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35 36
VNR2020
MOZAMBIQUE Voluntary National Review
SDG 3: Quality Health
National statistics28 show that in 2018 the number of Institutional Births grew from 71% to
87%, above the target set for the period 2015-2019, which was 75%. Data also show that
intra-hospital maternal mortality fell from 87 to 66 deaths per 100,000 live births (LB) between
2016 and 2018. Figure 18 below illustrates the performance of part of the indicators in the
health area for the period from 2014 to 2018:
Figure 18: Healthcare Performance, 2014-2018, in %
2018 2017 2016 2015 2014
TARV Coverage Pregnant Women
Adult ART coverage
TARV coverage for children
Cure Acute Malnutrition
in Children under 5 years
% Institutional Delivery Coverage
0 20 40 60 80 100 120
87
100
91
82
86
57
64
64
64
52
52
45
45
69
39
94
93
82
87
83
71
77
75
87
83
Source: Balanço do Programa Quinquenal do Governo (BdPQG) 2015-2019
The expansion of antiretroviral therapy (ART) in the country was signifcant: children (39%
to 52%), adults (52% to 57%) and pregnant women (82% to 87%). The cure rate for acute
malnutrition in children under 5 years increased from 75% to 87% between 2015 and 2018.
According to the Afrobarometer opinion polling, the perception of the quality of Health
Services improved from 2015 to 2018 - the number of people who had contact with the
Health Services is said to have increased from 55% to 65.7% and the number of people who
reported that the Government is handling Basic Health Services properly increased from
42% to 55%.
However, from the VNR29 surveys, there are still challenges to be overcome in Service Delivery,
such as lack of drugs, long distances to the health facilities and the need to increasingly
improve health care.30 Despite the country’s efforts to improve the accessibility of public
services for people with disabilities, such as the setting up of ramps, specifc locker rooms
and lifts, the challenges of improving national health services to be more comprehensive and
inclusive, especially for the elderly and people with disabilities, with regard to the accessibility
and allocation of specialized personnel to meet this specifc group, prevails.
|
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[
3
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{
"country": "moz",
"file_id": "sdg-03/vnr-report-moz-2020-en-3.pdf",
"language": "en",
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"size": "m",
"type": "vnr",
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}
|
OBJECTIF 3
PERMETTRE À TOUS DE VIVRE EN BONNE
SANTÉ ET PROMOUVOIR LE BIEN-ÊTRE
DE TOUS À TOUT ÂGE.
Cible 3.1
D’ici à 2030, faire passer le taux mondial
de mortalité maternelle au-dessous de
70 pour 100000 naissances vivantes.
Indicateur 3.1.1
Taux de mortalité maternelle
(Décès maternels pour 100 000
naissances vivantes).
source : Enquête MICS 2015
2011 ➜ 626
2015 ➜ 510
Indicateur 3.1.2
Taux d’accouchements assistés par
un personnel de santé qualifié (%).
source : Données SNIS (Système National
d’Information de la Santé, Ministère de la Santé)
2015 ➜ 64 %
2018 ➜ 72 %
Cible 3.2
D’ici à 2030, éliminer les décès
évitables de nouveau-nés et
d’enfants de moins de 5 ans, tous
les pays devant chercher à ramener
la mortalité néonatale à 12 pour
1 000 naissances vivantes au plus
et la mortalité des enfants de moins
de 5 ans à 25 pour 1 000 naissances
vivantes au plus.
Indicateur 3.2.1
Taux de mortalité des enfants de
moins de 5 ans (‰).
Source : Enquête MICS 2015
2011 ➜ 75 ‰
2015 ➜ 43 ‰
Indicateur 3.2.2
Taux de mortalité néonatale (‰).
Source : Enquête MICS 2015
2015 ➜ 29,96 %
2018 ➜ 29,51 %
Cible 3.3
D’ici à 2030, mettre fin à l’épidémie
de sida, à la tuberculose, au paludisme
et aux maladies tropicales négligées
et combattre l’hépatite, les maladies
transmises par l’eau et autres maladies
transmissibles.
Indicateur 3.3.1
Prévalence du VIH/Sida (%)
source : Données SNIS
2015 ➜ 0,5 %
2018 ➜ 0,5 %
Indicateur 3.3.3
Incidence du paludisme (pour 1000
habitants)
source : Données SNIS
2015 ➜ 11,18 %
2018 ➜ 3,64 %
Déf important pour l’ensemble des pays en développement, la Santé l’est tout autant pour la Mauritanie, où
l’enquête EPCV de 2014 montre un taux de morbidité de
4,9 %. Étant donné la taille moyenne des ménages en
Mauritanie selon le RGPH de 2015, soit 6 individus par
ménage, cela correspondrait à un ménage sur trois qui
a eu à faire face à un problème de santé au cours des
deux semaines qui ont précédé l’enquête. Cette situation
afecte davantage les femmes (5,6 %) que les hommes
(4,2 %) et afecte les tranches d’âge (0 à 4 ans) et (60 ans
et plus) à hauteur de 9,8 %. En moyenne toujours selon
l’EPCV 2014, 4,8 % du budget des ménages est consacré
aux dépenses de santé (consultations, analyses, soins
médicaux et chirurgicaux, transport, médicaments, etc.),
en nette augmentation par rapport à 2008 où ce taux était
de 3,8 %.
Parmi les principales causes de morbidité, on retrouve le
paludisme avec 19,7 %, la diarrhée (9,3 %) et les maladies
de la peau (9,1 %), selon les données de l’EPCV 2014,
comme le montre le graphique 2.
La santé est un problème central qui afecte presque un
ménage sur trois et qui pèse environ 5 % du budget des
ménages mauritaniens.
3 col = 43mm 4 col = 58 mm 5 col = 74 mm 6 col = 90 mm 8 col = 120 mm
ODD3
Graphique 2 Maladies les plus courantes (2014), en%
ODD3
Graphique 3. Taux de Prévalence du Paludisme en ‰ (2015-2018)
Blessures/Accidents
Tuberculose
Diabète
Maladies oculaires
Hypertention/AVC
Autres
Maladies cutanées
Diarrhée
Paludisme
19,4
9,1
9,3
8,3
4,6
2,9
1,5 2,2
6,7
0
2
4
6
8
10
12
2015 2016 2017 2018
11,18
8,48 9,43
3,64
Source : EPCV 2014
Graphique 2: Maladies les plus courantes, 2014 (en %)
Revue Nationale Volontaire des Objectifs de Développement Durable - Mauritanie
30
En 2013, le taux de mortalité maternelle était de 582 pour
100000, soit 8 fois plus que la valeur cible à l’horizon
2030, d’où l’importance des mesures prises, malgré leur
insufsance.
L’amélioration continue de l’ofre sanitaire, conjuguée avec
d’importantes mesures, dont notamment l’introduction du
forfait obstétrical (cf. encadré) a permis de passer d’un
taux d’accouchements assistés par un personnel médical
qualifé de l’ordre de 64 % en 2015 à 72 % en 2018. Ceci
devrait se voir refété dans le taux de mortalité maternelle,
qui sera fourni par les prochaines enquêtes.
Les nouvelles utilisatrices des services de maternité sont
en légère augmentation: de 137934 en 2016, elles sont
passées à 139615 en 2017, soit une progression d’à peine
plus de 1 %. La première consultation prénatale est restée
stagnante entre 2016 et 2017 autour de 81 % tandis que
la 4e visite prénatale a régressé, passant de 15,60 % en
2016 à 12,68 % en 2017.
Ce décalage important entre la couverture de la première (81 %) et de la 4eme consultation prénatale (12,68 %)
dénote d’une insufsance de couverture et de continuum
de l’ofre de service, mais surtout d’importants goulots
d’étranglements liés à la qualité et au coût des services
de santé, qui freinent l’avancée vers une amélioration de la
santé maternelle et infantile.
La prise en charge de la femme enceinte durant toute sa
grossesse et de la périnatalité devra tenir compte des faiblesses générales identifées dans l’EPCV, notamment en
termes de disponibilité et d’accessibilité des services de
santé, mais aussi en termes de qualité et de coût de ces
services.
Tableau 4: Temps de trajet vers une structure sanitaire (2014)
Moins de 30
minutes
30 à 60
minutes
Plus de 60
minutes
Urbain 37,2 % 53,2 % 16,0 %
Rural 21,3 % 14,7 % 64,0 %
Ensemble 20.4 % 20.1 % 23.3 %
Source : EPCV 2014
Les progrès en termes de mortalité
des moins de 5 ans et de mortalité néonatale se font
à un rythme lent.
Selon les données du Ministère de la Santé de Mauritanie,
la couverture en services de santé a connu durant la
période 2015-2017 une évolution conséquente, passant
de 79 % en 2015 à 83 % en 2017, soit une augmentation
de 4 points. Dans cette même période, l’utilisation des
services par la population est passée de 43 % à 60 %, ce
qui devrait avoir un impact encore plus signifcatif. Cette
augmentation est due à l’amélioration de l’ofre par l’ouverture de nouvelles infrastructures sanitaires (centres et
postes de santé) et à l’amélioration de la qualité des services par de meilleures dotations en ressources humaines
et en équipements.
Ce taux d’utilisation devrait s’améliorer par une meilleure
sensibilisation des populations et surtout par des mesures
vigoureuses et durables visant à améliorer l’accessibilité
géographique et économique des services de santé.
À cette fn, la phase pilote d’un programme de « fnancement basé sur les résultats » (INAYA) a été lancée dans
deux régions (Hodh Elgharbi et Guidimakha), avec pour
objectif de promouvoir l’accès des populations, y compris
les plus démunies aux services de santé. Par ailleurs, la
couverture de la CNAM (Caisse Nationale d’Assurance
Maladie), jusqu’ici limitée aux fonctionnaires et retraités de
l’État ainsi qu’aux employés du secteur formel à travers
un système de contribution obligatoire proportionnelle à
Incidence de la pauvreté non monétaire selon la Wilaya
Assaba
Gorgol
Brakna
Trarza
Adrar
Tagant
Guidimagha
Inchiri
Nouakchott Hodh Chargui
Hodh El Gharbi
Dakhlet Nouadibou
Tirs-Ezemour
Hodh Chargui
Hodh El Gharbi Assaba
Gorgol
Brakna
Trarza
Adrar Dakhlet Nouadibou
Tagant
Guidimagha
Tirs-Ezemour
Inchiri
Nouakchott
ALGÉRIE
SAHARA
OCCIDENTAL
SÉNÉGAL MALI 0 50 100 km
MALI
Utilisation des services de santé
(par wilaya)
40 à 55%
8 à 20 %
> 90 %
24 à 35 %
60 à 70 %
Source : Annuaire statistique Ministère de la santé - 2017
Utilisation des services de santé
Revue Nationale Volontaire des Objectifs de Développement Durable - Mauritanie
31
la rémunération, a été élargi en 2019 à tous les citoyens
sur une base volontaire, moyennant une contribution
forfaitaire. Cependant, l’efcacité de la couverture de la
CNAM restera sujette à caution tant que les plus démunis
(indigents) n’en bénéfcient pas et que le système de tiers
payant n’aura pas été généralisé.
Des progrès importants ont été réalisés dans la lutte
contre le paludisme, mais ils demandent à être consolidés
par l’amélioration du cadre de vie des populations.
L’incidence du paludisme a enregistré une baisse continue à partir 2015 avec une légère hausse en 2017. Avec
la généralisation du test rapide dans toutes les formations
sanitaires du pays l’incidence du paludisme est en 2018 de
3,64 cas pour 1000 habitants. Le Programme National de
Lutte Contre le Paludisme multiplie les actions de prévention par des distributions de Moustiquaires Imprégnées de
Longue Durée (MILDA) dans les centres sanitaires et l’organisation de campagnes de distribution aux populations
des wilayas où l’épidémie est endémique (Hodh Charghi,
Hodh El Gharbi, Assaba, Tagant, Guidimagha, Gorgol et
Brakna).
Cependant, la pérennisation de ces progrès demeure
largement tributaire de plusieurs actions combinées :
✲ la mise en place d’un plan d'accélération de la réduction de la mortalité maternelle et néonatale grâce à l'identifcation d'un réseau de soins obstétricaux et néonataux
d'urgence (SONU), couplé à la répartition équitable des
sages-femmes ;
✲ la prise en charge des maladies émergentes découlant de l’accroissement des infrastructures routières et
des moyens de déplacement et de communication, de
l’augmentation et de la diversifcation des importations
d’aliments et de produits chimiques ;
✲ l’amélioration de la gouvernance du secteur de la Santé
à tous les niveaux de la pyramide sanitaire, en amenant à
une plus grande prise de conscience des responsabilités,
des résultats attendus et d’obligation de rendre compte,
et par l’instauration d’une vraie politique de développement des ressources humaines et de gestion optimale
des ressources matérielles et fnancières ;
✲ l’amélioration des conditions de vie des populations,
notamment pour ce qui concerne l’habitat et son environnement immédiat (cf. ODD 11), surtout pour ce qui est des
questions de la gestion des ordures, de la salubrité des
habitations et du cadre urbain.
La hausse de la mortalité et de la morbidité, en particulier
chez les femmes et les enfants est due à d’importants
facteurs liés à la transition épidémiologique responsable
d’un cumul de maladies liées à un environnement géo-climatique et socio-économique défavorables et à des comportements favorisés par la pauvreté, l’analphabétisme et
le manque d’éducation sanitaire.
3 col = 43mm 4 col = 58 mm 5 col = 74 mm 6 col = 90 mm 8 col = 120 mm
ODD3
Graphique 2 Maladies les plus courantes (2014), en%
ODD3
Graphique 3. Taux de Prévalence du Paludisme en ‰ (2015-2018)
Blessures/Accidents
Tuberculose
Diabète
Maladies oculaires
Hypertention/AVC
Autres
Maladies cutanées
Diarrhée
Paludisme
19,4
9,1
9,3
8,3
4,6
2,9
1,5 2,2
6,7
0
2
4
6
8
10
12
2015 2016 2017 2018
11,18
8,48 9,43
3,64
Source : Données SNIS
Graphique 3: Taux de Prévalence du Paludisme en ‰ (2015−2018)
Revue Nationale Volontaire des Objectifs de Développement Durable - Mauritanie
32
Encadré 3.
Le forfait Obstétrical : une expérience concluante
pour l’amélioration de l’accessibilité financière des
femmes aux services de santé maternelle
Le forfait obstétrical (FO) est un dispositif d’assurance
volontaire couvrant les frais de santé maternelle au sein
des formations sanitaires publiques de tout niveau (postes,
centres, hôpitaux). Lors de leur première consultation prénatale, les femmes qui le souhaitent prépayent un montant
compris entre 15 à 17 USD, pour accéder ensuite gratuitement à toutes les consultations prénatales, aux examens
biologiques, à la prise en charge de leur accouchement et des
éventuelles complications ainsi qu’une consultation postnatale. Fin 2014, le forfait était proposé dans 144 formations
sanitaires sur les 627 fonctionnelles recensées dans le pays.
Le FO a permis de contribuer significativement à l’amélioration de l’accès des femmes aux services obstétricaux et
à la diminution de la mortalité néonatale générale dans les
moughataa qui ofrent le forfait avec plus de 80 % de taux
d’adhésion.
Selon les conclusions de cette évaluation « le FO est une
expérience originale, pertinente, positive qui vise à améliorer
l’accès financier des femmes à ces soins reconnus comme
essentiels pour réduire la morbidité ainsi que la mortalité
maternelle et infantile. Sa progression nécessite son intégration dans le système sanitaire du pays et son extension
demande une volonté politique plus soutenue, une gestion
rigoureuse, des contrôles efcaces et un suivi rapproché
avec une implication plus accrue des usagères. »
Paradoxalement, la Mauritanie a connu, ces dix dernières années, une augmentation importante quantitative de l’ofre de services de santé, qu’elle soit publique
ou privée, sans juguler le fux de malades se soignant à
l’extérieur du Pays (en Europe, au Maghreb ou même en
Afrique occidentale) en raison de la détérioration de la
qualité des services oferts aux populations.
Cette situation sera jugulée par la mise en œuvre d’une
politique de santé :
✲ pertinente, répondant aux problèmes prioritaires de
santé;
✲ efcace, utilisant de manière efcace les ressources
nationales disponibles (humaines, matérielles et fnancières);
✲ équitable, donnant la priorité aux zones et aux groupes
les plus vulnérables dans un élan de solidarité sociale et
de couverture universelle en santé;
✲ visant une amélioration durable de la santé des populations et
✲ soutenue par une décentralisation de la gestion des
ressources et
✲ une participation des principaux acteurs du secteur,
au premier chef desquels les ménages et les communautés qui sont à la fois, les principaux bénéfciaires et les
premiers bailleurs de la santé en Mauritanie.
Les éléments de base de cette politique sont déjà développés, dans la Stratégie de Croissance Accélérée et de
Prospérité Partagée.
Revue Nationale Volontaire des Objectifs de Développement Durable - Mauritanie
33
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VOLUNTARY NATIONAL REVIEW REPORT OF MAURITIUS 30
03ENSURE HEALTHY LIVES
AND PROMOTE WELL-BEING
FOR ALL AT ALL AGES
Mauritius recognises that the good health of its
citizens is vital to achieving an excellent quality
of life and the pursuit of happiness. The political
and historical context of Mauritius demonstrate
that, after independence, the country made longterm commitments to achieve Universal Health
Coverage (UHC), and have in place a public health
system which provides the conditions in which the
people can be healthy.
Successive Governments have sustained the
provision of free healthcare services in the
public sector because investing in health is an
effective and sustainable way to enhance human
development and social well-being. Today the total
expenditure of the health sector represents 5.83
percent of our GDP. Investment in public health
has increased from Rs 9.69 billion in financial
year 2015/16 to Rs 12.26 billion in financial year
2018/19, representing an increase of 27 percent.
Mauritius provides primary, secondary and
specialised health services through a network
of five regional, two district and six specialised
hospitals. These services are free to the population
and to non-residents visiting Mauritian hospitals. In
addition, the public service employs 51.7 percent
of total registered doctors in the country. We have
made remarkable progress towards achieving
UHC in Mauritius which has allowed us achieve
Target 3.8.
Mauritius has already achieved some of the targets
under SDG3 well ahead of 2030. In the last thirty
years, life expectancy at birth increased from 65
years to 74.7 years. The infant mortality rate per
thousand live births improved from 18.6 in 1991 to
12.2 in 2017. In 2017, the Under 5 Mortality Rate
was 14.3 per 1,000 live births. Maternal mortality
ratio is relatively low when compared to other
countries. In 2018, the Maternal Mortality Rate per
1000 live births was 0.39. Tuberculosis Incidence
Rate was low (9.4 per 100,000 population) and
Malaria Incidence Rate was very low (2.2 per
100,000 population) (all imported cases).
We have enumerated measures to achieve SDG3
targets in a number of key strategic policy papers.
In our Government Programme 2015-2019, we
emphasised the provision of universal, accessible
and quality health services, free of any user cost,
with emphasis on customer satisfaction. The
Three-Year Strategic Plan 2018-2019 to 2020-
2021 underscores Mauritius commitment to
support universal and affordable access to high
quality care for all. As per its Customer Charter,
the Ministry of Health and Quality of Life, has the
overall responsibility for ensuring that quality and
equitable health services are available to the entire
population.
Over the years, Government has encouraged the
private sector to invest in state-of-the-art medical
facilities. Civil Society is also our strong partner
as it has been supportive, mostly in areas such
as community empowerment on sexual and
reproductive health, combating alcohol and drug
abuse, prevention of cancer and diabetes, and
road safety awareness.
Despite significant progress in the health sector,
Mauritius is facing a number of health challenges,
such as a high prevalence of NCDs, including
cardiovascular diseases, diabetes, hypertension
and cancer17. Type II diabetes is expected to
account for an average of 1 out of 4 deaths in
Mauritius18.
17Health Statistics Report 2017
18National Sport and Physical Activity Policy for the Republic of Mauritius 2018-2028
VOLUNTARY NATIONAL REVIEW REPORT OF MAURITIUS 31
To address these, Government has engaged
in intensive sensitisation campaigns and is
promoting a healthy lifestyle amongst the citizens.
NCD Clinics in all Community Health Centres,
Area Health Centres and Mediclinics, have been
introduced with dedicated personnel. We have
set up specialised clinics for diabetic foot and
encourage people to stop smoking. Thus, routine
monitoring, screening as well as early detection
have enabled us to control the prevalence of
NCDs in the country. We increased our spending
on early disease detection programmes from Rs
2.80 million (approximately USD 78,000) in 2014
to Rs 47.84 million (approximately USD 1.3 million)
in 2016. In 2016, we spent around Rs 16.5 billion
(approximately USD 450 million), which is around
66.5 percent, on NCDs, the largest share of health
expenditure on diseases19.
Cancer remains a big challenge for us. In 2018, we
registered 2,86120 new cancer cases, an increase
of approximately 86 percent from 2009. The most
common are prostate cancer among males and
breast cancer among females. We also noted
that death from cancer has been on an increasing
trend from 9.4 percent of total deaths in 2000 to
13.8 percent in 201721.
With regard to HIV/AIDS, Government provides
free Voluntary Counselling and Testing (VCT),
anti-retroviral (ARV) drugs, methadone as well
as implement a Needle Exchange Programme
(NEP). A National Action Plan (NAP) has been
developed for HIV/AIDS covering the period
2017–2021 which includes effective strategies
such as 'Test and Treat' to meet the UNAIDS 90-
90-90 treatment targets. We have gone further
to now train healthcare assistants and social
workers from NGOs to conduct HIV testing and
provide counselling. HIV/AIDS Incidence Rate
was estimated at 29.1 per 100,000 population in
201722.
A National Drugs and HIV Council was set up
under the chairmanship of the Prime Minister which
fosters a multi-sectoral approach for a stronger
Drugs and HIV response in Mauritius. A National
Drug Secretariat has been created to coordinate
the National Drug response and the National AIDS
Secretariat currently under the Ministry of Health
and Quality of Life coordinates the National HIV
response.
We are also attentive to the needs of Mauritians
who have complicated health issues and cannot
be treated here. Such patients are provided with
financial assistance. In 2017, 199 patients were
referred abroad for treatment.
To complement the services of the public sector,
as at 2017, the island had 17 private healthcare
institutions, with a total of 664 beds. They provide
mainly curative and specialised services.
Source: World Health Organisation
19National Health Accounts Report 2017
20World Health Organisation
21Health Statistics Report 2017
22Health Statistics Report 2017
New Diabetes and Vascular Health Centre
at Souillac Hospital
Figure 7: Estimated number of new Cancer cases
in 2018
VOLUNTARY NATIONAL REVIEW REPORT OF MAURITIUS 32
BRIGHT SPOTS
1. National Sensitization Campaign to Combat
NCDs
In 2017, Government launched a National
Sensitisation Campaign on NCDs to educate its
citizens on the importance of good health and wellbeing. As a preventive measure, free screening
through mobile NCDs clinics is regularly carried
out throughout the country. We also provide
educational and communication material to the
public to educate them on NCDs and their risk
factors. We have increased taxes on alcohol and
tobacco. We also introduced a sugar tax on the
amount of sugar in soft drinks and banned soft
drinks from school canteens. These intensive
screening and sensitization programmes have, in
2017, reversed the trend in mortality due to NCDs
which was on the rise between 2011 and 201623.
2. Improving Management of Diabetes
Diabetes (23.1 percent) remains the principal
cause of death among our population. In 2006,
the prevalence of Type II Diabetes in the 20-74 age
group was 20.5 percent24. To further strengthen
existing facilities in the management, assessment
and treatment of diabetes, we are working closely
with the WHO and we introduced specialised
diabetes clinics. We appointed diabetologists
who were posted in Mediclinics and Area Health
Centres to improve proximity with diabetic patients.
With specialised personnel, these clinics adopt a
holistic and multidisciplinary approach in patient
care. The WHO also provided technical and
financial support for the training of doctors and
nurses in Rodrigues.
These initiatives have shown results. The
percentage of deaths due to diabetes decreased
from a peak of 26.3 percent in 2012 to 23.1
percent in 201725.
3. Girls’ and Women’s Health
Government provides free pre-natal, maternal and
child health care services in all public primary
healthcare facilities. There is close monitoring
of the health of future mothers and babies while
qualified and skilled personnel perform the
deliveries. We also ensure postnatal care services
for mothers and babies. The health of children is
also monitored at the pre-primary and primary
school levels.
These initiatives have allowed us mainly to keep
maternal mortality ratio per 1,000 live births at
0.39 in 2017. Infant mortality rate, that is, deaths
among children aged under-one, was 11.7 per
1,000 live births, compared to 11.6 in 2016 and
15.3 in 2007. The 2016 figure was the lowest ever
recorded. Among the main causes identified are
congenital anomalies, septicaemia and infections
specific to perinatal period. Infant mortality rate
was comparatively higher in Rodrigues with 19.8
per 1,000 live births in 2017.
Moreover, in 2017, we registered 8.3 percent of
total live births among mothers aged less than 20
years, a decrease from the 11.6 percent registered
in 2011 among teenagers, which demonstrates
that sex education is working.
23Health Statistics Report 2017 24National Health Accounts 2017
25National Health Accounts 2017
VOLUNTARY NATIONAL REVIEW REPORT OF MAURITIUS 33
4. HPV Vaccine and Breast Cancer Detection
The Caravane de Santé, that is the Mobile Clinic
Service, is geared towards providing health services
to the community at their doorstep. This service, in
2016, screened around 8,050 women for breast
and cervical cancer. The Human Papilloma Virus
(HPV) vaccination, which protects girls against
the four strands of HPV mostly associated with
cervical cancer has also been introduced. Some
24,804 doses were administered in 2017. Through
this measure, Government aims at the emergence
of a cervical cancer-free generation of women in
Mauritius.
5. Continuous Fight to Control HIV/AIDS
Adopting a human rights approach to HIV and
AIDS is key to eradicating stigma and discrimation
faced by people living with HIV. PILS (Prévention
Information Lutte Contre le SIDA), an NGO, has
been instrumental in bringing a catalytic revolution
in the sensitisation and awareness around HIV/
AIDS. Intense efforts by PILS working closely with
our health authorities led to the enactment of the
2006 HIV/AIDS Act. We have made significant
progress since then.
HIV prevalence was estimated at 0.80 percent in
2015 and remained under control below 1 percent
during 2016 and 2017. As of December 2017,
3601 adults and children were receiving AntiRetroviral Therapy (ART), with an adherence rate
of 74 percent. The percentage of pregnant women
who are HIV positive receiving antiretroviral
treatment to prevent mother-to-child transmission
has improved from 68 percent in 2009 to 96.3
percent in 2017. The prevalence of HIV among
pregnant women remains under 1 percent.
There are eight Day Care Centres for the Immunosuppressed and a Rapid Testing Caravan is
also operational to carry out HIV testing in the
community.
Mobile Clinic Service
Prison inmates are also provided with ARV drugs.
As at February 2019, only 15 percent of the prison
population were living with HIV/AIDS and 78 percent
of them were already on antiretroviral treatment.
Moreover, HIV/AIDS awareness programmes are
conducted at the national level, especially through
mass media and in secondary schools.
VOLUNTARY NATIONAL REVIEW REPORT OF MAURITIUS 34
CHALLENGES OPPORTUNITIES
According to the WHO only 23 percent of the
population are engaged in the recommended 150
weekly minutes of physical activity. The challenge
remains how to promote an active lifestyle and an
environment conducive to improved quality of life
and well-being to prevent NCDs.
Diabetes and Cancer remain our major
challenges.
We are implementing a National Sport and Physical
Activity Policy for 2018-2028 with tangible actions
to address our health crisis. We are encouraging
our citizens to include physical activities in their
lifestyle and meet the recommendations of 150
weekly minutes of physical activity as set by the
WHO.
With the support of the Commonwealth, Mauritius
will be positioned as a pilot country to introduce a
common indicator framework on Sports and the
SDGs into our national monitoring and evaluation
system.
Government is scaling up the prevention and
control of NCDs by developing a robust NCDs
surveillance system and improving specialised
services to address chronic conditions related to
NCDs.
Mauritius is investing in a new cancer hospital
which will provide more specialised clinical care
for cancer patients.
Mauritius has a low fertility rate and an ageing
population.
We aim to reduce infant mortality rate from 12.2
per 1,000 births in 2017, to 10 in 2020 and 6 by
2030, by improving neo-natal services in hospitals.
We are also enhancing the quality of services
offered to the public and we lay more emphasis on
people-centered services.
To support individuals experiencing fertility
problems, Government is considering to introduce
assisted reproductive technologies in public
hospitals.
Box 3: Leading practice - Smoking
As a party to the WHO Framework Convention on Tobacco Control (FCTC) since 2004, Mauritius
implemented some of the strongest and most progressive tobacco policies in Africa and we are one
of the leaders in tobacco control in the region. In 2009, Mauritius was the first in Africa to implement
pictorial warnings on cigarette packages. We are leading in implementing articles under the FCTC, in
the areas of packaging and labelling, tobacco cessation and smoke free regulations.
Mauritius is also the first African country to adopt a comprehensive smoke free legislation and the first
country worldwide to ban smoking in vehicles carrying passengers.
VOLUNTARY NATIONAL REVIEW REPORT OF MAURITIUS 35
CHALLENGES OPPORTUNITIES
Our healthcare system is very costly. The total
health expenditure in 2016 was approximately
5.83 percent of our GDP. Based on a total per
capita expenditure on health of Rs 20,100
(approximately USD 559), Mauritius has one
of the most expensive healthcare systems in
Africa26.
While provision of healthcare services to all is
our priority, other means would need to be found
for boosting the sector and bringing in high-end
medical care.
Mauritius is positioning itself as a medical hub. In
2016, some 18,000 foreign patients were treated
hence, representing a 70 percent increase from
2010.
To further boost health tourism, in 2018 we
introduced a Visitor Medical Visa. This is issued
to foreign patients upon arrival. This represents an
opportunity for the private sector to strengthen its
healthcare pillar.
The private sector remains our main stakeholder
and we provide private companies with a number
of facilities to further invest in healthcare. We are
giving exemptions from registration duties, on the
purchase or lease of land for the construction of
infrastructure; exemption of VAT on construction of
private hospitals, clinics, residential care homes
or nursing homes; free repatriation of profits,
dividends and capital; no capital gains tax27.
26National Health Accounts 2017 27Economic Development Board
Private Sector Investment in our Health Sector
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70
Indicator 3.1.1 Maternal Mortality Rate per 100, 000 live births
The maternal mortality for Malawi according to Figure 3.1 shows that maternal mortality has
declined from 1123/100,000 livebirths in 2000 to 439/100,000 livebirths in (MHDS, 2016),
2016 representing 94.0 percent decline. Please note that there are no recent data after the
2015/16 DHS survey. Under this goal, Malawi is making moderate progress and on track
considering that, the target for 2030 is less than 70 percent. The ministry of Health is
promoting and enforcing the mainstreaming of quality management in the delivery of health
care across the health system with a focus on handling maternal health issues.
Figure 3.1: SDG Indicator 3.1.1: Maternal Mortality Rate (Deaths/100,000 live births)
Source: NSO, MDHS Report, 2016
Indicator 3.1.2 Proportion of births attended to by skilled health personnel (%)
As shown in Figure 3 below, there is almost 50% increase in the proportion of births attended
to by skilled health personnel indicated by the trend from 56 percent in 2000, 71 percent in
2010 to 90 percent in 2016. With the current growth rates, this SDG target is likely to be
achieved.
Figure 3: SDG Indictor 3.1.2 Births attended by skilled personnel (%)
Source: MoFEPD, SDG Annual Report, 2018
55.6 56.0
71.0
90.0 MGDS III Target, 100 SDG Target, 100
0.0
50.0
100.0
150.0
Percent(%)
Current path MGDS III Target SDG Target Linear (Current path)
1123
984
675
439
94
MDGS III Target,
400
SDG Target, 70 0
200
400
600
800
1000
1200
2000 2005 2010 2016 2022 2030
Rate/100,000
Current path
Lineary projected value
MDGS III Target
SDG Target
71
Indicator 3.2.1 Under-five mortality rate
The rate of under-five mortality in Malawi has declined from 189/1000 live births in 2000 to
63/1000 live births in 2016 representing 66.0 percent decline in under-five mortality over a
period of 16 years. The country also shows a decline in infant mortality rate from 104/1000 live
births in 2000 to 42/1000 live births in 2016. At the current decline rates the country is likely to
achieve the SDG target for 2030 which is 25 deaths per 1000 live births.
Under-Five Mortality rate (3.2.1)
The graph below shows that all the childhood mortality rates are declining since 1992. This can
be attributed to a number of interventions that the Malawi Government and its development
partners have been implementing. The baseline values for under-five, infant and neonatal
mortality rates are 63 percent, 42 percent and 27 percent, respectively.
Figure 3.1: Trends in early childhood mortality rates
Source: MDHS (2015/16)
Maternal mortality ratio (3.1.1)
The MDHS 2015/16 estimated the pregnancy related mortality ratio with confidence intervals
for current and previous MDHS surveys. The estimates show a steady decline in pregnancyrelated mortality ratio in Malawi from 1,123 deaths per 100,000 live births in 2000 to 497
deaths per 100,000 live births in 2015/16.
Figure 3.4: Trends in pregnancy-related mortality ratio (PRMR) with confidence
intervals
Source: MDHS (2015/16)
234
189
133 112
63
135 104 76 66 41 42 42 27 31 27 0
100
200
300
Mortality rates
1992 2000 2004 2010 2015
Year
Under-5 Mortality Infant-Mortality Neonatal Mortality
72
SDG indicator 3.2.1 Under-five Mortality Rate
The rate of under-five mortality (deaths per 1000) live births in the first 5 years has declined
from 189 deaths per 1000 live births in 2000 to 63 in 2016 (Figure 3.3), this represents a 66.0
percent decline in under-five mortality over a period of 16 years. Infant mortality rate declined
from 104 deaths per 1000 live births in 2000 to 42 in 2016. The under-five mortality rate SDG
target for 2030 is 25. Nevertheless, at the current rates of decline path the country is likely to
achieve this target
Figure 3.1: SDG Indicator 3.2.1: Under-five Mortality Rate (Deaths/1000 live birth
Source: NSO, MDHS Report, 2016
Indicator 3.2.2 Neonatal mortality rate
There is slow decline in neonatal mortality rate in Malawi as indicated by the trend from
41/1000 births in 2000 to 27/1000 births in 2016. The country is on track to reach the SDG
target of 12 deaths per 1000 live births however there is need of extra effort to meet the target
as shown in figure 3.4 below.
Figure 3.2: SDG Indicator 3.2.2: Neonatal Mortality Rate (Deaths/1000 live births -28 days
period)
Source: NSO, MDHS Report, 2016
Interventions under Goal 3
The following are some of the government interventions taken to reduce poverty;
73
i. Essential Health Package (EHP) interventions are implemented through a five-year
Health Sector Strategic Plan (HSSP II) which provides the policy direction for health
in Malawi to address inequity factors so that all children, adolescents and women have
access to quality health care and services necessary to fulfill their rights to survival,
development, protection and participation.
Challenges
i. High maternal and neonatal mortality
ii. Distance to the health facility.
iii. Lack of medical equipment, infrastructure and health workers attitude.
iv. Culture and lack of decision making power within households.
Case Study: Ministry of Health in Malawi on track to eliminating trachoma as a public
health problem in Malawi
Malawi has been known to be endemic for trachoma since the 1980s. Malawi is a member of
the WHO Alliance for Global Elimination of Trachoma by 2020. The Trachoma Control
Programme was launched in 2011 to implement the SAFE strategy and it was implemented by
the Government and a consortium of non-governmental organisations, the leading one being
Sight-savers. Prevalence surveys conducted in 2008 in two districts (Chikhwawa and Mchinji)
in Central and Southern regions, revealed that the prevalence of trachoma was at a level to be
considered a public health problem in Malawi. To contribute to the achievement of the mission
of the MOH, Malawi therefore decided to actively address trachoma starting with the surveyed
districts through the multi-sectoral SAFE strategy, and recommended by WHO to achieve
Global Elimination of Trachoma by the year 2020 (GET2020). Later on trachoma mapping was
done in the rest of the endemic districts.
Malawi came up with a trachoma elimination action plan whose aim was to achieve the
VISION as ‘A Malawi free of blinding trachoma’ and the Mission as ‘To contribute to the
achievement of the mission of the Ministry of Health by leading in the elimination of
blinding trachoma by 2020 using the SAFE strategy’.
In 2014, Malawi benefited from the support of The Queen Elizabeth Diamond Jubilee Trust to
undertake interventions aimed at eliminating trachoma as a public health problem. At the time,
it was estimated that there were about 8.2 million people living in areas at risk of trachoma.
Malawi used the WHO-recommended SAFE strategy consisting of surgery (S), antibiotics (A),
facial cleanliness (F) and environmental improvement (E) interventions. The antibiotics
component of the SAFE strategy aimed at reducing the prevalence of active trachoma while the
surgery component provides corrective surgery to people with the blinding stage of the disease.
Facial cleanliness and environmental improvement interventions help to reduce rates of
transmission and are critical for the sustainability of trachoma elimination.
The trachoma programme was implemented from April 2014 to March 2019 by Ministry of
Health and a consortium of NGO partners led by Sight-Savers, other partners in collaboration
with the Ministry of Health and the Department of Water. The interventions were implemented
74
by MoH in 17 districts with 7 priority districts as most endemic areas needing full ‘SAFE’
inventions and 10 other districts needing surgeries for trichiasis. The results are as follows:
Surgery: Over 6,100 Trachomatous Trichiasis cases managed
Antibiotics: Over 12.9 million azithromycin treatments administered
Facial cleanliness:
729 villages integrating facial cleanliness into WASH practices
253 schools integrating facial cleanliness in the school WASH programme
56,262 hand/face washing facilities installed in households
2,026 Hand/face washing facilities installed in schools
Environmental improvement
CLTS/SLTS guidelines adapted leading to CLTS+ and SLTS+
30 WASH partners integrated trachoma in their programming
Trachoma messaging in the National Sanitation and Hygiene Strategy.
313 villages certified ODF using the CLTS+ protocol
79 schools certified ODF using the SLTS+ protocol
To monitor the effectiveness of the SAFE interventions, prevalence surveys have been
conducted in Malawi, the latest of which were conducted in 2019. The survey results show that
all previously endemic districts are now below threshold for both TT and TF meaning
trachoma is no longer a public health problem in Malawi, and can be managed within the
existing health care structure.
Importantly, the trachoma interventions were undertaken within national health systems and
integrated into national priorities, contributing to health system strengthening through the
building of knowledge, skills and capacity of various actors. Malawi is now in the final stages,
with support from Sight Savers, of completing the final surveillance surveys and finalising the
dossier to be submitted to the WHO for validation of elimination of trachoma as a public
health.
|
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{
"country": "mwi",
"file_id": "sdg-03/vnr-report-mwi-2020-en-3.pdf",
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|
Malawi 2022 Voluntary National Review (VNR) Report Malawi 2022 Voluntary National Review (VNR) Report
22 23
ENSURE HEALTHY LIVES AND
PROMOTE WELL- BEING FOR
ALL AT ALL AGES
Overview
Malawi recognises the importance of
health to sustainable development.
The country has made significant
progress and is likely to meet most
of the targets under SDG 3. Among
others: under five mortality; neonatal
mortality; and malaria related deaths
have declined. Lack of data on some
indicators, however, remain a big
challenge.
The VNR consultations revealed
that despite Malawi making such
progress, communities -especially
women, the youth, and persons with
disabilities, continue to experience
long distances to health facilities,
limited access to reproductive health
services and lack of disability-friendly
infrastructure as key challenges.
Progress
Indicator 3.1.1: Proportion of
births attended to by skilled health
personnel (%): The attendance of a
skilled and competent health worker
at every birth is a critical intervention
in reducing the risks of morbidity
and mortality to the mother and
baby. Figure 7 indicates an increase
in the proportion of birth attended
by skilled health personnel, from 90
percent in 2016 to 96.8 percent in
2021. The increase indicates that the
SDG target of 100 percent is likely to
be achieved by 2030.
Indicator 3.2.1: Under-five
mortality rate: Malawi has achieved
a significant reduction in under-five
mortality and remains on course to
achieve the SDG target of 25 deaths
per 1000 live births by 2030. Figure
Malawi 2022 Voluntary National Review (VNR) Report Malawi 2022 Voluntary National Review (VNR) Report
22 23
8 shows that the under-five mortality
rate has declined from 63/1000 live
births in 2016 to 56/1000 live births
in 2021 representing a 11.1 percent
decline over a period of 5 years.
Indicator 3.2.2: Neonatal mortality
rate: Neonatal deaths contribute
30 percent of under-five deaths
and remains one of the main direct
causes of high infant and child
death in Malawi. Neonatal mortality
marginally declined from 27 deaths
per 1000 live births in 2016 to 26
per 1000 in 2019, representing 3.7
percent drop.
Indicator 3.3.1 HIV Incident rates
for all age groups has decreased from
1.58 in 2028 to 1.13 in 2021, whilst
the incident rates for those between
15-49 has also decreased from 0.28
in 2018 to 0.19 in 2021. Currently,
about 5 percent of the country
are living with HIV 95 percent of
HIV positive know their status, 92
percent of those who know their HIV
positive status are on treatment, 87
percent of those on treatment have
the HIV virus suppressed. This is
against the UNAIDS global target
of 95%, 95%, 95% respectively by
2025. AIDS related deaths have also
decreases from 72 000 per year in
2006 to 11,000 in 2021.
Indicator 3.3.3: Malaria Incidence:
Malaria is a leading cause of
morbidity and mortality in children
under five years and pregnant
women. As of 31 December 2021,
malaria incidence stood at 361 cases
per 1,000 population while death is
at 13 per 100,000 population. The
malaria incidence has consistently
decreased in recent years. Records
show incidence decreased from as
high as 386 malaria cases per 1,000
population in 2015 to 361 cases per
1,000 in 2021. On the other hand,
Malaria death rate reduced by 43
percent from 23 per 100,000 in
2015 to 13 per 100,000 in 2021, see
Figure 9.
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: There has been
gradual progress in mCPR in Malawi
5
HMIS data
6
According to the FP2030 estimates
Malawi 2022 Voluntary National Review (VNR) Report Malawi 2022 Voluntary National Review (VNR) Report
24 25
. However, the unmet need for family
planning for unmarried women
is remain high at 44.8 percent
(compared to 15.4 percent among
married). The problem is more
pronounced for teenagers where
unmet need for family planning for
unmarried aged 15-19 is significantly
high (71.5 percent). This has huge
bearing on teen pregnancies and
population growth in Malawi.
Interventions under Goal 3
Malawi through the Ministry of
Health and partners is implementing
several interventions with the aim
of improving the health status of the
population including:
• Introducing 8 antenatal clinic
visits in 2019 to increase contacts
with service providers and
enhance early initiation of ANC
and identify danger signs at the
earliest stage;
• Intensifying trainings on the
perceived Quality Improvement
areas to improve the survival of
new-borns. Training included,
standards of care, helping baby’s
breath, resuscitation of newborns, including in standards of
cares, helping babies breathe,
resuscitation of new-borns, and
Kangaroo Mother Care (KMC);
• Continuing the recruitment,
training and deployment of
Health Surveillance Assistants
(HSAs) specifically trained
to manage the treatment of
common childhood illnesses in
the community; and
• Increasing the availability
of infrastructure through the
construction of health posts/
village clinics.
Lessons Learnt and Opportunities
The COVID-19 pandemic has
revealed the limitations, inadequacy
and weakness of the health system in
Malawi and has, to a larger extent,
negatively affected the progress on
some of the key health related SDG
indicators. For instance, access to
and utilisation of Maternal, Neonatal
Child Health (MNCH) services was
greatly affected. The COVID-19
pandemic has therefore made the
need for serious investments in the
health system apparent to ensure
that Malawi has a stronger and better
prepared holistic health systems with
the necessary capacity to respond to
and prevent health shocks.
Challenges
Some of the critical barriers include
the following:
• Distance to the health facility and
periodic drug stockouts;
• Lack of medical equipment and
infrastructure;
• Reliance on survey data which is
periodic and, therefore affects the
tracking of progress on different
health related indicators; and
Malawi 2022 Voluntary National Review (VNR) Report Malawi 2022 Voluntary National Review (VNR) Report
24 25
• Health financing continued to
heavily rely on external support.
Specific Recommendations
• Consider hybrid financing
mechanisms to ensure adequate
resource flow;
• Enhance the health administrative
data system to ensure evidencebased decision making; and
• Strengthen health systems
to ensure that traditionally
marginalised groups especially
women, girls and persons with
disabilities, have access to quality
services, including Sexual and
Reproductive Health and Rights
(SRHR) and COVID-19 testing
and vaccination services.
|
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INTRODUCTION
Malaysia has an efcient dichotomous healthcare sector,
comprising Government funded universal healthcare and private
sector led healthcare. The Ministry of Health (MOH) acts as both
the primary public care provider as well as the overall regulator of
the health sector. Other ministries such as the Ministry of Higher
Education, Ministry of Defence and Ministry of Women, Family
and Community Development also offer health-related services.
Health expenditure has hovered around 4 per cent of GDP despite
incremental year-over-year (YoY) increases. Approximately 52.5
per cent of health expenditure is funded through public sources
while the balance is via private spending, which includes outof-pocket (OOP) payments and insurance disbursements.
Consistent investments in healthcare have resulted in the
availability of a spectrum of quality services from preventative
health and diagnostic facilities to specialised treatment and care
services, as well as a large workforce of qualifed and trained
health professionals.
However, as Malaysia transitions towards a high-income
economy, the burden of chronic and age-related diseases increase
along with demand for quality healthcare, and this has led to an
upward trending healthcare expenditure. Non-communicable
diseases (NCDs) such as diabetes, cardiovascular diseases, and
cancer are on the rise, further straining the healthcare system
and making the current fnancing model unsustainable.
Sustainable Development Goal 3:
Good Health and Well-Being
Malaysia VNR 2021 57
Photo credit : Lano lan
Aggravating this further is the more recent COVID-19 pandemic,
which posed unprecedented challenges to the healthcare system.
This chapter provides a snapshot of Malaysia’s efforts since the
last review and future opportunities going forward.
Target 3.1.1: Maternal mortality ratio continues to improve.
Fewer women died because of complications during and
following pregnancy and childbirth.
Target 3.2.1: Under-5 mortality rates also improved.
Comprehensive programmes such as immunisation interventions
have led to lowering of under-5 mortality rates.
Target 3.3.1: HIV infections remain constant. The incidence rate
for HIV infection has remained constant at 0.2 persons per 1,000
for the past several years.
Target 3.3.3: Number of indigenous human malaria cases has
remained constant. Malaysia is likely to be declared malariafree if the zero-trend is continued for three consecutive years i.e.
2018-2020.
Target 3.4.1: Cancer, cardiovascular disease and diabetes
increasing. The probability of premature mortality (dying
between the ages of 30 to 70 years) due to these NCDs is 18.7
per cent for both sexes in the country.
Target 3.a.1: Prevalence of tobacco use is decreasing. The
number of new smokers is on a decline, indicating a change in
behaviour or shift to new related products such as e-cigarettes
and vape.
Target 3.b.1: Vaccination coverage continues to be high.
Uptake of various important vaccines for childhood diseases
maintained above 90 per cent.
-
STATUS AND PROGRESS
More than 70 per cent of the population access and depend on
the public healthcare system which provides universal healthcare
coverage and subsidises up to 98 per cent of healthcare costs56.
Health occupied at least 10 per cent of the federal budget.
Malaysia’s Total Expenditure on Health (TEH) in 2019 at RM 64.3
billion was 4.3 per cent of GDP57(Figure 3.1). About 52.5 per
cent was public funding while the remaining 47.5 per cent were
sourced from private spending. MOH’s provision under the federal
budget increased by 7.8 per cent from RM 27 billion in 2018 to
RM29 billion in 2019. This increasing trend also continued in
2020 where MOH received RM 30.6 billion, or 10.23 per cent of
the overall RM299 billion 2020 budget58.
In 2019, the government established MySalam, a national health
protection scheme which provides insurance coverage for lower
income households against certain critical illnesses.
A health screening pilot project, PeKaB40, was initiated to assist
low-income groups with their healthcare needs by focusing on
NCDs. The Government also introduced a sugar- sweetened
beverages (SSBs) tax in order to curb sugar intake.
Target 3.c.1: Improvements in number of health workers per
1,000 population. Malaysia stands at a ratio of one healthcare
worker for every 186 individuals, surpassing World Health
Organization's (WHO) recommendations.
Target 3.d.1: The country was well positioned to respond to
health emergencies. Malaysia established clear mechanisms
for command, control, and coordination of multisector health
emergency preparedness and response.
Source: Malaysian National Health Accounts (2010 – 2019)
Figure 3.1: Total Expenditure on Health, Malaysia, 2010-2019
Malaysia VNR 2021 60
RM Million
Source: Malaysian National Health Accounts (2010 – 2019)
Expenditure in 2020 took a massive uptick as the
Government allocated and spent more funds on COVID-19
related expenditure. The COVID-19 Trust Fund amounting
to RM45 billion was established through Act 830 Temporary
Measures for Government Financing (Coronavirus Disease
2019 (COVID-19)) Act 2020. The fund is used to fnance all
economic stimulus packages. This amount was increased in
December 2020 from RM45 billion to 65 billion considering
the new packages that have been announced and giving
fexibility to the Government for emergency pandemic
response, including for urgent health needs.
The 2019 Global Health Security Index survey ranked
Malaysia in 18th place among 195 nations, reviewed in terms
of overall preparedness to face a disease outbreak6¹. Guided
by the policy outline contained within the Malaysia Strategy
for Emerging Diseases and Public Health Emergencies
II (MySED II) Workplan, the Government implemented a
systematic and multisectoral collaborative strategy for health
security strengthening6². It established clear mechanisms for
command, control, and coordination of multisectoral health
emergency preparedness and response. This was provided
for under National Security Council Directive No. 20. The
directive describes the function of the National Disaster
Management Agency (NADMA) and other related agencies,
alongside the MOH’s Crisis Preparedness and Response
Centre (CPRC). The CPRC acts as the operational nexus
for preparedness planning, analysis, risk assessments and
coordination of health sector responses.
This workplan was backed by relevant legislations which
provided for necessary actions and IHR implementation.
These included the Prevention and Control of Infectious
Diseases Act 1988 (Act 342), Prevention and Control of
Infectious Diseases (Importation and Exportation of Human
Remains, Human Tissues and Pathogenic Organisms and
Substances) Regulations 2006, Food Act 1983 (Act 281), and
the Poisons Act 1952 (Act 366)63.
This multisectoral collaborative approach to health security,
has proven to be a tremendous asset in the COVID-19
response in 2020.
Since 2000, despite almost universal coverage of maternal
health services, the indicator for maternal mortality ratio
has been stagnant, hovering around 23 per 100,000 live
births (24.4 in 2000; 23.8 in 2015; and 21.1 in 2019) for
the past decade64. Often, there are inherent risks, such
as NCDs, obesity and advanced age that could result in
preventable maternal deaths unless timely and appropriate
medical treatment is available. As quality of care is a major
determinant in reducing maternal mortality, efforts are
ongoing to improve effective supervision, including providing
competency-based training for healthcare providers, and
strengthening of pre-pregnancy care at both hospitals and
clinics level. As part of pre-pregnancy care, contraceptive use
among high-risk women is also emphasised as part of family
planning services by the MOH and The National Population
and Family Development Board (Lembaga Penduduk dan
Pembangunan Keluarga Negara).
In addition, the Government is sourcing RM5 billion from Kumpulan
Wang Amanah Negara (National Trust Fund) to fnance the cost of
COVID-19 vaccinations.
The private healthcare sector is growing rapidly and consequently,
medical infation has a direct impact on health-related household
expenditures. At least 73.6 per cent of private sector health spending
is derived from OOP payments59. These payments are borne by either
patients or their family members and are not reimbursable by third
parties. Malaysia has consistently experienced double-digit medical
infation over the past few years. In 2019, it was estimated to be 13.6
per cent upwards from 12.7 per cent in 201760.
9,917
25,000
2010
2011
2012
2013
2014
2015
Year
2016
2017
2018
2019
20,000
15,000
10,000
5,000
0
11,466
12,649
13,933
15,373
16,776
17,790
19,462
21,127
22,492
Figure 3.2: Out of Pocket Payments for Health, 2010 - 2019
Malaysia VNR 2021 61
Over the past two decades, Malaysia has maintained high
proportions of births in health facilities and attended by skilled
personnel. As of 2019, only 0.6 per cent of recorded deliveries
were outside such facilities65. Most took place in Government
facilities (80.5 per cent) followed by private health facilities
(18.6 per cent). Unsafe deliveries were attributed to fve factors,
namely, fnancial constraints, being undocumented or not having
valid identifcation documents, transportation problems, longer
transfer times due to distance, and choosing home births without
a skilled birth attendant66.
The COVID-19 pandemic has also posed considerable challenges
in ensuring that the provision of maternal and new-born health
services in a safe and protective environment is available for
pregnant women, postnatal mothers, and their new-borns. In
some locations, despite resources being reprioritised to cater
to the pandemic, the maternal health services continue with
minimal disruption67.
Contrary to what is typical of an upper-middle income country,
the national contraceptive prevalence rate (CPR) at 52 per cent
has plateaued since 198468. Despite Malaysia’s low CPR, the
total fertility rate continues to be on a decline. In 2019, it was at
1.8 births per woman, below the replacement level of 2.1. The
average age at frst birth has also risen from 27.2 in 2010 to 27.9
in 201969. Taken together with a growing ageing population, the
situation implies a contraction in the overall populace.
There has been a clear improvement in the adolescent birth rate.
In 2019, 8.2 adolescents per 1000 women aged 15-19 years
gave birth, compared to 11.8 in 2015. This progress has been
attributed to long-term initiatives on adolescent health, including
establishment of the Adolescent Health Programme/Services as
an expanded scope of the Maternal and Child Health Programme
and Services, National Adolescent Health Policy (2001), National
Adolescent Health Plan of Action 2015 – 2020, Child Act 2001
and Sexual Offences Against Children Act 2017. There has been
continuous advocacy on sexual reproductive health (SRH) by the
Ministry of Health, Ministry of Women, Family and Community
Development, National Population and Family Development
Board, as well as various Government agencies and nongovernment organisations. Despite this progress, diverse SRH
related issues are continuously challenged by complex legal,
ethical, socio, cultural and religious practices and norms.
In terms of child health, immunisation coverage for diseases
under the National Immunisation Programme (NIP), remained
high (>90 per cent) during the period of 2017 – 2019. The NIP
currently protects children against thirteen vaccine-preventable
diseases, namely tuberculosis, Hepatitis B, diphtheria, tetanus,
whooping cough (pertussis) and polio, Haemophilus Infuenzae
type B, Measles, Mumps and Rubella (MMR), Japanese
Encephalitis, Human Papilloma Virus and Pneumococcal
disease70. Coverage for selected immunisation is summarised
in Table 3.1.
In 2020, MOH made two new improvements to the NIP by
introducing a 6-in-1 vaccine (DTaP-IPV-HepB-Hib)71, replacing
the 5 in 1 vaccine (DTaP-IPV//Hib). This 6-in -1 vaccine reduces
the number of immunisation visits at health clinics and will also
improve the compliance rate. The Government has also included
pneumococcal vaccine in the NIP, aiming to reduce further burden
of pneumococcal disease among children under 5 years of age.
Recent times have seen the increase of anti-vaccine sentiments,
attributed to the spread of false information on social media by
anti-vaccine groups. In response, MOH has equipped healthcare
providers with relevant skills and knowledge to educate and
increase awareness among the public on the importance of
immunisation. Resource and advocacy tools, health education
and promotional materials have been developed though
interagency collaboration with other ministries and NGOs. During
the movement control order (MCO) imposed due to the COVID-19
pandemic in 2020, realising the importance of preventing the
spread of vaccine preventable diseases, immunisation services
continued as usual72.
Table 3.1: MMR Dose 1, Hepatitis B Dose 3 and DPT Dose 3 Immunisation Coverage in
Children Aged 1 to Less than 2 Years, 2017-2019 (%)
Source: Ministry of Health
Malaysia VNR 2021 62
Despite challenges in expanding HIV treatment to all PLHIV,
Malaysia has been successful in treating virtually all pregnant
women living with HIV via comprehensive and fully integrated
maternal and child health services provided through nationwide
public healthcare facilities. In 2018, Malaysia became the frst
country in the Western Pacifc region to eliminate mother-to-child
transmission of HIV and syphilis.
Although Malaysia has not recorded any indigenous human
malaria cases since 2018, the risk of imported malaria remains a
key concern. Foreign workers in Malaysia, specifcally those that
are undocumented, and Malaysians returning from abroad, may
expose the local population to the disease. Dengue infection is
another tropical disease that remains a major cause of morbidity
and mortality in Malaysia. It has remained prevalent since it was
frst reported in the early 20th century.
Despite decades of efforts and numerous initiatives by the
Government to contain the disease, the number of cases
continue to rise unabated each year. The number of dengue
cases and related deaths saw a major surge in 2019 compared
to previous years, as can be seen in Table 3.2.
Despite the achievements to date, issues and challenges remain.
Malaysia is not on track to ending HIV/AIDS by 2030, mainly as
HIV infection rates have remained consistent at 0.2 persons per
1,000 uninfected population for the past several years73. HIV
incidence is expected to further increase this decade, as existing
treatment coverage is considered to be suboptimum. To end
AIDS, Malaysia needs to expedite HIV treatment as outlined in
the Mid-Term Review for the Malaysian National Strategic Plan
for Ending AIDS 2016 – 2030.
While antiretroviral treatment (ART) coverage among people living
with HIV (PLHIV) has been steadily increasingly in recent years,
the COVID-19 pandemic negatively affected this development
in 2020. Appointments were forced to be spaced out and ART
initiation was delayed for those newly diagnosed and outreach
workers were unable to deliver treatment related packages to
key populations due to restrictive movement measures. The
pandemic also hindered harm reduction activities, including
needle syringe exchange programmes, and limiting access to
health screenings and treatment. Methadone patients found
it difcult to travel daily to the relevant health facilities, despite
being permitted to travel for treatment during lockdowns.
Since the frst reported case of COVID-19 infection in Malaysia,
the pandemic has now seen three waves of infection74. The frst
wave was from 25 January to 16 February 2020, the second
between 27 February and 30 June 2020, and the ongoing third
wave began on 8th September 2020 (Figure 3.3).
Nationwide restrictions and lockdowns imposed on specifc
locations were enforced under existing disease prevention and
control legislation. A nationwide vaccination program is currently
underway.
Table 3.2: Number of Dengue Cases and Deaths, 2017 - 2020 (persons)
Source: Ministry of Health
ISSUES AND CHALLENGES
Malaysia VNR 2021 63
In recent decades, Malaysia’s population has witnessed a
dramatic surge of NCDs due to the prevalence of unhealthy diets
and lifestyles. NCDs currently account for around 74 per cent of
all deaths in the country. Many live for decades not knowing that
they have undiagnosed NCD risk factors. Direct and indirect costs
associated with treating late-stage diseases such as cancer and
kidney disease are increasing.
Malaysia is currently midway through its second National
Strategic Plan for Non-Communicable Disease 2016-2025. The
prevention and control of NCDs is also featured strongly in the
Twelfth Plan as the urgency to combat NCDs goes beyond the
health sector and requires multisectoral effort.
In 2019, Malaysia had one of the highest prevalence of diabetes
in the Asia-Pacifc region, with one in fve persons above the
age of 18 living with the disease75. The rising trend and cost of
diabetes is a growing concern for the country. One in two were
unaware of having diabetes, with 42 per cent of these individuals
under the age of 40, raising the risk of premature and serious
complications in the future. Despite widespread availability of
screening and diagnostic tests, people in the older age groups
are more likely to participate in health screening compared to
those who are younger.
Hypertension being one of the major risk factors for cardiovascular
disease, is a serious concern for Malaysians. 3 in 10 or 6.4 million
people in the country are estimated to have hypertension76.
Half of them are unaware that they live with the condition and
remain undiagnosed. Among those below the age of 30, men
are three times more likely to suffer from hypertension occurs
than women77. Although there are well-established treatment
regimens for hypertension, many people are not screened and
those who are diagnosed are not on effective treatment.
The burden of cancer on Malaysian society continues to climb.
Nearly a quarter of a million cancer cases and 150,000 deaths
have been reported over the past decade78. By 2030, these
numbers are expected to rise by 50 per cent. Cancer is now the
second leading cause of premature death in the country. One in
seven Malaysians is expected to develop cancer before reaching
75 years of age. The mortality-to-incidence ratio (MIR) at 61
per cent for Malaysia is higher than other upper middle-income
countries79. A reason for this is because more than 70 per cent
of cancer cases are diagnosed in Stages 3 and 480 which is
demonstrated in the breakdown of certain cancer types in Table
3.3.
Table 3.3: Late-stage (Stage lll and IV) Diagnosis in Cancer (%)
Figure 3.3 Reported Cases of COVID-19 in 2020
Source: Ministry of Health
Source: Ministry of Health
Malaysia VNR 2021 64
The National Strategic Plan for Cancer Control 2016-2020
identifed 9 areas of focus, spanning from prevention to palliative
care. Late detection, treatment barriers, and patient support
remain signifcant challenges which affect the health outcomes
of people living with cancer. Amid the COVID-19 pandemic,
cancer patients face an increasingly higher risk of economic
hardship and reduced survival than ever before. Unlike swift
public health responses that curb infectious diseases, cancer
control efforts must be sustained for years to have any impact
on health outcomes.
20.7 per cent of Malaysians are smokers81. Despite the fact that
there are more than 27,000 deaths a year related to tobacco use,
current data suggests that the prevalence of smoking behaviour
is declining82. However, since tobacco products, cigarettes and
e-cigarettes are often considered separately, it becomes difcult
to quantify the actual number of smokers in the country and the
prevalence of smoking. Hence, the use of vape and e-cigarettes
in recent years has raised concerns. As Malaysia is party to the
WHO’s Framework Convention on Tobacco Control (FCTC), there
is also concern regarding the sale of vapes particularly in terms
of taxation and non-nicotine vape.
According to the National Health and Morbidity Survey 2019,
at least 3 in 10 Malaysians aged 16 years and above live with
mental health problems. There is a large gap within the mental
health landscape. Generally, funding, and specialised services
remain limited for mental health.
Awareness and understanding of mental health conditions are
poor; and many individuals are stigmatised socially for having
these conditions - causing them to often stay away from seeking
care or treatment. There is also a shortage of mental health
practitioners within the public sector, including psychiatrists,
psychologists, and counsellors. This shortage causes long
waiting times, adding stress to patients. Many drop out of
treatment entirely, causing their condition to deteriorate to more
serious levels.
Psychiatric care is largely provided in the public health sector
at highly subsidised rates, but timely appointments may be
difcult to obtain. Though services are available in the private
sector, people may fnd them unaffordable and inaccessible as
psychiatric conditions are often not covered by current insurance
policies. Individuals then seek care from the public sector,
creating congestion in an already crowded system.
Enhancing Existing Healthcare Coverage and System Delivery
for Better Health Outcomes
This will involve strengthening preventive healthcare interventions
such as immunisation, nutrition, sanitation, antenatal and
perinatal care, as well as providing healthcare services such
as long-term chronic care closer to communities, homes, and
individuals, particularly for those in underserved communities.
Sustaining and increasing access to high-quality healthcare,
especially antenatal and perinatal care services, is one of the
areas of interest for further improvement in SDG indicators
related to maternal and neonatal mortality. With the country
facing the COVID-19 crisis, there is a need to also invest in longterm acute care which strengthens preparedness and response
towards health emergencies and disasters.
Intensifying Efforts to Control Both Communicable Diseases
and Non-Communicable Diseases
The healthcare delivery system will be better coordinated and
enforced at the state, regional and national levels. Areas that will
be covered include environmental health, hygiene, and sanitation
as well as food safety and nutrition, for better management of
public health. Efforts to prevent and control communicable
diseases and NCDs will be enhanced through implementation
of various policies and health initiatives such as research and
development, immunisation, health screening and awareness
programmes.
Exploring Healthcare Financing Alternatives for Improved
Affordability and Sustainability
Malaysia will explore various healthcare fnancing mechanisms
to ensure continued improvement, sustainability, and investment
in its healthcare system. As part of corporate social responsibility,
the private sector and NGOs will be encouraged to partner with
government bodies to establish health facilities that cater to the
needs of poor, lower and middle-income households.
Prioritising Preventive Healthcare Approach Towards
Improved Health Outcomes
The health ecosystem will be further developed and
strengthened, by exploring opportunities to increase preventive
healthcare particularly in health awareness and education. This
will involve individual and community behaviours, clinical care,
and both socioeconomic and physical environments. There is a
need to strengthen interagency collaboration to improve public
health services, and to increase the quality of data and analysis
of fndings to better inform interventions and policies related to
preventive health.
Strengthening Well-being and Inclusivity
As part of Malaysia’s continued commitment to SDG 3 to ensure
healthy lives and promote well-being for all, policies and initiatives
that aims to future proof and improve the resiliency of the
healthcare system, will be enhanced particularly in combatting
CDs and NCDs, increasing health crises preparedness, and
ensuring fnancial sustainability for healthcare.
Adopting a balanced development approach means giving equal
emphasis to both economic growth and well-being of the people.
Promoting healthy lifestyles and ensuring greater access to
quality healthcare are essential to sustain social and economic
development. To that end, several key areas are considered for
attention, commitment, and improvement by the Government,
civil society, and the private sector.
OPPORTUNITIES AND WAY FORWARD
Malaysia VNR 2021 65
Box Article 6: Vaccinating Against Polio Amidst the
COVID-19 Crisis
Malaysia had been polio-free from 1993 with the implementation of polio immunisation since 1972. However, on 8 December 2019,
MOH announced the country’s frst case of polio. Testing confrmed that the strain was genetically linked to outbreaks in the southern
Philippines83. In response, Malaysia embarked on a large-scale vaccination campaign in Sabah targeting over 800,000 children below 13
years old, including those who had already been vaccinated according to the national immunisation schedule84.
The campaign came amidst the beginning of the COVID-19 pandemic and the imposition of movement restrictions intended to contain
outbreaks of the coronavirus. In response, health centres implemented robust infection, prevention, and control measures at community
clinics, which included preventive measures such as physical distancing, use of masks and hand hygiene. The fying doctor service was
also instrumental in reaching out to vulnerable populations located deep in rural and remote areas. During the campaign, 95.6 per cent
of children received two doses of bivalent oral polio vaccine while 92 per cent of children in Sabah received two doses of monovalent
oral polio vaccine85.
The polio vaccination campaign in the middle of the COVID-19 pandemic is a remarkable testament to the efforts of Malaysian
healthcare workers. In addition, the successful collaboration among Government, volunteers and other agencies, as well as the trust of
parents and caregivers to make informed decisions ensured that all children were fully vaccinated against polio.
Malaysia VNR 2021 66
Box Article 7: Responding to Mental Health Impact
of COVID-19 Pandemic - The Storm Within A Storm
In March 2020, the declaration of COVID-19 as a pandemic
raised concerns regarding mental health and well-being. Prior
to the pandemic, the National Health and Morbidity Survey in
2019 found that 2.3 per cent of adults lived with depression
and 7.9 per cent of children have mental health problems86.
Low-income households, unemployed, and rural residents were
high-risk groups for mental health problems. However, stigma
and poor mental health literacy are obstacles to seeking help
and treatment. The Government and CSOs have led campaigns
to increase awareness on mental health. Social isolation under
repeated lockdown measures, a rise in unemployment and
fnancial insecurity, closure of schools, and pervasive fear of
infection, have exacerbated pre-existing stressors.
Early in the COVID-19 response, Mercy Malaysia launched
the Psychological First Aid (PFA) Hotline, in partnership with
government agencies87. As treatment and monitoring were
being managed in quarantine centres and hospitals, Mental
Health and Psychosocial Support Services (MHPSS) teams were
deployed for patients with COVID-19, persons under surveillance
or investigation, and healthcare workers. Hospitals and several
universities offered internal counselling programmes, and nongovernmental organisations such as Befrienders Malaysia
received increased volume of callers experiencing distress and
suicidal thoughts.
While more comprehensive data is needed, it was clear some groups had been negatively impacted more than others. Healthcare
workers and frontliners faced prolonged mental and physical demand from managing the pandemic. Women who called the PFA hotline
were predominantly seeking help for emotional and psychological support, household-related issues, and domestic violence refecting
their increased vulnerability and burdens88. Students, part-time employees, and the unemployed were found to have severe to extremely
severe levels of anxiety, depression, and stress89.
As mental health was incorporated into risk communication and highlighted by news media, there were more public awareness and
discourse including on decriminalisation of suicide during the pandemic90. Community-based mental health services set up since 2012,
called MENTARI centres, were promoted through the ofcial health information portal.
Challenges such as low levels of mental health literacy, inadequate community support, and limited resources for mental health services
must be addressed to signifcantly reduce mental health burden.
Malaysia VNR 2021 67
|
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Voluntary National Review 2018 17
sDG 3: ensUre HeaLtHY Lives anD ProMote WeLL-beinG for aLL at aLL
aGes
Namibia recognizes that health is fundamental to human rights and is committed to achieving health for all
Namibians. The main health and wellbeing issues for Namibia are Child and Maternal Mortality, HIV and TB related
deaths, Non-Communicable Diseases (NCDs) and Roads Accidents’ deaths.
Maternal Mortality
According to the National Demographic Health Survey (NDHS) of 2013, Namibia’s maternal mortality ratio is at
385/100,000 live births, a decrease from 449/100,000 live births in 2006-7. This could be attributed to the investments
made in health systems strengthening and the establishment of maternal waiting homes which enable women
from remote rural areas to deliver at health facilities.
Antenatal Services – Births attended to by skilled health Professionals
Antenatal services are available in all health facilities in the country, resulting in 87 percent of all births occurring
in health facilities and 88 percent attended to by skilled birth attendants.
Fertility Rates and Trends
Total fertility in the country in the 1970s was estimated at about 6 children per woman but has gradually decreased
over the years and stagnated at 3.6 between 2006-7 and 2013.
Contraceptives Use
The contraceptive prevalence rate increased from 46.6 percent in 2006-7 to 50.2 percent in 2013.
iMPLeMentation of sDGs
18 Voluntary National Review 2018
Teenage Pregnancy
Teenage pregnancy increased from 15.4 percent in 2006-7 to 19 percent in 2013 according to Namibia Demographic
Health Survey (NDHS).
Child Mortality ( including under-fves and infant mortality)
The neonatal mortality rate is 20 deaths per 1,000 live births which is a decline from 24 per 1 000 live births. This
shows no signifcant decline in the fve years preceding the survey. The under-fve mortality rate has declined
from 69 (2006-7) to 54 (2013) in the past fve years and infant mortality rates does not demonstrate a signifcant
decline for the past ten years which by global standards still remains high.
Immunization against Measles
Namibia embarked upon several immunization campaigns and other strategies which led to improved coverage
of 90% for measles in 2013.
Combating communicable Diseases –HIV/AIDS
HIV/AIDS prevalence in the general population currently stands at 13.3 percent1
. Prevalence among pregnant
women has declined from a peak of 22.5 percent in 2002 to 17.2 percent2 in 2016. In 2016, new HIV infections have
reduced by over 50 percent since 2001, while AIDS-related deaths by 48 percent since 2001.3 The overall mother
to child transmission (MTCT) rate declined from 23.7 percent in 2005 to 4.1 percent in 2015, with HTC and ART
coverage for PMTCT at 95 percent by 2016. MTCT rate at six weeks dropped from 13.3 percent (2005) to less than
2 percent in 2015. HTC coverage of pregnant women has increased to 95 percent and treatment of HIV positive
women is estimated to be more than 95 percent.
Combating communicable Diseases – TB and Malaria
Whilst there has been success in curbing communicable diseases such as TB, the progress that was seen in
Malaria has been since been reversed due to the recent foods and cross border movements between Angola and
Namibia in particular.
Combating Non-communicable Diseases
Non-communicable diseases accounted for 43 percent of the 14,000 total deaths in 2012 with Cardio-Vascular
Diseases (CVD) being the most common NCD in Namibia accounting for 21 percent of mortality in 2012. High
Blood Pressure rates range from 57 percent in the Khomas Region to 30 percent in the Kavango Region (NDHS
2013). Diabetes accounted for 4 percent of all mortality in Namibia in 2012. As of 2015, Namibia has a Health
Adjusted Life Expectancy of 65 years.
Gaps and Challenges
As the country moves into the era of the SDG, a number of ambitious targets have been set to address the high
burden of communicable and non-communicable diseases and reduce maternal and child mortality over the
next fve-year period of the National development plan.
1
MOHSS 2016 Estimates
2 MOHSS 2016 HIV Sentinel Surveillance among pregnant women
3 MOHSS 2016 Estimates
iMPLeMentation of sDGs
Voluntary National Review 2018 19
the key challenges to achieving these targets are:
As the country moves into the era of the SDG, a number of ambitious targets have been set to address the high
burden of communicable and non-communicable diseases and reduce maternal and child mortality over the
next fve-year period of the National development plan.
The key challenges to achieving these targets are:
1. Free cross-border movement of people seeking health care
2. Grazing presents a challenge to the elimination of communicable diseases
3. There has been a noted increase on mental health
4. There is a shortage of human resources, especially in the rural areas compelling the country to rely heavily
on expatriates
5. There is inadequate health research conducted in the country due to limited capacity. Availability of essential
drugs is affected by:
5.1 Protracted procurement processes
5.2 Lack of access to pharmaceuticals
5.3 Irrational uses of pharmaceuticals and wastage
5.4 Insuffcient storage capacity
5.5 Limited warehousing space at CMS
6. Maintenance of medical equipment is a major challenge
7. Double burden of under-nutrition and overweight or obesity is a challenge
Key strategies and targets for sDG 3, amongst others:
strategies for the attainment of the
targets
set national targets
1. Accelerate health infrastructure
development and resource
management (equipment, physical
building, maintenance, pharmaceutical
and fnance)
Health adjusted life expectancy rate to increase from 58 percent (2015) to 67.5 percent by 2022
2. Ensure the wellbeing of Namibian people Reduce TB mortality rate from 73 percent to 47 percent
Reduce Maternal Mortality from 385/100 0000 to 200/100 000
by 2022
Reduce Under-Five Mortality from 54 to 39
3. Improve talent management (human
resource development, recruitment and
retention)
Improve doctor per population ratio from 1:2485(2015) to per
population ratio to 1:1457 by 2022
Improve Registered nurse/population from 1:328(2015) to 1:270
by 2022
Improve pharmacist/population from 1:4095(2015) to 1:2289
by 2022
iMPLeMentation of sDGs
|
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|
10 | Namibia SDGs VNR Report 2021
GOOD HEALTH 3 AND WELL-BEING
Indicator 3.1.1 Indicator 3.1.2
Indicator 3.2.1 Indicator 3.2.2
Indicator 3.4.2 Indicator 3.3.3
Indicator 3.7.1
Namibia SDGs VNR Report 2021 | 11
Ensure healthy lives and promote the well-being for all at all ages
Overview
Namibia recognises that health is a fundamental human right and is committed to achieving health for all Namibians. The
main health and well-being issues for Namibia are child and maternal mortality, HIV, malaria- and TB-related deaths, NonCommunicable Diseases (NCDs), and road accident deaths.
Status and Trends
Namibia is on track with regard to improving the health status of its citizens. A continuous improvement is visible in HIV incidences,
TB incidences, birth support, mortality rate from non-communicable diseases, and the International Health Regulation Capacity
(IHRC). The maternal mortality ratio, neonatal mortality, harmful alcohol consumption, suicide rate, and vaccination coverage or
international support for the health sector show a positive trend. The TB incidence has recorded a constant decline on average
from 524 in 2018 to 486 in 2019. Hepatitis B incidence cases were 191 and 95 in 2019 and 2020, respectively. The malaria incidence
has recorded a significant decrease from 31.86% in 2018 to 2.84% in 2019.
The maternal mortality is still estimated at 384 per 100,000 (2013 statistics), which is still higher than the NDP5 target of
reducing maternal mortality to 311 per 100,000 in 2019. Despite the lack of recent data to measure progress, improvement due
to activities, such as capacity building of health care workers on Antenatal Care (ANC) and Essential Obstetric Care (EOC), to
reduce maternal mortality has been observed. Furthermore, the maternal, perinatal and neonatal death response guidelines
and measures were finalised and are currently being implemented.
Figure 3: Kangaroo Mother Care
Source: The Namibian Newspaper
The under-five mortality rate seems fairly constant since its initial decline between 2006 and 2013 from 69 to 59.6 deaths per
1,000 live births, which is above the NDP5 target of 48. Similarly, with maternal mortality there is a lack of recent data to measure
progress. Ever since the 2018 VNR reporting, there have been ongoing efforts towards reducing under-five mortalities, including
capacity building of health workers using the revised essential Newborn Care, the provision of Kangaroo Mother Care (KMC), and
the implementation of integrated management of new born and childhood ill nurses (IMNCI) programmes.
HIV Incidence
The total HIV incidence per 1000 uninfected (all ages) has decreased slightly from 3.31 in 2018 to 2.81 in 2020. The female and
male incidences were 3.96 and 2.66 in 2018, respectively. In 2020, both female and male incidences declined to 3.70 and 2.25,
respectively.
The number of HIV total infections in the 15-49 age category in 2018 was 7,190, while in 2020 it reduced to 6353.
The virus is more prevalent in females than in males, with a prevalence rate of 13.4 and 8.77 in females and males, respectively.
The target to reduce the new HIV infection rate to 3 was exceeded by a recording of 2.4. This recording can be attributed to
awareness campaigns on condom usage, HIV testing, and treatment adherence conducted country wide. Although the target
was 96%, Namibia trained 76% of nurses on the management of anti-retroviral therapy in the northern regions. Despite the high
HIV/AIDs burden, with an adult prevalence of 11.7%, Namibia has exceeded the 90-90-90 targets of treatment, care and support
of the viral load, and it is progressing in the fight against HIV/AIDs.
12 | Namibia SDGs VNR Report 2021
Reproductive Health
Namibia has embraced the utilisation of modern family planning methods. Government medical facilities and concerned
stakeholders are encouraging sexually active young adolescents to fight the stigma and to freely seek contraceptives and
family planning guidance. This has helped reduce the number of school-age pregnancies. Furthermore, Namibia has introduced
long-acting revisable contraceptive methods such as implants and patches.
Malaria Incidence and Mortality
The overall number and incidence of malaria cases increased between 2019 and 2020. The number of cases and incidences
more than doubled and were above the National Malaria Strategic Plan (NMSP) 2017-2022 targets of 6500 cases and 2.6 cases
per 1000 population in 2020, as indicated in Figure 4.
Figure 4: Malaria incidence and mortality since 2017
27.9
15.1
1.4
5.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
0
10000
20000
30000
40000
50000
60000
70000
2017 2018 2019 2020
Cases Incidence
Source: MoHSS
During the 2019/2020, Indoor Residual Spraying (IRS) coverage declined to below the WHO recommended levels as the spraying
campaign started late due to delays in the procurement and distribution of insecticides, equipment, and other essential
resources. The campaign was further compromised by the heavy rainfall received in many malaria regions, which made some
areas inaccessible and household preparations for IRS difficult.
Incidence of COVID-19
Due to COVID-19, the health sector has been the worst affected as health systems are over-stretched owing to ever increasing
cases and deaths. Attention to non-communicable diseases has been severely disrupted and a shortage of medication for such
diseases has been experienced since the pandemic began.
