lesquelles des
interventions
contre les maladies
tropicales sont
nécessaires
(maladies
parasitaires)
- - - - 9590000 - - - -
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 bienêtre
3.4.1 3.4.1 Taux de mortalité attribuable à des
maladies cardiovasculaires, au cancer,
au diabète ou à des
maladies respiratoires chroniques (%)
- - - 12,5 - - 12,4 - 4,16
3.4.2 3.4.2 Taux de mortalité par suicide pour
100.000 personnes
- - - 4,8 2,9 - - - 2,6
3.5 Renforcer la
prévention et le
traitement de l’abus
de substances psychoactives, notamment de stupéfants
et d’alcool
3.5.1 3.5.1 Couverture
des interventions
thérapeutiques
(services
pharmacologiques,
psychosociaux,
services de
désintoxication et
de postcure) pour
les troubles liés à la
toxicomanie (patients
suivis)
- - - - 15168 - 25685 - -
3.5.2 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
- - - - 0,69 0,74 - - 0,4
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
3.6.1 3.6.1 Taux de
mortalité lié aux
accidents de la
route pour 10 000
habitants
- - - 1,1 - - 0,937 - 0,55
54 Examen National Volontaire de la mise en œuvre des ODD
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
3.7.1 3.7.1 Proportion de
femmes en âge de
procréer (15 à 49
ans) qui utilisent des
méthodes modernes
de planifcation
familiale (en %)
- 56,7 - - - - 58,0 - 100
3.7.2 3.7.2 Taux de
natalité chez les
adolescentes (10 à
14 ans et 15 à 19
ans) pour
1 000 adolescentes
du même groupe
d’âge
- 32,0 - - - - 19,4 - -
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, efcaces, de
qualité et d’un coût
abordable
3.8.1 3.8.1 Couverture des
services de santé
essentiels (défnie
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)
- - - - 59 - - 68,8 100
3.8.2 3.8.2-a Proportion
de la population
consacrant une
grande part de ses
dépenses ou de ses
revenus domestiques
aux services de soins
de santé
(1) supérieur à 10%
- - 13,4 - - - - - -
Examen National Volontaire de la mise en œuvre des ODD 5555
3.8.2-b 3.8.2-b Proportion
de la population
consacrant une
grande part de ses
dépenses ou de ses
revenus domestiques
aux services de soins
de santé
(2) plus de 25%
des dépenses des
ménages
2
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
3.9.1 3.9.1 Taux de
mortalité attribuable
à la pollution de l’air
dans les habitations
et à la pollution
de l’air ambiant
(/100000 habitants)
- - - - - - - 28 -
3.9.2 3.9.2 Taux de
mortalité attribuable
à l’insalubrité de
l’eau, aux défciences
du système
d’assainissement et
au manque d’hygiène
(accès à des services
WASH inadéquats)
- - - - 1,9 - - 1,9 1,4
3.9.3 3.9.3 Taux
de mortalité
attribuable à un
empoisonnement
accidentel
- - - - - - - - -
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
3.a.1 3.a.1 Prévalence de
la consommation
actuelle de tabac par
les personnes de 15
ans ou plus (taux
comparatifs par âge)
- - - - - - 11,3 - -
56 Examen National Volontaire de la mise en œuvre des ODD
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 réafrme le droit
qu’ont les pays en
développement de
tirer pleinement
parti des
dispositions de
cet accord qui
ménagent une
fexibilité lorsqu’il
s’agit de protéger
la santé publique
et, en particulier,
d’assurer l’accès
universel aux
médicaments
3.b.1 3.b.1 Proportion de
la population cible
ayant reçu tous les
vaccins prévus par le
programme national
(en %)
- 90,9 - - - - 94,5 - 95
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
3.c.1 3.c.1 Densité et
répartition du
personnel de santé
pour 10 000
habitants
- Densité médicale
pour 10 000
habitants
- Densité
paramédicale pour
10 000 habitants
-
-
-
-
-
-
-
-
-
-
6,7
8,5
-
-
7,2
8,9
-
-
Source : ENPSF 2011 et ENPSF 2018, Ministère de la Santé, Enquête Nationale Démographique 2009-2010, HCP, Enquête nationale sur la consommation et les dépenses des
ménages, HCP 2014, Comité National de prévention des accidents de la circulation (CNPAC).
|
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{
"country": "mar",
"file_id": "sdg-03/vnr-report-mar-2020-fr-3.pdf",
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|
PERMETTRE
À TOUS DE VIVRE
EN BONNE SANTÉ
ET PROMOUVOIR
LE BIEN-ÊTRE
DE TOUS À TOUT ÂGE
ODD 3
26
Rapport volontaire sur la mise en œuvre des Objectifs de Développement Durable
P
lusieurs études internationales
placent la Principauté de Monaco
au premier rang mondial des pays
disposant de l’espérance de vie la plus
élevée. Cette situation est le résultat d’une
politique de santé publique adaptée à
la réalité particulière d’un petit territoire
très densément peuplé et qui accueille
quotidiennement des travailleurs
provenant de deux pays frontaliers.
Le dépistage et la prévention sont au cœur
de cette politique, grâce en particulier à
une entité publique dédiée : le Centre
monégasque de dépistage. Ce Centre
organise des campagnes de dépistage,
accueille, écoute et informe les personnes
concernées et, le cas échéant, les oriente
dans la recherche des soins appropriés et
appréhende les maladies transmissibles
et non transmissibles.
Parmi les services de santé proposés, ce
Centre effectue, en matière de maladies
transmissibles, le dépistage individuel
anonyme et gratuit du VIH, des hépatites
B et C et des infections sexuellement
transmissibles. Dans le cas des maladies
non transmissibles, il mène une action
préventive et organise des campagnes
sur plusieurs types de cancers
(colorectal, sein, col de l’utérus) à
destination des assurés sociaux de la
Principauté et de leurs ayants droit.
Ainsi appuyée sur de solides dispositifs
préventifs, la politique de santé publique
s’articule autour de 5 priorités.
Au PLAN
national
À Monaco,
l’espérance de vie
à la naissance en
2013-2015 est stable,
à 85 ans (82,1 ans
pour les hommes
et 88,2 ans pour
les femmes).
© AIA
Nouveau Centre Hospitalier Princesse Grace
Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge 27
L’éradication des épidémies
et des maladies
La gestion des risques sanitaires est une
préoccupation du Gouvernement Princier
qui dispose d’un encadrement juridique
en matière de sécurité alimentaire, de
maladies à déclaration obligatoire et de
vaccinations obligatoires.
Par une politique active de sensibilisation
et de vaccination préventive, la Principauté
a atteint ses objectifs d’éradication pour
le paludisme et la tuberculose. Monaco
maintient cependant un niveau élevé de
vigilance et s’associe chaque année à la
semaine de la vaccination.
Il est, ainsi, régulièrement rappelé à la
population générale et aux professionnels
exerçant une activité de nature à les
exposer ou à exposer des tiers à des
risques de contamination, l’impérieuse
nécessité de mettre à jour les vaccins
obligatoires, mais également l’importance
des vaccinations recommandées.
Dans le cadre de sa politique et compte
tenu des exigences de l’OMS pour la
vérification de l’élimination de certaines
maladies dans la région européenne, le
Gouvernement Princier a créé, en 2016,
le Comité national des vaccinations
(CNV), chargé de proposer une stratégie
vaccinale ainsi que des mises à jour du
calendrier des vaccinations obligatoires et
recommandées.
Il peut, en outre, être consulté pour toutes
questions relatives à la vaccination. Toute
personne susceptible d’être affectée peut
faire l’objet d’une prise en charge en
centre hospitalier.
La lutte contre les maladies
sexuellement transmissibles
et l’éducation à la santé sexuelle
La Principauté de Monaco assure
à tous l’accès à des soins de santé
sexuelle. L’interruption de grossesse y est
strictement encadrée par la loi. Dans le
cadre de l’éducation des jeunes à la santé,
l’éducation sexuelle et reproductive est
intégrée dans les programmes scolaires
de sciences de la vie et de la terre. Le
VIH/SIDA et les maladies sexuellement
transmissibles font l’objet d’une attention
particulière.
Tous les ans, des actions de sensibilisation
sont conduites auprès des lycéens,
en partenariat avec des associations
monégasques comme Fight Aids Monaco,
présidée par S.A.S. la Princesse Stéphanie.
La prévention des addictions s’inscrit,
quant à elle, dans le cadre plus général
de la promotion de la santé et de
l’hygiène de vie dispensée aux enfants
dès leur plus jeune âge.
PRÉVENTION DES MALADIES
SEXUELLEMENT
TRANSMISSIBLES
AUPRÈS DES LYCÉENS
Des séances d’information, des ateliers,
des tables rondes, des rencontres
avec des médecins et des spectacles
interactifs sont organisés au cours des
trois années de lycée, ce qui permet
tout à la fois, d’alerter sur les dangers,
de partager les moyens de prévention
et de rappeler les droits de chacun.
DÉPISTAGE ET PRÉVENTION :
DES CAMPAGNES CIBLÉES
Les campagnes de prévention du
cancer colorectal et du cancer du sein
(50-80 ans), de l’ostéoporose (55-80
ans), du cancer du col de l’utérus (dès
21 ans) et l’incitation à la vaccination
contre le papillomavirus (jeunes filles
de 11 à 14 ans), font l’objet d’envois par
le Centre Monégasque de Dépistage
de courriers individuels invitant les
personnes à risque à réaliser les
examens de dépistage.
28
Rapport volontaire sur la mise en œuvre des Objectifs de Développement Durable
La lutte contre le tabagisme
Depuis 2008, la loi interdit de fumer dans
des locaux à usage collectif. Elle organise
également la prévention et la protection de
la jeunesse, ainsi que des consultations de
tabacologie au sein d’un établissement public
de santé. Des campagnes sont menées en
lien avec les services de la médecine du
travail et de l’éducation nationale.
La santé mentale
Le Gouvernement Princier est attaché à
la promotion de la santé mentale et à
la prévention des troubles mentaux, à
toutes les étapes de la vie. Sa politique en
la matière s’inscrit notamment dans un
objectif plus global de lutte contre toute
discrimination à l’encontre des personnes
atteintes de troubles mentaux.
Dès la naissance, tout enfant bénéficie
d’un suivi médical régulier. Dès l’âge de 2
mois, il est susceptible d’être accueilli en
crèche collective ou familiale, puis, dès
l’âge de 3 ans, en milieu préscolaire. Toutes
les structures bénéficient de médecins
référents susceptibles d’intervenir avec
l’appui de psychologues dédiés.
Durant la scolarité, obligatoire dès l’âge de
6 ans, des programmes d’éducation à la
santé sont dispensés, pour lesquels les
établissements disposent d’un personnel
formé à accompagner les enfants en
difficulté, à dépister les troubles mentaux,
à intervenir en urgence auprès des enfants
en danger physique ou moral et à favoriser
l’intégration des enfants handicapés.
Au-delà du cadre scolaire, les jeunes sont
pris en charge en fonction des troubles
qu’ils présentent, voire en urgence, tant sur
un plan médical qu’éducatif. Cette prise en
charge précoce et adaptée est seule à même
de prévenir les handicaps secondaires.
La protection de l’enfance
Les familles rencontrant des difficultés
pour éduquer leurs jeunes enfants
bénéficient d’un suivi pluridisciplinaire
(regroupant selon l’âge des enfants divers
intervenants : puéricultrices, travailleurs
sociaux, psychologues…).
Il peut être ordonné par la Justice,
l’objectif principal étant de maintenir
l’enfant dans sa famille.
Toutefois, lorsque le maintien dans la
famille s’avère dangereux, le recours à un
placement est opéré au sein d’une famille
d’accueil, au foyer de l’enfance, ou auprès
d’institutions spécialisées.
Parallèlement, les parents en conflit peuvent
avoir recours à un service de médiation
familiale dont l’objectif est de placer l’intérêt
de l’enfant au centre de la démarche.
Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge 29
L
a Principauté s’est considérablement
investie dans l’amélioration de la
santé mondiale. Elle participe donc
activement à des initiatives diverses en ce
sens, tant au niveau multilatéral que sur
un plan bilatéral, à travers sa politique de
coopération internationale.
Au sein des instances internationales, les
orientations principales du Gouvernement
Princier concernent notamment la lutte
contre les maladies non transmissibles,
les liens entre l’environnement et la santé,
et la lutte contre certaines maladies
transmissibles telles que le VIH/SIDA, le
paludisme, la poliomyélite ou encore la
drépanocytose.
Monaco participe activement aux actions
de l’OMS contre les maladies non
transmissibles et a, à ce tittre, soutenu
l’inclusion d’une cible dédiée à cette question
dans les Objectifs de Développement
Durable. La Principauté apporte également
son soutien depuis plusieurs années à la
lutte contre le cancer en contribuant au
programme PACT conduit conjointement
par l’AIEA, l’OMS et le Centre international
de recherche sur le cancer.
La lutte contre les maladies transmissibles
est également un domaine d’action
privilégié de la Principauté, qui s’est
notamment associée au programme de
l’ONUSIDA dès que celui-ci est devenu
effectif, en 1996.
Cet engagement, toujours croissant, s’est
traduit par la conclusion, le 28 février 2007,
d’un accord-cadre de coopération avec ce
Programme (toujours reconduit depuis lors).
Son objet principal est d’apporter une aide
aux pays frappés par la pandémie, grâce
notamment au fonds d’accélération des
projets du Programme.
En outre, l’engagement personnel de
S.A.S. la Princesse Stéphanie dans la lutte
contre le VIH/SIDA a été consacré par Sa
nomination en qualité d’Ambassadeur de
bonne volonté de l’ONUSIDA, le 6 octobre
2006 à Genève. Cette nomination renforce
Son implication, par le biais de Son
Association Fight Aids Monaco, en faveur
d’une information de qualité, accessible
à tous, d’une prévention efficace et de
l’accompagnement des malades.
Autre pilier d’action de la Principauté dans
le cadre de la lutte contre les maladies
transmissibles au niveau mondial : son
intervention dans l’éradication de la
poliomyélite.
Au PLAN international
© Nebinger-Saussier
S.A.S. la Princesse Stéphanie de Monaco et Ban Ki-moon, ancien Secrétaire général des Nations Unies,
à l’occasion du Débat général de la Réunion de haut niveau sur le VIH/SIDA, 8 juin 2016
30
Rapport volontaire sur la mise en œuvre des Objectifs de Développement Durable
Santé et environnement
L’engagement fort de la Principauté pour
la santé et le développement durable se
traduit également par un investissement
majeur sur les thématiques de santé et
environnement.
En 2016, le Centre Scientifique de
Monaco (CSM), établissement public,
a été désigné centre collaborateur de
l’OMS pour la santé et le développement
durable, via son pôle santé humaine du
département de biologie médicale. Cette
désignation constitue la reconnaissance
du travail de longue date du CSM sur
cette thématique. Elle lui permettra
notamment de renforcer sa collaboration
avec le Bureau régional de l’OMS
pour l’Europe, en particulier, en ce qui
concerne les conséquences sanitaires
du changement climatique. Dans la droite
ligne de l’engagement de S.A.S. le Prince
Albert II pour l’environnement, Monaco
contribue également chaque année à des
programmes sur l’environnement et la
santé. Enfin, Monaco reste profondément
attaché à la construction de systèmes de
santé résilients. La Principauté répond à
la quasi-totalité des principales capacités
requises par le Règlement Sanitaire
International. Dans le respect de ses
spécificités, elle travaille actuellement à
la conclusion d’un accord bilatéral avec la
France, afin d’adapter les particularismes
monégasques aux exigences de ce
règlement.