The disrupted supply chain of essential goods and services to ensure healthy well-being was also adversely affected. The
country is, however, adjusting in order to cope.
The Ratio of Health Professionals to the Population
With regard to Namibia’s set target of doctor to population ratio of 1:2012, it was exceeded by the 2019/2020 Financial Year as
the 1:1920 doctor to population ratio was realised.
Namibia SDGs VNR Report 2021 | 13
In the same vein, and within the same financial year, the registered nurse per population ratio was 1:297 against the target of
1:307.
However, the target for pharmacist per patient’s ratio of 1:3286 was not met, as 1:3568 was recorded in the same financial year
(see Figure 5).
Figure 5: Health worker density and distribution by the 2019/2020 Financial Year
0
500
1000
1500
2000
2500
3000
3500
4000
Doctor per popula2on ra2o Registered Nurse per
polula2on ra2o
Pharmacist per popula2on
ra2o
2012
307
3286
1920
297
3568
Target Actual
Source: MoHSS
Suicide Mortality Rate
The suicide mortality rate has shown a decrease from 2017 to 2019. However, the rate increased in 2020, with males recording a
higher rate than females. The increase in suicide in 2020 was attributed to the socio-economic situation in the country.
Strategies Going Forward
· The country is enhancing access to public healthcare and improving treatment facilities of communicable diseases.
· Namibia recently introduced ‘sin taxes’ that specifically target lifestyle consumption habits.
· The country continues to qualify professional medical doctors, nurses and pharmacists in the effort to ensure universal
health coverage.
· The Government has rolled out a One-stop Centre policy on basic medical health, in all government clinics.
· Introduction of long-term contraceptives for young adolescents.
· Namibia enforced strict lockdown measures to curb the spread of COVID-19. Furthermore, it set up national communication
centres that centrally coordinated efforts to curb COVID-19. Other strategies to curb COVID-19 include awareness, tracing,
testing, treatment and vaccination.
· Sanitation measures to curb COVID-19 also contributed to curbing other sanitation-related illnesses such as Hepatitis-E.
· Finalise the National Strategic Plan on prevention and full implementation with stakeholders in all regions and districts.
· Implementation of the recommendations of the National Study on the Prevalence of Suicide in Namibia.
|
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[
3
] |
{
"country": "nam",
"file_id": "sdg-03/vnr-report-nam-2021-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2021
}
|
30
ODD3 BONNE SANTE ET BIEN-ETRE
Au cours de la période 2000-2015, correspondant aux OMD, le Niger a réalisé des progrès
significatifs dans l’amélioration de son système de santé et la réduction de la mortalité
infantile. Toutefois, pour assurer une bonne santé et un bien-être pour tous à l’horizon 2030,
des efforts sont à faire et le Gouvernement entend faire d’importants investissements dans le
domaine.
D’une manière générale, l’amélioration de la santé et du bien-être sera obtenue à travers : (i)
l’augmentation de l’accessibilité des populations aux services de santé, (ii) le développement
de la santé de la reproduction, (iii) l’accroissement de l’efficacité du système de prévention
sanitaire, (iv) la gestion efficiente des ressources, (v) la disponibilité permanente en
médicaments, vaccins, consommables, intrants alimentaires et thérapeutiques, réactifs, sang
et dérivés de qualité, (vi) le renforcement de la gouvernance en matière de santé et (vii) la
promotion de la recherche en matière de santé.
Dans le cadre de l’Agenda 2030, le Niger a retenu 7 cibles dont 3 de mise en œuvre et 15
indicateurs (figure 9).
D’ores et déjà, des engagements sont pris pour faire baisser le taux de mortalité maternelle
de 520 en 2015 à 100 décès pour 100 000 naissances vivantes en 2035 et réduire le taux de
Figure 9 - Cibles et indicateurs priorisés de l'ODD3
31
mortalité infantile de 51 pour 1000 en 2015 à 25 pour 1000 en 2035 et le taux de fécondité de
7,6 en 2012 à 5 en 2035 (SDDCI).
Les progrès récents observés permettent de s’assurer que ces objectifs peuvent être atteints,
du moins en partie. La fécondité a déjà baissé de 7,6 en 2012 à 6,0 en 2017 (EDS Niger, 2018).
La mortalité infantile a diminué de 5,1 % à 4,8%, la mortalité juvénile de 8,1% à 4,9%.
Toutefois, il y a lieu de noter un recul pour la couverture vaccinale totale ; seulement 30% des
enfants de 12 à 23 mois ont reçu la totalité des vaccins en 2017, contre 52% en 2012. Le taux
de vaccination varie selon les maladies. En 2012, 74% des enfants ont été vaccinés contre la
tuberculose, 55% contre la rougeole ; 52% contre l’hépatite B et 42% contre la polio.
Des efforts supplémentaires sont encore nécessaires pour améliorer le taux de couverture
vaccinale afin de maintenir le rythme actuel de réduction de la mortalité infantile.
|
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21
4.3. OBJECTIF 3 : DONNER AUX INDIVIDUS LES MOYENS DE VIVRE UNE VIE SAINE ET PROMOUVOIR
LE BIEN-ETRE DE TOUS
Au niveau de l’objectif trois, quatre cibles de résultat ont été retenues comme prioritaires pour
réaliser l’objectif. A celles-ci s’ajoutent trois cibles de mise en œuvre, soit. Elles totalisent sept (7)
cibles et quinze (15) indicateurs dont les valeurs disponibles sont analysées dans les paragraphes cidessous.
4.3.1. Situation et tendances
Les taux de mortalité infanto-juvénile et celui de mortalité maternelle ont substantiellement
baissé passant respectivement de 318 décès pour 1000 naissances vivantes en 1992 à 126 décès
pour 1000 naissances vivantes en 2015, soit une baisse de 8,6 points en moyenne par an et de 700
décès pour cent mille naissances vivantes en 1990, à 520 décès pour cent mille naissances vivantes
en 2015, soit une baisse de 7,2 points en moyenne par an. Ces progrès sont en partie liés à la
politique de la gratuité des soins pour les femmes enceintes et les enfants de moins de 5 ans,
représentant environ 28% de la population totale.
Par ailleurs, la prévalence contraceptive moderne bien qu’ayant connu une progression significative
entre 2006 et 2015, reste globalement faible. Elle est passée de 4,5% en 2006 à 12,1% en 2015
(EDSN, 2012 et ENISED 2015). Cependant, seulement 40 % des femmes enceintes sont assistées par
des agents de santé qualifiés en 2018.
La prévalence de la consommation de tabac chez les plus de 15 ans reste élevée (5,6%) en 2016.
Cible 3.1 D’ici à 2030, faire passer le taux mondial de mortalité maternelle en-dessous de 70 pour
100 000 naissances vivantes.
Indicateur 3.1.1 : le taux de mortalité maternelle.
Le taux de mortalité maternelle est passé de 700 décès pour cent mille naissances vivantes en 1990,
à 520 décès pour cent mille naissances vivantes en 2015, soit une baisse de 7,2 points en moyenne
par an. Si cette tendance se maintient, il est peu probable que cette cible (7O décès pour cent mille
naissances vivantes à l’horizon 2030) soit atteinte.
22
Graphique 9: Evolution du ratio de mortalité maternelle entre 1990 et 2015
Source : INS, EDSN 1992 à 2012 et ENISED 2015
Indicateur 3.1.2 Proportion d’accouchements assistés par du personnel de santé qualifié.
Au niveau national, la proportion des naissances assistées par du personnel de santé qualifié est de
39,7% en 2015 contre environ 29% en 2012. La cible du PDES 2017-2021 de 60% en 2021.
D’importantes disparités existent entre milieu urbain et milieu rural, et également entre régions. Le
graphique suivant retrace cette situation :
Graphique 10: Proportion d’accouchements assistés par du personnel de santé qualifié selon diverses
caractéristiques du contexte de résidence
Source : EDSN 2012, INS
Il ressort que plus le niveau d’instruction est faible, plus la femme n’éprouve pas le besoin de se faire
assister par un personnel qualifié lors de son accouchement. Les proportions d’accouchement
assistés par du personnel de santé qualifié les plus élevées s’observent chez les femmes ayant une
23
instruction secondaire ou plus et celles du quintile de bien-être le plus élevé, avec respectivement
75% et 71% en 2012.
Graphique 11: Proportion d’accouchements assistés par du personnel de santé qualifié selon diverses
caractéristiques socioculturelles et économiques
Source : EDSN 2012, INS
La proportion d’accouchements assistés par un personnel qualifié a connu une progression très
lente. Elle était passée de 17,7% en 2006 (EDSN 2006) à 29,3% en 2012 (EDSN 2012), puis à 39,7% en
2015 (ENISED 2015). Ce taux cache des disparités selon les milieux de résidence. En effet, Il est de
32,1% en milieu rural contre 82,5% en milieu urbain (ENISED 2015).
Graphique 12: Evolution de la proportion des accouchements assistes par du personnel de sante
qualifie entre 1992 et 2015
Source : EDSN 1992, 1998, 2006 et 2012 ; ENISED 2015 ; PDES 2017-2021
Par ailleurs, la répartition inégalitaire du personnel de santé sur l’étendue du territoire national serait
une importante source de contreperformance du système de santé nigérien. En effet, selon le
24
rapport d’évaluation du PDS 2011-2015, 76% des agents de la santé exercent en milieu urbain contre
24% en milieu rural où vivent 80% de la population nationale, en raison, entre autres, de la
concentration des infrastructures sanitaires en milieu urbain.
Cible 3.2 : D’ici à 2030, éliminer les décès évitables de nouveau-nés et d’enfants de moins de 5 ans,
tous les pays devant chercher à ramener la mortalité néonatale à 12 pour 1 000 naissances
vivantes au plus et la mortalité des enfants de moins de 5 ans à 25 pour 1 000 naissances vivantes
au plus
Indicateur 3.2.1 : Taux de mortalité des enfants de moins de 5 ans.
Selon le graphique ci-dessous, le taux de mortalité des enfants de moins de 5 ans est passé de 318
décès en 1992 à 126 décès pour 1000 naissances vivantes en 2015 pour une cible de 92 décès pour
mille naissances vivantes en 2021 dans le PDES.
Graphique 13: Evolution du taux de mortalité infanto-juvénile entre 1992 et 2015
Source : EDSN 1992 à 2012 , ENISED 2015
Le taux de mortalité infanto-juvénile présente des disparités selon le milieu de résidence. Il est de
163 pour 1000 en milieu rural, soit un peu plus du double de celui du milieu urbain (83 pour 1000).
Graphique 14: Taux de mortalité infanto-juvénile selon le milieu de résidence
Source : ENISED 2015, INS
25
Des disparités existent également au niveau des régions. Le taux de mortalité infanto-juvénile était
de 51‰ dans la région d’Agadez et de 190‰ dans la région de Dosso.
De même le taux de mortalité des enfants de moins de cinq (05) est plus faible chez les enfants dont
la mère a un niveau d’instruction secondaire ou plus (91‰) par rapport à ceux dont la mère a un
niveau d’instruction primaire (121‰) ou sans instruction (158‰).
Graphique 15: Taux de mortalité infanto-juvénile selon certaines caractéristiques des mères
Source : ENISED 2015, INS
La mise en œuvre des stratégies innovantes et porteuses de fruit, a permis sa réduction très
significative. Il s’agit principalement de la mise en œuvre de la gratuité des soins, le renforcement
des soins prénataux obstétricaux et néonataux d’urgence, l’amélioration de la couverture sanitaire,
la mise en œuvre des initiatives à résultats rapides, les sorties foraines et mobiles, la généralisation
de la prise en charge intégrée de la mère et de l’enfant, la réduction de l’incidence du paludisme chez
les enfants, l’amélioration de l’état vaccinal des enfants de 0 à 24 mois, le renforcement des
capacités du personnel de santé. Si cette tendance se maintient, le Niger atteindrait la cible (25 pour
mille en 2030).
Indicateur 3.2.2 : Taux de mortalité néonatale
Le taux de mortalité néonatale est passé de 40,7‰ en 1992 (EDSN, 1992) à 24‰ en 2015 (ENISED,
2015). Il existe toutefois, des écarts selon le milieu de résidence, la région et les quintiles de bienêtre ainsi que le niveau d’instruction de la mère.
26
Il est plus faible dans les régions d’Agadez (17‰), Diffa (4‰) et est plus élevé dans les autres régions
où le taux varie entre 20‰ et 39‰. De même, il varie de 25‰ pour les enfants des mères du quintile
de bien être le plus élevé à 35‰ pour les enfants des mères du quintile de bien être le plus bas.
Cet indicateur décroît avec le niveau d’instruction, de 23‰ pour les enfants des mères ayant une
instruction secondaire ou plus, à 32‰ pour les enfants des mères non instruites.
Graphique 16: Taux de mortalité Néonatale selon certaines caractéristiques des mères
Source : ENISED, 2015, INS
Selon les résultats d’un modèle réalisé dans l’étude sur les déterminants du faible niveau de l’IDH
publiée par l’INS, il ressort que :
Une augmentation de 10% du ratio de personnel qualifié par habitant, est associée à une
progression de 3,6 mois de l’espérance de vie.
Une hausse de 10% des dépenses de santé par habitant, se traduit par un allongement de 6,1
mois de l’espérance de vie.
Des augmentations de 10% du nombre de formations sanitaires et du taux de couverture en
eau potable en milieu rural, se traduisent respectivement par des gains en espérance de vie
de 12,1 mois et 5,9 mois,
Une baisse de 10% du ratio habitants par lit d’hospitalisation, est associée à un gain de 1,5
mois.
Cible 3.3 D’ici à 2030, mettre fin à l’épidémie de sida, à la tuberculose, au paludisme et aux
maladies tropicales négligées et combattre l’hépatite, les maladies transmises par l’eau et autres
maladies transmissibles
Indicateur 3.3.1 : Nombre de nouvelles infections à VIH pour 1000 personnes séronégatives,
par sexe, âge et principaux groupes de population.
Selon les données du tableau ci-dessous, le nombre de nouvelles infections a baissé entre 2015 et
2017. Il est passé de deux personnes pour 100 000 personnes non infectées en 2015 à une personne
pour 100 000 personnes non infectées en 2017. Les femmes semblent être les plus touchées par les
27
nouvelles infections que les hommes. En outre, les professionnelles de sexe et les homosexuels
hommes sont les plus concernés par les nouvelles infections malgré une tendance à la baisse
observée entre 2015 et 2017.
Quant à l’incidence du VIH/SIDA, elle passe de 0,07% en 2015 à 0,08 % en 2017 et 0,01% en 2018,
soit une baisse de 0,06 point de pourcentage en quatre ans. Ces résultats sont dus aux efforts
réalisés en matière de lutte contre ces maladies. En ce qui concerne le SIDA, 757 sites ont été créés
dont 85 sites prescripteurs pour la prise en charge des personnes infectées et 672 sites de Prévention
de Transmission Mère-Enfant (PTME) de 2011 à 2019.
Tableau 4: Evolution de l’Incidence du VIH/SIDA selon certaines caractéristiques de 2015 à 2018
Populations clés
Caractéristiques 2015 2016 2017 2018
HSH 2,04 1,75 1,53 1,43
CPS 0,1 0,09 0,08 0,08
PS 2,69 2,51 2,38 2,01
population carcérale 0,38 0,32 0,28 0,18
Autre pop féminine 0 0 0 0
Autre pop masculine 0,01 0,01 0,01 0,01
National 0,07 0,07 0,08 0,01
Source : CISLS
Par ailleurs, la proportion des personnes vivant avec le VIH sous ARV est passée de 53% en 2017 à
55,63% en 2018. Cette amélioration est due au renforcement du suivi de la file active (mission du
niveau centrale dans tous les sites prescripteurs), la modification du protocole (testé-traité),
disponibilité des ARV, la mise en œuvre du cadre stratégique national de lutte contre les IST VIHSIDA. Si cette tendence se maintient, le Niger pourrait atteindre l’objectif 0 nouvelle infection en
2030.
Indicateur 3.3.2 : Incidence de la tuberculose pour 1 000 habitants
L’incidence est de 0,9 cas pour mille habitants dont 0,73 cas chez les femmes et 1,2 chez les hommes.
Le nombre de nouveaux cas est passé de 10625 cas en 2015 à 10 165 cas pour 100 000 habitants en
2016, puis de 10 619 en 2017 à 10839 pour 100 000 habitants cas en 2018. Après une baisse en 2016,
on assiste à une hausse des nouveaux cas déclarés en 2017 et en 2018. Concernant la lutte contre la
tuberculose, 230 centres de dépistage et 525 centres de traitement ont été mis en place. De plus, il a
été acquis 43 microscopes à fluorescence, 153 microscopes ordinaires, 20 machines ‘‘genexpert’’ et
28 radios mobiles.
28
Tableau 5: Evolution des nouveaux cas de tuberculose par région de 2015 à 2018
Nouveaux cas de tuberculose 2015 2016 2017 2018
Agadez 283 324 301 279
Diffa 354 431 415 428
Dosso 1309 1116 1244 1315
Maradi 1360 1202 1370 1347
Tahoua 3005 3007 2986 3111
Tillabéri 1583 1573 1681 1685
Zinder 1135 1129 1254 1205
Niamey 1596 1383 1368 1469
Niger 10625 10165 10619 10839
Source : MSP, DS, Annuaires statistiques, 2015 à 2018
Le taux de guérison est passé de 81% en 2015 à 83% en 2017. Cette performance s’explique par la
mise en œuvre du Programme National de Lutte contre la Tuberculose à travers la disponibilité des
médicaments, des réactifs et consommables de laboratoire, la gratuité des diagnostics et du
traitement.
Indicateur 3.3.3 Incidence du paludisme pour 1 000 habitants.
L’incidence du paludisme pour 100 000 personnes est passée de 19 210 en 2015 à 16 620 en 2018 et
17093 en 2019, soit une moyenne annuelle de 17561 pour une norme recommandée de 10.000 cas
pour 100.000 habitants. Des campagnes de chimio-prévention du paludisme (7,4 millions d’enfants
de 3 à 59 mois touchés) ont été organisées et 17 millions de moustiquaires distribués.
Graphique 17: Incidence du paludisme pour 1 000 habitants de 2015 à 2019
Source : MSP, DS
29
Indicateur 3.3.4 Incidence de l’hépatite B pour 100 000 habitants.
Le nombre de nouveaux cas déclarés est passé de 215 en 2015 à 804 cas en 2016, puis 129 cas en
2017 et 367 cas en 2018. La recherche de l’hépatite B est faite plutôt au niveau des hôpitaux. Or, ce
niveau de la pyramide sanitaire souffre de complétude des données qui est de 44,6% en 2017 contre
51,2% en 2018. Des5 études réalisées au niveau de certains groupes de la population font état d’une
prévalence variant entre 11 et 20% pour l’infection à hépatite B et 1 à 3% pour l’infection à hépatite
C. Cela place le Niger parmi les pays hyper endémique. La lutte contre cette maladie est organisée à
travers un programme national spécifique.
Indicateur 3.3.5 : Nombre de personnes pour lesquelles des interventions contre les maladies
tropicales négligées (MTN) sont nécessaires.
Le Niger a ciblé 10 MTN6 dans son plan directeur 2011 à 2015, à partir de la liste de 17 MTN
recommandée par l’OMS.
Au niveau national, le pays a enregistré 3,92 millions de cas en 2015 contre 3,75 millions de cas en
2016. Les régions les moins touchées en 2016 sont Agadez et Diffa, avec respectivement 61 345 et 9
643 personnes, Les groupes d’âges de populations les plus touchées sont celles de 1-4 an et de 25
ans et plus.
Tableau 6: Nombre de personnes par région et groupe d’âge pour lesquelles des interventions contre
les maladies tropicales négligées (MTN) sont nécessaires en 2015 et 2016
2015 2016
Région
Agadez 104323 61345
Diffa 61766 112391
Dosso 597332 588009
Maradi 973636 867468
Tahoua 608185 298351
Tillabéry 754901 719434
Zinder 519846 608537
Niamey 300063 497036
Age
moins 2 mois 36633 31722
2-11mois 495271 477980
1-4 ans 1681141 1580492
5-9 ans 472407 462990
10-24 ans 551632 534313
25ans et plus 682964 665074
National 3920048 3752571
Source : DS, 2015, 2016, MSP
En 2019, il s’agit des campagnes de traitement de masse contre les maladies tropicales négligées
(26,2 millions de personnes contre la bilharziose, 43,5 millions contre la filariose lymphatique, 21,9
millions de trachome et 13,7 millions des géo-helminthes). Aussi, des opérations foraines ont été
réalisées contre la cataracte (71.506 personnes), le Trichiasis (74.500 personnes), l’hydrocèle (2054
personnes), l’éléphantiasis (304 personnes) et la fistule obstétricale (3.280 femmes).
5 Rapport 2016 du Ministère de la Santé Publique sur l’analyse de la situation des hépatites virales
6 Bilharziose, dracunculose, filariose lymphatique, lèpre, le trachome, la rage, l’onchocercose, le géo-helminthiase,
trypanosomiases humaine, leishmaniose
30
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 la prise
en compte de la santé procréative dans les stratégies et programmes nationaux
Indicateur 3.7.1 : Proportion de femmes en âge de procréer (15 à 49 ans) qui utilisent des
méthodes modernes de planification familiale
La prévalence contraceptive moderne bien qu’ayant connu une progression significative entre 2006
et 2012 reste globalement faible, Elle est passée de 4,5% en 2006 à 11% en 2012 (EDSN, 2006 et
2012). L’enquête nationale sur les indicateurs socioéconomique et démographique (ENISED 2015)
donne un taux d’utilisation des méthodes contraceptives modernes de 12,1% en 2015, Malgré cette
progression, la cible espérée de 25% en 2020 (Plan PF 2012-2020) risque de ne pas être atteinte.
Graphique 18: Evolution de la prévalence contraceptive moderne (%) entre 2006 – 2015
Source: EDSN 2006, 2012; ENISED 2015; Plan PF 2016-2020
Selon les résultats d’ENISED (2015), il y a de fortes disparités de taux d’utilisation de méthodes
contraceptives modernes entre les régions, les milieux de résidence des femmes et certaines
caractéristiques sociodémographiques et économiques des femmes. Si en milieu rural, ce sont près de
9,8% des femmes qui utilisent une méthode de contraception moderne, en milieu urbain, ces
proportions atteignent 22,1% des femmes de 15-49 ans.
Suivant les régions, on distingue d’une part Niamey qui enregistre le taux le plus élevé (22,4%), les
régions de Tahoua (14,5%), Dosso (13,4%), Agadez (11,5%) et Tillabéry (11,0) et Diffa (10,4) qui
enregistrent des proportions d’utilisation de contraception moyennes et d’autre part les régions de,
Maradi (9,8%) et Zinder (8,3%) où les taux d’utilisation sont relativement faibles.
Selon le rapport 2020 sur la Planification familiale en 2018, environ 20% des femmes mariées âgées de
15 à 49 ans ont un besoin non satisfait en matière de contraception moderne au Niger. Les dépenses
publiques en matière de planification familiale s’élèvent à 8,1 millions de dollars us.
Indicateur 3.7.2 : Taux de natalité chez les adolescentes (âgées de 10 à 14 ans et de 15 à 19 ans)
pour 1 000 femmes dans ce groupe d’âge.
La fécondité des adolescentes reste très élevée en 2015 (146,2 pour 1 000 avec ENISED 2015), même
si une baisse significative est enregistrée quand on compare ce taux de 2015 à celui de 2012 (206
pour 1 000 avec EDSN 2012)
31
En milieu rural ce taux est passé de 231 pour 1 000 en 2012 à 167,9 pour 1 000 en 2015 contre 112
pour 1 000 en 2012 à 53,5 pour 1 000 pour le milieu urbain. Elle est le corolaire de l’entrée en union
précoce des jeunes filles (environ 76% des filles de 20-24 ans en 2012 étaient mariées avant l’âge
exact de 18 ans).
Graphique 19: Taux de fécondité chez les adolescentes (âgées de 15 à 19 ans) pour 1 000 femmes
selon de résidence
Source : EDSN 2012 et ENISED 2015
Cible 3.a. Renforcer dans tous les pays, selon qu’il convient, l’application de la Convention-cadre de
l’Organisation mondiale de la Santé pour la lutte antitabac
Indicateur 3.a.1 Prévalence de la consommation actuelle de tabac chez les plus de 15 ans (taux
comparatifs par âge).
Le taux de prévalence de la consommation actuelle de tabac chez les plus de 15 ans est de 5,6%
(toute forme de tabac confondue) selon l’Enquête sur le Tabagisme réalisée en 2016.
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.
Indicateur 3.b.1 : Proportion de la population pouvant se procurer les médicaments et vaccins
essentiels à un coût abordable et de façon pérenne.
Il s’agit du pourcentage d'établissements de santé dotés de médicaments essentiels et de produits de
sauvetage. A ce niveau, un indicateur proxy a été retenu à savoir le taux de couverture vaccinale qui
passe de 90% en 2015 à 100% en 2018 comme l’indique le graphique suivant.
32
Graphique 20: Evolution du taux de couverture vaccinale de 2015 à 2018
Source : MSP
Grâce aux campagnes de vaccination organisées contre la poliomyélite, la méningite et la rougeole,
l’efficacité du système de prévention est accrue. En outre, cela a permis au Niger d’être certifié
exempt de polio depuis juin 2016.
Indicateur 3.b.2 : Montant total net de l’aide publique au développement consacré à la
recherche médicale et aux soins de santé de base.
Selon les comptes du Ministère de la Santé Publique, le montant total de l’aide publique au
développement consacré à la recherche médicale passe de 395 721 $.US en 2015 à 837 623 $.US en
2017. Sur cette période, ce montant a plus que doublé.
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
Indicateur 3.c.1 : Densité et répartition du personnel de santé
Il ressort que quelle que soit la catégorie d’agents, la densité du personnel de santé pour 1 000
habitants a plus que doublé en passant de 0,17 en 2017 à 0,4 en 2019 au niveau national
correspondant à la norme recommandée par l’OMS (0,4 pour 1000 habitants). Cela s’explique par les
efforts de l’Etat et de ses partenaires dans l’amélioration de la disponibilité des ressources humaines.
Cinq régions à savoir Niamey, Agadez, Diffa, Dosso et Tillabéry ont atteint la norme. La situation est
critique à Maradi Tahoua et Zinder en lien avec la forte densité de la population dans ces régions, la
mobilité des agents et l’inégale répartition du personnel entre les régions.
33
Graphique 21: Densité du personnel de santé pour 1 000 habitants spécifiques de 2017 à 2019
Source : DS, MSP
Par ailleurs, la part des dépenses de santé dans les dépenses budgétaires totales a plus que doublé
en passant de 5% en 2016 à 11% en 2018 dépassant la cible du Programme de Renaissance 10%.
Toute fois, cette performance demeure en deçà de l’engagement des chefs d’Etat africains à Abuja
en 2001 qui est de 15%.
4.3.2. Défis et enjeux nouveaux
Plusieurs défissont à relever dans le cadre de l’amélioration de la santé de la population :
La faible couverture en infrastructures sanitaires qui est de 51,35% en 2019 ;
L’insuffisance en ressources humaines en quantité et en qualité dont la densité du personnel
pour 1000 habitant est de 0,4 en 2019 pour une cible du Plan de Développement Sanitaire de
0,6 ;
La vétusté des équipements et matériels médicaux ;
L’insécurité dans certaines régions occasionnant un important flux de réfugiés et de déplacés
internes et l’inaccessibilité dans ces régions ;
La faible participation des collectivités territoriales dans le financement de la santé ;
Le retard dans le remboursement des factures de la gratuité ;
La léthargie des organes de participation communautaire.
4.3.3. Mesures prises pour remédier aux lacunes et aux défis existants
Pour améliorer l’état de santé de la population, plusieurs actions ont été menées, dont :
l’extension de la couverture sanitaire du pays, le Programme Elargi de Vaccination (PEV) de
routine et les campagnes de vaccination ;
l’intensification de la lutte contre les différentes formes de malnutrition et les campagnes de
distribution de vitamine A et moustiquaires imprégnées ;
34
la gratuité des consultations prénatales, des césariennes et des soins des enfants de moins de 5
ans ;
la gratuité des méthodes contraceptives modernes et l’offre de la PF à tous les niveaux du
système de santé et au niveau communautaire ;
l’amélioration de la santé de la reproduction liée à l’accroissement des centres de santé qui sont
bien équipés, les services de planification familiale et le nombre de personnel de santé ;
la sensibilisation des populations pour le suivi de la grossesse dans les centres de santé ainsi que
sur l’importance de l’accouchement assisté par un personnel qualifié ;
le renforcement des campagnes de dépistage et de prise en charge des malades, de
conscientisation, d'éducation et de sensibilisation pour un changement de comportement ;
la mise en place d’un système de gestion intégré et efficace de la chaine d’approvisionnement et
la mise en œuvre effective du plan de sécurisation des produits SR ;
le renforcement des interventions en matière de communication compréhensive et la
conception ;
le développement d'actions en matière d'assainissement et d'accessibilité aux centres de santé
de base ;
le développement des médecines alternatives et promotion de la pharmacopée traditionnelle ;
l’accroissement de la disponibilité et de l’accès aux médicaments antituberculeux et de la prise
en charge de tous les cas de tuberculose détectés.
|
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[
3
] |
{
"country": "ner",
"file_id": "sdg-03/vnr-report-ner-2020-fr-3.pdf",
"language": "fr",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
xv
ODD3 : Les taux de mortalité infanto-juvénile et maternelle ont substantiellement baissé passant
respectivement de 318 décès en 1992 à 126 décès pour 1000 naissances vivantes en 2015 et de 700
décès en 1990 à 520 décès pour 100 000 naissances vivantes en 2015. Ces progrès sont en partie liés
à la politique de la gratuité des soins pour les femmes enceintes et les enfants de moins de 5 ans,
représentant environ 28% de la population totale.
|
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[
3
] |
{
"country": "ner",
"file_id": "sdg-03/vnr-report-ner-2020-fr-4.pdf",
"language": "fr",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2020
}
|
27
4.3. OBJECTIF 3 : DONNER AUX INDIVIDUS LES MOYENS DE VIVRE UNE VIE
SAINE ET PROMOUVOIR LE BIEN-ETRE DE TOUS
Pour cet objectif, 4 cibles ont été priorisé, auxquelles s’ajoutent 3 autres liées à la mise en
œuvre, soit un total de 7 cibles et 15 indicateurs dont les valeurs disponibles sont analysées dans
les paragraphes ci-dessous.
28
4.3.1. Situation et tendances
La proportion d’accouchements assistées par un personnel de santé qualifié a connu une baisse
de 1,53 point de pourcentage en 2016 et 2020 et le taux de mortalité des enfants de moins de 5
ans est passé de 126 à 95 décès pour mille entre 2015 et 2018. Le taux de mortalité néonatale a
connu une baisse considérable de 24 pour mille en 2012 à 7,3 pour mille en 2019. L’incidence
du VIH/SIDA a connu une amélioration de 0,06 point de pourcentage entre 2015 et 2018 en
s’établissant à 0,01% en 2018. L’incidence de la tuberculose pour 1000 habitants et celui du
Paludisme, se sont dégradées en passant de 0,61 en 2015 à 0,9 en 2018 pour le premier et de
160,48 en 2015 à 198,02 en 2020 pour le second ; tandis que le taux d’utilisation de la
contraception moderne a connu une évolution significative de 22,96 points de pourcentage sur
la période 2016-2020 et le taux de couverture vaccinale s’est établi à 100% depuis 2018.
Cible 3.1 D’ici à 2030, faire passer le taux mondial de mortalité maternelle en-dessous de
70 pour 100 000 naissances vivantes.
Indicateur 3.1.1 : le taux de mortalité maternelle.
Le taux de mortalité maternelle est de 520 décès pour 100 000 naissances selon l’enquête
ENISED 2015. Selon les estimations de l’INS, ce taux connaitrait une baisse pour s’établir à
512,6 en 2017 et 505 en 2018. Cela pourrait s’expliquer par l’amélioration de l’accès aux
services de santé maternelle, notamment la gratuité de la césarienne et les consultations
prénatales.
Indicateur 3.1.2 Proportion d’accouchements assistés par du personnel de santé
qualifié.
La proportion des naissances assistées par du personnel de santé qualifié est passé de 39,06%
en 2016 à 37,53% en 2020. Une légère baisse est observée malgré les efforts réalisés dans le
cadre de l’accroissement de la couverture en formations sanitaires (le taux de couverture
sanitaire est passé de 50,13% en 2017 à 52,74% en 2020), mais aussi en terme de recrutement
du personnel de santé (1750 agents profils confondus recrutés entre 2017 et 2020).
L’amélioration de ces indicateurs est en partie due par les interventions des volontaires des
relais communautaires. Dans les zones d’intervention des volontaires, 60,21%8 des
accouchements sont assurés par des volontaires. La mise en œuvre de la loi sur le volontariat
au Niger, adoptée en mars 2014, contribuera à renforcer les interventions en cours.
Cible 3.2 : D’ici à 2030, éliminer les décès évitables de nouveau-nés et d’enfants de moins
de 5 ans, tous les pays devant chercher à ramener la mortalité néonatale à 12 pour 1 000
naissances vivantes au plus et la mortalité des enfants de moins de 5 ans à 25 pour 1 000
naissances vivantes au plus.
Cette cible est mesurée à travers deux indicateurs à savoir le 3.2.1 et le 3.2.2.
8 Contributions du volontariat à l’atteinte des ODD
29
Indicateur 3.2.1 : Taux de mortalité des enfants de moins de 5 ans.
Le taux de mortalité des enfants de moins de 5 ans était de 126 (pour 1000 naissances vivantes)
en 2015 (enquête ENISED 2015). Selon les estimations de l’INS, ce taux serait resté stable à
95 pour les années 2017 et 2018. La baisse de ce taux serait due entres autres à : (i) des
interventions à haut impact (approche communautaire (PCIME)) ; (ii) la mise en œuvre de la
gratuité des soins ; (iii) le renforcement des soins prénataux obstétricaux et néonataux
d’urgence ; (iv) l’amélioration de la couverture sanitaire ; (v) la mise en œuvre des initiatives à
résultats rapides ; (vi) les sorties foraines et mobiles ; (vii) la généralisation de la prise en charge
intégrée de la mère et de l’enfant ; (viii) l’amélioration de l’état vaccinal des enfants de 0 à 24
mois et (ix) le renforcement des capacités du personnel de santé.
Indicateur 3.2.2 : Taux de mortalité néonatale
Le taux de mortalité néonatale était à 24 pour mille en 2015 selon l’ENISED 2015. Les données
récentes ne sont pas disponibles car l’étude n’est pas réalisée.
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.
Cette cible est mesurée à travers 5 indicateurs à savoir : 3.3.1, 3.3.2, 3.3.3, 3.3.4 et 3.3.5
Indicateur 3.3.1 : Nombre de nouvelles infections à VIH pour 1000 personnes
séronégatives, par sexe, âge et principaux groupes de population.
Le taux d'incidence est le nombre de nouveaux cas par population à risque dans une période de
temps donnée. L'objectif final de la lutte mondiale contre le sida est de réduire le nombre de
nouvelles infections à moins de 200 000 en 2030. Suivre l'évolution du nombre de nouvelles
infections dans le temps permet de mesurer les progrès accomplis par rapport à cet objectif. Cet
indicateur est l'un des 10 indicateurs mondiaux figurant dans les lignes directrices unifiées sur
les informations stratégiques de l'OMS.
L’incidence du VIH/SIDA a connu une amélioration entre 2015 et 2018, passant de 0,07% en
2015 à 0,01% en 2018. Les proportions d’adultes et d’enfants infectés du VIH/SIDA sous ARV
ont progressé respectivement de 53,3% en 2017 à 52,4% en 2020 pour les adultes (15 ans et
plus) et de 39,3% à 44,4% pour les enfants (< 15 ans) au cours de la même période. Le nombre
de personnes (adultes et enfants) vivant avec le VIH (PVVIH) sous ARV s’est établi à 20427
en 2019. Ces résultats sont dus aux efforts réalisés concernant : (i) la création de plusieurs sites
prescripteurs pour la prise en charge des personnes infectées et pour la Prévention de
Transmission Mère-Enfant (PTME) ; (ii) le renforcement du suivi de la file active (mission du
niveau centrale dans tous les sites prescripteurs) ; (iii) la modification du protocole (testétraité) ; (iv) la mise à disposition des ARV et (v) la mise en œuvre du cadre stratégique national
de lutte contre les IST VIH-SIDA. Si cette tendence se maintient, le Niger pourrait atteindre
l’objectif 0 nouvelle infection en 2030.
30
Tableau 2: Evolution de l’Incidence du VIH/SIDA selon certaines caractéristiques de 2015 à 2018
Populations clés
Caractéristiques 2015 2016 2017 2018
Homme Sexuel Homme (HSH) 2,04 1,75 1,53 1,43
CPS 0,1 0,09 0,08 0,08
Professionnelle du sexe 2,69 2,51 2,38 2,01
population carcérale 0,38 0,32 0,28 0,18
Autre pop féminine 0 0 0 0
Autre pop masculine 0,01 0,01 0,01 0,01
National 0,07 0,07 0,08 0,01
Source : CISLS
Par ailleurs, selon l’étude réalisée en 2016 par Handicap International et la Fédération Ouest
Africaine des Personnes Handicapées, sur l’inclusion des personnes handicapées dans la
stratégie VIH de 6 pays d’Afrique de l’Ouest à travers la promotion de leurs droits, le taux de
prévalence du VIH chez les Personnes Handicapées est de 0,7%. Ce taux est encore plus élevé
chez les hommes (0,9%) que chez les femmes (0,4%).
Indicateur 3.3.2 : Incidence de la tuberculose pour 1 000 habitants
L’incidence de la tuberculose pour 1000 habitants a évolué en dents de scie entre 2015 et 2018.
Elle est passée de 0,61 en 2015 à 0,52 en 2016 avant de connaitre une dégradation pour s’établir
à 0,9 en 2018. Toutefois, le taux de succès thérapeutique de la tuberculose s’est amélioré entre
2017 et 2020, passant de 81,03% à 83,65%. Aussi, le nombre de nouveaux cas de tuberculose
est passé de 10364 cas en 2015 à 10839 pour 100 000 habitants cas en 2018. Cette évolution
s’explique par : (i) la mise en œuvre du Programme National de Lutte contre la Tuberculose à
travers la disponibilité des médicaments, des réactifs et consommables de laboratoire ; (ii) la
gratuité des diagnostics et du traitement ; (iii) la mise en place de 230 centres de dépistage et
de 525 centres de traitement ; (iv) l’acquisition de 43 microscopes à fluorescence, de 153
microscopes ordinaires, de 20 machines « genexpert » et de 28 radios mobiles.
Toutefois, des disparités existent entre les régions en matière d’évolution des nouveaux cas de
tuberculose au Niger. La région de Tahoua se positionne en tête avec 3111 nouveaux cas en
2018 contre 1338 en 2015 et la région d’Agadez enregistre les plus petites valeurs avec 279 cas
en 2018 contre 276 en 2015.
31
Tableau 3: Evolution des nouveaux cas de tuberculose par région de 2015 à 2018
Nouveaux cas de tuberculose 2015 2016 2017 2018
Agadez 276 314 294 279
Diffa 346 425 409 428
Dosso 1272 1110 1236 1315
Maradi 1338 1176 1344 1347
Tahoua 2961 2947 2932 3111
Tillabéri 1537 1526 1646 1685
Zinder 1099 1105 1226 1205
Niamey 1535 1328 1331 1469
Niger 10364 9931 10418 10839
Source : MSP, DS
Indicateur 3.3.3 Incidence du paludisme pour 1 000 habitants.
Il désigne le nombre de cas de paludisme pour 1000 personnes par an. Le graphique ci-dessous
donne l’ampleur de cette situation en 2015 et 2020.
Graphique 12:Incidence du paludisme pour 1 000 habitants de 2015 à 2020
Source : MSP, DS
L’incidence du paludisme pour 1000 habitants s’est dégradée entre 2015 et 2020. En effet, elle
est passée de 160,48 en 2015 à 198,02 en 2020, soit une dégradation de 37,54 points de
pourcentage, pour une norme recommandée de 10.000 cas pour 100.000 habitants.
L’augmentation des cas en 2020 peut s’expliquer par une pluviométrie importante enregistrée
au Niger qui a favorisé le développement important de gites larvaires. Cette évolution est
préoccupante malgré les efforts réalisés en terme de campagnes de chimio-prévention du
paludisme avec : (i) la distribution de moustiquaires imprégnées de longue durée d’action et (ii)
l’offre des quatre doses d’AQ-SP aux enfants de 3 à 59 mois.
Indicateur 3.3.4 Incidence de l’hépatite B pour 100 000 habitants.
Le nombre de nouvelles infections à l'hépatite B pour 100 000 habitants au cours d'une année
donnée est estimé à partir de la prévalence des anticorps totaux contre l'antigène de base de
2015 2016 2017 2018 2019 2020
160,48
80,5
159,61 166,20 154,99
198,02
32
l'hépatite B (Total anti-HBc) et l'antigène de surface de l'hépatite B (HBsAg) positif chez les
enfants de 5 ans, ajustés pour la conception de l'échantillonnage.
Le nombre de nouveaux cas déclarés est passé de 215 en 2015 à 804 cas en 2016. Des études
réalisées au niveau de certains groupes de la population font état d’une prévalence variant entre
11 et 20% pour l’infection à hépatite B et 1 à 3% pour l’infection à hépatite C. Cela place le
Niger parmi les pays hyper endémiques. La lutte contre cette maladie est organisée à travers un
programme national spécifique.
Indicateur 3.3.5 : Nombre de personne pour lesquelles des interventions contre les
maladies tropicales négligées (MTN) sont nécessaires.
Il s’agit du nombre de personnes nécessitant un traitement et des soins pour l'une des MTN
ciblées par la Feuille de route de l'OMS et les résolutions de l'Assemblée mondiale de la Santé
et signalées à l'OMS. Le traitement et les soins sont largement définis pour permettre un
traitement et des soins préventifs, curatifs, chirurgicaux ou de réadaptation.
Au niveau national, le pays a enregistré 3,92 millions de cas en 2015 contre 3,75 millions de
cas en 2016. Les régions les moins touchées en 2016 sont Agadez et Diffa, avec respectivement
61 345 et 9 643 personnes, les groupes d’âges de populations les plus touchées sont celles de
1-4 an et de 25 ans et plus.
Par ailleurs, des campagnes de masse ont été organisées pour lutter contre les maladies
tropicales négligées de 2017 à 2020. Il s’agit des campagnes de traitement de masse contre les
maladies tropicales négligées (19 107 774 de personnes contre la bilharziose, 19 106 050 contre
la filariose lymphatique, 12 646 955 pour le trachome et 21 105 303 des géo-helminthes). Aussi,
des opérations foraines ont été réalisées pour la prise en charge des complications dues aux
MTN contre la cataracte (55 818 personnes), le trichiasis (28 546 personnes), l’hydrocèle (1
229 personnes)
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 la prise en compte de la santé procréative dans les stratégies et programmes nationaux.
Cette cible est mesurée à travers les indicateurs 3.7.1 et 3.7.2
Indicateur 3.7.1 : Proportion de femmes en âge de procréer (15 à 49 ans) qui utilisent
des méthodes modernes de planification familiale
Les méthodes de contraception modernes sont autant des moyens pour lutter contre la mortalité
maternelle que des moyens de contrôle de la fécondité et de planification des naissances. Leur
utilisation est reconnue pour être efficace pour réduire le risque de mortalité et améliorer la
santé de la mère et des enfants par l’espacement des naissances.
L’évolution du taux d’utilisation de la contraception moderne au Niger a connu une avancée
significative entre 2016 et 2020. Cette évolution est présentée dans le graphique suivant :
33
Graphique 13:Evolution du taux de la contraception moderne de 2016 à 2020
Source : MSP/DS
L’analyse du graphique montre que le taux d’utilisation de la contraception moderne a évolué de
manière significative sur la période 2016-2020, passant de 25,94% à 48,90%, soit une progression
de 22,96 points de pourcentage. Si la tendance se maintient, la cible 2021 du PDES 2017-2021
de 50% pourrait être atteinte. Cette performance est due aux actions conjuguées de l’Etat et ses
partenaires à travers notamment : (i) la mise à disposition des contraceptifs et autres
consommables ; (ii) la mise en œuvre des stratégies impliquant les acteurs communautaires (RRI,
DBC) et (iii) la formation de 5 422 agents en Santé de la Reproduction (SR) et en technologie
contraceptive entre 2017 et 2020.
Toutefois, il est important de préciser que le rapport 2020 sur la Planification familiale révèle
qu’en 2018, environ 20% des femmes mariées âgées de 15 à 49 ans ont un besoin non satisfait en
matière de contraception moderne au Niger. Les dépenses publiques en matière de planification
familiale s’élèvent à 8,1 millions de dollars us.
Indicateur 3.7.2 : Taux de natalité chez les adolescentes (âgées de 10 à 14 ans et de 15
à 19 ans) pour 1 000 femmes dans ce groupe d’âge.
C’est le rapport entre le nombre de naissances vivantes chez les adolescentes (10-14 ans et 15-
19 ans) pour 1 000 femmes et le nombre total des adolescentes de même tranche d’âge au cours
de l’année.
Au Niger, le taux de natalité chez les adolescentes (âgées de 15 à 19 ans) pour 1 000 femmes
dans ce groupe d’âge s’est établi à 146,2 en 2015 (ENISED). Ce taux c’est établi à 186 en 2016
selon les résultats de l’enquête PMA réalisée par l’INS.
Cible 3.a. Renforcer dans tous les pays, selon qu’il convient, l’application de la
Convention-cadre de l’Organisation mondiale de la Santé pour la lutte antitabac.
Cette cible est mesurée à travers l’indicateur 3.a.1
0,00%
5,00%
10,00%
15,00%
20,00%
25,00%
30,00%
35,00%
40,00%
45,00%
50,00%
2016 2017 2018 2019 2020 Cible 2021
25,94%
31,01%
37,36%
41,15%
48,90% 50%
34
Indicateur 3.a.1 Prévalence de la consommation actuelle de tabac chez les plus de 15
ans (taux comparatifs par âge).
Les « produits du tabac fumé » comprennent la consommation de cigarettes, de bidis, de cigares,
de chiroots, de tuyaux, de shisha (tuyaux d'eau), d'articles pour la coupe fine (roll-your-own),
de krekets et de toute autre forme de tabac fumé, Les « utilisateurs actuels » comprennent des
utilisateurs quotidiens et non quotidiens de tabac fumé ou sans fumée.
Le « tabac sans fumée » comprend le tabac humide, le bouchon, le tabac à priser, les
dissolvables, le tabac sec, le gul, les feuilles lâches, les poudres rouges, les snus, les chimo, les
gutkha, les khaini, les gudakhu, les zarda, les quiwam, les dohra, les tuibur, les naways, naas /
naswar, Shammah, betel quid, toombak, pan (betel quid), iq'mik, mishri, tapkeer, tombol et tout
autre produit de tabac reniflé, retenu dans la bouche ou mâché.
Le taux de prévalence de la consommation actuelle de tabac chez les plus de 15 ans est de 5,6%
(toute forme de tabac confondue) selon l’Enquête sur le Tabagisme réalisée en 2016.
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.
Cette cible est suivie à travers Trois indicateurs 3.b.1 et 3.b.2
Indicateur 3.b.1 : Proportion de la population pouvant se procurer les médicaments
et vaccins essentiels à un coût abordable et de façon pérenne.
Cet indicateur n’est pas actuellement calculé par le système statistique national.
Indicateur 3.b.2 : Montant total net de l’aide publique au développement consacré à
la recherche médicale et aux soins de santé de base.
Il s’agit de l’aide publique au développement nette totale (APD) consacrée à la recherche
médicale et à la santé de base. Toutefois, les données disponibles concernent la recherche
médicale dont l’évolution est présentée dans le tableau suivant.
35
Tableau 4: Evolution de l’Aide Publique au Développement consacré à la recherche médicale et aux soins de santé de base (
en million de F CFA)
Indicateurs 2015 2016 2017 2018 2019
Montant total de l’Aide
Publique au Développement
consacré à la recherche
médicale aux soins de santé de
base
2 457,4 4 378 2 659,8 4 444 3 450,15
Source : OCDE
L’analyse du tableau montre que le Montant total de l’Aide Publique au développement
consacré à la recherche médicale aux soins de santé de base a connu une évolution en dents de
scie entre 2015 et 2019. La moyenne de cet indicateur s’établit à 3478 millions de F CFA sur
la période.
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
Indicateur 3.c.1 : Densité et répartition du personnel de santé
Le ratio personnel de santé/habitants est un indicateur de l’offre notamment de la couverture du
système de santé.
Le tableau ci-dessous donne le ratio des différentes catégories d’agents de santé.
Tableau 5:Evolution des ratios personnel de santé 2018 et 2019
Densité 2018 2019 Normes OMS
Médecins 1/32.419 1/23.148 1/10.000 habitants
Infirmiers 1/3.227 1/3.675 1/5.000 habitants
Sages-femmes 1/4.046 1/4.735 1/5.000 FAP
Source : DS, 2019, MSP
Il ressort que quelle que la norme OMS est respectée pour les infirmiers et les sages-femmes.
Par contre pour le cas des médecins, le ratio est nettement en deçà de la norme recommandée
par l’OMS.
Par ailleurs, la part des dépenses de santé dans les dépenses budgétaires totales a plus que doublé
en passant de 5% en 2016 à 11% en 2018 dépassant la cible du Programme de Renaissance
10%. Toutefois, cette performance demeure en deçà de l’engagement des chefs d’Etat africains
à Abuja en 2001 qui est de 15%.
4.3.2 Défis et enjeux nouveaux
L’accroissement de la couverture sanitaire ;
La résilience des populations face aux effets de la pandémie de la COVID-19 ;
36
La disponibilité des ressources humaines en quantité et en qualité ;
La participation effective des collectivités territoriales dans le financement de la santé ;
Le remboursement à temps de la gratuité des soins ;
L’opérationnalisation des organes de participation communautaire.
Mesures prises pour remédier aux lacunes et aux défis existants
Pour améliorer l’état de santé de la population, plusieurs actions ont été menées, dont :
L’extension de la couverture sanitaire du pays, le Programme Elargi de Vaccination
(PEV) de routine et les campagnes de vaccination ;
La mise en œuvre des interventions à haut impact (approche communautaire (PCIME)) ;
L’intensification de la lutte contre les différentes formes de malnutrition et les
campagnes de distribution de vitamine A et moustiquaires imprégnées ;
La gratuité des consultations prénatales, des césariennes et des soins des enfants de
moins de 5 ans ;
La gratuité des méthodes contraceptives modernes et l’offre de la Planification
Familiale à tous les niveaux du système de santé et au niveau communautaire ;
L’amélioration de la santé de la reproduction liée à l’accroissement des centres de santé
et du nombre de personnel de santé ;
La sensibilisation des populations pour le suivi de la grossesse dans les centres de santé
ainsi que sur l’importance de l’accouchement assisté par un personnel qualifié ;
Le renforcement des campagnes de dépistage et de prise en charge des malades, de
conscientisation, d'éducation et de sensibilisation pour un changement de
comportement ;
La mise en place d’un système de gestion intégré et efficace de la chaine
d’approvisionnement et la mise en œuvre effective du plan de sécurisation des produits
de la Santé de la Reproduction (SR) ;
Le développement des médecines alternatives et promotion de la pharmacopée
traditionnelle ;
L’accroissement de la disponibilité et de l’accès aux médicaments.
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[
3
] |
{
"country": "ner",
"file_id": "sdg-03/vnr-report-ner-2021-fr-5.pdf",
"language": "fr",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2021
}
|
xi
ODD3 : La proportion d’accouchements assistées par du personnel de santé qualifié est en
légère baisse passant de 38,71% en 2016 à 37,53% en 2020 et le taux de mortalité des enfants
de moins de 5 ans s’est établi à 126 en 2015 selon la dernière l’enquête EDSN. Quant au taux
xii
de mortalité néonatale, il est de 24 pour mille en 2012 (dernière donnée disponible. L’incidence
du VIH/SIDA a connu une amélioration entre 2015 et 2018, passant de 0,07% en 2015 à 0,01%
en 2018. L’incidence de la tuberculose pour 1000 habitants et celui du Paludisme, se sont
dégradées en passant de 0,61 en 2015 à 0,9 en 2018 pour le premier et de 160,48 en 2015 à
198,02 en 2020 pour le second ; tandis que le taux d’utilisation de la contraception moderne a
évolué de manière significative sur la période 2016-2020, passant de 25,94% à 48,90%. Le taux
de couverture vaccinale est de 100% depuis 2018.
|
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“Eradication of Poverty and Promoting Prosperity in a Changing World"
28 Implementation of the SDGs: A National Voluntary Review
3.4.3 Ensure Healthy Lives and Promote the Well-being for all
at all Ages (Goal 3)
The Overview
Nigeria’s human development indices in the health sector remain abysmally low and this portends
complex challenges in the health care delivery system. As enunciated in the NERGP, the top priority is
to improve the availability, accessibility, affordability and quality of health services by increasing access
to primary health care services, expanding health coverage and improving the quality of the services
provided.8
The plan is to provide a primary health care facility in each ward across the nation in order to
improve access to services and provide sustainable financing with the objective of reducing infant and
maternal mortality.
The government has rolled out the National Health Insurance Scheme (NHIS) in addition to promoting
tertiary and the Public Primary Pupils Social Health Insurance Programme to provide quality health
services to students and pupils in middle and lower-income socio-economic levels who are unlikely to have
coverage. To also accommodate the poor, a Mobile and Community Health Insurance Programme has been
rolled out. About 59 % of women were attended to by skilled health attendants both during and a!er child
birth in 2015. The under- five mortality was 89 for every 1000 births while the incidence of Human Immunodeficiency Virus (HIV) infections, Tuberculosis and Malaria was reduced. In light of the economic recession,
substance, alcohol abuse and suicide rates are emerging health issues in Nigeria. While support has come
through development partners in the areas of reproductive health and immunization, more remains to be
done to stem the tide of teenage pregnancy and Sexually Transmitted Diseases (STDs).
8 Federal Government of Nigeria Economic Recovery and Growth Plan 2017-2020 Page 85
“Eradication of Poverty and Promoting Prosperity in a Changing World"
Implementation of the SDGs: A National Voluntary Review 29
The table 3.4.3 provides the summary of the specific goal 3 targets and their corresponding SDG indicators.
TABLE 3.4.3: Goal 3 Indicators and Targets
SDGs Indicators Baseline
2015 %)
Derived 2020
Benchmark (%)
2030
Target (%)
Proportion of births attended by skilled health Personnel 59 72 100
Under-5 mortality rate (deaths per 1,000 live births) 89 68 25
Neo-natal mortality rate (deaths per 1,000 live births) 37 29 12
New HIV infections per 1,000 uninfected population 264 176 0
Tuberculosis incidence per 1,000 persons per year (Male) 12 8 0
Tuberculosis incidence per 1,000 persons per year (Female) 8 5 0
Malaria incidence per 1,000 population per year (Male) 99 66 0
Malaria incidence per 1,000 population per year (Female) 99 66 0
Number of new hepatitis B infections per 100,000 population in a
given year
0.01 0.05 0
The prevalence of hepatitis B infections in the female population
per 100,000 in Nigeria in 2015
0.09 0.062 0
Number of people requiring interventions against neglected tropical
diseases (Male)
15,000,034 10,004,806 0
Number of people requiring interventions against neglected tropical
diseases (Female)
15,007,209 10,004,806 0
Mortality of cardiovascular disease, cancer, diabetes or chronic
respiratory disease (Male).
159 141 106
Mortality of cardiovascular diseases, cancer, diabetes or chronic
respiratory disease (Female).
129 115 88
Suicide mortality rate (Male) 246 219 164
Suicide mortality rate (Female) 128 113 85.34
Coverage of treatment interventions (pharmacological, psychosocial
and rehabilitation and a!ercare services) for substance use
disorders
443 295 0
Coverage of treatment interventions (pharmacological, psychosocial
and rehabilitation and a!ercare services) for substance use disorders
591 394 0
Number of road tra"ic fatal injury deaths within 30 days, per 100,000
population (age standardized) Male.
4,245 3,538 2,122.50
Number of road tra"ic fatal injury deaths within 30 days, per 100,000
population (age standardized) Female.
1,195 996 597.55
Proportion of women of reproductive age (aged 15-49 years) who
have their need for family planning satisfied with modern methods.
78% 85% 100%
Mortality rate attributed to unsafe water, unsafe sanitation and
lack of hygiene by sex and year (Male)
335 223 0
Mortality rate attributed to unsafe water, unsafe sanitation and
lack of hygiene by sex and year (Female)
382 255 0
Source: NBS SDGs 2016 and MDGs 2015
“Eradication of Poverty and Promoting Prosperity in a Changing World"
30 Implementation of the SDGs: A National Voluntary Review
Federal Policy and Programme Drivers Towards Achieving Goal 3 Targets
The Federal Government’s main priority is to reduce infant and maternal mortality through the revitalization
of health systems. The target is to establish at least one functional primary health centre (PHC) in each
political ward across every local government in order to improve access to health care. Health care workers
are recruited and provided with service allowance and basic amenities to work in rural communities and hard
to reach areas. Modern health care equipment and drugs are supplied and distributed at a"ordable rate.
An estimated new infection rate of 264 for every 1,000 uninfected persons for HIV and Acquired Immune
Deficiency Syndrome (AIDS) will be reduced significantly through the provision of anti-retroviral medication
to people living with the disease. The prevention of mother to child transmission is also accorded priority.
Government also deemed it necessary to create projects to scale up immunization, roll back malaria and
other measures for the eradication of polio, malaria, measles and yellow fever.
To combat ailments like cardiovascular disease, cancer, diabetes and respiratory disease, the government
intends to invest in tertiary health care institutions in partnership with the National Sovereign Investment
Authority and other relevant stakeholders to establish diagnostic centers in all States9
. A comprehensive
programme will be developed through e-health mechanism to link specialized hospitals to rural communities
via mobile tele-medicine to increase access to quality health care.
Improvement in Healthcare infrastructure under CCT Health Systems Development Programme will boost
funding for the provision of vital equipment, upgrading of health facilities and recruitment of first class
health professionals. Partnership with private sector and Nigeria Diaspora organizations will result in the
development of at least one mega-health centre in each State to provide high-quality preventive and
curative healthcare. The Diaspora medical assistance programme will also assist in attracting the best set
of core medical professionals from all parts of the world to improve and raise the standard of our health
care system.
Sub-National Governments Policies and Programmes for Goal 3
Most sub-national government health policies and programmes prioritize reduction in maternal and child
morbidity by implementation of evidence based and cost-e"ective interventions. States operate and
manage Primary Health Care under One Roof (PHCUOR) programme to improve quality of service delivery
and prudent management of resources. Kaduna State o"ers free healthcare for pregnant women and
children under 5. Communities are also involved in the health planning and service delivery system of the
state. CSOs, NGOs and Community Based Organizations (CBOs) operating at grassroots level play critical
role in increasing awareness to increased access to care and ensuring programme outcomes. In Ebonyi
State with a Maternal Mortality Ratio (MMR) of 310 per 100, 000 live births, the State Government released
about N2.1 Billion as grants to six rural /mission hospitals in partnership with government on improvement
of maternal, new born and child health.10
Programmes on expanded infrastructure and harnessing pool of qualified sta" is an integral component
of the health system development strategy. This involves training and capacity building for healthcare
professionals. Yobe State has been able to deploy more resources to the funding of the School of Health
Technology and College of Nursing and Midwifery.11 This project will assist in providing a pool of the critical
sector skilled personnel to service the health institutions in the state.
9 See NERGP Page 85
10 See Ebonyi State Development Plan (2016-2020) Page 26
11 Yobe State Socioeconomic Agenda YOSERA IV 2016-2020 Page 59
“Eradication of Poverty and Promoting Prosperity in a Changing World"
Implementation of the SDGs: A National Voluntary Review 31
The recruitment and incentivizing of qualified health personnel is vital to improved health care services.
The Niger State implements enhancement in condition of service to attract and retain sta" through full
implementation of Consolidated Medical Salary Structure (CONMESS) and Consolidated Health Salary
Structure (CONHESS) as well as by providing other incentives,12 thereby contributing immensely in raising
the morale of the health care professionals in the state. Special incentives are also made available to those
that work in rural and hard to reach areas to expand coverage and access to quality care. Improvement
of Doctor to population ratio has worked well through recruitment of qualified Doctors and provision of
incentives to work in the rural communities.13
States recognize the need to have adequate data to plan for their health development strategies. Extensive
projects are ongoing in most states to roll out the Health Management Information Systems and to improve
health data collections, collation and reporting. States collect data through the review of national and
state level facility data and they have undertaken a trend and comparative analysis of what is obtainable
elsewhere in line with good practice.14 Strengthening the data collection mechanism through the National
Health Management Information System (NHMIS) remains critical in planning healthcare development and
delivery programmes.15
While the NHIS has worked well in expanding coverage for most Nigerians, States have designed their own
version of the comprehensive insurance scheme to provide coverage for their own citizens. Delta Health
Insurance Scheme is strategically designed to tackle a wide variety of ailments and diseases.16 The addition
of the state version provides alternative to healthcare financing in improvement in data collection through
the interrogation of NHMIS.17 Development of access to alternative healthcare financing system through
roll out of the community healthcare insurance scheme expands the coverage to the poor and those at the
bottom of the pyramid.
Establishment of mobile Health Care clinic and Implementation of free rural healthcare scheme are some of the
innovative ways most State governments are increasing access to quality healthcare. Many rural communities
are mired in traditional practices and sometimes are reluctant to access quality health care with preference
to unskilled health care personnel, with its associated consequences. The mobile health care clinic enables
services to get closer to citizens and increases their chances to access quality and safer medical services.
Programmes that are designed towards reduction in the scourge of HIV and AIDS, Tuberculosis (TB) and
Malaria are common among stakeholders in the health sector. Most states have established State Agency for
the Control of AIDS (SACA) to institutionally coordinate public health measures deployed in the last decade
expanding prevention, through advocacy for increased spending. The aim is to reduce the prevalence rate
of HIV and AIDS, malaria and tuberculosis. Other services include clinical consultation, counselling and
testing for HIV, antiretroviral therapy and ambulance services.
Civil Society Organizations Initiatives for Goal 3
Most civil society organizations in Nigeria are involved in advocacy, monitoring and evaluation of health
care projects. Education as a Vaccine (EVA) has worked extensively in mobilizing youths for political
lobbying and advocacy towards the implementation of the SDGs.18 EVA became part of the ACT 2015 Global
12 Niger State Medium Term Development Plan 2016-2019 Page 18
13 See Ebonyi State Development Plan (2016-2020) Page 20
14 Lagos State Development Plan Implementation Program Monitoring and Evaluation
15 Lagos State Development Plan Implementation Program Monitoring and Evaluation Page 32-34
16 Delta State Medium Term Development Plan 2016-2019
17 See Lagos State Development Plan Implementation Program Monitoring and Evaluation Page 32-34
18 Excerpts from the SDG Consultative Workshop on the NVR, Abuja 2016
“Eradication of Poverty and Promoting Prosperity in a Changing World"
32 Implementation of the SDGs: A National Voluntary Review
Alliance at its Phase 3. The Phase 3 was primarily to ensure that the national youth alliance get involved
in intergovernmental processes in order to strategize and develop a plan to advocate for the post-2015
process. The project which is presently in Phase 4 focuses on tracking progress towards 2030, through
youth led data driven social accountability measures to provide evidence based data for advocacy that will
ensure youth engagement in the implementation of the SDGs.19
New Life Community Care Initiative (NELCCI) campaigns for implementation of SDGs in rural communities
within the South-East Region of Nigeria. As part of its SDGs implementation campaign, NELCCI collaborates
with the State Agency for the Control of AIDS to run HIV status test in rural communities. Findings from
NELCCI’s test reports serve as one of the main information source for the Agency to plan for supplies of AntiRetroviral (ARV) drugs and other referral services.
|
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32
Progress in SDG 3: Ensure healthy lives
and promote well-being for all at all ages
Table 4 gives the five priority indicators for VNR 2020
and the baselines, as provided in the SDG Baseline
Report. Overall, the figures are poor with Nigeria posting
some of the worst figures in the world.
Indicator 3.1.1: Maternal Mortality
Ratio
Figure 10 shows a little progress in reducing the maternal
mortality ratio between 2016 and 2018. The year 2016
recorded 576 maternal deaths per 100,000, dropping
to 512 deaths per 100 000 in 2018. If this reduction
rate is maintained, then Nigeria will definitely achieve
its target of 288 maternal deaths by 2022 as reported in
the NSHDP II and possibly surpass it.
To clarify which geopolitical zones the government
should accord greater priority, research shows that
the highest maternal mortality rates (MMR) in Nigeria
are in the North West region. This is because of the
slower improvement in the provision of access to
quality healthcare services in that zone. It is also in the
North West that up to 90 per cent of pregnant women
deliver at home (Sloan et al., 2018), contributing to
the risk of mortality. Continuous implementation of the
strategic interventions highlighted in the NSHDP II (see
section 4.2.2 above), particularly the focus on primary
healthcare services and the provision of the NHIS and
the SSHIS, should ensure that Nigeria meets the 2030
maternal mortality ratio of under 70 per 100,000 live
births.
Indicator 3.1.2: Proportion of births
attended by skilled health personnel
(per 100 000 live births)
Sectoral reviews provide some explanation for the low
percentage of births attended by skilled health personnel
in Nigeria. The 2016-17 MICS5 reports that in the South
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33
A Second Voluntary National Review June 2020
East and South West, the majority of women (90.7 per
cent and 82.7 per cent respectively) are attended by
skilled health personnel during normal or Caesarian
deliveries, compared to 34.0 per cent and 23.6 per cent,
respectively, in the North East and North West which
have the lowest proportion of skilled health personnel
assisting with delivery. Also, the MICS 2016-17 survey
found that the presence of a skilled attendant at delivery
or Caesarian operation is associated with the educational
level and socioeconomic status of a woman (NBS &
UNICEF 2017). Moreover, the low attendance recorded
between 2016 and 2017 is considered a reflection of
the country’s economic situation, as research shows a
job loss of approximately 700,000 in 2017 (World Bank
2019). Furthermore, adverse situations such as this
could lead to further expansion in income inequality or
the rich-poor divide as the affluent could afford private
health care which is priced beyond the reach of the bulk
of the population (Olalubi & Bello 2020).
Sector studies show that to improve access of the poor
to healthcare services and thus achieve universal health
coverage, the government should strengthen the State
Social Health Insurance Scheme (SSHIS) and promote
its integration with the National Health Insurance
Scheme (Okpani & Abimbola 2016). Another major
policy recommendation is that government should
pay more attention to the health sector by increasing
budgetary allocation to it and implementing a public
finance system that links specific expenditure and
revenue decisions and ensures transparent usage of the
allocated fund (Bakare & Olubokun 2011).
Priority area 15 of the NSHDP II enjoins the government
to ensure that all Nigerians have access to health
services without any financial barriers or impediments
at the point of accessing the care. The NSHDP made
further recommendations through a variety of strategic
interventions, including advocating the allocation of 15
per cent of federal, state and local government budgets
to health (FMOH 2018).
Evaluations also show that the Nigerian government
has implemented a large number of interventions to
address health sector issues and meet the demands of
the SDGs, such as the Maternal, New-Born and Child
Health Weeks (MNCHWs). The underlying rationale
of the MNCHWs was to complement the weak routine
services of the PHC system in Nigeria, thereby bridging
gaps that the poor coverage of facilities and services may
have created. The evaluations found that government’s
plan to increase the coverage of MNCHW interventions
and ensure adequate investment in health education
led to improved household practices and care-seeking
behaviours. It also improved the utilization of primary
healthcare services by communities. Unfortunately, the
evidence suggests that these goals were not sufficiently
achieved. Factors that contributed to this included issues
with implementation and planning, delays in funding
or lack of funding, and significant investment in the
MNCHWs at the expense of the PHC facilities (UNICEF
2016).
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34
NIGERIAINTEGRATION OF THE SDGs INTO NATIONAL DEVELOPMENT PLANNING
Indicator 3.2.1: Under-fve mortality
rate (per 1000 live births)
The SDG baseline report shows that in 2015 there were
only 89 deaths per 1000 live births (OSSAP-SDGs & NBS
2017). However, this ratio has increased substantially to
128 deaths/1000 live births in 2016 and 2017, and 132
deaths/1000 in 2018 (see figure 12).
Research has shown that the causes of under-five
mortality in Nigeria are malaria, pneumonia, diarrhoea
and other preventable infectious diseases (Olalubi &
Bello 2020). The low rate of immunization of children
under five is also believed to contribute to the mortality
rate. While the NDHS found that only 21 per cent of
Nigerian children were fully immunized between 2016
and 2017 (NBS & UNICEF, 2017), the figure increased
slightly to 25 per cent in 2018 (Gyuse, Ayuk & Okeke
2018). Furthermore, while the government and several
international organizations have made quite an effort to
reduce under-five mortality in the country, there remain
several socio-economic factors that hinder progress.
These include low educational status, low income,
maternal unemployment, a rising rate of divorce and
widowhood, the continued practice of early girl-child
marriage, and the paralysis of economic activities by
the insurgency in the Northeast region of Nigeria. All
of these contribute to the high under-five mortality rate
(Mundi et al. 2019).
According to the 2019 SDG progress report,
immunization saves millions of lives and has gained
wide recognition as one of the world’s most successful
and cost-effective health interventions (UN 2019). With
improvement in immunization, as planned in the NSHDP
II, and effective implementation of the Reproductive,
Maternal, New-born, Child & Adolescent Health plus
Nutrition (RMNCAH+N) services and other health
packages, together with the provision of the NHIS and
the SSHIS, then the federal government’s target of 64
deaths per 1 000 by 2022 expressed in the NSHDP II will
be achieved. Such achievement would go far in helping
Nigeria to reach the 2030 SDG target of less than 25
under-five deaths per 1,000 live births. This is because
these strategic interventions address not only the healthrelated factors but also the socio-economic challenges of
the poor. Hence they should counteract the effects of
poverty on the health of the citizens.
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
Figure 13 shows that the proportion of women of
reproductive age (aged 15-49 years) who have their
need for family planning satisfied with modern methods
was 13.4 per cent in 2016 and 2017, decreasing slightly
to 12 per cent in 2018. The Nigeria Demographic and
Health Survey 2018 provides some explanation for this
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35
A Second Voluntary National Review June 2020
overall total. For instance, it has revealed similar figures
for a variety of modern methods, such as contraceptive
use among married women, which increased only slightly
from 15 per cent in 2013 to 17 per cent in 2018, increase
in the use of any modern method of contraception only
from 10 per cent in 2013 to 12 per cent in 2018, and
a small increase in the use of implants from 0 per cent
of women in 2008 to 3 per cent in 2018. Furthermore,
the NDHS survey found demographic differences
between the women who are more likely to use modern
contraception such as marital status, number of children,
educational background and household income – all of
which are clearly associated with socioeconomic status
(National Population Commission 2018).
Figure 13 shows that 77.8 per cent of women of
reproductive age used family planning with modern
methods in 2015 (OSSAP-SDGs & NBS 2017). While
the 2017 VNR anticipated an increase to 85 per cent
by 2020 (FGN 2017), it decreased sharply to 13.4 per
cent in 2016 and 2017 and even further to 12 per cent
in 2018. The Nigeria Demographic and Health Survey
2018 arrived at similar figures for a variety of modern
methods, with contraceptive use among married women
increasing slightly from 15 per cent in 2013 to 17 per
cent in 2018, with the use of any modern method of
contraception only increasing from 10 per cent in 2013
to 12 per cent in 2018, and a small increase in the
use of implants from 0 per cent of women in 2008 to
3 per cent in 2018. The latter suggests that, overall, a
small proportion of women of reproductive age (15-49
years) have their need for family planning satisfied with
modern methods, and this is only increasing marginally.
Furthermore, the NDHS survey found demographic
differences among women who are more likely to use
modern contraception. These differences pertained to
such as marital status, number of children, educational
background and household income – all of which are
clearly associated with socioeconomic status (National
Population Commission 2018). For the country to make
progress here, demographic and other factors should be
used to inform interventions.
One evaluation provides some explanation for the
findings in Figure 13. This was an examination of the
barriers to accessing health services for disadvantaged
adolescents in Nigeria. It found that adolescents in the
country generally lack awareness about health services,
which results in a lack of contact, especially among
adolescent refugees, those living in rural settings and
those with lower levels of education. The evaluation
also found a lack of knowledge among adolescent girls
regarding sexual and reproductive health and maternal
health issues. This reinforces the data showing low
levels of contraceptive use (both modern or traditional
methods) among adolescents, indicating a possible lack
of awareness, although cultural and social norms are
also likely influencing factors (WHO, 2019).
For policymakers, the evaluation recommends that
movement towards universal health coverage in Nigeria
must include subpopulations that have been left behind
historically. These include the ‘invisible population’,
such as the disadvantaged adolescents who hitherto
have not been invited to lend their voices to the list of
documented needs. Secondly, it is important to note that
the most significant health service inequities are found
in the North-west and North-east zones of the country
compared to the southern regions. These include the
non-availability of skilled personnel, non-functional
infrastructure, and lack of commodities and equipment.
Unless these issues are addressed, they will undermine
the universal health coverage reforms for adolescents
and all other women of reproductive age.
Findings from the MICS5 2016-17 reveal that only 33.3
per cent of women aged 15-49 reported having more
than one sexual partner in the previous 12 months, and
condoms were used the last time they had sex. This
compares with 46.6 per cent of young women aged
15-24 years who reportedly used condoms during the
last sexual intercourse they had with non-marital, noncohabiting sex partners within 12 months of the study.
Furthermore, MICS5 reveals that teenage pregnancy
was a problem in the country from 2016-17 as 15.8
per cent of young women aged 15-19 had a live birth,
3.3 per cent were pregnant with the first child, 19.2
per cent had begun childbearing, and 30.8 per cent
young women aged 20-24 had a live birth before age
18. Findings from the NDHS 2018 reveals that teenage
pregnancy is a significant health concern in Nigeria
because of its association with higher morbidity and
mortality for both the mother and the child. Moreover,
childbearing during adolescence is known to have
adverse social consequences, particularly as women
who become mothers in their teens are more likely to
drop out of school. This survey found in 2018 that 19
36
NIGERIAINTEGRATION OF THE SDGs INTO NATIONAL DEVELOPMENT PLANNING
per cent of Nigerian women aged 15-19 had begun
childbearing; 14 per cent had given birth, and 4 per cent
were pregnant with their first child.
Barriers to progress
The barriers and challenges to UHC include, firstly,
political economy barriers. Among them are:
• Poor governance, referring to inadequate political
will, commitment, and support to advance
UHC after passing the applicable laws. Actual
implementation of the law has been poor (Effa et
al. 2018; Aregbeshola 2019);
• Free healthcare services and exemption mechanisms
are sometimes politically motivated and used as
campaign promises only to be implemented poorly
and sometimes only last a few years (Aregbeshola,
2019);
• While health insurance has been chosen as a
pathway for achieving UHC, little attempt has
been made to harmonize the efforts of various
stakeholders working on UHC in Nigeria. This
includes a focus on the federal level at the expense
of the state level (Effa et al. 2018); and
• Corruption (Effa et al. 2018; Aregbeshola 2019).
Secondly, funding constraints are a critical barrier to
advancing UHC in Nigeria. The budgetary allocation for
health was 3.8 per cent in 2017, and this has remained
fairly constant since 2009. Ghana, by comparison,
allocated 3.3 per cent and Kenya 4.6 per cent of their
annual budget during the same period. There are lower
levels of funding at sub‐national levels, including the
local government level.
Thirdly, there is limited understanding of what UHC
stands for at different levels. This means that citizens
are unaware of UHC and their rights to healthcare
under the scheme. Decision-makers, including civil
servants at state and local government levels, funders,
policymakers and private sector operators, many of
whom are responsible for driving UHC, are not too sure
how it should work, resulting in poor governance and
no champions for the cause (Effa et al. 2018).
Fourthly, a weak health system and poor service delivery
are crucial barriers to achieving UHC. The barriers
include inadequate and poorly distributed health
personnel, weak referral systems, inadequate health
facilities/infrastructure, poor procurement and drug
management systems leading to a shortage of essential
drugs and supplies (ERGP), highly regressive out‐of‐
pocket expenditure, and inadequate mechanisms for
access to care (almost zero referral system). All of these
are identified as factors affecting the overall performance
of the health care system and progress towards UHC
(Effa et al. 2018 and Aregbeshola 2019).
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37
A Second Voluntary National Review June 2020
Bearing in mind the slow progress in the health sector
and Nigeria’s poor performance compared to other
countries, this is an important area to concentrate on.
Significant changes are needed for a change in outcomes
to be realized.
Areas to strengthen
The UHC is essential for fast-tracking human
development in Nigeria because of the high level of
productivity and welfare losses that are associated
with morbidity and disease burdens in the country.
In working to achieve the SDGs, evaluation of the
quality of healthcare service becomes imperative given
that over and above the physical buildings, services
rendered at primary healthcare facilities are the direct
inputs required to influence the recovery of sick people.
When these are deficient, a sceptic process develops.
An evaluative study assessing the state of medical
equipment and availability of drugs in the healthcare
system of 12 states from Nigeria’s six geopolitical zones
was conducted. It collected data from 2,480 healthcare
facilities between 2013 and 2014. The findings show
some discrepancies between the availability of basic
medical equipment and the functionality of the primary
healthcare facilities. It was also found that essential
drugs were not readily available at the selected health
facilities, thereby compromising service readiness of
the healthcare facilities. This suggests that the majority
of the healthcare facilities did not meet the minimum
standard for PHC service delivery (Oyekale, 2017).
There is a need to re-evaluate and take inventory
of services rendered in the PHCs as a way to inform
policies that would enhance their service quality. Going
forward, the government should also re-evaluate the
state of services delivered in rural healthcare facilities
with a view of re-equipping them with necessary drugs
and medical equipment. Given that essential drugs were
poorly available, addressing the removal of leakages
in drug acquisition and usage in healthcare facilities
should be paramount. Finally, the study could not
establish whether the drugs were diverted for personal
use or were simply never procured. A critical evaluation
of expenses in the PHCs would help bring clarity to this
uncertainty. Furthermore, proper auditing of PHC is
recommended. (Oyekale, 2017).
An evaluation which examines the influence of
demographic and socioeconomic characteristics of
women of child-bearing age on the survival of underfive children was conducted in Adamawa State. The
study found a high prevalence of under-five mortality
in the State, which is in the northeast of Nigeria, despite
interventions at various levels. Among the key predictors
of a woman experiencing the death of her under-five
child were low educational status, low income, maternal
unemployment, divorce and widowhood. Besides, the
continued practice of girl-child marriage, high divorce
rate and the paralysis of economic activities by the
insurgency in the Northeast zone have somewhat
sustained the high under-five mortality in Adamawa
State. It was thus recommended that government step
up efforts in improving girl-child education, provide
better maternal and child health services and combat
the insurgency to reduce child mortality (Mundi et al.
2019).
A third evaluation reviewed for this study was conducted
from 2015-16 on the Maternal and Child Health Week
(MNCHW) Programme implemented across Nigeria
in 2010. This was a response to the slow progress in
MDGs 4 and 5; hence the MNCHW was introduced
among other measures, as a priority and strategic
action to reduce child mortality and improve maternal
health. The primary purpose of the intervention was
to improve access to essential, quality MNCH services,
consistent with the objectives of the 2007 Integrated
MNCH Strategy. The overall goal was to improve the
health status of women and children by increasing the
coverage of vital MNCH interventions. The evaluation
found that despite its lack of impact on MNCH, as there
was no significant contribution to coverage or improved
health outcomes, the programme had the potential
of significantly increased coverage of crucial MNCH
interventions through efficient social mobilization that
creates awareness and participation. It is believed that
this can only be done through effective partnership,
adequate and timely release of funds, and the total
commitment of state governments (UNICEF 2016).
Several policy recommendations were made, some of
which could be applied to similar interventions:
• The National Primary Health Care Development
Agency (NPHCDA) should develop an accountability
framework in collaboration with partners and
governments at central and state levels to monitor
input activities and outputs. This is also to improve
38
NIGERIAINTEGRATION OF THE SDGs INTO NATIONAL DEVELOPMENT PLANNING
coordination.
• The NPHCDA should also modify the fixed/mobile
post approach. To improve coverage, it should
implement the MNCHWs at all PHCs. This reduces
the cost of deploying healthcare workers to mobile
or fixed posts. Savings from this can be used to
fund social mobilization
• FMOH, NPHCDA and partners should streamline
MNCHW approach with other ad hoc-activities
(IPDs, measles campaign, and so on) to improve
coverage.
• NPHCDA, in collaboration with its partners,
should develop an exit strategy for MNCHW to
compliment the policy direction of PHC in Nigeria
(implementation at scale of the national strategy of
1-PHC per ward) (UNICEF, 2016).
• It is equally necessary to strengthen the NHIS as a
pathway to fast track the attainment of the healthrelated SDGs.
• It is also helpful to adopt indicators and policies
on non-communicable diseases (NCDs) that are
inclusive of people of all ages, especially older
persons and persons with disabilities who are more
prone to these diseases.
With the ratification of the National Health Policy for
women and girls with disabilities in 2018, the federal
government has taken a tremendous step towards
improving the accessibility, affordability and inclusivity
of healthcare system for people with disabilities. While
this is a right step to take, its implementation and
domestication at the primary and secondary health
facilities require huge investments.
|
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[
3
] |
{
"country": "nga",
"file_id": "sdg-03/vnr-report-nga-2020-en-4.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
84
NIGERIAINTEGRATION OF THE SDGs INTO NATIONAL DEVELOPMENT PLANNING
SDG 3: Health and Well-being
• Strengthening the local level in health systems:
Greater involvement of the grassroots population
in policy and decisions around the health system.
A strategic deployment and adequate training
of Community Health Extension Workers at the
community level could greatly support this level
of decentralization in linking local authorities to
reach a wider spectrum of the population.
• Making greater use of ICT/technology innovation.
When operating at a decentralized level,
the challenge of reaching more deeply into
communities can be facilitated by ICT deployment.
This can help expand coverage of insurance and
increase accountability. Automating the health
insurance system at local level levels could
facilitate enrolment and also provide visibility to
the work of health maintenance organizations.
Strengthened collaboration between government
and CSOs could go a long way in supporting Local
Government Areas in improving community health
education and engagements to use such ICT/
Technology innovation.
• Improving access to healthcare. The principle of
following up on Priority Area of the NHSHDP II that
all Nigerians should have access to health services
without any financial barriers or impediments at
the point of service. This should be followed up
with a commitment to allocating 15 per cent of
federal, state and LGA budgets to health. At least
half of the basic health fund should be administered
by the National Health Insurance Scheme for the
provision of basic minimum of health services to
citizens . This fund should be used for subsidy
payment to state-led Social Insurance Scheme
for the health care rendered to those too poor to
afford the premium service of the NHIS, including
persons with disabilities and older persons.
|
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[
3
] |
{
"country": "nga",
"file_id": "sdg-03/vnr-report-nga-2020-en-5.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2020
}
|
xv
Evidence suggests that the general health of Nigerian
citizens, particularly the poor, is deteriorating. Among
the most debilitating is the very high maternal mortality
rate (512 per 100 000 in 2018), as it contributes to
household poverty by reducing household income or
creating child-headed households. There has also been
a slight increase in the under-five mortality rates with
deaths per 1000 rising from 128 in 2017 to 132 in
2018 (NBS, 2020). The country’s performance against
these indicators provides a lens into the weakness
of the healthcare system. The percentage of births
attended by skilled health personnel illustrates the
income inequality levels in the country. The public
healthcare system is failing the poor primarily because
of inadequate workforce and issues associated with the
National Health Insurance Scheme (NHIS) coverage.
The meagre percentage of women of reproductive age
whose need for family planning is satisfied with modern
methods perpetuates the poverty trap in which many
women in Nigeria find themselves because of additional
financial responsibilities brought on by children. A key
lesson for protecting the public in the COVID pandemic
is hygiene and the need to prioritize universal access
to clean water and nutrition, re-emphasizing the
indivisibility between SDGs 2, 3 and 6. Key areas for
action include reinforcement of implementation of the
Second National Strategic Health Development Plan
(NSHDP) prioritizing primary health care, including:
• Increasing the share of GDP allocated to primary
health care;
• Using the NHIS to administer 50 per cent of the
basic health fund to provide a ‘basic minimum of
health services to citizens’. This fund should be used
for subsidy payment to State-led Social Insurance
Scheme (SSIS) for the healthcare consumed by
those too poor to afford the premium services of
the NHIS or other vulnerable groups, including
older persons and persons with disabilities;
• Revamping the primary health centres to tackle
issues of access and affordability;
• Strengthening government collaboration with
civil society organizations (CSOs) to improve
community health education, with adequate
training, strategic deployment and effective use of
community health extension workers to bridge the
health force gap in communities.
Good health and wellbeing SDG 3
2030 Target
3.1.1 Maternal mortality ratio (per 100 000 live births)
3.2.1 Under-fve mortality rate (per 1000 live births)
|
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Página 20 de 105
-
ODS #3: GARANTIZAR UNA VIDA SANA Y PROMOVER EL BIENESTAR
DE TODOS, A TODAS LAS EDADES
EL MODELO DE SALUD FAMILIAR Y COMUNITARIO (MOSAFC)
A partir de 2007, entre las primeras acciones del Gobierno de Reconciliación y Unidad
Nacional se cuenta la RESTITUCIÓN DEL DERECHO A LA GRATUIDAD DE LA ATENCIÓN MÉDICA EN TODAS LAS UNIDADES DE SALUD, para tod@s sus ciudadanos, en
todas las modalidades; con acceso gratuito, atención de calidad y con calidez. La gratuidad también incluye los exámenes de laboratorios con equipos de alta tecnología, que
luego se extendió a los medicamentos prescritos; lo que ha sido motivo de reconocimiento
internacional.
Consecuente con lo anterior, entre 2007-2020 el Gobierno ha venido profundizando el
MODELO DE SALUD FAMILIAR Y COMUNITARIO (MOSAFC), desarrollando armónicamente un sistema de salud centrado en las familias y las personas, fuertemente orientado
a la vigilancia y evaluación de los factores que puedan afectar la salud, reforzando la red
de servicios y orientando los esfuerzos a la promoción, prevención, educación, atención
y rehabilitación de la población.
La implementación del MOSAFC ha generado un cambio en la cultura de la salud, aplicando un abordaje integral, interinstitucional e intersectorial, de unidad nacional y de
alianzas con el subsistema privado, con el protagonismo ciudadano organizado en los
Gabinetes de la Familia, Comunidad y Vida; desde el inicio de la vida, la adolescencia, la
adultez y envejecimiento activo y saludable, volviendo a las familias sujetos activos en la
construcción social de su propia salud.
Página 21 de 105
Gobierno de Reconciliación y Unidad Nacional
Primer Informe Nacional Voluntario: Avances en el cumplimiento
de los ODS, alineados con la Agenda 2030
Lo anterior ha estado respaldado con una asignación presupuestaria incremental a la
Salud, como parte importante de la política de Gasto Social del Presupuesto General de
la República. En este sentido, según registros del Ministerio de Hacienda y Crédito Público (MHCP), la asignación presupuestaria al Ministerio de Salud (MINSA), pasó de
C$3,088.3 millones en 2006 a C$17,803.9 millones en 2020 (+476%); siendo 2017, 2018,
2019 y 2020 los años con mayores asignaciones, a pesar del fuerte impacto negativo de
los 4 shocks que tuvo el país en la historia reciente.
PRINCIPALES LOGROS
REDUCCIÓN DE LA MORTALIDAD MATERNA A NIVEL NACIONAL. Según registros contenidos en el “Perfil de Salud Materna ODM-5 Nicaragua”, de la Organización Panamericana de la Salud (OPS), la Razón de Mortalidad Materna (RMM) pasó
de 73.3 defunciones por 100,000 nacidos vivos registrados (NVR) en el año 2000 a
121 en 2006. Fue hasta 2007 que el país inició un descenso sostenido de la RMM
con 78.2 defunciones por 100,000 NVR, luego a 60.5 en 2009, hasta alcanzar 36
defunciones por 100,000 NVR en 2020 (-70.2% respecto a 2006), un logro significativo al relacionarlo con los 1,533,877 partos atendidos en el periodo 2007-2020.
REDUCCIÓN DE LA TASA DE MORTALIDAD INFANTIL, con los programas de
atención pre y post natal que se han venido implementando. En 2006 la TMI8 fue de
29 defunciones por cada 1,000 NVR9 y en 2020 la fue de 13.0 defunciones por cada
1,000 NVR (-55.5%), y la Tasa de mortalidad neonatal ha pasado de 9.4 por 1,000
NVR en 2016 a 7.2 en 2020.
Desde el MOSAFC se impulsan estrategias comunitarias como: Entrega Comunitaria de Métodos Anticonceptivos (ECMAC); visitas a las embarazadas inasistentes a
sus controles prenatales; organización del transporte ante una complicación obstétrica (PLAN DE PARTO); referencia de las embarazadas a las Casas Maternas;
atención del parto con enfoque humanizado y adecuación cultural; desarrollo de la
estrategia Familia Canguro con prioridad a los recién nacidos prematuros y/o con
bajo peso al nacer; seguimiento comunitario a los niños y niñas con datos de malnutrición (PROCOSAN NIÑEZ).
También el MOSAFC impulsa acciones de Prevención de enfermedades con participación de la población organizada en los Gabinetes de la Familia Comunidad y
Vida que, junto al personal de salud, garantiza la vacunación sistemática y la ejecución de Jornadas Nacionales de Vacunación para la aplicación del ciclo de vacunas
a niños(as) menores de 1 año, para la prevención de diarrea por Rotavirus, poliomielitis, sarampión, paperas, rubéola, Neumococo, hepatitis B, enfermedad por influenza tipo B; así como la vacunación en el resto de la niñez según el esquema de
8 TMI: Tasa de Mortalidad Infantil. 9 NVR: Nacidos Vivos Registrados.
Página 22 de 105
Gobierno de Reconciliación y Unidad Nacional
Primer Informe Nacional Voluntario: Avances en el cumplimiento
de los ODS, alineados con la Agenda 2030
vacunación de acuerdo a la edad, logrando altas coberturas de vacunación aún en
territorios de muy difícil acceso geográfico.
Nicaragua, en el contexto de LUCHA CONTRA EL VIH, ha tenido resultados en
positivos en la prevención y enfrentamiento de la enfermedad. En este sentido, el
país ha mejorado la atención a los pacientes con VIH, y se trabaja en la prevención
del contagio de madre a hijo. Adicionalmente, el tratamiento para personas con VIHSIDA ha sido descentralizado en los hospitales regionales de Nicaragua logrando
una atención más oportuna para quienes sufren de esta enfermedad. En el 2020 se
realizaron 133,659 pruebas de VIH a embarazadas; +12% superior con respecto al
2016 (118,958 pruebas realizadas). De esta forma se aumenta la vigilancia para
evitar la transmisión vertical del virus. En 2020, 5,775 Adultos y niños con infección
del VIH avanzado recibieron el tratamiento Anti Retroviral; 50% más con respecto
al 2016. De estos 108 son mujeres embarazadas y 128 niños nacidos de madres
infectadas.
Con las Jornadas de VACUNACIÓN, en 2007 se aplicaron 3,594,268 dosis de vacunas para prevenir casos graves de tuberculosis, neumonía por neumococo, diarrea por rotavirus, tos chifladora, el tétano, la difteria, la hepatitis B, influenza, poliomielitis, sarampión, paperas y rubeola en niños, niñas, adolescentes, jóvenes, adultos y adultos mayores según el esquema nacional de inmunizaciones, en 2019 se
aplicaron 4,460,337 (incrementando en 24% el total de dosis), y en 2020 se aplicaron 5,813,256 dosis (61.7% superior en relación a 2007), de las cuales 1,840,566
han sido aplicadas durante las Jornadas de Salud del Poder Ciudadano. Actualmente el Gobierno está avanzando en la vacunación contra la COVID-19 y se espera alcanzar cerca del 70% de población inmunizada.
En Nicaragua, en 2016, a través de las JORNADAS DE SALUD DEL PODER CIUDADANO CONTRA EPIDEMIAS, se aplicó abate en 617,641 viviendas y para 2020
se realizaron 10,012,081 visitas a las viviendas para fortalecer la lucha anti epidémica. Para controlar los vectores, se trataron con larvicida los depósitos de agua
identificados en las viviendas y se eliminaron todos los criaderos. Se realizan de
forma permanente los controles de foco y planes de fumigación casa a casa. También, se desarrollan jornadas de limpieza en escuelas, hogares, barrios y comunidades, y capacitación en medidas preventivas contra el dengue, chikungunya y zika.
En 2006 en el Sector Salud se brindaron 6,630,741 CONSULTAS MÉDICAS GRATUITAS. Sin embargo, solo en el primer año del Gobierno Sandinista (2007), se
duplicó la cantidad de atenciones, llegando a 13,370,625 en el primer nivel de atención (Puestos de Salud y Clínicas Móviles). Esto continuó mejorando hasta alcanzar
en 2020 la cantidad de 28,428,520 atenciones (+329% respecto a 2006), de las
cuales el 86.3% fueron brindadas por el MINSA (24,542,585) y el 13.7% por el INSS
(3,885,779). Además, al 2009 se despachaban 24,255,860 recetas gratuitas y en
2020 se despacharon 44,593,214 (+84%).
En el 2007, con la paupérrima capacidad instalada en el sistema de salud público,
solo se realizaron 10,797,313 EXÁMENES ESPECIALIZADOS. En 2020, a pesar la
afectación de la Pandemia, se realizaron 31,950,370 exámenes (casi 3 veces más
Página 23 de 105
Gobierno de Reconciliación y Unidad Nacional
Primer Informe Nacional Voluntario: Avances en el cumplimiento
de los ODS, alineados con la Agenda 2030
respecto a 2007), de los cuales: 26,503,221 (83%) fueron realizados por el MINSA;
4,663,210 (14.5%) por el INSS y 783,939 (2.5%) por el subsector privado.
En 2005 Nicaragua contaba con 1,092 unidades de salud, la gran mayoría en condiciones deplorables. En el período 2007-2020 se ha logrado construir la RED DE
INFRAESTRUCTURA DE SALUD PÚBLICA MÁS GRANDE DE CENTROAMÉRICA, con la construcción de 19 nuevos Hospitales y la rehabilitación de 46, la construcción y rehabilitación de 1,259 puestos médicos y 192 Centros de Salud y la
construcción de 178 Casas Maternas (3 veces más de las que había en 2006). En
ese mismo período, se ha reforzado el sistema de salud con 66 clínicas móviles las
que en 2020 realizaron 1,890,944 atenciones.
En 2006 en el sistema de salud pública se realizaron 111,194 cirugías, pasando a
400,270 cirugías en 2020 (+260%).
A través de programa OPERACIÓN MILAGRO se han realizado entre 2011-2020
un total de 260,937 cirugías oftalmológicas, beneficiando principalmente a personas
de escasos recursos de todo el país.
El programa TODOS CON VOZ, de atención a las personas con discapacidad, inició
en febrero 2010 cuando el Presidente de la República solicitó a la hermana República de Cuba el apoyo solidario para realizar un diagnóstico de la situación de este
sector en el país, encontrándose 126,316 personas con diferentes tipos de discapacidad. Al 2020 se ofrecieron 358,370 atenciones integrales a adultos mayores y personas con discapacidad.
El sistema de salud nacional cuenta con un LABORATORIO DE BIOLOGÍA MOLECULAR, capaz de analizar pruebas de varias enfermedades, entre ellas la COVID19. Es el segundo más avanzado de la Región y cuenta con reconocimiento de la
OMS en el nivel 3 de Bioseguridad. La Planta de producción de medicamentos tiene
capacidad para producir 12 millones de vacunas contra la influenza al año.
En 2016 se realizaron en Nicaragua 55,255 EXÁMENES DE ALTA TECNOLOGÍA
(Tomografías computarizadas y Resonancias magnéticas), de los cuales el 75%
(41,337) corresponden al MINSA y el 25% (13,918) al INSS. En 2020, se realizaron
74,906 (+36% más respecto a 2016), de los cuales: 55,807 (74.5%) corresponden
al MINSA; 10,754 (14.4%) al INSS; 8,345 (11.1%) al sector privado.
En 2016 el ABASTECIMIENTO DE MEDICAMENTOS fue cubierto en un 88.0% y
el Abastecimiento de Material de Reposición Periódica en un 84.25%. Para el 2020
se garantizó el 92% del abastecimiento de Medicamentos, Material de Reposición
Periódica y Reactivos Laboratorio, con lo que se garantizaron los exámenes especializados y el medicamento gratuito para 44,715,879 de recetas despachadas.
Se ha INCREMENTADO EL PERSONAL EN EL SISTEMA DE SALUD PÚBLICA.
En 2006 había 22,083 trabajadores de la salud y 36,649 en 2020 (+66%), entre
médicos, personal de enfermería y técnicos. En 2006 había 2,715 médicos, al 2020
hay 6,045 médicos (+123%).
Gobierno de Reconciliación y Unidad Nacional
Primer Informe Nacional Voluntario: Avances en el cumplimiento
de los ODS, alineados con la Agenda 2030
LEGISLACIÓN CON ÉNFASIS EN LA SALUD
A favor de este objetivo se aprobaron 3 Leyes y 11 Decretos Legislativos. Una de las
leyes de mayor trascendencia fue la Ley 1053, Ley del Digesto Jurídico Nicaragüense de
la Materia de Salud, porque establece certeza jurídica en esa materia, a través de la
recopilación, ordenamiento, depuración y consolidación de este marco jurídico que contiene normas como la Ley Nº. 949, Ley Creadora del Centro Nacional de Clínicas Móviles
para la Salud, que entre otras cosas promueven el Modelo Constitucional de Salud Familiar y Comunitaria con énfasis en la prevención, auto cuido y responsabilidad compartida para la conservación de la salud, el acceso a la salud con servicios de calidad, calidez
y respeto, en las zonas rurales y urbanas del país, para garantizarle a la población consultas médicas generales y especializadas, consultas odontológicas, exámenes de laboratorio, exámenes especiales, ultrasonidos, toma de Papanicolaou, entre otras.
A través de Decretos Legislativos se aprobaron varios convenios de préstamos con instituciones como el Banco Interamericano de Desarrollo (BID); la International Development Association (IDA); Banco Centroamericano de Integración Económica (BCIE) y el
Banco de Exportación e Importación de la India (Exim Bank), con el fin de obtener recursos financieros que permitieran, entre otras cosas:
Fortalecer el Modelo de Salud Familiar y Comunitaria y consecuentemente la capacidad del Ministerio de Salud para reducir las disparidades en salud y acelerar la
reducción de la morbilidad y mortalidad materna e infantil en los Sistemas Locales
de Atención Integral en Salud del país;
Mejorar la infraestructura y reemplazar el equipamiento del área de consulta de
emergencia de varios Hospitales;
Ampliar la cobertura y mejorar la calidad de la atención médica para las condiciones
más prevalecientes de salud, con énfasis en los grupos vulnerables;
Fortalecer la capacidad del sistema de salud en la atención y contención del COVID19 en todo el país y reducir la morbilidad y mortalidad por COVID-19 así como mitigar los demás efectos indirectos de la pandemia sobre la salud de la población nicaragüense con énfasis en los más vulnerables y en los trabajadores de la Salud.
|
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{
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|
20 KINGDOM OF THE NETHERLANDS – REPORT ON THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS
SDG 3 Good health and well-being
At home
Several studies have shown that the Netherlands performs
well on SDG 3. The country is in full compliance with the International Health Regulations, and for seven years in a row has
topped the European Health Consumer Index. The healthcare
system is highly accessible: health insurance is mandatory, with
extensive coverage for chronic care. There is a national vaccination programme, and local governments offer youth care
and social support. One of the spearheads of the Netherlands’
approach, both at home and internationally, is the fght against
antimicrobial resistance.
Government policy on sexual and reproductive health is
dedicated to reducing perinatal mortality. While there is free
and unimpeded access to reproductive healthcare, uptake
by certain vulnerable groups of women remains a concern.
Maternal, neonatal and under-fve mortality in the Netherlands
are at or below the EU average. Men have an average healthy
life expectancy, while women’s is below average.
The National Prevention Programme will continue to promote
good health with a focus on health protection and reducing
health inequalities. Preventing smoking, overweight, excessive
use of alcohol, lack of exercise, diabetes and depression are
programme priorities. The Netherlands also aims to improve
healthcare in the Caribbean Netherlands, taking account of
local circumstances. With regard to reducing early deaths and
diseases caused by air pollution, particulates and nitrogen
dioxide concentrations have been declining since 1992.
Currently almost all concentrations are within European limits.
The estimated number of years of life lost to air pollution is
around the European average.
St Maarten is working to ensure access to basic, high-quality
physical and mental healthcare and to promote healthy lifestyles.
In 2001, Aruba introduced universal healthcare coverage,
providing equal health care benefts to all residents. Aruba’s
vaccination programme covers 98% of all children.
Abroad
Sexual and reproductive health and rights (SRHR) is the main
priority of international healthcare policy. However, progress
on SRHR is largely conditional on a well-functioning, accessible
healthcare system. The Netherlands therefore also invests in
strengthening healthcare systems. Through awareness-raising
programmes at schools, prevention of teenage pregnancies and
the provision of HIV screening and medication, special attention
is given to the position of young people. Around 1.8 million
women and girls have gained access to modern contraceptive
methods thanks to the Netherlands, working in collaboration
with a large number of CSOs and other partners. The goal is
to raise this number to 6 million by 2020. Economic missions
are helping companies from the Netherlands export knowledge
and products in the domain of life sciences and health to partner
countries like Brazil, China, India, Kenya, the UAE and the US.
The Kingdom also advocates affordable pricing of medicines
within the UN, WHO and WTO.
St Maarten, Aruba and Curaçao are partners of the Pan American
Health Organization, the World Health Organization and the
Caribbean Public Health Agency in improving healthcare
policies and services.
|
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[
3
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{
"country": "nld",
"file_id": "sdg-03/vnr-report-nld-2017-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2017
}
|
100
SDG 3 - Good Health and Well-Being
Sint Maarten is a partner of the Pan American Health
Organization, the World Health Organization, and the Caribbean
Public Health Agency in improving healthcare policies and
services. The strategic ambition is to provide quality access to
health care facilities and health coverage, and promote generally
healthy lifestyles and mentally healthy people who can fully
exercise their human rights in a stigma-free society. Furthermore,
the policy focus is to secure access to basic care, improve
healthcare, promote mental health wellbeing, and provide
accessible professional mental health care.
Achievements and prioritized activities
• In 2021 a “Dutch Caribbean Hospital Alliance” was established
as a cooperative association between the medical institutions in
the islands Curacao, Aruba, St. Maarten, Bonaire, Saba, and St.
Eustatius. This alliance will enhance collaboration between the
hospitals to improve the quality and continuity of care provided
to the residents of the Caribbean part of the Kingdom.
• A national health insurance is being implemented to increase
the insured population to more than 90% of St. Maarten
residents. This is estimated to be implemented in 2023.
• Ongoing structural community strengthening (educational
and awareness) projects geared towards prevention and
building resilience.
• Structural health promotion and disease prevention measures.
|
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[
3
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10 | Page
Goal 3 – Ensure healthy lives and promote well-being for all at all ages
Norway’s starting point in its work to fulfil SDG 3 is to integrate the goal and its targets into
its national policies, as well as into its development aid policy. The general health of
Norwegians is good. Life expectancy, both for men and women, is comparatively high, and
Norway has well-established public health policies and health services. The Sami people face
some challenges relating to access to culturally adapted health and care services. The
identification of relevant targets that are to receive particular attention at the national level has
been based on national data on mortality and morbidity. On this basis, Norway has decided
that targets 3.3, 3.4, 3.5 and 3.9 are of particular concern in a national setting. Good health in
a population is dependent on sound policies in other areas, such as spatial planning, education,
environment, effective anti-pollution measures, etc. For this reason, effective follow-up of,
e.g., target 3.9 will include collaboration with environment and municipal authorities. To
ensure coherence between the contributions from different parts of Norway’s health sector,
the Ministry of Health and Care Services has given the Directorate of Health a coordinating
role in the follow-up of SDG 3. The Directorate will also propose relevant policy areas for
cross-sectoral work. At the international level, global health has been a priority for Norway
for many years. In the period leading up to 2030, the SDG agenda will guide Norwegian
development aid.
Health and access to basic health services are fundamental human rights and a prerequisite for
economic growth and social inclusion. Investing in health, with a specific focus on women,
children and adolescents, is a central aspect of Norwegian development policy. Norway’s
investments are mainly channelled to public-private partnerships like Gavi, the Vaccine
Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Global Financing
11 | Page
Facility in support of Every Woman Every Child; and the Global Strategy for Women’s,
Children’s and Adolescent’s Health (2016-2030). Norway has recently pledged NOK 6.25
billion to Gavi. This is an increase of more than 50 % in Norway’s direct support to the
alliance. Since its inception, Gavi has helped save over 7 million lives. Norway has
announced support to the Global Financing Facility of NOK 3 billion for 2016-2020. In
addition, Norway is providing NOK 600 million to the Global Fund to Fight Aids,
Tuberculosis and Malaria in 2016. By 2016, this partnership is expected to have contributed
to saving 22 million lives. Furthermore, Norway’s support to the Global Fund, UNAIDS and
UNITAID has contributed to giving close to 16 million people access to antiretroviral
treatment, reducing the death rate from AIDS by 30 %. Since 2000, malaria mortality has
been halved. Despite the progress that has been made, weak health systems and a shortage of
health personnel are impeding our global efforts to secure the right to health.
|
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60
VOLUNTARY NATIONAL REVIEW 2021 NORWAY
3 Good health and well-being
Ensure healthy lives and promote
well-being for all at all ages
Government assessment
3.1 Norway has a very low maternal mortality rate
and safe maternity care with a high level of
skilled personnel.
3.2 The mortality rate for infants and children
under 5 years is less than 3 per 1,000. Risk
births are followed closely.
3.3 There is a low level of deaths by communicable
diseases, and hardly any water-borne diseases.
A vaccination programme has reduced chlamydia among young people.
3.4 Non-communicable diseases represent the
biggest burden of disease in Norway. Challenges are linked to risk factors like decreasing
physical activity, unhealthy diets and smoking.
These are related to social inequity. Mental
health problems are important and increasing
among younger people. The suicide rate is too
high.
3.5 Harmful alcohol consumption has gone down,
but alcohol use is still an important health risk.
Treatment for substance abuse is improving,
but the number of overdoses is stable.
3.6 Deaths and injuries in road accidents have
fallen signifcantly.
3.7 Universal access to sexual and reproductive
health-care services is very good for all, not
dependent on gender, age, ethnicity or sexual
orientation.
3.8 The level of universal health coverage is very
good, with limits on out-of-pocket payments.
Dental care coverage is limited to some groups.
3.9 Deaths and illnesses from pollution and contamination are few, but air pollution is a health
risk in some areas.
General status: Norway has a well-developed system of universal health coverage and access to quality health care for all. Life
expectancy is high and increasing; in 2020 it was 85 years for
women and 81.5 years for men. However, non-communicable
diseases and social inequities are still public health challenges.
Women and men with a short education (primary/lower secondary level) can expect to live about fve years less than those
with a long education.
Figure 6.3 Suicide mortality rate
0
5
10
15
20
25
1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Female Male
Per 100 000 population
Source: Norwegian Institute of Public Health
Main achievements: Life expectancy and healthy life years are
going up for both men and women. The reduction in smoking
and better medical interventions have signifcantly brought
down the number of premature deaths from cardio-vascular
disease and cancer in the last ten years. Norway has a well-developed health system, with universal health coverage, and
most health services are fnancially accessible to all. Access
to sexual and reproductive health services is very good for all,
not dependent on gender, age ethnicity or sexual orientation.
Preventive programs for HIV- risk groups have been introduced.
The level of air pollution is decreasing.
Main challenges: Decreasing physical activity as well as obesity
and unhealthy diets are a public health challenge. Despite a
drop in the number of daily smokers, smoking is still the main
contributor to illness and premature death, and is signifcant for
social inequality in health. Mental health issues are increasing.
Suicides account for an important part of premature deaths in
men. Alcohol use is a risk factor in the loss of healthy life years.
The death rate from overdoses of illegal drugs is relatively high
in Norway. Social inequalities persist as a major risk factor for
inequities in health.
Global responsibility: Financial support has been increased
considerably during the COVID-19 pandemic, including for
mobilising resources for access to vaccines, testing and other
COVID-19 tools. Norway’s contribution to the ACT Accelerator
is in excess of USD 500 million. Norway provides substantial
fnancial support to Gavi, the Coalition for Epidemic Preparedness Innovations, the Global Fund to Fight Aids, Tuberculosis
and Malaria, WHO, UNAIDS and the Global Financing Facility in
their work. Additionally, Norway support institutional collaboration at bilateral level to strengthen public health and health
systems. A strategy on non-communicable diseases (NCDs) has
been launched, which includes a focus on mental health. Norway endorses the Doha Declaration on the TRIPS Agreement
and Public Health.
Main policy initiatives 2016–2021
• National Action Plan for Better Nutrition (2017–2021).
• Strategy for Sexual Health 2017–2022: Talk about it!
• Strategy for Good Mental Health 2017–2022, followed by
an Action Plan for Mental Health in Children and Youths
(2019–2024).
• National Programme for an Age-friendly Norway
(2019–2023).
• National Alcohol Strategy (2020–2025).
• Dementia Plan 2020 and Dementia Plan 2025.
• The Government’s Action plan for Physical Activity (2020–
2029) ’Together for physically active lives’.
• White Paper No. 19 (2018–2019) Public Health Report – A
Good Life in a Safe Society.
• Better Health, Better lives. Combating Non-Communicable
Diseases in the Context of Norwegian Development Policy
(2020–2024).
61
VOLUNTARY NATIONAL REVIEW 2021 NORWAY
Civil society assessment
The following organisations have participated in this assessment: FORUT – Campaign for Development and Solidarity,
the Norwegian Medical Students´ Association (NMSA-Norway), SOS Children’s Villages Norway, UNICEF, Save the
Children Norway, IPPF-Norway, the Norwegian Association for Outdoor Organisations, the Norwegian Trekking
Association, the Norwegian Cancer Society, Unio (the Confederation of Unions for Professionals and Poly Norway.
TREND: STAGNANT
Norway has succeeded in having a well-developed health
system and a population in general good health. The goal
of reducing premature deaths from non-communicable diseases (NCDs) by 25 per cent by 2025 has been achieved, and
was adjusted to a reduction by a third by 2030. Important
factors are recognising voluntary work as an important role
in good public health, as well as maintaining one of the
world’s strictest tobacco policies.
Norway has succeeded in playing a leading role within
global health. Norway has contributed heavily in fnancial
terms to GAVI, CEPI and COVAX. Norway’s development policy has advocated for sexual and reproductive health and
rights (SRHR), and has helped raise awareness of harmful
traditional practices.
Norway’s challenge is the lack of political follow-up of
goals and measures, especially goals related to physical
activity, diet, overweight and obesity, and social inequalities in health. The UN has criticised Norway for not giving
the same health rights to undocumented migrants. Higher
education adds 5–6 years to a person’s life, compared
to those with low levels of education. The mortality rate
of drug-related deaths is high compared to other countries. Access to services connected to SRHR in Norway is
undemocratic and unequal, especially when it comes to
the Sáami population and other minorities. Sex workers
are also excluded from universal sexual and reproductive health-care services, especially in the wake of COVID.
Norway’s challenge is that studies by the Norwegian Institute of Public Health show levels of heavy metals, arsenic
and mineral manganese, measured in maternal blood
during pregnancy, associated with increased risk of ADHD
and/or autism. Diseases caused by climate change, environmental toxins and antibiotic resistance are in danger of
increasing and must be monitored.
Norway has launched an NCD strategy and an action plan,
in which mental health has been included as a factor for
early death for the frst time. However, Norway has yet to
prioritise NCDs in Norwegian development policies even
though they represent one of the greatest threats to achieving the SDGs.
Norway must:
• implement economic incentives on health-damaging
products such as alcohol, various foods, tobacco and
drugs;
• make health-promoting goods more available for the
whole population;
• involve the voluntary sector as a key player in preventive
and health-promoting work;
• introduce one hour of daily physical activity in schools,
and ensure good-quality outdoor areas in school, preschool and nursery facilities;
• give nature a higher priority in spatial planning and introduce a national goal of a maximum of 500 metres to the
nearest walking trail or nature area;
• recognise nature as a tool in preventing mental health
issues, and prioritise health-promoting work related to
mental health and well-being;
• in line with UN drug conventions, focus on prevention,
holistic treatment and rehabilitation programmes to
replace incarceration and fnes as a reaction to minor
drug ofences;
• implement an equitable health system that includes
dignifed follow-up for asylum seekers and stateless
persons;
• lead the international efort to integrate NCDs into the
development agenda, especially in relation to mental
health, and include civil society in its implementation;
• increase its support for the SAFER initiative to assist lowto middle-income countries;
• take the international lead to shape and coordinate
an improved system for pandemic preparedness and
response, including fair and equitable development of
medicines and vaccines.
Ensure healthy lives and promote
well-being for all at all ages
|
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[
3
] |
{
"country": "nor",
"file_id": "sdg-03/vnr-report-nor-2021-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2021
}
|
ii
Health and wellbeing (SDG 3): Significant progress has been made on reducing
mortality and improving health. The under-5 mortality rate reduced from 91/1000 live
iii
births in 2000 to 39 in 2016 while the infant mortality rate dropped from 64/1000 live
births in 2000 to 32 in 2016. The neonatal mortality rate dropped from 38/1000 live
birth in 2000 to 21 in 2016. The total fertility rate of women aged 15-49 dropped from 4.1
children in 2000 to 2.3 in 2016. The proportion of pregnant women having antenatal
check-ups by a skilled provider increased from 28 percent in 2000 to 84 percent in 2016.
The proportion of births in health facilities increased from 9 percent in 2000 to 57
percent in 2016 while the proportion of births attended by a skilled provider increased
from 11 percent in 2000 to 58 percent in 2016. This all led to the large drop in the MMR
from 850/100,000 live births in 1990 to 258 in 2015.
|
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{
"country": "npl",
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|
16
SDG 3: Ensure healthy lives and promote well-being for all at all ages
Nepal greatly reduced child mortality during the MDG period. The under-5 mortality
rate reduced from 91/1000 live births in 2000 to 38 in 2015. Nepal plans to reduce the
rate to 30 by 2019 and 22 by 2030. The infant mortality rate reduced from 64/1000 live
births in 2000 to 33 in 2015 and to 32 in 2016 in the first year of the SDGs (MOH 2017).
The rate thus reduced by half from 2000 to 2016. Nepal aims to reduce the rate to close
to that of other middle-income countries by 2030. Neonatal mortality also reduced in the
MDG period from 38/1000 live births in 2000 to 23 in 2014 (NPC 2014). It dropped
further to 21 in 2016 in the first year of the SDGs with the aim being to reduce it to
10/1000 live births by 2030.
Nepal has made remarkable progress on improving maternal health. The total fertility
rate (TFR) of women aged 15-49 declined from 4.1 children in 2000 to 2.3 in 2016 (MOH
2017). Nepal plans to attain a replacement level by 2030. Reducing the TFR has
multiplier effects on health and wellbeing of women and children.
The proportion of pregnant women getting antenatal care (ANC) check-ups increased
from 28 percent in 2000 to 68 percent in 2014 (NPC 2014) and 84 percent in 2016
(MOH 2017). The proportion of births taking place in health facilities increased from 9
percent in 2000 to 55 percent in 2014 and 57 percent in 2016 while the proportion
attended by a skilled attendant increased from 11 percent in 2001 to 55 percent in 2014
and 58 percent in 2016 (NPC 2014) and MOH 2017). These improvements led to the
maternal mortality ratio (MMR) dropping from 850/100,000 live birth in 1990 to 539 in
1996, 281 in 2005 and 258 in 2015.Nepal aims to reduce the MMR to 70 by 2030.
17
Nepal has made good progress on reducing the disease burden. Polio has almost been
eradicated while leprosy is in the elimination stage and 92.6 percent of one year children
were immunized against measles in 2015. Considerable efforts have been made to halt
and reverse TB, malaria and HIV/AIDS prevalence. The disease burden is shifting with a
growing numbers of deaths from non-communicable diseases including cancer, heart
attacks, diabetes and kidney disease.
The country still faces many health challenges. Poor and marginalized people face many
barriers to accessing health services. The distribution of health facilities is skewed to
accessible area and people in remote hill and mountain areas have to travel far to reach
one. Most specialized treatment services are in the big cities. The government has
initiated programmes to increase access to modern health services.
Since 2004, a sector-wide approach has been taken in the health sector with most
development partners directing their support through the government’s budget. The
government and its partners hold joint annual reviews (JAR), and jointly monitor
outputs and outcomes against investments. The government is increasing the volume of
the health budget to meet the growing demands.
The following measures (introduced under the new Health Policy 2014 and Nepal Health
Sector Strategy,2015-2020)have reduced inequality in access to health care services in
Nepal and address the constitutional right to health care. The government provides free
basic health care in health posts, primary health care centres and up to 25 bed district
hospital. About 70 types of basic drugs are provided free of cost. Poor and marginalized
people are provided free treatment for some acute diseases including like heart disease
and kidney failure. Transport allowances are provided to all women to give birth in a
health facility. The government has upgraded all sub-health posts to health posts and is
implementing a health personnel retention policy in rural areas. Private sector hospitals
have been instructed to allocate 10 percent of their beds to poor and marginalized
people. A health insurance scheme is being piloted ready for scaling up across the
country.
|
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32
NEPAL: NATIONAL REVIEW OF SUSTAINABLE DEVELOPMENT GOALS
SDG 3 - Ensure healthy lives and
promote well-being for all at all
ages
Due to various efforts of the government
in the health sector, as well as strong community participation, child mortality is decreasing in Nepal. The under-5 mortality
rate reduced from 91 to 38 per 1000 during
2000-2015. And it has further reduced to 28
per 1000 in 2019 (CBS, 2020b). The target to
reduce this to 18 per 1000 by 2030 looks feasible, with stronger support and more coherent and effective programs.
In the MDG period, neonatal mortality reduced from 38 per 1000 live births in 2000 to
23 per 1000 in 2014 (NPC 2014). It dropped
further to 21 in 2016 in the frst year of the
SDGs, and then reached 20 in 2019/20.
The aim is to reduce it to 10 per 1000 live
births by 2030. With continuous efforts
and commitment, it should be achievable. The total fertility rate (TFR) of women aged 15-49 declined from 4.1 children
per women in 2000 to 2.3 in 2016 and has
declined to 2.0 in 2019 (CBS, 2020b). The
proportion of pregnant women getting
antenatal care check-ups was 56 per cent
in 2019 (MOF, 2020a). The proportion of
births taking place in health facilities increased from 9 per cent in 2000 to 57 per
cent in 2016 to 77.5 per cent in 2019. Additionally, the proportion attended by a
skilled health personals increased from 11
per cent in 2001 to 58 per cent in 2016 and
then to 79.3 per cent in 2019 (CBS, 2020b).
The improvements and implementation of
various plans and programs led the maternal mortality ratio (MMR) to drop from
850 per 100,000 live births in 1990 to 539 in
1996, 281 in 2005 and 258 in 2015. It is now
at 239 per 100,000 live birth in 2018/19.
Nepal aims to reduce the MMR to 70 per
100,000 live birth by 2030. These fgures
show the remarkable progress made in
improving maternal health, and we need
to continue accelerating the progress to
achieve the goal by 2030 (Details in Table
5.3).
Health being a priority sector has witnessed signifcant government investment. Free basic health care systems in
health posts, primary health care centers
and 25-bed district hospitals are being
established, and 70 types of basic drugs
have been available free of cost. Under
the Safe Motherhood Programme, transport allowances are provided to pregnant
women who come for check-ups during
pregnancy periods. Additionally, the government plans to increase the percentage
of people associated with health insurance from 7 per cent at present to 60 per
cent by the end of the 15th Plan period,
and reduce personal expenses on health
Fig. 5.3: Targets and achievements in maternal and
child mortality rate
34
NEPAL: NATIONAL REVIEW OF SUSTAINABLE DEVELOPMENT GOALS
care from 53 to 40 per cent. Similarly, the
National Health Sector Strategy (NHSS-IP)
Implementation Plan (2016-2021) is based
on the realization of the SDGs as well as
the government's vision to graduate from
a Least Developed Country to a Middle Income Country. The NHSS also harnesses a
multi-sectoral approach to address the social determinants of health. The Health Policy 2019 has an objective of improving and
expanding the health service system in the
new federal set up. It also aims to improve
the quality of health services and, at the
same time, reduce MMR and IMR.
Despite this progress, there are still some
challenges to be addressed in the health
sector. The main diffculty is ensuring access to each and every citizen of Nepal, in
particular, the poor and marginalized communities. The health insurance scheme is
being implemented in partnership with the
federal government in order to decrease the
out-of-pocket expenditure of local people.
But there is a long way to go as data indicates that only 7 per cent of the population
has health insurance.
Apart from accessibility, the quality of
health services would also be maintained as
it is crucial for the safety of human lives. The
emergence of new diseases like COVID-19
also poses serious threats to the achievements made so far. This will be a further
challenge to a resource-constrained country like Nepal. Though the private sector
has also been involved in providing health
services, it is mainly concentrated in urban
areas. In addition, their services are quite expensive and, thus, out of reach of the common people. Focusing on preventive care
by increasing awareness will be an important additional way to ensure healthy lives
for all. Local level governments are better
positioned to undertake health activities so
they would be given responsibility with enhanced capacity to promote the health support programs across the country, especially
in rural and semi-urban areas.
Fig. 5.4: Targets and achievements in school enrolment (%)
Gross Enrollment in secondary education (grade 9 to 12)
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|
NEW ZEALAND’S PROGRESS TOWARDS THE SDGs – 2019
We want all New Zealanders to live full, independent
and healthy lives and to have greater access to universal
health care and disability services.
SDG3 – GOOD HEALTH
AND WELLBEING
NEW ZEALAND CONTEXT
New Zealand is committed to improving
health and wellbeing across all our
population. We have already achieved
a large number of Goal 3’s targets at
the aggregated level and we are well
placed internationally.
We also recognise that achieving
health and wellbeing for all requires
a comprehensive approach. Making
progress across the breadth of the
agenda will be necessary as many
of the Goals contribute to the broad
determinants of health. Similarly, a
healthier population will be better
placed to support the achievement of
the SDGs as a whole. We recognise
that improving health requires actions
across the broad determinants of health
including social, cultural, environmental
and economic conditions. We will strive
to achieve changes in those determinants
that may currently be a barrier to good
health and wellbeing.
We have four key health priorities, which
closely align with Goal 3: achieving
equity; child wellbeing; mental health;
and primary health care. In addition to
these priorities we are pursuing a set of
health system enhancements that will
also support implementation of this Goal.
CHALLENGES
While New Zealand is relatively wellplaced in terms of achieving Goal 3
by 2030, this is at the total population
level. At the disaggregated level strong
inequities still exist between subpopulations. This is particularly so for Māori
and Pacific peoples and for low socioeconomic groups, who bear a greater
burden of health problems and disease.
Achieving equity across population
groups is therefore a major priority
for the health sector. This will be New
Zealand’s greatest challenge in ensuring
healthy lives and wellbeing for all,
particularly for non-communicable
diseases, mental health and tobacco use
where substantial inequities exist. These
examples cause a large burden of disease,
and reducing the inequities here has the
potential to produce large health gains
for New Zealand. As we work towards
achieving Goal 3’s vision, we will need to
make sure that all relevant measurements
are able to be disaggregated by subpopulations to ensure all populations
in New Zealand are able to enjoy
healthy lives.
Another particular challenge for
New Zealand is achieving universal
health care coverage. Although all
New Zealand citizens are covered by
a public health system, challenges
still remain in accessing primary care
and dental care, with a fee-for-service
structure presenting a barrier to many.
Recent New Zealand Health Survey data
reports that approximately 15 percent of
adults did not visit a general practitioner
in the previous year due to cost. This
problem is particularly acute for Māori
and low socio-economic families.
INITIATIVES UNDERWAY
Achieving equity is a priority goal for
the government. A strategic framework
is being developed to guide this work
and better understand equity problems.
It is expected that the equity focus will
overlap with other strategic priorities,
such as improving child health, primary
THE MINISTRY OF HEALTH IS CONSIDERING
THE STRATEGIC DIRECTION FOR IMPROVING
HEALTH EQUITY FOR PACIFIC PEOPLES.
31
NEW ZEALAND’S PROGRESS TOWARDS THE SDGs – 2019
SDG 3 – GOOD HEALTH AND WELLBEING
health care and mental health.
Our primary health care work programme
aims to provide people with greater
access to primary care. Some changes
have already taken place that have
improved access, including extending
access to low-cost and zero-fee general
practice visits, and reducing prescription
charges for children under the age of
14. These changes have seen the cost of
visiting the doctor fall for up to 540,000
New Zealanders, while an additional
56,000 13 year olds now receive free
primary care visits. This is a step towards
improving universal health care coverage.
More generally, child and youth wellbeing
is a cross-government priority, with
the Department of the Prime Minister
and Cabinet leading development of
a strategy to improve the wellbeing of
children and young people. Our Ministry
of Health is contributing to initial
policy work, with a focus on children
experiencing optimal development in
their first 1,000 days and on children’s
mental wellbeing being supported.
In December 2018 we completed an
inquiry into mental health and addiction,
with the purpose to identify unmet needs
and develop recommendations for a
better mental health and addiction system.
This has resulted in a wide-ranging set
of recommendations aimed to provide
real and enduring change, including for
individual, family and whānau support. We
expect that there will be improvements
for mental health outcomes (including
those emphasised in Goal 3) as a result of
implementing the government’s response
to these recommendations.
A new National Cancer Action Plan
is being developed by the Ministry of
Health in close partnership with Māori
leaders, communities and other sector
representatives. Currently, cancer is
unevenly experienced in New Zealand.
Māori, Pacific people and those living
in rural areas who sufer from cancer
generally have poorer health outcomes
than the rest of the population. When
adjusted for age, Māori females have four
times the rate of lung cancer compared
to non-Māori, and Māori males have three
times the rate of lung cancer compared to
non-Māori. The plan will bring the Māori
world view to strategic decision-making
and service delivery by ensuring all work
is undertaken as a partnership, and embed
Māori leadership in the design of health
programmes. Through previous, similar
initiatives, New Zealand has already
achieved equity in survival outcomes
for children with cancer. We have
demonstrated that integrated, persistent
focus can increase Māori participation in
screening and outcomes.
The Ministry of Health is considering the
strategic direction for improving health
equity for Pacific peoples in New Zealand.
This may include developing new strategic
priorities and actions to improve Pacific
health. The Ministry is also considering
working with relevant agencies whose
work also impacts on Pacific people’s
health. Any new strategic direction for
Pacific health would need to involve
Pacific communities and the Ministry
would need to ensure this takes place.
The Pacific Aotearoa Vision, led by the
Ministry for Pacific Peoples, articulates
Pacific aspirations for the future across a
range of social and economic domains.
A key goal of the vision is having resilient
and healthy Pacific communities and any
strategic priorities or actions developed
by the Ministry of Health would closely
align with this work.
New Zealand has initiatives aimed to
reduce the burden of communicable
diseases. The New Zealand AIDS
Foundation has developed an Ending HIV
campaign. This has the ambitious goal
of no new transmissions of HIV in New
Zealand by 2025. We have seen progress
already. In March 2018 we were one of
the first countries in the world to publicly
fund the HIV prevention drug preexposure prophylaxis (PrEP), meaning
those at high risk of HIV have another
way to protect themselves.
New Zealand has a number of other
priority initiatives underway that
support the targets of Goal 3. We
are pursuing a set of health system
enhancements including drinking water
regulation, improving maternity care
and strengthening the midwifery
workplace, strengthening our District
Health Board performance framework,
road safety planning and enhancing
capital asset management.
New Zealand is currently undertaking
a Health and Disability System Review,
with the purpose of future-proofing
New Zealand’s health and disability
services. It will conclude in 2020 and
provide a set of recommendations on
how to achieve better health and wellness
outcomes for all New Zealanders, improve
health outcomes for Māori and other
population groups, reduce barriers to
access to health and disability service to
achieve more equitable outcomes for all
parts of the population.
On the international front, New Zealand’s
international development cooperation
for health seeks to ensure access to
essential and quality health services so
that Pacific people can achieve their
potential, and to contribute to prosperity,
safety and stability in the region. Our
focus is on improving health outcomes
through increasing the capacity of
country systems. Our priority areas
are prevention and control of noncommunicable diseases, sexual and
reproductive health and rights, child
health and nutrition and prevention and
control of communicable diseases.
WE HAVE FOUR KEY HEALTH PRIORITIES –
ACHIEVING EQUITY, CHILD WELLBEING,
MENTAL HEALTH AND PRIMARY HEALTH CARE.
WE’RE DELIVERING THE GOVERNMENT’S PRIORITIES
Achieving
equity
Child
wellbeing
Mental
health
Primary
health care
OTHER IMMEDIATE PRIORITIES
Drinking
water
regulation
DHB
performance
framework
Maternity
care and
midwifery
Planned
care
Capital
asset
management
33
NEW ZEALAND’S PROGRESS TOWARDS THE SDGs – 2019
BRINGING SUSTAINABILITY TO THE HEALTH CARE SECTOR ELIMINATE VIRAL HEPATITIS C BY 2030
The health sector is aware of its
significant contribution to greenhouse
gas emissions in New Zealand and is
working to improve its sustainability.
In New Zealand District Health Boards
(DHBs) are responsible for providing or
funding the provision of health services in
their district. A growing number of DHBs
employ sustainability ofcers and also
measure and take action to reduce their
greenhouse gas emissions. For example,
two leading DHBs in the country have
managed to reduce their greenhouse gas
emissions by 28 percent and 18 percent
over four years and six years respectively.
At one DHB in 2017/18, 2.8 million kWh of
energy was saved. This is equivalent to
the annual consumption of 395 average
New Zealand households. The driver
behind these reductions has been energy
savings from simple changes such as
installing LED lights and computer sleep
software, to larger changes such as
elevator upgrades and air-conditioning
plant optimisation.
THERE HAVE ALSO BEEN
INITIATIVES AT MANY DHBs
THAT ENCOURAGE THE USE OF
ACTIVE TRANSPORT: A WIN-WIN,
REDUCING GREENHOUSE GAS
EMISSIONS AND IMPROVING
INDIVIDUAL HEALTH.
Initiatives include changing parking
arrangements at hospitals to incentivise
carpooling, public transport use and
active transport use. DHBs are also
considering greener transport options
such as transitioning their vehicle fleets
to hybrid and electric vehicle options, as
well as making e-bikes available for use
by employees.
Supporting this work is the Sustainable
Health Sector National Network, an
association of New Zealand health
professionals working to embed carbon
reduction and sustainability into the
New Zealand health sector. They hold
regular meetings in order to encourage
collaboration and the sharing of ideas.
National-level forums on sustainable
healthcare have raised the profile of this
important work. The Ministry of Health
is also supporting and encouraging the
health sector to take action to become
more sustainable.
Get Hep C Tested Campaign, Health Promotion Agency
HEPATITIS C AFFECTS
APPROXIMATELY 50,000
NEW ZEALANDERS.
It is estimated that more than 20,000
people do not know they have hepatitis C,
with about 1,000 new cases each year.
In line with the World Health
Organization’s Global Hepatitis Strategy,
New Zealand has a goal of eliminating
viral hepatitis as a major public health
threat by 2030. To achieve this goal the
Ministry of Health is leading a crossgovernment response, including key
partnerships with our pharmaceutical
funding agency (PHARMAC) and the
Department of Corrections. A pangenotypic treatment, which is a potential
cure for hepatitis C, is now publicly
funded in New Zealand.
A National Hepatitis C Action Plan is
being developed to help focus resources
on key priorities that will have the
greatest impact on improving outcomes
for people with hepatitis C. This includes
improving access to hepatitis C treatment
in the community, improving prevention
and harm reduction and increasing
awareness and understanding.
The cross-sector working group
developing the National Hepatitis
C Action Plan will be made up of
representatives from primary health
organisations, government agencies, labs,
needle exchange services, community
alcohol and drug services, addiction
services, consumer representatives, the
hepatitis C workforce (including hospital
specialists, general practitioners and
nurses), the Māori and Pacific workforce
and other national organisations.
The Ministry of Health has also been
working in partnership with the Hepatitis
Foundation of New Zealand and the
Health Promotion Agency on a national
hepatitis C campaign, which commenced
25 February 2019. The focus of the
campaign is on identifying the more than
20,000 people in New Zealand who do
not know they have hepatitis C and
encouraging them to get tested.
35
|
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30
Voluntary National Review – Pakistan 2019
GOAL 3 – GOOD HEALTH AND WELL-BEING
I. SDG 3 – AN OVERVIEW
Health remains a top priority for Pakistan. Catering to the healthcare needs of its burgeoning population is a
mammoth task. Wide-ranging political will exists to improve the population’s health status, as the country
recognizes that investments in health promise positive results for the economy and society at large. SDG 3
is particularly important as a large segment of Pakistan’s population lives below the poverty line. Improving
their health is expected to directly translate into sustainable economic growth, as performance on health is
closely tied to economic performance. While a range of health-related challenges exist, Pakistan has been
taking dedicated steps towards improving the health status of its growing population.
II. PROGRESS, STATUS AND TRENDS
Pakistan’s infant mortality rate (IMR) declined from 74 deaths per 1,000 live births in 2012-13, to 62 in 2017-18.
In a similar vein, its Neonatal Mortality Rate fell from 55 deaths per 1,000 live births in 2012-13, to 42 in 2017-
201811. Estimates from 2015 indicate that the maternal mortality rate is 178 deaths per 100,000 live births12.
Improvements in the status of maternal and neonatal health are reflective of improved access, providers’
availability and competency, and stronger infrastructure, systems and policies in place. Pakistan is striving
to increase its critical workforce from 1.45 to 4.45 per 1,000 persons, in line with World Health Organization
(WHO) guidelines13. With a population growth rate of 2.4 per cent, and an unmet demand for contraceptives of
11 National Institute of Population Studies. 2019. Pakistan Demographic and Health Survey 2017-2018.
12 UNICEF. 2015. United Nations Maternal Mortality Estimation Inter-agency Group (WHO, UNICEF, UNFPA, United Nations Population
Division and the World Bank)
13 Ministry of National Health Services, Regulations and Coordination. 2018. National Human Resource for Health Vision 2018-2030.
31
Voluntary National Review – Pakistan 2019
17.3 per cent, Pakistan’s contraceptive prevalence rate in 2018 remained stagnant at 34.2 per cent. The
fertility rate has slightly decreased from 3.8 per cent in 2012-13, to 3.6 per cent in 2017-1814.
The Government stands firm in its commitment to ensure full eradiation of polio through intensive efforts.
Pakistan has tuberculosis incidence of 267 per 100,000 population15. The HIV prevalence rate is 0.1 percent,
with status of concentrated epidemic in high risk groups exceeding 5 percent16. The mortality rate
attributable to household and ambient air pollution is 173.6 persons per 100,00017. Mortality from noncommunicable diseases (NCDs) is 24.7 percent18, with age-standardized NCD mortality rate at 713 per 100,000
population19. Pakistan is exploring dedicated action to curb the rising burden of NCDs.
Goal 3: Good Health and Well-Being
Indicator 2013/14 2015/16
3.1.1 Maternal mortality ratio 276
3.1.2 Proportion of births attended by skilled health
personnel
52% 69%
3.2.1 Under-five mortality rate 89 74
3.2.2 Neonatal mortality rate 55 42
3.7.1 Proportion of women of reproductive age (aged
15–49 years) who have their need for family planning
satisfied with modern methods
49 47
3.7.2 Adolescent birth rate (aged 10-14 years; aged
15-19 years) per 1,000 women in that age group
44
3.b.1 Proportion of the target population (children
age 12-23 months) covered by all vaccines included
in their national programme
54% 66%
Sources: Pakistan Demographic and Health Survey 2012-2013 and 2017-18
III. KEY INITIATIVES
The National Health Vision Pakistan 2016-2025 (NHV) was launched, based on an intensive consultative
exercise at the national level. The National Health Vision enables provincial health departments to
contextualize their policy frameworks with a view to achieving universal health coverage. To this end,
supportive provincial legislation has been introduced, including the Punjab Hepatitis Act 2018, the Sindh
Occupation Safety and Health Act 2017, the Khyber Pakhtunkhwa Public Health (Surveillance and Response)
Act 2017, the Khyber Pakhtunkhwa Mental Health Act 2017, and the Balochistan Juvenile Smoking Act 2018.
Legislative frameworks have also sought to support training and research, such as the Pakistan Health
Research Council Act 2016 and the Khyber Pakhtunkhwa Medical Teaching Institutions Reforms Act 2016.
Alongside legislative initiatives, multiple actions have been taken by Pakistan’s federal and provincial
governments to advance health nationwide.
14 Ibid.
15 WHO Extranet TB Data. 2017. Pakistan Country Tuberculosis Profile. Retrieved from: www.who.int/tb/data/en/
16 WHO EMRO. 2015. Pakistan Programmes HIV AIDS Status.
17 WHO Data. 2016. Pakistan estimates for Mortality rate attributed to household and ambient air pollution, age-standardized (per
100,000 population)
18 Our World in Data. 2016. Pakistan Country Profile
19 WHO Database. 2016. Total NCD Mortality Data. Retrieved from: apps.who.int/gho/data/view.main.2490
32
Voluntary National Review – Pakistan 2019
Notable successes and good practices include the marked improvement in the percentage of deliveries
attended by a skilled birth attendant, rising from 52 per cent in 2012-13 to 69 per cent in 2017-1820. This is due
to multiple, simultaneous initiatives by provincial Maternal and Child Health Programmes. These range from
enhancing access by introducing rural ambulances and Mobile Health Units, to upgrading 1,000 Basic Health
Units (BHUs) to offer 24/7 services in Punjab, Sick Newborn Care and telemedicine units, and other publicprivate-partnership models in Sindh. Health weeks celebrated across extensive network of public health
facilities attracted millions and were valuable in early detection and timely initiation of treatments to many
screened.
Immunization drive and the use of geographic information system (GIS)-enabled, real-time vaccinator
mapping is another major initiative. Vaccination coverage under the Expanded Programme for Immunization
(EPI) rose from 54 per cent in 2012-13 to 66 per cent in 2017-1821. This was supported by execution of
immunization campaigns, through combined efforts of the government, UN agencies and other partner, for
reaching millions of young children.
To address the long-standing challenge of filling vacancies in primary public health facilities in rural settings,
the recent Central Induction Policy for post-graduate training awards additional points to doctors who have
served for over two years in rural or remote areas. This policy has been pivotal in attracting health workers
to previously non-functional government health facilities in remote locations, while encouraging the
retention of human resources for health and ensuring doctors’ availability in underserved districts. A health
emergency programme was launched in the province of Balochistan to scale up medical equipment, supplies
and the provision of medicines in health facilities.
To ensure universal health coverage and reduce out-of-pocket health expenses for people living below the
poverty line, a micro-health insurance programme was introduced at the national level. To date, the Sehat
Sahulat programme has provided healthcare to 3 million people in 44 districts. To overcome the challenges
of a lack of timely, accurate data, the process of revitalizing the Civil Registration and Vital Statistics
programme has been initiated at the national level, establishing much-needed data collection systems,
processes and a central information repository.
IV. CHALLENGES AND LESSONS LEARNED
To bring healthcare services closer to Pakistan’s population, a number of lessons learned have been
identified for scaling up across the country. These include the availability of rural ambulance networks for
pregnant women, the establishment of mobile health units, the upgrading of Basic Health Units, and the
promulgation of legislation related to SDG 3. As noted above, these interventions have played a pivotal role
in improving skilled birth attendance and deliveries in health facilities, directly affecting maternal and
neonatal health.
Developing human resources for health (HRH) is central to achieving SDG 3, as health systems can only
function when the health workforce is fully geared towards overcoming system challenges.
Compliance with international health regulations (IHR) is a critical area where Pakistan is seeking support to
develop local capacities and systems that bolster the country’s preparedness to prevent, detect and
respond to health threats. Since 2016, the provinces of Punjab and Khyber Pakhtunkhwa have taken
dedicated steps towards system strengthening. As part of Pakistan’s plans to establish a Public Health
Management Authority, a conceptual framework and draft public health legislation has been finalized in
Punjab. Roll out has also been initiated in Khyber Pakhtunkhwa with the establishment of a Public Health
20 Ibid, 30.
21 Ibid, 30.
33
Voluntary National Review – Pakistan 2019
Surveillance Laboratory. The National Institute of Health is leading capacity building initiatives and operating
a comprehensive National Reference Laboratory to spearhead disease surveillance. Pakistan is also looking
to collaborate with countries that have successfully established systems and processes under the One
Health approach.
V. PRIORITIES AND TARGETS
In order to make substantive progress on SDG 3, Pakistan’s priorities include:
• substantially increasing spending on health;
• reducing the maternal mortality rate from 178 to less than 130 deaths per 100,000 live births;
• reducing the infant and neonatal mortality rates from 74 and 42 deaths per 1,000 live births to
less than 40 and 30 deaths per 1,000 live births, respectively;
• reducing the fertility rate and improving modern contraceptive prevalence from 3.6 per cent to
3 percent;
• complying with international health regulations and improving preparedness;
• ensuring universal health coverage to make healthcare accessible, affordable and available to
all;
• establishing a network of maternal and neonatal child health hospitals;
• improving diagnostic facilities at public sector health facilities;
• strengthening the quality and increasing the availability of the health workforce;
• addressing school health and mental health; and
• improving health data generation and utilization.
VI. PLANNED INITIATIVES
At present, national per capita spending on health is USD 36.2. The Government will work with provincial and
partners to develop programmes and enhance health spending from the current 0.13 per cent of GDP to the
internationally recommended 5 per cent through a gradual, phased approach.
To reduce maternal mortality, Pakistan will focus on increasing skilled birth attendance. This will involve
enhancing access through upgraded Basic Health Units, and the establishment of maternal and child health
hospitals. To enable effective family planning, pre- and post-pregnancy care, and neonatal care, the Lady
Health Workers (LHW) programme will be revitalized through adequate training, support and a revised service
structure. Similarly, initiatives to reduce infant and neonatal mortality will involve training for birth attendants
on neonatal resuscitation and ensuring immunization for all.
To reduce the fertility rate and improve modern contraceptive prevalence, Pakistan will capitalize on
economies of scale, integrating provincial Population Welfare and Health Departments to raise community
awareness, and provide family planning commodities to families to promote optimal birth spacing.
With a view to complying with international health regulations (IHR) and ensuring preparedness, national and
provincial public health management authorities will provide scientific advice on protecting health, quantify
risks (and the effectiveness of interventions), and play a key role in public health stewardship. The formation
of Provincial Technical Committees in Sindh and Balochistan will guide the mainstreaming of SDG 3.
Ensuring universal health coverage – so as to make healthcare accessible, affordable and available to all –
the Sehat Sahulat programme will be scaled up to all of Pakistan’s districts. Price regulation measures and
drug quality control mechanisms will be introduced.
Improving public sector health facilities will encompass increasing the number of 24/7 Basic Health Units
(BHUs) and Rural Health Clinics (RHCs) equipped with a basic package of services, staff and ambulance
services. These efforts will be complemented by upgrading secondary care facilities through the provision
of adequate equipment, specialist doctors and medicines. It will also involve introducing incentive
34
Voluntary National Review – Pakistan 2019
programmes to attract more doctors, Lady Health Workers and nurses to Basic Health Units, particularly in
remote or hard-to-reach areas.
A focus will be placed on improving diagnostic facilities at public sector health facilities, alongside prioritizing
preventive and curative care for communicable diseases such as Hepatitis, tuberculosis and HIV.
To improve the quality, and increase the availability, of Pakistan’s health workforce, training institutes for
nurses and paramedical staff will be established nationwide. As part of efforts to promote school health, deworming programmes for school children and out-of-school children will be launched in collaboration with
Education Departments, to be delivered through bi-annual cycles. A National Mental Health Policy will be
developed, and the provinces will be encouraged to introduce initiatives to address mental health issues
through improved service delivery and research.
Efforts to improve data generation and utilization will center on strengthening the Civil Registration and Vital
Statistics programme, with a focused approach to collect data at the grassroots level. With WHO’s support,
the Islamabad Health Equity Model is being developed. This innovative model is expected to serve as a
hallmark to facilitate high-risk mapping on prevalent diseases, allowing for endemic control. Similar centres
of excellence will be established across the country, with learning documented and shared to inform scaling
up.
Areas which require advice and support for achieving SDG 3 – in terms of finance, capacity-building,
technology and partnerships – include realistic budgeting, health workforce training and management, and
the use of technology. First, realistic funding needs to be ensured for the effective implementation of SDG
3’s targets and related policies. There is a need for diversified financial inflows and for exploring co-sharing
mechanisms. Global models for setting up a comprehensive health care financing system will be explored in
order to define and develop local capacities to mobilize, pool and secure the equitable allocation of
resources. In tandem, training for Pakistan’s health workforce will be prioritized with adequate infrastructure,
an experienced and well-trained faculty, and dedicated funding.
While there has been rapid progress on the integration of technologies in health, particularly for data
monitoring, GIS-tracking and surveillance, these efforts need to be scaled up in Pakistan. Limited work has
been done on artificial intelligence – such as machine learning for diagnostics, and local research and drug
or technology development. Pakistan will strive to lessen reliance on international partners for drugs and
supplies sourcing, in order to reduce the costs of drugs for the public and decrease out-of-pocket health
expenses.
|
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|
46
ODS 3: SALUD Y BIENESTAR.
Garantizar una vida sana y promover el bienestar para
todos en todas las edades.
Situación del país
En el marco de disminuir las brechas en la mortalidad de los niños (as) menores
de cinco años, mejorar la salud materna y combatir el VIH/SIDA, el Paludismo
(Malaria) y otras enfermedades, señaladas en la evaluación de los Objetivos de
Desarrollo del Milenio (ODM), y dar cumplimiento a los ODS, el Ministerio de
Salud inicia el proceso de definición de objetivos estratégicos, metas e
indicadores para abordar los nudos críticos identificados y la elaboración del Plan
2030, que implica el desarrollo de procesos en el tiempo y espacio, de la mano de
la sustentabilidad, la eficiencia, eficacia y la equidad de los servicios.
Los ODS consideran un sólo objetivo para salud: ODS 3, Garantizar vidas
saludables y promover el bienestar en todas las edades. Catorce de los diecisiete
objetivos y 38 de las 169 metas se vinculan directamente con la salud. Las metas
e indicadores han de articularse con los objetivos estratégicos e indicadores de la
política de salud, con el Plan estratégico de Gobierno, el Plan Nacional de Salud,
los Planes programáticos y los Planes operativos anuales de las Regiones de
salud.
El Ministerio de Salud inició la revisión de metas e indicadores propuestos en el
Informe del Grupo Interinstitucional y de Expertos de la Organización de las
Naciones Unidas sobre los Indicadores de los ODS, identificando que no es
posible la medición de algunos indicadores. Debido a que no existen registros de
datos, algunas metas no se corresponden con los indicadores planteados o
requieren de la definición conceptual de la terminología que se emplea, y otros
carecen de indicadores para su medición, como es el tema particular de los
47
indicadores de promoción de la salud mental, enfermedades ambientales y las
enfermedades transmitidas por el agua.
CUADRO 13. ALGUNOS INDICADORES DE SALUD. AÑOS 2005-2015
INDICADORES
20
05
2
0
0
6
20
07
20
08
2
0
0
9
2
0
1
0
20
11
20
12
2
0
1
3
2
0
1
4
2015
Mortalidad materna por 100.000 nacidos vivos (Unidades). 87 8
8
89 92 9
4
1
0
1
10
2
10
1
9
9
9
7
94
Proporción de partos atendidos por personal de salud calificado. 91
.1
9
1
91
.5
8
8.
6
93
.5
9
1.
4
Tasa de mortalidad infantil (menores de 1 año) por 1.000 nacidos
vivos (Unidades).
19
.4
1
9
18
.5
18 1
7.
5
1
7
16
.5
16 1
5.
5
1
5.
1
14.6
Tasa de mortalidad de menores de cinco años por 1.000 nacidos
vivos (Unidades).
22
.9
2
2.
3
21
.7
21 2
0.
5
1
9.
8
19
.2
18
.7
1
8.
1
1
7.
6
17
Tasa de mortalidad neonatal (menores de 1 mes) por 1.000 nacidos
vivos (Unidades).
13 1
2.
6
12
.3
12 1
1.
6
1
1.
3
10
.9
10
.6
1
0.
2
9.
9
9.6
Tasa estimada de incidencia del VIH en menores de 15 años por
1.000 personas no infectadas (Unidades).
0.
03
0.
0
3
0.
04
0.
02
0.
0
2
0.
0
2
0.
01
0.
01
0.
0
1
0.
0
1
0.01
Tasa estimada de incidencia del VIH (Total) por 1.000 personas no
infectadas (Unidades).
0.
27
0.
2
7
0.
27
0.
27
0.
2
7
0.
2
7
0.
26
0.
26
0.
2
6
0.
2
6
0.26
Incidencia de la tuberculosis por cada 100.000 habitantes. 62 6
1
60 58 5
7
5
5
53 51 4
9
4
6
Tasa de mortalidad por accidentes de tránsito. 13
.6
1
5.
9
14
.5
15
.2
1
3.
4
1
3.
1
13
.9
9.
7
1
0
Tasa de natalidad de adolescentes por 1.000 mujeres adolescentes
de 15 a 19 años de edad.
78
.0
2
7
8.
8
80
.5
6
83
.5
3
8
5.
1
8
2.
3
89
.0
4
90
.3
5
9
1.
1
Flujos oficiales totales de investigación médica y sectores básicos
de la salud, por beneficiario en millones de balboas.
0.
48
0.
6
7
0.
49
0.
69
0.
9
2
0.
3
1
0.
18
0.
34
0.
6
7
1.
0
4
Densidad y distribución de trabajadores sanitarios por mil
habitantes.
3.
45
3.
4
6
2.
57
2.
68
2.
6
1
4.
0
3
3.
96
3.
08
3.
0
5
Índice de capacidad básica del Reglamento Sanitario Internacional
(IHR).
64
.6
77
.5
7
0.
8
6
8.
1
70.3
FUENTE: http://data.un.org
La Hoja de Ruta para la implementación de los ODS considera dos fases: (i)
primera fase de coordinación intrasectorial; y (ii) segunda fase de coordinación
extrasectorial.
48
La primera fase consiste de: (i) consulta con los principales actores del sector
salud; (ii) revisión del Listado de Indicadores presentados por el Grupo
Interinstitucional y de Expertos sobre los Indicadores de los ODS; (iii) identificación
de los indicadores vinculados a Salud; (iv) verificación de la disponibilidad de
datos; (v) integración de datos estadísticos del Ministerio de Salud y la Caja de
Seguro Social; (vi) definir la fuente, flujo, calidad, periodicidad y responsable
institucional de proveer el dato; (vii) elaborar y/o validación de las fichas técnicas
de los indicadores disponibles; (viii) definir la línea base de los indicadores
validados; y (ix) alineación del Plan Estratégico de Gobierno, Políticas, Plan de
salud, indicadores y línea base.
La segunda fase consiste en (i) consulta con los principales actores sociales e
instituciones gubernamentales vinculados a Salud; (ii) validación de los
indicadores de Salud vinculados a los ODS presentados por el Grupo
Interinstitucional y de Expertos sobre los Indicadores de los ODS; e (iii)
implantación de mecanismos de articulación inter – institucional y extrasectorial.
Hasta el momento, se han registrado avances en la implementación. En el marco
de una Jornada Taller; “Objetivos de Desarrollo Sostenible, Retos y Desafíos en
Salud” se realizaron varios Talleres, con la participación de Planificadores
Regionales, representantes del sector salud y otros actores vinculados, con el
propósito de: revisar y discutir los indicadores del ODS 3 “Garantizar vidas
saludables y promover el bienestar”; Identificar los indicadores de los ODS
vinculados a Salud, la disponibilidad de fuente de información, la validación o
construcción de indicadores y la elaboración de la Hoja de Ruta para el monitoreo
y evaluación de los indicadores de los ODS.
Entre los resultados logrados de esta convocatoria nacional, se señalan:
1. El consenso de Listado de indicadores de ODS 3 y los vinculados a salud
2. Revisión de Ficha técnica de cada indicador
3. Lineamientos para la elaboración de Planes operativos armonizados con
los objetivos del Plan estratégico de gobierno, el Plan Nacional de Salud y
los ODS.
Con el propósito de compartir los avances en la definición del listado de
indicadores de la Agenda 2030 y sus líneas bases a monitorear y evaluar, se
realizó una Reunión informativa y de coordinación de acciones, con la
participación del Representante de la Organización Panamericana de Salud y sus
asesores técnicos, la Dirección de Planificación y Jefes de Departamentos. Entre
las iniciativas consideradas, podemos señalar el desarrollo de reuniones
consultivas con informantes claves y la creación de un Observatorio de ODS.
49
Dando seguimiento a la Hoja de Ruta para el monitoreo y evaluación de los
Indicadores de los ODS, se realizó una reunión técnica entre los asesores de la
Organización Panamericana de la Salud y representantes de los Departamentos
de la Dirección de Planificación, para la revisión de la línea base de los indicadores
definidos y la identificación de las metas e indicadores que requieren de consulta
con informantes claves. En la misma se presentaron propuestas para la mejora
del registro de datos y construcción de algunos indicadores, los cuales serán
abordados con los actores involucrados de temas específicos.
Se desarrollaron diversas reuniones con informantes claves, según metas
específicas, para la búsqueda de consenso o construcción de indicadores, en
temas tales como salud ambiental, salud mental, SIDA, Tuberculosis, malaria,
hepatitis B, enfermedades tropicales desatendidas, entre otros.
El tema de los ODS es socializado en la página web del Ministerio de Salud, como
un espacio informativo para todos los asociados.
Acciones públicas de apoyo al logro de los objetivos
En los últimos años Panamá ha introducido las disposiciones jurídicas que regulan
el sector salud. Estas modificaciones en el marco jurídico se refieren
principalmente al fortalecimiento de la capacidad rectora del sector de la salud y
sus componentes; la separación y organización de funciones (regulación,
financiamiento, aseguramiento y provisión de servicios); la descentralización; y la
reforma de las instituciones de seguridad social.
Uno de los mecanismos para la implementación con de los ODS, lo constituye el
Convenio Marco de Control de Tabaco de la Organización Mundial de la Salud, su
protocolo y directrices.
La evidencia indica que el tabaco actúa en contra del desarrollo sostenible,
mermando la capacidad productiva, produciendo inequidad social, incrementando
el gasto público y de bolsillo, deteriorando el medio ambiente con el uso excesivo
de plaguicidas y fertilizantes tóxicos, es causa de entre el 2 y 4% de la
deforestación del planeta. A esto se suma la explotación infantil para el cultivo de
tabaco, con los riesgos específicos que esta actividad genera.
Con la visión de alcanzar las metas 3.4 y 3.a de la Agenda Post-2015, alcanzar el
desarrollo sostenible implica intervenir efectivamente controlando la demanda y
oferta de los productos de tabaco, con oportunidad y de conformidad con las
mejores prácticas, expresadas en el Convenio Marco de Control de Tabaco, su
protocolo y directrices. Ello sin duda, contribuirá favorablemente al logro de los 17
50
ODS, al combate de las Enfermedades Crónicas No Transmisibles (ENT´s) y al
descenso de la prevalencia según lo acordado en la Conferencia de las Partes del
Convenio Marco para el Control de Tabaco (COP).
Panamá ha asumido un compromiso innegable en la aplicación del Convenio
Marco para salvaguardar la salud y la calidad de vida de la población a lo largo
del curso de vida. Se realizaron iniciativas, tales como ambientes libres de humo
de tabaco, prohibición total de la publicidad, promoción y patrocinio de productos
de tabaco, advertencias sanitarias, un programa de atención integral para dejar
de fumar con entrega gratuita de medicamentos, incremento del impuesto
selectivo al consumo de tabaco con una visión de salud pública asignando el 50%
de la recaudación para el control de tabaco, lo que nos ha permitido apoyar la
cooperación a nivel regional y global, a través de la OPS/OMS y del Secretariado.
Se ha tipificado en el Código Penal el comercio ilícito de productos de tabaco
como delito, entendiendo que la violación a las normas sanitarias también es
tipificada como comercio ilícito.
Se ha prohibido la comercialización en el país y el uso de los sistemas
administradores o no de nicotina, en las mismas áreas donde está prohibido
fumar, prohibición sustentada en el principio de precautoriedad que puede aplicar
el Estado, a favor de la Salud Pública.
El Ministerio de Salud en conjunto con el Instituto Gorgas desarrolla una línea de
investigación sobre tabaco que genera conocimientos que son utilizados como
evidencia nacional para la toma de decisiones.
Estas acciones se han reflejado en una prevalencia de consumo de productos de
tabaco en población de 15 años y más de 6.4%, según se estimó en la Encuesta
Mundial de Tabaco en Adultos, 2013, con un descenso de 3% con respecto a
datos de 2007. En una mortalidad proporcional asociada al consumo de tabaco
de 12.6% en promedio para el periodo 2000 – 2014, que representa cerca de 2000
muertes por año. Se destaca el descenso de la tasa de incidencia de tumores
malignos de tráquea, bronquios y pulmón que pasó de 6.6 casos por 100,000
habitantes en el año 2000 a 4.0 casos por 100,000 habitantes en el año 2012.
En materia de salud, también se desarrollan acciones relevantes orientadas hacia
la política de gratuidad de la atención de los menores de 5 años, el diseño y puesta
en marcha de la Estrategia de Cuidados Obstétricos y Neonatales (CONE) y la
Estrategia de Atención Integrada a las Enfermedades Prevalentes de la Infancia
(AIEPI) además de la primera fase del Diálogo Nacional transformación y
mejoramiento del Sistema Público de Salud, elaborada por la Mesa de Diálogo
51
por la Mejora y Fortalecimiento del Sistema de Salud Integral, los programas de
vacunación masiva y el primer Censo Nacional de Salud Preventiva inciden en los
indicadores de salud y bienestar.
Las estrategias y programas dirigidos a mejorar las condiciones del cuidado
infantil y los servicios de atención primaria de la salud incluyen: el control de
crecimiento y desarrollo de los menores, la vacunación, y los programas de
nutrición; el mejoramiento de los servicios básicos, especialmente en lo referente
al agua potable y el saneamiento; y avanzar en la educación en salud. Este
proceso será fundamental, en tanto los principales indicadores asociados
comenzarán gradualmente a variar entre los años 2015 y 2050: tasas de
reproducción y de fecundidad, esperanza de vida, la mortalidad infantil.