Cette présence forte sur les enjeux de santé
mondiale se manifeste également par un
positionnement prioritaire de la santé dans
la stratégie de coopération bilatérale de la
Principauté, notamment dans les domaines
où les efforts conjoints des nations n’ont pas
permis d’avancer de manière significative,
comme la mortalité materno-infantile ou les
décès liés aux grandes pandémies.
PARTENARIAT MULTIPARTITE :
GAVI
Monaco soutient l’alliance mondiale
pour les vaccins et la vaccination (GAVI)
dans le cadre d’un partenariat public/
privé. Ce projet vise l’élargissement de
l’accès à la vaccination et l’amélioration
de la santé maternelle et infantile dans
plusieurs pays parmi les moins avancés
(PMA) comme le Burkina Faso, le
Mali, la Mauritanie, le Niger, le Sénégal
et Madagascar. Une attention
particulière est portée aux lieux de
distribution, à la question du genre et
au niveau économique des patients. Il
est prévu de vacciner 105.000 enfants.
MALADIE NÉGLIGÉE :
RÉSEAU DRÉPANOCYTOSE
Depuis 10 ans, Monaco soutient la
lutte contre la drépanocytose, 1ère
maladie génétique au monde, à travers
la construction et l’accompagnement
de centres de référence.
Cela se traduit par la prise en charge
des malades, le financement d’un
diplôme universitaire à Bamako
pour former les médecins africains
et la création d’un réseau Ouest
Afrique/Madagascar regroupant
les associations de patients et les
médecins référents de 6 pays.
Ce réseau permet de coordonner leurs
efforts et leurs actions au Burkina Faso,
à Madagascar, au Mali, en Mauritanie,
au Niger et au Sénégal.
Appui à la vaccination des enfants de moins de 5 ans
© UNICEF
Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous à tout âge 31
Dans le cadre de l’Agenda 2030, Monaco
maintiendra son effort sur cet enjeu majeur
pour le développement des pays du Sud et
déploiera sa stratégie d’appui dans les pays
partenaires, notamment de la zone subsahélienne.
Celle-ci est fondée sur 3 axes :
• favoriser l’accès aux soins médicaux pour
tous, en fournissant un appui aux systèmes
de santé publique et en contribuant à la
formation du personnel de santé ;
• améliorer la santé maternelle et infantile,
en contribuant à la nutrition et au soin
des femmes enceintes, ou encore par la
vaccination des enfants ;
• poursuivre la lutte contre les pandémies
(paludisme, VIH/Sida) et les maladies
négligées dans les pays du Sud
(drépanocytose, soutien aux structures
de santé dédiées et aux associations
de patients).
Dans une approche sociale, une attention
particulière est accordée aux groupes
de populations les plus pauvres dans
les zones marginalisées, afin de réduire
les inégalités sociales et territoriales
dans l’accès aux prestations de santé.
Dans ce domaine, Monaco privilégie
une approche partenariale mobilisant
l’ensemble des acteurs publics et privés.
La Principauté, deuxième plus petit pays au monde en
superficie, compte parmi les 40 premiers bailleurs de
fonds en volume de l’Organisation Mondiale de la Santé.
Le 6 octobre 2006 à Genève, S.A.S. la Princesse
Stéphanie a été nommée Ambassadeur de Bonne
Volonté de l’ONUSIDA.
MORTALITÉ MATERNELLE :
PROJET FORFAIT OBSTÉTRICAL
EN MAURITANIE
La Principauté soutient le projet, porté par
l’Agence Française de Développement
(AFD), visant à réduire le taux de
mortalité maternelle et néo-natale en
Mauritanie, par l’amélioration de la qualité
de l’offre de soins publique pour les mères
et leurs enfants, l’accès des femmes
aux prestations en santé maternelle et
périnatale et l’assurance de meilleures
conditions de travail aux professionnels
de santé dans les zones d’intervention.
Au total, 32 structures bénéficient
du dispositif appelé « forfait obstétrical ».
LUTTE CONTRE
LA POLIOMYÉLITE
La Principauté a été et reste encore
aujourd’hui un important contributeur
dans la lutte contre cette affection
et assure notamment la co-présidence
du Groupe des partenaires de l’Initiative
mondiale pour l’éradication de la
poliomyélite.
|
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40 REPUBLIC OF MOLDOVA VOLUNTARY NATIONAL REVIEW
HEALTH AND WELL-BEING
Public health is a major social concern, so the Government’s actons are intended to provide
citzens with high-quality medical services and afordable prices for efcient and good-quality
Progress Report 2020 41
medicines. In this context and given their commitments under SDG 3, the authorites have initated several reforms and interventons to achieve these objectves. The Natonal Health Policy
of the Republic of Moldova 2007-2021 aims to improve the health of the populaton and reduce
inequites between social groups and regions in the country.
While there has been progress in recent years in meetng commitments under SDG 3, the
indicators stll fall behind regional comparators. The chart below shows these two situatons.
The progress in percentage terms between 2010 and 2018 is shown on the horizontal axis, with
positoning further to the right indicatng more signifcant progress. The vertcal axis represents
the indicators to the average values of the WHO European region,16 with higher fgures indicatng
that the country is further from reaching the regional average. We can conclude the following:
(a) compared to 2010, the Republic of Moldova made progress in 2018 for the vast majority of
targets included in SDG 3,17 reducing the mortality rate of non-communicable diseases by 20 per
cent, and making progress in reducing suicide, road accidents and incidence of tuberculosis; (b)
at the same tme European average rates have not been atained, even though incidence of tuberculosis in the Republic of Moldova fell by 30 per cent, the indicator is stll 217 per cent higher
than the European regional average. Vaccine coverage of children with routne vaccines did not
change signifcantly (the percentage of children vaccinated with DTP 3 was 89.5 per cent in 2010
and 91 per cent in 2019) and did not reach the 95 per cent target. This indicates the need for a
strong and comprehensive public policy response.
16 http://www.euro.who.int/en/countries
17 Progress related to maternal mortality need to be interpreted carefully because 2010 was a rather atypical year in which this indicator
(quite volatile for Moldova) was very high.
Figure: 10 PROGRESS IN 2018 COMPARED TO 2010 AND COMPARED TO THE AVERAGE OF WHO
COUNTRIES IN EUROPE
Source: NBS, WHO, World Bank
aternal 1ortality
nder )=e 1ortality
rate
n(ant 1ortality
Neonatal 1ortality
HIV
Incidence of TB
e6att9
Non$o11<ni$a#le di9ea9e9
9e o( al$o,ol Suicide oad a$$ident9
dole9$ent #irt,
o9t o( ,ealt,$are
e?eed9 ¦ in$o1e
11<niAaton o#a$$o 91o0ing
ealt, >or0(or$e
-50
0
50
100
150
200
250
-10 0 10 20 30 40 50 60 70
Progre99 $o16ared to
region <ro6eT¦
Progress in 2018 compared to 2010, %
42 REPUBLIC OF MOLDOVA VOLUNTARY NATIONAL REVIEW
In the context of a new cycle of health policy response, included in the 2030 Agenda for Sustainable Development, the strategic goal for health policies and interventons is to focus primarily on promotng healthy and actve lifestyles, as well as on preventon, quality diagnosis
and early and contnuous interventon, thus reducing health inequites, especially concerning
access to health services in rural areas and health insurance coverage. At the same tme, to
have a positve impact, the health system, in collaboraton with insttutons outside the system,
will reduce the infuence of risk factors and will create the best possible mechanisms to react to
their infuences on public health.
Some health inequites have reduced. To beter understand the trends in inequalites concerning
the main SDG 3 targets, the fgure below correlates the level of inequalites in 2018 (horizontal axis) with how they changed between 2010 and 2018 (vertcal axis). The chart shows three
types of outcome, marked with diferent colours. Most of the inequalites for which basic data
are available (eight in total) are marked in green: these reduced between 2010 and 2018. Four
inequalites are marked in red colour: these became more pronounced between 2010 and 2018,
and include gender inequalites concerning the mortality rate for non-communicable diseases.
Inequalites for both gender and rural/urban locaton increased with regard to incidence of tuberculosis. The third group of inequalites, marked in blue colour, are inequalites that reversed
between 2010 and 2018.
Gender inequalites concerning mortality are quite pronounced for the main causes of death.
Non-communicable diseases are the main causes of death among the working-age populaton.
To understand the level of gender inequality in mortality rates for diferent causes of disease, we
analyse these indicators for the 35-59 age group, to somewhat normalize the efects of difeFigure: 11 EVOLUTION OF HEALTH INEQUALITIES 2010-2018
nder )=e
1ortality rate 6
n(ant 1ortality
p
Neonatal
1ortality 6
Incidence of TB
p
e6att9
p
dole9$ent #irt,
p
o9t o( ,ealt,$are e?eed9
10% income p
,ealt, in99<ran$e 6
nder )=e 1ortality rate g
n(ant 1ortality
g
Neonatal 1ortality g
HIV
g
Incidence
of TB g
Non$o11<ni$a#le
di9ea9e9 g
o9t o( ,ealt,$are
e?eed9 ¦
in$o1e g
ealt,
in99<ran$e
g
-80
-60
-40
-20
0
20
40
60
80
-80 -30 20 70 120 170 220
Dynamics of ine7ualites in 2018
compared to 2010,%
Ine7ualites in 2018,%
Sursa: NBS, PPI/POB
Note: p – Rural/Urban inequality in the fgure
g – Men/Women gender inequality in the fgure
Progress Report 2020 43
rences in men’s and women’s life expectancy. The chart above presents gender inequality for ten
types of death. The vertcal axis shows the level of gender inequality that indicates the factor to
which the mortality rate of men is higher than that for women. The horizontal axis presents the
percentage of general mortality made up by each type of disease. This is done to understand
whether gender inequality is higher or lower in the case of diseases with high mortality rates.
This shows that for some diseases the mortality rate is nine tmes higher (such as self-inficted
injuries) or six tmes higher (such as accidents, pneumonia and heart atacks) for men than for
women. Many of them have behavioral determinants related to alcohol, tobacco and other harmful substances, and there is also a greater predilecton of men for risky behaviour determined by
traditonal gender roles, especially those related to masculinity.
By 2030, the authorites intend to reduce premature mortality caused by non-communicable diseases by 30 per cent through preventon and treatment (SDG target 3.4). Interventons
will include a focus on gender mainstreaming and inclusion to implement a holistc approach in
healthcare policies, including interventons in all policy areas that afect public health, in partcular
pre-school, primary and secondary educaton, assistance to vulnerable groups, living and working
conditons, producton, marketng and consumpton of food, alcoholic beverages and tobacco
products, the environment and public transport.
Although the fnancial accessibility of health care services is improving, some social groups
contnue to face signifcant unmet demand for health care services. Every second elderly person is limited in their opportunites of living an independent, healthy and safe life, while in the EU
countries only a third of the elderly are in such a situaton.18 With regard to the general popula18 Active Aging Index in the Republic of Moldova, UNFPA, CCD https://moldova.unfpa.org/sites/default/files/pub-pdf/Policy%20Paper_
Indiceele%20imbatranirii%20active_2015.pdf
Figure: 12 MORTALITY RATE BY MAIN CLASSES OF CAUSES OF DEATH, 2018
Source: NBS, NPHA
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Mortality rate by main classes of causes of death,out of total, %
44 REPUBLIC OF MOLDOVA VOLUNTARY NATIONAL REVIEW
ton, the proporton with health insurance increased slightly from 76.4 per cent in 2014 to 80 per
cent in 2018, and the proporton receiving compensated essental medicines also increased, from
19.5 per cent in 2015 to 29.4 per cent in 2018. In 2018, government interventons reduced the
prices of the medicines most in demand by 16 per cent; 59 common internatonal names were
added to the list of compensated medicines and 120,000 more people became eligible for subsidized medicines. The proporton of households, for which health expenditures made up more
than 10 per cent of total household expenditure fell from 15.4 per cent in 2014 to 13.1 per cent
in 2018. However, several groups of citzens are reluctant to consult doctors, even if they are in
need. The chart below sets out the extent of unmet demand for health care services. The groups
with the highest levels of unmet demand are persons with disabilites, low-income people and
women. The most signifcant barrier is the need to make informal payments for health care services. Informal payments are quite prevalent in the health care system. The groups who paid the
most informal payments are young people, the rich and women. The share of vulnerable groups
who paid money informally reached 20%.
To strengthen the level of integrity in the health care system and, implicitly, to reduce informal payments, the authorites approved the Code of Ethics of the Health Care Worker and
Pharmacist (Government Decision 192/2017), which regulates the conduct and communicaton
between doctor and patent, as well as the Sectoral Plan for Ant-Corrupton Actons in the Field
of Health and Compulsory Health Insurance for 2018-2020 (Government Decision 892/2018),
which aims to strengthen the capacites of ethics (bioethics) commitees established in health
care and pharmaceutcal insttutons.
Migraton has already caused a major shortage of professionals in key sectors, in partcular in the
health care system. The health care sector is afected by two related phenomena: i) emigraton of
Figure: 13 UNMET DEMAND FOR HEALTH CARE SERVICES
Sursa: CPD/EEF 2019
18-29 years
30-44 years
45-59 years 60+
Male Female
Households with
persons with
disabilites
Households with
persons with no
disabilites
Low income
High income
Roma
Non Roma
5
10
15
20
25
30
30 35 40 45 50 %
of people for who
m hospitalizat
on is a
very big problem
% of people who did not address to a doctor, even if they had such a need
Progress Report 2020 45
medical specialists; and ii) shortage of young health professionals to cover staf shortages. Only 8
per cent of medical professionals who have emigrated practce their profession abroad, which leads
to a signifcant wastage of their training. In 2017, more than 4,300 health care professionals lef the
medical system, including to fnd jobs abroad. According to the Health System Trade Union, about
28.5 per cent of doctors employed in health care facilites in 2017 are of retrement age. The latest
data show that the migraton of doctors has become more acute since 2017.
Access to sexual and reproductve health services (SDG target 3.7) is increasing. A key achievement of the health sector in the feld of young people’s health between 2011 and 2018 was
to create and expand the network of youth-friendly health centres. There are currently 41
Youth-Friendly Health Centres (Youth Klinik) integrated into the primary health care system in
all districts and municipalites in the country. Young people aged 10-24 can use reproductve
health services free of charge, including contraceptves. In 2018, the Youth Klinik network covered about 27 per cent of young people aged 10-24 with services, compared to 5 per cent in
2011. However, young people in rural areas stll face barriers to accessing reproductve health
services because of their limited fnancial resources to travel to the district centre,19 and because
reproductve health issues are stll taboo in the family, school and community.20
Voice of Youth
While health policies and programmes targetng adolescents, including free access to general
and reproductve health, are in place, the pregnancy rate among teenagers in the Republic of
Moldova remains three tmes higher than the European average. The challenges are even greater
in rural areas. Aside from policy strengthening, there is a need to increase investments to ensure
coverage and quality of these services, as well as improved outreach and communicaton for
behavioural change actvites.
Source: Report on the situaton of young people in the Republic of Moldova and their interacton with the Sustainable
evelopment Goals
Fertlity is declining among 15-19 year old females, but at the same tme is signifcant for the
regional context. The birth rate among adolescents, though it has fallen in recent years, remains
three tmes higher than the European average, at 31.45 per 1,000 girls and women in 2018.21
Thus, notwithstanding the expansion of health service coverage for adolescents and young people, there is a great need to expand access for young people in rural areas, and in partcular those
in vulnerable groups, including for family planning services, to reduces the risk of unplanned pregnancies and sexually transmited infectons, including HIV. Currently, in the Republic of Moldova
girls and women with disabilites face many obstacles to realizing their sexual and reproductve
rights.22 Access to sexual and reproductve health services (SRHS) is considered difcult by women with disabilites, as not all insttutons providing SRHS provide physical access (there is a lack of
19 Analysis of the segmentation of the modern contraceptive market in the Republic of Moldova, UNFPA 2017
20 Qualitative study ‘Adolescent pregnancy in the Republic of Moldova’, UNFPA 2019
21 National Bureau of Statistics, 2018.
22 Situational analysis of the problems faced by women and girls with disabilities of the musculoskeletal system in Moldova in the exercise
of sexual and reproductive rights REPORT, 2016 https://www.cidsr.md/wp-content/uploads/2018/03/Raport_Evaluare-DSR-persoane-cudizabilitati_FINAL_27.02.17.pdf
46 REPUBLIC OF MOLDOVA VOLUNTARY NATIONAL REVIEW
access ramps, support bars, lifs (if the doctor’s ofce is upstairs), and so on). With development
partner support, the authorites approved the Natonal Programme on Sexual and Reproductve
Health and Rights 2018-2022, the main objectve of which is to ensure equitable access for all
groups of benefciaries to reproductve sexual health services. In additon, more resources were
mobilized to ensure the reasonable adjustment of more SRHS providers so that they become
more accessible to girls and women with disabilites.
In the Republic of Moldova, the rate of use of modern contraceptve methods is stll low (42
per cent, compared to the average for the Eastern European countries of 52 per cent). One of
the key achievements is the provision of free contraceptves to certain populaton groups through
family doctors using state budget funds (see the box below). Also, since 2017, in order to ensure
public access, in vitro fertlizaton procedures are fnanced from Compulsory Health Insurance
funds, thus three health care insttutons have been contracted for a total of MDL 951,900 to
conduct these services for 30 couples. The number of in vitro fertlizaton procedures increased
from 30 in 2017 to 60 in 2018, as the amount allocated for this from Compulsory Health Insurance funds increased to MDL 1.8 million.
The Republic of Moldova made some progress in combatng cervical cancer and breast cancer.
However, estmates for 2018 show that the Republic of Moldova is among the countries with the
highest incidence rate of cervical cancer, at 30.4 per 100,000 women, compared to an average of
16.0 per 100,000 for Eastern Europe. 23
There is a chronic need to further strengthen capacity at natonal level to respond promptly to the
needs of the populaton in public health emergencies (such as crises and pandemics), including by
ensuring the contnuity of sexual and reproductve health services, especially for women, young
people and other vulnerable groups.
Financial sustainability in providing reproductve health services: The Republic of Moldova has made progress in providing the populaton with reproductve health services, especially
access to modern methods of contracepton, transitoning from receiving donatons of contraceptves from donors to purchasing them from the state budget. With the support of UNFPA,
the Ministry of Health, Labour and Social Protecton (MHLSP) conducted a populaton needs
analysis and developed a regulatory framework for the distributon of modern means of family
planning. Currently, seven groups of people beneft from free contracepton purchased from the
state budget and distributed through the primary health care system: persons with low incomes; persons living with HIV; young people; persons who abuse alcohol, use drugs or take other
psychotropic substances illegally; persons with mental health disorders; victms of sexual abuse;
and women who have had abortons in the previous year.
23 ECIS - European Cancer Information System https://ecis.jrc.ec.europa.eu/explorer.php?$0-0$1-MD$4-1,2$3-All$6-0,14$5-
2008,2008$7-7$2-All$CEstByCancer$X0_8-3$CEstRelativeCanc$X1_8-3$X1_9-AE28
Progress Report 2020 47
To fully fulfl their commitments under SDG 3, the authorites must achieve the following objectves:
by 2030, premature mortality caused by non-communicable diseases should be reduced through preventon and treatment by 30 per cent (SDG target 3.4);
by 2030, HIV transmission, burden of tuberculosis and communicable diseases should be reduced;
preventon and treatment of substance abuse, including drug abuse and alcohol consumpton,
should be strengthened (SDG target 3.5);
by 2030, universal access to sexual and reproductve health services should be ensured, including for family planning, informaton and educaton, contnuous and specialized support (SDG
target 3.7) and the country’s commitments under the Acton Plan of the Internatonal Conference on Populaton and Development should be fulflled;
actve aging programmes and intergeneratonal dialogue should be strengthened;
universal health coverage, including protecton against fnancial risks, access to quality essental health services and access to safe, efectve, quality and afordable basic medicines and
vaccines for all, should be achieved (SDG target 3.8).
|
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DEUXIEME RAPPORT NATIONAL VOLONTAIRE DE MADAGASCAR SUR LE DEVELOPPEMENT DURABLE JUILLET 2021
45
ODD 3 : BONNE SANTÉ ET BIEN ÊTRE
3.1. D’ici 2030, faire passer le taux mondial de mortalité maternelle audessous de 70 pour 100 000 naissances vivantes
3.1.1 Taux de mortalité maternelle
3.1.2 Proportion d’accouchements assistés par un personnel de santé qualifié
7 Ministère de l’Agriculture de l’Elevage et de la Pêche
En 2013, l’enquête ENSOMD a recensé 478
décès maternels pour 100.000 naissances
vivantes. Cette situation s’est améliorée au fil des
années: en effet, en 2018 le ratio de mortalité
maternelle a baissé à 426 décès maternels
pour 100.000 naissances vivantes. Toutefois,
le taux de mortalité maternelle reste élevé à
Madagascar. Plusieurs facteurs contribuent à
cette situation, à savoir la grossesse précoce,
l’absence ou l’insuffisance de personnel de
DEUXIEME RAPPORT NATIONAL VOLONTAIRE DE MADAGASCAR SUR LE DEVELOPPEMENT DURABLE JUILLET 2021
46
santé qualifié lors d’un accouchement et
surtout le manque d’accès aux soins de santé
de base et aux soins obstétricaux et néonatals
d’urgence, surtout notamment en milieu rural.
En effet, plus de la moitié de la population vit à
plus de 5 km d’un centre de santé.
Une des stratégies utilisées pour atteindre la
cible 3.1. (faire passer le taux de mortalité
maternelle au-dessous de 70 pour 100.000
naissances vivantes d’ici 2030) est d’éliminer
le tétanos maternel à travers la vaccination.
55,2% des femmes enceintes ont été vaccinées
contre le tétanos en 2018, réduisant le nombre
de décès maternels pour 100.000 naissances
vivantes de 10,9% par rapport à 2013. Il est
à remarquer que le pays vise à réduire à 326
le nombre de décès maternels pour 100.000
naissances vivantes en 2023.
Les résultats du RGPH3 de 2018 indiquent une
forte variation du ratio de mortalité maternelle
selon les régions, allant de 156 décès à Itasy, 199
décès à Vakinankaratra, 214 à Analamanga
où se trouve la capitale Antananarivo, à 798
décès à Menabe et Melaky et 928 décès dans
la région de Vatovavy Fitovinany.
L’assistance de personnel de santé qualifié
lors d’un accouchement est primordiale pour
réduire la mortalité maternelle et infantile.
Par conséquent, il est vivement recommandé
d’assurer la promotion de l’accouchement
assisté en milieu institutionnel avec un
personnel de santé qualifié et des matériels
adéquats pour une prise en charge de
qualité de l’accouchement et des éventuelles
complications obstétricales. Le Gouvernement
a renforcé les capacités des sages-femmes et
les a redéployer dans les formations sanitaires.
Il est essentiel de remarquer que la proportion
d’accouchements assistés par un personnel de
santé qualifié est passée de 44% à 46% entre
2013 et 2018.
Pour adresser la question de santé maternelle,
de nombreuses initiatives ont été menées par
le Ministère de la Santé, avec l’appui des
partenaires techniques et financiers afin de
réduire le décès maternels évitables, durant et
pendant la pandémie de COVID-19. Le pays a
continué à mettre en place et à opérationnaliser
au niveau des régions des maternités de
références en Soins Obstétricales et Néonatales
d’Urgences (SONU). En 2019, cette initiative
a été menée au niveau de 13 régions avec
les séances de renforcement de capacité des
prestataires de santé. Par ailleurs, la distribution
de kit d’accouchements au niveau des centres
hospitaliers et centres de santé a été menée et
accentuée durant la période de la pandémie de
COVID-19 en 2020.
Un exercice d’évaluation des coûts pour
l’atteinte de zéro décès maternel évitable à
l’horizon 2030 est actuellement en cours. Pour
atteindre les zones les plus défavorisées et les
populations les plus vulnérables, des stratégies
ont été mises en œuvre avec des cliniques
mobiles dans les régions Androy, Vatovavy
Fitovinany et Atsimo Andrefana. Tous ces efforts
entrent dans le cadre de l’engagement pris
au Sommet de Nairobi sur la CIPD 25 pour
éliminer les décès maternels évitables.
3.2. D’ici 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.
3.2.1 Quotient de mortalité des enfants de moins de 5 ans.
3.2.2 Quotient de mortalité néonatale.
Les enfants de moins de 5 ans vivant en milieu
rural, ceux des ménages les plus pauvres ou des
femmes sans instruction sont les plus exposés
au risque de mortalité bien que des progrès
importants aient été accomplis. En effet, le
quotient de mortalité des enfants de moins
de cinq ans (infanto-juvénile) défini comme la
probabilité de décès entre la naissance et le
cinquième anniversaire valait 59 pour 1.000 en
2018 (MICS 2018). L’objectif est de descendre
à 35 pour 1.000 d’ici 2023.
DEUXIEME RAPPORT NATIONAL VOLONTAIRE DE MADAGASCAR SUR LE DEVELOPPEMENT DURABLE JUILLET 2021
47
Graphique 7 : Taux de mortalité des moins de 5 ans pour 1000 naissances de 2012 à 2018
Source: Enquête MICS 6-2018- INSTAT
Le quotient de mortalité néonatale définit la
probabilité pour un enfant de décéder dans
le premier mois de sa vie. Il était à 21 pour
1.000 en 2018 contre 26 pour 1.000 en 2013,
attestant une légère amélioration en 5 ans. Le
quotient de mortalité néonatale est plus élevé
en milieu rural, soit de 23 pour 1.000 contre
19 pour 1.000 en milieu urbaine.
3.3. D’ici 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
3.3.1 Nombre de nouvelles infections à VIH pour 1000 personnes séronégatives
3.3.2 Prévalence de la tuberculose (pour 100 000 habitants)
3.3.3 Taux de mortalité due au paludisme pour 1000 personnes par an
Proxy : Nombre de jeunes bénéficiant le dépistage de VIH au niveau des coins santé
Taux de mortalité dûs au paludisme en milieu hospitalier
Depuis les premiers cas de VIH/SIDA détectés
à Madagascar en 1987, le taux de prévalence
est relativement faible mais n’a cessé de
progresser. De 0,02% en 1989, il est passé
à 0,3% pour la frange de population de 15
à 49 ans en 2020. Madagascar figure parmi
les pays en situation d’épidémie peu active
selon la définition d’OMS/ONUSIDA car la
prévalence demeure inférieure à 1%. Mais
l’épidémie évolue. Le nombre de nouveaux
cas pour 1.000 personnes séronégatives est
passé de 1 à 2 de 2013 à 2018. Le nombre
de personnes porteuses du virus est estimé à
35.490 en 2020; seulement 6.800 personnes
seulement qui suivent des traitements contre le
VIH. Un Plan stratégique 2018-2022 est mis
en œuvre par le Secrétaire Exécutif du Comité
National de Lutte contre le SIDA SE-CNLS pour
compléter le cadre légal et réglementaire. La
valeur cible est de réduire au moins de 29.000
à 7.250 (soit 75%) le nombre de nouvelles
infections au VIH dans les populations les plus
exposées aux risques d’infection au VIH, chez
les jeunes de 10 à 24 ans et la population
générale d’ici fin 2022.
Parmi les actions visant à contenir la
propagation du VIH/SIDA chez les jeunes, il y a
la mise à leur disposition de services de santé
de reproduction à travers un « coin santé »
(counseling, services de Planification Familiale,
dépistage de VIH) ou, un référencement des
jeunes vers d’autres « Services amis des jeunes
» (centre de santé, CECJ). Ces services sont
à créer auprès de 45 maisons des jeunes, et
13 espaces jeunes répartis dans le pays. Ces
établissements ont pour principale vocation de
permettre aux jeunes de vivre en bonne santé et
de promouvoir leur bien-être.
DEUXIEME RAPPORT NATIONAL VOLONTAIRE DE MADAGASCAR SUR LE DEVELOPPEMENT DURABLE JUILLET 2021
48
La tuberculose est une maladie contagieuse qui
reste préoccupante à Madagascar. L’incidence
de la maladie est de 139 pour 100.000
habitants en 2018 selon le rapport d’activités
du Programme National de Lutte contre la
Tuberculose. Madagascar n’a pas fixé une
valeur cible à atteindre à un horizon donné. En
revanche, il a retenu entre autres comme défis
la réduction de la tuberculose multi résistante à
9 mois au lieu de 18 mois.
En 2017, Madagascar était en phase de
contrôler le paludisme dans tout le pays.
L’objectif consigné dans le Plan Stratégique
National de la lutte contre le Paludisme 2018-
2022 est de réduire à zéro la mortalité liée au
paludisme d’ici 2022. Toutefois, cette maladie
demeure un problème majeur. Depuis le début
de l’année 2020, les cas de paludisme ont
augmenté avec 663.558 cas enregistrés, dont
398 décès, contre 402.385 cas en 20198 . En
2018, le taux de mortalité dûs au paludisme
est de l’ordre de 4 pour 1.000 en milieu
hospitalier
9
.
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
3.4.1 Taux de mortalité spécifique par AVC en milieu hospitalier.
3.4.3 Pourcentage des régions disposant d'infrastructures de prise en charge correcte des troubles
mentaux.
Le taux de létalité d’AVC en milieu hospitalier est
28% en 2018 contre 35% en 201510 . L’objectif
est de réduire la létalité d’AVC de 40% à 20%
d’ici 202111
.
Le pourcentage de régions disposant
d’infrastructures de prise en charge correcte des
troubles mentaux est de 45% en 2018. Le nombre
de patients souffrant de troubles mentaux ne
cesse d’augmenter d’année en année (Revue
Médicale de Madagascar, 2017). L’amélioration
de la disponibilité et de l’accessibilité des soins
de santé mentale au sein des collectivités est
recommandée.
3.7. D’ici 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.
3.7.1 Taux de prévalence contraceptive. 8 https://www.mesvaccins.net/web/news/15840-evolution-des-epidemies-a-madagascar-en-2020 9 Rapport GESIS du Ministère de la Santé Publique
10 Rapport GESIS du Ministère de la Santé publique
11 Plan Stratégique national de lutte intégrée contre les maladies non transmissibles et la prévention du
handicap,2017-2021
Le taux de prévalence contraceptive de
Madagascar figure parmi les plus élevés dans
les pays francophones. Cet indicateur, mesuré
chez les femmes de 15-49 ans mariés ou en
union, s’est accru de 37% en 2012 à 44% en
2018 (MICS 2018). Les efforts se concentrent
sur l’amélioration de l’accès des jeunes, en
particulier les filles et les mères aux services de
planification familiale de qualité basée sur les
droits humains. Le cadre légal et réglementaire
s’y prête mais l’approche communautaire,
l’engagement du secteur privé, la mobilisation
des ressources nationales et les efforts déployés
pour assurer la disponibilité continue des
méthodes de contraception ont également
contribué à ce résultat. La sécurisation des
produits contraceptifs reste un grand défi pour
le pays car elle est principalement financée
par les partenaires techniques et financiers
tels que l’UNFPA et l’USAID. Les besoins totaux
en contraceptifs étaient estimés à près de
12.000.000 USD en 2018 avec un gap de près
de 2.000.000 USD. L’une des priorités actuelles
du gouvernement reste la disponibilité des
produits de santé au dernier kilomètre.