Desafíos
En la medida en que la dinámica de la transición demográfica varíe, emergerán
nuevos retos en materia de salud. La desigualdad en la atención de salud está
vinculada con las carencias de accesibilidad sociocultural y geográfica. De allí que
sea necesario enfrentar cambios de la demanda, producto de las dinámicas
demográfica, epidemiológica y tecnológica, que requieren nuevas prestaciones y
tratamientos, con el consecuente incremento de los costos. Esto significa abordar
simultáneamente los aspectos relacionados con las carencias históricas que
presenta la región en materia de equidad de acceso real a servicios de salud
oportunos y de calidad, la escasez de recursos humanos y financieros y los
problemas de articulación de los sistemas con relación con las intervenciones
intersectoriales, integradas en estrategias más amplias de desarrollo y de
reducción de la pobreza.
Para el logro de la Agenda 2030 en el ODS 3 y avanzar en los indicadores de
cobertura y calidad de los servicios de salud de forma sostenida, debe impulsarse
una estrategia dirigida hacia la promoción de una vida sana con bienestar para
todos a lo largo del ciclo de vida: unificar y homologar el sistema de salud,
fomentar una cultura de estilos de vida saludables y la promoción de la salud
focalizada en estilos de vida saludables y propiciar el mayor involucramiento y
participación de la población en los procesos de salud.
Uno de los desafíos para el logro de los ODS es la salud, especialmente la de las
mujeres, las niñas y los niños, que constituyen una población prioritaria en las
políticas de desarrollo. La implementación de planes, estrategias y programas y
el incremento de la inversión pública en la salud, el crecimiento y el desarrollo,
contribuye a formar y fortalecer sociedades pacíficas, estables y productivas.
52
La estrategia debe fortalecer y ampliar la cobertura integral de los servicios de
salud reproductiva, materna, neonatal e infantil en las áreas rurales e indígenas.
De esta forma, disminuir el índice de mortalidad materna; reducir la tasa de
mortalidad de niños menores de 5 años y aumentar la cobertura de servicios
esenciales de salud basados en intervenciones con trazadores que incluyen la
salud reproductiva, materna, neonatal e infantil, las enfermedades infecciosas, las
enfermedades no transmisibles, la capacidad de los servicios y el acceso a ellos,
entre la población y los más desfavorecidos.
CUADRO 14. ACCIONES RELEVANTES PARA PROMOVER LA SALUD Y EL BIENESTAR
Cobertura universal de salud en el marco de un proceso creciente hacia la equidad en salud, sin discriminación por sexo,
identidad de género, edad, grupo étnico-racial, área de residencia, nivel socioeconómico y/o estatus político.
Construcción participativa de la gestión de las políticas públicas de salud.
Abordaje integral e intersectorial de los determinantes de la salud para la disminución de inequidades y garantía del derecho
a la salud.
Integralidad de las acciones de salud, para la reducción de la carga de enfermedades transmisibles y no transmisibles y
sus factores de riesgos.
Promover el abordaje integral de las enfermedades crónicas, Salud mental, violencia y accidentes viales, control del tabaco,
enfermedades infecciosas prevalentes (malaria, VIH/sida, Tuberculosis) y zoonóticas, derechos de la salud sexual y
reproductiva.
Reducción de la mortalidad materna y de menores de 5 años.
FUENTE: Sesiones Consultivas.
|
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231
Objetivo 3. Garantizar una vida sana y promover el bienestar para todo en todas las edades
Meta 3.1 De aquí a 2030, reducir la tasa mundial de mortalidad materna a menos de 70 por cada 100,000
nacidos vivos
Indicador 3.1.1 Razón de mortalidad materna
La mortalidad materna registra a nivel nacional una reducción, de 15.8%; variando de 52.7 por cien mil nacidos
vivos en el 2015 a 45.5 por cien mil nacidos vivos en el 2018; sin embargo, a nivel interno persisten altos
niveles de mortalidad en las provincias y comarcas indígenas en la cuales, las condiciones socioeconómicas
son menos favorables y donde los servicios de salud, pese a los esfuerzos realizados, no disponen de la
infraestructura necesaria para garantizar la servicios de atención de la salud reproductiva, materna, neonatal
y el acceso a ellos. La mayoría de las muertes maternas son producidas por embarazo ectópico, preeclampsia
eclampsia, atención a la madre y por otras complicaciones principalmente relacionadas con el embarazo;
se da en mujeres, con edades comprendidas entre los 35 y 49 años consideradas como grupo de riesgo.
Cabe destacar, que en el período en mención se registra una reducción, en la comarca indígena Emberá
Wounaan (515.5 por cien mil nacimientos en el 2015 a 392.2 por cien mil nacidos vivos en el 2018) y en
la provincia de Darién (192.5 por cien mil nacidos vivos en el 2015 a 95.4 por cien mil nacidos vivos en el
2017), la cual posee un alto porcentaje de población rural. Entre las provincias que presentan incrementos
en este indicador, resaltan Bocas del Toro, Coclé y en menor proporción los Santos (39.6%, 55.9% y 6.3%
respectivamente).
PANAMÁ, 2020
232
GRÁFICA 9. RAZÓN DE MORTALIDAD MATERNA, SEGÚN PROVINCIAS
Y COMARCAS INDÍGENAS: AÑOS 2015 - 2018
0
100
200
300
400
500
600
Nota: Por cien mil nacimientos vivos, con base en la estimación de la población de mujeres de 15 a 49 años, al 1 de julio.
Bocas
del Toro
Total
52.7
49.2
35.4
45.5
Año 2015
Año 2016
Año 2017
Año 2018
46.7
70.8
67.5
65.2
45.6
23.8
46.3
71.1
84.4
18.0
36.8
18.4
24.6
36.8
11.5
23.4
192.5
206.2
95.4
0.0
0.0
124.1
0.0
61.3
86.7
0.0
0.0
92.2
37.1
18.5
34.3
31.1
27.5
55.4
18.3
27.0
45
24.9
0.0
0.0
273.2
339.6
0.0
263.5
515.5
0.0
392.2
0.0
130.2
162.5
83.6
138.4
Coclé Colón Chiriquí Darién Herrera Los
Santos
Panamá
Oeste
Veraguas Comarca
de Guna
Yala
Comarca
Emberá
Wounaan
Comarca
Ngäbe
Buglé
Panamá
Indicador 3.1.2 Proporción de partos atendidos por personal sanitario especializado
En Panamá, durante el período 2015-2018, se registra una disminución en la proporción de nacimientos
con asistencia de personal especializado, de 2.1 puntos porcentuales, observando que pasó de 95.0 % en
el 2015 a 92.9% en el 2018. En el área urbana, la proporción se mantuvo constante a lo largo del período;
mientras, en el área rural disminuyó de 86.1% en el 2015 a 81.5% en el 2018.
A nivel regional, el mayor descenso en la proporción de nacimientos con asistencia profesional, para el
período en mención, se observa en la provincia de Bocas del Toro (6.5 puntos porcentuales) y la Comarca
Nägbe Bugle (5 puntos porcentuales). Sin embargo, hay provincias que experimentaron un incremento
en esta proporción, en el período en mención, siendo relevante, el observado en la Comarca Emberá
Wounaan (17.5 puntos porcentuales), lo cual incidió sobre la reducción que se registra en la tasa de
mortalidad materna.
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo, Sección de Estadísticas Vitales. .
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233
0.0
20
40
60
80
100
120
95.0
99.9
86.1
94.6
99.9
85.3
94.2
99.8
84.7
2015 2016 2017 2018 Años
Total Área Urbana Área Rural
GRÁFICA 10. PROPORCIÓN DE NACIMIENTOS VIVOS CON
ASISTENCIA DE PERSONAL SANITARIO ESPECIALIZADO SEGÚN,
ÁREA: AÑOS 2015 - 2018
92.9
99.8
81.5
Porcentaje
Indicador 3.2.1 Tasa de mortalidad de niños menores de 5 años
La tasa de mortalidad, de los menores de cinco años por mil menores en esa edades, pasó de 16.2 en el
2015 a 17.7 en el 2018, lo que representa un incremento de 9.3%. En el 2018 ocurrieron 1,361 defunciones,
con un aumento de 130 nuevas defunciones en el tiempo transcurrido entre estos años.
El 47.6% de las defunciones ocurridas en el 2018, se debieron a malformaciones congénitas, ciertas
enfermedades infecciosas y parasitarias, enfermedades del sistema respiratorio y a enfermedades
endocrinas, nutricionales y metabólicas. La mayoría de las defunciones son masculinas, representando el
56.6% del total de defunciones de menores de cinco años, ocurridas en el 2015 y el 55.6% (757) de las
ocurridas en el 2018.
Entre el 2015 y el 2018 se registra una disminución en Colón, Herrera y las Comarcas indígenas; siendo más
signifcativa en estas últimas, en particular en la Comarca Emberá Wounaan. Por otro lado, las tasas más
altas por mil nacidos vivos, se dan en el 2018, en Bocas del Toro (30.6), la Comarca Ngäbe Buglé (26.8),
y Darién (24.2); en el caso de estas provincias cabe acotar, que además de tener un alto porcentaje de
población rural, también poseen un alto porcentaje de población indígena.
Meta 3.2 Para 2030, poner fn a las muertes evitables de recién nacidos y de niños menores de 5 años,
logrando que todos los países intenten reducir la mortalidad neonatal al menos hasta 12 por cada 1.000
nacidos vivos, y la mortalidad de niños menores de 5 años al menos hasta 25 por cada 1.000 nacidos vivos
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo, Sección de
Estadísticas Vitales.
PANAMÁ, 2020
234
Indicador 3.2.2 Tasa de mortalidad neonatal
La mortalidad neonatal, se ve más infuida por la atención al embarazo y parto así como por los cuidados
que recibe el neonato. Los datos de este indicador para Panamá, indican un incremento en la tasa de
mortalidad de los menores de 28 días en el período en estudio, pasando de 7.2 (548 defunciones) por mil
nacidos vivos en el 2015 a 8.6 (661 defunciones) por mil nacidos vivos, en el 2018; los nenonatos de sexo
masculino, en comparación con los de sexo femenino, registran, tasas más alta de defunciones (8.2 vs 6.2
para el 2015 y 9.2 vs 8.0 para el 2018).
A nivel interno se observan distintas magnitudes, fuctuando para el 2018, entre 4.3 por mil nacidos vivos,
que se registra en la provincia de Herrera, y 13.7 por mil nacidos vivos que se da en la provincia de Darién,
en el primer caso continúa con un descenso signifcativo en comparación con el 2015, donde la tasa era
de 9.3; mientras que en el segundo caso, la situación es inversa el indicador tenía un valor de 2.9 por mil
nacidos vivos; se requiere para cambiar esta tendencia, la implementación de programas más agresivos que
garanticen el control de la mujer durante el embarazo. Por su parte, la Comarca Emberá Wounaan evidencia
avances importantes en la disminución de la mortalidad neonatal, la cual se redujo en ese período en la
mitad (15.5 vs 7.5).
MAPA 3. TASA DE MORTALIDAD DE NIÑOS MENORES DE 5 AÑOS,
SEGÚN PROVINCIAS Y COMARCAS INDÍGENAS: AÑO 2018
LOS SANTOS
COCLÉ
COLÓN
NGÄBE BUGLÉ
EMBERÁ
GUNA YALA
BOCAS DEL
TORO
CHIRIQUÍ
PANAMÁ
OESTE
PANAMÁ
DARIÉN HERRERA
VERAGUAS
30.6% 15.3%
26.8%
21.1%
10.1%
12.9%
14.7%
17.1%
18.7%
14.9%
13.7%
8.6%
24.2%
Total País 17.7%
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo, Sección de Estadísticas Vitales.
II INFORME NACIONAL VOLUNTARIO
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235
GRÁFICA 11. TASA DE MORTALIDAD NEONATAL, SEGÚN PROVINCIAS
Y COMARCAS INDÍGENAS: AÑOS 2015 - 2018
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Bocas
del Toro
Total
7.2
7.7
7.7
8.6
Año 2015
Año 2016
Año 2017
Año 2018
10.5
13.2
9.0
9.6
6.8
6.0
7.2
9.2
6.8
7.7
8.8
8.1
8.7
9.9
10.0
10.1
2.9
9.3
11.5
13.7
9.3
3.7
5.8
4.3
1.7
7.5
8.1
5.5
7.3
7.0
8.1
9.5
5.8
7.5
7.9
8.5
4.3
5.0
3.2
7.0
4.1
13.6
4.2
6.6
15.5
11.8
0.0
7.5
9.4
7.8
4.7
5.3
Coclé Colón Chiriquí Darién Herrera Los
Santos
Panamá
Oeste
Veraguas Comarca
de Guna
Yala
Comarca
Emberá
Wounaan
Comarca
Ngäbe
Buglé
Panamá
Indicador 3.3.1 Número de nuevas infecciones por el VIH por cada 100,000 habitantes, desglosado
por sexo, edad y poblaciones clave.
La tasa de incidencia del VIH en el 2015 representa 28 nuevas infecciones por cada 100,000 habitantes,
mientras que en el 2018, son 32 por cada 100,000 habitantes; entre los años mencionados se dieron 184
nuevos casos. Las edades que presentan la mayor incidencia, son aquellas comprendidas entre los 20 y 35
años; siendo, más relevantes las del grupo de edad de 20 a 29 años. En los hombres se incrementa en mayor
medida (41.6 por cien mil habitantes en el 2015 vs 47.8 en el 2018), mientras las mujeres tienen una tasa más
baja y el incremento es menor (15.3 vs 15.5 por cien mil habitantes).
0
10
20
30
40
50
60
28.5
41.6
15.3
24.1
32.9
15.3
28.6
44.4
12.8
2015 2016 2017 2018 Años
Total Hombre Mujeres
GRÁFICA 12. NÚMERO DE NUEVAS INFECCIONES POR EL VIH POR
100,000 HABITANTES, SEGÚN SEXO: AÑOS 2015 - 2018
31.7
47.8
15.5
Meta 3.3 De aquí a 2030, poner fn a las epidemias del SIDA, la tuberculosis, la malaria y las enfermedades
tropicales desatendidas y combatir la hepatitis, las enfermedades transmitidas por el agua y otras
enfermedades trasmisibles
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo (INEC), Sección de Estadísticas Vitales.
Fuente: Ministerio de Salud, Departamento de Epidemiología , Sección de Estadísticas.
PANAMÁ, 2020
236
Indicador 3.3.2 Incidencia de la tuberculosis por cada 100.000 habitantes
El indicador revela para el período en mención, una variación de 2.2%, pasa de 42.2 por 100,000 habitantes
en el 2015 a 41.3 por 100,000 habitantes en el 2018; en el 2016, registra una caída bastante signifcativa, para
luego alcanzar en el 2017 niveles mayores que los obtenidos en el 2015 y declinar nuevamente para el 2018.
GRÁFICA 13. INCIDENCIA DE LA TUBERCULOSIS POR CADA 100,00
HABITANTES: AÑOS 2015 - 2018
30.0
0.0
2015 2016 2017 2018
32.0
34.0
36.0
38.0
40.0
42.0
46.0
42.2
39.3
44.4 41.3
Indicador 3.3.3 Incidencia de la malaria por cada 1.000 habitantes
El país, realiza ingentes esfuerzos para controlar la malaria, entre el 2015 y el 2018 registra una incidencia
de esta enfermedad, que fuctúa entre 0.14 y 0.20 por mil habitantes, la tasa más alta se da en el 2016, para
luego declinar en el 2018; los hombres, presentan las tasas de incidencia más altas.
Por edad, se observa que la población de 1 a 19 años mantienen entre el 2015 y el 2017, los mayores
valores (fuctuando entre 0.23 y 0.34 por mil habitantes), sobresale en este período y dentro de este grupo
poblacional, la incidencia en los menores de 1 a 4 años (0.23, 0.34 y 0.29, respectivamente).
GRÁFICA 14. INCIDENCIA DE LA MALARIA POR CADA 1,000
HABITANTES, SEGÚN SEXO: AÑOS 2015 - 2017
0
0.05
0.1
0.15
0.2
0.25
0.3
0.14
0.17
0.11
0.20
0.23
0.17 0.17
0.20
0.14
2015 2016 2017
Años
Total Hombre Mujeres
Fuente: Ministerio de Salud, Departamento de Epidemiología en coordinación con el Programa de Tuberculosis.
Fuente: Ministerio de Salud, Departamento de Control de Vectores en coordinación con el Departamento de Epidemiología
II INFORME NACIONAL VOLUNTARIO
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Indicador 3.4.1 Tasa de mortalidad atribuida a las enfermedades cardiovasculares, el cáncer, la
diabetes o las enfermedades respiratorias crónicas.
Las defunciones de la población causadas por estas enfermedades, se han ido incrementando a través
del tiempo tanto en hombres como mujeres, pero con mayor fuerza en los primeros. Este indicador pasa
a nivel total de 252.8 por 100,00 habitantes a 265.8; en el caso de los hombres, varía de 269.8 por cien
mil habitantes en el 2015 a 286.8 en el 2018, mientras que para las mujeres varía de 235.6 por cien mil
habitantes a 244.7. En el 2018, el 54% de las 11,054 defunciones ocurridas, corresponden a enfermedades
circulatorias, el 28.4% a tumores y el 17.6% a diabetes o enfermedades respiratorias crónicas; es pertinente
señalar, que las defunciones por enfermedades cardiovasculares, son las que más se han incrementado
durante el período en mención.
0
50
100
150
200
250
300
350
252.8
269.8
235.6
253.9
268.1
239.6
256.6
273.0
240.0
2015 2016 Años 2017 2018
Total Hombre Mujeres
GRÁFICA 16. TASA DE MORTALIDAD POR 100,000 HABITANTES,
ATRIBUIDA A LAS ENFERMEDADES CARDIOVASCULARES, EL
CÁNCER, LA DIABETES O LAS ENFERMEDADES RESPIRATORIAS
CRÓNICAS, SEGÚN SEXO: AÑOS 2015 - 2018.
265.8
286.8
244.7
Meta 3.4 De aquí a 2030, reducir en un tercio la mortalidad prematura por enfermedades no transmisibles
mediante su prevención y tratamiento, y promover la salud mental y el bienestar
GRÁFICA 15. INCIDENCIA DE HEPATITIS B POR CADA 100,000
HABITANTES, SEGÚN SEXO: AÑOS 2015 - 2017
4.7
6.16
3.18 3.2
4.29
2.09 2.2 2.14
2.35
2015 2016 2017
Años
Total Hombre Mujeres
Fuente: Ministerio de Salud, Departamento de Epidemiología en coordinación con el Programa de Tuberculosis
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo
(INEC), Sección de Estadísticas Vitales
PANAMÁ, 2020
238
Años
Total Hombre Mujeres
GRÁFICA 17. TASA DE MORTALIDAD POR SUICIDIO POR 100,000
PERSONAS, SEGÚN SEXO: AÑOS 2015 - 2018.
2015
2015 2016 2017 2018
0
1.0
2,0
3.0
4.0
5.0
6.0 2016 2017
2018
4.6 4.6
5.3 5.3
2.8 2.6
3.0 3.0
1.0 0.8
0.7 0.7
Indicador 3.6.1 Tasa de mortalidad por lesiones debidas a accidentes de tránsito
Panamá, muestra avances en relación a disminuir el número de defunciones producidas por accidentes
de tránsito, del 2015 al 2018 ocurrieron 473 y 400 defunciones, respectivamente, lo cual se refejó en una
reducción de la tasa de mortalidad de 12.0 por 100,000 habitantes a 9.7; las edades en las que se concentra
el mayor número de defunciones son aquellas comprendidas entre los 20 y 49 años. La provincia de Panamá
sobresale con el mayor número de defunciones, seguida de la provincia de Chiriquí; el menor número de
defunciones, se observa en la provincia de Coclé.
Por sexo, los hombres han disminuido en forma sostenida durante todo el período el número de defunciones,
sin embargo superan el promedio nacional de defunciones por esta causa, la tasa va de 19.4 por cien mil
habitantes en el 2015 a 15 por cien mil habitantes en el 2018.
Meta 3.6 De aquí a 2020, reducir a la mitad el número de muertes y lesiones causadas por accidentes de
tránsito en el mundo
El país registra en el 2015, una tasa de suicidios de 2.8 por cien mil habitantes, con oscilaciones entre este
año y el 2018, para luego experimentar un leve descenso en este último año 2.6 por cien mil habitantes;
es importante resaltar, que este descenso es producido, por un incremento poblacional, más que por una
disminución en el número de defunciones ya que en ambos años fallecieron 110 personas por esta causa.
Los datos evidencian, que los hombres son más propensos al suicidio con una tasa de 4.6 para esos años;
en comparación, con las mujeres que registran tasas muy inferiores de 1.0 a 0.7 respectivamente. La mayor
cantidad de suicidios en el 2018, se da entre los 20 a 24 años (16), los 35 a 39 años (16) y los 45 a 49 (12).
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo (INEC), Sección
de Estadísticas Vitales.
II INFORME NACIONAL VOLUNTARIO
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Años
Total Hombre Mujeres
GRÁFICA 18. TASA DE MORTALIDAD POR 100.000 HABITANTES,
POR LESIONES DEBIDAS A ACCIDENTES DE TRÁNSITO, SEGÚN
SEXO: AÑOS 2015 - 2018.
2015
2015 2016 2017 2018
0.0
5.0
10.0
15.0
20.0
25.0
2016 2017
2018
19.4 19.4 18.8
15.7
12.0 11.8 11.4
9.7
4.5 4.0 3.9 3.7
Indicador 3.7.2 Tasa de fecundidad de las adolescentes (entre 10 y 14 años y entre 15 y 19 años) por
cada 1.000 mujeres de ese grupo de edad
La evolución de la fecundidad de adolescentes a nivel nacional refeja una disminución entre el 2015 y el 2018
para ambos grupos de edad. En el 2018 se registraron 76,863 nacimientos en todo el país, correspondiendo
el 17.4 % a este grupo poblacional. La tasa de fecundidad de las adolescentes menores de 20 años, varío
en el período citado de 43.01 por mil mujeres a 37.9.
Por su parte, el grupo de 10 a 14 años de edad, si bien disminuye, se mantiene durante ese tiempo con muy
pocas variaciones. En la fecundidad de las adolescentes predomina el grupo de 15 a 19, el cual pasó de
84.03 por mil mujeres a 73.5.
El nivel de las tasas de fecundidad por edad de la madre de estos grupos de edades, varía a nivel provincial;
para el 2018, las tasas más altas del grupo 10 a 14, se registran en la Comarca Emberá Wounaan (10.2
por mil), la Comarca Gnäbe Buglé (10.1 por mil) Bocas del Toro (7.5 por mil), Darién (6.6 por mil), y la
Comarca Guna Yala (6.2 por mil). Es preciso acotar, que excepto Bocas del toro, el resto incrementa su tasa
de fecundidad entre el 2015 y el 2018.
Meta 3.7 De aquí a 2030, garantizar el acceso universal a los servicios de salud sexual y reproductiva,
incluidos los de planifcación familiar, información y educación, y la integración de la salud reproductiva
en las estrategias y los programas nacionales
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo(INEC), Sección de
Estadísticas Vitales.
PANAMÁ, 2020
240
En lo que respecta al grupo 15 a 19, la Comarca NGäbe Buglé tiene la tasa más alta (172.8 por mil), seguida
de Bocas del Toro (133.3 por mil) y Darién (101.1); cabe mencionar, que Bocas del Toro pese a sus altos
niveles de fecundidad, muestra una tendencia a la disminución.
Años
Total 10 a 14 15 a 19
GRÁFICA 19. FECUNDIDAD DE MENORES DE 20 AÑOS, SEGÚN
GRUPO DE EDAD: AÑOS 2015 - 2018
2015
2015 2016 2017 2018
0.0
10.0
20.0
30.0
40.0
60.0
70.0
80.0
50.0
90.0 2016
2017 84.0 2018
78.8 75.3 73.5
43.0
40.3 38.7 37.9
3.4 2.9 2.9 2.9
Indicador 3.9.3 Tasa de mortalidad atribuida a intoxicaciones involuntarias
El comportamiento durante el período 2015-2018, no permite observar tendencias a futuro; el indicador,
experimentó a nivel total un crecimiento importante hasta el 2017, llegando a duplicar el valor inicial del año
base (pasa de 0.10 a 0.22 por 100,000 habitantes). En los hombres se observa el pico más alto en el 2017
(0.34), para luego descender en el 2018; mientras las mujeres, alcanzan su máximo valor en el 2016 (0.20),
para luego descender hasta cero el 2018. Independientemente de esta situación, la tasa de los hombres
alcanzó niveles superiores.
Meta 3.9 De aquí a 2030, reducir considerablemente el número de muertes y enfermedades causadas por
productos químicos peligrosos y por la polución y contaminación del aire, el agua y el suelo.
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo (INEC), Sección de Estadísticas Vitales.
II INFORME NACIONAL VOLUNTARIO
SECRETARÍA TÉCNICA DEL GABINETE SOCIAL
241
GRÁFICA 20. TASA MORTALIDAD POR 100,000 HABITANTES,
ATRIBUIDA A LA INTOXICACIÓN ACCIDENTAL SEGÚN,
SEXO: AÑOS 2015 - 2018
Años
Total Hombre Mujer
2015 2016 2017 2018
0.00
0.05
0.10
0.15
0.20
0.30
0.35
0.40
0.25
2015
2016
2017
2018
0.15
0.34
0.05 0.05 0.05
0.20
0.10
0.00
0.10
0.12
0.22
0.02
El país presenta un leve incremento de la densidad del personal sanitario, el cual pasa de 6.45 por mil
habitantes en el 2015 a 6.92 en el 2018; en todas las áreas, en mayor o menor medida se da este incremento,
a excepción de la comarca Guna Yala en donde se redujo de 3.16 a 2.67 por mil habitantes.
Es importante destacar, las disparidades en la densidad a nivel regional; en ese sentido, la comarca
Emberá Wounaan tiene una densidad de 0.24 en el 2018; en contraste con las provincias de Herrera
y Los Santos que ostentan una densidad, para ese mismo año de 15.41 y 12.83 respectivamente; esas
densidades, que son las más altas del país, son consecuencia del decrecimiento de su población, debido
a fuertes fujos migratorios.
En lo concerniente a la distribución de los trabajadores sanitarios, se observa un ligero incremento en su
número pasando de 28,627 en el 2015 a 28,763 en el 2018. De este personal el 23.3 % son médicos, el 21.8%
enfermeras, 18.5% Técnicos en enfermería, el 4.4% asistentes de enfermería. El menor porcentaje se registra
en optometrista y dietistas 0.1% respectivamente, técnicos en electrocardiogramas 0.4%, inspectores
de saneamiento 0.6%, psicólogos 0.9%, trabajadores sociales 1.0%, Terapistas físicos 1.1%. El 27.8%
corresponde a laboratoristas, asistentes de laboratorio, técnicos radiólogos, farmacéuticos, asistentes de
farmacia, técnicos dentales, técnicos de registros médicos entre otros. Cabe destacar, que las cifras incluyen
tanto el sector público como privado ya que proceden de la encuesta de salud que se aplica a todas las
instalaciones.
Meta 3.c Aumentar considerablemene la fnanciación de la salud y la contratación, el perfeccionamiento,
la capacitación y la retención del personal sanitario en los países en desarrollo, especialmente en los
países menos adelantados y los pequeños Estados insulares en desarrollo
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo (INEC), Sección de Estadísticas Vitales.
PANAMÁ, 2020
242
GRÁFICA 21. DENSIDAD DEL PERSONAL SANITARIO, SEGÚN
OCUPACIÓN: AÑOS 2017 - 2018
0.0
Ocupación
5.0
10.0
15.0
20.0
25.0
2017 2018
19.318.5
4.3
4.4
4.1 4.2
2.1 2.2 2.2 2.5 3.0 3.0 3.1 3.4
2.6 2.4 1.3 1.0 1.1 0.9 0.1 0.1 1.2 1.1 0.8 0.8 0.1 0.1
5.4 4.8
0.7 0.4 0.8 0.6
22.8
23.3
20.7
21.8
4.4
4.3
Técnicos en
Enfermería
Asistentes de
Enfermería
Asistentes de
Laboratorio
Técnico
Radiólogos
Farmaceúticos
Asistentes de
Farmacia
Técnicos
Dentales
Trabajadores
Sociales
Técnicos de
Registros Médicos
Técnicos en
Electrocardiograma
Inspectores de
Saneamiento
Enfermeras
Odontólogos
Médicos
Nutricionistas
Optometristas
Terapistas físicos
Dietistas
Psicólogos
Laboratoristas
Meta 3.d Reforzar la capacidad de todos los países, en particular los países en desarrollo, en materia de
alerta temprana, reducción de riesgos y gestión de los riesgos para la saluda nacional y mundial
Indicador 3.d.1 Índice de capacidad básica en el Reglamento Sanitario Internacional (RSI)
El Reglamento Sanitario Internacional (2005) o “RSI (2005)” o “el Reglamento” es un acuerdo jurídicamente
vinculante entre los Estados Miembros de la OMS y otros Estados que han aceptado quedar obligados
por él (Estados Partes). En el RSI (2005), su “fnalidad y alcance” se defnen así: “prevenir la propagación
internacional de enfermedades, proteger contra esa propagación, controlarla y darle una respuesta de
salud pública proporcionada y restringida a los riesgos para la salud pública y evitando al mismo tiempo las
interferencias innecesarias con el tráfco y el comercio internacionales”. Este indicador ha registrado una
leve mejoría en el período 2015 a 2018, varió de 68 a 71; sin embargo, registra una desaceleración, ya que
el valor alcanzado en el 2018 es igual al del 2016.
GRÁFICA 22. ÍNDICE DE CAPACIDAD BÁSICA DEL REGLAMENTO
SANITARIO INTERNACIONAL (IHR): AÑOS 2015 - 2018
2015 2016 2017 2018
68
71
76
71
Fuente: Contraloría General de la República, Instituto Nacional de Estadística y Censo (INEC), Sección de Estadísticas Sociales.
Nota: Los datos publicados corresponden a la información recopilada con base en la Encuesta sobre Servicios de Salud.
Fuente: Organización Mundial de la Salud.
|
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79
Garantizar una vida sana y promover
el bienestar para todos en todas las
edades
ODS:
• Situación del país
En lo concerniente al logro de una vida sana
y el bienestar de la población, los indicadores
muestran avances y retrocesos ya que aunque
la razón de mortalidad materna muestra una
disminución importante a nivel nacional, variando
de 52.7 defunciones por cien mil nacidos vivos en
el 2015 a 45.5 defunciones por cien mil nacidos
vivos en el 2018, se observan muchas disparidades
entre las provincias y las comarcas indígenas,
donde las condiciones socioeconómicas de la
población son menos favorables y los servicios
de salud son poco adecuados para garantizar
la atención de la salud reproductiva, materna y
neonatal.
Cabe anotar que la mayoría de las muertes
maternas son por causas prevenibles y se dan en
mujeres en edades comprendidas entre los 35 y
49 años. Al respecto, es importante mencionar
que aunque la proporción de nacimientos con
asistencia de personal especializado ha variado
de 95% en el año 2015 a 92.9% en 2018, en el
área urbana la proporción se mantiene constante
durante el período, mientras que la disminución se
da en el área rural, especialmente en la provincia
de Bocas del Toro y la Comarca Ngäbe Buglé, lo
cual se relaciona con la mortalidad materna en
estas regiones.
Junto con lo anterior, las tasas de mortalidad
de menores de 5 años, mortalidad infantil y
mortalidad neonatal muestran un retroceso. Al
respecto, la tasa de mortalidad de menores
de 5 años aumentó de 16.2 defunciones por
mil nacidos vivos en el 2015 a 17.7 defunciones
por mil nacidos vivos en el 2018, observando
que el 47.6% de estas muertes en el año 2018
se debieron a malformaciones congénitas,
ciertas enfermedades infecciosas y parasitarias,
enfermedades del sistema respiratorio ya
enfermedades endocrinas, nutricionales y
metabólicas. La tasa de mortalidad neonatal
pasó de 7.2 defunciones por mil nacidos vivos
en el año 2015 a 8.6 defunciones por mil nacidos
vivos en el año 2018. Estos indicadores también
muestran diferencias notorias a nivel geográfco,
destacando que las áreas indígenas son las más
afectadas.
El número de nuevas infecciones por VIH, por cien
mil habitantes, muestra incrementos sostenidos
en el período 28.5, 24.6, 28.6 y 31.7 en los años
2015, 2016, 2017 y 2018, respectivamente. Sin
embargo, es importante indicar que casi el 80%
de las personas infectadas con VIH reciben
tratamiento en las clínicas de antirretrovirales del
Ministerio de Salud (MINSA) y la Caja de Seguro
Social (CSS), de éstos el 68% logran superar la
carga viral. En los indicadores sobre la incidencia
de enfermedades como la tuberculosis, la malaria
y la hepatitis B se observan disminuciones.
No obstante, la tasa de mortalidad atribuida
a enfermedades cardiovasculares, el cáncer,
la diabetes y las enfermedades respiratorias
crónicas, emerge como uno de los graves
problemas de salud de la población ya que se
viene incrementando paulatinamente durante el
período, especialmente cuando se discrimina por
sexo, donde los hombres parecen ser los primeros
afectados. Por otro lado, la tasa de mortalidad
por suicidio es más alta en los hombres que en
las mujeres y se muestra más o menos constante
PANAMÁ, 2020
80
durante el período, con una tendencia a la
disminución; igual que la tasa de muertes por
accidentes de tránsito que, aunque muestra un
decrecimiento importante, continúa afectando
más a los hombres.
Un indicador importante, a nivel nacional
en Panamá, es la tasa de fecundidad de las
adolescentes (entre 10 y 14 años y entre 15 y 19
años) por cada 1.000 mujeres de ese grupo de
edad, refeja una disminución entre el 2015 y el
2018 para ambos grupos de edad; no obstante,
en el 2018 se registraron 76,863 nacimientos
registrados de éstos el 17.4% corresponden a
menores de 20 años cuya tasa de fecundidad
varió de 43.01 a 37.9 por mil mujeres, entre los
años 2015 y 2018. La tasa de fecundidad de las
adolescentes de 10 a 14 años muestra muy pocas
variaciones, aunque su tendencia es descendiente,
en este grupo las tasas más altas se observan en
las áreas indígenas y en la provincia de Darién;
similar comportamiento se evidencia en la tasa de
fecundidad entre el grupo de 15-19 años, siendo
más alta que en el resto del país.
La densidad del personal sanitario presenta
un leve incremento, pasando de 6.45 por mil
habitantes a 6.92 por mil habitantes entre los años
2015 y 2018, respectivamente; y en la distribución
se observa que la mayor proporción son médicos,
seguidos de enfermeras, técnicos de enfermería
y asistentes de enfermería. El resto del personal
sanitario registra bajas proporciones. A nivel
regional, se puede observar que en las provincias
más alejadas y las comarcas indígenas, esta
densidad sigue mostrándose baja, afectando los
servicios de salud que se brindan en ese nivel.
• Acciones públicas de apoyo al logro de los
objetivos
Una de las estrategias del Pilar Estratégico 1,
del PEN 20308
, se refere a Garantizar una Vida
sana y promover el bienestar de todos en todas
las edades, tiene como fnalidad fortalecer
las políticas de agua, saneamiento, ambiente
saludable y educación para ampliar la cobertura
integral de los servicios de salud reproductiva,
materna, neonatal e infantil y de nutrición en las
áreas rurales e indígenas.
En cuanto a normativas referentes a la Primera
Infancia, se sancionó la Ley 135 de 23 de marzo de
2020 que reforma la Ley 50 de 1995, que protege
y fomenta la lactancia materna, y modifca
el Código de Trabajo. La norma establece
que las universidades ofciales y particulares,
las entidades autónomas y semiautónomas,
los centros comerciales, los aeropuertos, las
empresas e instituciones en general deberán
adecuar salas de lactancia materna en los lugares
de trabajo bajo los parámetros establecidos para
tal fn por la Organización Panamericana de la
Salud, la Organización Mundial de la Salud, y
el Fondo de Naciones Unidas para la Infancia.
Incluye el desarrollo de jornadas educativas y de
concienciación de los benefcios de la lactancia
materna, también planes y programas que la
promuevan.
En octubre de 2019 se presenta ante la Asamblea
Nacional (AN) el Proyecto de Ley 155 referente a
la Protección a la Primera Infancia y Promoción
del Desarrollo Infantil Temprano el que una vez
sea aprobado, servirá para impulsar el cuidado
de la población de niños y niñas entre las
edades de 0-8 años. La propuesta de ley tiene
por objetivo establecer las bases, las directrices
técnicas y de gestión intersectorial para la
política del Estado en materia de Primera Infancia
y Desarrollo Infantil Temprano. Además, se
instituye la Ruta de Atención Integral a la Primera
Infancia (RAIPI), como la herramienta de gestión
intersectorial e interinstitucional que integra y
articula los programas, servicios y atenciones
a niños y niñas que contribuyen a la garantía
de sus derechos. Crea la Comisión de Alto
Nivel para la Primera Infancia como organismo
articulador cuyo objetivo es alinear, aprobar
y articular las políticas, estrategias, planes y
presupuesto para la protección integral de los
niños y niñas en primera infancia. Esta Comisión
estará conformada por los ministros (as) o, en su
defecto, por los viceministros (s) del Ministerio
de Desarrollo Social (MIDES), Ministerio de la
Presidencia, Ministerio de Economía y Finanzas ____________________
8 CCDN, Plan Estratégico Nacional con visión de Estado, Panamá 2030, alineando el desarrollo nacional con los Objetivos de Desarrollo Sostenible, Panamá 2017.
II INFORME NACIONAL VOLUNTARIO
SECRETARÍA TÉCNICA DEL GABINETE SOCIAL
81
(MEF), Ministerio de Educación (MEDUCA),
Ministerio de Salud (MINSA), y el (la) Director
(a) General de la Secretaría Nacional de Niñez,
Adolescencia y Familia (SENNIAF), quién asistirá
a las reuniones de la Comisión de Alto Nivel con
derecho a voz y llevará las labores de Secretaría.
PEG 2019 - 2024 considera entre sus objetivos
reforzar programas enfocados a la atención de
las familias con la asignación de profesionales
especialistas en promoción de valores, relaciones
familiares y reducción de la violencia; lo mismo
que promover la creación de Centros en las
comunidades para la atención y fortalecimiento
integral de la familia que permitan acciones que
garanticen fortalecer en valores, promover la
salud, la economía familiar y las habilidades para
la vida; lo que se alinea con el Eje Estratégico 4:
Democracia, institucionalidad y gobernanza del
Plan Estratégico Nacional con visión de Estado,
Panamá 2030 (PEN 2030).
Panamá se ha propuesto brindar a las familias
servicios, atenciones, apoyos, y herramientas
que fortalezcan su rol como espacio natural para
el cuidado y sano desarrollo de los niños, niñas
y adolescentes, implementando actividades que
promuevan la comunicación asertiva, crianza
positiva, disciplina no violenta, la reunifcación
familiar, entre otras actividades, desarrolladas a
nivel individual-familiar y a nivel comunitario con
el fn de promover el fortalecimiento del tejido
social y el desarrollo de una sociedad sana, así
como generar una mejor convivencia familiar y
comunitaria.
Las acciones de intervención primaria para esta
población están alineadas y articuladas con la
Estrategia Colmena “Panamá libre de pobreza y
desigualdad, la Sexta Frontera” en este sentido,
la SENNIAF estructura su oferta programática
para brindar los servicios y atenciones en el marco
del desarrollo regional, acercando su oferta en 33
distritos prioritarios para proteger a los niños,
niñas y adolescentes de la violencia, a través del
fortalecimiento familiar y comunitario, integrando
acciones para la prevención del abuso sexual
infantil, lo que permitirá identifcar situaciones de
vulneración de derechos de forma más oportuna
y garantizar su derivación al sistema de atención9
.
El mapeo de los indicadores ODS relacionados
con la niñez y adolescencia muestra avances
positivos de iniciativas y compromisos asumidos
por el Ministerio de Salud (MINSA) con relación
a la elaboración de fchas metodológicas de los
indicadores; la creación de la Comisión Técnica
Nacional para el Monitoreo y Evaluación del
ODS 3; los avances en la implementación del
Sistema Electrónico de Información de Salud
(SEIS); la nueva Encuesta Nacional de Salud
(ENSPA) del año 2019; las acciones que realiza
la Dirección de Epidemiología relacionadas con
el Plan Estratégico Nacional para el Control de
la Tuberculosis 2018 - 2022 (PENTB) y el Plan
Estratégico de Eliminación de la Malaria (PEEM)
2018 - 2022.
Por otra parte, en alianza entre el MEDUCA y el
MINSA apoyados por el Ministerio de Cultura y
Sistema Estatal de Radio y Televisión (SERTV),
se desarrollan acciones para fomentar la
promoción de la salud y las prácticas de estilos
de vida saludable para que desde los jóvenes, se
divulgue y sensibilice en temas relacionados con
la prevención del uso y abuso de alcohol y drogas,
embarazo en adolescentes y enfermedades
de transmisión sexual, así como la depresión,
ansiedad y el suicidio. Un ejemplo de ello es el
concurso de oratoria “Juventud, Somos la Fuerza:
Prevención del Uso y Abuso de Alcohol y Drogas”,
con un alcance regional en el país.
Por otra parte, Panamá cuenta con un Plan
Nacional de Prevención de los Accidentes de
Tránsito basado en cinco pilares: (1) Gestión de
la seguridad vial, mediante la coordinación del
Consejo Nacional de Tránsito y Seguridad Vial
(CONTSEVI) (2) Planifcación, diseño, construcción
y funcionamiento de las vías de tránsito y
movilidad más segura; (3) Mejoramiento continuo
de la tecnología de seguridad pasiva y activa
para lograr vehículos más seguros (4) Cambio
del comportamiento de los usuarios de las vías
de tránsito (educación, vigilancia del uso cinturón
de seguridad, casco, velocidad, alcohol, celular
y otros riesgos) y (5) Aumento de la capacidad ____________________
9 SENNIAF. Nota Técnica 2, Programas de Inversión. Junio 2020.
PANAMÁ, 2020
82
de respuesta a las emergencias y rehabilitación
a mediano y largo plazo, desde la perspectiva
de los derechos humanos, que incluye la
identifcación de los puntos de las carreteras
nacionales donde haya más accidentes para la
señalización correspondiente; promover, por
medio de la Fuerza de Tarea Conjunta un plan de
atenciones de emergencia y respuesta oportuna
de accidentes de tránsito para atender a las
víctimas y disminuir las esperas en las carreteras10.
En este mismo sentido, en octubre de 2019 se
sanciona la Ley 108 que adopta medidas para
la promoción de la educación vial e incluye el
Programa de Educación Vial, que se dictará en los
centros escolares, estará a cargo de: MEDUCA,
MINSA, MOP, IFARHU, ATTT, Sistema Único de
Manejo de Emergencias, Cuerpo de Bomberos,
la Cruz Roja y el SINAPROC.
Se trabaja para lograr una coordinación funcional
y efectiva entre el MINSA-CSS en todos los
niveles de atención hacia un sistema público
de salud integrado por etapas priorizar la red
de atención primaria de salud (primer nivel
de salud, el que está más cerca de la gente) y
reforzar el recurso humano, tales como médicos,
enfermeras, técnicos de enfermería, asistentes
clínicos, asistentes de salud para áreas rurales y
comarcales, y programa de parteras; implementar
programas para resolver la mora quirúrgica y citas
médicas; implementar un sistema moderno de
información (epidemiológica, administrativa,
entre otras) para la toma de decisiones,
estrategias y asignación presupuestaria; así como
crear programas de detección y seguimiento de
enfermedades crónicas, tales como diabetes,
hipertensión, enfermedades cardiovasculares;
fortalecer las intervenciones sanitarias para los
padecimientos de salud mental, como depresión
y ansiedad; implementar a nivel nacional el
expediente y receta electrónica. En el tema
políticas públicas MINSA–CSS, se crea el Programa
para la prevención, tratamiento y control de la
diabetes en el sector salud, se decreta la Ley 136
de marzo de 2020, que las funciones para ello
serán ejercidas por las instituciones de salud a
nivel nacional, tanto en sector público como en
el privado, con el fn de impulsar la formación
de una cultura integral de conocimiento de esta
enfermedad y el autocuidado.
Mediante la Ley 109 de 12 de noviembre de 2019,
se adopta la Política Nacional de Medicamentos
en la República de Panamá, establece principios,
objetivos y estrategias para implementar las
acciones que orienten a la gobernanza de
la autoridad sanitaria, a la promoción de la
producción, disponibilidad, accesibilidad, calidad
y control de los medicamentos para toda la
población. Es de interés fortalecer los Programas
de Sanidad Ambiental, así como fortalecer la
Dirección Nacional de Farmacia y Drogas bajo la
rectoría del MINSA con el propósito de mejorar
los procesos y controles de calidad y seguridad
de los medicamentos, agilizar los procesos de
registros sanitarios; crear y fortalecer las unidades
de cuidados intensivos neonatales en otras
regiones; revisar y reglamentar la Ley de la línea
de auxilio 911 para brindar un servicio oportuno,
con una mejor coordinación interinstitucional
para casos de emergencia; realizar un diagnóstico
de todas las infraestructuras de salud que permita
saber las condiciones físicas, de equipamiento y
de recurso humano.
El programa “RESCATE” para ejecutar los
proyectos sin concluir de infraestructura
hospitalaria, tiene la intensión de remodelar
los hospitales, recuperar los puestos de
salud abandonados dotándolos de equipos,
medicamentos básicos, insumos, personal
adecuado y la energía eléctrica con paneles
solares y cadena de frío; construir nuevos
hospitales; transformar los servicios de salud
con un enfoque de gestión en los usuarios,
equidad, calidad, seguridad y calidez utilizando
tecnología innovadora.
El uso de la inteligencia artifcial es un recurso que
se pretende implementar, en los primeros 3 años,
a través del programa “Salud Digital”, a través
de sistemas electrónicos homologados entre
MINSA-CSS, que permitan reducir al mínimo la
espera en la atención de servicios de salud. Esto ____________________
10 Plan Nacional para el Decenio de Acción para la Seguridad Vial 2011-2020 de la República de Panamá. ATTT, MOP, OPS/OMS, PN, Consejo Nacional de Tránsito y
Seguridad Vial (CONTSEVI).
II INFORME NACIONAL VOLUNTARIO
SECRETARÍA TÉCNICA DEL GABINETE SOCIAL
83
incluye universalización de los sistemas de citas,
expediente electrónico único del sistema público
de salud, recetas de medicamentos electrónicas
y otros.
El Programa “Panameño Sano, Panameño
Feliz” trata de la estrategia de atención primaria
de salud en las comunidades instaurando un
programa de estilo de vida saludable (atención
preventiva, nutrición, deporte y recreación) con
la participación de los municipios. El Programa
“Mi Salud, Mi Decisión, Mi Futuro” es un portal
web ciudadano y con uso de dispositivos
móviles (celulares, tabletas) con información y
recomendaciones de salud para la prevención de
enfermedades.
En Panamá, es innovador la regulación de la
zooterapia como actividad terapéutica para
mejorar el desenvolvimiento biopsicosocial, la
salud emocional y física de toda la población en
especial de los pacientes niños, niñas y personas
con discapacidad, a través de la Ley 137 de 23 de
marzo de 2020 que crea el Programa de Provincial
de zooterapia. El programa establece centros o
sedes en las cabeceras provinciales del territorio
nacional y tendrá la función de implementar la
metodología terapéutica, educacional y deportiva
complementaria a través de terapias tradicionales
o convencionales asistidas con animales. El
MINSA será el responsable de la aplicación de
esta ley, procurará registros obligatorios de todas
las instituciones públicas o privadas dedicadas a
la zooterapia y brindará las capacitaciones para
el conocimiento técnico-científco en las áreas de
salud, educación y deporte para los pacientes.
El Plan Estratégico del Servicio de Salud (2019-
2024) con visión de Estado, fue elaborado con
un enfoque integral, de equidad, calidad, con
las adecuaciones necesarias, con énfasis en la
Atención Primaria de Salud y Enfoque Sanitario.
Prevé establecer el Observatorio “Atención
Pronta” a la lista de espera de cirugías, de citas
y procedimientos, consultas priorizadas para
agilizar la atención y promoción de salud en línea.
También iniciar un plan piloto de “Centros de
Vejez Saludable” esto es un hospital de segundo
nivel de complejidad.
Con respecto a insumos y medicamentos, se
propone crear las condiciones de disponibilidad
de medicamentos y mejores precios; crear el
Centro Nacional de Compra de Medicamentos
e Insumos; promover el uso de medicamentos
genéricos bioequivalentes de calidad; optimizar
el uso de medicamentos, aplicando las guías y
protocolos institucionales, establecer una sola
normativa de adquisiciones de medicamentos
para todo el Estado. Ello implica revisar la Ley
1 de 2001 de medicamentos asegurando la
calidad, seguridad y efcacia de los mismos
y otros productos para la salud humana y su
reglamentación; revisar periódicamente la lista
homologada de medicamentos para todo el
Estado y la canasta básica de medicamentos, para
que los panameños tengan sus medicamentos y
evitar compras directas a sobreprecios al Estado,
se realizarán compras únicas de medicamentos
e insumos para el sistema público de salud con
precios de referencia, a través de un “Centro
Nacional de Compra de Medicamentos e
Insumos” incluyendo la opción de comprar a
través de organismos internacionales como la
OPS y UNOPS.
Para un abastecimiento efectivo de los
medicamentos, se pondrá en ejecución los
programas logísticos y tecnológicos (por ejemplo:
LOGHOS), para una mejor planifcación y un
efectivo control del inventario desde las órdenes
de compra, recibo en depósito y la entrega
de medicamentos al paciente; “Farmacias
Populares” en los barrios y comunidades, para
ofrecer medicamentos de calidad y seguridad,
a precios accesibles, privilegiando el uso de
medicamentos genéricos bioequivalentes; para
promover la competencia y reducir los precios,
se les dará trámite expedito a los medicamentos
aprobados por FDA de Estados Unidos y EMA de
la Unión Europea.
Se creará el Observatorio Panameño de
Medicamentos en coordinación con la Autoridad
de Protección al Consumidor y Defensa de
la Competencia (ACODECO), ampliando la
Canasta Básica de Medicamentos (CABAMED)
se ha de crear la aplicación “MedicAppPanamá”,
para la búsqueda y compras online de precios y
PANAMÁ, 2020
84
disponibilidad de medicamentos, a fn de que
las personas sepan en cuál farmacia pueden
encontrar los medicamentos más económicos
del mercado, incluyendo las alternativas de
genéricos y/o bio-equivalentes disponible.
Con ello se busca promover la inversión de la
industria farmacéutica nacional e internacional
para fomentar la fabricación de medicamentos
en Panamá (Hub Farmacéutico).
Otros temas incluyen acciones como crear el
Programa “Estamos Contigo” el que consistirá
en establecer un fondo para un plan piloto en
atención a las personas adultas mayores con
enfermedades que los mantengan encamados
o que no puedan valerse por sí solos para
recibir atención domiciliaria, medicamentos,
movilización y cuidados paliativos, previa
evaluación socioeconómica. Crear un fondo para
un plan piloto de apoyo a las familias para enfrentar
la tragedia ante Enfermedades Catastrófcas,
(atención domiciliaria, medicamentos,
movilización, cuidados paliativos); monitoreo del
mercado de salud privado en cuanto a seguros
médicos y la atención oportuna y adecuada
de los reclamos por servicios de urgencia,
hospitalización y medicamentos. Crear el Centro
de Geriatría moderno en las instalaciones del
actual complejo hospitalario una vez terminada la
construcción de la Ciudad de la Salud.
El establecimiento de un programa de salud
pública, higiene, salud y seguridad ocupacional
especializada para el sector educativo, que tome
en cuenta el contexto y que de manera continua
se encargue del estudio, prevención, diagnóstico
y atención integral de la salud física, mental y
social de estudiantes, docentes y administrativos.
Construir las nuevas Facultades de Medicina y
Enfermería en coordinación con la Universidad de
Panamá; así como, coordinar con las universidades
existentes la formación del recurso humano que
requiere el Sistema Nacional de Salud.
Para los servicios de atención de pacientes con
cáncer, como política de salud pública, a través
de la Ley 154 de 13 de mayo de 2020 se crea
el Programa Nacional de Apoyo, Prevención y
Atención Integral para las Personas que padecen
Enfermedades Oncológicas, que consiste en
brindar las facilidades para que el paciente o
enfermo reciba atención o tratamiento en un
hospital o centro hospitalario de salud pública,
en cuanto a gastos de hospedaje, transporte,
alimentación, exámenes, medicamentos
prescritos (10% de descuento) y cualquier
otro resultado de la enfermedad, inclusive
los gastos de la persona que lo acompaña.
Garantizar los cuidados paliativos del enfermo
para ello se establecerá un Fondo Especial para
los Benefciarios del Programa para Personas
con Enfermedades Oncológicas en cada junta
comunal de los municipios, un aporte económico
a nivel nacional. El MINSA, en coordinación con
CSS y el Instituto Oncológico Nacional crearán un
registro digital de datos del paciente o caso. Se
espera crear el “Sistema Nacional de Atención
al Paciente Oncológico” que cumpla con los
estándares del Instituto Oncológico Nacional,
incluyendo la construcción de otros centros
hospitalarios y de atención en algunas regiones
y ampliar el apoyo a los centros de la ANCEC a
nivel nacional.
Además, se espera incrementar las estrategias
de prevención y promoción de salud para reducir
los casos de VIH/SIDA y una mayor cobertura
de atención de las clínicas antirretrovirales, en
colaboración con algunas organizaciones no
gubernamentales. Para ello, se frmó la Resolución
363 de 1 de abril de 2020 que establece el Plan
Nacional para la Eliminación de la Transmisión
Materno Infantil del VIH y la Síflis Congénita, el
cual integra todas las estrategias y acciones y sirve
de guía para todo el personal de salud pública
involucrado en la atención de embarazadas
y personas viviendo con VIH, este plan es de
estricto cumplimiento en todas las instalaciones
de salud pública del territorio nacional.
En materia de salud básica para hacer
desaparecer toda causa de enfermedad
comunicable o mortalidad especial, así como el
control de todo factor insalubre de importancia
local producida por vectores se establece el
Decreto Ejecutivo No. 526 de 09 de abril de 2020
que modifca el Decreto Ejecutivo No. 180 de 08
de junio de 2018 que crea la Comisión Nacional
Intersectorial e Interinstitucional de Estrategia
de Gestión Integrada Anti-Aedes (EGI-Aedes)
II INFORME NACIONAL VOLUNTARIO
SECRETARÍA TÉCNICA DEL GABINETE SOCIAL
85
y otros vectores que afecten la salud pública.
La EGI-dengue está implementada en el país a
nivel de todas las regiones de salud y dentro del
plan maestro mesoamericano para la prevención
y control del Dengue/Chikungunya/Zika. En
epidemiología se logra una notifcación semanal
de los casos con la publicación de boletines
epidemiológicos semanales para estos arbovirus.
En lo relacionado a promoción de la salud,
se ha logrado alianzas estratégicas con los 14
diferentes sectores (políticos, ONGs, comunidad),
la formación activa y permanente de la comisión
Intersectorial tanto a nivel nacional, regional y
local así como la organización del día D (post
Covid-19) en todas las regiones sanitarias del
país. En el componente de atención al paciente
se han realizado capacitaciones con base en
la guía clínica de OPS, se realizan auditorías en
todo caso de defunción sospechosa por dengue
y se cuentan con un plan de contingencia para
el manejo de casos en situaciones de brotes y
epidemias11.
Salud y Desarrollo
El desarrollo infantil temprano requiere intervenciones sistemáticas, integrales y articuladas
en protección social, salud, educación, nutrición, protección especializada e identidad para
todos los niños desde su gestación.
Panamá, a través del Ministerio de Desarrollo Social, presentó un proyecto de ley para la
protección de la Primera Infancia con el fin de promover los derechos fundamentales de esta
población prioritaria (0 a 8 años) respetando los principios de no discriminación, de
prevalencia del interés superior del niño y la niña, de derecho a la vida, supervivencia y
desarrollo y el principio de participación y derecho a ser escuchado.
Por otro lado, el país también reafirmó su compromiso protector de los derechos de niños,
niñas y adolescentes adoptando el “Plan Maestro para la Salud durante la Primera Infancia
2018-2025” del Ministerio de Salud, cuyo fin protector enfatiza la promoción de la salud, la
calidad de vida y prevención de enfermedades, satisfaciendo las necesidades particulares de
cada etapa del ciclo de vida. En materia de nutrición, se han realizaron diversas intervenciones
en los determinantes sociales de la salud específicamente en la promoción de estilos de vida
saludables. El Programa de Alimentación Temprana Materno Infantil contribuye a mejorar el
estado nutricional de niños de 6 a 59 meses de edad, embarazadas, madres lactantes que
acuden a sus controles de salud, en la red de servicios del Ministerio de Salud, beneficiando
a 31,866 niños entre 6-24 meses a 10,631 infantes entre 25-59 meses y 12,868 embarazadas.
En cuanto a detecciones tempranas, el país lleva a cabo el Plan de Diagnóstico y Tratamiento
Oportuno de Trastornos del Neuro-Desarrollo, que se implementa con el objetivo de mejorar
la detección e intervención temprana de trastornos del Neurodesarrollo para ello, se
fortalecieron las competencias de 140 funcionarios que atienden niños entre 0 a 5 años de las
regiones de salud de Panamá Centro y San Miguelito, así como entrega de equipos básicos
para la atención. La atención especializada cuenta con el Centro Ann Sullivan Panamá
(CASPAN) que apoya a niños con autismo y otras condiciones de discapacidad cognitiva, sus
familias y la comunidad; el Centro Nacional de Cirugía de Epilepsia permitirá que se realicen
evaluaciones y diagnósticos más certeros también apoyará en mejorar las funciones
deterioradas y evitar un mayor daño cognitivo en los pacientes que viven con esta condición.
Recientemente con la sanción de la Ley 147 de 15 de abril de 2020, se garantiza a los niños y
niñas menores de 18 años quienes padezcan leucemia, cáncer o enfermedades
degenerativas, en estado grave o terminal, que sus padres o guardas quienes laboren en el
sector público o privado, tendrán derecho a licencia laboral especial y remunerada para
ejercer los cuidados que necesitan.
Fuente: Ministerio de Salud.
Recuadro No. 4.
____________________
11 Pérez, Carmen. Seguimiento de la Estrategia de Gestión Integrada para la Prevención y el Control del Dengue en el Marco de Transición hacia el Manejo Integrado
de las Arbovirosis. Salubrista Epidemiología-Región Metropolitana de Salud Ministerio de Salud de Panamá, Informe de reunión OPS, OMS. 2017.
PANAMÁ, 2020
86
• Desafíos
Aunque son importantes los avances de
acciones públicas en apoyo al logro del ODS
3, el Covid-19 ha evidenciado la necesidad de
hacer transformaciones en el sistema de salud
panameño para ser más efciente, efectivo,
seguro y que a la vez que permita robustecer la
capacidad de respuesta.
Está claro que aún persisten desafíos en varios
temas, principalmente en las comarcas indígenas,
tales como la Salud Materna que históricamente
muestra los mayores rezagos y desigualdades
sociales y económicas afectando a las mujeres
y niñas. Es un desafío mejorar la oferta en salud
mediante la incorporación de elementos que
den cuenta de la interculturalidad, así como
desarrollar planes concretos, fortalecer la
educación, reducir los factores de riesgo y mejorar
los servicios básicos con la participación de la
comunidad para contribuir a cerrar las brechas
existentes. El cuidado y manejo del agua para
evitar enfermedades y de suma importancia es el
tema del mejoramiento sustancial del transporte
público y el acceso a áreas distantes.
Continúa el desafío de enseñar y orientar a los y
las adolescentes sobre la salud y lo derechos de
salud sexual y reproductiva y la educación para
la planifcación y la vida familiar. En ese caso,
Panamá debe actualizar el Plan Nacional de Salud
Sexual y Salud Reproductiva e incorporar, dentro
de la currícula educativa, la educación integral
en sexualidad, fundamentada en Derechos
Humanos, lo mismo que el uso productivo del
tiempo libre.
Derecho a una Salud Integral
Los niños, niñas y adolescentes son las principales víctimas de delitos contra la libertad e
integridad sexual. Según el Ministerio Público en 2018 la tasa de maltrato de niños, niñas o
adolescentes fue de 214 por cada 100 mil habitantes, tres veces mayor que la observada el
año 2015 (69 por cada 100 mil), lo que evidencia la urgencia de una política pública en materia
de Educación Integral en Sexualidad, y de un Sistema de Protección Integral para este grupo
de atención prioritaria (1).
El Estado, en algunas ocasiones para poder establecer políticas públicas sobre temas
sensitivos a la sociedad debe superar tensiones y objeciones a través de estrategias de
negociación, divulgación y concienciación. En Panamá, este es el caso de la salud sexual y
reproductiva dirigida a niñas, niños y adolescentes que, como política pública, viene
evolucionando en un marco de tensiones culturales e ideológicas profundas que algunos
sectores de la sociedad han cuestionado el deber y la facultad del Estado para regular esta
materia. Sin duda, representa un desafío no menor para el país del que se hace eco el Plan
Estratégico de Gobierno al señar que “cada 50 minutos, nace un niño de una madre
adolescente. Ya es hora de que nos pongamos de acuerdo con la educación sexual"(2).
Recuadro No. 5.
II INFORME NACIONAL VOLUNTARIO
SECRETARÍA TÉCNICA DEL GABINETE SOCIAL
87
El Ministerio de Salud cuenta con el Programa Nacional de Salud Integral de la Mujer cuyo
objetivo es asegurar la elaboración de las normas para la atención integral de la salud sexual
y reproductiva y su cumplimiento a través de acciones de atención, promoción, vigilancia
epidemiológica, de gestión sanitaria en salud sexual y reproductiva y del monitoreo en las
instalaciones de salud.
El MINSA también cuenta con el Programa Nacional de Niñez y Adolescencia, cuyas normas
técnicas y administrativas mandatan que la atención a los y las adolescentes deben ser
amigables y de calidad; de esta normativa nacen los Servicios de Salud Amigables para
Adolescentes (SSAA), que cuentan con apoyo técnico del UNFPA. Los SSAA son un programa
multicomponentes: tienen los componentes de atención, educación, familia, ciudadanía y
calidad que están basados en las demandas y necesidades de salud de las y los adolescentes
con enfoque de derechos, equidad e interculturalidad, donde adolescentes intercambian
experiencias sobre estilos de vida saludables por medio de dinámicas participativas y de
integración grupal, actividades lúdicas, exposición dialogada de temas seleccionados, socio
dramas y presentaciones culturales. Al 2019, existen 102 SSAA, de las que 99 pertenecen al
MINSA y 3 a la CSS.
Por su parte, el Ministerio de Educación ha preparado 5 guías o documentos pedagógicos,
sensible a las diferencias cognitivas por ciclo de vida, con la colaboración de instituciones
como SENNIAF, MINSA, MIDES, INAMU, CSS, APLAFA, grupos de padres de familia, Pastoral
Educativa de la Iglesia Católica, docentes de grado, supervisores y personal técnico de
MEDUCA para implementarse durante el 2020 con los estudiantes de todos los niveles y
condición
.
Fuentes:
(1) Ministerio de Seguridad (MINSEG), Dirección del Sistema Nacional Integrado de Estadísticas Criminales.
(2) Plan Estratégico de Gobierno 2020-2024, “Uniendo Fuerzas”. pp. 162
En el tema de enfermedades transmisibles para la
población en general, continúa siendo un desafío
defnir estrategias que permitan garantizar
que la fnanciación de los programas se asigne
correctamente y respalde las intervenciones
más efcaces, incluida la investigación de
maneras innovadoras de prevenir las nuevas
infecciones. Para establecer sistemas integrados
que vinculen a las personas con atención clínica
inmediatamente después del diagnóstico y
apoyar la retención de pacientes para conseguir
la supresión viral y así maximizar los benefcios
del tratamiento temprano y reducir el riesgo de
adquirir. También, complementar los servicios
de atención con políticas incisivas como apoyo
para las necesidades básicas a fn de promover
una vinculación oportuna con la atención del
VIH y la retención de los pacientes, así como
indicadores para medir el progreso. Apoyar la
atención integral, coordinada y centrada en el
paciente para las personas que viven con el VIH,
que incluye atender las condiciones concurrentes
relacionadas con el VIH y la problemática de
satisfacer las necesidades básicas, como la
vivienda.
Es necesario fortalecer y revisar el Programa de
Acompañamiento Familiar, a través del Promotor
Social de la Red de Oportunidades (RdO), con el
objetivo de mejorar y consolidar la relación entre
los hogares benefciarios y el programa para
que estos aprovechen las acciones de la RdO y
cumplan con las corresponsabilidades y logren
salir del círculo de la pobreza.
Es un gran reto también reforzar y abastecer las
instalaciones de salud con los medicamentos
indispensables, el mantenimiento de equipos
PANAMÁ, 2020
88
médicos, equipo rodante y telemedicina; así
como, el desarrollo de la electrifcación rural (para
comunidades, instalaciones de salud y escuelas)
con ello se podría ampliar la cobertura del control
prenatal en los corregimientos de la Comarca,
mejorando la calidad y calidez de los servicios
básicos y capacidades del equipo de salud,
reducir la morbimortalidad materna y perinatal
para mejorar el diagnóstico, prevención, control
y atención del embarazo y el parto.
Los retos ante la EGI-Aedes y otros vectores implica
realizar la rotación de insecticidas, fortalecer la
capacitación de personal técnico, distribución
de los insumos e información a la población;
fortalecer el apoyo de los gobiernos locales en
las intervenciones que desarrolla el sistema de
salud, entendiendo que la salud y la enfermedad
no son responsabilidad solo del sector salud sino
de todos; realizar investigaciones operativas que
permitan desarrollar modelos donde se refeje la
motivación de la comunidad y la transmisión de
mensajes preventivos12.
Continúa siendo un reto mejorar la coordinación y
articulación intersectorial e intrainstitucional para
unifcar sistemas de información en materia de
primera infancia, estado nutricional y la cobertura
de inmunización de menores de un año13.
Los resultados de la consulta indican que para el
ODS 3 las instituciones públicas consideran que
en primer lugar se encuentra la meta 3.1 Reducir
la tasa mundial de mortalidad materna a menos
de 70 por cada 100.000 nacidos vivos; para la
empresa privada prioriza la meta 1.2 Poner fn a
las muertes evitables de recién nacidos y de niños
menores de 5 años, logrando que todos los países
intenten reducir la mortalidad neonatal al menos
a 12 por cada 1.000 nacidos vivos y la mortalidad
de los niños menores de 5 años al menos a 25
por cada 1.000 nacidos vivos; mientras que las
organizaciones de la sociedad civil se inclinaron
por la meta 3.8 Lograr la cobertura sanitaria
universal, incluida la protección contra los
riesgos fnancieros, el acceso a servicios de salud
esenciales de calidad y el acceso a medicamentos
y vacunas inocuos, efcaces, asequibles y de
calidad para todos.
____________________
12 Pérez, Carmen. Seguimiento de la Estrategia de Gestión Integrada para la Prevención y el Control del Dengue en el Marco de Transición hacia el Manejo Integrado
de las Arbovirosis. Salubrista Epidemiología-Región Metropolitana de Salud Ministerio de Salud de Panamá, Informe de reunión OPS, OMS. 2017.
13 UNICEF, hoja de Ruta de articulación y fortalecimiento de Sistemas de Información enfocados en la Niñez y Adolescencia en Panamá, marzo de 2020.
|
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[
3
] |
{
"country": "pan",
"file_id": "sdg-03/vnr-report-pan-2020-es-6.pdf",
"language": "es",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
27
28
A major accomplishment on health is the reduction of out-of-pocket spending, as a
percentage of total health expenditure from 45 percent in 2016 to about 40 percent in
2020. This is largely due to the Universal Health Care (UHC) enacted in February 2019.
However, the other health outcomes have slightly worsened. By 2021, the number of
newly diagnosed HIV infections per year increased by 33.5% from 2016. per year.
This brings the number of new cases per year from 9,238 in 2016 to 12,341 in 2021.
The overall mortality rate attributed to non-communicable diseases has also stagnated
from 2016 to 2020. The mortality rate attributed to cardiovascular disease slightly
worsened from 2.7 percent in 2016 to 2.8 percent in 2020; the mortality rate attributed
to diabetes has stagnated at 0.6 percent during the same time frame; and the mortality
rate attributed to cancer and chronic respiratory disease has improved by 0.1 percent,
bringing the mortality rates down to 1 percent and 0.2 percent, respectively. (see Table
1).
Table 1.Progress on Goal 3: Ensure healthy lives and promote well-being for all at all ages
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13
SDG 3 includes 12 targets. Some (e.g. maternal mortality and
communicable diseases), reflect continuing commitment to the
unfinished work of the Millennium Development Goals
(MDGs). Others (e.g. child health) expand on MDG achievements and still others, such as 3.8 (universal health coverage), 3.4 (non-communicable diseases and mental health),
and 3.A. (tobacco control), reflect a higher ambition to address
underlying determinants of health and well-being.
Palau incorporates 8 of the 12 SDG 3 targets into the national
SDG framework plus one Pacific Regional target carried forward from the MDGs (measles immunization).3
Maternal and Reproductive Health
SDG 3.1, 3.7, 5.6
Target 3.1 addresses maternal mortality and is closely linked
to SDG Targets 3.7 and 5.6 (universal access to sexual and
reproductive health services) which have been achieved by
3 Color code: Blue (achieved); Green (on-track); Yellow (progressing); Red (off-track); Grey – lacks data.
Palau. All births take place at Palau National Hospital under
the supervision of skilled health personnel and in most years,
there are zero maternal deaths. A full range of family planning
services are available through the Bureau of Public Health at
no cost and without restrictions due to age, ethnicity, or marital
status. Contraceptives are also available through private clinics and pharmacies. Completed fertility rates are stable at 2
births per woman (MOH, Title V, 2017; MOH, 2014). On average 22 percent of births occur to women 35 years of age or
older but less than 8 percent occur to women 15-19 years of
age yielding an Adolescent Birth Rate of 27 (Statistical Yearbook, 2017 and Census, 2015). The major maternal health
risk factors identified by the Ministry of Health include (a) older
mothers; (b) pre-existing health issues including obesity; (c)
delayed enrollment in prenatal care; and (d) use of betel nut
with tobacco during pregnancy (MOH, Title V, 2017; MOH,
2014).
Child Health
SDG 3.2 and P.3.1
Target 3.2 addresses infant and child health, also integrated
across SDG 3 and in targets 2.1 and 2.2. Neonatal mortality
(deaths in the first 28 days f life), infant mortality (deaths under
1 year), and under-5 mortality have declined continuously over
recent years so that Palau has already met the SDG child
mortality targets for 2030.
Over the 20-year period, 1996-2015, the number of infant
deaths in Palau ranged from an annual low of one to a high of
Health and Well-Being
Ensure healthy lives and promote well-being for all at all ages
SDG 3.1
Maternal mortality
SDG 3.2
Child deaths
SDG 3.3
Communicable
diseases
SDG 3.4
NCDs & mental
health
SDG 3.5
Substance abuse
SDG 3.7
Reproductive
health
SDG 3.8
Universal coverage
SDG 3.A
Tobacco (FCTC)
Well-being
The words “and promote well-being” were incorporated into
SDG 3 at the behest of Palau’s former Ambassador to the
United Nations, Dr. Caleb Otto. Speaking before the UN, he
noted, “there are three basic components of the human
being: the body, the mind, and the soul. The well-being of
human beings is optimum only when all three of these component parts are healthy.” He goes on to explain that this
concept of holistic health is recognized in the Palauan language by the many words that contain “reng”, Palauan for
“heart” (25 September 2016)
SDG P.3.1
Measles
Immunization
14
eight (average four deaths per annum) yielding a 20-year
average 17 deaths per 1,000 live births, a rate that is still high
for a high-income country. Analysis is hampered by the low
number of births which means that one additional death from
one year to the next can cause a massive change in the rate.
Palau’s measles vaccination rate for children 12-23 months
of age was 96 percent in 2017 (The World Bank Group,
2017). The overall immunization rate for all childhood vaccines was estimated by MOH as 67.5 percent (2015). The
national goal is to raise immunization coverage across all
antigens to 95% by 2022 (MOH, MCH State Plan, 2017).
Communicable Diseases
SDG 3.3
Communicable diseases represent a relatively small proportion of Palau’s overall health burden but still require continuous surveillance and aggressive management.
Although the number of HIV/AIDS cases is low (14 HIV+ diagnoses between 1989 and 2017), one of the challenges is a
high level of stigma and discrimination related to HIV/AIDS.
There are no laws or policies, however, that hinder access to
treatment. Sexually transmitted disease rates, especially
Chlamydia, remain high and surveys show high levels of risky
sexual behaviors (multiple partners and inconsistent use of
condoms) thus necessitating ongoing education and surveillance. Tuberculosis incidence is high by the standards of highincome countries but is about half the rate of the Pacific Island
Region and most cases are imported. These data underscore
the need for ongoing surveillance and aggressive case management. Palau has recently been certified as free of lymphatic filariasis, a Neglected Tropical Disease included in SDG
3.3. Malaria is not present in Palau. Dengue fever, a mosquito-borne disease associated with climate change, is a Palau
health priority, but is not included among SDG targets. A Palau-specific target and indicator for dengue fever will be developed for future monitoring and reporting.
Non-Communicable Diseases (NCDs)
SDG 3.4
Target 3.4 addresses the “Big Five” NCDs – cardiovascular
diseases, cancer, diabetes, chronic obstructive lung diseases,
and mental health disorders. Target 3.4 is closely linked to
Target 3.5 (substance abuse disorders) and 3.A (tobacco
control). NCDs are at epidemic levels in Palau and account for
80 percent of all deaths and for low life expectancy, especially
for men (57.6 years) in comparison to women (74.5 years)
(MOH, 2014). Palau has one of the world’s highest rates of
schizophrenia together with high rates of depression (MOH,
2014).
NCDs are a driver of poverty and inequality and threaten to
undermine socio-economic progress. Combating NCDs requires action not just on SDG 3 but across multiple SDGs—1
(poverty), 2 (food and nutrition), 4 (education), 5 (women), 6
(water and sanitations), 8 (economy), 10 (inequality), 11 (cities
and local government), 13 (climate), 14 (oceans), 15 (land), 16
(justice and strong institutions), and 17 (partnerships).
Strengthening Health Systems
SDG 3.8
An effective and efficient health system accessible to all at
affordable cost is a prerequisite for achieving SDG 3 targets
as well as targets under other Pillars. Target 3.8 calls for universal health coverage with financial risk protection.
Healthcare in Palau is provided by the government through
the Ministry of Health supplemented by private clinics (three
medical, two dental, two optical, and one physical therapy
facility) and visiting specialty teams sponsored by Palau’s
partners in health – Japan and the US among others. The
Ministry of Health provides comprehensive primary, secondary, and limited tertiary services in Koror and nationally
through a network of nine Community Health Centers (CHC).
Except in the sparsely populated states of Hatohobei and
Sonsorol (2015 population of 65) served intermittently by visiting health teams traveling by ship from Koror, all Palau residents live within one-half hour travel time to a primary care
facility.
Monitoring Health Trends:
Challenge of Small Numbers
Palau’s small population creates challenges for monitoring
health trends. Using the maternal mortality ratio as an example, in most years, Palau reports no maternal deaths. In
any population, however, a maternal death will occur from
time-to-time. The difference of one death is considerable
when translated into rates.
0 deaths = MMR of 0
1 death = MMR of 469
With one death, Palau can go from a top-performing country to one of the worst performing countries. To address
this issue, five-year moving averages are used to more
accurately monitor trends.
15
The Palau Constitution mandates government, through the
Ministry of Health to provide free preventive health services
and subsidized health care for citizens. To implement these
provisions sustainably, the Palau Healthcare Fund (HCF) was
established in 2010 and consists of two components, individual Medical Savings Accounts (MSA) and a pooled universal
social health insurance fund commonly known as National
Health Insurance (NHI). These components are funded
through mandatory contributions on earned income (2.5 percent of earnings contributed by the employee and matched by
an equal contribution by the employer). NHI complements
MSA by providing coverage for catastrophic illnesses and offisland referrals approved as medically necessary by a Medical
Referral Committee established within the MOH. Government
pays the MSA premiums for unemployed senior citizens and
the severely disabled using funds earmarked for this purpose
from tobacco taxes. With this, Palau has largely achieved
Universal Health Coverage. HIES data show that less than 2
percent of average household expenditures are for health
suggesting that the HCF is achieving financial risk protection
(HIES, 2014).
Examples of Actions Taken
Maternal and child health: (1) life cycle approach healthy
girls – healthy mothers – healthy babies; (2) universal access
to reproductive health services and family planning; (3) promotion of early prenatal care; (4) promotion of tobacco and alcohol cessation.
Communicable diseases: (1) active surveillance and education among at-risk groups; (2) contact tracing; (3) aggressive
patient management including anti-retroviral therapy (HIVAIDS) and Directly Observer Treatment Short-Course (tuberculosis); (4) supported by inputs from the Global Fund, pointof-care testing using the SD Duo test kit, is offered for key
populations (men who have sex with men, transgender women, and sex workers) who are being reached with HIV prevention information and tested for HIV and syphilis, counseled,
and referred for care; (5) review and updating of the national
HIV/STI guidelines are in line with the latest WHO guidelines
for HIV testing, STI diagnosis, treatment, and management.
Non-communicable diseases: (1) Presidential Executive
Order 295 (May 2011) declared a state of emergency and
directed a whole-of-government approach to addressing the
NCD crisis; (2) this approach was expanded to a whole-ofsociety strategy by Executive Order 379 (2015); (3) National
NCD Strategic Plan (2015-2020) developed with progress
closely monitored; (4) health promoting schools and workplaces where “healthy choices are easy choices”; (5) although
measurable indicators progress are mixed (2014-2018), significant progress is noted in hypertension rates (down from 49 to
30 percent of adults, 2014-2017).
Tobacco control: (1) Many years of tobacco education and
advocacy by Government in partnerships with the NGO, Coalition for a Tobacco Free Palau; (2) Comprehensive Tobacco
Act enacted in 2011 put effect to the WHO FCTC with
amendments now pending to update and further strengthen
implementation and enforcement; in 2013 the minimum age of
sale of cigarettes was raised from 19 to 21 and the tobacco
tax increased in 2014 and 2015 with excise tax now reaching
over 70% of the retail price; 10% of tax revenue set aside for
community engagement in NCD control.
Strengthening health systems: The health sector’s vision for
2030 and beyond is “healthy communities with access to high
quality healthcare services”. This vision is supported by a
health plan (MOH, 2014-2018) that prioritizes five strategic
objectives: (1) provide accessible and high-quality patientcentered hospital services; (2) provide accessible and high
quality primary and preventive health services; (3) ensure
effective partnerships are developed and maintained; (4) value
Whole of Government and
Whole of Society Approach to NCDs
Palau is one of the first countries to implement a holistic
approach to NCD prevention. Executive Order No. 379
(May 2015) established a multi-sectoral National Coordinating Mechanism on NCDs that includes civil society, A 2016
public law (RPPL 9-57) allocated 10 percent of combined
alcohol and tobacco taxes for NCD action by communities
and civil society thus supporting direct community engagement in resolving the NCD crisis.