Mais il y a encore du chemin à faire car
l’objectif de 50% fixés pour 2020 dans le cadre
du partenariat mondial Planning Familial 2020
n’a pas été atteint (le taux minimal requis est de
65%). Il est à noter qu’une disparité
DEUXIEME RAPPORT NATIONAL VOLONTAIRE DE MADAGASCAR SUR LE DEVELOPPEMENT DURABLE JUILLET 2021
49
régionale sur l’utilisation des méthodes
contraceptives existe. Par exemple, le taux
d’utilisation est de 56% pour la Région Haute
Matsiatra contre 8,5% pour l’Androy. La
prévalence contraceptive est aussi variable
selon le niveau d’instruction : 29% pour les
femmes sans niveau d’instruction, 44,7%
pour celles avec un niveau d’éducation
primaire et 40,9% pour celles avec un niveau
d’éducation secondaire et plus. Le taux de la
demande insatisfaite reste élevé : 44% pour
les adolescentes en union et 56% pour les non
mariées. Madagascar s’est engagé à éliminer
les besoins non satisfaits en planification
familiale lors du Sommet de Nairobi sur la
célébration du 25ème anniversaire de la CIPD
en Novembre 2019. L’engagement pour le
partenariat Global Family Planning 2030 a été
renouvelé et un exercice d’évaluation des coûts
pour l’atteinte des résultats a été initié. Aussi,
la feuille de route pour la capture du dividende
démographique a été budgétisée avec un
engagement fort du Gouvernement.
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, efcaces, de qualité et d’un coût
abordable.
3.8.1 Proportion de population couverte par une assurance maladie ou un système de santé
publique.
Proxy: Pourcentage d'enfants âgés de moins de 5 ans et de 5 à 17 ans hommes et femmes de
15-49 ans bénéficiant d'une assurance maladie.
Le pourcentage de femmes et d’hommes
âgés de 15-49 ans, d’enfants de 5-17 ans et
d’enfants de moins de 5 ans bénéficiant d’une
assurance maladie est respectivement: • 4 % pour les hommes (10,4% en milieu
urbain et 1,9% en milieu rural), 3 % pour les
femmes de 15-49 ans (8,2%en milieu urbain et
1,5% en milieu rural); • 1,7 % pour les enfants de moins de 17
ans (5,5% en milieu urbain et 0,8% en milieu
rural) • 2,2% pour les enfants de moins de 5 ans,
(7,2% en milieu urbain et 0,9% en milieu rural
selon le MICS 2018).
Ces disparités suivant le lieu de résidence se
retrouve également au niveau des Régions
L’Etat Malagasy a décrété l’urgence sanitaire le
21 mars 2020 pour faire face à la pandémie
de COVID-19, instituant notamment un
confinement de plusieurs semaines. Par
conséquent, on a constaté des perturbations ou
même une annulation des activités du Ministère
de la Santé par faute de financement de la part
de l’Etat ou des PTF. En revanche, la prestation
des services de soins au niveau des formations
sanitaires s’est poursuivie malgré la réquisition
des personnels de santé pour la lutte contre la
pandémie.
Des efforts ont été déployés par l’Etat et les PTF
à savoir: • La dotation des matériels, équipements
et intrants (respirateurs, gels hydroalcooliques,
lunettes de protection, des Équipements
de Protection Individuelle (EPI), produits
désinfectants, gants, masques, ambulances,
médicaments, etc.); • La mise en place et opérationnalisation
du laboratoire LA2M pour l’analyse des
échantillons des tests PCR; • La mise en place d’un Centre de
Commandement Opérationnel COVID-19
(CCOC) au niveau national et de Centres
Régionaux de Commandement Opérationnel
COVID-19 (CRCO); • Le renforcement de capacités des
personnels par contractualisation des Sagesfemmes dans les régions Analamanga, Haute
Matsiatra, Alaotra Mangoro et Atsinanana; • L’investigation et les ripostes dans les
régions les plus touchées; • La mise en place et l’ opérationnalisation
du Centre Opérationnel d’urgence Sanitaire
(COUS) dans la Région Atsinanana.
|
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{
"country": "mdg",
"file_id": "sdg-03/vnr-report-mdg-2021-fr-5.pdf",
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|
Voluntary National Review for the High Level Political Forum 2017 – Maldives, July 2017
9
Goal 3 – Ensure healthy lives and promote well-being for all at all ages
The health status of the people of Maldives has significantly improved in the past few decades.
The Maldives Health Statistics show that during the period of 2006-2015 the infant mortality rate
decreased from 16 to 9 per 1000 live births. During this period, under 5 mortality rates also
decreased from 18 to 11 per 1000 live births. Maternal mortality ratio has decreased from 69 per
100,000 births in 2006 to 13 per 100,000 births in 2012. The decline of maternal mortality ratio is
due to factors such as the wide dispersion of obstetric and other health services to outer atolls,
with access to skilled attendants in delivery and provision of antenatal care.
The Maldives has made considerable achievements in the health sector through the provision of
universal healthcare. In the past two years, extensive efforts have been made to expand the reach
of pharmacies with the result that at least one has now been established in each inhabited island.
The Maldives is the first country in the South Asia Region to be awarded certification of
elimination of Malaria, Lymphatic Filariasis and Measles. The Maldives is further committed to
tackle HIV/AIDS, TB and other communicable diseases whilst grappling to control frequent
outbreaks of vector borne diseases such as dengue and chikungunya. Focus is also given to care
for non-communicable diseases (NCDs) such as cancer, thalassemia and mental health.
With the fast changing lifestyle and development, chronic non-communicable diseases are
emerging as the main cause of morbidity and mortality in the country. The Health Master Plan
2016-2025 recognizes this as one of the key critical areas that need concerted actions by the
government in the coming years. Factors such as living condition and lifestyle factors such as
tobacco use, unhealthy diet or nutrition, obesity, child malnutrition (stunting and wasting of
children under five years) and inadequate physical activity is a concern which is addressed in
collaboration with schools.
Drug use has been a growing concern to the society’s wellbeing and harmony. According to the
National Drug Use Survey Maldives (2011/2012), the prevalence of drug use in Male’ and atolls
were 6.64% and 2.02% respectively.
Furthermore, reproductive health needs of young people deserve a special attention. As such, a
more holistic approach towards access to adolescent friendly health services including
reproductive health services is needed. This includes issues of sexual and gender-based violence,
Voluntary National Review for the High Level Political Forum 2017 – Maldives, July 2017
10
sexual diversity, discrimination, relationship issues, and fears and concerns about sex and
sexuality.
The reliance on expatriate workers as healthcare service providers remains a major challenge.
There is a further need to enhance the local capacity, including through education and training of
medical personnel for the Maldivian health sector. The dispersed islands pose challenges to
logistic management, particularly in providing necessary supplies and equipment, assuring quality
services and regular maintenance and administration of the service delivery. This also results in
considerably high cost to the government.
|
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[
3
] |
{
"country": "mdv",
"file_id": "sdg-03/vnr-report-mdv-2017-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2017
}
|
SDG 3: Ensure healthy lives and
promote well-being for all at all ages.
Ensuring a healthy life and promoting the
well-being of the population is a basic condition for ending inequality and poverty and
guaranteeing the comprehensive human
development of all.
ADVANCES
• The number of people with access to
healthcare has risen by 6.2 million
people (CONEVAL, 2016).
• The Popular Insurance Program has
53.7 million people enrolled (SSA,
2017).
• 84.5% children and adolescents have
healthcare coverage (SIPINNA, 2018).
• 96.7% of children have all of their
vaccinations (SSA, 2015).
EMBLEMATIC ACTIONS
• The following prevention programs
are in place: Health in Your School,
Safe Consultation, PreventIMMS and
PreventISSSTE and the National
Strategy for the Prevention and Control of Obesity and Diabetes.
• The SSA’s Universal Vaccination Program and National Health Weeks
prevent the primary causes of infant
mortality.
• The INMUJERES National Strategy
for the Prevention of Teen Pregnancy
(ENAPEA) consists of inter-institutional measures aimed at preventing
teen pregnancy that are coordinated
with national, state and municipal
policies and plans.
• IMSS-PROSPERA’s Early Childhood
Development Strategy promotes
holistic growth, nutritional monitoring, cognitive and socio-emotional
development and the timely detection and response to developmental
issues.
• The Mexican Social Security Institute’s mobile app allows members to
schedule appointments with their
doctor, saving them time and money.
CHALLENGES
• Ensuring effective access to quality
healthcare services, eliminating discriminatory barriers, closing service
gaps between different social groups
and regions and ensuring the generation and effective use of healthcare
resources.
• Guaranteeing the existence of relevant, reliable and truthful information
on sexual and reproductive health, as
well as access to birth control methods.
• Having a properly implemented legal
framework for the control of drugs.
75
|
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[
3
] |
{
"country": "mex",
"file_id": "sdg-03/vnr-report-mex-2018-en-5.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2018
}
|
RECUADRO 11:
Posturas complementarias al ODS 3 expresadas en procesos de consulta24
• 2 de cada 10 nacimientos en México
son de una mujer menor de 20 años
(ENSANUT, 2012) y 1 de cada 2 adolescentes de 12 a 19 años que inicia su
vida sexual se embaraza (INEGI, 2016).
• Para el año 2025, es necesario reducir
en 50% la anemia en mujeres no embarazadas en edad reproductiva; asimismo, reducir en 40% la desnutrición crónica de niñas y niños menores de 5 años.
• Se requiere construir y reforzar políticas de seguridad alimentaria que aseguren la sostenibilidad de los objetivos
en nutrición, por ejemplo, mediante el
apoyo económico, técnico y de infraestructura a pequeños productores.
24 Para profundizar la discusión temática, en este
apartado se incluyen datos y fuentes propuestos
por el Sistema de Naciones Unidas y diversas OSC,
responsabilidad de cada uno de los participantes.
• En 2018, la Secretaría de Educación
Pública puso en marcha el Programa de
Educación Inicial: Un buen comienzo, el
cual adopta el nuevo enfoque de desarrollo de la primera infancia en el que se
anuncia la apropiación del Marco de
Cuidados Sensibles y Cariñosos como
base para la educación inicial.
• 16.2% de la niñez en México carece de
acceso a servicios de salud; la razón de
mortalidad materna es de 34.6 defunciones de mujeres por cada 100 mil
nacidos vivos (CONEVAL, 2015) y la
tasa de mortalidad de menores de 5
años es de 15.1 defunciones por cada
mil nacidos vivos (INEGI, 2018).
• 27.6% niñas, niños y adolescentes presenta carencia por acceso a la alimentación (CONEVAL, 2014). La desnutrición crónica afecta a 1.5 millones de
niños y niñas menores de 5 años (INSP,
2012) y el sobrepeso y la obesidad a
33.2% de la población de 5 a 11 años
(INSP, 2016).
|
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[
3
] |
{
"country": "mex",
"file_id": "sdg-03/vnr-report-mex-2018-es-4.pdf",
"language": "es",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2018
}
|
ODS 3: Garantizar una vida sana
y promover el bienestar para todas
las personas a todas las edades.
Garantizar una vida sana y promover el bienestar de la población es una condición básica
para la terminar con las desigualdades, la
pobreza y asegurar un desarrollo integral de
las personas.
AVANCES
• 6.2 millones de personas más tienen
acceso a servicios de salud (CONEVAL,
2016).
• El Seguro Popular tiene 53.7 millones
de personas afliadas (SSA, 2017).
• 84.5% de niñas, niños y adolescentes
tiene cobertura de servicios de salud
(SIPINNA, 2018).
• 96.7% de niñas y niños cuentan con un
esquema básico completo de vacunación (SSA, 2015).
ACCIONES EMBLEMÁTICAS
• Se cuenta con los siguientes programas
de prevención: Salud en tu Escuela,
Consulta Segura, PrevenIMSS y PrevenISSSTE, la Estrategia Nacional para la
Prevención y Control de Sobrepeso, la
Obesidad y la Diabetes.
• El programa de Vacunación Universal y
las Semanas Nacionales de Salud, de la
SSA, permiten prevenir las principales
causas de mortalidad infantil.
• La Estrategia Nacional para la Prevención del Embarazo en Adolescentes
(ENAPEA), a cargo del Instituto Nacional
de las Mujeres (INMUJERES), comprende acciones interinstitucionales coordinadas con políticas y planes nacionales,
estatales y municipales para prevenir el
embarazo adolescente.
• La estrategia de Desarrollo Infantil
Temprano, del Programa IMSS-PROSPERA, promueve el crecimiento integral,
la vigilancia nutricional, el desenvolvimiento cognitivo y socio-afectivo, la
detección oportuna y la atención de
riesgos y problemas en el desarrollo.
• La aplicación móvil del Instituto Mexicano del Seguro Social (IMSS) permite
que los derechohabientes puedan agendar citas médicas ahorrando tiempo y
costos relacionados con la asignación
presencial de citas.
DESAFÍOS
• Asegurar el acceso efectivo a servicios
de salud de calidad, eliminando barreras
discriminatorias, cerrando brechas entre
diferentes grupos sociales y regiones, y
asegurando la generación y el uso efectivo de los recursos de salud.
• Garantizar la existencia de información
oportuna, confable y veraz para la
salud sexual y reproductiva, así como el
acceso a métodos anticonceptivos.
• Contar con un marco jurídico en materia de control de sustancias nocivas
para la salud que sea llevado a cabo
efectivamente.
75
|
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[
3
] |
{
"country": "mex",
"file_id": "sdg-03/vnr-report-mex-2018-es-5.pdf",
"language": "es",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2018
}
|
VOLUNTARY NATIONAL REVIEW EXECUTIVE SUMMARY
SDG 3. Ensure Healthy Lives and Well Being for All Ages
While our broad human development indicators such as infant and child
mortality rates have steadily improved since independence, the overall
progress in building healthy lifestyles can still be improved. Our strategy
embraces the value of “Kumiti Ejmour” or “health is a shared responsibility”.
The “kumit” lifestyle is one where every Marshallese supports one another in
every effort to improve healthy lifestyles now and in the years to come.
The NSP articulates our vision for sustainable development, one that is people-centered, founded
on human rights and forward looking to the realization of Sustainable Development Goal 3
“Ensure healthy lives and promote well-being for all ages”. Universal health coverage, including
universal access to sexual and reproductive health, increased immunization coverage and better
protection for children and mothers, addressing non-communicable diseases, cancers and
mental health are high priorities. Our ambition will be short-lived if we do not respond
proactively to the adverse impact of climate change and pandemics such as COVID-19 as real
threats to the survival of our people and to our efforts to ensure universal health coverage.
Additionally, the Healthy Islands concept has remained an inspiration for the RMI and the Pacific.
We remain committed to applying a Healthy Islands concept, and this has played a significant
role in energizing the approach to Non-Communicable Diseases (NCDs). It has framed how our
health leaders have engaged with other sectors, and framed the largely successful efforts in
support of bringing global attention to the ongoing NCD epidemic. There is widespread
consensus that the Healthy Islands concept is sound and should be maintained and supported.