Featured Partnership:
Ministry of Health and Coalition for a Tobacco Free
Palau (CTFP)
Since establishment in 1995, the Coalition for a Tobacco
Free Palau has partnered effectively with the Ministry of
Health to support and advance tobacco control policy and
legislation In the early 2000s, the partnership focused on
ratification of the WHO Framework Convention on Tobacco
Control (FCTC). Since the Treaty came into effect in 2005,
and recognizing it as “an accelerator for sustainable development”, the partnership has focused on its implementation.
16
the health workforce and support their continuing growth and
development; (5) ensure that administrative and support services are accountable and sustainable. Strategic objective #5
includes continued work to strengthen Health Management
and Information Systems in support of the SDGs.
Pathways to 2030
While it is critical to maintain progress across all health targets, NCDs, inclusive of mental health issues, are clearly the
priority for the coming decade. The NCD Plan and associated
architecture is an excellent start but progress must be accelerated with more focus on policy measures that “make healthy
choices, easy choices”.
Closing gaps
Continued strengthening of sexual and reproductive
health services.
Focus on preventing NCDs in early childhood starting
pre-conception through the school years; encourage
healthy food choices beginning with exclusive breastfeeding for the first six months of life.
Adopt measures that make tobacco less affordable and
enact amendments to tobacco control legislation that
strengthen implementation and enforcement of the WHO
FCTC.
While considering new policy measures to address NCDs
(e.g. taxes on unhealthy food imports), strengthen enforcement of existing legislation, especially tobacco and
alcohol.
Improving quality and reach
Adopt internationally validated best practices to strengthen tobacco, alcohol, and substance abuse services.
Change social norms around tobacco and alcohol.
Strengthen law enforcement measures to control the
import of illicit drugs (see SDG 16).
Building resilience
Address the health impacts of climate change including
the increasing risk of vector borne diseases (e.g. dengue
fever and leptospirosis), health impacts of droughts and
natural disasters, and on mental health.
Palau has a well-developed public health system, but
most services are funded by U.S. federal grants available
through the Compact of Free Association; looking forward to possible reductions in US Compact Funding in
2024, more domestic resources need to be invested in
public health to build sustainable futures.
As Palau has acknowledged with the NCD Coordinating Mechanism, action against NCD cuts across many SDGs inclusive of SDG 2 (food and nutrition), SDG 4 (education), SDG 6
(water and sanitation), SDG 8 (economic growth and decent
work), SDG 13 (climate action), SDG 14 (oceans), SDG 15
(land and forests), SDG 16 (justice and strong institutions),
and SDG 17 (partnerships).
Progressing with the Past:
Palauan Medicine
Traditional medical practices have evolved over millenniums and include ethno-biology (plants, leaves, and vines)
and massage. Traditionally medical arts were considered
to be secret knowledge to be closely guarded and passed
through family lines. In recent years, western and traditional practitioners have begun to collaborate. A Palau Primary
Health Care Manual has been published and rigorous
scientific research initiated to validate some traditional
medicines. In one particularly promising clinical trial, the
Palauan medicinal plan “Ongael” or “Delal a Kar” has been
shown to be effective in treating diabetes mellitus. A local
organization – Pacific Academic Institute for Research –
has spearheaded this study, as well as others, in partnership with Palau Community College.
Passage of legislation in 2018 to Create a national framework for access and fair and equitable sharing of benefits
of genetic resources and traditional knowledge associated
with genetic resources (RPPL 10-28) sets out a procedure
for creating access and benefit sharing agreements to
protect traditional knowledge, the knowledge holder, and
ensure equitable distribution of benefits arising from any
use of that knowledge. This bill is an essential foundation
for encouraging further scientific research into Palau’s
living traditional medical legacy.
Delal a Kar has
shown promise for
treating diabetes.
(Photo credit Dr.
Chris Kitalong)
|
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[
3
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{
"country": "plw",
"file_id": "sdg-03/vnr-report-plw-2019-en-2.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2019
}
|
28 29
SDG 3. GOOD HEALTH
AND WELLBEING
Ensure healthy lives and promote well-being
for all at all ages
Overview
The health sector has remained GoPNG’s priority over the
years. It has brought in primary health care services guided
by free primary health care and subsidised specialist service
policies, aimed at achieving the National Health Plan 2011-
2020, MTDP III, DSP, Vision 2050 and the SDG 2030 Agenda,
as well as the overall aim of universal coverage across
the country. The annual budget allocation has consistently
increased and in 2019, government funding was PGK1.8
billion (9.7 percent) of total budget allocation.
Overall, PNG is faced with a double-disease burden of both
infectious and emerging chronic lifestyle diseases. The
‘traditional’ infectious (communicable) diseases account
for 45 percent, while a dramatic increase in lifestyle (noncommunicable) disease is noted with 45 percent due to
increase in the consumption of processed foods (high in
fat, salt and sugar), cigarette smoking and sedentary urban
behaviour9
.
Notable improvements are seen in the 29 high-level key
indicators of the National Health Plan, especially life
expectancy which has improved to 64 years for males and 68
years for females, but other indicators have stagnated. As a
recourse, the government introduced health reform, including
establishing the Provincial Health Authority system to deliver
front line primary health care and specialist services. There
are still challenges in the functionality and capacity of rural
health posts and centres, including addressing the acute
shortage of different cadres of health professionals, revamping
the medical supply system, and increasing the response and
management capacity of disease outbreaks like the COVID-19
pandemic.
Status and Trends
The National Health Plan tracks 29 high-level indicators that
are both captured in the MTDP III and the SDGs. PNG performed
well in reducing malaria incidence, maternal mortality rate,
childhood illness, and implementing key reforms such as the
Provincial Health Authority Act 2007. However, indicators on
TB and immunisation coverage pose significant challenges.
HIV and AIDS prevalence was substantially reduced to 0.65
percent in 2014 but has increased to 0.9 percent in 2018,
nearing generalised epidemic status, although testing
and treatment have been significantly scaled up. With the
onslaught of the COVID-19 global pandemic, PNG will have
to build and strengthen its rapid response and management
capacity for current and future disease outbreaks.
More resources are needed for the health sector to finance its
priorities in the coming years to achieve the 2030 SDG agenda
including annual increase in government funding, as well as
from national and international development partners such
as Government of Australia, Asian Development Bank, World
Bank, World Health Organization, UNICEF, United Nations
Population Fund, Government of New Zealand, GAVI (the
Vaccine Alliance), Global Fund and others.
The private sector also assisted by establishing 49 health
facilities and supporting many health programs. CSOs such as
churches provide 60 percent of rural health services, which
run 502 of the total 3,841 health facilities across the country.
Churches have consistently supported the government
in providing health and vital social services in rural and
remote communities, reaching the furthest and most isolated
population in a bid to ensure ‘no one is left behind’.
Health Systems Strengthening
Government and its key development partners invested heavily
in health infrastructure improvements. The Government
of Australia puts significant investments in building and
refurbishing major hospitals and clinics around the country,
such as the Angau Memorial Hospital in Lae and Daru
Hospital. Asian Development Bank also invested in upgrading
many health centres around the country. The Government of
the Republic of Korea, through its development agency KOICA
has supported the ‘Community Health Post’ pilot, to build an
upgraded primary health care facility with a midwife, nurse
and community health worker targeting childhood illnesses
and maternal mortality outcomes. Although scaling-up of the
program has been slow, the government continues to support
the rollout to some districts and provinces.
However, more needs to be done to scale-up and strengthen
access to comprehensive primary health care at the
community level, as nearly 40 percent of aid posts and health
centres remain closed or barely functioning. Most operating
health facilities are also understaffed, suffering from a lack of
necessary equipment and a poor medical supply system.
Providing sustained medical supply has been a challenging
issue in PNG. Several reviews have been conducted such
as the Ministerial Taskforce on Medical Supplies under the
Somare Government (2008) that lead to some reforms in
creating the medical health ‘kit system’, which contributed
to improved availability of essential medicines by 64 percent
using WHO standards10. (This led to the formulation of the
National Medicines Policy 2014 and related reforms, however,
weak capacity and poor implementation disrupted the
sustained supply.)
The perennial issue on medical supplies has recently been
a subject of a National Parliamentary Accounts Committee
inquiry that started in November 2019. It was revealed that
the medical supply chain is riddled with poor management
issues such as constant stockouts, over supply in some parts,
expired drugs, illegal sales on the streets or in privately
owned shops, fake and counterfeit low potency drugs, and
dishonest practices in tender and management of service
providers. Insufficient numbers and inadequate competency
of pharmacy personnel is also noted as a key contributor to
continued problems in maintaining reliable medical supplies
chains. Drug quality testing facility, however, has been
installed in some areas.
In other aspects of the health system, PNG has an acute
shortage of human resources across all cadres of the health
workforce. Most recent estimates of health worker densities
reflect 0.5 physicians per 10,000 population and 5.3 nurses per
10,000 population11 The health workforce is characterised by:
• an ageing workforce
• low numbers of critical cadres, such as midwives and
community health workers
• a demotivated workforce due to poor working conditions
including low wages and poor physical infrastructure
• insufficient training capacity to produce the number of
health workers to meet population needs
• maldistribution of specialist clinical and technical skills,
where 30 percent of skilled health professionals occupy
administrative and management positions.
Major challenges to human resources for health development
include: a high level of fragmentation in the institutional and fiscal
relationships between national, provincial, and lower levels of
government; and an unclear allocation of responsibilities for
service delivery. The recently developed National Health Plan
will address the aforementioned challenges.
9 WHO PNG Report<https://www.who.int/ncds/surveillance/steps/PNG_2007-08_STEPS_Report.pdf> 10 Australian DFAT Medical Supply Review
<https://www.dfat.gov.au/about-us/publications/Pages/medical-supply-reform-impact-evaluation-papua-new-guinea)
11 World Bank PNG <http://documents.worldbank.org/curated/en/216511468332461651/pdf/NonAsciiFileName0.pdf>
12 Provincial and District Health Profiles 2018 < https://www.health.gov.pg/pdf/SPAR_2018.pdf>
Indicator Value Year Value Year
Maternal mortality rate per 100,000 live births 145 2014 175 2018
Infant mortality rate (%) per 1000 live births 47.3 2013 40 2018
Under 5 mortality rates (per 1000 live births 61.4 2013 48 2018
TB incidences rate per year per 100,000 population 6184 2008 26,8244 2018
Cancer incidence rate per year per 100,000 population - - - -
Incidence of reported malaria patients per 1000 population 270 2008 103 2019
Percentage of children under 1 year old immunised against
measles (%)
58 2014 80 2018
Proportion of 1-year old children immunised with doses
of DTP-Hep B-Hib per year
56 2014 35 2016
Number of new HIV infections per 1000 (un-infected population
by sex and region)
0.65 2014 <0.8 per
1000
2018
Table 3: Status of Goal 3 - Health Indicators
Baseline Actual
Source: PNG National Department of Health: Health Profile 201812
30 31
Mixed results are observed in the health performance
indicators. Some of the notable improvements are observed in
maternal mortality, reducing from 220 per 100,000 live births
in 2014 to 175 in 2018. Maternal mortality remains a cause of
concern as the 2006 DHS recorded 733 deaths per 100,000
live births.
Since then, the Government and its partners have mobilised
targeted interventions in addressing underlying causes such
as access to antenatal care by mothers and delivery with the
assistance of skilled health workers. It is noted that antenatal
care services received by mothers has slightly improved from
53 percent (rural 48 percent and urban 88 percent) in 2014 to 76
percent (89 percent urban and 75 rural)13 in 2016-2018 DHS, and
births occurring at health centres or hospital improved from
44 percent in 2014 to 56 percent delivered by a skilled health
worker and 55 percent at a health facility in 201614. Couples’
access to counselling and voluntary family planning has also
improved from 24 percent in 2013 to 59 percent in 201615.
Marked improvement in the childhood mortality indicator
is also noted. While PNG has a higher childhood mortality
rate compared to other countries in the region, the recorded
61.4 deaths per 1,000 live births for under-five mortality in
2013 has now been reduced to 48 (2018), and 47.3 for infant
mortality to 40 (2018).
Vaccination coverage has fluctuated over the years. In 2012,
49.13 percent were vaccinated against measles which slightly
increased to 58 percent in 2014 but dramatically increased
to 80 percent in 2018. Also, the proportion of children under
one year of age who received three doses of the DPT-HepBHIV preventative vaccines decreased from 65 percent in 2008
to 56 percent in 2014 and further to 35 percent in 201616, but
markedly increased to 80 percent with 3.5 million children under
15 covered in 201917. Increases in immunisation coverage was
due to efforts to contain outbreaks of measles and polio and
to strengthen the current outreach and immunisation activities.
Progress of Communicable Diseases
HIV and AIDS in PNG stabilised its epidemic status from 2003
which saw one percent of the population infected, dropping
to 0.65 percent in 2014. However, the prevalence resurged
to 0.8 percent in 2018 which effectively infected 1.82 new
persons per 1,000 un-infected persons18 Increasing national
prevalence was attributed to increased cases from five
provinces. At the same time, HIV and AIDS services have
expanded since 2004 to provide vital counselling, testing
and treatment, especially the provision of antiretrovirals not
only in Port Moresby but in another 120 facilities around the
country. This allows 66 percent of people living with the virus
to access to antiretroviral services19.
Malaria still poses a serious public health challenge with an
average of 1.5 to 1.8 million suspected cases annually, with
more than 50 percent of the population living in potentially
high transmission areas (below 1,200 m of elevation)., It
was the leading cause of outpatients’ visits, fourth highest
cause of hospital admission, and third leading cause of death
until 2008. Between 2008 and 2019, malaria cases reduced
significantly from 270 to 103 per 1,000 population due to
increased distribution and use of treated mosquito bed nets,
effective testing and treatment protocol, mass advocacy,
communication and awareness campaigns.
TB remains a serious public health issue. TB cases increased
considerably since 2008 with 6184 cases (93 per 100,000
population) to 28,244 cases (376 per 100,000 population) in
201820 Likewise, the population-screening rate for TB rose
from 0.1 percent in 2008 to 0.4 percent in 2016. Detection was
facilitated through the Directly Observed Treatment ShortCourse which began in 1997 and was widely adopted by all
provinces from 201221.
However, recently there has been an increasing incidence
of drug resistant and multidrug resistant TB. In 2016, extrapulmonary TB accounted for 42 percent of all cases. The
proportion of pulmonary TB cases with no sputum test results
was high with a national average of 26 percent, of which 27
percent occurred in children. The treatment success rate fell
from 80 percent in 2014 to 73 percent for bacteriologically
confirmed TB and 64 percent for all forms of TB in 2016, far
below the global target of 90%. For all forms of TB, 19 percent
of patients usually missed out of their follow-up treatment.
Threats of Non-Communicable Diseases
Non-communicable diseases (lifestyle diseases) have
increased over the last decade, accounting for nearly half of
mortality and morbidity in PNG especially among the urban
populace. In 2004, lifestyle diseases made up 38 percent of the
disease burden which increased to almost 50 percent in 2019.
Most prevalent lifestyle diseases include cardiovascular and
coronary artery diseases, cancers (especially oral and lung
cancers), respiratory diseases, and diabetes. This is largely
due to risk factors such as rapid uptake of urban sedentary
lifestyles with low physical activity, high intake of processed
food high in sugar, salt and fat content, and the widespread
use of betel nut which leads to an increase in oral cancers. In
addition, harmful use of alcohol and traffic-related deaths and
injuries accounted for 19.1 percent of cases (2016) due to poor
traffic rules adherence.
However, prevalence of tobacco use among adults has been
significantly reduced from 44 percent (60 percent males;
27 percent females) in 200722 to 26.3 percent in 2010 (37.3
percent men, and 14.5 percent women)23 although, smaller
surveys might contrast this. The same trend is also noted in
youths ages 13-15 years with a 53 percent relative reduction in
cigarette smoking from 43.8 percent in 2007 to 20.7 percent in
201024. However, this increased to 33.3 percent (40.1 percent
boys and 28.3 percent girls) in the Global Youth Tobacco
Survey25. This is encouraging to note after PNG signed the
WHO Framework on Tobacco Control 2004 and ratified it in
2006. While the country was slow in implementing the treaty
obligations, the government has consistently increased
tobacco taxes to control its use. The government initiated
the Tobacco Control Policy in 2015 and passed the Tobacco
Control Act 2016 but is still working on the regulations and the
implementation guidelines.
Gaps and Challenges
Overall, the PNG health care system is challenged by many
factors such as chronic shortage of different cadres of health
workers, inefficient systems and ill-practices in procurement,
supply chain, distribution, and management of service
providers. The primary health care system remains fragmented
with 40 percent of rural health centres and aid posts closed
or partially functional. More nursing professionals are aging
or are reaching retirement age and the staff ceiling is not
compatible with the supply of new nursing professionals.
This is further compounded by the “double-disease burden”
of both infectious and chronic lifestyle diseases that accounts
for almost half of the country’s disease burden and leads
to additional pressure on an already weak health system.
Relatedly, diseases such as cholera, measles and polio have
re-emerged with episodes of outbreaks long after they were
thought eliminated, and measles re-emerged due to low
immunisation coverage which forced the country to scale-up
vaccination campaigns. While a lot of focus has been on the
Public Health Authority system, services need to continue
such as routine immunisation which has dropped significantly
below the WHO standards of 80 percent coverage.
While improvements are noted for maternal health with
marked improvement in the maternal mortality rate for 733
deaths per 100,000 live births in 2006 to 145 deaths per
100,000 live birth in 2018, it is more difficult for women in rural
areas than urban areas due to access issues. The community
health post concept has not been implemented after the trials
in Central and Eastern Highlands Provinces. Factors such as
gender-based violence (GBV) continue to fuel morbidity and
mortality for women and girls.
An effective, functioning health system is critical to address both
communicable and non-communicable diseases, including the
global threat of coronavirus (COVID-19 pandemic) and future
outbreaks or impacts of climate change. While good progress
is made in revamping the provincial health systems through
the Public Health Authority, its functionality and effectiveness
are still at too early a stage to observe its impact.
COVID-19 and other disease outbreaks such as measles,
cholera and polio in the past few years have exposed a lot of
weaknesses in the health system, in terms of disease outbreak
response, control and management capacity. Although only
nine cases have been reported in PNG for COVID-19, many of
the health workers were stretched in prevention activities.
Also, laboratory capacities need to be strengthened with
training and appropriate equipment installed in many of the
hospitals.
Medical supply systems have been a chronic issue needing
attention, as per the current Parliamentary Commission of
Inquiry. Issues of mismanagement and corrupt practices have
surfaced and are being referred for appropriate actions to be
undertaken.
Health financing is another area of challenge. In the past
few years, health financing has been boosted significantly by
government and donor contributions and a health sector wide
approach to financing (Health Services Improvement Program)
11 PNG Youth Tobacco Survey Report, 2016.
13 National Statistical Office - 2016-2018 Demographic & Health Survey
<https://www.nso.gov.pg/images/DHS2016_2018/PNG_DHS2016-2018_KIR.
pdf>
14 ibid 15 ibid 16 ibid
17 UN Annual Progress Report 2019 <https://papuanewguinea.un.org/
en/47273-annual-progress-report-2019>
18 UNAIDS 2018 <https://www.aidsdatahub.org/sites/default/files/country_
review/PNG-2019-UNAIDS-data.pdf>
19 ibid 20 Aia, et al, 2018, Western Pacific Surveillance and Response Journal, WHO, 21 ibid
22 PNG STEPS survey (https://www.who.int/ncds/surveillance/steps/PNG_2007-08_STEPS_Report.pdfL)
23 PNG Household Income & Expenditure Survey 2009/2010 <https://www.nso.gov.pg/index.php/projects/household-income-expenditure-survey>
24 ibid <
25 PNG GYTS 2016 <https://www.who.int/tobacco/surveillance/gyts/en/>
Photo courtesy of Equal Playing Field
32 33
but continues to face capacity constraints to set up a functional
system. In addition, many global partners such as GAVI and
Global Fund for HIV, TB and Malaria still operate in isolation and
siloes, without strong government coordination mechanisms.
As such, funds are directly provided to implementers.
Next Steps
GoPNG is reviewing its current National Health Plan 2010-
2020 and will be focusing on improving some of the key areas
under the health systems as well as continuing to deliver on
key primary health care services. Some of the key areas of
focus are:
•Rehabilitation of rural aid posts and health centres –
between 40-60 percent of rural primary health care
facilities that are closed or partially opened to enable
the majority of the people to access them. This will bdone
through partnerships with health service providers such
as churches, private sector operators and foundations and
development partners such as Asian Development Bank.
• Continue to strengthen maternal health care programs,
especially at the primary care levels.
• Strengthening partnerships between Provincial Health
Authorities and churches, NGOs, private sector and
development partners. Capacity building and strengthening
of Provincial Health Authorities in health governance and
management.
• Building rapid response and adequate management
capacity for public health emergencies especially with the
onset of COVID-19 and other emerging diseases.
• Capacity to respond to lifestyle diseases needs to be built
and strengthened, including programs addressing risk
factors such as tobacco, alcohol and unhealthy food.
• Urgent action to strengthen the transparency and stock
management of the medical supply system.
• Urgent action for the quality and quantity of the health
workforce to meet demand, especially at rural health
care levels.
|
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The 2018 National Report
35
The available measures of the state of health of the population indicate that the state of health of the Polish society
is below the average for the entire EU population18. As in
most European countries, the ageing of the population
is also progressing. In 2010, the population of Poland
aged 60+ constituted 19.6% of the population, while in
2016 it was already 23.6%.
The average life expectancy of women in health in Poland
in 2016 was 64.6 years, men 61.3 years (for the EU
63.3 and 62.6 years, respectively in 2015), and diseases of the circulatory system continue to be the most
life-threatening diseases (in 2016 they were responsible
for 43.3% of deaths), followed by malignant neoplasms
diseases (over 25.8% of deaths). In 2017, the coefficient
expressing the number of infant deaths per 1,000 live
births was 4.0‰. The Euro Health Consumer Index
(EHCI), measuring the care quality level, indicates that
Poland’s position is still poor, 12th in 2005 and 31st
in 201619. A significant factor is the low level of public
spending on health care (4.4% of GDP in 2015, while
the average for OECD countries is 6.5%). The health of
the population is adversely affected by air pollution, one
of the largest in Europe, which causes 40,000 deaths
per year. This shows that there are many challenges for
the national health system.
Priorities
The priority for Poland is to reduce the incidence
and mortality of civilisation diseases, as well as to
reduce inequalities in access to health care, and to
increase health awareness and detection of diseases
at early stages of development. There is a need to increase investment in health care, while maintaining
flexibility in spending, and to improve the quality of the
health care system and patient safety. The Polish health
care system also requires the development of e-health.
For many years now, the priority has been to increase
the number of medical staff in the system in response to
various needs of particular age groups, including mainly
children and the elderly, and due to the need to improve
working conditions of medical staff.
Poland also aims to achieve a comprehensive improvement
of air quality to a non-emergency state in line with EU
legislation and, in the longer term, the WHO guidelines,
as well as to raise public awareness of the negative impact
of air pollution on human health.
SDG 3
Ensure healthy lives and promote wellbeing for all at all ages
35
18. See Eurostat, Health in the European Union – facts and fgures,
http://ec.europa.eu/eurostat/statistics-explained/index.php/
+ealthBinBtheB(uroSeanB8nionB( BfactsBandBfgures
(accessed: 07.05.2018).
19. In 2005,12 countries participated in the EHCI study, while 35 in 2016.
Implementation of the Sustainable Development Goals in Poland
36
Measures
The key documents in the area of public health in Poland are the Act
on public health from 11 September 2015 (Dz. U. [Journal of Laws]
2017 item 2237, as amended) and the National Health Programme
for 2016-20 (NHP). The programme sets out priority directions for
action in 6 areas:
1. improvement of diet, nutritional status and physical activity in
the population;
2. preventing and solving problems related to the use of psychoactive substances, behavioural addictions and other risky
behaviours;
3. prevention of mental health problems and the improvement of
mental well-being;
4. reduction of health risks arising from physical, chemical and
biological hazards in the outdoor environment, workplace,
home, recreation and study areas;
5. promotion of healthy and active ageing;
6. improvement of reproductive health of the society.
The following health policy programmes complement the activities
implemented under the NHP.
One of the elements limiting the number of complications and consequences of neonatal developmental defects is the Programme of
comprehensive diagnostics and intrauterine therapy in the prevention of
the consequences and complications of fetal developmental defects and
diseases - as an element of improving the health condition of foetuses
and newborns 2014-17. In addition, the Polish newborn screening
programme is implemented to reduce newborn, infant and child mortality from congenital metabolic abnormalities and to prevent severe
and permanent physical and intellectual impairment resulting from
these abnormalities. In terms of improving the reproductive health
of the population, the Comprehensive programme for the protection
of reproductive health in Poland has been implemented, aimed at
increasing the availability of high Tuality servicesin the feld of fertility
diagnostics and treatment. Since 2016, Poland has introduced a health
service called Coordinated care for pregnant women.
The Programme for the prevention and treatment of cardiovascular
diseases POLKARD 2017-20 fnancestasNsrelated to the ftting and
equipping with medical equipment of medical entities dealing with
the diagnosis and treatment of cardiovascular diseases, conducting
nationwide prevention of primary cardiovascular diseases, screening
for abdominal aortic aneurysm in patients over 65 years of age, ensuring remote consultation of clinical situations of patients with severe
stroke for invasive treatment in stroke units, introducing Day Units
of Heart Failure and establishing and maintaining medical records.
On the other hand, within the framework of the National Programme
for Combating Cancer Diseases, activities related to the promotion
of cancer prevention, screening, purchase of equipment for cancer
diagnostics and treatment and educational activities are carried out.
In January 2015, the so-called oncological package was launched in
Poland, the aim of which was to shorten the period from the suspicion
of cancer to the commencement of treatment, to guarantee the comSle[ity of thistreatment,asZellas unlimited fnancing of diagnostics
and oncological treatment.
The policy of the state towards the HIV and AIDS epidemics has been
defned in the laZ and in the National Programme for Preventing
HIV Infections and Combating AIDS, under which the programme
Antiretroviral treatment of people living with HIV in Poland 2017-21
is implemented.
Poland also has asystem of widespread preventive vaccination, effectively preventing the spread of dangerous infectious diseases.
As regards prevention of mental health problems and improvement
of mental well-being, the Programme for prevention of depression in
Poland 2016-20 and the National Programme for Mental Health
Protection 2017-22 are carried out in Poland.
On the other hand, the subject of addictions - prevention and solving
problems related to the use of psychoactive substances, behavioural
addictions - is included in the National Programme for Counteracting
Drug Addiction and the National programme for prevention and
resolution of alcohol problems.
In order to reduce the mortality and post-traumatic disability of injured
persons in accidents, injury centres for adults have been established
in Poland, where traumatic patients, including accident victims, are
treated. It is planned to create injury centres for children.
In the area of chemicals management, Poland undertakes, within
the framework of cooperation with the European Union and OECD
countries, actions to eliminate substances posing athreat to human
health, including workers using chemicals and consumers, as well as
to the environment from the market. Such substances shall be subject
to procedures for restricting or prohibiting their manufacture, use
or placing on the market. A group of substances considered to be
dangerous for human health and the environment shall be subject to
identifcation Sroceduresand to Srogressive substitution by suitable
safer alternatives. At the national level, there has been a system in
place for several years to collect information (on physicochemical,
toxicological and ecotoxicological properties) on hazardous mixtures
placed on the national market.
,n the feld of telemedicine and telecare, a number of recent legislative changes have been introduced which have removed barriers to
the development of telemedicine, such as the requirement for the
patient to be personally examined by a doctor has been abolished, the
possibility of determining his state of health also by ICT systems has
been introduced, the provisions enabling a doctor, a dentist, a nurse
and a midwife to practise the profession and the provisions enabling
the provision of pharmaceutical services also by means of information
and communication systems have been introduced, as regards entities
providing exclusively outpatient health services by means of informa-
The 2018 National Report
37
20. Detailed description in SDG 11.
tion and communication systems - the obligation to meet technical
requirements concerning premises and equipment required from
entities providing services under the classic formula (i.e. with the
patient’s and doctor’s personal contacts) has been abolished. At the
same time,the Sossibility of defning reTuirementsfor Åtelemedicineµ
providers was introduced. The National Health Fund has introduced
a new range of health care services to be contracted separately: geriatric
teleconsylium, cardiological teleconsylium and hybrid cardiological
telerehabilitation. In addition, the project Electronic Platform for
Collection, Analysis and Sharing of Digital Medical Records (P1) is
being imSlemented in 3oland,t is cofnanced from (uroSean funds
and includes the implementation of IT systems that will enable the
improvement of processes related to the planning and provision of
health services, monitoring and reporting on their implementation.
It is also worth pointing out to other IT projects of strategic importance
in the area of e-health: building a nationwide platform of high quality
and accessibility of public e-services in medical entities established
and supervised by the Minister of National Defense, introduction of
modern e-services in medical entities supervised by the Minister of
Health , e-Blood - computerization of public blood services and development of blood management supervision, e-health in Independent
Healthcare Centres of Ministry of the Interior and Administration -
implementation of integrated IT systems and development of modern
medical eservicesto imSrove the accessibility, Tuality and effciency
of public services.
In the context of improvement of health condition, activities aimed
at comprehensive improvement of air quality - implementation of
the Clean Air Programme20 - reduction of air pollution emissions,
in particular dust pollution, will be important.
Implementation of the Sustainable Development Goals in Poland
38
Healthy Mother - awareness-raising activities aimed at improving public knowledge
of reproductive health, improving qualifications of doctors and midwives, infertility treatment, improving the quality of perinatal care, developing prevention for
pregnant women (and prenatal children).
Effective health care - a package of programmes to improve the situation in Polish
health care, including mapping of health needs, introduction of coordinated care,
determining the demand for medical personnel, training of personnel, investments
in modern medical equipment and apparatus, development of e-health and building
information systems in health care.
Comprehensive support programme for families “For Life” - comprehensive solutions concerning support for families with persons with disabilities, including
children with disabilities, in particular in areas concerning support for pregnant
women, early support for the child and its family, support and rehabilitation services, health, education, housing support, as well as coordination, counselling and
information. The solutions adopted in the Programme are aimed at enabling real
and full social integration of people with disabilities and at providing psychological,
social, functional and economic support to their families.
A healthier society - a package of actions to strengthen prevention, health awareness
and healthy lifestyles.
Strategic projects
Examples of initiatives
Preparation of the Health as an Investment Report in the context
of the Action Plan for the implementation of the 2030 Agenda
for Sustainable Development and Health 2020, prepared by
the WHO, the Ministry of Health and the National Institute of
Public Health - NIPH.
Within the framework of the National Health Programme (NHP)
within the Operational Objective 1 - Improving the diet, nutritional status and physical activity of the population e.g. non-governmental organisations initiated the organisation of health picnics
throughout the country in towns of less than 5 thousand inhabitants,
the aim of which was to encouraging the physical activity of the local
community. During the meetings, nutritionists offered advice. Substantive materials have also been developed to provide information
on the benefts of regular Shysicalactivity
Within the framework of the NHP as regards the Operational Objective 3 - Prevention of mental health problems and improvement
of mental well-being of the society, the assessment of mental health
was carried out by non-governmental organisations, within which, inter
alia, tools for mood disorders screening were developed, dedicated
websites www.zdrowiepsychiczne.org and www.pozytywnyrozwoj.org
and an online forum were created, expert advice on mental health was
provided, educational and information campaigns were conducted,
educational materials on coping with crisis situations and information
materials on available assistance on mental problems were developed
and made available,as Zellasinstructional flms, radio Srogrammes
and publications.
|
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|
SDG 3 Good health and well-being
Ensure healthy lives and promote
wellbeing for all at all ages
Ensuring the health and well-being of citizens
has taken on particular importance as a result
of the outbreak of the Covid-19 pandemic. Reducing
inequalities in access to healthcare and strengthening
the healthcare system, particularly in the area
of e-health through digitisation of healthcare
services, became a particular priority for Poland.
National priorities:
1. Decrease in morbidity and mortality
due to civilization diseases.
2. Inequality reduction in access to healthcare.
3. Increase in early disease detectability
and increase in access to modern therapies.
4. Improvement of healthcare system
quality and patient safety including
the development of e-health area.
5. Comprehensive improvement of air quality reaching
the state of no risk to health and environment
in accordance with EU legislation and, in a longerterm perspective, WHO guidelines by reducing
emissions of pollutants into the air.
75
SDG 3
Review of progress under each goal
Implementation of the Sustainable Development Goals in Poland. The 2023 National Report
Diagnosis
Trend description
Poland has a rapidly ageing population and a number
of negative trends related to the lifestyle of the
society (low physical activity, highly processed food)
and unfavourable phenomena in the environment.
The rate of healthy life expectancy remains at a
siQilar leZel GoQTared Xo Ɓ Jor Qen ]ears
in and ]ears in and Jor [oQen
64.3 years in both 2018 and 2020. (Eurostat, 2021).
In Poland, public health plays a key role. Prevention,
prevention and health promotion are the most important
factors responsible for the sustainability of the health
care system and the extension of life, including healthy
life. In the face of current demographic and social
changes, proper organisation of public health is of
ever-increasing importance for prolonging and improving
the quality of life of Polish women and men. The analysis
of prevalence, mortality, as well as other health data
(dietary habits, addictions, physical activity), indicates
an urgent need to strengthen public health in Poland.
The challenge is still to limit the increase in prevalence,
especially in cardiovascular diseases, cancer, metabolic
diseases (diabetes), neurological and psychiatric
diseases and various forms of allergies.
A worrying trend is still the high number of deaths
from malignant neoplasms, although there was a
slight decrease between 2018 and 2020 (from 263.9 to
261.6 per 100,000 population). In contrast, the number
of deaths from diabetes per 100,000 population
increased (from 23.5 in 2018 to 31.9 in 2020).
The problem of overweight and obesity remains
a signifGanX GLallenge 8Le TerGenXage oJ TeoTle oZer
15 years old suffering from obesity, according to BMI,
has increased from 16.7% (2014) to 18.5% (2019).
In parallel, the digitalisation of healthcare services
is progressing. The percentage of healthcare entities
with IT solutions that allow medical records to be
maintained in electronic form has increased, from 56.6%
in 2018 to 68.4% in 2021. These activities contribute
to improving the level of quality of the healthcare
system and patient safety, reducing inequalities
in access to healthcare, increasing health awareness
and detecting diseases at early stages.
Poland’s air condition is improving. Between 2018
and 2021, the number of zones with exceedances
oJ air UualiX] sXandards Las deGreased signifGanXl]
especially for the PM10 and PM2.5 fractions, which
have been the most problematic so far; not only
due to the favourable meteorological conditions,
but primarily as a result of the corrective measures
taken at all levels of air quality management.
The particularly positive effects of the measures taken
are evident in the downward trend of the so-called
national average exposure indicator for PM2.5.
The value of the indicator has decreased from
vgQ3
in Xo vgQ3
in 2021.
Key actions contributing to the
SDG achievement in Poland
» Implementation of the National Health
Programme 2016-2020 and 2021-2025,
the strategic objective of which is to increase
the number of years lived in health and reduce
social inequalities in health.
» 7XrengXLening inGreasing XLe eƾGienG]
and quality of primary health care and coordinated
care, streamlining and accelerating
the patient’s treatment pathway.
» Implementation of the Newborn
Screening Programme in Poland
for 2019-2026 aimed at reducing mortality
of newborns, infants and children
due to congenital diseases and preventing
severe and permanent physical and intellectual
impairment resulting from these diseases.
7uƾGienX ToliG] and iQTleQenXaXion
andor QeX Fased on daXa
76
SDG 3
Review of progress under each goal
Implementation of the Sustainable Development Goals in Poland. The 2023 National Report
» Medical Fund to support activities aimed
at improving health and quality of life in Poland
by providing additional sources of funding.
» Antimicrobial resistance as one
of the measures to improve patient safety
[as iQTleQenXed under XLe ƈ2aXional %nXiFioXiG
Programme 2016-2020” and then under
the National Health Programme 2021-2025.
» POLKARD Cardiovascular Disease Prevention
and Treatment Programme 2017-2020.
» Continuation of the nationwide campaign
ƈ(eTression 9ndersXand ,elTƉ
as part of the Programme for the Prevention
of Depression in Poland 2016-2020.
» Establishing a Support Centre for adults
in mental health crisis as a 24-hour, free,
specialised help and support service and access
to information on where to seek help and raising
public awareness of mental disorders.
» Purchase of antiretroviral drugs and vaccines
for adults and children as part of antiretroviral
treatment for people living with
HIV in Poland for 2017-2021.
» Launch of the Home Medical Care Platform
to monitor the status of people undergoing
Covid-19 and to implement telemedicine
pilots and prevention programmes.
» Actions to increase the 5-year survival rate from
the end of cancer treatment, increase cancer
detection at early stages and improve quality
of life during and after treatment as part of the
National Oncology Strategy 2020 – 2030.
» Aiming for self-suffciency
in quantity and improved safety
of blood and blood components.
» Free medicines for seniors over
75 years of age. The list of free medicines
is updated by the Ministry of Health.
» Clean Air Priority Programme.
» Stop Smog Programme.
Strategic documents setting out directions for action
» Strategy for Responsible Development for the period up to 2020 (including the perspective up to 2030)
» Human Capital Development Strategy 2030
» Strategic framework for the development of the health system 2021-2027, with an outlook to 2030 (Healthy Future)
» Strategy of deinstitutionalization – health care for the elderly (annex to the Healthy Future)
» National Health Programme for 2016-2020 and for 2021-2025
» National Programme of Cardiovascular Diseases 2022-2032
77
SDG 3
Review of progress under each goal
Implementation of the Sustainable Development Goals in Poland. The 2023 National Report
Challenges and lessons learned
» Building an effective public health system focusing on the promotion of proper lifestyle habits (reducing
exposure to risk factors, especially those related to lifestyle) and on the implementation of long-term
and preventive actions with the primary goal of preventing the occurrence of civilisation diseases.
» Reducing disparities in access to medical services and improving the functioning of the health care system.
» Development and dissemination of digital e-health services and the use of innovative technologies
in XLe LealXL seGXor GoZer TriQaril] XLe Jollo[ing areas deZeloTQenX oJ TuFliG digiXal serZiGes inGreasing
accessibility to healthcare services, building digital competencies on the part of patients and medical staff
and measures to increase digital maturity of entities performing medical activity, development of innovation.
» Creation of a network of strong, effective and competent laboratories performing
research tasks as a guarantee of patient safety and medication safety.
» Increasing the availability of adequate technical and organisational
conditions for the collection of blood and blood components.
» Returning to pre-pandemic donation and transplantation activity, and then moving closer
to European rates in the number of organs, tissues and cells collected and transplanted.
» National Oncology Strategy 2020-2030
» National Programme for the Development of Transplantation Medicine,
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78
SDG 3
Review of progress under each goal
Implementation of the Sustainable Development Goals in Poland. The 2023 National Report
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PROGRESS ON GOALS AND TARGETS 18
4.3 Goal 3. Ensure healthy lives and promote well-being for all
4.3.1 Progress and challenges
The DPRK Government ensures more cultured living conditions and constantly promotes their
well-being. The State has legislated that the people’s lives will be protected and the health of
working people promoted through consolidation and development of universal free medical care
system, strengthening of district doctor system and implementation of the policy on preventive
medicine7
. Thanks to the universal free medical care system, all the people have access to medical
services without any charge, irrespective of sex, age, occupation or residence. The universal free
medical care system was enforced from 1953 and the complete universal system from 1960. There
are the health facilities from the central to the lowest level, medical university, health staff training
centres including nurses’ training school and the medical science and research institutes in every
province. The district doctor system is operated and the prevention kept ahead of all medical services,
to protect and promote the people’s health.
The consolidation of material and technical foundations has been accelerated in the public
health sector. Between 2012 and 2020, modern health facilities were established in a modern style,
including Breast Tumor Institute of Pyongyang Maternity Hospital, Okryu Children’s Hospital,
Ryugyong General Ophthalmic Hospital, Ryugyong Dental Hospital and Myohyangsan Factory of
Medical Appliances as well as health oxygen factories in Pyongyang and several provinces, thus the
health services for the people have been consistently improved. In 2020, the government has started
a new construction project, Pyongyang General Hospital, for the purpose of the comprehensive
medical service to the people.
There has been considerable progress in protection of maternal life and health. The
Government set the target to reduce the maternal mortality ratio to less than 40 per 100 000 live
births by 2030.
7 “DPRK Socialist Constitution” Article 56
PROGRESS ON GOALS AND TARGETS 19
Figure 4. Maternal mortality per 100 000 live births
Proportion of births attended by skilled health personnel was increased from 97.3％ in 2010 to
99.5％ in 2017. Its target is to reach 100% by 2030.
Considerable progress has been made in reducing child mortality. The Government set the target
of, by 2030, reducing the neonatal mortality rate per 1 000 live birth to less than 6 and under 5
mortality rate to less than 12.
Figure 5. Under 5 and neonatal mortality rates per 1 000 live births
The notable success achieved during MDG period was the malaria incidence reduction. Its
incidence rate has been rapidly declined since 2010, from 0.52 in 2015 to 0.15 in 2020, and there was
no direct death from the epidemic.
The tuberculosis (TB) incidence decreased from 451 in 2015 to 354 in 2018 but increased in 2019
to 376 and again decreased to 351 in 2020 and Hepatitis B from 6.8 in 2015 to 5.9 in 2020 per 100
000 population.
The supports from Global Fund against AIDS, TB and Malaria contributed to the reduction of
malaria and TB incidence.
Suicide mortality does not rise as a social issue in the DPRK where the people are the master of
everything and everything is geared to their benefits.
PROGRESS ON GOALS AND TARGETS 20
The Death rate by road traffic injuries per 100 000 population was 8.5 and 7.3 respectively in
2015 and 20208
.
The Government set the target of, by
2030, reducing by one third the
premature mortality from noncommunicable diseases through
improving the quality of the universal
free medical care system and
implementing preventive medical
policy.
The reproductive health services
have been improved. Proportion of
women of reproductive age who have
their need for family planning
satisfied with modern methods was
89.6% in 2014 and 89.7% in 2017,
and adolescent (aged 15-19) delivery rate per 1 000 women was 19
.
Mortality rate attributed to household and ambient air pollution is not confirmed yet and the
ambient density of PM2.5 increases gradually. However there are some difficulties including in
measuring the PM and introducing clean fuel and combustion technologies.
Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene is not confirmed
yet. Several measures were taken including the introduction of the gravity fed water supply system
and pumping system powered by wind and/or solar energy.
The mortality rate attributed to unintentional poisoning per 100 000 population was 0.6 in 2015
and 0.4 in 202010.
The State acceded to the Framework Convention on Tobacco Control and raises awareness
among the people on the harmful use of tobacco and “Cessation Law in DPRK” has been adopted in
October 2020, but the prevalence of tobacco use is still high among persons aged 15 or over, as
46.3% in 2015 and 46.1 in 201711.
The lack of the capacity of health personnel, low technical foundation of pharmaceutical and
medical appliance plants and shortage of essential medicines remain as challenges. Some of the
pharmaceutical, vaccination and medical appliance plants do not reach at the level of GMP of WHO
and not meet the local demand as well. Most vaccination is supplied through joint funding
mechanism between the Government and GAVI, the Global Alliance.
Measurement: The MoPH collects routine data on morbidity by age, sex and cause from the central
hospitals down to the lowest clinics. Data on well-treated and/or not-treated diseases in the particular
hospitals or clinics, treatment methods, medicines and facility conditions are also compiled and
comprehensively analyzed for the treatment of diseases. In addition, data are collected and
aggregated through regular medical examination of household members by section doctors and
physical examination of children and pupils at nurseries, kindergartens, baby homes, orphanages and
primary schools in the country. Assessments are also done through surveys including MICS and RH
survey in cooperation with UNICEF and UNFPA.
8 Ministry of Social Security, DPRK 9 2017 DPRK Multiple Indicator Cluster Survey 10 Ministry of Public Health, DPRK 11 2015 DPRK Non-communicable Disease Survey, 2017 National Smoking Survey
21
4.3.2 Plans
The DPRK gives priority to the following plans.
Stick to the policy on preventive medicine: With full implementation of the “Law on Public Health
of the DPRK” (adopted on 3 April 1980, amended), it should increase the average life expectancy of the
population, prevention rate of infectious diseases and other health indicators to the world’s advanced
level; by means of strong section doctor system, section doctors pay routine visit to households and
workplaces under their charge to take preventive steps and cares of health with responsibility.
Consolidate the material and technical basis of the public health sector: It is to complete the
Pyongyang General Hospital at the highest level, build Provincial People’s Hospitals in a modern
general style and modernize the curative and preventive facilities of the country like the Samjiyon
City People’s Hospital as a model. The basis for the provision of the materials should be firmly
established including through renovation and modernization of the pharmaceutical factories such as
Pyongyang Pharmaceutical Factory and the factories of the medical consumables.
Improve the quality of medical service: It is to improve the quality of medical service through
perfect telemedicine and emergency medical care systems and introduction of quality management
system of medical care. It is also to make traditional Koryo medicine more scientific and localize
essential medical equipment and medicines at high level.
Construct the solid basis of the anti-epidemics. It is to thoroughly prevent the invasion of the
communicable diseases from abroad by strict inspection and quarantine of personnel at every entry
points and thorough measurement to detect the probable cases like feverish case in time as well as
the strict system of disinfecting all imported goods. To cope with any global health crisis, the
material and technical basis of the hygiene and anti-epidemic sector should be completed and the
anti-epidemic system be strengthened to ensure the life and safety of the people.
|
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{
"country": "prk",
"file_id": "sdg-03/vnr-report-prk-2021-en-3.pdf",
"language": "en",
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"type": "vnr",
"year": 2021
}
|
17
II.1.3 SDG 3 - ENSURE HEALTHY LIVES
AND PROMOTE WELL-BEING FOR
ALL AT ALL AGES
ASSESSMENT OF PROGRESS
Main planning instruments and policy measures
according to the assessment of the governance areas:
National Programme for Oncological Diseases,
of 2016, in which the establishment of population-based screening for breast cancer, cervical
cancer and colon and rectal cancer is highlighted;
COVID-19 Vaccination Plan, the implementation
of which proved effective in combating the disease;
National Diabetes Prevention and Control Programme, 2016, in which the highlights were the
measures for risk assessment of type 2 diabetes in
primary health care in the adult population, population-based screening for diabetic retinopathy and
access to diabetic foot consultations in all primary
health care units, as well as the implementation of
the integrated diabetes management model;
National Programme for Smoking Prevention
and Control (PNPCT), 2016, which sets as its 1st
objective the reduction to below 17.0% of the prevalence of smokers in the population aged 15 years
or over, its 2nd objective is to halt the increase
in tobacco consumption among women, its 3rd
objective is the elimination of exposure to environmental tobacco smoke and its 4th objective is
the reduction of inequalities in the proportion of
smokers according to the country’s regions;
National Programme for the Promotion of Physical Activity (PNPAF), 2016, highlights of which
18
are the measures to encourage and improve the
quality of the promotion of activity in health care
and the capacity-building of professionals in this
regard. It also aims to promote epidemiological
surveillance and the monitoring of behaviour related to physical activity/sedentary lifestyles and
their determinants, as well as improving the population’s empowerment to choose and implement
an active lifestyle throughout life;
National Programme for Mental Health (PNSM),
2016, highlights of which are the measures to
monitor the mental health of the Portuguese
population, with regards to the main indicators of
morbidity and the use of services, to implement
programmes to promote the mental well-being
and health of the population and the prevention,
treatment and rehabilitation of mental illnesses,
and to articulate specialised mental health care
with primary health care;
In addition, other planning instruments and policy
measures included in the GO and PNR stand out:
Strategic Management Programme for NHS
Human Resources, the main objective of which
is to enhance the value of NHS professionals
and establish a planned recruitment system that
makes it possible to respond to demands, aiming
to increase the quality of the organisation and the
provision of the necessary health services to the
population;
Promotion of sustainability through the association of therapeutic innovation with the use of generic and biosimilar medications.
Strengthen hospital management autonomy in
terms of hiring health professionals;
Reform of primary health care with the completion of the process of decentralisation to Municipalities of health responsibilities.
Also, emphasis should be given to the creation of the
Regional Integrated Care Network and the New Elderly
Programme, designed to create a proximity response that
allows the elderly to continue living at home and in the
community.
ASSESSMENT OF PROGRESS
IN THE AUTONOMOUS REGIONS
AUTONOMOUS REGION OF AZORES
The main planning instruments and policy measures highlighted by the Government of the ARA are:
Regional Health Plan 2014-2016 (with extension
to 2020), issued by Government Council Resolution No. 133/2014 of 6 August 2014;
Public health measures - combat the spread
of emerging infections in the framework of the
COVID-19 pandemic, resulting in the production
of daily and weekly reports to monitor the pandemic situation and more than 1 million COVID-19 tests;
The Regional Vaccination Plan against COVID-19 is also to be highlighted, where weekly vaccination reports were presented, showing the sum
of half a million doses administered; 92.7% of the
population with complete vaccination and 55.5%
of the population with a booster vaccination.
Projects such as Operation Periphery with the
support of the Ministry of National Defence and
the Nurses’ Association, referring to the mass vaccination of islands without a hospital, are also to
be highlighted in this context;
Creation of COVID-19 Testing Centres;
Creation of the Platform for Monitoring the
SARS-CoV-2 Pandemic, created by DRS;
Public health control measures on entry to the
ARA, as well as the creation of the Special Monitoring Committee for the Fight Against the Covid-19 Pandemic.
AUTONOMOUS REGION OF MADEIRA
The main planning tools and policy measures highlighted by the ARM government are:
Strengthen early intervention in the control
of risk factors for non-communicable diseases,
such as chronic diseases and neoplasms, for communicable diseases and for accidents;
Strengthen early detection of diseases (i.e.
cardiovascular diseases, oncological diseases,
Alzheimer’s disease and other dementias, chronic
obstructive pulmonary disease, chronic liver diseases and viral hepatitis, AIDS and other sexually
transmitted diseases, vector-borne diseases);
Promotion of policies and practices aimed at preventing injury and poisoning events, including
occupational risks and suicide risks, throughout
life. This set of highlighted measures is the result
of the Regional Health Plan 2021-2030 which is
the main planning instrument of the ARM for the
achievement of SDG 3.
In addition, awareness-raising campaigns for
healthy behaviour and to seek out health are also
highlighted, as well as the A Pause for Prevention
project, which is a workplace-based project to
raise awareness, educate and train managers and
workers on the issue of psychoactive substances
use in the workplace.
|
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59
ASSESSMENT OF PROGRESS
OVERALL EVALUATION
The reduction in mortality rates in general stands out
favourably, as well as the reduction in fertility rates among
adolescents. There is also a reduction in the percentage of
smokers. Also worthy of emphasis is the equally favourable
growth of vaccine coverage and the increase in the number
of pharmacists and dentists. Another item of data to be highlighted is the number of doctors per 1,000 inhabitants,
which went from 5.2 in 2017 to 5.7 (provisional data) in 2021.
Other health professionals, such as nurses, pharmacy professionals or dentists, were also greater in number in 2021,
compared to the !gures registered in 2017.
In the opposite direction, an increase in maternal
mortality rates was recorded, although the indicator is
below the threshold of the target (less than 70 deaths per
100,000 live births).
The increase in the maternal mortality rate, standing
at 20.1 in 2020, remains under analysis by the authorities.
For this purpose, a multidisciplinary Commission for Monitoring Maternal Mortality was created in July 2022, for
a period of !ve years, consisting of several experts from
different medical areas, representatives from the Order of
Doctors and Nurses, the scienti!c !eld and Obstetrics and
Maternal-Foetal Medicine. Factors such as comorbidities
and the increase in the average age of pregnant women
may have in"uenced the increase in these values.
The impact of the COVID-19 pandemic on SDG 3,
as with other SDGs, has not yet been fully assessed. Effects such as the delay in the monitoring of chronic diseases
during the pandemic period, especially those that may have
longer-term symptoms, may not yet be re"ected in the population’s main health indicators. This SDG is also interlinked with aspects associated with other SDGs that were
perhaps not captured by the statistical indicators. Pandemic crises and other natural disasters such as those associated with the effects of climate change (SDG 13), i.e. !res,
"oods, cold spells or heat waves, can have an impact on the
quality of the health of the population, especially those who
are most vulnerable, with worse incomes and poorer living
conditions (SDG 1, 7, 11).
ASSESSMENT OF PUBLIC POLICIES
The Programme for the Prevention and Control of
Smoking (PNPCT) report of 2020 assessed the results of the
implementation of the public policy. It reported, on a positive note, the 15% decrease in the prevalence of smokers
aged 15 years and over, between 2014 and 2019. The total
prevalence of smokers in 2019 was 17%, and that of daily
smokers was 14.2%. These values, contrary to the stability
trend of recent years, indicate a clear decrease in smoking
5. Progress on the goals and targets and evaluation of policies and measures taken so far from the perspective of the Government
5.2 Progress and current situation of the SDGs
in both sexes. There was also a decrease in smoking by women, which was another of the objectives that the PNPCT
aimed to achieve. The assessment recommends, despite
this result, reinforcing investment in smoking prevention
and control, promoting a paradigm shift from the perspective of a chronic and irresolvable health problem to a muscular approach to eradicating smoking.
Furthermore, the National Health Plan 2030, recently approved by the Council of Ministers in May 2023,
which progresses from the National Health Plan 2012-2016
Extension of 2020, will play a decisive role in achieving the
goals of this SDG.
MAIN CHALLENGES
The main challenges related to the pursuit of SDG
3 in Portugal are associated with the evolution of health
needs and increased demands and expectations regarding
the appropriate functioning of the National health Service
(NHS), as a guarantee of the fundamental right of all citizens to health protection. The National Health Plan 2012-
2016 Extension 2020 is the main instrument of strategic
planning in this !eld, taking on a cross-cutting role in the
implementation of public health policies in their varied
!elds. The Strategic Management Programme of the
NHS’s human resources was approved for that purpose.
Its objective is to improve the recruitment process of health professionals and enable their enhancement. It is also
important to mention the approval and conclusion of the
Commitment Agreement with ANMP, which aims to provide municipalities with the necessary means for decentralisation of competences, in this !eld. This will make greater
proximity between the NHS and local populations possible.
ASSESSMENT OF PROGRESS
IN THE AUTONOMOUS REGIONS
OVERALL EVALUATION
The situation of the autonomous regions, similar to
that of the mainland, is characterised by a positive overall
trajectory since 2017, albeit more moderate in comparison
with the results of mainland Portugal. The increase in the
number of physicians per 1,000 inhabitants, from 3.3 in
2017 to 3.9 (provisional data) in 2021 in the ARA and from
4.1 in 2017 to 5.1 (provisional data) in 2021 in the ARM, is to
be highlighted. Other health professionals such as nurses,
pharmacy professionals or dentists were also more numerous in both regions in 2021 than in 2017, similar to the situation registered for the country as a whole. The decrease in
2021, compared to 2017, of the neonatal mortality rate and
the number of deaths of children aged under !ve years in
both autonomous regions should also be highlighted. The
adolescent fertility rate decreased signi!cantly in the ARA
60
2023 VOLUNTARY NATIONAL REVIEW
On a less positive note, and contrary to what has
happened in the country as a whole, the death rate from
intentionally self-in"icted injuries (suicide) per 100,000
inhabitants rose slightly in both island regions in 2020,
compared to 2017.
Figure 30 – Physicians per 1,000 inhabitants, autonomous regions
Source: INE (2023), Statistical Annex in «Sustainable Development Goals. Indicators for Portugal. The 2030 Agenda»
Figura 30
2017 2018 2019 2020 2021
3,3‰
4,1‰ 4,3‰
3,4‰
3,6‰
4,4‰
3,7‰
4,7‰
3,9‰
5,1‰
Azores AR Madeira AR
(from 15% in 2017 to 11.3% in 2020). It increased slightly in
the ARM (from 6.1% in 2017 to 6.2% in 2020). The proportion of smokers among the resident population aged 15
years and over has also decreased in both regions, similar to
the !gures of the overall national assessment.
AUTONOMOUS REGION OF AZORES
The 2014-2020 Regional Health Plan Mid-Term
Evaluation Report (2018) shows that the measures taken
to promote school health, combat obesity and comply with
the Regional Vaccination Plan (PRV) had a positive impact,
demonstrated by the evolution of the respective indicators.
The programme’s contributions to the !ght against child
obesity are highlighted, in particular the recruitment of
professionals focused on school health, which includes the
hiring of nutritionists for the School Health Teams. The results of the PRV arise from raising awareness among pupils,
parents and the educational community about the importance of vaccination and the updating of the PRV. Other
drivers of the good results of the PRV are the care taken in
inviting people to take vaccines and the updating of vaccine
records and the achievements in child health surveillance
measured by the increase in the percentage of General
Health Examinations performed. Dissemination and raising
the awareness of pupils, parents and the educational community has contributed to raising the importance of health
surveillance.
Finally, projects on health literacy - health education
activities in various areas - were also highlighted.
AUTONOMOUS REGION OF MADEIRA
The Mid-Term Evaluation of the Regional Health Plan Extension 2020 (2019) presents the result of the
evaluation of a set of indicators selected within the scope of
the programme. The analysis shows the positive evolution
in the neonatal mortality rate indicator, which decreased
from 3.1 deaths in 2017 to 1.1 deaths in 2020 per thousand
births, as well as the infant mortality rate indicator, which
decreased from 3.6 deaths in 2017 to 3.2 in 2020 per thousand inhabitants. It is also important to mention that the
assessment noted the predominance of vaccine coverage
in children of the region.
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Segundo Informe Nacional Voluntario del Paraguay 2021
154
Situación general a nivel de meta e indicador
Meta 3.1 Para 2030, reducir la tasa mundial de mortalidad materna a menos
de 70 por cada 100.000 nacidos vivos.
Indicador 3.1.1 GLO. Razón de mortalidad materna por 100.000 nacidos vivos. La tasa de mortalidad materna ha descendido considerablemente entre
el 2015 y el 2018, bajando de 81,8 muertes por cada 100.000 nacidos vivos,
a 70,8 muertes por cada 100.000 nacidos vivos, a nivel nacional. Si bien esta
tendencia se observa en todos los niveles de desagregaciones del indicador,
se visualizan brechas, como, por ejemplo, por regiones del país. En este sentido, al 2018, la tasa de mortalidad materna era de 68,1 en la Región Oriental;
en la Región Occidental, la tasa alcanzaba 144,5 por 100.000 nacidos vivos.
De forma similar, se observa una brecha urbano-rural, en favor de áreas rurales, debido a la reducción significativa de la tasa en el área rural, y al ascenso
de la misma tasa en el área urbana (Figura 39).
Antes de la pandemia, el país experimentó grandes avances en materia
de salud, como ser la reducción de la mortalidad infantil y materna, y el
aumento de la esperanza de vida. A pesar de estos avances, el Paraguay
sigue enfrentando grandes desafíos en materia de salud y bienestar. Con
el surgimiento de la crisis sanitaria derivada por el COVID-19, numerosos
problemas estructurales en el país fueron evidenciados, siendo algunos
de ellos la cobertura universal de la salud y el acceso a servicios de
salud de calidad. Para dar respuesta a la crisis sanitaria, el Paraguay
se vio forzado a tomar medidas estrictas en poco tiempo, con miras a
precautelar la salud de la ciudadanía y preparar el sistema sanitario para
lo que vendría. Hacia el futuro, sin embargo, el país necesita implementar
políticas estructurales que permitan mejorar el sistema de salud.
Figura 39 • Razón de mortalidad materna por 100.000 nacidos vivos.
Años 2015 y 2018.
Fuente: MSPyBS/DIGIES/DES. Subsistema de Información de Estadísticas Vitales (SSIEV). 2015-2018. Recopilado por INE
- Sistema de Indicadores ODS.
CAPÍTULO 9 • Progreso en metas y objetivos
155
Indicador 3.1.2 GLO. Proporción de partos con asistencia de personal sanitario calificado (médicos y obstetras).
El siguiente indicador que busca monitorear el progreso hacia la Meta 3.1 hace referencia a los partos asistidos por personal sanitario califcado. En cuanto a la evaluación de este indicador, se observa un retroceso a nivel nacional, como regional, ya que,
del 2015 al 2018, la proporción de partos con asistencia de personal especializado bajó.
A nivel nacional, se observa una reducción del orden de 4,2 puntos porcentuales. La
desagregación del indicador a niveles regionales y áreas de residencia permite evidenciar algunas brechas regionales. Por ejemplo, se observa que en la Región Occidental
se dan muchos menos partos acompañados por profesional sanitario, que en la Región
Oriental.
De forma similar, se observan brechas a nivel urbano-rural. En el área urbana, los
partos con acompañamiento profesional son casi universalidad; sin embargo, en las
áreas rurales, hay mucho espacio para mejorar (Figura 40). Una mayor desagregación
de este indicador puede ser encontrada en la Tabla A28 del Anexo. Asimismo, la Tabla
A29 presenta datos para el indicador alternativo.
Figura 40 • Proporción de partos con asistencia de personal sanitario calificado
(médicos y obstetras) (%). Años 2015 y 2018.
Fuente: MSPyBS/DIGIES/DES. Subsistema de Información de Estadísticas Vitales (SSIEV). 2015-2018. Recopilado por INE
- Sistema de Indicadores ODS.
Meta 3.2 Para 2030, poner fin a las muertes evitables de recién nacidos y
de niños menores de 5 años, logrando que todos los países intenten reducir
la mortalidad neonatal al menos hasta 12 por cada 1.000 nacidos vivos, y la
mortalidad de niños menores de 5 años al menos hasta 25 por cada 1.000
nacidos vivos.
Segundo Informe Nacional Voluntario del Paraguay 2021
156
Para evaluar el progreso hacia esta meta, el Paraguay produce actualmente dos indicadores globales, los que se presentan a continuación.
Indicador 3.2.1 GLO. Tasa de mortalidad de niños menores de 5 años. La
tasa de mortalidad de niños menores de 5 años, por cada 1.000 nacidos
vivos, a nivel nacional, se ha reducido pasando de 16,4 en el año 2015 a 15,5
en el año 2018. Al desglosar este indicador por sexo, se observa que la tasa
de mortalidad es más elevada en la población de niños que en la de niñas.
Otro dato interesante se da al analizar el desagregado por área de residencia, ya que la tasa de mortalidad de niños menores de 5 años es casi el doble
en áreas urbanas en comparación con las áreas rurales. Todos los datos y
desagregaciones de este indicador se presentan en la Tabla A30 del Anexo
Estadístico de este documento.
Meta 3.3 Para 2030, poner fin a las epidemias del sida, la tuberculosis, la malaria y las enfermedades tropicales desatendidas, y combatir la hepatitis, las
enfermedades transmitidas por el agua y otras enfermedades transmisibles.
Indicador 3.3.1 ALT. Número registrado de nuevos diagnósticos por el VIH
por cada 1.000 habitantes.
En cuanto a este primer indicador, se observa un leve incremento del número de
nuevos diagnósticos, pasando de 1.430 en el año 2015, a 1.605 nuevos casos al 2019,
a nivel nacional. Este incremento fue determinado por el aumento de casos en la población masculina, ya que la femenina observó una reducción de nuevos casos en el
mismo período de tiempo. Otro aspecto resaltante es que este fagelo afecta principalmente a los varones (Tabla A31).
Indicador 3.3.2 GLO. Incidencia de la tuberculosis (casos nuevos+recaídas)
todas las formas, por 100.000 habitantes.
En cuanto a la incidencia de tuberculosis, en la Figura 41 se observa un aumento
a nivel total país entre los años 2015 y 2019. Este incremento también se observa en
diferentes niveles de desagregación. Este fagelo nuevamente afecta mayormente a la
población masculina. Asimismo, al desglosar el indicador por rangos etarios se observa que las personas de 30 años y más son las más afectadas por esta enfermedad. El
país también produce un indicador alternativo a este, que es presentado en el Anexo
estadístico de este documento.
CAPÍTULO 9 • Progreso en metas y objetivos
157
Indicador 3.3.3 GLO. Incidencia de la malaria. Casos autóctonos por cada
1.000 habitantes.
Tabla 17 • Incidencia de la malaria. Casos autóctonos por cada 1.000 habitantes. Año 2019.
Desagregaciones
2019
N.º de casos P. total Tasa
Total país 2 7.152.703 -
Fuente: MSPyBS/SENEPA Servicio Nacional de Erradicación del Paludismo. 2015-2019. INE. Paraguay. Proyección de la Población por Sexo y Edad, según Departamento, 2000-2025. Revisión 2015
En cuanto a este indicador, se reportaron casos solo en el año 2019, y fueron solo
2; es decir, la incidencia de malaria no es importante en el país, y de hecho está casi
erradicada.
Indicador 3.3.4 GLO. Número registrado de nuevos diagnósticos por la hepatitisB, por cada 100.000 habitantes.
El número de nuevos diagnósticos por hepatitis B ha ido incrementando en los
últimos años; sin embargo, siguen siendo mínimos. En el año 2016, como se observa
en la Tabla A35 del Anexo Estadístico, se habían reportado 57 casos, dando una tasa
de 0,83 por cada 100.000 habitantes. En el año 2019, los casos aumentaron a 329 casos,
Figura 41 • Incidencia de la tuberculosis por 100.000 habitantes. Período 2015-2019.
Fuente: MSPyBS/DIGIES/DES. Subsistema de Información de Estadísticas Vitales (SSIEV). 2015-2018. Recopilado por INE
- Sistema de Indicadores ODS.
(a) Incidencia de la tuberculosis por 100.000
habitantes, según sexo.
(b) Incidencia de la tuberculosis por 100.000
habitantes, según rango de edad en años.
Segundo Informe Nacional Voluntario del Paraguay 2021
158
equivalentes a una tasa de 4,60 por cada 100.000 habitantes. Al desglosar este indicador por sexo, se observa que esta enfermedad afecta en mayor medida a los varones.
La desagregación del indicador por rangos etarios evidencia que la enfermedad afecta
en mayor medida a la población entre 25 y 49 años.
Indicador 3.3.5 GLO2. Número de casos positivos de leishmaniasis tegumentaria y leishmaniasis visceral por cada 1.000 habitantes.
De acuerdo con los datos reportados en el período 2015 al 2019, el Paraguay logró
reducir el número de casos positivos de leishmaniasis, alcanzando una tasa de 0,01 por
1.000 habitantes al 2019, la más baja en el período analizado.
Indicador 3.3.5 GLO3. Número registrado de nuevos diagnósticos de lepra.
Los datos de este indicador denotan una reducción importante de los casos registrados de lepra en el período 2015 al 2019. El desglose por sexo evidencia que esta
enfermedad afecta en mayor medida a los hombres. Otro aspecto resaltante es que
esta enfermedad se presenta mayormente en la población de 65 años y más, como se
observa en la Tabla A37 del Anexo Estadístico.
Indicador 3.3.5 GLO4. Número de personas con diagnóstico confirmado de
rabia humana autóctona.
El país ha logrado la erradicación de los casos de rabia humana, ya que en el período analizado de 2015 a 2019, no se han reportado o confrmado casos.
Indicador 3.3.5 GLO5. Número registrado de nuevos diagnósticos de ceguera por tracoma, similarmente al caso del anterior indicado, no se han
registrado casos de nuevos diagnósticos de ceguera por tracoma en los años
2015 a 2019.
Además de los indicadores reportados en esta sección para monitorear la Meta
3.3, el país produce otros indicadores complementarios, los cuales se presentan en el
Anexo Estadístico de este documento.
Meta 3.4 Para 2030, reducir en un tercio la mortalidad prematura por enfermedades no transmisibles mediante la prevención y el tratamiento, y promover la salud mental y el bienestar.
Indicador 3.4.1 GLO. Tasa de mortalidad a causa de cáncer, diabetes, enfermedades cardiovasculares y respiratorias crónicas en la población de 30 a
70 años de edad.
CAPÍTULO 9 • Progreso en metas y objetivos
159
La tasa de mortalidad capturada por este indicador ha presentado un incremento
desde el 2015 con respecto al 2018. Al analizar el indicador desglosado por sexo, se
observa que la tasa de mortalidad es mayor para la población masculina. De las cuatro enfermedades capturadas por este indicador, la tasa de mortalidad es mayor para
muertes por enfermedades cardiovasculares.
Tabla 18 • Tasa de mortalidad a causa de cáncer, diabetes, enfermedades
cardiovasculares y respiratorias crónicas en la población de 30 a 70 años de
edad. Período 2015-2018. (en números)
Desagregaciones
Año
2015 2016 2017 2018
Total país 246,3 257,8 247,4 255,1
Por sexo
Hombre 278,8 291,5 278,3 294,5
Mujer 213,4 223,8 216,3 215,5
Por causas
Cardiovasculares (I00-I99)
Hombre 133,1 143,4 138,8 148,4
Mujer 78,5 82,0 78,8 79,8
Cáncer (C00-C97)
Hombre 88,8 86,2 89,4 88,5
Mujer 85,7 87,3 92,3 88,9
Diabetes (E10-E14)
Hombre 44,7 46,8 36,8 41,4
Mujer 44,7 49,5 40,5 41,1
Respiratorias crónicas (J40-J47)
Hombre 12,2 15,1 13,3 16,3
Mujer 4,5 5,1 4,8 5,7
Fuente: MSPyBS/DIGIES/DES. Subsistema de Información de Estadísticas Vitales (SSIEV). 2015-
2018. Recopilado por INE - Sistema de Indicadores ODS.
Indicador 3.4.2 GLO. Tasa de mortalidad por suicidio (X60-X84; Y87.0) por
100.000 habitantes.
En cuanto a este indicador, se observa un aumento en la tasa de suicidios por
100.000 habitantes, a nivel nacional. Al desglosar este indicador por sexo, se observa
una mayor tasa de mortalidad por suicidios en la población masculina que en la femenina (Figura 42, a). Por otra parte, el desglose por área de residencia evidencia que los
Segundo Informe Nacional Voluntario del Paraguay 2021
160
suicidios son más frecuentes en las áreas urbanas que en las áreas rurales. Otro aspecto
destacable en el período analizado es que la tasa de mortalidad por suicido aumentó
en las áreas urbanas, en tanto que disminuyó en las áreas rurales, entre los años 2015
y 2018 (Figura 42, b). Finalmente, se observa que las muertes por suicidio son más
frecuentes en la Región Oriental que en la Occidental.
Figura 42•Tasa de mortalidad por suicidio por 100.000 habitantes.
Período 2015-2018.
Fuente: Elaboración propia con base en los datos reportados por INE.
(a) Tasa de mortalidad por suicidio por
100.000 habitantes, según sexo.
(b) Tasa de mortalidad por suicidio por
100.000 habitantes, según región y área de
residencia.
Meta 3.5. Fortalecer la prevención y el tratamiento del abuso de sustancias
adictivas, incluidos el uso indebido de estupefacientes y el consumo nocivo
de alcohol.
Para medir el progreso en esta meta, el país cuenta con dos indicadores alternativos
que son:
Indicador 3.5.2 ALT1. Prevalencia del consumo de bebidas alcohólicas (vida,
año, mes) en estudiantes de 12 y más años de edad que declararon haber
consumido algún tipo de bebida alcohólica para capital y 7 departamentos
con más de 30.000 habitantes.
Indicador 3.5.2 ALT2. Incidencia del consumo de bebidas alcohólicas en estudiantes de 12 años y más edad que declararon haber consumido por primera vez algún tipo de bebida alcohólica (el último año o el último mes previo
al estudio) para capital y 7 departamentos con más de 30.000 habitantes.
En el caso de estos dos indicadores, se cuentan con datos del 2015 solamente, por
lo que no es posible analizar la evolución. Sin embargo, los datos reportados denotan
CAPÍTULO 9 • Progreso en metas y objetivos
161
una importante proporción de la prevalencia del consumo de bebidas alcohólicas en
estudiantes de 12 años y más, llegando a un 58,9% de esta población (Tabla A42), y
la tasa de prevalencia para los que declararon consumir por primera vez es del 40%
(Tabla A42).
Meta 3.6 Para 2020, reducir a la mitad el número de muertes y lesiones causadas por accidentes de tráfico en el mundo.
Indicador 3.6.1 GLO. Tasa de mortalidad a causa de accidentes de tránsito.
La tasa de mortalidad a causa de accidentes de tránsito muestra una modesta reducción entre los años 2015 y 2018. Al desglosar este indicador por sexo, se observa
que la tasa de mortalidad por accidentes de tránsito es sustancialmente mayor para la
población masculina relativo a la población femenina y el total país (Figura 43, a). En
el desglose de este indicador por tipo de vehículo se observa una tasa sustancialmente
mayor de mortalidad a causa de accidentes de tránsito por motocicleta (Figura 43, b).
Figura 43 • Tasa de mortalidad a causa de accidentes de tránsito por 100.000
habitantes. Período 2015-2018.
Fuente: Elaboración propia con datos del INE.
(a) Tasa de mortalidad a causa de
accidentes de tránsito, según sexo.
(b) Tasa de mortalidad a causa de accidentes
de tránsito, según tipo de vehículo.
Meta 3.7 Para 2030, garantizar el acceso universal a los servicios de salud
sexual y reproductiva, incluidos los de planificación de la familia, información
y educación, y la integración de la salud reproductiva en las estrategias y los
programas nacionales.
Indicador 3.7.1 GLO. Porcentaje de mujeres de entre 15 y 49 años actualmente casadas o en unión que usan (o que sus parejas usan) algún método
anticonceptivo moderno.
Segundo Informe Nacional Voluntario del Paraguay 2021
162
Tabla 19 • Porcentaje de mujeres de entre 15 y 49 años actualmente casadas
o en unión que usan (o que sus parejas usan) algún método anticonceptivo
moderno. Año 2016.
Desagregaciones Año 2016
Total país 66,5
Área
Urbana 65,4
Rural 68,2
Educación
Ninguna 59,9
EEB (1.° y 2.° ciclo) /Ex primaria 65,1
EEB (3.er ciclo) /Ex sec. básica 70,5
Educ. Media/ Ex bachillerato 67,9
Superior 65,0
Por quintiles de ingreso
Más pobre 69,1
Segundo 69,6
Medio 67,6
Cuarto 64,4
Más rico 61,9
Etnia/idioma del jefe de hogar
Indígena 55,5
Hablante solo guaraní 66,6
Hablante guaraní y castellano 67,9
Hablante solo castellano 65,5
Hablante de otro idioma 61,7
Fuente: MSPyBS/DGEEC/UNICEF. Encuesta MICS Paraguay 2016. Recopilado por INE - Sistema de
Indicadores ODS.
Además de este indicador, el país produce otros alternativos, los que se pueden
encontrar en el Anexo Estadístico de este reporte.
Meta 3.9 Para 2030, reducir sustancialmente el número de muertes y enfermedades producidas por productos químicos peligrosos y la contaminación
del aire, el agua y el suelo.
Indicador 3.9.2 GLO. Tasa de mortalidad atribuible al agua insalubre
(A00-A01; A03-A04; A06-A09; B76-B77; B79; E40-E46).
Indicador 3.9.3 GLO. Tasa de mortalidad a causa de envenenamiento accidental (X40; X43-X44; X46-X49).
CAPÍTULO 9 • Progreso en metas y objetivos
163
En ambos casos, las tasas de mortalidad a causa de agua insalubre y de envenenamiento accidental son bastante bajas, y no han mostrado sustanciales cambios entre los años 2015 y 2018 (Tabla A45 y Tabla A46).
Meta 3.b. Apoyar las actividades de investigación y desarrollo de vacunas y
medicamentos para las enfermedades transmisibles y no transmisibles que
afectan primordialmente a los países en desarrollo y facilitar el acceso a medicamentos y vacunas esenciales asequibles, de conformidad con la Declaración de Doha, relativa al acuerdo sobre los ADPIC y la Salud Pública, en la
que se afirma el derecho de los países en desarrollo a utilizar al máximo las
disposiciones del Acuerdo sobre los aspectos de los derechos de propiedad
intelectual relacionados con el comercio en lo relativo a la flexibilidad para
proteger la salud pública y, en particular, proporcionar acceso a los medicamentos para todos.
Indicador 3.b.1 GLO1. Proporción de la población menor de 1 año inmunizada
con la vacuna pentavalente en su tercera dosis que contiene DPT.
Indicador 3.b.1 GLO2. Proporción de niños que recibieron dos dosis de vacuna que contiene sarampión de acuerdo con el calendario nacional recomendado.
Indicador 3.b.1 GLO3. Proporción de niños que recibieron la última dosis de
la vacuna neumocócica conjugada de acuerdo con el calendario nacional
recomendado.
Indicador 3.b.1 GLO4. Proporción de niñas de 15 años de edad que recibieron la última dosis de la vacuna VPH entre 9 y 14 años de edad de acuerdo
con el calendario nacional recomendado.
En cuanto a estos cuatro indicadores que permiten evaluar el progreso hacia la
Meta 3.b, se observa una mayor tasa de niños inmunizados con la vacuna DPT en su
tercera dosis, así como una mayor proporción de niños que recibieron sus dos dosis
de la vacuna contra el sarampión, entre los años 2015 y 2018. Sin embargo, se observa
una reducción modesta en la proporción de niños que recibieron la última dosis de la
vacuna neumocócica en el mismo período (Figura 44, a). Por otra parte, se observa
una signifcativa reducción de la proporción de niñas de 15 años de edad que revieron
la última dosis de la vacuna VPH entre los años 2017 y 2019 (Figura 44, b).
Segundo Informe Nacional Voluntario del Paraguay 2021
164
Figura 44 • Proporción de niños con inmunizaciones (%), según tipo de vacuna.
Período 2015-2019.
Fuente: Elaboración propia con datos del INE.
(a) Proporción de niños inmunizados según tipo de
vacuna. Período 2015-2018.
(b) Proporción de niñas de 15 años
de edad que recibieron la última dosis
de la vacuna VPH entre 9 y 14 años de
edad. Período 2017-2019.
Para evaluar la Meta 3.b, el país produce numerosos indicadores complementarios y alternativos, los que se presentan en el Anexo Estadístico en formato Excel que
acompaña a este documento.
Marco institucional y normativo
El Sistema Nacional de Salud del Paraguay fue creado a partir de la promulgación
de la Ley n.° 1032. Este sistema está descompuesto en dos subsectores: i) el sector público, y ii) el sector privado. El sector público, por su parte, comprende el Ministerio
de Salud Pública y Bienestar Social (MSPyBS), el Instituto de Previsión Social (IPS),
las Sanidades de las Fuerzas Armadas y la Policía, la Universidad Nacional de Asunción y los servicios asistenciales de las empresas descentralizadas Itaipú Binacional y
Yacyretá. En tanto que el sector privado incluye a las aseguradoras privadas, los prestadores con fnes de lucro, los prestadores sin fnes de lucro y los prestadores mixtos.
CAPÍTULO 9 • Progreso en metas y objetivos
165
Planes y acciones
La epidemia de dengue que se dio en Paraguay en el año 2020 fue acompañada
de la pandemia derivada del COVID-19, revelando la realidad desatendida históricamente en el área de salud en Paraguay. Estos eventos generaron mayores necesidades,
pero también la oportunidad de ocasionar una valoración jerarquizada de los trabajadores de blanco por parte de la sociedad. En este espacio, se describen algunas de las
acciones más importantes llevadas a cabo en esta área, tanto por parte del Gobierno
como de otros sectores no gubernamentales.
En cuanto a las acciones que contribuyen a la consecución del ODS 3, el Ministerio
de Salud Pública y Bienestar Social ha liderado varias iniciativas. Por ejemplo, esta
institución extendió la cobertura de las Redes Integradas e Integrales de Servicios de
Salud (RIIS), basada en la estrategia de Atención Primaria a la Salud (APS), a través de
una diversidad de servicios que buscan garantizar el acceso, la gratuidad, la calidad y
la calidez de la atención médica. Así también, la instalación de Unidades de Salud de la
Familia (USF), defnidas como una estructura física donde trabaja un equipo de salud
de la familia —compuesto por un médico, una licenciada en enfermería u obstetricia
acompañados de un auxiliar o técnico en enfermería u obstetricia y agentes comunitarios— que ha ayudado a progresar hacia el objetivo de lograr la universalización
de la atención primaria de la salud. Desde el inicio de gestión del Gobierno actual, se
han construido y refaccionado 160USF e incorporado 1.765 recursos humanos para
el fortalecimiento de la Atención Primaria de la Salud.
Por otra parte, el MSPyBS ha lanzado el Plan Nacional de Salud Sexual y Reproductiva 2019-2023, con el objetivo de lograr el acceso universal a la salud sexual y reproductiva sin discriminaciones. Asimismo, esta institución ha venido implementando
el Programa de Planifcación Familiar como estrategia para disminuir la mortalidad
materna, fetal y neonatal.
En el contexto de las necesidades de la niñez, se han venido implementando acciones de promoción, prevención, atención integral y rehabilitación, asegurando acceso y
cobertura de intervenciones costo-efectivas a través del curso de vida, en servicios de
salud, la familia y la comunidad, en el marco del Plan Nacional de Salud Integral de la
Niñez 2016-2021. Así también, el MSPyBS ha lanzado recientemente la Guía de Derechos de la Niñez y la Adolescencia en Servicios de Salud (2016), la cual está orientada
a profesionales de salud de manera que los profesionales brinden atención de alta
calidad, y así garantizar respuestas efectivas ante posibles situaciones de violación de
derechos, en el contexto de la población de adolescentes. Esta guía justamente se lanzó
en el marco del Plan Nacional de Salud Adolescente 2016-2021.
Por otra parte, en el año 2020 se realizaron acciones concretas con relación a la
implementación del servicio de teleconsultas en 511 establecimientos de salud de dis-
Segundo Informe Nacional Voluntario del Paraguay 2021
166
tintos niveles y en diversas especialidades. En este sentido, al cierre del 2020, se habían
realizado más de 69.866 teleconsultas.
Igualmente, en respuesta a los grandes desafíos enfrentados en año 2020, se incrementó la capacidad de cuidados intensivos del sistema de salud pública en un 130%,
mediante el fortalecimiento de los servicios de salud y articulaciones estratégicas. Solo
en el año 2020 se habilitaron 280 camas. Al cierre del 2020, se contaban con 636 camas
para pacientes críticos, de las cuales 545 son de terapia intensiva y 91 son camas de
reanimación. Además, se sumaron 548 incorporaciones y se generó el espacio para
especializar a recursos humanos en cuidados intensivos, benefciando a más de 1.300
profesionales.
Por otra parte —y como ya fuera mencionado anteriormente—, el programa Tekoporã presta un enfoque particular a la protección de niños, niñas y adolescentes
(NNA), a través de corresponsabilidades en salud y educación, con lo que se busca
fortalecer el capital humano del país, y terminar con la transmisión intergeneracional
de la pobreza.
En cuanto a las acciones de actores no gubernamentales, se pueden mencionar las
acciones llevadas a cabo por Pacto Global, el cual liderando la campaña “Disposición
Responsable de Mascarillas”, buscó generar conciencia para contribuir al cuidado del
medioambiente y a la salud en tiempos de pandemia, contribuyendo así a los ODS 3
y 13.
Recursos presupuestarios para el ODS 3
En el año 2020, debido a la crisis sanitaria y las grandes necesidades sanitarias generadas por la pandemia, el 14,7% del Presupuesto General de la Nación (PGN) fue
invertido en acciones en torno al ODS 3, situándose en el ODS de mayor presupuesto
en este año (MH-DGP, 2020).
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|
28
Palestinian National Voluntary Review on the Implementation of the 2030 Agenda
There have been tangible improvements on national health
indicators during the last two decades. The average life
expectancy has increased over the last 8 years reaching 73.7
(72.1 Males, 75.2 Females) as of 2016. Vaccination coverage has
reached 99%, and contagious diseases are declining due to the
efforts and interventions of the government and its
partners. Since 1994, the Palestinian government has widened
its healthcare coverage and capacities, evident by the rise in the
number of primary healthcare clinics and their expanding
coverage. The number of clinics increased by 63% from 454 in
1994 to 739 in 2016, where the government operates 64% of
primary care clinics and 54% of total hospital beds in Palestine
- 27 hospitals with a total bed capacity of 3325 beds19.
Additionally, maternal mortality has decreased by 36% to reach
24.1 per 100,000. Child (under five years) mortality rates have
also decreased to 22 per 1,000, while infant (less than one year
old) mortality rates have decreased to 18.2 per 1,00020.
However neonatal mortality (within 28 days from birth) still
account for almost 2/3 of infant mortality and half of under-five
child deaths, which could be prevented. In addition, 99% of
births occurred under professional supervision and 95.5% of
SDG 3: Ensure healthy lives and promote
well-being for all at all ages
“Quality healthcare for all must
be assured throughout all of
Palestine”. National Priority 9 of the
NPA targets quality healthcare for
all. The government is committed
to reforming the public health
insurance system, and ensuring the
fiscal sustainability of healthcare
in Palestine through establishing a
cost-effective approach to patient
referrals and the procurement
of medical services. Above all,
improving the quality and
availability of healthcare services,
including infrastructure, equipment,
medicines, the training of healthcare
workers and general standards,
is of the utmost importance. The
NPA acknowledges that prevention
is always better than cure. The
government intends to strengthen
preventative healthcare measures,
including promoting healthy
lifestyles and raising awareness,
introducing a family health
approach, and improving chronic
disease management.
29
Implementing The SDGS: PEOPLE
Key challenges to good health and wellbeing:
Despite the efforts of the MoH to improve the Palestinian
healthcare system, violence and the policies of the Israeli
occupation continues to put severe restrictions and strains on
the well-being of Palestinians and development of Palestinian
healthcare. Since the beginning of the March of Return, Israeli
Occupying Forces killed 131 Palestinians and 14,000 injured.
Serious injuries result in long-term disabilities and the need
for continuous medical treatment, particularly as the majority
of those injured are children or youth.
Preventative health in Palestine is strained by numerous
environmental factors, which are consequences of the Israeli
occupation, constituting a major health hazards. The restrictive
planning and permit regime and the unequal water policies
have resulted in poor water infrastructure and the inability of
vulnerable communities to connect to the water network in
Area C (See SDG 6). Furthermore, only 30% of Palestinians are
connected to the sewage network, therefore leaving many
vulnerable Palestinian households relying on cesspits,
particularly in the Gaza Strip. As such, water contamination is a
major issue in Gaza and the West Bank, water sources are
increasingly contaminated from wastewater and pollution
from illegal Israeli settlements and settlement industries. Food
insecurity has also led to rising levels of malnutrition, where
doctors have seen significant rises in malnutrition-related
conditions (See SDG 2).
Israeli restrictions on construction have severely hindered the
expansion of Palestinian health infrastructure in Area C and
East Jerusalem, where the siege and continuous assaults on
Gaza has limited the capacity for reconstruction leaving
health infrastructure crumbling. The discriminatory Israeli
permit and planning regime has meant that permits to
expand or even renovate infrastructure is increasingly difficult,
where hospitals in occupied East Jerusalem have attempted
to cope through renting hotel rooms to ensure there are
enough beds for Palestinian patients. Severely restrictive
movement through a system of checkpoints, the wall and
other barriers limit the ability of vulnerable Palestinians to
access to necessary healthcare, particularly owing to the
poorer healthcare provision in marginal areas, while
simultaneously limiting the government and healthcare
providers’ ability to expand coverage and improve services in
these areas. Six hospitals in occupied East Jerusalem provide
the highest quality of healthcare in Palestine, however many
Palestinians in Gaza and the West Bank are unable to reach
such services as they require prior Israeli approval for travel. In
October 2017, as many as 45% of patient applications to
access health care outside of Gaza were rejected by Israel , the
occupying power.
pregnant women received medical anti-natal care (minimum
of 4 medical visits throughout pregnancy). Contraception
usage is still low, however, at 57.2% while exclusive breastfeeding
is at 38.6% for the first 6 months21.
Palestinian laws provide for the provision of health care to
persons with disabilities and their free access to health
services covered by governmental health insurance. A person
with a disability is granted government health insurance if the
disability rate is 60% or above. Persons with mental and
psychiatric disabilities are also part of the government funded
free public health insurance. To facilitate their access to health
services, the Government has adapted all government
hospitals to the needs of people with mobility disabilities and
has worked to adapt primary health care centers. The
Government and its partners provide medical assistive
devices and tools, and provide rehabilitation, psychological
and social support services. Despite efforts, persons with
disabilities continue to face difficulties in accessing health
care, especially women with disabilities, and persons with
mental disabilities. Lack of adequate infrastructure for the
needs of persons with disabilities, lack of specialized medical
staff in the areas of disability, lack of mental health care
services, and the difficult economic situation of persons with
disabilities are all factors impeding their access to health care.
According to 2016 data, however, the number of doctors and
specialized doctors remain low. There are currently 10,439
physicians in Palestine, (6,416 general physicians and 4,023
specialists, 21.7 physicians per 10,000 and 0.84 specialists per
10,000). Regarding nurses and midwives, the rates are also
considered low, where there are 20.9 nurses per 10,000 and 2
midwives per 10,00022.
While the Ministry of Health (MoH) and its partners made
significant headway in combatting a number of infectious
diseases, major challenges remain in combating and preventing
the spread of certain communicable diseases including, hepatitis,
brucellosis, tuberculosis, and meningitis. Non-communicable
diseases remain a major public health challenge in Palestine, as
cardiovascular diseases are the main cause of death in Palestine,
followed by cancer and strokes23. Non-communicable diseases
are continuously increasing where reported cancer cases
reached 2536 in 2016 an increase of 5.7% between 2015 and
201624. Road accidents in Palestine have also seen a dramatic rise
between 2011 and 2016, where the number of deaths from road
accidents increased from 3.8 to 5.3 per 100,00025. Illicit drug use
also remains an issue with 26,500 endangered addicts, where
synthetic marijuana, tramadol and Lyrica are the most widespread
illicit drugs26. Additionally, the deteriorating socioeconomic
conditions alongside increasingly aggressive Israeli occupational
practices has also resulted in the higher demand and need for
mental and psychosocial health services.
30
Palestinian National Voluntary Review on the Implementation of the 2030 Agenda
The healthcare system in the Gaza Strip suffers the most
destruction and debilitation, as health care providers are
struggling to cope with the deteriorating living conditions
alongside the limited equipment and infrastructure.
Restrictions on imports to Gaza extend to essential medical
supplies and equipment where of 516 medications on the
essential drug list, 223 (43%) were at zero stock levels in
November 2017, of which 198 were completely depleted.
The lack of essential medicines coupled with the inability for
patients in need to seek adequate treatment outside has
resulted in a health crisis in Gaza, where hospitals continue to
struggle without regular electricity and the lack of clean
available water.
These challenges have resulted in a strained ability of the
MoH to address the extensive health needs of citizens,
particularly as the challenges are ongoing effects of the
occupation27. As the major cause of death in Palestine are
from non-communicable diseases, the MoH spends around
80% of its budget on initiatives to combat non-communicable
diseases, constituting a major burden on its resources due to
the increase in population and the reduction in external
funding to the healthcare system. Additionally, a significant
portion of the national health budget is used to fund medical
referrals for Palestinian patients to neighboring and
international specialized hospitals. This strain on resources
has also aided the limited capacity of the MoH to fulfill the
health requirements and coverage for citizens.
Achievement within this goal will remain limited unless
efforts of other sectors are also mobilized to help achieve
health outcomes. It is vital to work hand in hand with the
Ministry of Finance to improve the overall performance of
health financing and the Ministries of Labor, Education and
Social Development on relevant health related matters.
Health priorities also need to be factored into poverty
alleviation strategies.
31
Looking forward:
As a part of the NPA, the Palestinian government is committed
to “Quality Healthcare for All”, which entails the continuation
of MoH efforts to strengthen the health system in Palestine
while focusing on the WHO framework which is in line with
the national health plan 2017-2022.
The MoH is committed to widening its specialty coverage
network and localizing services to reduce its budget
for referring special cases to hospitals abroad and create local
specialized healthcare coverage through partnership with the
hospitals in East Jerusalem. This includes: widening primary,
secondary and tertiary healthcare services and improving
health access especially in vulnerable areas especially to
persons with disabilities both physical and mental, residents
in Area C, and improve maternal and sexual health; providing
quality free drug rehabilitation services to all drug abusers;
and implementing international standards for healthcare. To
combat the detrimental health effects of the Israeli occupation,
partnerships between the civil society, private sector,
government and international organizations like the UNRWA
are the cornerstone of providing quality healthcare.
Preventive health, complemented with the implementation
of a family practice approach and promoting healthy living are
key national priority policies for promoting wellbeing as well
as to reduce the financial strain on government finances
while ensuring the financial sustainability of the healthcare
system. This approach aims to further improve primary
healthcare delivery system and reduce communicable and
non-communicable diseases by improving community
health and health awareness. The government hopes to
support healthy lifestyle and promote healthy practices in an
attempt to reduce reliance on health services and to increase
life expectancy.
Implementing The SDGS: PEOPLE
|
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3
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{
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|
22
SDG 3: Ensure healthy lives and promote well-being for all at all ages
To achieve the health goals set out in Qatar's Permanent Constitution and National
Vision, Qatar has designed two strategies to develop the health sector within the 1st
National Development Strategy 2011-2016 and the 2nd NDS 2017-2022 that go in line
with the said goals. The goals include building an integrated healthcare system that
delivers highest-standard services through public and private healthcare institutions
guided by a national health policy. This system will cover all preventive and therapeutic
healthcare aspects, take care of both physical and psychological health while taking into
consideration the different needs of men, women and children, and build national staff
that are able to provide the best health services. Qatar's commitment to providing the
funding necessary for maintaining citizens' health does not contradict establishing
partnerships to undertake healthcare costs.
Qatar generously spends on the healthcare of all its residents and provides three-level
healthcare for all at low costs compared to any other healthcare system as well as
medications at about 10-20% of their costs. As predicted, with the huge increase of
Qatar's population over five years by over 1.7 million people, the government spending
on health continued to rise totally and individually. The spending on healthcare in 2016
was about QAR 22.7 billion, which represents 10.8% of total government spending in
that year and 41.3% higher than in 2012/2013. The government annual per capita
spending on healthcare, measured by the PPP against the USD, rose by 89% from US$
2719 in 2010 to US$ 5138 in 20166
.
Achievements of National Health Strategy 2011-2016
The National Health Strategy (NHS) has made major achievements developing Qatar's
health sector, especially in establishing an integrated healthcare system and developing
preventive and therapeutic care, as follows:
1. Promoting the healthcare system governance and building a more balanced
system through increasing the opportunities of access to primary healthcare and
to community centers. Moreover, all private-sector healthcare workers were
certified by the Qatar Council for Healthcare Practitioners (QCHP), the
integration between public and private health institutions was promoted and
progress was made in building an active workforce and further training health
workers;
2. Regarding preventive healthcare, means of early detection of diseases
developed, death rates in people over 60 years old due to diabetes,
cardiovascular diseases and trauma declined, healthy practices were
encouraged and transparency in patients' rights and responsibilities improved;
3. As for therapeutic healthcare, emergency and urgent care services were
developed, and six new primary healthcare centers were opened as well as the
first socio-psychological healthcare service center in November 2014; and
6 The PPP against the USD was used in 2010 and 2016. Source: World Bank Development Indicators
23
4. Popularizing "We are Healthy Kids "and "Health at Workplace "programmes,
opening five smoking-cessation clinics early in 2015, raising awareness of the
risks of cousin marriages and establishing more specialized hospitals, the last of
which was the Communicable Disease Center. By the end of 2016, 80% of the
strategic projects and their outputs was achieved.
Challenges facing the health sector between 2011-2016
The 1st NHS faced several challenges that can be summarize as follows:
1. Transition from focusing on recovery to focusing on the primary and community
healthcare model which provides a connected and integrated series of health
services;
2. The spread of non-communicable diseases, including chronic diseases, and those
related to unhealthy lifestyle and behavior;
3. The need for the healthcare system to keep up with the quickly increasing
population, which raises the demand for health services beyond the capacity of
the system;
4. The lack of high-quality healthcare workforce; and
5. The lack of IT abilities and the gap in health statistics and data.
National Health Strategy 2017-2022
The 2nd NHS 2017-2022 identified a key result related to sustainability and improvement
of healthcare, which is "to improve the health of Qatar’s population and meet the needs
of the existing and future generations through an integrated healthcare system that aims
at better health, better care, and better value for all. ”The 2nd NHS was based on the
achievements of the 1st NHS and on the lessons learned from it. It set new priorities
based on three key pillars: better health, better care and better value. The "better
health" pillar aims to improve population's health through cooperating with local
communities and individuals to determine their needs and implement programmes
necessary for promoting a healthy lifestyle. "Better care" aims to provide integrated and
coordinated healthcare services to citizens at the right time and place. "Better value"
considers spending on health a profitable investment through improving health services
and providing patients with a better value.
The 1st NHS 2011-2016 continuously faced health challenges, like failure to adopt a
healthy lifestyle by citizens and residents, leading to negative consequences
(overweight and huge increase of diabetes rates), the challenge of building national
healthcare capacities as well as building and maintaining a highly-skilled workforce, the
increasing rates of traffic and workplace injuries and the occurrence of new
communicable diseases transmitted by expatriate workers that pose a threat to Qatar's
health situation. Therefore, the 2nd NHS 2017-2022 maintained the seven goals of the
1st NHS while prioritizing seven population groups in the health sector: healthy kids and
teenagers, women's health for healthy pregnancy, workers' health and safety,
psychological and mental health, improving the health of patients with chronic diseases,
24
improving the health and well-being of people with special needs and disease-free
aging. The 2nd NHS defined quantitative indicators to measure the improvement of each
group as a result of health programmes, projects and interventions during the strategy
implementation period. It is worth mentioning that 2030 Agenda goals adopted the same
approach of focusing on improving the public health of certain population groups.
|
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44 45
Overview
Reduce rate of maternal and infant mortality, lower the incidence of
infectious and chronic diseases, prevent and treat cases of substance
the abuse and mental diseases
Ensure healthy lives and
promote well-being for all at all ages
Romania’s goal
The life expectancy in Romania was ࠄࠆ.ࠅ in ࠈࠀ߿ࠁ, below the EU average
of ߿ࠇ.ࠅ years. The health system has been severely disrupted by the
Covid-ࠈࠀ pandemic, which caused a temporary decrease by ࠀ.ࠃ years,
up to ࠃࠆ.ࠁ in ߿ࠁ߿ࠁ, with women living ࠇ years more than men, ࠇࠆ.ࠃ
compared to ߿ࠆ.ࠄ respectively.
From ࠅࠀ߿ࠁ to ࠀࠁ߿ࠁ, the infant mortality rate decreased from ࠅ.ࠇ to ࠄ.ࠆ
deaths at ࠀ,߿߿߿ live-born, following the increase in the percentage of
births assisted by qualifed staff to ࠅࠈ.ࠆ%.
Tuberculosis continues to be the main epidemic disease, reaching
%ࠀࠄ.ࠇࠂ by decreasing ,ࠀࠁ߿ࠁ in inhabitants ߿߿߿,߿߿ࠀ per cases new ࠆࠃ.ࠂࠂ
compared to ࠅࠀ߿ࠁ. Viral hepatitis affected about ࠈࠀ.߿ persons per
߿߿ࠀ,߿߿߿ inhabitants in ࠈࠀ߿ࠁ. In the context of COVID-ࠈࠀ pandemic, by
applying sanitary protection measures, the incidence of viral hepatitis
decreased at ࠄ.ࠆ new cases per ߿߿ࠀ,߿߿߿ inhabitants in ߿ࠁ߿ࠁ. HIV virus
affects ߿ࠃ.ࠇ persons per ߿߿ࠀ,߿߿߿ adult and child inhabitants on a
yearly basis.
Cardiovascular diseases are the main cause of mortality, with an
increasing rate from ࠆࠅࠆ,ࠈ to ࠁࠀࠈ.ࠂ deaths per ߿߿ࠀ,߿߿߿ inhabitants from
ࠇࠀ߿ࠁ to ࠀࠁ߿ࠁ. The mortality rate attributed to diabetes is also on an
.ࠆ.ࠁࠁ to ࠁ.ࠃࠀ from ,trend upward
Lung cancer is the most common cause of death and contributes to
the mortality caused by cancer in Romania, which recorded a slight
downward trend, from ࠁࠂࠁ.ࠇ to ࠁࠀࠁ.ࠀ deaths per ߿߿ࠀ,߿߿߿ inhabitants.
The mortality rate caused by mental and behavioural disorders
recorded a value of ࠁ.ࠄ cases per ߿߿ࠀ,߿߿߿ inhabitants in ࠀࠁ߿ࠁ, showing
an increase compared to the pre-pandemic period.
ࠂ,ࠁࠀࠂ,ࠄࠇ߿ confrmed cases were reported during the COVID-ࠈࠀ
,respectively ࠀࠆࠃ,ࠆࠂࠁ,ࠂ %,ࠆ.ࠆࠈ ,these Of .ࠁࠁ߿ࠁ December ࠀࠂ on pandemic
were cured cases, according to European Center for Disease
Prevention and Control.
The National Committee for Special Emergency Situations managed
the pandemic combating measures. In order to prevent the spread of
the virus, states of emergency and alert were decreed, establishing
limitations on the activities of public hospitals for the admission and
treatment of urgent cases, changes in the structure of hospitals for
the admission of COVID-ࠈࠀ cases, procurement of materials and
medicines needed in the pandemic, remote medical consultations in
primary care and specialist outpatient clinics.
Measures were established to: increase the response capacity in
residential centres for disabled persons, elders and other vulnerable
categories; ensure the resilience of communities by wearing the
protection mask, quarantine, isolation, etc.; reduce the impact of the
type of risk by establishing the categories of allowed/prohibited
activities, fulflling the Strategy of COVID-19 Vaccination.
The European framework was implemented to issue, check and accept
the EU Covid digital certifcate. From February ࠀࠁ߿ࠁ to December ࠁࠁ߿ࠁ,
ࠇ,߿ࠃࠀ,ࠇࠅࠃ persons received the frst dose, ࠁࠃ.ࠃ% of the Romanian
population respectively, of which ߿ࠄ.ࠈ% adults and ࠆ.ࠁ% persons under
ࠇࠀ. Since July ࠁࠁ߿ࠁ, COVID-ࠈࠀ vaccine has been included in the National
Vaccination Programme, being recommended to the entire population,
but especially the persons in the risk groups, by means of family Policies and measures physicians.
Next steps
Response to COVID-19 pandemic
Health services are accessible and/or free of charge to all children,
being ensured by law, without payment or any connection with the
parents’ contribution. The groups exempted from payment include
children under ࠇࠀ, young people up to the age of ࠅࠁ enrolled in
education, patients who are subject to national health programmes,
pregnant women without any income and pensioners.
Emergency care is free of charge and more than ߿ࠅ % of the
population is exempted from the payment of fees required for the use
of hospital services, due to the contributions paid to the sole health
insurance national fund.
Good practice
Challenges
Uneven distribution of family medicine practices, especially in the
rural area, where the average number of insured included in the
family physicians' lists is higher than in the urban area
Insuffcient human resources and infrastructure for community
medical care, palliative and rehabilitation-recovery care
Improve, professionalise, and diversify care facilities in
institutional and non-institutional day and long-term care centres,
including at home, for the elderly and disabled population
Extend the population screening to increase the prevention,
diagnosis, and treatment capacity
Increase the proper response capacity to multi-drug resistant
tuberculosis and major mental health problems, including forms
of long-Covid and, in particular, the neuro-psychological forms
generated by it, taking into account the risk of later developing
neuro-degenerative diseases, strokes, etc
The health system, including the rehabilitation, modernization,
extension of hospital infrastructure shall be strengthened by
implementing the new National Health Strategy, Strategy for the
Surveillance, Control and Prevention of HIV/AIDS, Strategy for the
Control of Tuberculosis, Multi-year Strategy for the Development of
Human Resources for Health and Law for the Prevention and Control of
Cancer.
To improve the access to medical care services, it is planned to equip
at least ߿ࠂ public health units, including through the construction of
new buildings, providing ambulatory health care, the development of
߿߿ࠁ integrated community centres and the construction of three
operational regional emergency hospitals, increase by more than ߿ࠄ%
of human resources in public health, diversify their skills, including for
the creation of multidisciplinary teams for integrated case
management shall improve diagnostic capacity.
Extensive public education and awareness campaigns are planned for
all ages and at all social levels, on regular health screening, so that
the activity of family physicians is directed towards prevention and
active health monitoring. Vaccine coverage is aimed for more than
߿ࠈ% of all vaccines included in the national immunisation programme
and ߿ࠆ% for the vaccination of groups exposed to the risk of diseases
preventable through vaccination.
HIV Outcomes Romania, multi-stakeholder initiative including the HIV
patient associations and pleading for the quality of life of HIV persons,
co-organised public policy consultations and roundtables with
community and non/governmental experts. Thus, the new National
Strategy of HIV/AIDS is focused on the needs of HIV persons and
provides for ߿ࠂ߿ࠁ: ZERO new infections, reach the new targets UNAIDS
ࠄࠈ-ࠄࠈ-ࠄࠈ for testing-treatment-viral suppression in the risk
communities, reduce the health stigma, increase the NGOs
involvement, prevention programmes in the immigration receiving
centres.
Give Life has set up the most famous social involvement initiative in
Romania: #NoiFacemUnSpital. Thus, more than ߿ࠄࠂ,߿߿߿ persons and
more than ࠆ,߿߿߿ companies supported with trust and their own funds
the construction from scratch of the First Children's Hospital, providing
multidisciplinary care to children with cancer and other serious
diseases. What started as a project meant to renovate the paediatric
oncology department of the Marie S. Curie Children's Emergency
Hospital in Bucharest turned into the frst building of ࠁࠀ,߿߿߿ mࠁ and ࠈ
foors and continues the plans to create a true medical campus. The
construction works are completed. The hospital shall be donated to
Marie S. Curie Hospital and shall operate as a public hospital. Give Life
currently works with the Romanian authorities to implement a pilot
project for the management of the Department of Paediatric
Radiotherapy within the Hospital, based on the corporate governance
and medical governance principles.
Hospital for children with cancer, a project of the “Give Life” Association
Source: Give Life
The National Strategy of Health aimed at reversing the health service
pyramid, based on excessive hospitalisation, by increasing coverage
with good quality and prevention-focused basic services, through
family physicians, community centres and specialised outpatient care,
including in vulnerable group communities.
Civil society contribution
|
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50 RUSSIAN FEDERATION / VOLUNTARY NATIONAL REVIEW
SDG 3
Ensure healthy lives and promote
well-being for all at all ages
51
Reduce maternal mortality ratio (Target 3.1),
end preventable deaths of children under 5 years
of age (Target 3.2)
From 2000, maternal mortality ratio in the Russian Federation has reduced more than fourfold.
Between 2015 and 2018 this figure fell from 10.1 to 9.1 per 100,000 live births.
In 2010–2018, the proportion of births attended by skilled health personnel in the Russian
Federation was constant (99.7%), which far exceeds the target included in the Thirteenth General
Programme of Work (WHO) for 2023 (88.6%) and closely reaches the goal of 100% set out for 2030.
“Healthcare” National Project is also targeted at enhanced training of specialists in perinatology,
neonatology and pediatric simulation centers and the development of medical attendance
to women during pregnancy, childbirth, and postnatal period, including within the financing
available under birth certificates.
Against 2015, the under-five mortality rate in the Russian Federation decreased by 21.3% (2015–8;
2018–6.3 per mille). The target established by “Development of Children’s Healthcare, including
the Creation of State-of-the-Art Infrastructure for Provision of Medical Care to Children” Federal
Project is 5.9 per 1,000 live births 23 by 2024.
In the Russian Federation, neonatal mortality rate has been steadily reducing, from 3.9 to 2.8 per
mille in 2015–2018, due to the implementation of three-tier medical assistance model, including the
development of perinatal centers, provision of state-of-the-art equipment to healthcare providers,
development of personnel skills in working with low-birthweight infants and monitoring of the
screening quality during antenatal period24. Information on medical assistance provided to women
during pregnancy and maternity periods is presented in SDG 5 section.
End communicable diseases (Target 3.3)
The sentinel epidemiological monitoring and oversight system providing for registration
of communicable disease cases within Russia has been operating in the Russian Federation
for many years. Furthermore, disease and death cases are registered as part of the continuous
statistical monitoring; since 2017, the Federal Register of Tuberculosis Cases and the Federal
Register of Human Immunodeficiency Virus (HIV) Cases have been maintained, including case
follow-up, treatment and treatment efficiency data for each reported tuberculosis and HIV
infection case within Russia.
The number of registered patients with a first-time diagnosis of HIV infection (per 100,000
population) in Russia reduced by 27.3% from 3.3 persons in 2015 to 2.4 in 2018. According to the
Ministry of Health of the Russian Federation, HIV prevention measures at federal and regional
levels promoted a considerable increase in screening coverage from 19% in 2015 to 26% in 2018
(with early disease detection in 70% of HIV cases).
23 The age group 0–4 years of age used in Russia corresponds
to the international category “Children under age 5”.
24 Order of the Ministry of Health of the Russian Federation No. 572n of 1 November 2012.
52 RUSSIAN FEDERATION / VOLUNTARY NATIONAL REVIEW
Tuberculosis incidence has been reducing faster than planned (in 2018–44.4 against the target of
49.9 per 100,000 population). In 2019, the sectoral special-purpose programme was adopted, which
is aimed at the improvement of the tuberculosis epidemiologic situation25. In 2015–2018, hepatitis
B incidence reduced from 11.9 to 9.9 (per 100,000 population) (Figure 4).
The Russian Federation is one of the principal partners in addressing the international health
problems. Thus, on 1 December 2018, the World AIDS Day, the Government of the Russian Federation
decided to make the next voluntary target contribution to the Joint UN Programme on HIV/AIDS
(UNAIDS) in the amount of USD 17.8 mln to provide assistance in 2019–2021 to some countries of
Eastern Europe, South Caucasus and Central Asia (EESCCA) for prevention, control and monitoring
of HIV/AIDS and other communicable diseases. From 2012, the overall input of the Government of
the Russian Federation in the provision of assistance to EESCCA countries to combat HIV/AIDS
amounted to USD 50 mln target contribution to UNAIDS and USD 12 mln on a bilateral basis.
On 11 March 2020, WHO declared the outbreak of a disease caused by a new coronavirus infection
(COVID-19) a pandemic. Executive Order of the Government of the Russian Federation included
COVID-19 in the list of diseases that pose a danger to others 26. Detailed information on measures
implemented by Russia to prevent COVID-19 spread is presented in section “COVID-19 response
in the Russian Federation”.
25 Order of the Ministry of Health of the Russian Federation No. 199 of 5 April 2019.
26 Decree of the Government of the Russian Federation No. 66 of 31 January 2020.
FIGURE 4. NUMBER OF REPORTED FIRST-TIME DIAGNOSED HIV CASES,
INCIDENCE OF TUBERCULOSIS AND INCIDENCE OF HEPATITIS В
Rosstat / per 100,000 population
Tuberculosis incidence
Hepatitis B incidence
The number of registered patients with a first-time diagnosis of HIV infection
60
40
20
2015 2016 2017 2018
0
3.3 2.8 2.6 2.4
57.7
53.3
48.3
44.4
11.9 11.1 10.4 9.9
53
Reduce mortality from non-communicable diseases
(Target 3.4)
Against 2015, in 2018, mortality in the Russian Federation declined (Figure 5): from cardiovascular
disease— by 8.2%; from chronic respiratory disease— by 19.7%; from cancer— by 1.2%. Low
mortality reduction rate from malignant neoplasms may be related to the changed age distribution,
with an ever-increasing proportion of the elderly. One of the objectives of “Healthcare” National
Project is the reduction of mortality from cardiovascular diseases and cancer.
Cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases are the four key
causes of mortality from non-communicable diseases for adult population. In 2018, the adult
population (30–69) mortality from non-communicable diseases continued to decline to 23.7%.
According to Rosstat, suicide mortality rate (per 100,000 population) for the last four years
(2015–2018) reduced from 17.4 to 12.4 or by 28.7%.
FIGURE 5. MORTALITY RATE ATTRIBUTED TO CARDIOVASCULAR DISEASE,
CANCER, CHRONIC RESPIRATORY DISEASE
Rosstat / per 100,000 population
Cardiovascular diseases
Cancer
Chronic respiratory disease
800
400
2015 2016 2017 2018
635.3
202.5
51.8
616.4
201.6
48
587.6
197.9
42.2
583.1
200
41.6
0
54 RUSSIAN FEDERATION / VOLUNTARY NATIONAL REVIEW
The Russian Federation has been consistently and comprehensively supporting WHO in the
achievement of global progress in prevention and control of non-communicable diseases (NCDs).
On the global level, the Russian Federation was one of the initiators of the establishment of, and
provides financial support to, the UN Inter-Agency Task Force on the Prevention and Control
of NCDs, which rallied all relevant UN special-purpose agencies, NCD programmes and UN funds
in order to provide support to countries in the achievement of NCD-related SDGs. On the regional
level, from 2014, the Russian Federation has been financing the operation of the WHO office for
the prevention of NCDs, which have launched a series of programmes and ensured positive trends
in reducing the burden of non-communicable diseases in countries of the European region.
Reduce the number of deaths and injuries
from road traffic accidents (Target 3.6)
According to Rosstat, the Russian Federation shows downward trends in the number of deaths
from road traffic accidents: a 20.5% reduction from 12.2 to 9.7 per 100,000 population in 2015–2018.
National Road-Traffic Safety Strategy of the Russian Federation adopted in January 201827 has
an ambitious goal of improving road safety and achieving zero deaths from road traffic accidents
by 2030. Speed limitations of no more than 60 km/h in populated localities, and no more than
20 km/h in housing areas, cycle areas and courtyards were introduced. Furthermore, under
“Housing and Urban Environment” and “Digital Economy” National Projects, “Smart City” Project
is implemented, with the solution bank that includes, among others, projects for introducing an
intelligent system of road traffic control and photo and video recording of road traffic offences,
including at junctions and railway crossings.
The targets of “Safe and Quality Roads” National Project include the introduction in 2019–2024
of at least 130 standards and technical requirements for road facilities construction, including
based on digital technologies, aimed at elimination of road traffic accidents concentration
points; introduction of automated and robotic technologies of traffic management and control
of compliance with the road traffic regulations; and ground public passenger transport rolling
stock renewal in 20 biggest urban agglomerations.
Achieve universal health coverage (Target 3.8)
In 2019, the mortality rate (number of deaths per 1,000 persons) in Russia reduced to 12.3
compared to 2015 (13.0) and 2010 (14.2), with the life expectancy at birth showing a steady upward
trend (72.91 in 2018 against 71.39 in 2015; 73.34 by estimate for 2019). These improvements are
largely due to the implementation of the relevant measures. The mortality rate for employment
ages (16–59 for men and 16–54 for women) continues to decline— for Russia generally, by 2018
to 482.2, or by 11.8% compared to 2015 (546.7 deaths per 100,000 population).
Russia provides all people from birth and throughout the lifetime with free medical care under the
Programme of State Guarantees of Free Provision of Medical Care, including coverage by such
measures as prevention and screening and high-tech health interventions. Free medicines are
27 Decree of the Government of the Russian Federation No. 1-r of 8 January 2018.
55
given to all patients provided with emergency medical services and taking treatment in all-day and
daytime patient facilities. Guarantees apply to medicines within the list of vital and essential drugs
(EDL) and to benefit recipients 28.
In achieving this target, a special role is played by availability of transport to ensure access to
healthcare and disease-prevention service providers, first aid services and transportation of
patients from remote areas to specialized health facilities. The proportion of persons who were
not able to visit a healthcare provider because they could not get there without aid reduced
from 4.9% in 2014 to 3.4% in 2018, the improvement being due, among other things, to the
implementation of the 2011–2025 State Programme 29 “Accessible Environment”. Also, the State
Programme 30 “Integrated development of rural areas” provides for the reduction of the mid-radius
of accessibility of rural health units to 6 km in 2025 (15 km in 2017).
Furthermore, under “Healthcare” National Project, in 2019, rural dwellers (in populated localities
with up to 2,000 population) were able to have access to healthcare due to putting into operation
of more than 350 new rural health units (RHUs) and dispensaries, and 500 mobile health units.
Mobile RHUs have also been equipped with modern technical means, including patients’
examination and treatment rooms, and resuscitators. Ambulance vehicles have also been
modernized, enabling healthcare workers to test patients and make electrocardiography in the
vehicle. Modern computer equipment was installed, including webcams for teleconsultations,
as required, telecommunication with a clinic physician. Electrocardiograms are also examined
in online mode, enabling paramedics to prescribe treatment promptly.
Further reduction of mortality and increased life expectancy (up to 78 years by 2024
and up to 80 by 2030) are the targets of “Healthcare” National Project.
Reduce the number of deaths and illnesses
from hazardous chemicals and air, water
and soil pollution and contamination (Target 3.9)
According to the Federal Service for Surveillance on Consumer Rights Protection and Human
Wellbeing data, in 2018, there were about 75,400 deaths (or 80.0% of 2013 level) and about 3.0
mln illnesses of children and adults (or 70.5% of 2013 level) directly associated with air, water
and soil pollution and contamination in urban and rural settlements. Generally, the proportion
of deterioration of health cases reliably associated with negative habitat factors, such as air,
water and soil quality, has been gradually reducing in recent years, largely due to the application
of the risk-based approach to control and monitoring and systematic consistent improvement
of human environment quality in Russian regions.
28 The Great Patriotic War veterans, persons with disabilities, families with many children
or certain disease cases, such as orphan and oncological diseases, diabetes, HIV, tuberculosis.
29 Decree of the Government of the Russian Federation. No. 1297 of 1 December 2015.
30 Decree of the Government of the Russian Federation No. 696 of 31 May 2019.
56 RUSSIAN FEDERATION / VOLUNTARY NATIONAL REVIEW
In addition, Russia together with UNECE and other UN programmes, funds, and specialized
agencies is working for a considerable reduction of hazardous air emissions (including by
transport) and use of ecologically clean technologies. More detailed information is also
presented in SDG 13 section.
Strengthen the implementation of the WHO Framework
Convention on Tobacco Control (Target 3.a)
According to Rosstat sampling survey findings, as at 2018, the percentage of tobacco smoking
persons aged 15–24 in the total population aged 15–24 was 11.2% (the least percentage typical
for age group 65+— 9.7%) (Figure 6).
In 2012, tobacco risks warnings were approved 31. From 15 November 2017, such warnings
are placed on smoking products in the upper parts of the front and back sides of consumer
packaging (the warning may be placed at the bottom of the back side if it is overlapped
by the excise stamp), and shall occupy at least 50% of the side surface. The Federal Law
“On Advertising” also bans advertising of tobacco, tobacco goods and products and smoking
accessories including smoking pipes, hookahs, cigarette paper and lighters. Free-of-charge
distribution of tobacco products is also banned in Russia.
FIGURE 6. AGE-STANDARDIZED PREVALENCE OF CURRENT TOBACCO USE
AMONG PERSONS AGED 15 YEARS AND OLDER, 2018
Rosstat / %
40%
20%
15–24
11.2
65+
9.7
55–64
22.3
45–54
29
35–44
29.6
24–34
26.5
0
31 Paras 1–12 of part 1 of Article 10 of the Federal Law No. 268-FZ of 22 December 2008.
57
Increase health financing and development and training
(Target 3.с)
Health worker density and distribution per 1,000 population in 2015–2018 has no apparent
dynamics, remaining more than 4.0 for medical doctors and 10 for nursing stuff (including
midwifery personnel and dentists).
Decree No. 204 32 is aimed at staffing of health organizations with skilled personnel, including
the implementation of the lifelong learning system for health workers, remarkably, with the use
distant education technologies. “Healthcare” National Project includes “Providing Healthcare
Organizations with Qualified Personnel” Federal Project, which targets include the development
of accreditation system for health specialists, as well as education modules.
Case study
The All-Russian Public Movement of Medical Volunteers
Healthcare Volunteers Movement was founded in 2013 and today remains one of the
largest voluntary healthcare organizations in Europe. About 4 mln Russians receive help
and support from medical volunteers every year. Main targets and goals include, inter alia,
increasing health awareness of population, promoting the prestige of medical specialties
and building human resource capacity for the healthcare industry.
Strengthen the capacity for early warning, risk reduction
and management of global health risks (Target 3.d)
The Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing is the
designated International Health Regulations (IHR, 2005) focal point in the Russian Federation.
As part of IHR implementation, Russia provides assistance to CIS countries 33, as well as Guinea,
Mongolia, China and Vietnam, to combat dangerous communicable diseases. Relevant initiatives
include assistance to foreign partners in elimination of measles and rubeola, reduction of risk
of import and spread of plague, IHR implementation, reduction of risks of microbial antibiotic
resistance, and combatting HIV/AIDS. In 2017–2018, more than 400 specialists from specialized
32 Decree of the President of the Russian Federation No. 204 of 7 May 2018.
33 Including Armenia, Belarus, Kazakhstan, Uzbekistan, Tajikistan, Azerbaijan, and Kyrgyzstan.
58 RUSSIAN FEDERATION / VOLUNTARY NATIONAL REVIEW 58
institutions in Kazakhstan, Kyrgyzstan, Armenia, Belarus, Tajikistan, and Mongolia received
training. In 2015–2018, 14 mobile laboratories were supplied to six countries: 3 to the Republic
of Kazakhstan, 2 to the Republic of Uzbekistan, 2 to the Republic of Tajikistan, 3 to the Kyrgyz
Republic, 2 to Republic of Armenia, and 2 to the Republic of Belarus.
In 2020 and 2021, Russia will pay up to USD 2.8 mln and 1.9 mln, respectively, as a voluntary
contribution to WHO to promote IHR implementation.
Information on humanitarian aid supplies from Russia to foreign countries during COVID-19
pandemic is presented in section “COVID-19 response in the Russian Federation”.
Looking forward
One of the subprogrammes of the State Programme “The Development of Pharmaceutical and
Medical Industry in 2013–2020” is the development of medicines production. The subprogramme
objectives include the development of generic and innovative drugs for treatment of socially
significant diseases, relevant technologies, and start of production of innovative drugs for
treatment of socially significant diseases. Investments in research and development, technological
innovations and re-equipment of drugs production is expected to amount to 112.4 bln rubles by the
end of 2020, and the share of domestically produced drugs in the total healthcare consumption
in monetary terms will be 50%34.
34 The State Programme “The Development of Pharmaceutical and Medical Industry in 2013–2020”.
|
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[
3
] |
{
"country": "rus",
"file_id": "sdg-03/vnr-report-rus-2020-en-5.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2020
}
|
11
SDG 3 “Good health and well-being“. Healthy people is one of Russia’s
key priorities. In 2019, the mortality rate slid to 12.3 persons per 1000
as against 2015 (13.0) and 2010 (14.2). The mortality rate of working-age
population (16–59 for male and 16–54 for female) continues to fall. By
2018, in Russia generally, it dropped to 482.2 or by 11.8% as against 2015
(546.7 deaths per 100,000 population). The life expectancy at birth shows
a steady upward trend (72.91 years in 2018 as against 71.39 in 2015;
initially estimated 73.34 in 2019).
The achievement of higher life expectancy (up to 78 years by 2024 and
to 80 years by 2030) is one of the goals of “Healthcare” National Project,
which is focused, among other things, on the development of health care
system, reduced mortality from circulatory illnesses and neoplasms,
communicable and non-communicable disease control, extension of
healthcare infrastructure and the delivery of skilled medical personnel.
|
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{
"country": "rus",
"file_id": "sdg-03/vnr-report-rus-2020-en-6.pdf",
"language": "en",
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"size": "s",
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}
|
2019 RWANDA VOLUNTARY NATIONAL REVIEW (VNR) REPORT
71
SDG 3 – ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING
FOR ALL AT ALL AGES
Status and Trends
Rwanda has made impressive gains in health, placing the country as one
of the few in Africa to achieve the MDGs health targets, with a steady
decline in maternal mortality, from 1,071/100,000 (2000) to 210
(2014/15) (Figure 11). The results are due primarily to the Government’s
concerted investments in building a comprehensive health system.
Consequently, care starting with the first prenatal visit to antenatal care
is now almost universal (99 percent, DHS 2015) and over 90 percent
of women have skilled assistance during delivery. The fertility rate has
declined significantly, from 6.1 births per woman of childbearing age in
2005 to 4.2 in 2014/15, with rural women having almost one child more
than urban women (4.3 and 3.6, respectively) (DHS).
Furthermore, infant mortality has declined substantially in the past
10 years:
- 2005: 86 deaths/1,000 live births;
- 2007-08: 62/1,000 live births;
- 2010: 50/1,000 live births in 2010; and,
- 2014-15: 32/1,000 live births in 2014-15.
Figure 11: Maternal mortality ratio for the period 0-4 years prior to the 2000, 2005, 2010 and
2014/15 RDHS
1400
1200
1000
800
600
400
200
0
RDHS 2000 RDHS 2005 RDHS 2010 RDHS 2014-15
1,267
1,071
875
368
592
Source: Demographic Health Survey 2014/15
134
908
584
287
750
476
210
72
CHAPTER 3. REVIEW OF SDGs IMPLEMENTATION IN RWANDA
Under-5 mortality also declined during this period, from 152
deaths/1,000 live births in 2005 to 76/ 1,000 live births in 2010,
to 50/1,000 live births in 2015 (Figure 11). Child immunization
coverage has steadily improved over the last 10 years: 93 percent
of children aged 12-23 months have received all basic vaccines and
89.4 percent have vaccination cards, with no significant variation
between boys and girls or between rural and urban locations (DHS
2014/15). Rwanda’s vaccination programme generally follows the
World Health Organization’s recommended vaccines for routine
immunization (WHO, February 2015), and all required vaccines
now are given routinely. Each child who is vaccinated receives an
immunization card on which all of the vaccines received are recorded.
Death rates due to road trafc accidents (per 100,000 population)
was 2.7, according to the 2018 Statistical Yearbook. Interventions to
prevent these deaths include installing speed governors into public
transport buses to reduce roads accidents caused by excess speed,
furnishing police with cameras and speed radars, and holding
regular public awareness campaigns.
Currently, Rwanda has 1,475 health facilities, including eight
referral hospitals, four provincial hospitals, 36 district hospitals,
Figure 12: Trends in childhood mortality rates
Infant mortality (1q0) Under-5 mortality (5q0)
250
200
150
100
50
0
Source: Demographic Health Survey 2014/15
107
86
62
50
32
196
152
RDHS 2000 RDHS 2005 RDHS 2007-08 RDHS 2010 RDHS 2014-15
103
76
50
2019 RWANDA VOLUNTARY NATIONAL REVIEW (VNR) REPORT
73
four specialized hospitals, 504 health centers, 670 health posts,
five private clinics, 135 dispensaries, 13 specialized clinics and
96 clinics. Significant efforts have been made to increase health
services at the sector and cell levels, with at least one health centre
per sector and plans to roll out one health post per cell (cells are the
second-lowest level of local administration, just above the village).
Access to health insurance has improved significantly (84 percent),
particularly for the poorest households. There are currently 1,392
medical doctors (one doctor/ 10,055 people and 10,975 nurses (one
nurse/1,094 people, compared to the World Health Organization
target of one/1,000).
Rwanda implemented a national Community Health Worker
(CHW) programme in 2007. The CHWs are recognized for their
performance in community health mobilization, disease prevention
and control at the community level. An effective CHW chain helped
Rwanda achieve its health goal over the past 10 years. The decrease
in under-5 mortality has been attributed to the expansion of this
community health programme, where community health workers
began managing and treating children for some of the most deadly
diseases at the grassroots level. Every village (around 100–250
households) has four CHWs, for a total 45,516 CHWs deployed
countrywide. At the initial stage, each village had 3 CHWs. Two of
them – a man and a woman - make up a pair, referred to, in French,
as binômes. They focus primarily on case identification and referral
for a variety of diseases, as well as reating childhood diseases such
as pneumonia, diarrhea and malaria, and on community support
for malnutrition. The third CHW in each village is a maternal health
worker responsible for identifying pregnant women, conducting
antenatal care visits, ensuring delivery at health facilities and
following up with newborns and mothers in the postnatal period.
In 2018, the Government added a fourth CHW per village, in line
with its priority of achieving universal health coverage. The fourth
health worker is responsible for social affairs in the community and
for compiling performance-based financing reports. CHWs receive
performance-based financing through cooperatives.
Based on its past success, the health sector, under the new Strategic
Plan (the fourth Health Sector Strategic Plan (HSSP) 2018/19-
2023/24), is proposing new priorities, taking into account important
changes in epidemiology, maternal and child health, human resources
for health, infrastructure and service delivery, linking the Plan with
Rwanda’s National Constitution and Vision 2050, NST1, the Health
74
CHAPTER 3. REVIEW OF SDGs IMPLEMENTATION IN RWANDA
Sector Policy 2015, Universal Health Coverage (UHC) principles
and the Sustainable Development Goals (SDGs).The objective is to
ensure universal access (geographically and financially) to equitable
and affordable quality health services (preventative, curative,
rehabilitative and promotional services).
Interventions and opportunities to accelerate progress
HSSP 4 will continue to ensure that all persons in Rwanda have access to
equitable and quality maternal, neonatal, child and community health
services (MCCH). Immunization coverage will be maintained at around
95 percent (or above), with the Government paying at least 30 percent
of the full cost of vaccines. In addition, stunting will be reversed by
implementing multi-sectoral interventions described in SDG2; uptake
of long-term methods in family planning (FP) services will be increased
by targeted promotional activities; and palliative services and health
needs of the elderly will be mainstreamed in the essential package of
care at the different levels, including the package at household level.
In tackling communicable and non-communicable diseases,
reducing the prevalence and incidence of morbidity/mortality will
be emphasized through expanded, responsive and client-centered
services; improved diagnostic capacity; and control of risk factors
and scaling up preventive efforts related to life-style interventions
(nutrition, sugar, exercise, alcohol and smoking). In health security,
HSSP 4 seeks to ensure that Rwanda is free of epidemic-prone
diseases and public health threats by building a sustainable, effective
and efcient national surveillance, response and recovery system.
The cost of implementing HSSP 4 has been computed using the
OneHealth tool. At the end of th HSSP 4 period, the mean per capita
cost would be USD 60 per capita, up from USD 36 per capita in 2018,
during the period of the last health sector strategic plan (2012-2018).
Challenges
One serious drawback in recent years was the upsurge in malaria
cases that began in late 2012 and continues today. The malaria
incidence rate stands at 308/1,000 people (Malaria Annual Report,
2015-2016). Experts attribute this upsurge to several factors found
both in Rwanda and in the subregion, such as vector density and
resistance, climate change (increase in temperature and rainfall),
human behaviour, and non-universal coverage of effective
interventions; this, despite a sustained and intensive effort by the
Government. By 2024, the target is to decrease malaria incidence
Innovations
Rwanda lifesaving blood and
medicines deliveries using
drones
Rwanda delivers lifesaving
blood and medicines to
about 21 regional hospitals
launching more than 50
drones daily for on-demand
deliveries. Remote clinics
can now place orders for
lifesaving blood via text
message, with drones
dispatched from fulfillment
centers dotted around the
country to deliver it. Since
its launch, drones have flown
over 300,000 miles on more
than 10,000 flights, delivering
thousands of units of blood.
2019 RWANDA VOLUNTARY NATIONAL REVIEW (VNR) REPORT
75
from 308/1,000 to 122/1,000 and to decrease mortality due to
malaria in health facilities by 40 percent. The Government will
ensure sustained universal coverage of long-lasting insecticide nets
(LLNs) atone net per two people and improve malaria vector control
by implementing indoor residual spraying in high burden districts
and early diagnosis and treatment. In addition, the HSSP 4 target
is to reduce the prevalence of soil-transmitted helminthiasis (STH)
from 45 percent to less than 20 percent by 2024. Meeting these
targets requires strengthening inter-sectoral collaboration and
partnership for effective prevention and control interventions for
malaria and neglected tropical diseases .
Under-5 mortality remains high, at 50 deaths/1,000 live births
compared to the SDG target of 25 deaths/1,000 live births. Moreover,
under-5 mortality is twice as high in the poorest quintile than in the
wealthiest (84/1,000 live births compared to 40/ 1,000 live births,
respectively). Declines in neonatal mortality have been only modest,
indicating the need for further investment in neonatal and antenatal
care and improved quality of assisted delivery services.
After increasing from 17 percent in 2005 to 52 percent in 2010, the
use of all FP methods rose only slightly in 2014-15, to 53 percent. Use
of modern FP methods also increased dramatically between 2005 and
2010 (from 10 percent to 45 percent) and then rose slightly in 2014-
15 (to 48 percent). To address the slowing adoption of contraceptive
use, the Government will continue to implement community peer
education system promoting the continuous use of long-acting and
permanent methods of FP services and emergency contraceptives.
In 2015, specialized physicians represented a small portion (24
percent) of the total number of physicians in clinical practice
in the country. Additionally, specialized physicians are located
primarily in and around Kigali City, whereas 76 percent of general
practitioners are distributed in district hospitals in the rural areas.
Only a small number of medical graduates pursue a specialization
(A0/A1 nurses represent 31 percent of all nurses, and specialized
physicians, 24 percent of all physicians). The human resources for
health quality improvement efforts target both health care providers
and health managers. They are conducted in close collaboration
with the Ministry of Education, which is responsible for overseeing
the curricula content. In parallel, top international universities
are participating in an initiative through which professors provide
specialist training to Rwandan doctors annually.
|
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[
3
] |
{
"country": "rwa",
"file_id": "sdg-03/vnr-report-rwa-2019-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2019
}
|
2023 RWANDA VOLUNTARY
NATIONAL REVIEW 66
Rwanda has registered considerable progress towards ensuring good health and nutrition
to the Rwanda population. In fact, maternal mortality ratio decreased from 476 per 100,000
lives birth in 2010 to 203 in 2019/20 while the neonatal mortality rate decreased from 27
in 2010 to 19 per 1000 lives birth in 2019/2042. At the same time, the under-five mortality
rate decreased from 76 deaths per 1,000 live births in 2010 to 45 in 2020. Similarly, the
proportion of eligible population with HIV having access to Antiretroviral Treatment:
reached at 83.1 percent in 2019 against a baseline of 78.2 percent in 2013.
The proportion of women aged 15-49 who have access to sexual and reproductive health
service in the last 12 months has increased from 45 percent in 2013 to 58 percent in 2021.The
main drivers for the registered achievements in the health sector are summarized below:
Promoting maternal health, and accelerating action on family planning
• The coordination mechanisms of key players from Central to Local Government
were strengthened as well as partnerships with diferent stakeholders working in
Reproductive Maternal, Newborn, Child and Adolescent Health (RMNCAH).
• Reliable sources of funding through increased domestic funding, health insurance
coverage and RMNCAH services considered as part of CBHI health benefits. This
contributed to the reduction of Out-of-Pocket (OOP) spending from 5 percent in
2023/14 to 4,5 percent of the Total Health Expenditures in 2019/201.
• Created an enabling environment through informed policies, strategic plans, guidelines
(Health sector Strategic plan, RMNCH policy, Maternal, Newborn Health and ASRH/FP
strategic plan, among others.
• The country invested in Family Planning, among other preventive services. Improved
demand, uptake and the expansion of quality RMNCAH services to all health facilities
through organized campaigns and outreach resulted in a reduced average time to reach
the nearby service delivery point from 56 min to 50 min.
• The RapidSMS/ rapid pro system has facilitated the transfer of pregnant women in
labour to the appropriate health care facility improved skilled birth attendance from 69
percent in 2010 to 94 percent in 2020 which had a positive impact on outcomes.
• The focus to improve emergency obstetric and neonatal care services, improved referral
systems through increased numbers of ambulances country-wide and Functional
Maternal Prenatal child death surveillance and response, have also contributed to the
well-being of the Rwandan population.
• Strengthened Supply Chain Management through Coordinated Procurement and
Distribution System (CPDS) and use of eLMIS system improved the management of
drugs and other supplies as well as their availability up to the last mile in the community.
• Strengthened the capacity of health care providers for the provision of quality and
equitable RMNCAH health services at all levels through mentorships and e-learning
systems.
42 NISR, Demographic and Health Survey
5.1.2. Good Health and Well-Being
2023 RWANDA VOLUNTARY
NATIONAL REVIEW 67
Constructing/upgrading and equipping Health facilities
• Continuous construction/upgrade and equipping of health facilities
• Constructing at least one Health Post in every administrative cell, by the end of 2021;
1,202 Health Posts were constructed across the country.
Improving the coordination of health workforce production and establishing retention
strategies for the skilled workforce
• The Human Resource for Health (HRH) Secretariat was established and is operational.
The National Strategy for Health Professional Development was completed to enhance
health professional training.
• The Dual Clinical Practice Policy and Ministerial Instructions were approved and
disseminated with following impact on retention strategies of skilled health workforce,
» Serve to supplement low public salaries and help governments to recruit and retain
health professionals in public facilities even in rural and remote areas without extrabudgetary burden, which could escalate access to services in these locations.
» Enhance technical knowledge and skills of government health care providers thus
boost public services quality.
» Dual practitioners do their best to provide quality services in their public job to get
a good reputation.
» Reduce the public waiting lists and increase access to health care services.
• Currently 7 schools across 7 Districts have started to deliver the nursing studies at high
school levels.
• Further developing the capacity of health professionals in diferent fields through
domestic institutions including; University of Global Health Equity (UGHE) ofering
courses in medicine, surgery, health leadership, and global health delivery, School
of Medicine in the Adventist University of East and Central Africa, the University of
Rwanda and IRCAD for digestive cancer treatment and minimally invasive surgery
training (about to start).
Establishing model health centers of excellence through partnership with private
investors for treatment of Non- Communicable Diseases (NCDs)
• Radiotherapy centers have started in Butaro Hospital and Rwanda Military Hospital.
• Organ transplant services have started operating at King Faisal Hospital (KFH).
• An Open-heart surgery center is yet to start at KFH- So far, the center is operating on
mission basis in partnership with Team Heart whereas the establishment of the center
is ongoing under the supervision of American Council of Surgeons
• There is an ongoing Partnership with Faith Based Organizations (FBO) to implement
specialized orthopedic centers.
2023 RWANDA VOLUNTARY
NATIONAL REVIEW 68
Promoting industries in pharmaceuticals and manufacturing of vaccines and medical
equipment as well as supporting medical research
• 4 pharmaceutical production units (Pharma lab, Apex Biotech Ltd. Agropy Ltd and
LTC YAMEI Rwanda Ltd) have been established, producing a diferent range of
pharmaceutical products such as medicines, medical consumables, pesticides, Personal
Protective Equipment (PPE).
• BioNTech is building its first manufacturing facility in Kigali, Rwanda, to support the
production of mRNA vaccines in Africa.
Strengthening disease prevention awareness and reducing Communicable and NonCommunicable Diseases (NCDs)
• Mass sports promoted in all districts including the car free days for mass sports events
every month coupled with medical outreaches conducted by the Rwanda Biomedical
center to screen people in communities.
• Increased percentage of eligible population with annual medical community checkup
for Non-Communicable Diseases (NCDs) from 10 percent in 2013 to 85 percent in 202144
• Deployment of community health workers in all villages
Preventing and fighting drug abuse and trafcking among all sections of the population
especially youth
• Regular awareness campaigns in media targeting the youth are always conducted. This
include reinforcement of anti-drugs campaigns in schools and out of school for the
youth and producing and disseminating sensitization materials
• Inter-ministerial coordination on fighting drugs was initiated to harmonize the activities.
• District task forces were put in place to implement the decentralization of the National
strategy to fight against drug abuse
• Positive parenting skills were transmitted through radio shows.
• Use of digital messages to fight drug abuse, designed and disseminated protocols and
guidelines for handling patients of drug abuse in all health facilities, including health
centers.
44 MoH (2022). BLJSR 2021/22
|
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44 45
03
Ensure healthy lives and promote
well-being for all at all ages
“We will work to upgrade performance of
government agencies, including the scaling
up of healthcare services to all citizens in
all parts of the Kingdom, in such a way that
health centers as well as referral and specialist
hospitals will be accessible to all wherever they
live.”
Custodian of the Two Holy Mosques
King Salman bin Abdulaziz
46 47
With the largest share of state budget allocations, health constitutes the largest and most
important sector that receives the Kingdom’s utmost focus for development and upscaling. As a
result, the Kingdom’s health sector has witnessed remarkable progress and has gained significant
momentum over the past decades. Through Vision 2030, Saudi Arabia seeks to make a qualitative
leap in terms of the standards and quality of medical and healthcare services, in line with Islamic
Sharia principles and professional health ethics. The core objective is to promote preventive
healthcare and to provide integrated healthcare.
Analysis of Vision 2030 strategic objectives shows relevance of SDG 3 with the Vision’s strategic
objectives and related initiatives, as follows:
Ease access to healthcare services
Improve value of healthcare services
Strengthen prevention against health threats
Promote sports activities in society
Improve quality of services provided in Saudi cities
Substantially reduce air, noise, water and soil pollution
Enhance the nation's immunity towards drug abuse
Promote traffic safety
Safeguard the environment from natural threats
Enhance family involvement in preparing for their children's future
Empower citizens through the welfare system
In conformity with Vision 2030, Saudi Arabia has developed a patient-based National Healthcare Model.
Vision 2030 strategic objectives
Strengthen healthcare services
provided over the hotline
Enhance services of the
Saudi Center for Disease
Control and Prevention
Comprehensive health
polyclinics
Antenatal care services
National referral
network Pre-marriage
medical examination
Advanced home-based
healthcare services
Health research
programs
School-based education
programs
School safety
programs
National Healthcare Model
The Ministry of Health conducted a survey of health sector manpower in line with the SDG
indicator of intensity and distribution of health professionals. The survey revealed that Saudi
Arabia’s score has improved considerably since 2016. For each 10,000 medical staff, Saudi
Arabia has 28.3 medical physicians, including dentists, along with 57 nursing staff, including
midwives, 7.9 pharmacists and 33.8 allied medical staff.
In 2018, budget allocations for the health services and social development sectors amounted
to about USD 39.2 billion (SAR 147 billion), including about USD 8.8 billion (SAR 33 billion)
for Vision 2030 Realization Programs. The budget includes allocations for the completion of
construction and furnishing of hospitals and primary healthcare centers in all provinces of
the Kingdom. Currently, 36 new hospitals are being built and upgraded in various provinces
with a total bed capacity of 8,950 beds, in addition to two medical cities with a total bed
capacity of 2,350 beds. In the course of the current year, one new hospital was commissioned
into service with a bed capacity of 100 beds. Furthermore, about 25 new hospitals will be
received from contractors during the period 2016-2018, accounting for 58% of the total
number of hospitals planned for the five- year period 2016-2020. The two medical cities
currently under construction and upgrading will not be completed before the end of fiscal
year 2018.
Overall, Saudi Arabia’s health sector has made significant progress. A recent World Health
Organization study put Saudi Arabia in the forefront of countries in terms of health system
quality. According to WHO data, Saudi Arabia ranks 26th in the list of health systems of 190
countries worldwide in 2017. In this regard, Saudi Arabia took precedence over some advanced
countries, like Canada (ranks 30th), Australia (ranks 32nd) and New Zealand (ranks 41st). The
Kingdom tops all GCC countries in this regard, compared to UAE (ranks 27th), Qatar (ranks 44th)
and Kuwait (ranks 45th).
World Health Organization
Health Care System
Kingdom of
Saudi Arabia
26
United Arab
Emirates
27
Among 190 health
care systems in
the world
Canada
30
Among 190 health
care systems in
the world
Among 190 health
care systems in
the world
Ministry of Health Ministry of Health
48 49
Saudi Arabia strives to strengthen and upgrade its health sector, taking into account the SDGs.
In this regard, the Kingdom provides a new national healthcare path for pregnant women
(safe delivery path), which involves three stages, namely antenatal, pregnancy and postpartum
healthcare under the supervision of health professionals. This stems from the attention accorded
by the Kingdom to reduce maternal mortality rate to less than 70 deaths per 100,000 live births by
2030.
The Kingdom has also been keen to reduce the incidence of genetic diseases through premarriage and antenatal medical examinations. In addition to healthcare provided during
pregnancy, along with healthcare to newborn babies, the Kingdom follows up on the health of
children below 5 years of age through periodic medical examinations and vaccinations, with an
aim to reduce death rate to less than 25 deaths per 1,000 live births.
Saudi Arabia continues to upgrade national research centers through furnishing of state-ofthe-art laboratory technologies for examination, detection and control of communicable as
well as epidemic and non-epidemic diseases. Several specialized centers have been set up for
certain communicable diseases. Vision 2030 gives due attention to the promotion of preventive
care under the Vision’s theme of “vibrant society”. The theme includes several educational and
other initiatives and programs. In this regard, several initiatives have been prepared with respect
to cardiovascular diseases, diabetes, respiratory disease and obesity. Under these initiatives,
campaigns were launched to promote awareness as to the health risks and the bad health
habits associated with these diseases, along with the proper healthy practices to prevent and
eliminate related health risks. Awareness campaigns were also launched to promote a culture
of sports through which these diseases can be avoided and healthy habits and practices can be
developed. Within this context, several athletic events were organized (such as marathons, hiking,
cycling). The first female marathon took place in Al Hasa at the end of 2017. Launched under the
campaign title “Al Hasa on the run” the event saw an unprecedented participation of 1,500 ladies
who ran for 3 kilometers, having been grouped into athletes, young women, children and senior
age participants. Community events, including hiking, were also organized in Riyadh, Jeddah and
Jubail at the end of 2017 in recognition of the role of sports in promoting community health and
to promote sports among community members in order to develop a vibrant and health-minded
society. During these events, presentations are conducted as to the health and physical benefits
associated with hiking. Approximately 5,000 participants took part in these events which involved
over 2 km covered by participants. Promotional prizes were given to participants of all ages.
Saudi Arabia endeavors to rectify bad nutrition habits through the promotion of ideal ways of
healthy nutrition. In this regard, teams from competent authorities make visits to schools and
universities, along with participation in community events and shopping mall promotions. On
the other hand, authorities make it mandatory for restaurants as well as food suppliers and
manufacturers to display nutritional information on food labeling in order for consumers to
identify ingredients and nutritional value. Saudi Arabia also increased excise taxes on some
harmful food products. The Kingdom provides medical examination of chronic diseases through
public health protection programs, in addition to ongoing healthcare services. Saudi Arabia
makes strenuous efforts to fight and control drugs, by conducting continuous examinations of
youth in upper school grades through school and university health centers. Programs are also
conducted to raise awareness as to the risks of drug abuse and associated psychological and
social impacts, besides the health dangers. The Kingdom has several ideal rehabilitation centers
to treat, rehabilitate and educate drug addicts, along with follow up activity after completion of
rehabilitation. In cooperation with several agencies, Saudi Arabia offers educational programs on
traffic safety. A key educational program “Al Afia” offers community awareness of traffic safety.
1
Furthermore, Saudi Arabia makes considerable efforts to combat and control drugs. Ideal
rehabilitation centers have been set up in the Kingdom to rehabilitate, educate, monitor and
reintegrate drug addicts into society after treatment. For example, the national drug prevention
program (Nebras) is designed to curb the spread of drugs and to promote positive values among
society members as to abstention from drug abuse. It also benefits from joint agreements with
other entities, such as the Ministry of Education, for drug-awareness.
2
1 Ministry of Health
2 Ministry of Interior
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48 49
GOOD HEALTH 3 AND WELL-BEING
50 51
The Saudi government has made health a priority, refected in increased budgetary allocations and improved
health indicators. The focus has been on non-communicable diseases and a comprehensive response to the
COVID-19 pandemic. A top priority, the sector has consistently been one of the largest recipients of government
expenditures accounting for 17.7% in 2021, and as a result of the COVID-19 pandemic, was expected to reach
14.5% in 2022.4
The Kingdom’s wasting prevalence of 4.4% in 2020 is lower than the global average and the regional (Middle East
and North Africa) average. This indicates better performance in addressing malnutrition in comparison to other
countries. Also, Saudi Arabia’s stunting prevalence of 12.4% in 2022 is lower than the global and regional (Middle
East and North Africa) averages from 2021.
Since 2015, the proportion of births attended by skilled health personnel has been stable and has remained above
98%. The consistently high proportion of births attended by skilled health personnel indicates that the country has
good access to quality healthcare during childbirth, which is essential for the health and safety of both mothers
and newborns. During this period, the maternal mortality ratio has been low (about 12 per 100,000) compared to
global averages, indicating a relatively low risk for maternal deaths in the country. The under-fve mortality rate
has remained below 9 deaths per 1,000 live births, which is low compared to global averages. In the same period,
infant and child mortality rates have declined, due in part to the effectiveness of the immunization program and
reduced transmission of communicable diseases.
1. General Situation
2
4
6
8
10
12
14
0
2015 2016 2017 2018
Tuberculosis infection rate for every 100,000 inhabitants Male
Tuberculosis infection rate for every 100,000 inhabitants Female
Tuberculosis infection rate for every 100,000 inhabitants Total
Tuberculosis incidence per 100,000 population
2020 2021
0.002
0.004
0.006
0.008
0.01
0.012
0.014
0.016
0.018
0.02
0
2015 2016 2017 2018
Malaria incidence per 1,000 population
2019 2021
MALE FEMALE TOTAL
YEARS
The SDG data from GASTAT indicates that Saudi Arabia
haX RaIe XignificanY UrogreXX in reIZcing Yhe YZGercZQoXiX
incidence rate from 11 per 100,000 2015 to under 8 2021.
Throughout the years, the tuberculosis infection rate has consistently been higher among males compared to
females. The data also shows that Saudi Arabia has made signifcant progress in reducing the malaria incidence
rate from 2015 to 2021, with both males and females experiencing a decline in incidence rates. Furthermore, Saudi
Arabia has made progress in reducing the hepatitis B incidence rate from 2015 to 2021. Both males and females
genders experienced a signifcant decline in hepatitis B incidence by 2021, with males at 0.88 and females at 0.68
per 100,000.
4
Document available at www.mof.gov.sa.
Saudi Arabia has undertaken crucial measures to streamline access and enhance the quality and efciency of
healthcare services. The government has made substantial investments, particularly in promoting preventive
measures for health risks. Additionally, various initiatives have been implemented to improve trafc safety and
educate the public about healthy lifestyles.
52 53
0.5
1
1.5
2
2.5
3
0
2015 2016 2017 2018
Hepatitis B incidence per 100,000 population by gender
2019 2021
MALE FEMALE TOTAL
YEARS
5
10
15
20
25
30
35
40
45
50
0
2015 2016 2017 2018
Number of deaths due to road traffic injuries per 100,000 population by gender
2019 2021
MALE FEMALE TOTAL
YEARS
0.5
1
1.5
2
2.5
0
2016 2017 2018 2019
Number of suicide mortality per 100,000 persons by gender
2020 2021
MALE FEMALE TOTAL
YEARS
3
3.5
95
95.5
96
96.5
97
97.5
98
98.5
99
94.5
2015 2016 2017 2018
Population covered by all vaccine
2019 2021
Hexa Vacine (%) MMR Vaccine (%) Pneumococcal Conjugate Vaccine (PCV) (%)
YEARS
The SDG data from GASTAT also shows full coverage (100%) for substance use disorders for both males and
females between 2015 and 2021. This suggests that the country has been successful in maintaining access to
treatment interventions for the population. The data also shows a signifcant reduction in road trafc fatalities for
both genders from 2015 to 2021. This trend suggests that road safety measures have been effective in reducing
the number of fatalities. The SDG data indicates that Saudi Arabia has maintained a high and stable vaccination
coverage rate for Hexa, MMR, and PCV vaccines from 2015 to 2021. While there have been minor fuctuations in
the coverage percentages over the years, the overall trend demonstrates a strong commitment to immunization.
The SDG data indicates improvements in TB treatment success, consistently high coverage of DTP vaccination,
and signifcant progress in providing antiretroviral therapy to people living with HIV in Saudi Arabia. However,
more data is needed to analyze trends in fasting plasma glucose levels and smoking prevalence among adults.
Antenatal care data only covers one year, so it is not possible to analyze trends or changes in the coverage of
antenatal care services over time. Hospital bed data a stable proportion of hospital beds per 10,000 population
over the years.
Saudi Arabia’s health policy framework is underpinned by the Healthcare Law and the National Health Strategy.
The Healthcare Law provides for comprehensive and accessible healthcare services to the whole population. The
National Health Strategy outlines the vision, goals, and objectives for the development of the health sector. Key
priorities include the development of a national health information system, improvement of primary healthcare
services, expansion of public-private partnerships, and promotion of healthy lifestyles.
The Health in All Policies (HiAP) initiative was launched in 2017 to prioritize the population’s health in all polices
and regulations. Furthermore, the Health Sector Transformation Program was launched under the Vision 2030 in
2021 and is aimed at restructuring the health sector into a comprehensive, effective and integrated health system
based on the health of the individual and society. An array of policies and programs have been established by the
Saudi government (outlined in the fgure below).
National Healthcare
Development Strategy
National Center For Mental Health
Promotion
National Physical
Activity Program
Telemedicine Program
National Plan Cancer Control
Maternal And Child
Health Program
National Tobacco
Control Program
School-Based Health Awareness
Program
Obesity Control & Prevention
Strategy 2030
Healthy Living Program
National Tuberculosis Program
Emergency Medical Services
Program
National E-Health Strategy
Reproductive Health Program
Non-Communicable Diseases (Ncd)
Prevention Program
National Strategy For Diet And
Physical Activity
Health Insurance Program
Care For The Elderly
2. Institutional Framework and Key Ongoing Initiatives
Ecosystem of Policies and Programs in the Healthcare Sector
Communicable Diseases: Saudi Arabia is working to combat communicable diseases, with specifc goals to end
tuberculosis by 2035 and eliminate Hepatitis C as a public health threat by 2030.
Non Communicable Diseases: As Saudi Arabia᾽s population ages, the prevalence of non-communicable diseases
(NCDs) such as cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases is expected to rise,
increasing the demand for costlier healthcare services. NCDs currently account for 73.2% of deaths in the country,
with cardiovascular disease being the leading cause. The Saudi government is committed to addressing the rising
issue of unhealthy lifestyles and has initiated several prevention activities targeting tobacco use, unhealthy diets,
and physical inactivity.
The Ministry of Health (MOH) has allocated substantial resources to the National Tuberculosis Control
Program, which reported 1,970 cases of pulmonary tuberculosis in 2021. To address latent tuberculosis,
the program launched a project to detect and treat high-risk groups, resulting in over 54,000 individuals
screened and nearly 2,800 positive cases treated.
In line with the World Health Organization᾽s global targets, Saudi Arabia is also striving to eliminate
Hepatitis C by 2030. The MOH reported 1,960 cases of Hepatitis C virus (HCV) in 2021. The country
has implemented a project for HCV elimination that focuses on enhanced detection through integrated
screening for the whole population and high-risk groups. As a result, over 13 million individuals were
screened, with more than 6,500 cases identifed and treated. The new class of medications has
revolutionized HCV management, offering a cure rate of over 90% and preventing complications and
transmission. The following in-depth case provides more information.
In 2018, the Saudi Food and Drug Authority (SFDA) developed a healthy food strategy to enhance healthy
lifestyles and reduce the intake of salt, sugar, and saturated and trans fatty acids. This strategy, along with
other nutrition policies, aims to empower consumers and create a healthier food environment to combat
NCDs.
The Quality of Life Program᾽s Lively Community initiative encourages citizens to participate in physical
activities, supports sports groups and federations, and promotes women’s participation in community
sports.
The National Tobacco Control Committee (NCTC), established in 2007, supervises the implementation
of the Framework Convention for Tobacco Control MPOWER5
policies. Saudi Arabia has achieved a high
level of implementation, with best practices in offering help to quit smoking, warning about tobacco
dangers, and enforcing bans on tobacco advertising, promotion, and sponsorship. The country was the
frst in the Eastern Mediterranean Region to implement plain packaging6
for tobacco products in 2019
and has established a WHO collaboration center for plain packaging. Additionally, the number of tobacco
cessation clinics has increased, and virtual cessation services have been established to facilitate access
to therapeutic services and integrate these clinics with other healthcare providers.
•
•
•
•
•
54 55
The following are some additional initiatives that have been launched by the Saudi government in the healthcare
sector:
Mother and Child Health: Mother and child
health have seen signifcant improvements
in recent years. Infant and child mortality
rates have declined. These results have been
enabled by, the immunization program and
reduced transmission of communicable
diseases among children. Maternal health
has improved with a decrease in the maternal
mortality ratio. Almost all deliveries are now
attended by trained personnel. An increasing
number of women of reproductive age had their family planning needs met with modern methods. The Ministry of
Health has introduced the Breast Cancer Early Detection program to reduce breast cancer mortality and increase early
detection. Additionally, the Early Childhood Development policy covers a comprehensive range of aspects, including
health, nutrition, breastfeeding, vaccination, early detection of developmental delays, and services to strengthen young
children᾽s development. The policy also focuses on parenting, responsive care, and support for caretakers to provide
the best possible care in a safe, secure, and stimulating environment for development.
SDG 3 GOOD HEALTH
AND WELL-BEING:
Screening to Identify and Treat
Hepatitis C Across the Kingdom
In 2018, the Kingdom launched a project focusing on enhancing detection of the HCV virus through integrated
screening of the entire population, with priority, to vulnerable groups. The project included training an adequate
number of staff and improving facilities to fght the virus.
1,960 cases of
Hepatitis C reported
in 2021
The goal was set to
eliminate hepatitis
C by 2030.
IN-DEPTH CASE
Since the health vscreenings
began in 2018, over 9M people
had been screened and 90,000
diagnosed with Hepatitis C, then
received treatment.
The impact of this project has
been enormous, having potential
to avert tens of thousands of
deaths, through early screening
and the projected elimination of
the disease.
Transmission of Hepatitis C from
migrant workers or during the
visits of large number of pilgrims
to holy sites in Mecca and Medina
shape additional challenge in
control and prevention.
Challenge
IMPACT
NEXT STEPS
SUMMARY
The goal is to reach the SDG target and
eliminate the virus.
The campaign will raise awareness
about the importance of screening
and treatment among the general
population.
Challenge
5
MPOWER comprises a set of six cost-effective and high-impact measures that help countries reduce demand for tobacco. More information can be found here:
https://www.emro.who.int/tf/mpower/index.html.
6
Plain packaging of tobacco is a common-sense policy that removes the promotional, marketing, and advertising features on packs of tobacco, but leaves the
health warnings, tax stamps, and other features required by government.
SAUDI ARABIA’S GOVERNMENT HAS PURSUED SEVERAL KEY
PUBLIC HEALTH INITIATIVES AIMED AT IMPROVING ACCESS
TO SOCIAL SERVICES.
Launched initiatives aimed at improving the quality of life for the elderly, including
increasing access to health care services and improving access to social services.