The breadth of this concept is only now being realized, with its weave of health, environmental,
and Pacific cultural concepts. Without a healthy population, we cannot eradicate poverty, we
cannot ensure quality education, we cannot achieve gender equality and women’s
Community Lifestyle Program (SDG 3)
Canvasback Missions provide a range of programs that target medical issues, help manage chronic
illnesses and create a culture of wellness within the community. One of their major focus targets
lifestyle changes through diet and exercise. Trained wellness teams visit the communities to help
monitor blood glucose levels, heart rate and blood pressure then provide counsel to reverse their health
issues. One sustainable intervention is a Home Garden Program which provides training on how to
grow fresh vegetables and produce that can adapt to the environment conditions. To date, over 200
home gardens have been established in Majuro with progress still on-going. Similar classes are also
provided to the outer islands.
An islander, Lee Pero, shared this: “When I started the Canvasback program, the level of my sugar
was high (299-350) and so was my blood pressure. After joining the program, my blood pressure
went down to 109/70.” He also mentioned that he had difficulties in breathing but no longer has it.
VOLUNTARY NATIONAL REVIEW EXECUTIVE SUMMARY
empowerment, nor economic growth, provide decent work, reduce inequalities, ensure peaceful
and inclusive societies and build genuine and durable partnerships.
Ensuring the last mile assurance for SDG target 3.7 “universal access
to sexual and reproductive health care services”.
With the support of UNFPA, the Ministry of Health and Human Services is building national capacity
and strengthening mechanisms to progress health logistics and supply chain management system. In
advancing universal access to sexual and reproductive health, the MOHHS is conducting Supply Chain
Management training for health workers with regular spot checks of health facilities using the newly
deployed Tupaia MediTrak tool to compare with the baseline data observed in 2019 during the
implementation of the RMI Health Facility Readiness and Service Availability Assessment. The spot
checks are a key component of the Last Mile Assurance audit and to ensure a wide range of
contraceptive choices are available for women, couples, persons with disabilities and young people
even in the remotest atoll of the Marshall Islands
|
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{
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|
VOLUNTARY NATIONAL REVIEW Page 19
6. PROGRESS ON PRIORITY SDG’S (SDG 3, 8, 10 and13)
SDG 3: Ensure Healthy Lives and Promote Well-Being for all at all Ages
SDG Targets (Goal 3) NSP Alignment/Policy Objective
(3.1) (3.2) (3.3) (3.4) (3.5) (3.6) (3.7)
(3.8) (3.b) (3.c)
(SC 1.1.1) (SC 1.1.2) (SC 1.1.3)
(SC 1.1.4) (SC 1.1.5) (SC 1.1.6)
(GG 5.3.2)
S&C 1.1.1 Strengthened response to non-communicable diseases, including nutrition, mental
health, and injuries (SDG Indicators 3.3.2, 3.3.3, 3.3.4. 3.3.5, 3.4.1, 3.5.1 3.8.1)
Prevalence of stunting in children has not yet reached the target of less than 10% with a 2019
statistic showing 35%. The prevalence of overweight children (in 2019) was below the target of
less than 5% with information showing 4% of children in the RMI are overweight. Responsible
investment in agriculture contributes to food security and nutrition. An increase in locally
produced food will ensure a healthier diet for the household and in the long term contribute to
improving nutrition and decreasing incidence of NCD.
S&C 1.1.2 Improved maternal, infant, child and adolescent health (SDG Indicators 3.1.1, 3.1.2,
3.2.1, 3.7.1. 3.7.2, 3.B.1)
In progressing SDG Target 3.1 “reduce the global maternal mortality ratio to less than 70 per
100,000 live births” by 2030, the Ministry of Health and Human Services has taken steps to ensure
availability, accessibility and quality of care services to treat complications that may arise during
pregnancy and child delivery. With a 99% Skilled Birth Attendance coverage in 2018, above the
target of 95%, the Marshall Islands has seen a steady reduction in infant and maternal mortality
in 2018 and 2019. Outreach awareness were conducted in urban and rural areas in developing
the three-food guideline lunch program to public schools and in-patient meals.
As of 2019 infant mortality rate was 16/1000 live births and early childhood mortality (under 5)
is 17/1000 live births. Infant mortality rate has remained steady with the baseline (2016),
however this is short of the target of 12/1000. The early childhood mortality rate has surpassed
the target of 25/1000 improving from 32/1000 in 2016 to 17/1000 in 2019. Improvements in
early childhood health awareness and coverage continue to be implemented and progress is
expected to continue.
Maternal Mortality
According to 63-year old Helen Jetnil-David, the oldest surviving midwife in RMI, the Ministry of Health
has come a long way to reduce maternal and child mortality. At the celebration of the International
Day of the Midwife in May 2021, Helen Jetnil-David’s 35 years of service was acknowledged by UNFPA.
In the receipt of the Plaque for Longest Surviving Midwife in the Marshall Islands, Helen acknowledged
the investments of the Ministry of Health in building the capacity and the pool of midwives since she
started her midwifery care work in 1985. Continued efforts to strengthen capacity in a COVID-19
context, include optimizing on-line learning opportunities to strengthen midwifery faculty, curriculum
and competencies, such as the Midwifery Faculty Development Program developed by UNFPA Asia
Pacific and the Burnet Institute.
.
VOLUNTARY NATIONAL REVIEW Page 20
S&C 1.1.3 Strengthened response and resilience to communicable disease, environmental
health, and health emergency preparedness (SDG Indicators 3.3.2, 3.3.3, 3.3.4. 3.3.5,
3.8.1)
Information regarding NCDs continues to remain flat, and at times moving in a negative direction
(as of 2019). Diabetes and other NCDs remain prevalent. NCD response and awareness is a focus
of the Ministry of Health through the Healthy Islands Concept. Outreach awareness were
conducted in urban and rural areas in developing the three-food guideline lunch program to
public schools and in-patient meals.
S&C 1.1.4 Strengthened planning, management and administration of human and financial
resources (SDG Indicators 3.8.1, 3.C.1)
From the baseline of $519/per capita spending (2016) RMI per capita spending was $560 in 2019.
The RMI target for per capita spending is yet to be defined. Health sector planning continues to
monitor and focus on the issue of per capita health spending, especially during the current COVID
19 pandemic.
The NSP includes these targets 1) by the end of each fiscal year, 90% of medications on essential
list in stock and are in place, 2) by the end of each fiscal year, staff attendance work rate is
increased by 10% annually 3) by the end of each fiscal year, average purchase order, contract,
personnel action processing times is reduced by 15% and 4) by the end of each budget period,
budget and end-of-year utilization % (“burn rates”) is at least 90%.
S&C 1.1.5 Provision of quality health care infrastructure, especially cancer care, for all
Marshallese (SDG Indicators 3.8.1, 3.C.1)
In 2019 the mortality rate attributed to cancer was 134/100,000. This continues to approach the
target of 122. However, this is higher than the 2016 baseline of 128. Health care infrastructure
has come to the forefront during the COVID-19 pandemic. As a result, health care facilities
country wide, are being reviewed for needed improvements. The NSP specifies that at least four
HPV campaign events will be completed annually.
S&C 1.1.6 Strengthened outer island health services (SDG Indicators 3.8.1, 3.C.1)
Information from 2019 indicates the RMI continues to improve regarding medical staff density.
In 2019 the ratio for doctors was 1266:1 and for nurses was 243:1. The baseline shows a density
of 1452:1 for doctors and 477:1 for nurses. However, the targets remain at a distance with targets
of 600:1 for doctors and 4:1 for nurses. This issue can be partially attributed to the geographic
isolation of the RMI and the problems with attracting qualified personnel. As part of the Healthy
Islands Concept, health care infrastructure, specifically in the outer islands is being reviewed for
needed improvements.
GG 5.3.2 Require robust and unbiased enforcement of laws, justice and regulatory processes
(SDG Indicators 3.5.2, 3.6.1)
The NSP underscores our objectives to strengthen the abilities of law enforcement institutions
to deliver personal security, particularly for vulnerable groups, using new and innovative
approaches such as community policing and other best practices approaches.
|
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"file_id": "sdg-03/vnr-report-mhl-2021-en-4.pdf",
"language": "en",
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|
Voluntary National Review | 27
SDG 3 – Good Health
and Well-Being
General Situation
Recognizing health as a fundamental human right, North Macedonia is committed to developing an affordable and sustainable healthcare system that provides quality care to all citizens in a non-discriminatory manner. Health Strategy 2020sets a range of priorities, including but not limited to managing the
burden of non-communicable disease, preparedness and responses to communicable diseases, health
systems and resources, and other public health initiatives. Signifcant investments have been made to
improve infrastructure and equipment, including personnel and medicine available at health facilities.
So far, 30 health facilities have been refurbished across the country and over 27 million Euro worth of
sophisticated medical equipment have been procured. To retain health professionals in the public sector, salaries and incentives have been raised, state fnancing for specialization has been increased and
additional training has been made available. The Ministry of Health (MoH) has introduced “Moj Termin”
as an instrument for the integration of all health data, including national registries of diseases, prescriptions, and healthcare referrals. To better monitor the prevalence of rare diseases, an electronic registry
is now used to track patients with rare diseases. Six new medicines have been made available at public
hospitals to improve the quality of care.
Signifcant improvements have been achieved with regard to infant mortality. Both the mortality of premature babies and infant mortality have decreased by at least 50 percent. The mortality of premature
babies decreased from 7.5 percent in 2016 to 3.4 percent in 2018. Similarly, infant mortality decreased
from 11.9 percent in 2016 to 5.7 percent in 2018. Perinatal mortality also fell from 16 percent in 2016 to
10.4 percent in 2018. The immunization coverage for all vaccines is below the recommended 95 percent
with a decreasing trend over the previous fve-year period. Life expectancy in the period 2016-2018 has
been on average 74 years of age for males and 78 years of age for females. Nevertheless, non-communicable diseases remain the largest burden of diseases. Cardiovascular diseases account for more than
50 percent of total mortality, followed by cancer at 18 percent. New therapies and medicines have been
made available to improve the quality of health care.
Voluntary National Review | 28
Figure 11: Mortality rate for non-communicable deceases per 100,000 individuals
0
50
100
150
200
250
300
350
Value
249
329
24 27
234
335
27 31
234
324
26 30
237
302
24 31
235
319
24 30
238
328
24 35
249
301
30 36
234
300
31 33
238
302
30 35
2010 2011 2012 2013 2014 2015 2016 2017 2018
Cancer Cardiovascular Disease Chronic Respiratory Disease Diabetes
Source: State Statistical Ofce
The prevalence of HIV remains low, thanks also to the continuous partnership between MoH, CSOs and
funding agencies such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM). Even without GFATM, the Government has continued fnancing and implementing its HIV/AIDS prevention programmes targeting the at-risk populations. It has established a system where CSOs are providing HIV
services. As a result of activities fnanced by GFATM, the absolute number of newly registered patients
with TB has dropped from 285 in 2014 (13.8 / 100,000) to 220 in 2017 (10.6/100,000). The incidence rate,
as well as the prevalence rate, shows a downward trend.
Work on sexual and reproductive health is governed by the National Strategy for Sexual and Reproductive Health (2010-2020), National Strategy for Safe Motherhood (2010-2015), and a set of quality
standards for sexual and reproductive health services. A cost-beneft analysis of contraceptive use was
conducted to inform the introduction of contraception, particularly for vulnerable groups.
The Action Plan for the Promotion of Health Care for Children and Persons with Disabilities ensures the
rights of children and people with disabilities. These measures include awareness-raising activities for
rights and needs for health services, as well as specifc measures to reduce barriers, prejudice and stereotypes. MoH, with support from United Nations International Children’s Emergency Fund (UNICEF)and
other UN agencies, has organized training for health professionals on the timely detection of disabilities
in children. MoH is also collaborating with other ministries in promoting the integration of children with
disabilities in society. Home visit programmes have been introduced for individuals who are chronically
ill, elderly or disabled. They also cover vulnerable populations in rural areas, including Roma people.
Financial assistance is now available for qualifed vulnerable people, including retirees and children of
families relying on assistance programmes.
Obesity represents a new challenge. In 2017, the obesity rate10 was 55.7 percent, compared to an average
of 54.8 percent in the EU and EU candidate countries. The majority of obesity cases consists of pre-obese
individuals. Given the adverse impact of obesity on health – including “type 2 diabetes”, high blood pressure, and sleep disorders – the Government is seeking to reduce its rate.
According to the general population survey on the use of tobacco, alcohol and other substances (2017),
46 percent of the population aged 15 to 64 (54 percent male and 33 percent female) were smoking tobacco. The study on health behaviours among children (2018) indicated that 12 percent of boys and 15
percent of girls aged 11 to 15 had smoked at least once in their life. Ten counselling centers for cessation
of smoking were opened under the Centers for Public Health, as well as one center operating in the
framework of the Institute for lung diseases and tuberculosis in Skopje. The Institute for public health
together with the Centers for public heath are providing education on healthy lifestyles for children in
primary and secondary schools.
10 Obesity rate by body mass index (BMI) (sdg_02_10), Eurostat, available from https://ec.europa.eu/eurostat/web/sdi/zero-hunger
Voluntary National Review | 29
Strategic and Legal Framework
The main strategic framework in this area is the Health Strategy and Action Plan 2020,which outlines
priorities and responsibilities for health issues. The Government has also adopted the following strategic
and legal initiatives:
• National Strategy (and Action Plan) on Sexual and Reproductive Health 2010-2020 (2009) contributes towards the reduction of perinatal and infant mortality rates.
• Immunization Strategy (2012) aimed at increasing overall vaccinations.11
• Amendment to the Law on Termination of Pregnancy (2019) has streamlined the process of
seeking authorization for termination of pregnancies, eliminated the unnecessary barriers and
improved access to safe procedures, and ofered the right of choice to women and girls.
• Mental Health Strategy (2019) has promoted better mental health.
• National Strategy on Rare Diseases is under preparation and will provide the framework for
timely diagnosis and provision of continuous and quality care.
• Action Plan for Strengthening the Capacities of the National System for Monitoring, Prevention
and Control of Communicable Diseases (2019), as well as the National Strategy for Control of
Antimicrobial Resistance and Action Plan 2019-2023, ensure the country’s preparedness to a
potential outbreak.
• Law on Protection of Patients’ Rights was amended in 2019 to remove discriminatory terms and
ensure the provision of appropriate accommodations for persons with disabilities.12
• National Strategy for Drugs 2014-2020 is being implemented and a new one is under preparation.
Ongoing Initiatives
• Additional investments in public health facilities are planned, as well as the procurement of sophisticated medical equipment.
• MoH is committed to e-Health and further upgrades of the “Moj Termin” system. Further development of e-health is ongoing through the preparation of the National e-Health Strategy.
• Although communicable diseases contribute to a smaller portion of the overall burden of diseases, activities are ongoing to prevent, manage and respond to any outbreaks.
• Measures are being taken to improve cancer screening. The National Cancer Registry will be
established and the Strategy for Malignant Diseases will be prepared.
• Preparation of key strategic documents is ongoing – National Health Strategy 2030 and National
Master Plan for Perinatal Care.
• The Government is planning to expand the home-visit programme for vulnerable populations
which is currently operating in two cities.
• Programme targeting the Roma people are being implemented, especially through Roma health
media to reworking in nine municipalities with predominant Roma populations.13
• The Government has increased funding for rare diseases from 3,455,989 Euro in 2017 to 8,550,734
Euro in 2020. Three new medicines were procured for the treatment of Gaucher’s disease, idiopathic pulmonary fbrosis and spinal muscular atrophy.
• MoH continues to support the multi-sector initiative to develop a standardized assessment model to evaluate children and youth with disabilities based on the WHO’s International Classifcation
of Functioning, Disability and Health (ICF).
11 Two new vaccines were made available for children (pneumococcal and rotavirus) and free infuenza vaccines were ofered to vulnerable populations (children
aged 2 or older, pregnant women, elderly aged 65 or above and healthcare professionals).