Improved the accessibility of healthcare services for people with disabilities including the
creation of specialized healthcare facilities and the development of assistive technologies
to improve the delivery of health services to this population.
Promoted telemedicine and digital health solutions to improve access to health care
services, particularly in rural and remote areas.
LEAVING NO
ONE BEHIND
56 57
Road Trafc Safety: Road trafc accidents (RTAs) have been a signifcant challenge, resulting in high mortality
and injury rates. The Kingdom aims to reduce road trafc fatalities to less than 8 per 100,000 by 2030, as well
as to minimize related injuries and losses. In 2017, the Saudi government established the Ministerial Committee
of Trafc Safety (MCTS) to oversee the implementation of the national Road Safety Strategy and collaborate with
relevant stakeholders. The National Center for Road Safety was founded in 2018 to further improve road safety.
Other key initiatives include the establishment of the Saher Automated System by the Ministry of Interior, a road
safety training program, and the development of the National Transport & Logistics Strategy to position Saudi
Arabia among the most advanced countries in terms of road quality and safety. These measures have contributed
to the reduction of the number of fatalities in the last fve years (see SDG data above).
Research and Infrastructure Development:
Saudi Arabia is investing in research and
infrastructure development to improve its
healthcare sector. The Health Research
Center was established to elevate health
research, while the National Research
Centers focus on infectious and noncommunicable diseases and epidemics.
Under Vision 2030, the government plans
to invest over $65 billion in healthcare
infrastructure and aims to increase
private sector contributions, targeting the
privatization of numerous hospitals and
primary health centers.
The National Unifed Procurement
Company (NUPCO) is responsible for
procuring and delivering pharmaceutical
supplies and medical devices, striving to
enhance government spendingefciency by
investing in logistics, digital infrastructure,
and localizing pharmaceutical industries.
NUPCO played a crucial role during the
COVID-19 pandemic and has launched
various health services projects, including
a state-of-the-art medicine storage and
distribution center in partnership with
King Abdullah Economic City. The King
Abdulaziz City for Science and Technology
(KACST) is implementing the Saudi
Genome Program, which aims to reduce
KACST success stories
The Saudi Genome Program.
A 11
/2
year old girl was diagnosed with a brain tumor
(glioblastoma) that was removed successfully
through surgery, however it then grew again after 3
months. The family denied standard therapy (memo
and radiation).
A sample of the removed tumor was sent to the lab for
genomic profling in the Saudi Genome program labs.
The results showed a genetic alteration that causes
continuous activation of a specifc protein,which caused
the tumor to grow again. Luckily, a drug was available
that inhibited the genetic mutation found in the sample.
Access to the drug was granted and the patient
received the treatment. It was very well tolerated with
excellent results.
This is a successful application of personalized
medicine and a true example of the power of
genomic testing, where the drug is selected based on
the patient’s genomic profle. Conventional treatment
would have been another surgery. chemotherapy and
radiation, which have many side effects and may not
have been very successful in this particular instance.
TITLE
PROBLEM
SOLUTION
RESULTS
IMPACT
Success Stories
Digitalization: The Ministry of Health is undertaking an ambitious program to digitalize healthcare, with over 500
health centers and hospitals already connected to the electronic system. Initiatives include the SEHA Virtual
Hospital, which supports 130 hospitals and provides over 30 specialized services, and the creation of Virtual
Clinics accessible through the Sehhaty app. The government has invested signifcantly in technology and digital
health infrastructure, ensuring all health information systems are fully electronic. The SEHA virtual hospital is
among the largest worldwide, with real-time monitoring of health sector indicators for timely decision-making and
emergency response.
Key areas for attention include addressing the increasing burden of chronic diseases like diabetes and heart
disease, controlling and preventing the spread of tuberculosis and Hepatitis C transmission from migrant workers
and pilgrims, and mitigating the impact of rapid urban growth and public transportation on trafc deaths and
injuries. Additionally, adapting to digital health services requires cultural and behavioral transformations among
health providers and benefciaries, as well as improved data management and infrastructure readiness. Lastly,
combating child obesity, which has long-term physical and mental health consequences, is crucial for curbing the
rise of non-communicable diseases.
The following are key actions for this SDG area:
3. Key Areas for Attention and Next Steps
• The Ministry of Health aims to screen 100% of highrisk individuals living in the country at least once in
their lifetime for latent tuberculosis and Hepatitis C.
• The SEHA virtual hospital plans to expand its capacity
by 20% to provide more specialty services and support
facilities in peripheral areas.
• Continued emphasis will be placed on early childhood
development, including early detection and intervention
for children with disabilities.
• The Ministry of Transport and Logistics Services
is leading the development and enforcement of the
Saudi Road Code, which is expected to be launched
by 2024. The road code aims to achieve the highest
levels of safety, security, quality, economic efciency,
environmental protection, and sustainability.
• Saudi Arabia will continue to provide assistance in the
area of healthcare to low- and middle-income countries
and contribute to sustainable development globally.
Sehha App: Enhancing public health by providing remote
medical and preventive care to users. Sehha was launched in
March 2017 and provided around 2.1 million consultations to
16 million users by 2020.
Sehhaty App: Launched in August 2019. The app was used
extensively during the response to the COVIO-19 pandemic,
providing appointments for corona virus testing, vaccinations
and health information. If had over 1.2 million users by 2020.
Mawid App: Launched in April 2018 to help users book,
reschedule. Modify or cancel appointments at primary health
care centers. Around 14.3 million benefciaries booked more
than 67 million appointments by the end of 2020.
The Tabaud App (COVID-I9 social distancing): Launched in
2020, the app was created to protect citizens and residents
from the spread of COVID-19.
Tabaud complements the Tawakkalna app. It uses Bluetooth
to inform users that they have been in contact with continued
cases of COVID-19 whist maintaining users’ privacy.
Key achievements over the period from launch in June 2020
until the end of 2020:
- 3rd country worldwide to launch an app that informs users
of contact
- 30K+ notifcations of positive diagnosis
- 3+ million users
The government has made signifcant investments in
technology and digital health infrastructure. E-health and
electronic transformation involve all aspects of health planning,
administration and provision. All health information systems
have become fully electronic. The SEHA virtual hospital is the
largest in the region and among the largest in the world with
over 35 specialties. Real time monitoring of indicators of all
aspects of the health sector allows timely decision making
and response to emergencies. And with the beginning of
2023, implementation of electronic medical records will be
introduced.
Wasfaty Service: Links hospitals and primary healthcare centers
with community pharmacies. Thereby avoiding medical errors
resulting from written prescriptions and making medicines
available at any time. The service reduces dispensing frequency
and offers automatic identifcation of any medicines which may
trigger a patient’s allergies. Around 8.4 million prescriptions were
provided through the service by August 2020.
Facilitated access to healthcare
through technology and innovation
genetic disease incidence using advanced genomic technologies, leading to improved healthcare provision,
personalized medicine, cost reduction, and enhanced quality of life while positioning the Kingdom as a global
leader in genomics research and AI-driven personalized medicine.
|
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[
3
] |
{
"country": "sau",
"file_id": "sdg-03/vnr-report-sau-2023-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
25
Goal 3. Ensure healthy lives and promote well-being
for all at all ages
Progress
Sudan has made some progress in advancing maternal and child health. The trend of maternal
mortality ratio is on the decline from 509 per 100,000 live birth (L.B) in 2000 to 295 per 100,000 LB
in 2020, despite the remarkable increase on the year 2006. Nevertheless, a considerable decline
occurred at 2010, where the rate dropped to 216 per 100,000 LB.
There are no recent figures for child mortality, however the trends for Under Five, Infant and
Neonatal Mortality rates are declining as the child mortality fell from 113 per 1000 LB in 2000 to 68
per 1000 LB in 2015. The infant and neonatal rates dropped from 72 and 36 to 52 and 33 per 1000
LB respectively.
The worst health indicators are the nutrition indicators; The percentage of children under five who
were severely underweight (weight for age, -3SD) was 9.4% in 2006; it increased to 12.6% in 2010.
Then it dropped slightly to 12% in 2014 before it increased again to 14.10 in 2018. While the
percentage of moderate stunting (height for-2SD) among children under five was 32.5% in 2006, it
has increased to 35% in 2010, and continued increasing to become 38% in 2014, before it dropped
slightly to 36% on 2018 (2010 SHHS, 2014 MICS, 2018 S3M).
The immunization program in Sudan is the most successful primary health care intervention in the
country. The year 2017 witnessed great improvement in measles vaccination that was stagnant for
several years, where MCV1 reached 90% for the first time and MCV2 reached 72% at national level13.
Over thirteen million boys and girls are now protected against measles, resulting in a nine-fold
decline in measles cases compared to before the immunization campaign14.
Regarding infectious diseases TB prevalence is low and declining while HIV is low and started to
decline in 2020 as shown below. Nevertheless, there is an increase in the new cases of malaria. The
incidence of malaria cases increased from 13.7 per 1000 population in 2016 to 17.8 in 2017 to 40.9
cases per 1000 population in 2019 according to Malaria Program report.
26
Figure 7: Sudan health selected indicators
Source: VNR Goal 3 health working group and Maternal mortality from Progress UN Trends in MR 2000-2017
and *inter agency child and MMR estimates.
Challenges
• Sudan has witnessed repeated outbreaks of cholera, hemorrhagic fevers in East and West
States, Hepatitis B, in addition to Malaria, cholera, and the six childhood infectious diseases.
The protracted civil conflicts, humanitarian emergency situation in the country, poor water,
sanitation and hygiene infrastructure among other factors, are the main drivers of the
repeated outbreaks. Lack of integrated diseases surveillance system makes preparedness
and response to epidemic and pandemic-prone diseases difficult.
• There are shortages in health infrastructure. About 40% of existing PHC facilities are not
functioning according to the recent mapping survey conducted in ten states by the federal
Ministry of Health.
• Low public expenditure on health results in high out-of-pocket expenditure reaching 67
percent. With a poverty incidence above 60 percent on average in the country, many people
cannot afford these payments
• The 2.5 million IDPs, 1.1 million refugees, frequent conflicts, natural disasters like floods and
heavy rains, have put extreme pressure on the health system in the country. Many are being
left behind by the health services. The situation was further compounded by COVID-19.
• Since 2017, Sudan has struggled to sustain adequate supply of medicines and medical items
due to the economic crisis, hard currency shortages, and many challenges in the
pharmaceutical and health technologies sector.
• The health indicators profile is outdated and at least a decade old in many areas of
intervention. Data quality assurance is limited. Systems for data management and analysis
are largely manual and focus on the public sector. Data on availability of services and health
27
human resources is not systematically collected.15 The subnational level provides most of
the health services, however, due to lack of trained staff at this level there is a constraint in
providing accurate and regular data to the national level for better planning16.
Way forward
The National Health Sector Recovery and Reform Policy 2021-2024 was formulated with the vision of
health and well-being for all the people in Sudan. The goals are to achieve Universal Health Care,
addressing social determinants of health, and implementing the health in all policies' approach. The
National Health Sector Recovery and Reform strategic plan 2021-2024 was formulated based on
National Health Policy. The strategic plan is being built on a Primary Health Care (PHC) model and it
is based on six crucial projects, the first three are about the service delivery, while the rest are about
strengthening the health system capacities for aiding delivering of the health services:
A. Primary health care and essential health care services for all: For achieving universal
coverage by equitable integrated, people centered primary health care services guaranteed
through adoption of Health Benefit Package, and ensuring financial risk protection
B. Health security, preparedness, response and resilience against all hazards with focus on
COVID-19: Ensure that the health system is prepared and resilient to prevent and respond to
health emergences and disasters' risks at all levels; with adherence to the International
Health Regulations
C. Hospital Sector reform with focus on emergency and critical care: Hospital services including
emergency and critical care are available, accessible, affordable, and of good quality,
including through implementation of an appropriate referral and ambulance system,
implementation of infection prevention control and rehabilitation of infrastructure.
D. Access to Medicines: The project will assist the population to receive medicines. Medicines
became unaffordable for many segments of the population due to the high prices influenced
by the soaring inflation rates. The difficulties encountered by the National Medical Supplies
Fund in providing medicines at affordable prices will be resolved.
E. Governance and leadership of the health system: The project will address the many
bottlenecks affecting the health system as a whole, especially revising and updating the
public health laws, structures, roles and responsibilities of all levels of the health system,
and involvement and empowerment of the community. An important aspect of this project
is also the coordination with other related sectors to ensure that all aspects of health social,
economic and environmental determinants of health are addressed.
F. Capacities enhancement: Special emphasis will be on the health information system, health
research, human resources for health, health finance, etc.
|
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|
SENEGAL : MEFP_2018_ODD
RAPPORT FINAL 33
Objectif 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de tous
à tout âge
108. A travers le Plan National de Développement Sanitaire (PNDS 2009-2018), le Plan Stratégique de
lutte contre la malnutrition, le Plan Stratégique de la Couverture Maladie Universelle, le soussecteur de la santé et de la nutrition poursuit les objectifs de réduction de la morbidité, de la
mortalité maternelle et infanto-juvénile, d’amélioration des performances du secteur en matière de
prévention et de lutte contre la maladie, du renforcement durable du système de santé et de la lutte
contre la malnutrition, en conformité avec les orientations du PSE et les cibles de l’ODD3.
3.1 : D’ici à 2030, faire passer le taux mondial de mortalité maternelle en dessous de 70 pour 100 000
naissances vivantes.
109. Le Sénégal, dans le cadre de la mise en œuvre du PNDS, accorde une importance particulière à la
santé maternelle et infanto-juvénile à travers le programme « Santé de la mère, du nouveau-né, de
l’enfant et de l’adolescent ». En effet, en vue de l’atteinte de la cible 1 de l’ODD3, le sous-secteur
de la santé et de la nutrition vise à : réduire le fardeau de la morbidité et de la mortalité maternelle
et infanto-juvéniles à travers l’amélioration de la santé de la mère, de l'enfant et du nouveau-né et
la généralisation de l'assistance à l'accouchement.
110. Le taux de mortalité maternelle se situerait à 315 décès pour 100 000 naissances en 2015. Ce
taux élevé au Sénégal exige des réformes et des investissements pour lutter contre les décès
évitables. Aussi, la feuille de route multisectorielle (2006-2015) a-t-elle été adoptée et mise en
œuvre ainsi que le plan d’urgence de la mère et du nouveau-né pour accélérer la réduction de la
mortalité maternelle et néonatale. Ces mesures ont permis de relever la proportion
d’accouchements assistés par du personnel qualifié et le taux de prévalence contraceptive. Ainsi,
la proportion de femmes ayant accouché dans un établissement sanitaire est passée entre 2005 et
2016 de 62% à 76%.
111. La proportion d’accouchements assistés par du personnel qualifié, elle est passée de 68,4% en
2017 à 59% en 2016 et 53% en 2015. Parallèlement, la proportion de femmes ayant accouché dans
un établissement sanitaire est passée 76%. en 2016, pour se situer à 78,2% en 2017.Les résultats
obtenus sont imputables au renforcement du personnel par des sages-femmes itinérantes, le
renforcement des capacités des prestataires, la dotation des structures sanitaires en matériel pour
le renforcement de la santé de la mère et de l’enfant ainsi que le rôle joué par les « Badiènu Gox »
dans la promotion de l’accouchement assisté.
112. Toutefois, dans les régions de Kédougou (48,2%), Tambacounda (52,1%) et Sédhiou (59,4%), les
accouchements à domicile restent encore importants. Les résultats positifs enregistrés ont été
jumelés au renforcement des effectifs et des compétences du personnel, au recentrage des
interventions en CPN, au monitoring des Soins obstétricaux et néonataux d’urgence (SONU), à la
stratégie des sages-femmes itinérantes (SAFI) et à l’amélioration de la prise en charge
psychologique des accouchements.
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.
113. La cible 2 de cet ODD est prise en compte par l’orientation stratégique de réduire le fardeau de la
morbidité et de la mortalité maternelle et infanto-juvénile. Les actions opérationnelles consistent
SENEGAL : MEFP_2018_ODD
RAPPORT FINAL 34
à l’amélioration de la couverture vaccinale de l’enfant et à la couverture adéquate en consultation
post natale.
114. La poursuite de la mise en œuvre des programmes de survie de l’enfant vise la réduction
significative de la mortalité infanto-juvénile. Cependant, en dépit des efforts consentis, le taux de
mortalité infanto-juvénile a connu une hausse en 2017, sous l’effet de l’augmentation des taux
de mortalité infantile et néonatale. Ainsi, il a enregistré une dégradation de 5 points pour mille,
soit 9,8% en valeur relative par rapport à 2016. En effet, les mortalités infantile et néonatale se
sont détériorées respectivement de 16,7% et de 33,3%, passant de 36‰ à 42‰ entre 2016 et 2017
pour le taux de mortalité infantile et de 28‰ à 21‰ pour le taux de mortalité néonatale.
115. Cette contreperformance relève des faibles résultats du programme de vaccination, des lenteurs
dans la mobilisation effective des ressources financières et les ruptures de médicaments. A ce titre,
après avoir atteint 76% en 2015, la proportion d’enfants de moins de 11 mois complètement
vaccinés a connu une chute de 10 points de pourcentage entre 2016 et 2017, pour se situer à 71%,
imputable au manque de certains types de vaccins (BCG, VPI, VAA).
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.
116. Pour la réalisation de cette cible, les actions du PSE passent par l’accroissement des performances
en matière de prévention et de lutte contre la maladie, mais également par le renforcement de la
surveillance intégrée de la maladie et de la riposte. Cette cible est prise en charge dans la mise en
œuvre du PNLS, PNLT, etc.
117. En termes de résultats, depuis 2005, le Sénégal a stabilisé le taux de prévalence du VIH/SIDA
approché par l’incidence du VIH /SIDA autour de 0,5% grâce à la bonne mise en œuvre du
Programme national de lutte contre le Sida. La proportion de personnes vivant avec le VIH
sous Anti Retro Viraux (PVVIH) est passée de 85,3% en 2015 à 97,4% en 2016 puis 99% en
2017. Dans la même période, 5 740 nouvelles personnes dépistées séropositives au VIH ont été
reçues dans les sites pour des soins et 5 441 anciennes et nouvelles PVVIH ont été mises sous
ARV. Ce résultat s’explique par le démarrage de la décentralisation de la prise en charge devenue
effective dans 118 postes de santé, l’application de la stratégie tutorat des enfants vivant avec le
VIH dans 14 sites avec 904 EVVIH bénéficiaires et 632 tuteurs formés.
118. Le taux de succès thérapeutique des nouveaux cas de Tuberculose à microscopie positive a
légèrement baissé de 2016 à 2017 en passant de 90% à 89%. La notification des nouveaux cas de
TB toutes formes a cependant augmenté en 2017 de 375 cas par rapport à 2016. Les activités de
communication et de formation des acteurs ont contribué à renforcer le dépistage des cas en 2017.
119. Dans le cadre de la lutte contre le paludisme, une baisse régulière du paludisme a été observée ces
dernières années grâce notamment à une intensification des interventions à haut impact. A cet
effet, l’incidence du paludisme s’est établie à 2,4% en 2017 contre 3,5% en 2016. Ces résultats
ont été obtenus grâce à la distribution des moyens de prévention, notamment la distribution de
8 960 663 moustiquaires imprégnées à longue durée d’action (MILDA) pour un coût de 13
milliards de F CFA.
120. Un plan Stratégique de lutte contre les maladies tropicales négligées sur la période 2016- 2020 a
été élaboré en vue d’éradiquer la filariose lymphatique et le trachome. Ce dernier est la deuxième
cause de cécité au Sénégal avec plus de 25 000 aveugles à son actif. Son élimination est une des
SENEGAL : MEFP_2018_ODD
RAPPORT FINAL 35
priorités de santé publique et justifie l’engagement dynamique de la communauté internationale
avec un objectif d’élimination à l’horizon 2020 conformément aux grandes orientations de
l’initiative "vision 2020 - le droit à la vue" et de « l’alliance pour l’élimination mondiale du
trachome ». Conformément aux directives de l’OMS, le Sénégal a achevé sa cartographie de base
en 2014, avec 24 districts endémiques sur les 76.
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.
121. La réalisation de la cible est prise en compte à travers la mise en œuvre de l’orientation du PNDS
relative à « accroître les performances du secteur en matière de prévention et de lutte contre la
maladie », dans la protection sociale à travers le renforcement de la lutte contre la vulnérabilité
des ménages et des catégories sociales défavorisées.
122. En ce qui concerne les maladies non transmissibles, c’est grâce à la collaboration avec les
laboratoires Sanofi que deux nouvelles cliniques de diabète et de l’HTA (CDH) ont été inaugurées
en 2017. En effet, dans le cadre de la lutte contre le diabète, une progression de 2,7% du taux de
couverture a été notée passant de 35,3% en 2015 à 38% en 2016, soit une augmentation de 8 points
de pourcentage par rapport à la cible (30%). La prise en charge des cas de diabète s’est globalement
améliorée et se situe à 22% en 2017.
123. Ces résultats s’expliquent par l’opérationnalisation des unités de prise en charge. Cependant, des
efforts restent à faire pour un bon maillage territorial.
3 .5 : Renforcer la prévention et le traitement de l’abus de substances psychoactives, notamment de
stupéfiants et d’alcool.
124. Ayant constaté que les réseaux de trafic de drogue s'étendent en Afrique, les chefs d’Etat et de
Gouvernement de l'Union Africaine ont décidé à l'unanimité d'adopter en 2002, les lignes
directrices d'un plan de lutte contre le trafic de stupéfiants et la consommation exagérée de drogue.
La déclaration met en exergue les grandes orientations qui devraient présider au contrôle des
drogues dans l'espace africain. Ainsi, le Sénégal a élaboré et mis en œuvre une stratégie de lutte
contre la drogue sur la période 2012-2016. Aujourd’hui, le nouveau plan d’action stratégique sur
le contrôle des drogues, qui est en cours de finalisation sous la coordination du Comité
interministériel de lutte contre la drogue (CILD) énonce de nouvelles politiques et initiatives dans
le domaine de la lutte contre la drogue, y compris en ce qui concerne la réduction de la demande,
la prévention, le traitement et la réadaptation, la réduction de l’offre et l’amélioration de la
coordination interinstitutionnelle. Parallèlement, la CEDEAO a élaboré un programme régional
pour la lutte contre le trafic illicite de drogues, la criminalité organisée et l’abus de drogues.
125. Par ailleurs, depuis décembre 2014, le Sénégal a mis en place un Centre de prise en charge intégrée
des addictions de Dakar (CEPIAD), logé à l'hôpital de Fann, le seul en Afrique de l’Ouest de
traitement de la toxicomanie qui propose des services intégrés d’information, de soins de santé, de
traitement, de réadaptation, de formation professionnelle et de réinsertion sociale aux personnes
atteintes de troubles liés à l’abus de drogues et à la toxicomanie. Il propose un traitement de
substitution à la méthadone ainsi que des soins médicaux ambulatoires et dépêche des équipes
mobiles chargées de nouer le contact avec les usagers de drogues et de leur fournir des trousses
contenant des seringues stériles, des préservatifs et du matériel médical de base pour prévenir la
transmission de maladies véhiculées par le sang telles que le Sida et l’hépatite C.
SENEGAL : MEFP_2018_ODD
RAPPORT FINAL 36
126. En 2015, la prise en charge de 425 patients a été réalisée à travers, notamment, une consultation, un
suivi addictologique, un accompagnement psychothérapeutique, ainsi qu’une prise en charge des
infections liées au VIH/SIDA, à la tuberculeuse et aux maladies buccodentaires, dont 110 patients
inclus dans le programme de substitution aux opiacés par méthadone et 314 sur rendez-vous.
3 .6 :D’ici à 2020, réduire de moitié à l’échelle mondiale le nombre de décès et de blessures dus à des
accidents de la route.
127. Le sous-secteur des infrastructures de transport met en œuvre sa lettre de Politique Sectorielle
2016-2020 (MITTD) qui est en cohérence avec les objectifs de développement. Les objectifs qui
contribuent à la réalisation de cette cible visent entres autres à : (i) développer des infrastructures
routières à travers la construction, réhabilitation et entretien de routes et ouvrages d’art ; (ii)
promouvoir la bonne gouvernance sectorielle par le renforcement de la sécurité routière et de la
sureté et la facilitation du transport dans les corridors. L’indicateur retenu est approché par le
nombre de personnes décédées par accident de la route que le cadre de suivi de la politique
économique et sociale renseigne régulièrement.
128. Le nombre de personnes décédées par accident de la route est passé de 569 en 2015 à 604 décès
en 2016 pour s’établir à 635 en 2017. Ce résultat est imputable à la surcharge, au non-respect de
la réglementation de la circulation, à la vétusté du parc automobile. A cet effet, il est prévu : (i) la
sécurisation et la numérisation des titres de transport intégrant la mise en place du permis à points ;
(ii) le renforcement du contrôle technique (l’ouverture à Mbao d’une annexe) ; (iii) la création
d’une structure de gestion et de coordination de la sécurité routière et (iv) la mise en place d’un
guichet unique d’immatriculation des véhicules automobiles.
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 la prise en compte de
la santé procréative dans les stratégies et programmes nationaux.
129. Le Sénégal a entamé sa transition démographique, du fait de la baisse constatée de la fécondité (6,4
en 1986, 5,0 enfants par femme en 2011, et 4,6 enfants en 2017) et de l’importance de la population
en âge de travailler. Le pays dispose donc d’une réelle opportunité à travers la capture du dividende
démographique pour accélérer sa croissance économique (PSE). Cependant, il est nécessaire
d’anticiper sur les investissements dans la protection sociale si l’on veut inscrire le pays dans une
trajectoire démographique favorable. Les projections démographiques sont généralement basées sur
plusieurs hypothèses d’évolution de la fécondité́ et une seule hypothèse d’évolution de l’espérance
de vie à la naissance et des migrations internationales. C’est ainsi qu’ont été́ construites les diverses
projections de population du Sénégal qui éclairent les stratégies à mettre en œuvre.
130. La cible est prise en charge dans l’action de réduire le fardeau de la morbidité et de la mortalité
maternelle et infanto-juvéniles par l’amélioration de l'accès aux soins des femmes en milieu rural
et la promotion de la planification familiale. En effet, la proportion de femmes âgées de 15-
49ans, utilisant des méthodes modernes de planification familiale, approchée par le taux de
prévalence contraceptive est passée de 21,2% en 2015 à 23,1% en 2016 pour se situer à 26,3%
en 2017 et reste loin de la cible fixée de 45% en 2020.
131. En matière de santé des adolescents/jeunes, des efforts importants ont été consentis pour la
promotion d'une offre d'informations et de services de santé de la reproduction adaptée à ce groupe
à travers le renforcement des capacités des prestataires et pairs éducateurs, l'aménagement
d'espaces ados/jeunes dans les structures sanitaires (41), les Centres Conseils Ados (CCA) et les
SENEGAL : MEFP_2018_ODD
RAPPORT FINAL 37
Espaces Jeunes. Cependant, le taux de natalité chez les adolescentes (15-19ans) demeure
important en passant de 80‰ en 2015 à 72‰ en 2016 et s’établit à 78‰ en 2017.
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.
132. Cette cible est prise en compte par les objectifs stratégiques de protection sociale « étendre la
protection sociale au secteur informel et aux groupes vulnérables et renforcer la sécurité sociale des
Travailleurs et des Retraités » ainsi que les actions : développement des mutuelles de santé ;
extension de la gratuité des soins sanitaires en faveur des groupes vulnérables ; mise en œuvre de la
réforme sur l'Assurance Maladie Obligatoire (AMO) ; amélioration du système formel de sécurité
sociale et de la gestion des prestations et la mise en œuvre de la politique de développement des
infrastructures à travers la carte sanitaire. Dans le secteur de la santé et nutrition, il est poursuivi
les actions d’améliorer de la disponibilité des médicaments et des produits médicochirurgicaux et
la promotion de la recherche en santé.
133. Dans l’amélioration de la couverture en infrastructures sanitaires, le niveau des réalisations a
atteint 73,26% en 2017 contre 67% en 2016 et 53% en 2015. Si en termes d’infrastructures
fonctionnelles chaque région dispose au moins d’un hôpital de niveau 2 (les 3 CHU, de niveau 1,
se trouvant tous à Dakar) et plusieurs centres et postes de santé, le personnel de santé en activité
est en deçà de la demande. En effet, pour 2013, la couverture sanitaire est d’un médecin pour
12 300 habitants, d’un infirmier pour 4 300 habitants et d’une sage-femme pour 2 500 femmes. En
outre, la répartition géographique sous-optimale impacte négativement les activités préventives et
curatives et 1 162 professionnels de santé sont recrutés pour la mise en place du couple gagnant
infirmier/sage-femme dans les 1 033 Postes de santé des régions périphériques.
134. En dépit des performances enregistrées pour l’amélioration de l’état de santé de la population au
cours de ces dernières années, il convient de souligner qu’il reste encore des efforts pour améliorer
l’accès aux services de santé. Dans cette perspective, des initiatives sont en cours pour la
densification de la carte sanitaire et l’extension de la couverture du risque maladie. Le taux de
couverture du risque maladie a sensiblement augmenté avec l’enrôlement des bénéficiaires des
bourses de sécurité familiale et des personnes handicapées détentrices de la carte d’égalité de
chances. Ainsi, il est passé de 46% à 46,8% entre 2015 et 2016, pour se situer 49,3% en 2017.
L’extension de cet enrôlement aux élèves du préscolaire, du primaire, du moyen, du secondaire et
des écoles coraniques modernes est en cours.
3.9 : D’ici à 2030, réduire nettement le nombre de décès et de maladies dus à des substances chimiques
dangereuses, à la pollution et à la contamination de l’air, de l’eau et du sol.
135. Cette cible est en phase avec les orientations déclinées dans lettre de politique du secteur de
l’Environnement et du développement durable- LPSEDD (2016-2020) et dans la lettre de Politique
du sous-secteur de l’eau et de l’assainissement (2016-2025). De même, dans le domaine de la
Gestion des Risques et Catastrophes une attention particulière est accordée à l’amélioration de la
sécurité du transport de matières dangereuses. Par ailleurs, l’Etat du Sénégal a mis en place depuis
2008, un centre de gestion de la qualité de l’air (CGQA) qui dispose d’un laboratoire de référence
et de cinq stations fixes de mesure de la pollution de l’air répartis à travers la ville de Dakar. Ces
stations fixes sont complétées par un laboratoire mobile qui effectue des mesures dans des endroits
ciblés. Le travail de suivi du CGQA, concerne principalement cinq polluants, très nocifs pour la
SENEGAL : MEFP_2018_ODD
RAPPORT FINAL 38
santé : les PM10 (poussière) et 2,5 (d'origine automobile et industrielle), l’ozone de surface, le
monoxyde de carbone, le dioxyde de souffre et le dioxyde d’azote.
136. Au Sénégal, les maladies respiratoires constituent le second motif de consultations après le
paludisme. De plus, on a constaté ces dernières années une forte prévalence des maladies
cardiovasculaires, classées première cause de mortalité à l’heure actuelle dans le pays. Il est
néanmoins difficile en l’absence d’études de bien situer le problème et de déterminer
éventuellement la part induite par la pollution atmosphérique.
3.a : Renforcer dans tous les pays, selon qu’il convient, l’application de la convention-cadre de
l’Organisation mondiale de la sante pour la lutte anti-tabac.
137. Le tabac est unanimement reconnu comme un problème de santé publique. A cet égard, pour lutter
contre ces aspects négatifs plusieurs mesures ont été prises par le Gouvernement notamment la Loi
2014-14 du 24 mars 2014 interdisant de fumer dans les lieux publics et les publicités liées au tabac,
l’augmentation de la taxe sur le tabac, etc. La prévalence de la consommation actuelle de tabac
chez les plus de 15 ans (taux comparatifs par âge) est de 5,9% en 2015.Elle est particulièrement
élevée parmi les hommes (10,7%), qui ont 27 fois le taux de prévalence des femmes (0,4%).
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.
138. L’offre de médicaments enregistre une hausse, avec un pourcentage de produits traceurs
disponibles estimé à 89% en 2017 contre 82% en 2016 et 77% en 2015. Par ailleurs, la durée
moyenne de rupture des médicaments est passée de 36 jours en 2016 à 54 en 2017 au niveau des
EPS, soit un accroissement de 18 jours. La durée moyenne de rupture des médicaments et produits
essentiels sur les trois premiers trimestres a diminué de 4 jours entre 2016 et 2017 passant de 31 à
27 jours pour une cible de 9 jours. L’introduction de certains produits pharmaceutiques dans le
circuit public par la PNA a contribué à une meilleure accessibilité surtout financière..
139. Ces dernières années, la pharmacie nationale d’approvisionnement (PNA) a mis en œuvre
plusieurs stratégies pour rendre disponibles et accessibles les médicaments et produits essentiels.
Il s’agit principalement du renforcement du maillage du territoire par la mise en place de onze (11)
pharmacies régionales d’approvisionnement (PRA), de la mise en place dans les structures
sanitaires de Dépôts-ventes avec reversement de la marge, de la mise en œuvre d’initiatives
innovantes facilitant la distribution des médicaments et produits essentiels jusqu’au niveau des
districts ou des postes de santé (PRA Mobile, « Jegessinaa », « Yeksinaa »). Le secteur privé
complète les efforts de l’Etat. Il dispose d’environ 1 060 officines privées et dépôts de
médicaments et offre une plateforme nationale d’approvisionnement et de distribution de
spécialités et de génériques.
140. Les ruptures de médicaments et produits phares constatées au niveau de la PNA résultent en grande
partie des défaillances ou des retards de livraisons de certains fournisseurs, des lourdeurs des
procédures de marchés publics et des défaillances de paiement des structures sanitaires ce qui
augmente les créances de la PNA
SENEGAL : MEFP_2018_ODD
RAPPORT FINAL 39
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.
141. La cible est prise en compte par l’objectif améliorer la gouvernance du sous-secteur à travers
l’objectif de promouvoir la gouvernance sanitaire par la mise en place d'un système de gestion des
ressources humaines et l’amélioration des capacités du secteur en matière de planification et de
gestion administrative et financière.
142. Le droit à la santé et à un environnement sain est garanti par l’article 8 de la constitution du Sénégal.
L’Etat garantit aux familles en général et à celles vivant en milieu rural en particulier l’accès aux
services de santé et au bien-être. A travers son axe 2 portant sur le capital humain, le Plan Sénégal
Emergent (PSE) a clairement défini les objectifs stratégiques du Gouvernement en matière de santé et
de protection sociale. Le Sénégal s’est approprié les engagements internationaux à savoir : (i) la
déclaration de Tunis du 5 juillet 2012 qui engage les pays africains à mettre en œuvre la Couverture
sanitaire universelle ; (ii) les engagements pris par les Chefs d’Etats Africains depuis 2001 à Abuja
d’allouer au moins 15% de leur budget national au secteur de la santé.
143. L’accès aux services de santé et le financement des priorités nationales de santé publique sont
limités par une répartition inadéquate des ressources (humaines, matérielles et financières).Au
cours des dernières décennies, le niveau de ressources destinées à financer l’accès des populations
aux paquets de services a augmenté progressivement. L’analyse des séries de comptes nationaux
de la santé (CNS) montre une augmentation considérable des dépenses de santé qui sont passées
de 245 milliards de FCFA en 2005 à 431 milliards de FCFA en 2013 (+5% du PIB), soit une
augmentation de près de 76%. Le budget alloué par l’Etat au Ministère de de santé et de l’action
sociale (MSAS) est passé de 135 milliards de FCA en 2015 à 163 milliards de FCFA en 2017, soit
une augmentation de 20,74% en valeur relative.
144. Malgré ces efforts, le budget consacré à la santé est encore faible. Il se situe à 8% du budget
national alors que les engagements des Chefs d’Etat Africain à Abuja sont de le porter à 15%. En
outre, si le taux d’exécution pour le budget de fonctionnement dépasse régulièrement 90%, celui
du budget d’investissement atteint rarement 70% du fait, entre autre, des contraintes liées aux
procédures de décaissement et à la planification des dépenses d’investissement. La contribution
des collectivités locales dans le financement de la santé sur fonds propres est de 1%. Ce faible
niveau de contribution s’explique en partie par les ressources limitées de certaines collectivités
locales. Les comptes nationaux de la santé ont en 2005 estimé à 21% la part de l’assistance
étrangère dans les dépenses totales de santé dont 59% des fonds proviennent de la coopération
bilatérale, 14% de la coopération multilatérale, 26% des ONG. En 2013, la part de l’appui des PTF
dans les dépenses totales de santé a baissé à 14%.
145. Pour tendre vers la couverture sanitaire universelle, plus de ressources devront être mobilisées au
plan domestique, mais également à travers l’appui des partenaires techniques et financiers.
146. Dans le domaine du développement des ressources humaines, la tendance à la résorption
progressive des gaps en ressources humaines se poursuit grâce aux efforts de l’Etat mais aussi à
l’engagement des partenaires techniques et financiers. Le recrutement de 1 000 agents en 2016 a
permis de renforcer les structures implantées en zones périphériques. A cela s’ajoute l’appui de
certains partenaires, qui a permis de doter les postes de santé de toutes les régions hormis Dakar
et Thiès grâce au recrutement de 1 162 infirmiers et sages-femmes.
|
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{
"country": "sen",
"file_id": "sdg-03/vnr-report-sen-2018-fr-3.pdf",
"language": "fr",
"locality": null,
"size": "l",
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}
|
MEPC\DGPPE\UCSPE@juin 2022 P. 25 / 98
ODD – REVUE NATIONALE VOLONTAIRE 2022
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Objectif 3. Permettre à tous de vivre en bonne santé et promouvoir le bien -être
de tous à tout âge.
Le Sénégal aspire à une vie collective en bonne santé et à une réduction nette du nombre de décès
et au contrôle des maladies, en faisant bénéficier à toutes ses populations d’une couverture
sanitaire universelle. Les programmes mis en œuvre par le Gouvernement, à travers le Plan national
de Développement sanitaire et social (PNDSS 2019-2028), visent l’amélioration des conditions
socio-sanitaires des populations sans aucune forme de discrimination. Pour ce faire, la Stratégie
nationale de financement de la santé (SNFS) et le plan d’investissement pour un système de santé
et de l’action sociale résilient et pérenne qui concourent à une couverture sanitaire universelle (CSU),
soutiennent la définition des orientations stratégiques de financement du secteur de la santé pour
la concrétisation des ambitions du PSE.
Santé maternelle, néonatale et infantile.
Le secteur de la santé a connu des améliorations significatives ces dernières années. Cependant,
les résultats dans les domaines de la santé maternelle et infantile restent encore modestes au
regard des cibles. Le taux de mortalité maternelle reste toujours élevé. Il se situe à 236 pour
100 000 naissances vivantes en 2017, contre 315 pour 100 000 naissances vivantes en 2015. La
proportion d’accouchements assistés par du personnel qualifié est en constante hausse ces
dernières années et a atteint 97% en 2021 contre 53,2% en 2015.
L’analyse démontre qu’en 2021, les régions de Dakar, 99%, Kaffrine, 98,5 %, Louga, 98,2 et
Saint Louis, 98%, ont enregistré les meilleures performances. Cependant, les régions de Matam,
Sédhiou et Diourbel ont affiché de très faibles résultats avec respectivement 94,2%, 94,5% et
95%.
Par ailleurs, le taux d’achèvement en CPN a également connu une hausse de 7,5 pdp entre 2015
et 2021, passant ainsi de 48% à 55,5%. Cette progression est notamment constatée dans les
régions de Diourbel, Kédougou, Kaffrine, Kaolack, Matam, Sédhiou, Saint louis et Tambacounda.
La mortalité néonatale a très peu évolué ces dernières années. Son taux est passé de 23‰ en
2015 à seulement 21‰ en 2019. Les principales causes de la mortalité néonatale sont la
prématurité, les asphyxies, les septicémies, les anomalies congénitales, entre autres. Sur la même
période, le taux de mortalité infanto-juvénile a connu une baisse appréciable, il est passé de
59‰ en 2015 à 37‰ en 2019.
Ces progrès notés peuvent s’expliquer par le renforcement de l’offre de services d’accouchement
de qualité, la formation de prestataires qualifiés, le recrutement de personnel, le renforcement des
Soins Obstétricaux et Néonatals d’Urgence (SONU) ainsi que la mise en œuvre d’un paquet intégré
de services au niveau communautaire, l’équipement des maternités, la sécurisation des produits
d’importance vitale pour la santé de la mère et du nouveau-né, la bonne surveillance des décès
maternels et la riposte avec la systématisation des audits des décès maternels et néonatals.
MEPC\DGPPE\UCSPE@juin 2022 P. 26 / 98
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Lutte contre les maladies (sida, tuberculose, paludisme et maladies tropicales négligées).
Le Sénégal s’est engagé́ pour le renforcement de la disponibilité des tests de diagnostic rapide
(TDR) du paludisme à tous les niveaux qui a permis, malgré le contexte de la pandémie de Covid19, de maintenir à plus de 99% la performance liée au diagnostic des cas de paludisme. Le taux
de réalisation des tests de diagnostic a connu une augmentation de 0,3% en 2020 en passant de
99,3% en 2015 à 99,7% en 2020. Ainsi, l’incidence du paludisme est passée de 34,5‰ en 2015
à 31‰ en 2021. L’incidence du paludisme varie d’une région à une autre, l’analyse a montré que
les régions de Kédougou, Kolda et Tambacounda demeurent des zones de forte transmission du
paludisme.
Pour ce qui est de la lutte contre la tuberculose, le taux de succès thérapeutique est estimé à 91%
en 2020 et 89,34% en 2021 et l’incidence de la tuberculose est passée de 140 en 2015 à 117
pour 100 000 habitants en 2020.
Des efforts sont à noter pour ce qui est de la gestion du VIH/Sida, notamment l’utilisation des
autotests grâce aux innovations du programme « santé de base ». Le taux de prévalence du
VIH/Sida est passé de 0,7% à 0,3% entre 2015 et 2020. En 2020, le nombre de PVVIH était de
l’ordre de 39 400 dont 21 180 femmes de 15 ans et plus et 3 900 enfants de moins de 15 ans.
En 2021 le pourcentage de PVVIH mises sous ARV est de 85%.
Le programme national de lutte contre les Maladies tropicales négligées (MTN) a réalisé des
performances en 2020, malgré le contexte de la pandémie de Covid-19. Il s’agit de l’atteinte des
objectifs de couverture lors des campagnes de distribution de masse de médicaments (DMM) : 71%
de couverture pour la filariose lymphatique pour un objectif de 65% ; 89% pour l’onchocercose
pour un objectif de 80%, 102% pour les schistosomiases et 86,54% pour les géohelminthiases pour
des objectifs de 75%. Cependant, l’insuffisance des ressources financières reste une contrainte dans
la lutte efficace contre les MTN.
Couverture maladie universelle (CMU).
L’indice de couverture des services pour les différents domaines de la CSU a connu une hausse, en
passant de 44,5 en 2015 à 49 en 2021. Le taux de couverture du risque maladie des
populations a augmenté, passant de 46,8% en 2015 à 53,2% en 2021. La contribution des
mutuelles est estimée à 23% en 2020 contre 17,4% en 2019, mais en deçà de l’objectif de 32%
fixé pour 2020.
MEPC\DGPPE\UCSPE@juin 2022 P. 27 / 98
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Accès aux soins de santé sexuelle et procréative.
L’Indice Synthétique de Fécondité (ISF), qui mesure le nombre d’enfants qu’aurait une femme au
cours de sa vie reproductive. Le taux de fécondité par âge actuels chez les femmes de 15-49 ans,
présente une tendance à la baisse (5,09 en 2015 contre 4,9 en 2021). Toutefois, le taux de
prévalence contraceptive a évolué sur la même période en passant de 21,2% en 2015 à 26% en
2020, même s’il reste encore très en deçà de la cible de 40%. Ces résultats ont été obtenus grâce
à la politique de renforcement de l’offre de services de planification familiale, combinée à une
stratégie soutenue de communication et de plaidoyer pour accroître la demande. Malgré tous ces
efforts, le taux de natalité chez les adolescentes de 15 à 19 ans est encore loin de la cible de
32,8‰ d’ici 2030. Il est estimé à 71‰ en 2019 contre 80‰ en 2015.
Accident de la route et suicide.
L’État du Sénégal s’est engagé à réduire de 50% le nombre de tués et de blessés graves sur les
routes par certaines mesures phares entre autres : la mise en place d’une Structure Autonome
chargée de la Sécurité routière et l’institutionnalisation du Bulletin d’Analyse des Accidents
Corporels (BAAC). Selon le ministère de la Santé et de l’Action sociale, le nombre de décès liés
aux accidents de route a connu augmentation ces dernières années. En effet, Il est passé de 745
en 2019 à 877 décès en 2020, les femmes représentent 24% contre 76% d’hommes. Pour
renforcer la gouvernance dans la sécurité routière, il faudra mettre en œuvre la formation continue
des chauffeurs professionnels ; actualiser le plan National de Sécurité Routière et la mise en place
des Brigades mixtes de sécurité routière. Le taux de suicide (pour 100 000 habitants) est passé
de 9,5 en 2016 à 9,2 en 2019.
Des substances chimiques dangereuses, à la pollution et à la contamination de l’air, de
l’eau et du sol.
Le taux de mortalité attribuable à la pollution de l’air dans les habitations et à la pollution de
l’air ambiant est de 160,7 sur 100 000 habitants en 2016, le taux de mortalité attribuable à
l’insalubrité de l’eau, aux déficiences du système d’assainissement et au manque d’hygiène est de
23,9 décès pour 100 000 habitants en 2016 et le taux de mortalité attribuable à un
empoisonnement accidentel est passé de 1,17 en 2016 à 1,1 décès pour 100 000 habitants en
2019.
MEPC\DGPPE\UCSPE@juin 2022 P. 28 / 98
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Accès aux vaccins et aux médicaments.
La couverture vaccinale de base est passée de 70% en 2015 à 77% en 2019 avec des taux à
95% pour le BCG, 85% pour la dose de polio, 3,86% pour la rougeole et 92% pour le Pentaval 3
en 2019. Le pourcentage d’enfants 12-23 mois ayant reçu tous les vaccins appropriés se situe à
61%. Parmi les enfants de 24-35 mois, 37% ont reçu tous les vaccins appropriés. La couverture
vaccinale DTC III chez les enfants d’un an a évolué de 89% en 2015 à 96% en 2020.
Recrutement, perfectionnement, formation et le maintien du personnel de santé.
Au Sénégal, la répartition du personnel de la santé selon la région révèle que la région de Dakar
concentre plus du tiers (36%) des professionnels de santé, suivi de Thiès (11%). La région de
Diourbel occupe la troisième position avec 8% du personnel de soins du pays. Cette situation de
Dakar s’explique par sa forte démographie et sa position politique et économique nationale et
abritant le plateau technique le plus relevé du pays. Toutes les autres régions regroupent moins de
10% de professionnels de santé : 1% pour Kédougou, 2% pour Sédhiou, 3% pour Kaffrine et
Kolda et 7% pour Ziguinchor.
Le Sénégal compte 4,5 agents de santé pour 10 000 habitants en 2019 contre 4,7 en 2020. Ce
ratio reste inférieur aux normes de l’OMS qui veut que la densité du personnel de soins soit à 23
agents de santé pour 10 000 habitants pour relever les défis de l’atteinte de la couverture
sanitaire universelle. Par ailleurs le pourcentage de personnels qualifiés disponibles au niveau des
structures publiques de santé est de 53% en 2020 et 56% en 2021, mais reste en dessous des
besoins du secteur sanitaire qui a pour cible 65% en 2021. Pour faire face à cette situation et
combler le gap en personnel de santé, le Plan National de Développement des Ressources
Humaines en santé et action sociale (PNDRHSS 2020 - 2028) s’articule autour de quatre
orientations stratégiques relatives : (i) au renforcement de la gestion prévisionnelle des emplois et
des compétences ; (ii) à l’amélioration de la production et du développement des ressources
humaines ; (iii) à l’amélioration de l’environnement de travail, et (iv) au renforcement du dispositif
de gouvernance des ressources humaines et du partenariat.
Pour s'attaquer aux principales contraintes qui entravent les résultats en matière de santé, il est
essentiel de (i) systématiser la notification et l’audit des cas de décès maternels et néonatals ; (ii)
réduire la répartition inégale de l’accès aux services de santé ; (iii) améliorer l’accessibilité
financière des médicaments et produits essentiels de qualité aux populations ; (iv) renforcer la
gestion des ressources de santé.
|
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|
SUSTAINABLE
DEVELOPMENT GOAL 3:
Ensure Healthy Lives and Promote Well-being for All at All Ages
1 According to the Global Burden of Disease 2016 Study (GBD 2016).
2 According to the Bloomberg Global Health Index (2017) in a ranking of 163 countries.
SINGAPORE’S HEALTHCARE SYSTEM
Singapore’s greatest resource is our people. In order to
ensure the long-term sustainability and well-being of
our population, the accessibility to and provision of
quality healthcare has been our priority since independence.
Singaporeans are living longer in full health than people of
other nationalities.1
Our healthy life expectancy at birth was
73.6 years in 2016, and the highest in the world.2
This can
be attributed to several factors – the accessibility of quality
and affordable basic medical services for all, the active
promotion of preventive health programmes and medicine,
high standards of living, clean water, hygiene, and a culture
of healthy living. Singapore’s healthcare system has three
distinctive features. First, our public hospitals function as
corporate entities. Although government-owned, they have
operational autonomy for day-to-day activities for greater
effciency and competitiveness. Second, we offer universal
healthcare coverage to all Singaporeans in the form of
the “3M” system – Medisave, Medishield, and Medifund.
Medisave is a national medical savings scheme which helps
individuals set aside part of their income to meet future
medical fees. Medishield is a basic health insurance plan
which helps to fund large hospital bills and selected costly
outpatient treatments. Medifund is an endowment fund to
help those with fnancial diffculties pay their medical bills.
Beyond the “3M” system, subsidies are available to keep
costs down and ensure that basic services remain affordable.
Third, there is tight regulatory supervision and control
over all healthcare providers to ensure a high quality of
healthcare services.
BRIGHT SPOTS
Accessible and Improved Health Care
Singapore has low neonatal, under-fve, and maternal
mortality rates. In 2016, neonatal mortality rate was 4.8 per
100,000 live-births, and under-fve mortality rate was 2.7
per 1,000 live-births. Maternal deaths are extremely rare,
with rates ranging from zero to eight per 100,000 live-births
over the last decade.
Access to sexual and reproductive health services for
women has also improved. Screening for breast and
cervical cancers, some of the most common cancers among
Singaporean women, at all governmental clinics is heavily
subsidised. A Women’s Health Advisory Committee was
also set up in 2012 to equip women with the knowledge
and skills to look after their health.
Singapore recognises that the social and healthcare needs
of the elderly are closely related to and have an impact
on their well-being. To coordinate the delivery of such
services, the Agency for Integrated Care (AIC) helps seniors
access eldercare services and works with the eldercare
sector to expand and improve services. There are several
funds available to support the elderly, such as the Seniors’
Mobility and Enabling Fund, which subsidises assistive
devices and home care consumables, and the eldercare
sector. The AIC also conducts outreach to promote active
ageing, and encourages community partners to befriend
and care for vulnerable seniors.
Control of Communicable Diseases
Given our high population density and urban environment,
it is important that we ensure Singaporeans are protected
from the most common infectious diseases. Singapore has in
place the National Childhood Immunisation Schedule (NCIS)
and the National Adult Immunisation Schedule (NAIS), which
recommend vaccinations for children and adults. The roll-out
ACTION PLAN FOR SUCCESSFUL AGEING
10
of the NCIS has resulted in high vaccination coverage and
immunity among the population. The NAIS was recently
introduced to complement the NCIS and in recognition of
the importance of lifelong immunisation.
We have also enhanced our surveillance and response
capacities for disease outbreak management following
our experience dealing with the 2003 Severe Acute
Respiratory Syndrome (SARS) crisis and the 2009 H1N1
pandemic. In 2010, a Singapore-Field Epidemiology
Training Programme (S-FETP) was set up within the Ministry
of Health (MOH) to develop capability in conducting
epidemiological surveillance, investigation, and response
to outbreaks and other public health emergencies. In 2016,
the Healthcare Epidemiology Team was established within
MOH to strengthen the national response to outbreaks of
hospital-acquired infections, including Multi Drug Resistant
Organisms (MDROs). A National Outbreak Response
Team was also formed to rapidly mobilise public health
experts to facilitate the national outbreak response. In
addition, Singapore continuously engages the international
community at international and regional platforms such as
WHO and ASEAN to fght the global spread of disease.
Control of Non-Communicable Diseases
Non-communicable diseases in Singapore accounted for
more than 80% of the local disease burden in 2016, of which
a third is attributed to cancer, ischaemic heart disease, and
stroke.3
An extensive suite of measures is in place to combat
some of the most common non-communicable diseases in
Singapore, such as diabetes and cardiovascular diseases. In
addition, several health campaigns have been introduced to
encourage positive changes in Singaporeans’ lifestyles, such
as increased physical activity and healthier eating choices.
About six Singaporeans die prematurely from smokingrelated diseases every day. To address this concern, we
adopt a multi-pronged approach towards tobacco control,
comprising strategies such as public education, provision
of smoking cessation services, legislation controlling
tobacco advertising and sales of cigarettes to minors, and
taxation. This has helped reduce the smoking prevalence
in Singapore.
CHALLENGE
Increasing Healthcare Expenditure due to an Ageing
Population
While we have thus far managed to maintain our
healthcare spending at a modest level, Singapore’s
rapidly ageing population means that healthcare
expenditures will inevitably rise. We continue to explore
innovative solutions for high quality healthcare services
at affordable cost. We also recognise the importance
of preventive care, and have been investing heavily
in health promotion, early vaccination, and screening
for diseases.
FUTURE CHALLENGES & OPPORTUNITIES
OPPORTUNITY
Innovative Medical and Health Technology and
Solutions
There is a growing number of healthcare start-ups in
areas such as chronic disease management, digital
diagnostics, and consumer health and wellness. These
start-ups provide a myriad of products such as mobile
apps to connect patients and doctors, and that serve as
digital platforms for healthcare services. Singaporeans
have also proven to be relatively receptive to healthcare
technology, with four in 10 owning a health application
or gadget.
SINGAPORE’S WAR ON DIABETES
Diabetes is a major public health concern. Today, over
400,000 Singaporeans are living with the disease. The
number is projected to reach one million by 2050 if
current trends continue. In 2016, MOH launched the
“War on Diabetes”, a nationwide effort to reduce the
burden of diabetes by helping people lead diabetesfree lives, and assist those with diabetes to manage
the condition well. These initiatives encourage healthy
living and prevention, early detection and intervention,
and better disease management. We also emphasise
public education, stakeholder engagement, and data
analytics to research and better understand diabetes
and its complications. We will organise the Ministerial
Conference on Diabetes in Singapore in November
2018, which will be attended by Health Ministers,
senior government offcials, academics as well as
representatives from the World Health Organisation
(WHO), World Bank and ASEAN. We hope that the
Conference will put diabetes high on the global
agenda, and serve as an opportunity to share effective
strategies and international best practices to prevent
and manage diabetes.
11
3 Based on the Disability-Adjusted Life Years (DALYs) for Singapore estimated from GBD 2016.
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16 17
SUSTAINABLE
DEVELOPMENT GOAL 3:
Ensure Healthy Lives and
Promote Well-Being for All
Singapore prioritises the provision of quality healthcare.
Our life expectancy at birth is one of the highest in the
world and can be attributed to: (a) the accessibility of
quality and affordable basic medical services; (b) the
active promotion of preventive health programmes; (c)
high standards of living, clean water, and hygiene; and
(d) a culture of healthy living.
Our healthcare system has three distinctive features.
First, we offer universal healthcare coverage to all
Singaporeans with a mixed fnancing system that
has multiple layers of protection. Second, there is
close regulatory supervision of all public and private
healthcare providers. Third, our public hospitals
function as corporate entities. Although governmentowned, they have operational autonomy for greater
effciency.
Building Upon Strong Foundations
While Singapore has managed to maintain our
healthcare spending at a sustainable level, a rapidly
ageing population means that healthcare expenditure
will inevitably increase. We are working to prevent or
delay the onset of ill health, and slow or even reverse
these trends. A national campaign, Healthier SG,
focuses on upstream preventive health and anchoring
care in the primary care sector to avoid acute stress on
the healthcare system downstream.
Accessible and Improved Healthcare
Singapore has low neonatal, child, and maternal
mortality rates. Access to sexual and reproductive
health services for women has improved. Guided by
the WHO’s Health Promoting Schools framework,
preventive health programmes are available to all
from the age of fve.
Screening for breast and cervical cancers, some of the
most common cancers among Singaporean women,
at Government clinics and many private clinics, is
heavily subsidised. There are also annual campaigns
to raise awareness about the importance of regular
health screenings. These efforts may be carried out in
partnership with NGOs to amplify outreach activities.
Control of Communicable Diseases
Singapore has invested in preparedness,
surveillance, and outbreak response capabilities for
endemic and global emerging infectious diseases.
We launched the National Centre for Infectious
Diseases (NCID), an infectious disease management
facility with integrated clinical, laboratory, and
epidemiologic functions, in 2019. NCID administers
national public health programmes targeting the
human immunodefciency virus, tuberculosis, and
antimicrobial resistance, among other responsibilities.
We also have in place a comprehensive vaccine
recommendation and delivery system to ensure
accessibility and affordability of vaccines.
Singapore’s Healthcare System
Learn more about
Healthier SG here
18 19
Control of Non-Communicable Diseases
We have an extensive suite of measures in place to
combat some of the most common non-communicable
diseases, such as diabetes, cardiovascular diseases,
and some cancers. The national Screen for Life
programme offers heavily subsidised health screenings
to encourage Singaporeans to undergo screenings.
In addition, several health campaigns have been
introduced to encourage physical activity and healthier
eating choices. We have also adopted a multi-pronged
approach towards tobacco control, comprising
strategies such as public education, provision of
smoking cessation services, legislation controlling
tobacco advertising and sales of cigarettes to minors,
and taxation.
Singapore was one of the frst countries
to detect COVID-19, and we activated early
and wide-ranging measures to fght and contain the
pandemic, such as rapidly boosting testing and hospital
bed capacity. Singapore also relied on its Homefront
Crisis Management System, a Whole-of-Government
mechanism which coordinates inter-agency response
to crises. To develop our preparedness and response
capabilities for future pandemics, Singapore set up the
Programme for Research in Epidemic Preparedness
and Response (PREPARE) to strengthen key research
capabilities and develop a strong regional infectious
disease collaboration network.
In 2016, the Ministry of Health launched the War on
Diabetes, a nationwide effort to encourage healthy
living and prevention, early detection and
intervention, and better disease management.
We also emphasised public education,
stakeholder engagement, and data analytics.
Age-standardised diabetes prevalence fell to
under 8% from 2017 to 2020, an observable
decline from 8.6% in 2010.
Did You Know?
6 Data is preliminary. 7 Data is preliminary.
Key Figures
Life expectancy at birth
83.5
years (2021)6
AGEING
Around one in four citizens are expected to be 65
and above by 2030, up from one in fve in 2022. As
people get older, they are more likely to fall sick or
suffer from disabilities.
Challenges
RISING IMPACT OF CHRONIC DISEASES
Putting age aside, the prevalence of chronic diseases
such as hypertension and hyperlipidaemia has risen
to worryingly high levels, at 32% and 37% of our
population respectively.
CUSTOMISATION OF CARE
Technology has allowed a greater degree of
personalisation across industries. We will leverage
technological advancement in areas such as
wearables, machine learning, and precision medicine
(use of genomic data) to deliver more targeted and
customised care.
Opportunities
SHIFT IN CARE MODEL
Digitalisation has enabled new approaches
to healthcare and a shift in care models and
approaches, with medical devices becoming more
widely available and accessible, and the increasing
use of digital therapeutics and healthcare solutions
in non-traditional settings.
Future Challenges and Opportunities
INCREASING OUR EFFORTS
IN PREVENTIVE CARE
Through Healthier SG, we have shifted our focus
towards preventive care to improve our population’s
health, and to put our healthcare system on a
more sustainable fnancial footing. Recognising
the importance of preventive care, we have
been investing heavily in health promotion, early
vaccination, and screening for diseases.
ENSURING DATA SECURITY
AND CYBERSECURITY
With the increasing need for data to be shared
across the healthcare ecosystem, we recognise
the importance of ensuring data security and
cybersecurity. We can leverage privacy enhancing
technologies to allow better data privacy without
compromising the modelling or analyses. We will
also bolster our data governance frameworks and
cybersecurity capabilities to enable healthcare
clusters, family doctors and partners to work more
closely together in a secure environment.
The Women’s Health Committee, comprising
stakeholders from community outreach and advocacy
organisations, healthcare partners, and Government
Engaging Stakeholders
agencies, actively looks at equipping all female Singapore residents
with knowledge and skills to improve their health and well-being.
Programmes include talks on cancer awareness and early detection
conducted in schools, as well as workshops that equip volunteers
with the knowledge on bone health and skills to administer the
Osteoporosis Self-Assessment Tool for Asians for seniors.
SDG 3.4.1
1.1 (2021)
Neonatal mortality rate
(per 1,000 resident live
births), down from 1.3
in 2018 SDG 3.2.2
(2021) 2.1 7
Under-fve mortality rate (per
1,000 resident live births),
down from 2.6 in 2018 SDG 3.2.1
2.6(2021)
Maternal mortality ratio (per
100,000 live births), down
from 10.2 in 2018 SDG 3.1.1
10.1% (2020)
Smoking prevalence rate,
down from 11.8% in 2017
SDG 3.a.1
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[
3
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{
"country": "sgp",
"file_id": "sdg-03/vnr-report-sgp-2023-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2023
}
|
53
7.2 SDG 3 (Inclusive Health)
Within its Human Capital Development flagship programme launched in the last two years, GoSL
has also ramped up focus and support for the health sector, especially towards the development of
the child.
Over the period 2013-2019/20 the country decreased under-five mortality rate from 156 deaths in
2013 to 122 deaths in 2019/20 per 1,000 live births; infant mortality dropping from 92 to 75 deaths
per 1,000 live births during the same period; as well as neonatal mortality rate, from 39 to 31
deaths per 1000 live births. Maternal mortality rate also dropped from 1165 in 2013 to 716 deaths
per 100,000 live births during the period. This can be associated with a reduction in stunting among
children under 5 years from 38 to 30 percent; wasted children from 9 to 5 percent; and underweight
from 16 to 9.9 percent, during 2013-2019/20. However, HIV prevalence somehow increased from
1.5 to 1.7 percent among adults age 15-49 during 2013-2019 (women 2.2 percent in 2019 compared
to 1.7 percent in 2013; men 1.3 percent in 2019 compared to 1.1 percent in 2013).
With increased resolve by the government to continually scale up investment in the health sector,
especially in the context of advancing its Human Capital Development, increased public
investment has been made in this sector, given the following key deliverables produced during
2018/19-2020/21 to advance health outcomes:
Budgetary allocation to public health sector increased from 6 percent in 2018 to 11 percent
in 2020;
The National Emergency Medical Services (NEMS) established to manage a network of
216 ambulances around the country, to strengthen referral of patients within the country;
Advanced digitalization of health information systems at CHPs and MCHPs
Accreditation received for training of surgeons, obstetricians, physicians and pediatricians,
and training begun for first set of specialists, while plans advanced to improve condition
of service for specialist to make it attractive to the diaspora.
Public-private partnership encouraged in the sector with the development of appropriate
policy; implementation of initiative already because at the largest tertiary hospital (the
Connaught Hospital) for pharmaceutical product management.
The Secretariat Sierra Leone’s Social Health Insurance established
Increased the coordination of NGO operations in the sector through the signing of Service
Level Agreement with the Government
The Health Service Commission completed recruitment of over 4,000 health workers.
GPS tracking system installed on all drug distribution trucks to increase management of
health products across the country
7.3 SDG 5 (Gender)
|
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}
|
38
ODS 3
Salud y bienestar
Entre 2015 y 2021, el país ha avanzado en la garantía de la salud materno-infantil, la mortalidad
materna se ha mantenido en niveles favorables a los exigidos por los ODS (una tasa inferior a 70).
En 2021, aproximadamente solo 2 de cada 100 partos no fueron atendidos por personal sanitario
calificado, como una garantía social para la prevención de la muerte materna por causas
previsibles.
Asimismo, han descendido los niveles de mortalidad en la niñez menor de 5 años en un 12.19%, al
pasar de 12.30 muertes por cada mil nacidos vivos en 2015 a 10.80 en 2021. En el marco de la
crisis por la COVID-19, la mortalidad neonatal se elevó levemente de 5.1 muertes por cada mil
nacidos vivos a 5.7 en 2021. De igual forma, se perdieron los pocos avances alcanzados entre
2015 y 2019, en el marco de los cuales, esta tasa de mortalidad pasó de 5.7 a 5.1. En este contexto
de la pandemia, se ha elevado el número de muertes de menores de un año del total de menores
fallecidos hasta los cinco años, al pasar de 46.34% en 2015 a 52.78% en 2021. A la mitad del
período de implementación de los ODS, más de la mitad de las muertes en la primera infancia
menor de 5 años ocurren en el primer año de vida.
Cuadro II.4. Estado de avance en las metas e indicadores priorizados del ODS 3 que están
relacionadas con la salud materno-infantil y la salud sexual-reproductiva.
Meta Indicador
Valor de
línea base
2015
Valor meta
Brecha por
superar
2015-2030
Valor de
medio
término 2021
Brecha por
cerrar al
2030
Tendencia en
estado de
avance
Meta 3.1: Reducir la
tasa de mortalidad
materna a menos de 70
por cada 100 mil
nacidos vivos
3.1.2 Porcentaje de partos
con asistencia de personal
sanitario calificado
97.70 100.00 2.30 98.10 1.90 ●
Meta 3.2: Poner fin a las
muertes evitables de
recién nacidos y de
niños menores de 5
años
3.2.1 Tasa de mortalidad de
niños menores de 5 años,
por cada mil nacidos vivos
12.30 0.00 12.30 10.80 10.80 ●
Meta 3.7: Garantizar el
acceso universal a los
servicios de salud
sexual y reproductiva,
incluidos la
planificación familiar,
información y
educación y su
integración en las
estrategias y programas
3.7.1 Porcentaje de mujeres
en edad de procrear (entre
15 y 49 años) que cubren
sus necesidades de
planificación familiar con
métodos modernos
67.90 No definida Aumentar 52.00 Aumentar ●
3.7.2 Tasa de fecundidad de
las adolescentes de 15 a
19 años por cada mil
74.00 No definida Reducir 39.00 Reducir ●
39
Meta Indicador
Valor de
línea base
2015
Valor meta
Brecha por
superar
2015-2030
Valor de
medio
término 2021
Brecha por
cerrar al
2030
Tendencia en
estado de
avance
mujeres de este grupo
etario
Nota: El valor de la línea base de los indicadores 3.1.2, 3.7.1 y 3.7.2 es 2014, mientras que en el indicador 3.1.1 es 2015. El
valor de la línea de medio término de todos los indicadores es 2021.
Fuente: elaboración de CNDS a partir de información suministrada por el MINSAL.
En este contexto, se contribuirá a reducir la tendencia de la mortalidad materna y neonatal, con
una atención de calidad desde la atención preconcepcional, embarazo, parto y puerperio; así
como los cuidados del recién nacido. Esto se logrará con la vigencia de la Ley Nacer con Cariño
la cual integrará un enfoque territorialmente diferenciado que reducirá de manera acelerada la
mortalidad materna y neonatal en todo el país, y en particular aquellos departamentos en donde
está por encima de las 70 muertes por cada cien mil nacidos vivos.
Figura II.3. Estado de avance de medio término en la garantía de la salud materno-infantil.
El Salvador, 2021.
Tasa de mortalidad materna por cada cien mil nacidos vivos
Ahuachapán 58.9
Santa Ana 76.3
Sonsonate 94.6
Chalatenango 116.7
La Libertad 71.4
San Salvador 59.7
Cuscatlán 22.2
La Paz 85.3
Cabañas 93.3
San Vicente 34.9
Usulután 31.4
San Miguel 36.8
Morazán 111.3
La Unión 0.0
Menos de 30 30 a 49.00 50 a 66.99 70 o más
40
Tasa de mortalidad neonatal por cada mil nacidos vivos
Fuente: elaboración CNDS a partir de datos suministrados por MINSAL.
A la par de estas acciones a favor de la salud materno-infantil, se necesitar alinear la estrategia de
salud sexual y reproductiva con las dinámicas de la estructura demográfica del país. Entre 2015 y
2030, el porcentaje de mujeres en edad fértil se mantendrá por encima del 50% y la tasa global de
fecundidad por debajo de los niveles de reemplazo (UNFPA, 2019). Entre 2015 y 2021, el
porcentaje de mujeres en edad de procrear que cubren sus necesidades de planificación familiar
con métodos modernos bajó de 67.9% a 52.0%. Si bien, la tasa de fecundidad en las adolescentes
de 15 a 19 años ha bajado un 47.29%, al pasar de 74 por cada mil mujeres de 15 a 19 años en 2014
a 39 en 2021, aún se debe reforzar el disfrute pleno de los derechos sexuales y reproductivos
desde el inicio de su vida fértil, especialmente en los departamentos con la tasa más alta (valores
superiores a 40). Estas acciones necesitan incluir un enfoque urbano-rural diferenciado. En 2021,
la tasa rural fue 23 puntos más alta a la urbana (55 en contra de 32).
Ahuachapán 6.6
Santa Ana 5.8
Sonsonate 5.4
Chalatenango 5.8
La Libertad 6.9
San Salvador 5.3
Cuscatlán 6.7
La Paz 5.8
Cabañas 4.0
San Vicente 4.9
Usulután 4.4
San Miguel 5.6
Morazán 6.4
La Unión 5.0
Menos de 5 5 a 5.4 5.5 a 5.9 6 o más
41
Figura II.4. Estado de avance de medio término en la garantía de la salud sexual y
reproductiva desde el inicio de la vida fértil, desde una perspectiva departamental.
El Salvador, 2021
Tasa de fecundidad en las mujeres adolescentes de 15 a 19 años
Fuente: elaboración CNDS a partir de datos suministrados por MINSAL
Entre 2015 y 2021, se ha avanzado en la reducción de la incidencia de enfermedades infecciosas
prioritarias como la tuberculosis y la malaria; y el volumen de la demanda de atención por
enfermedades tropicales. Además, se ha mejorado en la lucha contra el VIH, además han
intensificado las estrategias de mejorar la búsqueda activa de nuevos casos de VIH mediante
diversas acciones, incluyendo novedosos asocios público-privados. En este contexto, la tasa de
nuevas infecciones por cada mil habitantes se ha mantenido entre 0.17 y 0.19 en el período 2015-
2021, excepto en 2020 cuando bajó a 0.14, en el marco de la crisis sanitaria por la COVID-1910
dado que se refleja el efecto del confinamiento poblacional.
Cuadro II.5. Estado de avance en las metas e indicadores nacionalmente priorizados del
ODS 3 que están relacionados con la mortalidad de enfermedades transmisibles,
enfermedades no transmisibles, lesiones y contaminación ambiental.
Meta Indicador
Valor de
línea base
2015
Valor meta
Brecha por
superar
2015-2030
Valor de
medio
término 2021
Brecha por
cerrar al
2030
Tendencia en
estado de
avance
Meta 3.3: Poner fin a
epidemias como SIDA,
tuberculosis, malaria,
enfermedades
tropicales y combatir la
hepatitis, enfermedades
transmitidas por agua y
otras enfermedades
transmisibles
3.3.1 Número de nuevas
infecciones por el VIH por
cada mil habitantes no
infectados
0.18 No definida Ajustar al
contexto 0.19 Ajustar al
contexto ○
3.3.2 Incidencia de la
tuberculosis por cada 100 mil
habitantes
38.00 0.00 38.00 26.00 26.00 ●
3.3.3 Incidencia de la malaria
por cada 100 mil habitantes 0.05 0.00 0.05 0.00 0.00 ●
10 De acuerdo con información del Sistema Único de Monitoreo y Vigilancia Epidemiológica del Ministerio de Salud
(SUMEVE) para esta Revisión Nacional Voluntaria de los ODS, esta estrategia basada en la detección de casos nuevos ha
influido en un ligero aumento en el total de casos. Entre 2017 y 2021, el total de casos de infección por VIH ha subido
levemente hasta llegar a 1,188 casos en 2021, después del descenso registrado de 1,821 en 2011 a 1,159 en 2016.
Ahuachapán 50.0
Santa Ana 35.0
Sonsonate 44.0
Chalatenango 45.0
La Libertad 39.0
San Salvador 27.0
Cuscatlán 34.0
La Paz 41.0
Cabañas 72.0
San Vicente 53.0
Usulután 69.0
San Miguel 40.0
Morazán 54.0
La Unión 30.0
Menos de 30 30 a 39.99 40 a 49.99 50 o más
42
Meta Indicador
Valor de
línea base
2015
Valor meta
Brecha por
superar
2015-2030
Valor de
medio
término 2021
Brecha por
cerrar al
2030
Tendencia en
estado de
avance
3.3.4 Incidencia de la hepatitis
B por cada 100 mil habitantes 0.80 0.00 0.80 1.00 1.00 ●
3.3.5 Número de personas que
requieren intervenciones
contra enfermedades
tropicales desatendidas, en
millones
1.27 No definida Reducir 1.10 Reducir ●
Meta 3.4: Reducir en un
tercio la mortalidad
prematura por
enfermedades no
transmisibles mediante
prevención y
tratamiento y promover
la salud mental y el
bienestar
3.4.1 Tasa de mortalidad
atribuida a las enfermedades
cardiovasculares, el cáncer, la
diabetes y las enfermedades
respiratorias crónicas (por 100
mil habitantes)
216.00 72.00 144.00 272.30 200.30 ●
3.4.2 Tasa de mortalidad por
suicidio, por 100 mil
habitantes
2.80 0.93 1.87 2.23 1.30 ●
Meta 3.5: Fortalecer la
prevención y el
tratamiento del abuso
de sustancias adictivas,
incluido el uso indebido
de estupefacientes y
consumo nocivo de
alcohol
3.5.2 Consumo nocivo de
alcohol definido como
Consumo de alcohol per
cápita (a partir de los 15 años)
durante un año civil en litros
de alcohol puro
2.68 No definida Reducir 2.87 Reducir ●
Meta 3.6: Reducir a la
mitad el número de
muertes y lesiones
causadas por
accidentes de tráfico
3.6.1 Tasa de mortalidad por
siniestros de tránsito, por 100
mil habitantes
17.79 8.90 8.90 21.46 12.57 ●
3.6.1 (a) Tasa de lesionados
por siniestros de tránsito por
100 mil habitantes
146.53 73.27 73.27 76.40 3.14 ●
Meta 3.9: Reducir
considerablemente el
número de muertes y
enfermedades
causadas por
productos químicos
peligrosos, la
contaminación del aire,
el agua y el suelo
3.9.1 (a) Tasa de mortalidad
atribuida a la contaminación
de los hogares, por 100 mil
habitantes
17.30 No
establecida Reducir 21.14 Reducir ●
3.9.1 (b) Tasa de mortalidad
atribuida a la contaminación
del aire del ambiente, por 100
mil habitantes
19.40 No
establecida Reducir 26.86 Reducir ●
3.9.3 Tasa de mortalidad
atribuida a intoxicaciones
involuntarias, por 100 mil
habitantes
1.26 No
establecida Reducir 0.50 Reducir ●
Nota: El valor de la línea base para todos los indicadores es 2015 y el valor de la línea de medio término es 2021
Fuente: elaboración CNDS a partir de información suministrada por el MINSAL y el VMT.
En la lucha contra la Hepatitis B entre 2015 y 2021, se refleja una tendencia creciente entre 2015
y 2018, en el marco de la cual la tasa de incidencia pasó de 0.8 a 2.1. Aunque, la tasa ha bajado de
2.1 en 2018 a 1.0 en 2021. Asimismo, ha aumentado la carga de mortalidad atribuida a
enfermedades no transmisibles, la contaminación ambiental y la inseguridad vial. Desde 2015, la
tasa de mortalidad por enfermedades no transmisibles (enfermedades cardiovasculares, cáncer,
diabetes y enfermedades respiratorias crónicas) han aumentado. Entre 2015 y 2021, la tasa de
mortalidad subió en un 26.1%, al pasar de 216 por cada cien mil habitantes a 272.3. En 6 de los 14
departamentos del país, la tasa de mortalidad excedió el parámetro nacional (Chalatenango,
Cuscatlán, La Paz, Cabañas, San Miguel y La Unión).
43
Gráfica II.3. Trayectoria de avance en la reducción de la mortalidad prematura por
enfermedades no transmisibles. El Salvador, 2015-2030.
Tasa de mortalidad atribuida enfermedades cardiovasculares, el cáncer, la diabetes y las
enfermedades respiratorias crónicas, por cada 100 mil habitantes.
Fuente: elaboración CNDS a partir de datos suministrados por MINSAL.
Entre 2015 y 2021, la mortalidad atribuida a la contaminación de los hogares ha subido un 3.8%
(la tasa ha pasado de 17.3 por cada 100 mil habitantes a 21.1) y la contaminación del aire del
ambiente, ha incrementado 7.5% (la tasa ha pasado de 19.4 por cada 100 mil habitantes a 26.9).
Además, se ha elevado la letalidad de los accidentes de tráfico. Entre 2015 y 2021, se han reportado
menos lesionados por accidentes de tránsito, pero la tasa de mortalidad ha subido. En 2015, las
muertes representaban 12.14% de los lesionados; mientras que, en 2021, el 28.09%.
Se ha reducido la carga de mortalidad por suicidio entre 2015 y 2021, como un asunto prioritario
en la gestión de la salud mental, como resultados de los descensos alcanzados en determinados
grupos etarios (como la población joven de 15 a 34 años y la población envejeciente de 80 años
o más), se necesita reforzar la atención al riesgo de suicidio en la niñez de 10 a 14 años, la
población en edad productiva avanzada de 34 a 54 años y la adultez mayor de 60 a 79 años. 216.0 206.5 229.8 243.0 240.8 263.9 272.3
Meta al
2030
72
0.0
50.0
100.0
150.0
200.0
250.0
300.0
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
44
Infografía II.3. Estado de avance de medio término en la reducción de la mortalidad por
suicidio.
El Salvador 2021.
Tasa de mortalidad por suicidio por cada 100 mil habitantes, por grupo de edad.
Fuente: elaboración CNDS a partir de datos suministrados por el MINSAL.
En la atención de la carga epidemiológica por enfermedades no transmisibles, suicidio,
inseguridad vial y contaminación ambiental, se necesita adoptar una perspectiva de género. De
acuerdo con los datos desagregados por sexo, los hombres presentan tasas de mortalidad más
altas que las mujeres.
Figura II.4. Estado de avance de medio término en la carga epidemiológica
no transmisible, desde una perspectiva de género. El Salvador 2021
Hombres Mujeres
Enfermedades no
transmisibles
Tasa de mortalidad atribuida a enfermedades cardiovasculares, el cáncer, la diabetes y
las enfermedades respiratorias crónicas, por cada 100 mil habitantes 327.2 231.5
Salud mental Tasa de mortalidad por suicidio, por cada 100 mil habitantes 3.4 1.2
Inseguridad vial Tasa de mortalidad por siniestros de tránsito, por cada 100 mil habitantes 18.2 3.2
Contaminación
ambiental
Tasa de mortalidad por contaminación de los hogares, por cada 100 mil habitantes 23.1 19.4
Tasa de mortalidad por contaminación del aire del ambiente, por cada 100 mil
habitantes 29.3 24.7
Tasa de mortalidad por intoxicaciones involuntarias, por cada 100 mil habitantes 0.7 0.1
Fuente: elaboración CNDS a partir de información suministrada por el MINSAL y el VMT.