12 Furthermore, two action plans were prepared and implemented: Action Plan for Promotion of Healthcare for Children and Persons with Disabilities and Action
Plan of the National Coordination Body for Implementation of the UN Convention on the Rights of Persons with Disabilities.
13 Assistance is provided to Roma populations in the realization of the right to health insurance, the right to choose one’s own doctor/ gynaecologist /dentist, and
conduct an educational consultation on healthy lifestyles and assist in discovering unvaccinated or irregularly vaccinated children that are referred to relevant services.
Voluntary National Review | 30
Key Challenges
Key challenges in the area of health include:
• Improvement of infrastructure (construction of new facilities, improvement of existing infrastructure and equipment, especially for cancer treatment);
• Modernization of the health system through the establishment of an integrated National Health
E-system;
• Development of new strategies and policies such as community-based palliative care, community-oriented psychiatric services for children and adolescents and development of daycare centers.
Other challenges that the health sector is facing include reducing the infant mortality rate, reducing
non-communicable diseases, improvement of the diagnosis of rare diseases, reductions in out-of-pocket
payments, and full implementation of tobacco control policies. Additionally, in recent years the vaccination rates for certain communicable deceases have decreased– including vaccinations for measles and
polio.
Table 1: Vaccination Rates (percent)
Year DPT Polio Measles Tuberculosis Hepatitis B HiB
2010 96.8 94.8 95.4 99.2 90.4 88.8
2011 96.0 97.0 97.0 93.2 95.6 96.1
2012 94.7 96.9 96.1 92.0 98.1 94.7
2013 98.2 97.9 96.1 96.9 96.5 97.1
2014 95.4 95.9 93.3 98.8 96.6 93.6
2015 91.3 92.1 88.8 94.2 91.8 88.6
2016 95.3 95.3 82.1 98.2 93.8 94.0
2017 91.1 91.1 82.6 96.8 91.3 91.1
2018 92.5 92.5 74.8 93.4 92.3
Average 94.6 94.8 89.6 95.9 94.0 93.0
Source: Institute for Public Heath of the Republic of North Macedonia
At the institutional level, the Government has identifed the retention of health professionals as one of
the key challenges. Investments in human resource development will continue and future programmes
to better incentivize health professionals to work in the public sector are anticipated.
Environmental health challenges, mainly air pollution, are a major cause of several diseases and represent a serious challenge. The development of national inter-sector policy to address air pollution is a key
priority.
Next Steps
Ministry of Health will continue the implementation of initiatives and activities outlined in the strategic
documents and action plans and will start the preparation of the new National Health Strategy for the
period up to 2030. The strategy will provide direction for reforms of the health care system at all levels.
Investments in infrastructure will continue, as well as the provision of medical equipment, especially for
diagnostics and treatments of malignant diseases, gynecology, obstetrics and neonatology. The National
Perinatal Care Master Plan 2020-2030 will be developed to provide a stratifed model of obstetric and
newborn care for the next ten years and through remodelling the services for perinatal health care will
accelerate progress in this area. With respect to modernizing the Health Care System and improving its
functionality, an integrated health e-system will be established, including further investments for the
training of medical professionals. Specifc measures will be implemented to retain health professionals
in the public sector. Also, eforts will be made to modernize emergency health services and establish an
efcient health preparedness system able to cope with crises and emergencies.
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3
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{
"country": "mkd",
"file_id": "sdg-03/vnr-report-mkd-2020-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
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|
Mali
Rapport National Volontaire sur la mise en œuvre des ODD -- juillet 2018 34
ODD 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être
7 Enquête SMART, 2016
Mali
Rapport National Volontaire sur la mise en œuvre des ODD -- juillet 2018 35
L'espérance de vie au Mali a légèrement augmenté au cours des dernières années. En 2000,
elle était inférieure à 50 ans. En 2009, elle était de 55,6 ans. A partir de 2013, elle a atteint 58
ans. En moyenne, les femmes ont une espérance de vie plus élevée que les hommes (58,4 ans
contre 53 ans).
Les ressources limitées, l’insécurité, l’insuffisance et l’instabilité du personnel qualifié aux
niveaux régional et opérationnel constituent des difficultés majeures à l’accessibilité aux
services sociaux de base.
Alors que le taux de mortalité infantile était de 116 pour 1 000 naissances vivantes, cette
statistique a chuté jusqu’à 74,5 en 2015. Le taux de mortalité maternelle était estimé à 587
pour 100 000 naissances vivantes alors qu’en 2000, ce chiffre était de 834. Les
problématiques d’accessibilité et de qualité des soins continuent de présenter des enjeux en
termes de santé et de bien-être.
Ces dernières années ont été aussi marquées par un progrès sensible dans le cadre de la
réduction des taux de décès au sein de la sous population des moins de 5 ans. En effet, les
taux de mortalité infantile, juvénile, et infanto-juvénile sont passés respectivement de 96‰,
105‰, 191‰ en 2006 à 58‰, 48‰, 98‰ en 2010 et 56‰, 55‰, 108‰ en 2015 (MICS
2015). En 2015, 57 femmes sur cent ont bénéficié d’une assistance en donnant naissance
contre 50 % en 2016. Par ailleurs, le Gouvernement a rendu la césarienne gratuite.
Les maladies transmissibles (diarrhée, infections respiratoires, tuberculose, VIH/SIDA, etc.),
les maladies non transmissibles et/ou chroniques (le paludisme, le Diabète sucré,
l’Hypertension artérielle, la Drépanocytose, les Cancers, etc.) prennent de plus en plus de
l’ampleur et contribuent de façon significative à l’augmentation des dépenses de santé.
Au niveau national 57% des enfants âgés de 12 à 23 mois seulement sont vaccinés contre la
rougeole alors qu’en 2010, le taux enregistré était de 72%, dans le cadre du Programme Elargi
de Vaccination (PEV).
Le taux global de mortalité intra hospitalière en pédiatrie dans les Etablissements Publics
Hospitaliers (EPH) (11,1% en 2016) est globalement en baisse par rapport au niveau de 2015
(15,2%).
Dans le cadre de la lutte contre le paludisme, l’effectivité de la gratuité des produits de lutte
contre le paludisme pour les enfants de moins de 5 ans et les femmes est assurée ainsi que la
gratuité des tests de diagnostic rapide pour toute la population. En outre, une large campagne
de distribution de moustiquaires imprégnées a été organisée dans le cadre de la prévention du
paludisme.
En ce qui concerne la lutte contre la tuberculose, 7 035 cas toutes formes confondues ont été
notifiés en 2016 contre 7 015 en 2015 et la prise en charge des soins est gratuite au niveau des
structures sanitaires.
Dans le cadre de la lutte contre le VIH/SIDA, le Gouvernement a affiché sa volonté manifeste
d’éradiquer le fléau en mettant en place le Haut Conseil National de Lutte contre le SIDA
(HCNLS). Des progrès notables ont été réalisés, entre autres, la gratuité des soins, la
Mali
Rapport National Volontaire sur la mise en œuvre des ODD -- juillet 2018 36
distribution gratuite d’Anti Retro Viraux (ARV), la multiplication des Centres de Conseil de
Dépistage Volontaire (CCDV), la Prévention de la Transmission Mère Enfant (PTME). Le
nombre de patients suivis sous ARV est passé de 31 472 en 2014 à 34 974 en 2015 et à 37
902 en 2016. En outre, le Gouvernement a élaboré un Plan de rattrapage pour l’accélération
de la réponse au VIH qui s’inscrit dans le cadre de l’atteinte des 3X90 recommandé par
l’ONU-SIDA. Un Cadre Stratégique National de lutte contre le VIH et le Sida (CSN 2017 –
2021) a été adopté.
|
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{
"country": "mli",
"file_id": "sdg-03/vnr-report-mli-2018-fr-3.pdf",
"language": "fr",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2018
}
|
RAPPORT NATIONAL VOLONTAIRE 2022 SUR LA MISE EN ŒUVRE DES OBJECTIFS DE DEVELOPPEMENT DURABLE (ODD) DU MALI 43
ODD 3 : Permettre à tous de vivre en bonne santé et
promouvoir le bien-être de tous à tout âge
141. Dans sa dynamique de promouvoir le bien-être des populations, le Gouvernement du Mali a
poursuivi ses efforts à travers les stratégies et priorités existantes parmi lesquelles on peut
citer : (i) la gratuité de la prise en charge du paludisme chez les enfants de moins de 5 ans
et les femmes enceintes, de la césarienne et des intrants de prise en charge de la malnutrition
aiguë ; (ii) le renforcement des soins essentiels dans la communauté à travers la mise en
place des superviseurs dédiés aux Agents de Santé Communautaire ; (iii) le déploiement des
sage femmes.
142. Par ailleurs, le Gouvernement a pris des dispositions à travers :
- le Plan stratégique National de la Santé de la Reproduction et la Feuille de route pour
l’accélération de la réduction de la mortalité maternelle et néo natale ;
- la création de l’Office National de la Santé de la Reproduction (ONASR) par le Décret
n° 14/PRM du 03 avril 2020.
143. Au-delà des progrès sus mentionnés, le Gouvernementa également réalisé des résultats non
moins importants dans le cadre de la Conférence Internationale pour la Population et le
Développement (CIPD) regroupant une série d’engagements pris par le Mali.On note entre
autres, les avancées suivantes : (i) la production régulière des rapports de suivi du Dividende
Démographique. (ii) la création d’un Comité de suivi des engagements pour la mise en œuvre
des engagements de la CIPD ; (iii) l’évaluation du budget estimatif pour la réalisation des 03
résultats transformateurs au Mali (0 décès maternels évitables, 0 VBG, 0 besoins non satisfait
en PF).
144. Toutes ces initiatives entreprises par le Gouvernement se sont effectivement traduites en
resultats,dont les plus importants sont présentés ci-dessous :
145. Le taux de mortalité maternelle est en nette amélioration. Au bout de cinq ans, il a enregistré
une baisse notable en passant de 368 pour 100000 naissances vivantes en 2012 à 325 pour
100000 naissances vivantes en 20187
. Cependant, ce taux reste à un niveau très élevé par
rapport aux objectifs définis par les ODD, c’est-à-dire au-dessous de 70 pour 100 000
naissances vivantes, voire ceux relatifs à zéro décès de femmes en cas de grossesse ou
d’accouchement. Cette situation est également liée à la faible utilisation des méthodes contraceptives modernes dans le pays.
Figure 7 : Taux de mortalité maternelle pour 100 000 naissances vivantes
Source : EDSM VI
7 L’enquête EDSM qui permet de renseigner l’indicateur est réalisée tous les 05 ans.
44 RAPPORT NATIONAL VOLONTAIRE 2022 SUR LA MISE EN ŒUVRE DES OBJECTIFS DE DEVELOPPEMENT DURABLE (ODD) DU MALI
146. La survenue de la Covid-19 le 25 mars 2020 a impacté les activités de Santé de la
Reproduction, par exemple, le taux de Consultation Prénatale (CPN) était en augmentation
de 2017 à 2019, avant de connaitre une baisse en 2020 (24,31%). Il a ensuite enregistré une
haute de 3,3 points de pourcentage entre 2020 et 2021. Quant à la Proportion
d’accouchements assistés par du personnel de santé qualifié, elle a aussi varié en passant
de 33,4% en 2017 à 42% en 2019, il a enregistré une baisse en 2020 en se fixant à 38,9%..
Le taux de césarienne est resté presque stationnaire. La prévalence contraceptive est passée
de 14,3% en 2019 à 17,11% en 2020. Eu égard au défi démographique, ce taux doit être
amélioré à travers notamment le renforcement des campagnes de sensibilisation.
Figure 8 : Evolution des indicateurs de santé de la reproduction (SR)
Source : CPS/Secteur Santé, Développement Social et Promotion de la Famille
Tableau 5 : Taux de mortalité des enfants et taux de couverture vaccinale
Sources : EDSM V et VI
147. Les ratios de mortalité des enfants de moins de 5 ans restent élevés. En 2018, sur 1 000
naissances vivantes, 54 enfants meurent avant d’atteindre leur premier anniversaire, 101 enfants n’atteignent pas l’âge de 5 ans8. La mortalité néonatale établie à 33 ‰, représente le
tiers des décès chez les enfants de moins de 5 ans et plus de la moitié des décès des enfants
de moins d’un an9. Cette mortalité est plus élevée chez les nouveau-nés de mères de moins
de 20 ans (39 ‰), notamment les adolescentes.
148. Les problèmes néonataux, le paludisme, la pneumonie et la diarrhée sont encore à la base
de 7 décès sur 10 chez les enfants de moins de cinq ans ; la majeure partie de ces décès,
soit 70%, survient au niveau communautaire. Ces enfants demeurent également exposés aux
maladies évitables du fait d’une couverture vaccinale encore trop faible. En 2020, seulement
45% des enfants ont été complètement vaccinés.
8 Institut National de la Statistique, Sixième enquête démographique et de santé au Mali, Indicateurs clés, 2018
9 https://data.unicef.org/resources/dataset/child-mortality/, consulté le 16 novembre 2018.
Indicateurs de suivi du
progrès 2017 2018 2019 2020 2021
3.2.1 Taux de mortalité des
enfants de moins de 5 ans
108/1000
(EDSM 2012-
2013)
101/1000
(EDSM 2018)
101/1000
(EDSM 2018)
101/1000
(EDSM 2018)
101/1000
(EDSM 2018)
3.2.2 Taux de mortalité
néonatale
34/1000
(EDSM 2012-
2013)
33 (EDSM VI
2018)
33(EDSM VI
2018)
33 (EDSM VI
2018)
33 (EDSM VI
2018)
3.2.3. Taux de couverture
vaccinale complète 39 (EDSM V) 45%(EDSM
VI)
45%(EDSM
VI)
45%(EDSM
VI)
45%(EDSM
VI)
RAPPORT NATIONAL VOLONTAIRE 2022 SUR LA MISE EN ŒUVRE DES OBJECTIFS DE DEVELOPPEMENT DURABLE (ODD) DU MALI 45
149. La mise en place du Plan Stratégique National pour la Sécurisation des Produits de la Santé
de la Reproduction 2017-2021 (DPM) et du Plan stratégique national de la santé de la reproduction du Mali 2020-2024 est une avancée significative, toutefois, des défis demeurent dans
le domaine de la réduction du nombre de décès maternel, néonatal et infanto-juvénile en milieu rural et chez les ménages ayant le bien-être économique le plus bas.
150. Le défi consiste à améliorer entre autres :
- le taux de CPN4 qui est à seulement 27.6% en 2021 pour une prévision de 60% ;
- le taux d’accouchements assistés par un personnel qualifié en 2021 est à 45.1 % pour
une prévision de 80% ;
- le taux de prévalence contraceptive méthode moderne (17,5% pour une prévision de
20%;
151. Par ailleurs, il faut renforcer la couverture vaccinale des moins de cinq ans qui est selon
l’EDSM VI de 2018 à 45% pour les enfants complètement vaccinés. Ce taux laisse en fait
plus de la moitié des enfants sans protection.
152. Les principales contraintes auxquelles le système de santé est confronté en 2021 sont
notamment :
• l’insuffisance de mobilisation des ressources sur budget d’état et de certains Partenaires ;
• l’insuffisance dans la réalisation des audits des décès maternels et périnatals ;•
• l’insuffisance dans le suivi des recommandations des audits des décès maternels et
périnatals ;
• l’insuffisance de logistiques, notamment en matériels roulants, informatiques et
bureautiques ;
• l’inaccessibilité de certaines localités due à l’insécurité ;
• la limitation des activités à cause de la pandémie de la covid-19.
153. Les bonnes pratiques consisteront, entre autres à renforcer la sensibilisation des femmes en
général et enceintes en particulier aux pratiques suivantes :
• le dépistage du cancer du col de l’utérus ;
• le dépistage du VIH et du SIDA ;
• l’assiduité à la CPN ;
• la vaccination complète des enfants ;
• l’utilisation des MILD pour les enfants et les femmes enceintes.
|
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3
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{
"country": "mli",
"file_id": "sdg-03/vnr-report-mli-2022-fr-3.pdf",
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|
23
- SDG 3: Good Health and Wellbeing
Malta’s universal health coverage
The Maltese healthcare system provides universal coverage, where a comprehensive package
of services is offered to all entitled1 individuals free at the point of use. Malta scores 79% on
the Universal Health Coverage Tracer Index that reflects coverage of essential health services.
Malta has one of the lowest rates of unmet need for medical care, scoring well below the EU
average.
24
Indicators Malta progress 2017
3.8.1 Coverage of essential health services
(defined as the average coverage of essential
services based on tracer interventions that
include reproductive, maternal, newborn and
child health, infectious diseases, noncommunicable diseases and service capacity and
access, among the general and the most
disadvantaged population)
Universal Health Coverage
Tracer Index - 79%
3.8.2 Number of people covered by health
insurance or a public health system per 1,000
population
In Malta, entitlement to public
health services is ‘practically
universal’
Table on Target 3.8
Maternal and Infant Mortality
Malta’s maternal mortality rate is down to 9 per 100,000 live births, and all births are attended
by skilled health personnel, as per the below table:
Indicators Malta progress 2017 World progress 2015
(2017)
3.1.1 Maternal mortality
ratio
9/100,000 live births 216/100,000 live births
3.1.2 Proportion of births
attended by skilled health
personnel
100% 78%
Table on Target 3.1
Work is being undertaken to end preventable deaths of newborns and children under 5 years of
age. In order to reach this target a number of measures have been put in place, which include a
project to introduce phenylketonuria (PKU) screening and sensory integration therapy. In
2018/2019, a screening for deafness for all newborns and a national screening programme for
congenital neonatal hypothyroidism was also put in place.
25
Indicators Malta progress 2017 World progress 2015
(2017)
3.2.1 Under-five
mortality rate
6.4/1,000 live births 43/1,000 live births
3.2.2 Neonatal
mortality rate
4.4/1,000 live births 19/1,000 live births
Table on Target 3.2
Addressing and preventing communicable and other diseases
Under target 3.3, Malta has launched and is implementing the following strategies, which
remain ongoing:
• Prevention, Control and Management of Tuberculosis: A National Strategy for Malta
(2012)
• Communicable Disease strategy (2013)
• National plan for the elimination of Hepatitis C by 2025 launched for consultation on
February 2018. Plan includes widening entitlement to medications for the treatment of
Hepatitis C
• Updating current availability of HIV treatment
• Introduction of rapid HIV testing at genitourinary clinic as well some private
pharmacies. A mobile HIV testing clinics project is in the final stages of
implementation.
Additionally, persons with HIV are entitled to free medical treatment. Screening of all blood
products for emerging viruses to ensure safety of blood products is undertaken.
Malta has a National Immunisation Schedule which provides free access to immunisation for
various vaccine-preventable diseases including the recent introduction of the Human Papilloma
Virus vaccine for 12 year-old girls and Hepatitis B vaccine (97% of children are covered).
26
Indicators Malta progress WHO European
Region
3.4.1 Mortality rate attributed
to cardiovascular disease,
cancer, diabetes or chronic
respiratory disease
224 deaths per 100,000 (in
populations age 30–69 years,
2014 data)
379 per 100,000 (in
populations aged 30-69
years, 2014 data)
3.4.2 Suicide mortality rate 7.2 per 100,000 (increasing
trend, especially Males, 2014
data)
10.5 per 100,000 (2014
data)
Table on Target 3.4
Other ongoing strategies undertaken by Government in relation to SDG 3 include the
following:
- A Strategy for the Prevention and Control of Non-Communicable Disease in Malta
(2010)
- Healthy Weight for Life (2012-2020)
- National Breastfeeding Policy And Action Plan (2015-2020)
- Food and Nutrition Policy And Action Plan (2014-2020)
- Diabetes: A National Public Health Priority. A National Strategy for Diabetes
(2016-2020)
- The National Cancer Plan (2017-2021)
Other Healthcare services
Other measures contributing to prevention, good health, and wellbeing in Malta include:
- Introduction of a screening programme for cervical cancer and further expansion of age
ranges for the breast cancer and colorectal cancer screening programmes;
- Introduction of fast-track nurse and nurse navigators that guide cancer patients through
multidisciplinary management during their cancer illness;
- Introduction of free glucose monitors and glucose-testing sticks for all insulindependent diabetics as well as the addition of new anti-diabetic medications on the
national formulary;
- Investment in the upgrading of renal dialysis machines;
- Inauguration of a stroke rehabilitation unit.
27
Mental Health and Disorders
Malta has also laid out a national screening programme for symptoms of autism in 18 monthold children.
The Malta Inspire Foundation has a ‘Structured Training and Education Programme (STEP)
Early Years’, which is a specialised programme for children aged 2-5 years with difficulties on
the autism spectrum.
The main aim of the ‘Early Years’ intervention programme at Inspire is to provide each child
with training that will build on his or her strengths, teaching new skills, and providing
compensatory skills for areas that require development. The programme also aims to provide
parents with information to help them better understand their child’s behaviour and needs, thus
improving the outcome for the child. The programme is accredited by the National Autistic
Society (NAS) UK.
Content of the programme includes:
- support in coping within the mainstream educational setting (and preparing for school
years)
- independent skills training
- social competence development training
- functional spontaneous communication
- cognitive skill development
- play skill development
- child engagement
- generalisation of skills
- proactive approaches to challenging behaviour
- parental empowerment
A perinatal mental health project involving the screening of pregnant women for mental health
problems by midwives was also introduced. These women are followed up by psychiatrists and
obstetricians at a joint clinic during and after their pregnancy.
Individualised multidisciplinary care plans for inpatients at psychiatric facilities have also been
introduced. A new acute psychiatric hospital is in the process of being built and the current
psychiatric hospital is undergoing a five-year refurbishment plan which will turn it into a state
of the art facility. A mental health strategy is being developed together with protocols relating
to inpatient psychiatric care.
28
Sexual and reproductive health-care services
With regard to universal access to sexual and reproductive health-care services, including for
family planning, information and education, Malta has implemented the National Sexual
Health Policy (2010) and a National Sexual Health Strategy (2011), both of which refer also
to persons with disabilities. Malta has also introduced assisted reproductive technology,
including in-vitro fertilization (IVF), as part of the national health service.
A case study
MY SELF-MY BODY
MY SELF – MY BODY is a project implemented by the Inspire Foundation and co-funded by
the Malta Community Chest Fund for Voluntary Organisations. It involves sex education to
people with intellectual disabilities as well as support to their parents/guardians in order to
address such a sensitive topic and ensure a holistic approach towards a fulfilled life.
A common misconception is that people with an intellectual disability do not need education
related to their sexuality because they will always remain ‘child-like’ and therefore non-sexual.
People with an intellectual disability have the same range of thoughts, attitudes, feelings,
desires and fantasies as people without disabilities. Yet, they often have fewer opportunities to
engage in age-appropriate behaviours than others of the same age. It is important that all young
people are educated and given the chance to explore, enjoy and express their sexuality in
positive, healthy and safe ways.
The Programme will be delivered free of charge in the afternoon between the months of
October 2018 and February 2019. The aim is develop the project further after its expiry.
Treatment of Substance abuse and Alcohol
As a means of addressing target 3.5, Malta has in place a National Drug Policy that is specific
to its needs. The Policy’s main objectives is to ensure a high level of security, health protection,
well-being, and social cohesion. Malta evaluates its drug policy through ongoing indicator
monitoring and specific research projects. A National Drug Focal Point monitors the drug
situation in Malta and monitors and compiles relevant data. In 2018, Malta will have its first
National Alcohol Policy that will address three main areas of intervention - underage drinking,
harmful drinking in adults, and drink-driving. These policies underpin efforts to strengthen the
prevention and treatment of drug use as well as in tackling the harmful use of alcohol.
Infrastructure in the health sector
As a means of promoting affordable and equitable access of infrastructure related to the health
sector, Government has provided capital investments on ongoing infrastructural projects for
29
the construction of primary and secondary healthcare facilities and ongoing upgrading of
emergency preparedness. The Government has introduced an electronic card scheme and
electronic prescriptions to manage free patients’ medicines entitlement. Work is also underway
on the establishment of new registers on dementia, rare diseases and cerebral palsy, in addition
to long-standing, established registers for births, birth defects, cancer, deaths, injuries, and
transplants.
The national e-health programme includes various projects planned for the period 2017 – 2021
utilising both national and EU funds. The programme aims to further develop Malta’s e-health
infrastructure. Examples include the ‘MyHealth’ project, that gives patients and private family
doctors access to healthcare data securely online, and the ‘Converge’ project, which aims to
establish a national electronic health record.
Other medical services
The Malta Medicines Authority regulates medicinal products and pharmaceutical activities,
while ensuring their good quality. The Authority also evaluates requests and monitors clinical
trials carried out in Malta. The Malta Laboratories Network provides a focal point for the
industry on the island, fostering cooperation between different sectors. The laboratory carries
out testing for harmful pesticides in water, as well as toxicology and criminal forensic tests
used by the police and the Law Courts.
Other measures in this area include the adoption of the patient charter, the setting up of a
Valletta Technical Group, comprising 10 countries which negotiates with the pharmaceutical
industry to contain the ever-increasing prices of new drugs, and the launch of new
chemotherapeutic drugs on the national formulary. As part of Malta’s commitment towards
providing quality healthcare, a restructuring of services is underway to increase the delivery of
elective care in the community instead of in hospital. The Pharmacy of Your Choice Scheme,
which has been running for 10 years, enables patients to collect medications they are entitled
to for free from their chosen pharmacy. A recent project also covers the delivery of medications
to the homes of elderly patients eligible for this service. Furthermore, new care homes are
being opened for elderly people who can no longer cope with living on their own. Other
services include a physical education programme for older adults to promote active ageing and
to maintain and improve physical wellbeing.
In an effort to reduce waiting lists for different medical services, out-of-hours scheduling of
Magnetic Resonance Imaging (MRI) and investment in new medical equipment have been
undertaken. Several training sessions for medical staff have also been organised, focusing on
different areas of specialisation.
|
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[
3
] |
{
"country": "mlt",
"file_id": "sdg-03/vnr-report-mlt-2018-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2018
}
|
105
SDG 3: Ensure healthy lives and promote well-being for all at all ages
Enhance healthcare of mothers, new-born babies and other vulnerable and
disadvantaged groups of population SDG 3 (3.1, 3.2 and 3.7)
Increase the focus on the promotion of healthy lifestyle, prevention and
disease control, SDG 3 (3.4, 3.5 and 3.6)
Improve the efficiency of healthcare system and the quality of healthcare, SDG
3 (3.8 and 3.c)
Provide preconditions for healthy development of individuals within their
families, SDG 3 (3.1, 3.2, 3.7)
Eliminate discrimination of LGBT population, SDG 3 (3.3)
Eliminate discrimination of persons with disabilities
Eliminate discrimination of elderly people, SDG 3 (3.8)
Enable efficient protection of the protected areas of nature, environmentally
valuable habitats, forest, ware and coastal ecosystems, protected species of
flora and fauna, air and land, SDG 3 (3.9)
Improve the monitoring of the condition of biodiversity, waters, sea and land,
SDG 3 (3.9)
Establish the mechanisms of inter-sectorial cooperation for the purpose of
improving population health, SDG 3 (3.9)
Strengthen institutional risk management framework, SDG 3 (3.d)
Enhance the readiness to respond to disasters and renewal through recovery,
rehabilitation and reconstruction, SDG 3 (3.d)
|
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{
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The Second Voluntary National Review: Montenegro and Sustainable Development Goals 2016–2021
92 93
The Second Voluntary National Review: Montenegro and Sustainable Development Goals 2016–2021
87 Instrument for Pre-Accession Assistance for Rural Development.
88 According to the UN Common Country Analysis, health expenditures increased from 3.7% of GDP in 2014 to 5.2% in 2018, but they
are still among the lowest in the European region.
7.7.2 SDG 3: Ensure healthy lives and
promote wellbeing for all at all ages
Activities to improve the health system to achieve
universal healthcare (which is set as a goal by
the national planning framework, and which is
in line with SDG target 3.8) and the increase of
budget expenditures88 on healthcare brought some
improvements, as evidenced by the review of the
SDG health indicators, which are also available in the
process of reporting on 2030 NSSD implementation
(Table 7.3).
Developments in the right direction have been noted
in SDG targets 3.1, 3.2, 3.3, 3.7 and 3.c, which pertain
to reducing the global maternal mortality ratio,
ending the preventable deaths of new-borns and
children under 5 years of age, ending the epidemic
of AIDS, tuberculosis and malaria, universal access
to sexual and reproductive healthcare services,
and increasing health financing and funds for the
development of the health workforce. Numerous
challenges remain – both in the access to and in the
quality of health services.
Table 7-3: Indicators available through the NSSD 2030 monitoring process
SDG Indicator Value Comment
3.1.2
Proportion of births attended by skilled
health personnel (2018)
(2018)
98.8%
97.5% for the Roma and Egyptian
communities
3.2.1
Under-5 mortality rate per 1,000 births (2020)
3.7
Stable value (with fewer oscillations) in the
period from 2016–2020, significantly lower
than in 2010
3.2.2
Neonatal mortality rate per 1,000 births (2020)
2.8
Slight decline compared to 2016, significant
compared to 2010 (lowest value 1.3 in 2017)
3.3.1
Number of new HIV infections per 1,000
uninfected members of population
(2020)
0.05
25–26 newly infected per year, no
disaggregated data (by sex, age, etc.) is
available
3.3.2
Tuberculosis incidence per 1,000
members of population
(2019)
13.2
Gradually decreasing
3.3.3
Malaria incidence per 1,000 members of
population
(2020)
0.001613
One or two cases per year (not including
cases in 2016 and 2019)
3.7.1
Proportion of women of reproductive
age (aged 15–49 years) who have their
need for family planning satisfied with
modern methods
(2018)
27.7%
Available from the Multiple Indicator Cluster
Surveys (MISC),
15.5% in the Roma community
3.7.2
Adolescent birth rate (aged 10–14 years;
aged 15–19 years) per 1,000 women in
that age group
(2020)
0.11
9.4
Stable values, with certain oscillations in the
period 2016–2021, declining compared to
2010; the rate for the Roma and Egyptian
communities is approximately 15 times higher
than in the general population
3.a.1
Age-standardized prevalence of current
tobacco use among persons aged 15
years and older
(2017)
35.4%
The latest available data is for 2017
3.c.1
Health worker density and distribution
(physicians, nurses, dentists,
pharmacists)
+
Slightly increasing for all categories in the
period 2015–2020
89 Estimates of the Public Health Institute published in the UN Common Country Analysis, 2021.
The target to reduce by one third premature
mortality from non-communicable diseases by 2030
(target 3.4) is one of those where Montenegrin
society faces significant challenges. The frequency
and e
fects of the most common non-communicable
diseases – diabetes, cardiovascular diseases, cancer
and chronic respiratory diseases – are of concern.
Cumulatively, these four groups of diseases cause an
estimated 72.7% of deaths and 32.4% of the disease
burden.89
The Second Voluntary National Review: Montenegro and Sustainable Development Goals 2016–2021
94 95
The Second Voluntary National Review: Montenegro and Sustainable Development Goals 2016–2021
Developments in substance abuse (target 3.5),
global deaths and injuries from road trafc accidents
(target 3.6) and tobacco control (target 3.a) are also
concerning. The long-term efects of the COVID-19
pandemic have yet to be analysed.
As for target 3.9, which is about reducing the
number of deaths and illnesses from hazardous
chemicals and air pollution, the Public Health
Institute, with the assistance of the WHO, prepared
a health impact assessment of air pollution in the
municipalities of Podgorica, Nikšić and Pljevlja in
2016. Air pollution, especially in urban areas, poses
a risk to the health of children and adults. It is
measured in Pljevlja, Bijelo Polje, Nikšić, Podgorica,
Bar and Kotor; the results show that the legally
permitted thresholds are exceeded on a regular
basis in several municipalities. The mortality rate
attributed to unsafe water, unsafe sanitation and
a lack of hygiene (SDG indicator 3.9.2) was last
updated for Montenegro by the WHO in 2019 and
was equal to <0.1.90
Health indicators show a significant diference for
certain vulnerable groups compared to the general
population. Thus, for example, life expectancy for
the general population is 76.7 years of age (74.1 for
men and 79.4 for women), while it is 20 years less
(55 years of age)91 for members of the Roma and
Egyptian populations; diferences in health outcomes
for Roma and Egyptians are also shown in Table 7.3.
90 Reporting on the NSSD 2030 implementation – Action Plan for Strategic Goal 3.3.
91 Data from the research conducted for the purposes of drafting the National Strategy for Social Inclusion of Roma and Egyptians for
the period 2016–2020, published in the UN Common Country Analysis, 2021.
92 https://montenegro.un.org/sites/default/files/2020-09/Report%20on%20the%20Rapid%20Social%20Impact%20
Assessment%20of%20the%20COVID-19%20outbreak%20in%20Montenegro%2C%20April–June%202020_0.pdf.
93 Multiple Indicators Cluster Survey in Montenegro (MICS) 2018, MONSTAT, UNICEF and UNHCR: www.monstat.org/userfiles/file/
MICS/MNE/n/MNE_MICS6%20Statistical%20Snapshot%20ECD%20ENG_Montenegro%202018_FINAL.pdf.
94 UN Common Country Analysis, 2021.
Concerning the health of children and young
people, the data on the immunization of children
is particularly worrying. The percentage of children
vaccinated against measles, mumps and rubella in
Montenegro fell from 90% in 2010 to only 24%
in 2020. In addition, only 24% of new-borns are
breastfed in the first hour after birth, and 20% are
breastfed during the first six months of life (MICS,
2018).
Both children and young people emphasize the
importance of mental health before and during
the COVID-19 pandemic, and believe that the
psychological support in general is insufcient,
especially for young people.92 One of the key issues
is limited involvement of parents in activities with
their children. Collectively, 44% of fathers were
engaged in four or more activities with their young
children in 2018, compared to 84% of mothers.93
The existing health information system is
incomplete, fragmented and insufciently
interoperable to provide satisfactory information for
the efcient management of the health system.94
Air pollution
especially in urban areas,
poses a risk to the
health of children
and adults
The percentage of children
vaccinated against measles,
mumps and rubella
in Montenegro fell from 90%
in 2010 to only 24% in 2020.
In addition, only 24%
of new-borns are breastfed
in the first hour after birth,
and 20% are breastfed
during the first
six months of life
|
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{
"country": "mne",
"file_id": "sdg-03/vnr-report-mne-2022-en-3.pdf",
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|
20 MONGOLIA VOLUNTARY NATIONAL REVIEW REPORT 2019
Goal 3. Ensure Healthy Lives and Promote Wellbeing
for All at All ages
Mongolians are living longer. Life expectancy
at birth rose steadily from 63.2 years in 2000
to 69.914 years in 2017, up by 6.7 years.
Female life expectancy (75.4 years) is almost
10 years more than males (65.9 years), which
is twice the world average of 4.6 years. The
lower growth in overall male life expectancy
may be associated with factors specifc to
men, such as health risks from alcohol and
tobacco use, unbalanced diets, and a lack of
physical activity15. This phenomenon needs
further analysis.
Mongolia was one of nine countries to meet
the MDG’s maternal mortality target.However,
the maternal mortality ratio increased
almost two-fold since then reaching 48.6
per 100,000 live births in 201616, indicating
the fragility of Mongolia’s health system and
its vulnerability to external shocks, including
economic diffculties. Early detection and
surveillance measures on reproductive
health, including compulsory testing for
genetic problems, contributed to lowering
the maternal mortality rate (MMR) to 26.9
in 2017. The MMR is still high in rural areas.
The main direct cause of maternal mortality
were identifed as septic conditions (24.2
percent), hemorrhages (17.7 percent,) and
preeclampsia (17.7 percent)17.
Mortality among children has decreased.
From 2010 to 2017, the child mortality rate
for children under fve years of age dropped
to 16.7 from 25.6 per 1000 live births, and
infant mortality rate dropped to 13.6 from
20.2 per 1000 live births.
Mongolia has done well in ensuring skilled
birth attendance. During the period 2015-
2017, over 95 to 99 percent of live births
were assisted by skilled health personnel.
However, the fertility rate among adolescent
girls (aged 15-19) is high, increasing from
40.4 (2013) to 42.6 per 1,000 women in
201818. Limited access to reproductive health
services and poor awareness is leading to
unwanted pregnancies among adolescent
girls.
Infectious diseases and non-communicable
diseases remain areas of concern. Although,
there are many laws and policies on
communicable diseases, people are still
suffering from preventable illnesses. They
are suffering needlessly from preventable
diseases and too many are dying prematurely.
Despite high immunization coverage
(98 percent), there are still outbreaks of
communicable diseases. Measles increased
in 2015-2016, contributing to infant mortality.
The highest number of tuberculosis cases
were detected among the people aged 15-
34 years, and 65 years and above; moreover,
55.1 percent of tuberculosis patients are
male, while 44.9 percent are women19. Of
HIV/AIDS positive people, 61 percent are
youths between the ages 25-3920. As of 2018,
sexually transmitted infections account for
34.7 (2017) percent of total communicable
diseases21, and 42 percent of sexually
transmitted disease cases were recorded
among the population aged 15-24 years22.
Nevertheless, the country’s major concern
remains non-communicable diseases23,
which constitutes 85.9 percent of mortality.
Pollution, especially air pollution, is a
growing contributor to premature deaths
and morbidity, more so in urban areas. There
are high rates of drug related crime among
young people. Among them, 40.9 percent
are unemployed and 76.3 percent are youth
between the ages of 18-3524.
|
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|
MONGOLIA VOLUNTARY NATIONAL REVIEW 2023 41
Although the implementation of the goal of
promoting health is assessed as moderate and
there is a positive trend towards achieving the
2030 goal, particular attention needs to be paid
to targets such as the maternal mortality ratio
and public health emergency preparedness.
The birth rate of teenage girls is gradually
decreasing. The adolescent birth rate for
teenage girls (15-19 years) is 24.2 per 1,000
girls, which is 8.4 less than the average of the
last 10 years and 3.8 less than the previous
year.23 In 2010, teenage girls accounted for 8.0
per cent of all births. This indicator has
decreased by 4.7 per cent over the past 20
years, but it remains higher than the regional
average for Asia and the Pacific.
Maternal mortality rates skyrocketed during
the COVID-19 pandemic. The maternal mortality rate per 100,000 live births reached 94.9 in
2021, an increase of 54.8 from the 10-year
average and 64.7 from the previous year, and
about 35 cases higher than the average for
Asia-Pacific countries. This indicator halved to
23 between 2016 and 2019, but increased
dramatically in 2020 and 2021. Nearly 85 per
cent of all maternal deaths are indirect obstetric
mortality. Specifically, maternal deaths due to
COVID-19 infection accounted for 67.6 per cent
of all cases in 2021. Some studies24 have
raised important issues warning that maternal
health and mortality are not just a health
system problem, but a chronic public health
condition that requires a wide range of modern,
evidence-based treatments and technologies.
For example, in addition to delays caused by
individuals and families, maternal mortality is
influenced by factors such as alcohol consumption among women, domestic violence, suicide,
and mental health problems.
Nationwide, 99.2 per cent of all births were
attended by skilled health personnel in 2021,
but 80 cases of unattended births were recorded. This is an increase of 14 cases, or 17.5 per
cent, from the previous year.
Newborn and under-five mortality rates are
lower than the global and Asia-Pacific regional
averages. The three leading causes of newborn
mortality in 2017-2021 were respiratory
distress, lack of oxygen to the brain, and
congenital malformations. However, the
leading causes of death for children under five
are diseases, accidents, and congenital malformations during the perinatal period.25 Therefore, attention must be paid to reducing deaths
from preventable (accidents) and treatable
(respiratory diseases) mortality among
newborns and children under five. Most
under-five deaths occur in infancy, and the
majority of neonatal deaths occur in the first
few years, when they are most dependent on
primary and emergency health services, pointing to the need to develop prenatal care
services.
Communicable and non-communicable
diseases remain a pressing concern. The
prevalence of tuberculosis among the Mongolian population is the fourth highest among
countries in the Western Asia-Pacific region.
According to WHO estimates, the incidence rate
of tuberculosis per 100,000 population in 2020
was 428, which was 296 higher than the global
average (132) and 332 higher than the regional
average (96). The prevalence rate of HIV infection in Mongolia is less than 0.1 per cent in the
general population and less than 5.0 per cent in
the population at risk, making Mongolia one of
the countries with a low prevalence of HIV
infection in the general population and a
concentrated prevalence in the population at
risk.
While the risk of premature death from the four
leading causes of death from non-communicable diseases - cardiovascular disease, cancer,
diabetes and chronic respiratory diseases - is
decreasing, 6,230 people aged 30 to 70 died
from non-communicable diseases such as
cardiovascular diseases, cancer, diabetes, and
chronic respiratory diseases in 2021, accounting for 31.3 per cent of all deaths. Mortality
rates from these causes are higher among men
Goal 3. Promote health
42 MONGOLIA VOLUNTARY NATIONAL REVIEW 2023
aged 30 to 70 compared to women.
Mongolia is the ninth country in Asia and the
Pacific for the highest prevalence of deaths
from road traffic accidents. By gender, male
deaths from road traffic accidents are 2.3 times
higher than female deaths, male pedestrian
deaths are 1.5 times higher than female pedestrian deaths and male motorcyclist deaths are
13 times higher than female motorcyclist
deaths. In terms of age groups, the distribution
of deaths due to road traffic accidents in 2021
is as follows: children under the age of 15
accounted for 14.0 per cent, individuals aged
15-29 accounted for 19.6 per cent, those aged
30-39 accounted for 20.6 per cent, and individuals aged 40-49 accounted for 24.3 per cent of
the total deaths caused by road traffic
accidents.
The mortality rate due to unintentional poisoning and exposure to toxic substances has
shown an increasing trend in recent years. In
2021, a total of 1,019 cases were registered
throughout the country, 326 cases more than
the average of the past 10 years and 249 cases
more than the previous year. The mortality rate
due to unintentional poisoning and exposure to
toxic substances stands at 31 per 100,000
population. Notably, this rate is 3.5 times higher
in males compared to females. Among the
deaths caused by toxic substances, the majority (84 per cent) of the deaths were caused by
alcohol poisoning.26
The number of drug users is increasing and
there is little progress in treatment coverage.
The number of drug users increased from 90 in
2015 to 174 in 2016 and rose sharply to 966 in
2018. This sharp increase is due to an increase
in the number of users and an improvement in
police activity and detection.27 The National
Center for Mental Health (NCMH) has developed 11 new diagnostic and treatment
standards, used 19 new psychotropic drugs for
treatment in the last three years, and introduced
new methods and tests for 13 types of urine
and saliva testing. Despite the use of drugs
registered in Mongolia, meeting the standards
for the treatment of people with substance use
disorders, and utilizing modern psychotherapy,
the percentage of people receiving treatment
increased by only one percentage point, from
16.5 per cent in 2018 to 17.5 per cent in 2019.
Although the percentage of the population that
consumes alcohol is decreasing, the gender
gap is large. According to a national survey, the
percentage of the population aged 15-64 who
consumed alcohol in the past year was 57.7 per
cent28 in 2019, a positive trend of a 6.9 per cent
decrease compared observed in 2013. However, 34.8 per cent of the total population aged
15-64 consumed alcoholic beverages in the
past month, and the percentage of the population who consumed “six or more standard
drinks” in one session or “excessively
consumed” alcohol was 19.8 per cent nationwide. The gender gap in risk behaviours for
excessive alcohol consumption is large, about
2.5 times higher for men (28.2 per cent) than for
women (11.5 per cent).
The prevalence of smoking among the population aged 15 and over is on the rise. As of 2018,
58.0 per cent of men aged 15-49 used
cigarettes, an increase of 1.9 percentage points
since 2013, and 9.2 per cent of women in the
same age group smoked, an increase of 1.4
percentage points over the same period.29
Regarding tobacco use among individuals aged
15-69, one in four smoked. In terms of gender,
men consumed at a rate that was 8.7 times
higher than women. One in five of the population smoked cigarettes daily, with 39.5 per cent
of men and 4.1 per cent of women smoking
regularly. The average age at which people start
smoking was 18.9 years, and the average duration of smoking was 19.9 years.30
Progress is being made to ensure access to
health services for all, including protection
against financial risks, much-needed quality
health care, and access to safe, effective, quality and affordable essential medicines and
vaccines. The coverage rate of essential healthcare services was 85 per cent in 2020, 19
percentage points higher than the global
average (66) and eight percentage points higher
than the regional average (77).
The percentage of the target population
covered by all types of vaccines included in the
national programme is set to be increased to
97.5 per cent by 2025 and 99.0 per cent by
2030. Vaccination coverage among children is
MONGOLIA VOLUNTARY NATIONAL REVIEW 2023 43
more than 90 per cent. For example, the
percentage of children aged 12-23 months who
were vaccinated against diphtheria, pertussis,
tetanus, hepatitis B and Haemophilus influenzae type B (pentavalent vaccine) was 91.9 per
cent in 2018 and increased by 3.4 percentage
points to 95.3 per cent in 2021. In 2018, the
percentage of children aged 12-23 months who
received the first dose of measles, mumps and
rubella vaccine (MMR1) was 91.6 per cent in
2018. This percentage of children aged 30-35
months who received the second dose was
81.3 per cent in 2018, and this indicator
increased to 93.7 per cent in 2021, showing a
positive trend towards the target level.
Despite the increase in health worker density,
public health emergency preparedness
remains inadequate. In 2021, there were 178.8
health professionals per 10,000 people, of
whom 22.1 per cent were physicians, 23.0 per
cent were nurses, 5.0 per cent were pharmacists, 3.1 per cent were methodologists, 2.2 per
cent were administrative staff, and 2.3 per cent
were laboratory technicians. Of these, 80 per
cent of the physicians worked in primary and
specialty care. There were 39.5 physicians and
41.0 nurses per 10,000 population, an increase
of 1.0 physicians and 0.4 nurses over the previous year.
The capacity to implement the International
Health Regulations and public health emergency preparedness decreased by 5.0 percentage
points since 2015, reaching 80.0 per cent in
2021. Although this decrease is due to the
impact of the COVID-19 pandemic, it is necessary to accelerate the implementation of activities in this direction to meet future targets.
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[
3
] |
{
"country": "mng",
"file_id": "sdg-03/vnr-report-mng-2023-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
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