En respuesta a esta variedad de desafíos para la gestión de una vida saludable en condiciones de
igualdad, se necesita reforzar la cobertura y calidad de los servicios de salud, así como de la
conexión de la población con los esquemas de aseguramiento público proporcionados como
parte de la seguridad social. Al cierre del primer quinquenio para el logro de los ODS, aún faltaba
asegurar el acceso a servicios de salud esenciales al 23.50% de la población. Además, se necesita
revertir la pérdida progresiva de cobertura de inmunización que se aceleró en el marco de la crisis
sanitaria por la COVID-19. Entre 2015 y 2019, el porcentaje de población inmunizada por todas las
vacunas incluidas en su programa nacional pasó de 91.1 a 85.5; y luego, en el marco de la
pandemia, de 85.5 a 78.0 entre 2019 y 2021.
En atención a estos retos de cobertura, se han dado pasos importantes para mejorar las
capacidades del sistema de salud, especialmente en situaciones de emergencia. En comparación
0.5
4.7 5.3
3.3
2.2
3.1
1.9
3.2
1.0
3.4
0.9
2.7 2.5
4.3
3.0
2.6
2.3
4.3
2.8
0.7
0.0
5.0
10.0
10 a 14 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 69 70 - 74 75 - 79 80 y más
2015
2021
Estado de avance en la reducción de la tasa de 2021 en comparación a 2015.
45
a 2015, se ha elevado la cantidad de personal sanitario por cada 100 habitantes y se ha logrado
establecer un sistema de salud 100% preparado para la atención de emergencias médicas de
conformidad a reglamentos internacionales. Además, se han mejorado la capacidad para movilizar
recursos de cooperación internacional de forma efectiva a favor de la investigación médica y con
ello, contribuir a la instalación de capacidades para desarrollar políticas de salud basadas en
evidencia.
Cuadro II.6. Estado de avance en las metas e indicadores nacionalmente priorizados del
ODS 3 que están relacionadas con la capacidad instalada del sistema nacional de salud.
Meta Indicador
Valor de
línea base
2015
Valor meta
Brecha por
superar
2015-
2030
Valor de
medio
término
2021
Brecha por
cerrar al
2030
Tendencia en
estado de
avance
Meta 3.8: Lograr cobertura
sanitaria universal, incluida
protección contra riesgos
financieros, acceso a servicios de
salud esenciales de calidad, a
medicamentos y vacunas
3.8.1 Cobertura de los
servicios de salud
esenciales
74.30 100.00 25.70 76.50 23.50 ●
3.8.1.a Número de
personas con cobertura de
un sistema de salud
pública contributiva por
cada mil habitantes
233.00 No establecida Aumentar 246.88 Aumentar ●
3.8.2.a Gasto mensual
promedio en salud por
hogar
33.50 No establecida Ajustar al
contexto 43.61 Ajustar al
contexto ○
3.8.2.b Proporción de la
población que vive en
hogares cuyo gasto en
salud es mayor al 10% de
los ingresos del hogar.
2.30 No establecida Ajustar al
contexto 4.06 Ajustar al
contexto
○
Mecanismo 3.b: Apoyar las
actividades de investigación y
desarrollo de vacunas y
medicamentos contra las
enfermedades transmisibles y no
transmisibles
3.b.1 Porcentaje de
población inmunizada por
todas las vacunas incluidas
en su programa nacional
91.10 No establecida Aumentar 78.00 Aumentar ●
3.b.2.(a) Valor en dólares
de la Ayuda Oficial para el
Desarrollo para el sector
de investigación médica
(en millones USD)
0.24 No establecida Aumentar 73.39 Aumentar ●
Mecanismo 3.c: Aumentar
considerablemente el
financiamiento de la salud y la
contratación, el
perfeccionamiento, capacitación y
retención del personal sanitario
3.c.1 Densidad y
distribución del personal
sanitario (por 100 mil
habitantes)
19.5 No establecida Reducir 21.87 Aumentar ●
Mecanismo 3.d: Reforzar la
capacidad de los países en materia
de alerta temprana, reducción y
gestión de riesgos para la salud
3.d.1 Capacidad prevista
en el Reglamento Sanitario
Internacional (RSI) y
preparación para
emergencias de salud
93.00 No establecida Aumentar 100.00 Aumentar ●
Nota: el valor de la línea base de todos los indicadores es 2015. En cambio, el valor de la línea de medio término de todos
los indicadores es 2021, excepto en los 3.8.1 (2019), 3.8.1.a (2020) 3.8.2.a (2019) y 3.8.2.b (2019) y 3.c.1 (2020).
Fuente: elaboración CNDS a partir de información suministrada por la DIGESTYC, el MINSAL, INS, FOSALUD y MRREE.
|
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|
36 — 37
GOAL
/3
SAN MARINO REPORT FOR THE 2021
VOLUNTARY NATIONAL REVIEW
GOAL 3
↗ THE REPUBLIC OF
SAN MARINO HAS A FREE
HEALTHCARE SYSTEM
↘ FOR ALL. IN THE COMING YEARS,
THE HOSPITAL WILL NEED
TO BE RENEWED AND
STRENGTHENED.
↘ WORK NEEDS TO BE
DONE TO STRENGTHEN
INTEGRATION BETWEEN
HOSPITAL AND TERRITORIAL
SERVICES, WITH A GREATER
DEVELOPMENT OF THE
LATTER.
↗ THE SOCIAL SECURITY
INSTITUTE (SSI) GUARANTEES
HIGH ACCESSIBILITY TO ALL
HEALTH AND SOCIO-HEALTH
SERVICES.
GOAL 3
SAN MARINO REPORT FOR THE 2021
VOLUNTARY NATIONAL REVIEW
GOAL 3 38 — 39
San Marino Socio-Health System was created
in 1955 with the establishment of the Social
Security Institute (SSI) and ensures a fair and
solidarity-based welfare system for all.
The functions and organization of the SSI
are defined, in particular, by Law no. 42 of
22 December 1955, Law no. 21 of 3 May 1977,
Law no. 69 of 25 May 2004 and Law no. 165
of 30 November 2004 and their subsequent
amendments and integrations, and by the
documents related to planning, i.e. health
and socio-health plans, corporate guidelines,
budgets, personnel plan and investment plan.
The mission of the SSI is to meet the health
needs of San Marino population through a
quality health, social and welfare system for
all consisting of prevention and rehabilitation
activities, as well as primary health care, social and welfare assistance.
The vision of the SSI is oriented to the constant strengthening of the organizational system to ensure appropriateness, timeliness,
effectiveness and quality of services offered to
patients, while respecting their health needs,
by continuously improving the quality of supply and citizens’ satisfaction and by optimizing the management of available resources.
The SSI is organized into Departments and Areas:
- Hospital Department, consisting of
an Emergency Department and an Urgency and Emergency Service (118) and
providing outpatient, diagnostic, inpatient and medical and surgical services. It is divided up into 2 areas (one
providing diagnostic and intervention
services and the other medical and rehabilitation services).
- Socio-Health Department, consisting of Primary Care services, which
provide primary health care, health
promotion and disease prevention at
a territorial level through, for example,
the promotion of vaccinations and advisory activities aimed mainly at women's health, and of Socio-Health and
Social services, which include Mental
Health, Minors’ Service, Elderly Service
and services for the disabled.
- Prevention Department, dealing
with food safety and veterinary medicine, environmental protection, safety
in the workplace, occupational medicine and public health laboratory.
- Strategic Management Staff and
Administrative Area, consisting of
cross-cutting healthcare and administrative processes such as pharmaceuticals, management control, forensics,
personnel management, budgeting
and management of the social security system, which provides for example
pensions and family allowances.
MOTHERS AND CHILDREN
The SSI has always paid great attention to the
health of children, starting from the health of
mothers throughout pregnancy and puerperium. For some years now, a birth program,
managed in a multidisciplinary way, has been
set up. Its focus is on preparing parents for
childbirth, supporting puerperium and on
"home visiting". This makes it possible to
identify post-partum depression or parental
distress at an early stage and to subsequently provide parenting support programs and
interventions against juvenile and gender violence.
Health care during pregnancy and childbirth
is provided for all women, and the focus on
the mother and the process to delivery has resulted in a zero maternal mortality rate since
before 2000.
In San Marino, neonatal and under-five mortality have been below the thresholds of 12 per
1000 (neonatal) and 25 per 1000 (under-five)
for more than a decade.
HEALTH AND PREVENTION
The SSI pays particular attention to the prevention and treatment of infectious diseases.
Tropical diseases such as malaria, mentioned
in indicator 3.3.3, are not present in San Marino. Antimalarial chemoprophylaxis is provided free of charge to all those volunteering in
countries at risk and a Travel Medicine service
provides advice to all travelers. The limited
cases of tuberculosis are mostly imported.
As far as sexually transmitted diseases are
concerned, the SSI collaborates with schools
to educate about affectivity and make students aware of the use of condoms.
With regard to sexual and reproductive health
care services, the SSI provides services for
adolescents to inform and advise them on
contraceptives. Particular attention is paid to
women through the Women's Health Centre.
Oral contraceptives are offered free of charge
by the SSI for all women of childbearing age.
In order to raise public awareness, the SSI has
been participating in the WHO World AIDS
Day for several years and HIV tests can be requested free of charge and anonymously at
the SSI.
There is an active collaboration with AUSL
Romagna (Italian Health Service of the surrounding territory) for the management of
cases requiring high level expertise.
Prevention of hepatitis B is primarily done
through vaccination, which is mandatory from
the age of three months and offered free of
charge. Treatment with innovative and curative drugs for hepatitis C is offered free of
charge to all eligible persons.
To calculate healthy life expectancy at birth
San Marino has planned several surveys for
the 2020-2030 decade, including:
- Passi and Passi d’argento on lifestyles
2010 2011 2012 2013 2014 2015 2016 2017 2018
3.2.1 Under-five
mortality rate
(under-five deaths/
population 0-4
years)*1000
0.60 1.19 0 0.60 0.61 0 0.67 0.70 0.75
3.2.2 Neonatal mortality
rate deaths in the
first 28 days/live
births (deaths
under 5 years/live
births)*1000
2.99 0 0 0 0 0 3.82 0 4.26
3.2.2 Neonatal mortality
rate (deaths in 1
year of life per live
birth *1000)
2.99 3.08 0 3.13 3.38 0 3.82 0 4.26
SAN MARINO REPORT FOR THE 2021
VOLUNTARY NATIONAL REVIEW
40 — 41
of adults aged 18-64 and those over 65;
- 02 on health determinants in early
childhood;
- Global Youth Tobacco Survey (GYTS);
- Childhood Obesity Surveillance Initiative (COSI);
- Health Behavior in School-aged Children (HBSC).
Chronic non-communicable diseases represent one of the main challenges for the countries of the European region as life expectancy
increases. In order to try to reduce premature
mortality due to chronic diseases, the SSI has
developed integrated diagnostic and therapeutic programs between hospital and territorial services, according to the proactive
medicine model, for chronic diseases such as
diabetes, chronic obstructive pulmonary disease (COPD), heart failure and arterial hypertension.
With regard to the over-65 population, programs and activities are being developed
to promote active ageing and to manage,
in a multidisciplinary way, “fragile” elderly
through the involvement of the Operational
Units of Geriatrics, Residential Elderly Care,
GOAL 3
2010 2011 2012 2013 2014 2015 2016 2017 2018
3.3.4 Hepatitis B
incidence
per 100,000
population
9.4 3.1 3.1 0 6.1 0 0 0 0
2010 2011 2012 2013 2014 2015 2016 2017 2018
3.4.1 Age-standardized
mortality rate
between 30-69 years
of age from major
causes of death
(deaths between
30 and 69 years of
age due to NCDs/
population 30-69
years*100,000)
151.42 173.00 144.66 160.01 138.38 116.47 158.75 174.19 100.36
3.4.2 Age-standardized
suicide mortality
rate (suicides
per population
*100,000)
3.15 12.48 0 6.15 3.06 15.20 6.04 9.03 11.99
Neurology, Territorial Home Service and Primary Care.
The Mental Health Service and the Minors’
Service, which are closely integrated with the
other services of the SSI and non-health sectors (schools, court, etc.), play a fundamental
role in guaranteeing psychic well-being and
preventing certain discomforts from evolving
into mental illness.
The prevention, treatment and rehabilitation
of people suffering from mental and psychiatric illnesses are, indeed, at the heart of the
system through which the SSI has provided
health and socio-health services since its inception.
The SSI Mental Health Complex Operative
Unit, in collaboration with the Emergency
Department, Primary Care, other SSI services, police forces and schools, carries out
important activities for the prevention and
treatment of substance abuse. Particular attention is paid to the treatment of pathological addictions, by means of agreements with
specialized centers, also outside the territory,
and social rehabilitation activities through job
placement programs.
San Marino complies with the UN Global Status Report on Road Safety. The SSI ensures
adequate assistance in the event of road accidents involving injured persons and, within the
scope of its competence, collaborates with
the Authority for the Authorization, Accreditation and Quality of Health, Socio-Health and
Socio-Educational Services, for the transmission of data on road accidents with fatalities
or injuries.
In the case of driving under the influence of
alcohol or drugs, rehabilitation programs are
provided.
With reference to the statistics indicated below on road accidents with fatalities or injuries, it should be borne in mind that data may
fluctuate widely, given the limited population
of San Marino.
The number of accidents with fatalities or injuries and the number of annual injuries fell
during the decade under review. This decrease is mainly attributable to an improvement in the road system, closure of the most
risky passages on the highway (the main road
connecting San Marino to the Italian territory), construction of roundabouts, etc.
San Marino model, as also described in the
preceding paragraphs, provides for health
coverage for all, thus fully meeting the indications of Target 3.8. Indeed, it guarantees
2010 2011 2012 2013 2014 2015 2016 2017 2018
3.6.1 Road accidents
harmfulness rate
(injuries per accident
per population
*100,000)
739.13 502.50 550.52 495.05 605.86 474.19 383.85 349.08 338.67
3.6.1 Number of road
traffic fatal injuries 0 1 1 1 1 3 0 3 3
3.6.1 Number of road
traffic injuries
235 161 178 161 198 156 127 116 113
SAN MARINO REPORT FOR THE 2021
VOLUNTARY NATIONAL REVIEW
42 — 43
and manages the provision of health services,
temporary economic benefits, lifelong economic benefits, family allowances and social
security benefits.
Since 2017, particular attention has been paid
to the prevention of communicable diseases
through the establishment of a Vaccine Commission, which corresponds to the NITAG
(National Immunization Technical Advisory
Group) provided for by WHO.
The Commission provided technical support
for the updating of the vaccination calendar
and for a review of the vaccination office’s
working methods, thus leading to a reversal of the downward trend in the coverage of
compulsory vaccinations and to an increase in
recommended vaccinations, with a special focus on certain high-risk categories. As a result
of the implemented campaigns, coverage for
the first dose of the measles, mumps and rubella vaccine in the group of children born in
2015 increased by about 10 percentage points
compared to the 2014 group.
The Vaccine Commission and the Pharmaceutical Commission provide technical support to
the General Directorate for the continuous updating of the pharmaceutical handbook and
the SSI guarantees affordable prices for drugs
and products that are not free of charge.
In 2018, a collaboration agreement was signed
for the implementation of research and training projects for health personnel at the Ikonda
GOAL 3
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
3.b.1 Influenza
vaccination
coverage
age 65+
31.04% 31.10%
3.b.1 Pediatric
vaccination
coverage:
polio
91.80% 94.50% 91.00% 88.50% 86.90% 87.70% 94.10% 94.00% 94.50% 89.10%
3.b.1 Pediatric
vaccination
coverage:
measles
88.80% 90.50% 86.50% 84.30% 82.70% 85.60% 89.30% 85.00% 89.30% 85.70%
3.b.1 Pediatric
vaccination
coverage:
rubella
88.80% 90.50% 86.50% 84.30% 82.70% 85.60% 89.30% 85.00% 89.30% 85.70%
With regard to the density and distribution of health care professionals:
Consolata Hospital in Tanzania by SSI staff.
The Health Authority is in charge of coordinating and supervising the system of authorization and institutional accreditation of
public and private health, socio-health and
socio-educational facilities, and of developing tools and methodologies to assess the appropriateness of the management of care programs. By exercising its functions, the Health
Authority guarantees the continuous improvement of the quality of health and socio-health
facilities for citizens and users, as well as the
systematic and planned development of public health and socio-health services.
COVID-19
The first case of COVID-19 in the Republic of
San Marino was registered on 26 February
2020. The Institutions’ response to the spread
of the epidemic was prompt:
- Decree Law no. 35 of 28 February
2020 declared a state of emergency;
- Decree Law no. 42 of 5 March established the Extraordinary Commissioner
with the task of managing and implementing the urgent measures to tackle the situation caused by the virus.
The Extraordinary Commissioner was
also assigned the coordination of the
Coordination Group for Health Emergencies, made up of the SSI Director
General, the Health Authority and the
Civil Protection, with the commitment
to meet periodically to plan assistance to the population and respond
to emerging needs for diagnosis and
treatment;
- Decree Law no. 43 of 5 March 2020
introduced special and urgent measures to prevent and contain the spread
of COVID-19.
In addition to the above-mentioned legislative
acts, further measures have been put in place
to deal with the epidemiological emergency,
in particular in the following areas:
1- Prevention: by strengthening the
contact tracing service;
2- Territory: by setting up a COVID-19
team of doctors and nurses to take
care of patients at home;
3- Hospital: by increasing bed availability with the opening of two new
wards and the conversion of some Or2018
3.c.1 Practicing physicians (tot. physicians/population*1,000) 338.67
3.c.1 Nurses and midwives (tot. nurses + midwives/
population*1,000)
8.9%
3.c.1 Dentists (dentists working in San Marino/
population*1,000)
1.5%
SAN MARINO REPORT FOR THE 2021
VOLUNTARY NATIONAL REVIEW
44 — 45
ganizational Units for the isolation of
infected patients.
In addition, in collaboration with the Civil
Protection, two tents were set up outside the
hospital to ensure safe access for patients
with a suspected COVID-19 diagnosis and to
take swabs. Also important was the establishment of a psychological support service both
for people who had to cope with the difficulty of isolation at home or at the hospital and
for health workers involved in the COVID-19
emergency.
For their efforts made during the emergency
that ended on 30 June 2020, on 24 August
2020 the Congress of State awarded the First
Class Medal of Merit to the Social Security
Institute, the Health Authority, the Civil Protection and all those who distinguished themselves in the management of the pandemic.
During summer, there was a relative slowdown in the spread of the virus, which allowed
for the recovery and resumption of all routine
diagnostic, treatment and screening activities
involving patients who were on waiting lists.
However, the Coordination Group for Health
Emergencies, well aware that the period of
fewer infections would be limited, continued
its work and drew up the plan for managing
a new COVID-19 wave, setting as one of its
objectives the strengthening of the influenza
vaccination campaign as a means of preventing complications and promoting health, especially in at-risk groups. A high percentage
of professionals and of the general public
joined this vaccination campaign, with a very
high number of doses administered.
In autumn, as had been predicted, the number
of new confirmed COVID-19 cases increased
again, with an average of 35 per day, and the
first peak of infections was reached in January
2021 due to the arrival of the English variant.
Consequently, there was an increase in admissions to the intensive care unit and the
isolation ward, which had reopened in October 2020. However, the effort to continue with
routine activities was deployed until the end
of March 2021, when the highest number of
active infected people was reached.
Crucial in the fight against the epidemic was
the continued activity of the Contact Tracking
Service and the COVID-19 Territorial Team,
which had been re-established in October
2020 for home follow-up of infected patients.
The turning point in the battle to contain the
spread of the virus was undoubtedly the start,
on 25 February 2021, of the COVID-19 vaccination campaign, following the adoption of
the Anti-SARS-CoV-2/COVID-19 Vaccination
Plan of the Republic of San Marino, drawn
up by the professionals of the Social Security Institute gathered in the Vaccine Commission (the Plan is available on the SSI website
https://vaccinocovid.iss.sm/#moduli). This
campaign was promoted through a massive
information campaign called "My health for
the health of all".
The Plan identifies the categories of people
to be vaccinated as a priority, starting with
health and socio-health workers and guests of
sheltered residential facilities, to be followed
by people over 85 and patients suffering from
chronic diseases, then by people over 75,
teachers and the members of police forces.
Since the end of March 2021, the vaccine has
been offered to adolescents between 16 and
18 years of age and to all age groups.
The opening of two vaccination hubs, one at
territorial level and one at the hospital, made
it possible to vaccinate an average of 800
patients per day, reaching a total number of
33,752 doses on 9 May, of which 21,210 were
first doses and 12,542 second doses. This ensured a population coverage of 62.5% with
GOAL 3
the first dose and 37.5% with the second
dose. More specifically, the coverage was 65%
in the 16-49 age group, over 70% in the 50-59
age group and over 80% in the 60+ age group,
with a peak of 87% in the 75-84 age group.
Worth mentioning is also San Marino's participation in two studies on vaccine safety and
efficacy conducted in collaboration with the
University of Bologna with regard to safety,
and with the Spallanzani Institute in Rome
with regard to efficacy.
After a year and two months, the smallest
and oldest Republic in the world, thanks to
the resilience of all the health and non-health
professionals of the Social Security Institute,
demonstrated its capacity to respond and
adapt, enabling it to overcome the Sars-CoV-2
health emergency for the second time.
|
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14 THE FEDERAL REPUBLIC OF SOMALIA | VOLUNTARY NATIONAL REVIEW REPORT 2022
© Siyaad Mohamed /Ildoog/ WHO SOMALIA
GOOD HEALTH AND WELLBEING
Ensure healthy lives and promote well-being
for all at all ages
P
eace dividends, increased government
capacity alongside investment from
international partners has improved Somalia’s
health sector. However, investment still
remains low with only 1.3 per cent of government
spending dedicated to the health sector41. Health
in Somalia is dominated by the private sector
with at least 60 percent of health services and
70 percent of the country’s medicines estimated
to be delivered by the private sector, primarily in
41 World Bank (2021). Somalia Economic Update
urban areas. Due to Somalia’s nascent health sector
regulatory capacity, there are no quality standards
nor functional regulatory bodies for health services
or pharmaceutical products. As a result, the private
sector is largely unregulated, and providers can
operate without any oversight and produce services
and products of unknown quality. This limits the full
potential of the private sector; as effective private
sector investment requires functional regulations to
be effective.
GOAL 3
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT 15
Serious gaps remain which include weak
government coordination mechanisms, limited data
on health to inform decision making, shortage of
good training institutions and qualifed professionals
as well as inadequate fnancing42. Due to these
challenges Somalia is unable to meet the healthcare
services for most of its population with women and
children most affected.
Somalia struggles with scarce data on the health
sector. In response to this, in 2020 the Somalia
National Bureau of Statistics conducted the Somalia
Health and Demographic Survey which presents
information on the health and lives of Somalis living
across the country. More than 100,000 nomadic,
rural and urban households were assessed over
two phases to collect data mainly on Somali
women of childbearing ages and children. This
survey is the most recent compressive data set
collected measuring the health needs of Somalia’s
population.
The Ministry of Health and Human Services is
the institution responsible for attaining the better
health of Somalia’s population through good service
delivery deriving from good policies.
Universal Health Coverage
In 2019, the Ministry of Health and Human
Services released the Universal Health
Coverage (UHC) roadmap 2019-2023, which was
developed following consultations with UN, other
development partners, donor community and
civil society. The roadmap details three goals for
Somalia’s health sector, namely;
• More Somali people will beneft from universal
health coverage
• More Somali people will be better protected
from health emergencies
• More Somali people will enjoy better health
and well-being43
Considerable work continues on increasing access
to health services including increasing fxed and
mobile health clinics, increasing vaccinations
and the training of health workers. The Ministry
of Health and its international partners provided
essential health services to 488,745 out-patient
department consultations, the immunization
of 76,238 children, 87,564 antenatal care visits,
5,958 facility-based deliveries and 516,334 health
42 Second Phase Health Sector Plan 2017-2021
43 The Somali Roadmap to Universal Health Coverage 2019-2023
promotions44.
National Health Policy
The Somalia National Health Policy vision is for
people to enjoy the highest attainable standard of
health and quality of life and have universal and
equitable access to essential quality health services
with a priority focus on maternal, neonatal and child
health and nutrition, and on the prevention and
control of high burden diseases and related risk
factors.
The following principles and values underpin the
health policy priority directions:
• Universal and equitable access to acceptable,
affordable, cost-effective, and quality health
services with maximum impact on Somali
populations’ health to ensure the realization of
the right to health
• Effective, transparent and accountable
governance and leadership in managing the
different components of the health system
with decentralized management of health care
service delivery
44 UN country results report 2020
Essential health services provided
by the Ministry of Health and its
international partners by the numbers:
488,745
Out-patient department consultations,
76,238
Children immunized,
87,564
Antenatal care visits,
5,958
Facility-based deliveries
516,334
Health promotion
16 THE FEDERAL REPUBLIC OF SOMALIA | VOLUNTARY NATIONAL REVIEW REPORT 2022
• Building effective collaborative partnerships
and coordination mechanisms engaging
local community, national and international
stakeholders and pursuing the aid
effectiveness approaches.
Essential Package of Health Services
The 2009 Essential Package of Health Services
(EPHS)45, which is currently being implemented,
does not reach the entire population. EPHS
implementation started in 2013 through the Joint
Health and Nutrition Programme (JHNP) and the
Health Consortium for Somali People.46 While
the full package was not delivered under the
JHNP due to limitations in available fnancing and
implementation capacity, the JHNP coordinated
health service delivery between partners.
However, following the closure of the JHNP after
the end of external fnancing in 2016, the previously
coordinated EPHS implementation became
fragmented, with partial geographic coverage
and varying package components supported by
different funding partners. According to WHO
2017 fgures, approximately 47 out of 89 districts
(5.7 million people) were covered by part of the
EPHS, representing approximately 41 percent of
the population. In 2020, the Government updated
the EPHS, developing a comprehensive package
of health services supported by the development
partners including the World Bank under the
leadership of the Government.
45 The 2009 EPHS is comprised of core and additional programs.
The EPHS 2009 six core programs were: Maternal, reproductive and neonatal health; Child health; Communicable disease
surveillance and control, including WASH promotion; First
aid and care of critically ill and injured; Treatment of common
illness; and HIV, STIs and TB. The four additional programs
are: Management of chronic disease and other diseases, care
of the elderly and palliative care; Mental health and mental
disability; Dental health; and Eye health. Compared to the
2003 BPHS prepared in Afghanistan, the Somalia EPHS was
much broader and subsequently required more resources to
implement.
46 JHNP was fnanced by DFID (currently FCDO), USAID, Finland,
Australia, Switzerland, and Sweden; and managed by UNICEF
with engagement from WHO and UNFPA.
Covid-19
Covid19 hit in a period where the country was still
recovering from the 2017 drought. Somalia recorded
a total of 26,439 confrmed cases and 1,361 deaths
from Covid19 though this fgure is likely higher due
to lack of recorded data. Data is underreported
due to limited testing facilities, expensive testing
costs, and the stigma associated with Covid-19,
among other factors. Furthermore, the country’s
civil registration system does not exist, which
hinders reporting the correct disease fgures and
the causes of deaths.
The Government selected the Astra Zeneca/Oxford
University (COVAX) as the vaccine of choice.
Somalia received 3.7million Covid-19 vaccinations
through the COVAX facility and donations from
countries. Subsequently, the Ministry of Health
and Human Services delivered a good vaccination
campaign which led to the administering of 2.6
million doses reaching 1.3 million people47. The frst
batches were allocated to health care workers,
other frontline workers and elderly people. Thus far
around 17 per cent of the population has received
the vaccination.
The Somali Government has taken important steps
to improve Somalia’s COVID-19 response, including
the establishment of a testing facility at the
National Public Health and Reference Laboratory in
Mogadishu and increasing the country’s intensive
care unit bed capacity.
Further, in 2019, the Ministry of Health and Human
Services put in place a preparedness and response
contingency plan to support the early detection,
prevention, and control of Covid-19. Similarly, the
Ministry of Education also prepared Somalia’s
Education Sector Covid-19 Response Plan to
Support students and their families to prevent the
transmission and spread of Covid-19 and ensure
continuity of learning through the implementation
of critical activities aimed at maintaining quality
learning and well-being of teachers and students
during the pandemic.
The pandemic highlighted that investing in
47 OCHA and FGS- Covid-19 response in Somalia 2022
3.7M
vaccinations were received through COVAX facility donations
from countries
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT 17
Somalia has reduced maternal
mortality from 732 in 2015 to
692 per 100,000 live births
Somalia’s health system is crucial for reducing
fragility and improving economic development. Prior
Covid-19, Somalia’s economy was on an upward
trajectory, recovering from the 2016/17 drought. The
economy grew at an estimated rate of 2.9 per cent
in 2019, on par with population growth. In 2020,
Somalia’s GDP dropped to -0.3 per cent compared
to the 3.2 per cent growth predicted for the same
year. The growth shrinkage can be attributed to the
Covid-19 restrictions and lockdowns.
Somalia’s Key Health Indicators
Somalia’s lagging health outcomes refect the
country’s insecurity, vulnerability, and deeprooted poverty, limiting opportunities for people to
access basic social services, including education
and health. As seen in Table 1, Somalia’s health
indicators remain among the worst in the world,
with an average life expectancy of 56 years.
Other indicators lag behind those in the WHO
AFRO region as well as most indicators in select,
comparable Fragility, Confict, and Violence (FCV)
impacted countries in WHO’s EMRO region, of
which Somalia is a part.48 While most health
outcomes in Somalia improved from 2006 to 2019,
some indicators such as fertility and stunting have
declined since 2016.
Maternal mortality
Somalia has reduced maternal mortality from 732
in 2015 to 692 per 100,000 live births49. Despite
the gains made, Somalia still faces signifcant
challenges in maternal mortality rates which can be
attributed to low uptake of antenatal care, postnatal
care and a low number of deliveries at health
facilities or with skilled health care providers.
Antenatal healthcare is vital for reducing the risks
associated with the morbidity and mortality for the
mother and child during pregnancy and delivery. A
good antenatal healthcare programme ensures the
timely detection and treatment of problems during
pregnancy. Data from the Somalia Health and
Demographic Survey 2020, showed that only 31
per cent of women aged between 15-49 received
antenatal care from skilled health workers during
the pregnancy of their last birth (from doctors/
clinical offcers or nurses/midwives/auxiliary
midwives) at least once. Twelve per cent of women
received antenatal care from a doctor or clinical
offcer, while 19 per cent received care from a
48 Although Somalia belongs to the WHO EMRO region, geographically and culturally, it is part of sub-Saharan Africa. As
a result, AFRO region data are more applicable and are used
here.
49 Somalia Health and Demographic Survey 2020
Indicator 2006a 2016b 2019c
WHO AFRO
Regional
Average
(2016)d
Maternal Mortality
Ratio (per 100,000
live births)
1040 865 692 536
*(2017)
Neonatal Mortality
Rate (per 1,000 live
births)
45.1 39 N/A 26
Infant Mortality Rate
(per 1,000 live births) 103.3 80.4 N/A 51
Under-fve Mortality
Rate (per 1,000 live
births)
170.5 128.4 N/A 80.5
Total Fertility Rate
(no. of births per
woman)
7.2 6.3 6.9 N/A
Adolescent Fertility
Rate (births per
1,000 women;15-19
years)
127.17 102.14 140
102.1
*(2015-
2020)
Stunting (agefor-height among
children under fve
years of age)
N/A 25.3%
(**2009) 28% 29%
Table 1 Somalia’s Key Health Indicators
midwife, nurse or auxiliary midwife. Sixty-eight per
cent of women did not make antenatal care visits
during their most recent pregnancy in the fve years
prior to the Somalia Health Demographic Survey
2020.
In urban areas 40 per cent of women received
antenatal care from skilled providers compared to
35 per cent of women in rural areas. Only 9 per
cent of women in nomadic areas had received ANC
from skilled health personnel. The level of education
and means of capital were strong determining
factors for whether women received antenatal care
a World Bank 2006
b World Bank 2016
c The 2020 SHDS included no child mortality data including neonatal, infant, and under fve
mortality. This is a major gap in the results and discussions are currently under way with
partners and UNFPA (which conducted the survey) on whether raw data exist to rectify
this and other data gaps in the survey, including the absence of geographically disaggregated data.
d Although Somalia belongs to the WHO EMRO region, geographically and culturally, it is
part of sub-Saharan Africa. As a result, AFRO region data are more applicable and are
used here.
18 THE FEDERAL REPUBLIC OF SOMALIA | VOLUNTARY NATIONAL REVIEW REPORT 2022
from skilled health care providers. Seventy-seven
per cent of women with higher education received
antenatal care from a skilled provider, compared
to 26 per cent of women with no education.
Also, 33 per cent of younger mothers aged 20-34
years received antenatal care from skilled medical
personnel compared to 25 per cent of older women
aged 35-49 years.
Infant mortality rate and postnatal
care
Somalia has a neonatal mortality rate of 43 per
1000 live births according to data from 200650.
Most maternal and neonatal deaths occur 48 hours
after delivery. Only 31 per cent of births were
attended by skilled health personnel according to
50 Multiple Indicator Cluster Survey 2006
data from 2019. Data from the Somalia Health and
Demographic Survey showed that only 11 per cent
of women received a postnatal check within the
critical frst two days of delivery. Eighty-nine per
cent of the mothers did not receive any postnatal
check-up.
Somalia has an infant mortality rate of 91 per
100051. Further there is a 135 per 1000 mortality
rate for infants under fve years old from 2006
fgures.
HIV/AIDs
Somalia has one of the lowest HIV/AIDs infection
rates in Africa and this is attributed to Somali
society’s strong adherence to Islamic morals. The
infection rate is estimated to be very low at about
51 Multiple Indicator Cluster Survey 2006
Percent
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
2000 2006 2019
All Area Nomadic Rural Urban
50.2
33.5 33.0 31.9
65.0
51.0
19.5
10.2 8.3
14.5
36.9
Both Sex Female Male
140
130
120
110
100
90
80
70
Per 1000 live births
2000 2001 2002 2003 2004 2005 2006
91.0
86.0
76.0
134.0
132.0
130.0
Figure 3 (3.1.2) Proportion of births attended by skilled health personnel (%)
Figure 4 (3.2.1a) Infant mortality rate (death per 1,000 live births)
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT 19
0.55 per cent52 and an estimated fgure of 2,370
annual deaths53. However, the actual prevalence
may be higher as a result of undetected infections.
Somalia has adopted the UNAIDS ambitious 90-
90- 90 treatment target. Specifcally, these targets
state that: (i) By 2020, 90 per cent of all people
living with HIV will know their HIV status; (ii) By
2020, 90 per cent of all people with diagnosed
HIV infection will receive sustained antiretroviral
therapy; and (iii) By 2020, 90 per cent of all people
receiving antiretroviral therapy will have viral
suppression. By 2019, Somalia was not meeting
the three targets with the frst and third 90 needing
signifcant reduction if the national HIV burden
is to be signifcantly lowered. There have been
challenges with treatment adherence and capacity
to monitor viral suppression in the country54.
The lack of knowledge, social stigma and lack of
services are major risks to the prevention of HIV/
AIDs
Health Worker Density and Health
Utilization
There are gaps in essential provisions such as
health workers, essential medicines, and medical
equipment, particularly in public facilities. Somalia’s
public health worker density is 0.43 per 1,000
people and private health worker density is 0.49 per
1,000 people. The combined health worker density
fgure (0.92) is signifcantly below the WHO’s cut-off
for “critical” human resource shortages, which is
2.28 health workers per 1000 people. Under the
health worker distribution indicator, 78.4 per cent
of are male and 21.5 are female according to 2014
fgures. The availability of qualifed medical staff
is predictably concentrated in urban areas, with
52 Somalia Health Demographic Survey 2020
53 UNAIDS 2014 Report
54 Somali HIV National Strategic Plan and M&E Framework
2021-2023
rural areas facing more pronounced recruitment
and retention challenges. There are also many
unqualifed individuals believed to be providing
health services, particularly in private facilities
due to lack of regulation and weak government
enforcement.
2,286,299 people require interventions against
neglected tropical diseases. Somalia’s international
health regulations capacity is recorded at 20%
according to data form 2018.
Health service utilization is low, particularly in the
public sector, estimated at 0.23 outpatient visits
per person per year and 0.81 hospital discharges
per one hundred people per year (SARA, 2016).
Traditional medicine, seeking health services from
family members and outside of formal medicine
are believed to be common. Reports on health
service data indicate that patients prefer private
facilities over public facilities based on perceived
higher quality, pharmaceutical availability, and easier
access. Pharmacies are by far the most accessible
health care delivery points in Somalia.
Out-of-pocket payments (OOP) as a percentage of
per capita health expenditure in Somalia are high
at 46 percent. Average annual household OOP on
health is estimated at US$2 per capita out of a total
of US$6 (2019) and varies substantially between
the richest quintile and the poorest quintile,
indicating that households are accessing healthcare
services based on the ability to pay instead of their
healthcare needs, resulting in health inequities.55
Socio-cultural factors also play a signifcant role in
the health seeking behaviours and status of women
in Somalia. Responsibility for decisions related
to health-seeking behaviour, such as when to get
treatment at a clinic, resides primarily with men and
contributes to delays in seeking care. According
to the 2020 SHDS, 42 percent of women report
needing permission to access services as a barrier
to healthcare during pregnancy. Furthermore,
early marriage is prevalent and a signifcant factor
contributing to early frst pregnancies, high fertility
rates and the high maternal mortality ratio. Thirty
six per cent of women between 20 and 24 years
old were married before 18 years of age, and
average age at frst marriage is 20 for women and
23 for men.56
55 The Lancet 2020
56 SHDS 2020
Health Indicators Data Year
Percentage of all people
living with HIV who know
their HIV status
32% 2019
Percentage of all people
diagnosed with HIV that
receive sustained ART
79.4% 2018
Percentage of all people
receiving ART that have
viral suppression
73.7% 2019
Table 2 Country Performance on the UNAIDS 90-90-90 targets
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37
Children in Serbia are facing decreasing risks of mortality in the earliest stages of their lives. Since 1990,
the under-fve mortality rate has dropped from 18 deaths per 1000 children in 1990 to 5.8 per 1000 children
in 2017. However, children living in Roma settlements have lower chances of early survival, as indicated by
the mortality rate of 14.4 per 1000 of children in 2014.29 Health related issues that require a higher policy
response are the recent trends of decreased immunization of children and consequent increase in the prevalence
of measles cases.
Important health concerns are also related to the sexual and reproductive health of young people. Although
Serbia does not face the problem of adolescent pregnancies and births at the rate as high as some developed
North-Western countries of Europe and North America, it is still an issue that requires high policy attention.
Adolescent birth rate (girls, 15-19) has significantly dropped from 44.5 per 1000 women of that age in 1990
to 15.1 per 1000 women in 2017.30 The prevalence of adolescent child birth is higher among girls living in
Roma settlements: 23.8% of girls aged 15-19 had a live birth, 9% were pregnant with first child, 32.8% have
begun childbearing and 3.7% had a live birth before the age of 1531.
Consumption of tobacco, alcohol and cannabis is prevalent among young people, increasing health risks.
More than a third of young people (15-29) smoke. In certain age groups smoking is highly prevalent – i.e.
among persons aged 22-25, 40% smoke. 32 Young people participating in VNR consultations have emphasized
that consumption of tobacco products is the choice of individuals, but at the same time they pointed out that
it is important to educate young people about harmful consequences of this habit. The minority of young
people (28% of female and 21% male) never drinks alcohol, while 25% of young women and 31% of
young men drink alcohol regularly during weekends or several times per week. Consumption of cannabis
is reported by 7% of young people. 33
Research about mental health of adolescents (aged 16-17)34 carried out in 2014 indicates that almost one
half of respondents has experienced at least one stressful life event (most often the loss of a family member
or the family member’s loss of a job). Further, 33% of adolescents stated problems with increased hostility
and social adjustment problems. Around 10% have experienced high anxiety, like panic, unrest or distress;
more than 20% of adolescents complained about relatively frequently present conditions of negative mood
and sadness. Around 45% of adolescents had a feeling of constant worry, 12% of them felt worthless and 7%
had suicidal ideations. Based on the increased intensity of mental discomfort, about 16% of those adolescents
can be identifed as vulnerable in terms of mental health, which means they would need psychosocial help
and support.
29 http://sdg.indikatori.rs/en-us/area/good-health-and-well-being/?subarea=SDGUN030702&indicator=03070201IND01
30 UNICEF, Serbia – Multiple Indicator Cluster Survey and Serbia – Roma settlements – Multiple Indicator Cluster Survey 2014: 102.
31 Popadić, D., Pavlović, Z., Mihailović, S. (2019) Young People in Serbia 2018-2019, Friedrich Ebert Stiftung, Belgrade, http://library.fes.de/pdffiles bueros/belgrad/15295-20190411.pdf
32 Ibidem.
33 Ministry of Youth and Sports project “Support to mental health of youth in Serbia”, 2014, https://www.mos.gov.rs/public/documents/upload/test/
Men- talno%20zdravlje%20mladih.pdf
34 UNICEF, Sustainable development for and by children and youth – Contribution to Voluntary National Review on the Implementation of the
2030 Agenda.
ENSURE HEALTHY LIVES AND PROMOTE
WELL-BEING FOR ALL AT ALL AGES
38
Youth perspective on SDG 3
Young people emphasized the importance of sexual and reproductive health (SRH) education. They think
that they are not well informed about sexual and reproductive health and they suggested to significantly
improve SRH education in schools at all levels. Workshop participants emphasized the importance of
mental health that is often neglected according to their opinion. They think that mental health and mental
hygiene is a great problem in the situation like it is today and that stigmatization of people with mental
health problems is still very high. The initial step should be made by educating young people within schools
about the importance of mental health.
Existing gaps and challenges / desirable solutions
“I think that the sexuality, especially in our age, is very important. No, we are not suffciently educated
in that sphere, and yes, that is a big problem. We need the subjects in the schools that would improve
knowledge and information on this topic. It is important to know about sexually transmitted diseases
and their consequences. It is important to raise awareness about this topic, it is necessary. ”
“Mental health should be introduced in a system of regular health examinations of children and young
people. A conversation with a psychologist should be a part of systematic health checks. Prior to that
maybe the psychological test should be introduced in order to assess who needs this kind of support.”
“’Greater awareness of mental health and mental hygiene is a matter that must become a priority
in informing both the young and older generations as, unlike many diseases, the fnal outcome of
uncontrolled depression is always suicide.”
Participants in the youth consultations
Areas requiring advice and support (policy responses)
“The National Strategy for Public Health of the Republic of Serbia 2018-2026 sets among
its priority objectives the prevention and elimination of smoking and exposure to the
tobacco smoke, abuse of alcohol and drugs, with the target of reducing the number of
young people consuming such products by 10%. The objective should be achieved through
a set of measures, including a set of specific policies (such as the Strategy for tobacco
control with Action Plan), support to mechanisms for tobacco control, adoption of new
regulation in line with WHO Convention on tobacco control and EU laws, monitoring of
the implementation of the National programme for prevention of alcohol abuse, drug
abuse, etc. Support to the implementation of activities focused on early development is
among the strategic measures aimed at the improvement of the population health. There
are also measures aimed at the improvement of health education in preschool, primary and
secondary schools. The Programme “Healthy Kindergarten” is planned to be expanded
to 45% of preschool institutions, while the programme ‘Healthy School’ is planned to be
implemented in at least 30% of primary and 20% of secondary schools. The National
Programme for protection and promotion of sexual and reproductive health of the citizens
of Republic of Serbia, adopted in 2017, contains sets of measures aimed at increasing
the use of modern contraception in family planning, reduction of risky sexual behaviour
39
among youth, early childbearing, particularly among young Roma women, better access
to sexual and reproductive health services for young women with disabilities, etc. The
Strategy for Youth sets as one of the main objectives the improvement of health of the
young population, reduction of risk factors and main health problems and development
of the health care system adjusted to the young population. It also incorporates specific
objectives related to the health care of young people from vulnerable groups and their
higher participation in programmes for health promotion. An important set of measures
is aimed at better protection from sexually transmitted diseases and protection of sexual
and reproductive health. The National Strategy for Gender Equality 2016-2020 also
includes measures related to the improvement of sexual and reproductive health among
young women and men.”35
Local self-government perspective on SDG 3
Main challenges of LSGs in this area are the following: (1) insufficientlevel of cooperation and communication
with competent institutions and other stakeholders; (2) regulations not being harmonized; (3) insufficien
budget allocation for health care at the local level (around 1% on average); (4) insufficient capacities for
dealing with health (negligible number of employees in the local administration working in this field); (5)
insufficiently active local health councils; (6) inadequate fulfilment of legal obligations of LSGs regarding
public health planning (around 20 LSGs have adopted public health plans, although the national strategy
was adopted last year, so it can be said that this process is in the initial stage), regular monitoring of the
health status of the population, adoption of programmes in the field of public health and capacity building
and (7) insufficient protection of patients’ rights (according to the SCTM findings, this institute is not fully
functional in around 30% of LSGs).
The SCTM, in partnership with the Ministry of Health and public health institutes, is supporting the
development of the health care responsibility in the local self-government. The priority is the support for
development of public health plans, risk assessment for public health and plans for preservation of health in
emergencies. The SCTM supports municipalities and cities in providing a functional system of patient rights
protection at the local level and guaranteed rights for all, with emphasis on marginalized groups, through
strengthening the visibility of patient rights, building the local self-government capacity to implement these
responsibilities and networking all stakeholders. The SCTM builds capacities of employees in social
activities and local health councils. The SCTM advocates for and supports the right to affordable, efficient
and high quality primary health care for all, with the emphasis on integrating social and health care services
(assisted living caregiver, palliative care of the terminally ill, etc.). Integrated services at the local level are
not sufficiently developed and constant, so the support for their development will be a part of the SCTM
activities, especially for the exchange of experiences and good examples among LSGs.
One of the localization mechanisms of this SDG are also the Health Councils - advisory, compulsory bodies
at the local level, whose establishment and operation are governed by the Law on Patients’ Rights and
the Law on Public Health. Through continuous capacity building of the LSGs and Health Councils, around
100 LSGs with their Health Councils are actively participating in the work of the SCTM Health Network.
In 2018, 60 LSGs went through the cycle of support for the development of public health plans. So far,
25 cities and municipalities have adopted the plans in their local assemblies. The process of supporting
the development of public health plans and capacity building of health councils continues, and the SCTM
supports it in cooperation with the network of public health institutes.36
36 Information submitted by the Standing Conference of Towns and Municipalities – National Association of Local Authorities in Serbia (SCTM) as the
contribution to writing the VNR.
35 Information submitted by the Standing Conference of Towns and Municipalities – National Association of Local Authorities in Serbia (SCTM) as
the contribution to writing the VNR.
40
Since April 2016, parents of newborns (babies) can do everything needed to enter the child into the birth
register, register his or her place of residence and register for his or her health insurance in 15 minutes, while still
in the maternity ward, in one place, free of charge and without having to fill in any forms. Bearing in mind that
the Office for IT and e-Government is constantly working to improve its information systems and services, in the
beginning of 2018 this system was improved as well, and now, in addition to the procedures above, parents can
also apply for parental allowance (state-level benefit) and for local financial benefits which are currently available
in the City of Belgrade.
With the aim of making the public administraton an efcient service for the citzens, the Government of the Republic of
Serbia launched the project “Baby, Welcome to the World” in order to simplify the procedures related to the birth of a
child. This allowed parents to spend their precious tme with their new family member instead of having to go to
various public administraton bodies. The procedures above are initiated by the authorized person of the health care
institution within the information system ''Baby, Welcome to the World'', with parent's consent, and all documents,
such as birth certificate, health insurance card and decision on eligibility to parental allowance or local financial
benefit, are delivered to people's homes. Please note that it is not mandatory for parents to initiate these procedures in
the maternity ward and that they can still initiate all the procedures above in the standard way, by going to the
appropriate institution. So far, more than 165,000 babies have been registered electronically, with over 148,000 of
them registered through initiating the procedures enabled by this project. Such statistics speak in favour of the
Government of the Republic of Serbia having excellently recognized and satisfied the needs of the citizens, because
90% of parents decide to initiate the mentioned procedures already in the maternity ward. The project was jointly
implemented by the Ministry of Public Administration and Local Self-Government, Ministry of Interior, Ministry of
Health, Ministry of Labour, Employment, Veteran and Social Affairs, Health Insurance Fund, Central Registry of
Compulsory Social Insurance and numerous other authorities, and with the technical and organisational support of the
Office for IT and eGovernment and coordination of the Office of the Prime Minister. The project ''Baby, Welcome to
the World'' is the first step in the reform of the public administration towards it being an efficient service for the
citizens, eliminating bureaucratic barriers and introducing common sense in administrative procedures that will be
further simplified. This modern electronic service puts Serbia among the rare European countries that provide
electronic services at such a high level.
Good practice example: Project “Baby, Welcome to the World”
|
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|
53
SDG 3
Health is a fundamental human right for the development of societal capabilities. It is influenced by the environment and the
conditions in which people live, from food to education, employment and income, housing, among others.
According to the Constitution of the DRSTP, all Santomeans have the right to health protection and have the duty to defend it. The
State is responsible for promoting Public Health, which has as its objective the physical and mental well-being of the populations
and their balanced insertion in the socio-ecological environment in which they live, as evidenced by the National Health System
(article 50). In order to comply with the constitutional mandate, the Government approved legislation (Basic Health Law - Law
no. 09/2018, June 6) to regulate the health sector, through which it established the National Health Service (SNS) - "an ordered
and hierarchical set of all the organizational structures of the public health sector that contribute to the provision of health care,
operating under the supervision or tutelage of the Minister responsible for the health sector". The SNS is characterized by: (a)
being universal in terms of the population covered; (b) providing, in an integrated manner, global care or guaranteeing its provision;
(c) being partially free of charge for users, taking into account the economic and social conditions of citizens; (d) guaranteeing
equity of access for users, in order to mitigate the effects of economic, geographical and any other inequalities in access to care;
(e) being organized by district and region and having a decentralized and participated management.
To implement the policy for the sector, the Government approved the National Health Development Plan 2017-2021, aligned with
this SDG, under the slogan "More health and more wealth". Its implementation was aimed at "improving the state of health in Sao
Tome and Principe, with equitable national coverage, making it the reference for excellence in the sub-region of the Gulf of Guinea
in the 2030 target.
STP has made remarkable gains in health. For example, it has excellent coverage in antenatal care, which has led to a decrease in
maternal mortality rates in the country. The proportion of births assisted by a health professional increased from 92.5% in 2014 to
96.8% in 2019 (Table 3.1, in annex). In the same period, the prenatal care coverage rate at the first consultation increased from
97.5% to 98.1%. In 2019, about 98% of women aged 15-49 years received antenatal care at least once from qualified health
personnel.
Data from statistical operations conducted in the country (IDS 2009, MICS 2014), as well as administrative data, show a consistent
decrease in maternal mortality in STP, which went from 100 deaths per 100,000 live births in 2009 to 74 in 2014 (Table 3.2,
annexed). These gains are the result of policy measures undertaken by successive governments, namely the provision of services
and measures to strengthen the health system, increase in the number of assisted deliveries, audits of maternal deaths, improvement
of the referral chain up to the community level. Also, functional emergency obstetric care facilities have been created and various
campaigns have been conducted to sensitize women to go to the health centers nearest their area of residence for follow-up. In
addition, there has been a strong focus on raising women's awareness so as to encourage them to have their deliveries in a health
facility, and that they are assisted by a qualified health professional.
Despite these good results obtained in maternal and neonatal mortality, where the country is close to achieving the global target,
efforts continue to be made to maximize gains by improving health conditions, such as infrastructure, equipment and the expansion
in terms of access, improving quality, including the services and human resources provided, and increasing the number of qualified
professionals. Human resources in the health sector are the most important assets for a functional health system and as such, the
country has implemented policy measures to improve them (human resources) and thus ensure the health well-being of the
population. One of these measures was the creation of the Higher School of Nursing, which has contributed to training nurses to
meet the needs in terms of national coverage. As for doctors, the country has essentially resorted to foreign universities, with which
it has cooperation, to train health professionals. However, many of these professionals, after their academic training, do not return
to the country, preferring to work abroad, where the conditions are more attractive. Therefore, the Government intends to create
mechanisms and incentives so that young professionals return to the country after their training, in order to give their contribution
to this important sector.
It is noteworthy that in 2019, only about 3% of deliveries in STP were not attended by a skilled health worker (INE, MICS 2014
and 2019), thus exceeding the target set by WHO (World Health Report, 2006) that achieving 80% coverage of skilled care requires
a threshold of 2.28 skilled medical personnel (doctors, nurses and midwives) per 1,000 population. Increasing the proportion of
births that are attended in health facilities is an important factor in reducing health risks for mother and child. Adequate medical
54
attention and hygienic conditions during childbirth can reduce the risks of complications and infections, which can cause morbidity
and mortality for the mother or the baby. In 2014, about 91% of births in STP were carried out in a health structure, having evolved
to 95% in 2019. In terms of regions, the evolution recorded in the Southeast Region stands out, having increased from 76.8% in
2014 to 94.8% in 2019.
Age and level of education are the factors that influence women to seek a health structure for delivery. In 2014, the lowest levels
of births made in a health structure were found in the most advanced ages (35 to 49 years), with about 85.9%, rising to 94.2% in
2019, an increase of about 10 percentage points, which may be a result of the awareness-raising work being done (Table 3.3, in
annex).
The neonatal mortality rates in STP have reduced significantly in recent years, thanks to the increased coverage of maternal and
child services. According to data from the MoH, 97.2% of pregnant women attended at least one antenatal care consultation. As a
consequence, the neonatal mortality rate has halved in the period between 2014 and 2019, from 18 per 1,000 live births to 9 per
1,000.
Graph 3.1: Neonatal mortality rate, per 1,000 live births, 2014 - 2019
2014 2019
TOTAL URBAN RURAL
Source: MICS 2014 and 2019
In the same period, infant and youth mortality fell from 43 per 1,000 to 17 per 1,000 (MICS 2014 and 2019). This reduction
confirms the trajectory that the country has been on since 2000. STP has practically already achieved target 3.2 of this SDG (By
2030, end preventable deaths of newborns and children under 5 years, with all countries committed to reducing neonatal mortality
to at least 12 per 1,000 live births and mortality of children under 5 years to at least 25 per 1,000 live births), which is a source
of great satisfaction for the Santomean State, which remains committed to maintain and improve the gains. 18
9
17
8
19
10
55
2014
42%
Urban
44%
Rural
21%
Rural
2019
16%
Urban
Figure 3.2: Infant and child mortality rate, per 1,000 live births, 2014 - 2019
Total
2014 2019
Source: MICS 2014 and 2019
. In terms of Communicable Diseases, the indices are relatively low in STP, as a result of the efforts that have been undertaken by
successive governments, particularly with preventive actions and measures to raise awareness among the population. With important
support, particularly from the Global Fund, it has been possible for the country to guarantee free treatment for communicable
diseases such as malaria, AIDS and tuberculosis. The country also already has some laboratory capacity to carry out tests to detect
these diseases, although it is necessary to invest in the qualification of human and technological resources, particularly in terms of
equipment maintenance. In addition, other important actions have been implemented, which contribute to reducing the levels of
transmissibility and improving the quality of life of those infected:
• Installation of treatment centers in all Health Districts;
• Providing a free medical-medication service to patients;
• Existence of the HIV STP network for voluntary testing;
• Integration of SRH services in STI/HIV/AIDS control;
• Availability of viral load.
The level of knowledge of the population regarding HIV is 99%, which is extremely positive. The situation in the country regarding
this disease has been improving, as shown by data from the MS's Health Information System (SIS) (2021). In 2019, the country
registered 41 new cases of HIV, which corresponds to a rate of 0.2 per 1,000 inhabitants, and a decrease of about 29% compared
to the previous year, as shown in the following Graphs. The vast majority of the new cases notified in 2019 were in the 30-69 age
group, with men being the most affected.
Figure 3.3: Number of new HIV infections per 1000 population, by sex, 2018 - 2019
Total Men Women
Source: MS (SIS), 2021
As for the prevalence of HIV, by sex and age, according to data from the Report of the National AIDS Program (PNLS), in 2017
it was higher in women than in men (0.84/1000 against 0.08/1000). Regarding age groups, HIV affects more the adult population,
that is, aged 25-49 years and over 50 years, with 2.1/1000 and 2.2/1000, respectively.
43% 17%
58 2018 2019 2020
41
32
19 22 26
19
11
56
Graph 3.4: Rate of new HIV cases per 1,000 population, by sex, 2018 - 2019
Source: MS (SIS), 2021
Tuberculosis is another communicable disease in which the country has been making progress in its fight. In 2016, STP recorded
a total of 162 cases per 100,000 inhabitants, falling to 118 cases in 2020, a decrease in the order of 27%. Men have been the most
affected by tuberculosis.
Figure 3.5: Tuberculosis incidence rate per 100,000 population, 2016 - 2020
162
2016 2017 2018 2019 2020
Source: Global SDG Database: https://unstats.un.org/sdgs/UNSDG/countryprofiles
STP, due to its geographical location, is very affected by malaria, also called malaria, which is a parasitic disease transmitted by
mosquitoes and is potentially deadly if not treated in time. For this reason, as early as 1996 the fight against malaria was recognized
as an absolute priority of the national health system, and the country defined the strategy for action, the National Malaria Control
Program (PNLP). Within the scope of the PNLP, the country has worked mainly in terms of information, awareness-raising and
prevention of mosquito bites, through the use of repellents, appropriate clothing and mosquito nets, but also through the taking of
medication.
There has been a substantial reduction in the incidence of malaria in the country, thanks to the integrated intensification of malaria
control activities, such as provision of free services for all malaria control measures, namely anti-malarial drugs (simple and severe
malaria), biological diagnosis (RDT and microscopy), intra-household spraying, distribution of long lasting insecticide
impregnated nets (LLINs) and anti- larval control. Currently, malaria is no longer the leading cause of morbidity and mortality in
STP. Only 1944 malaria cases were reported in 2020, a decrease of about 21% compared to 2019 and no deaths were reported
during those two years.
Regarding malaria incidence in STP, it was 11.6, per 1000 population in 2016 and set at 8.2, per 1000 population in 2020, according
to data from the Malaria Program Report HBS Study, 2017.
117 124
114 118
57
Graph 3.6: Malaria incidence rate /1,000 population, 2016 - 2020
11.6 12.5
14.6
11.9
8.2
2016 2017 2018 2019 2020
Source: Malaria Program Report HBS Study, 2017
Água Grande and Lembá districts are the most affected by malaria, with incidences of 17% and 20%, respectively. In the other
districts, malaria incidence is below the national average of 11.9% (Chart 3.7 in annex). However, with the Covid-19 pandemic,
there were increases in malaria cases in the country, which led the PNLP, with the support of China, UNICEF and WHO, to draw
up 3 emergency plans, in order to eliminate the foci in the Districts where they were considered epidemic (Lembá, Mé-Zochi, and
Lobata including Água Grande). Therefore, overall, STP has made remarkable progress in the fight against malaria, and the goal
of eliminating this disease by 2025 is attainable.
In terms of Hepatitis B, the incidence per 100 000 inhabitants has been low, from 1.36 in 2015 to 1.31 in 2020 (Chart 3.8, in
annex). However, efforts have been made to further reduce the incidence, such as strengthening the control and prevention of
recommended vaccination, especially for children.
Non-Communicable Diseases (NCDs), namely cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, have
also merited great attention from the country's health authorities. Many of these diseases are the result of environmental, hereditary
and behavioral factors, so the focus on promoting improved health, combating inappropriate habits, improving food safety and
encouraging physical activity is part of the national authorities' strategy. Currently, among NCDs, cardiovascular diseases are the
leading causes of mortality in STP, with an incidence rate in 2020 of 0.37 per 1,000 inhabitants, the same level recorded in 2017.
Women are the main victims of these diseases. Next appear deaths caused by cancer, with a rate of 0.18 per
1.00 inhabitants in 2020, a rate higher than that recorded in 2017, which was 0.13 per 1,000 inhabitants, with men being the most
affected. Immediately following appear deaths from respiratory diseases, responsible 0.09 per 1,000 inhabitants in 2020, and,
lastly, deaths caused by diabetes, whose levels are extremely residual (Table 3.4, in annex).
The suicide mortality rate by sex (deaths per 100,000 population) is extremely residual and on a downward trend. According to
WHO estimates, STP had 2.1 deaths per 100,000 population in 2015, reducing to 1.5 in 2019.
The consumption of substances harmful to health has been a concern in STP, especially the consumption of alcohol, due to the
levels it has been reaching. For this reason, the national authorities have been working on a strategy to address the situation, namely
the approval of a law to regulate the sale and consumption of alcohol. Harmful alcohol consumption, with reference to the national
threshold defined for the consumption of liters of pure alcohol per capita (persons aged 15 and over), was 5.9 liters in 2018 .9
According to MICS 2019 data, more than half of women of reproductive age (52%) have ever consumed alcohol, with the highest
incidence at ages above 24. In men, this percentage reaches about two-thirds (62%) (Table 3.5 in the annex).
In terms of traffic, many accidents have occurred in STP, with loss of human lives. According to PN data, in 2014 the country
recorded 26 deaths by traffic accident, increasing to 27 in 2017 and without the highest number (32) occurred in 2015. The main
causes relate to poor road signs, drunk driving, speeding, driving without a license and without helmets.
9 https://unstats.un.org/sdgs/UNSDG/countryprofiles
58
Graph 3.9: Number of deaths by traffic accident, 2014 - 2017
26
32 30 27
2014 2015 2016 2017
Source: National Police of STP
However, as a result of the hard work being done by the police authorities, especially in terms of driver awareness, the levels of
traffic fatalities are starting to decrease.
Family planning, using modern contraceptive methods, is important to monitor progress towards the goal of ensuring universal
access to sexual and reproductive health services, including information and education, and the integration of reproductive health
into national strategies and programs.
In STP, the percentage of women of reproductive age (15-49 years) who had their family planning needs met with modern
contraceptive methods was 60% in 2019, a positive development compared to 2014. Regarding the means of residence, in this
period, there were improvements in the urban environment, (Table 3.4, in annex). The Northwest and Southeast regions have the
highest levels of use of modern contraceptive methods by women aged 15-49, married or in a consensual union (INE, MICS 2019).
In order to improve levels of contraceptive use by women aged 15-49 years, as part of the strategy for reproductive health, STP
has been focusing on raising awareness of appropriate sexual behaviors, in order to reduce the risk of transmission of diseases such
as HIV. According to the available data, there has been a positive evolution in the use of contraceptive methods by women aged
15 to 49, currently married or in a consensual union, rising from 37.4% in 2014 to 49.7% in 2019. The pill and injections are the
most commonly used methods of contraception. However, condom use in the country is still extremely low (INE, MICS 2014 and
2019) (Table 3.7, in annex).
Prevention of early pregnancy in adolescents is a country priority under the policy on contraceptive use. Age-specific fertility rates,
expressed as the number of births per 1,000 women in a given age group, show the pattern of fertility by age. With regard to
adolescent fertility (15 and 19 years old), there were 92 births for every 1,000 adolescents aged 15 to 19 in 2014, a decrease of
about 7% compared to 2019. The highest numbers were recorded in rural areas, with 116 births (compared to 80 in urban areas) in
2014 , and 102 (compared to 78 in urban areas) in 2019 (INE, MICS 2014 and 2019).
Figure 3.10: Adolescent birth rate (age-specific fertility rate for women aged 15-19), by means of residence, 2014 -
2019
TOTAL URBAN RURAL
Source: MICS 2014 and 2019
2014 2019
92
86
80
78
116
102
59
It is found that in 2019, about 16% of women aged 15-19 had already started their sex life, 12.3% had a live birth and 3.4% were
pregnant with their first child. About a quarter of women had children before the age of 18, with levels being higher in rural areas,
with 28.2% (compared to 23% in urban areas) in 2014 and 29.2% (compared to 28.2% in urban areas) in 2019 (INE, MICS 2014
and 2019) (Chart 3.11, in annex). With regard to the Synthetic Fertility Index (SFI), i.e. the number of live births a woman would
have if she were subject to the current age-specific fertility rates in her childbearing years (15-49 years), it increased from 4.4 in
2014 to 3.8 in 2019 (Chart 3.12, in annex).
In STP, primary health care coverage has increased from 58% in 2015 to 60% in 2019, according to WHO data (2021)10 . On the
other hand, to health insurance coverage, including financial risk protection, the situation in STP inspires special attention. In 2019,
the percentage of women aged 15-49 years covered by health insurance was only 0.8%, with 0.3% for children aged 5-17 years
and 1.4% for children under 5 years, (MICS 2019). In absolute terms, only 1,395 men and 3,115 women had health insurance
coverage in 2019.
The mortality rate attributed to unintentional poisonings by sex (deaths per 100,000 population) is residual in STP, standing at
about 0.7 deaths per 100,000 population in 2019, with 0.1 female and 1.2 male. These levels are virtually the same as recorded in
2015, according to WHO (2021) .11
As for tobacco consumption, although the situation is not worrying, there has been some increase. In 2019, the percentage of
women aged 15 to 49 who smoked cigarettes or used tobacco for smoking was only 1.3%, with half already smoking before the
age of 15. The highest percentages of smokers are in rural areas. In men, the percentage of smokers is almost five times higher.
Príncipe Island is the region of the country with the highest percentage of smokers in 2019, at about 15% (INE, MICS 2019).
At vaccine level, the National Immunization Program in STP includes all the vaccines marked in the national vaccine calendar,
with doses of BCG, polio and Hepatitis B vaccine (within 24 hours of birth), three doses of pentavalent vaccine containing DTP,
hepatitis B and Haemophilus influenzae type b (Hib) antigens. It also contains three doses of polio vaccine, three doses of
pneumococcal vaccine (conjugate), three doses of rotavirus vaccine, two doses of measles and rubella (MMR) vaccine and one
dose of yellow fever vaccine. All vaccines should be received in the child's first year of life, except the second dose of SR which
is given at 18 months. According to MICS6 2019 data, the percentage of children aged 12 to 23 months who received all
recommended immunizations before their first/second birthday was 94% against diphtheria, tetanus and pertussis (DTP), and 93%
for pneumococcal (conjugate) immunization. Vaccination levels were higher in girls, and the highest vaccination rates were
recorded in urban areas (Chart 3.13, in annex).
In terms of total net ODA to medical research and basic health sectors between 2015 and 2019, STP benefited from about USD 20
million, with the highest share received in 2017, about USD 6.4 million, and the lowest in 2019, about USD 2.5 million (OECD).
One of the necessary conditions for the provision of a good health service is the financial sustainability of the health system and
the availability of qualified personnel to meet the challenges of the sector. At the level of human resources for health, according
to the World Health Report 2006, to achieve 80% coverage of qualified care requires a threshold of 2.28 qualified medical
personnel (doctors, nurses and midwives) per 1,000 inhabitants. STP has achieved signature progress at this level, with the country
having 87 doctors per 100,000 population and 413 nurses per 100,000 population in 2017, while the world average was 146 doctors
per 100,000 population and 334 nurses per 100,000 population, respectively (Statistical Yearbook of Health 2020). In 2019, the
country had 749 health workers for a population of 205,965 inhabitants, distributed across the different Districts.
The ARP has the highest rate of coverage of health professionals, with 1.28%. At the other extreme is Água Grande and Mé-Zóchi
Districts, (Table 3.8, in annex).
10 https://www. who.int/data/monitoring-universal-health-coverage 11 https://www. who.int/data/monitoring-universal-health-coverage
60
5.34
With regard to health expenditure, in 2018, the Government allocated amounts corresponding to 6.3% of GDP to the health sector, an
increase of 17.3% compared to 2015.
Graph 3.14: Current health expenditure (% of GDP), 2015 - 2018
6.43 6.46 6.27
.
2015 2016 2017 2018
Source: The WB: https://pt.theglobaleconomy.com/Sao-Tome-and-Principe/Health_spending_as_percent_of_GDP/
The Government is working towards the achievement of all the goals of this SDG and the country has been making important
progress, thanks to the creation of legal and institutional conditions, the investments made, especially at the level of human capital,
and, as a result, has achieved remarkable results, even reaching, in 2019, an HDI of 0.625, occupying the 135th position, out of
189 countries and territories.
|
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[
3
] |
{
"country": "stp",
"file_id": "sdg-03/vnr-report-stp-2022-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2022
}
|
SDG 3: Ensure healthy lives and promote well-being for all at all ages
While enjoying a healthy and prosperous environment in Slovenia, obesity, consumption of alcohol, and smoking
represent a serious threat to health and well-being. 6.4% of youth9 in Slovenia are overweight. MSS works closely
with its members on a project called ‘For Youth Health’ that formed a network of young promoters of health
across Slovenia, who are trained to educate youth and organise well-being programme in their local
environments.
MSS proposes: Healthy lifestyle awareness must become an incremental part of the study curricula on all levels
of education, and physical education must be introduced on all levels of education, from primary to tertiary.
|
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3
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{
"country": "svn",
"file_id": "sdg-03/vnr-report-svn-2017-en-4.pdf",
"language": "en",
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|
23
Goal 3: Ensure healthy lives and promote well-being for all at all ages
Slovenia is among the countries with the lowest infant
mortality rate in the world. This is the result of highquality and efficient pre- and post-natal health care
and organised child health care. The life expectancy
of infants born in 2015 was 77.7 years for boys and
83.4 years for girls. The number of people infected
with HIV is low (less than 1 per 1,000 people). The
new National Strategy for Prevention and Control of
HIV Infections 2017–2025 aims to make Slovenia a
country with very few new HIV infections, which will
be detected at an early stage and treated
successfully. The strategy also addresses prevention
of spreading of other sexually transmitted diseases.
Challenges remain in the field of use of drugs,
alcohol, and tobacco. The Restriction on the Use of
Tobacco and Related Products Act, adopted in 2017,
sets the provisions of the directive and also lays down
measures for the implementation of the World Health
Organisation (WHO) Framework Convention on
Tobacco Control. For example, the Act will introduce
generic packaging from 2020 onwards. The primary
goals of the new law are to prevent the initiation and
the progression to higher smoking levels among
children, adolescents and young adults, to promote
smoking cessation, reduce exposure to tobacco
smoke among minors and consequently reduce
morbidity and (premature) mortality and social costs
due to tobacco use. In line with the National Health
Care Plan 2016-2025 "Together for the Health
Society," we want to reduce the consumption of
tobacco by 30% by 2025, that is also the goal of the
World Health Organization's Global Strategy for the
Prevention and control of Non-Communicable
Diseases.
Slovenia recognizes that ensuring a good health of
people also in the future will be a great challenge, as
the ageing of the population will contribute to an
increase in chronic illnesses. Reducing inequalities in
health is one of the key challenges in creating
conditions for a high quality of life, whereby the health
condition of the population, particularly among the
elderly, socially weaker and less-educated groups
must be improved.
Care for mental health is also important, as it enables
individuals to utilise their mental and emotional
capabilities and to successfully face challenges and
contribute to the communities in which they live.
Mental illness present social and economic burden
that is projected to continue to increase in the future,
according to WHO. Quality programs for
strengthening mental health, prevention, early
detection and treatment of mental disorders,
psychotherapy, rehabilitation and social integration of
people with mental health problems are not yet
equally accessible to all population groups in
Slovenia. In order to ensure continuous and effective
treatment of people with mental disorders, Slovenia
is builing an institutional structure to better coordinate
between the primary and secondary level of health
care as well as community care.
In the future great attention will be paid to the
transition from various forms of institutional care to
the services in the community. A special attention will
be given to those with mental health problems
coming from vulnerable groups of the population,
also in terms of better coordination between health
and social care, education and non-governmental
organizations. Particularly challenging is the
increasing number of population suffering from
various forms of dementia, which most heavily affects
fiscal sustainability of the health system. Due to the
rapidly aging society a national strategy on dementia
management has been adopted in 2016.
SDG Target Indicator Data for Slovenia
3.4 By 2030, reduce by one
third premature mortality from noncommunicable diseases through
prevention and treatment and
promote mental health and
wellbeing
Mortality attributed to
cardiovascular diseases, cancer,
diabetes and chronic respiratory
diseases
704.8 per 100,000 population
(2015)
Circulatory diseases (I00-I99)
Neoplasms (C00-D48), diabetes
(E10 and E14), respiratory diseases
(J00-J99)
Mortality due to suicide 20.5 per 100,000 population (2015)
24
Achieving the Sustainable Development Goals
Selected Measures, Activities, and Examples of Good Practice
Slovenia @ home
► Organised screening programme for early
detection of cancer
Treatment of most cancers is more effective if they
are detected at an early stage of development.
Screening programmes can discover cancer or
precancerous changes prior to the development of
symptoms or signs of the disease. Three screening
programmes for early detection of cancer are carried
out in Slovenia. All three were recommended by the
Council of the European Union in 2003: ZORA – early
detection of premalignant and malignant changes of
the cervix; DORA – early detection of breast cancer;
SVIT – early detection of colorectal cancer.
The primary purpose of all cancer screening
programmes is to reduce the mortality caused by
these diseases by treating precancerous lesions and
to reduce the incidence of these cancers (the number
of new cancers). For these programmes to be
successful, all processes in the programmes must be
of adequate quality, and they must be participated in
by at least 70% of the target population groups. The
programmes show measurable results: ZORA, the
oldest programme, managed to halve the mortality
rate for cancer of the cervix; the SVIT programme has
already indicated a decrease in the incidence of
cancer of the colon and rectum; the DORA
programme is successfully being expanded in the
screening centres throughout Slovenia with a view to
bringing this quality service closer to all women.
ZORA is the national screening programme for
cervical cancer, organised by the Institute of
Oncology Ljubljana in cooperation with the Ministry of
Health and the Health Insurance Institute of Slovenia
to reduce morbidity and mortality from cervical
cancer in Slovenia. The method applied by the
programme is to actively screen all apparently
healthy women aged between 20 and 64 years. Their
Pap smear cells are tested once every three years (if
the results of the first two tests carried out within one
year are negative). The programme began in 2003;
to date, the incidence of cervical cancer has been
reduced by half. In 2014, the lowest incidence of
cervical cancer in the past 60 years was recorded:
105 women were diagnosed, which is nearly half less
than in 2003, when the ZORA programme was
launched, and 211 women were diagnosed. The aim
of ZORA is to perform the three-year tests on 73 to
75 per cent of the target population of NP ZORA by
the end of 2021 and to maintain the incidence of
cervical cancer to between 100-120 new cases per
year.
DORA is the national screening programme for
breast cancer, organised by the Institute of Oncology
Ljubljana in cooperation with the Ministry of Health
and the Health Insurance Institute of Slovenia. The
programme provides treatment for women aged 50-
69, who are invited to mammography screening
every two years. The programme has been running
since 2015, and we have managed to include 72 per
cent of all the relevant Slovenian women by
expanding the programme. The objective of the
DORA programme is to reduce the mortality in breast
cancer in the screened group of women by 25-30 per
cent.
SVIT is the national screening programme organised
by the National Institute of Public Health in
collaboration with the Ministry of Health and the
Health Insurance Institute of Slovenia with the aim of
the prevention and early detection of cancer of the
colon and rectum. The programme includes
Slovenian men and women aged 50 to 74 years, with
screening tests conducted every two years. SVIT can
prevent many colon and rectum cancers due to
discovery and removal of polyps that are the
precursors of cancer.
The programme has been in place since 2010 and
achieved the following results: in 70% of the
programme participants, the detected cancer was
limited to the intestine (it did not extend to lymph
nodes and other organs), while prior to the
implementation of SVIT, this was the case with only
12-14% of patients, so the achievement of the
screening programme is significant. In 2011, 2012,
and 2013, we observed a reduction in the incidence
of colon and rectum cancer by 10 per cent per year
for the first time. The aim of the programme is, inter
alia, to increase participation in the programme to 65
per cent of the target population by the end of 2019.
Slovenia as a Responsible Global Citizen
We strive for improved health and better living
conditions for children and women in the Mukungu
and Musango regions of Rwanda by providing
information to couples who are planning the birth of
their children, raising awareness among pregnant
women about reproductive health and the need to
give birth in maternity hospitals, and providing
training on healthcare, hygiene and food for newborns and young children.
|
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|
SDG 3: ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL
AGES
Since its independence in 1991, Slovenia has reformed its healthcare system based on the values of solidarity,
equality and justice and has provided accessible and quality healthcare to its citizens. Health security has
been ensured on the basis of the social model of compulsory health insurance, which includes practically all
citizens (around 99% in 2019). The principle of the Council of Europe to provide insured persons preventive
and/or curative healthcare has been upgraded in Slovenia by providing emergency treatment also to
persons without health insurance (around 1% in 2019). Almost 30 years on, Slovenia’s healthcare system
in international comparisons achieves good results in terms of the key indicators for health and well-being.
However, Slovenia still has to tackle several challenges posed by the changing health needs of the ageing
population, the growing burden of chronic non-communicable diseases, perceived health inequalities,
costly health technologies, and public health threats posed by climate change, environmental pollution and
other natural and health stressors caused by people.
Slovenia will continue to improve the health of its citizens, paying special attention to raising awareness and
educating the population about behavioural and nutritional health risk factors. Slovenia will thus contribute
to the improvement of health outcomes associated with alcohol, unhealthy eating and infectious diseases.
At present, the standardised mortality rate due to alcohol and intentional self-harm is among the highest in
the EU. With the ageing of the population, the number of people sufering from various forms of dementia
is on the rise, which places mental healthcare among the main priorities for Slovenia. Thus the SOPA project
“Establishing an interdisciplinary integrated approach to the detection and support of abstinence from
harmful and risky alcohol consumption among adults” aims to reduce excessive alcohol consumption and its
negative efects on health and establish a responsible attitude towards alcohol.
Slovenia implements compulsory vaccination programmes for children and adolescents. Vaccination of
preschool children against diphtheria, tetanus, pertussis, polio and haemophilus infuenzae type b infections
(94.2%) and against measles, mumps and rubella (93.2%) was relatively high in 2017, but it has been declining
over recent years. The low vaccination coverage against seasonal fu, especially among those over 65 years
of age, is a particular cause for concern. Slovenia is one of the countries with the highest incidence of tickborne meningoencephalitis in Europe, so it is mandatory to vaccinate people who are exposed to the virus
and it is recommended for anyone over one year of age. In 2017, 28,764 people started getting vaccinated
against tick-borne meningoencephalitis (13.9/1,000 people vaccinated with the frst dose). In 2019, Slovenia
introduced a vaccination programme against tick-borne meningoencephalitis as part of the compulsory
health insurance, which includes one generation of adults aged 49 and one generation of children aged
three. After vaccinating the two age groups, the programme will also cover vaccination of new generations
of children and adults, which will increase vaccination coverage in Slovenia.
In addition to a well-established and accessible basic healthcare infrastructure, an important factor for the
health and well-being of an individual is a rich and accessible cultural infrastructure. Creativity is one of the
fundamental experiences, and indeed we take part in the creative process by simply walking around our
cities – visiting cultural heritage, concert halls, galleries, museums, theatres and libraries. Both the act of
creativity itself and its active perception and processing provide a valuable individual experience that can
have positive efects on our physical and mental health and well-being.
Indicator
Standardised mortality rate
due to suicide
Healthy life expectancy at
birth
Data for 2015 Data for 2018
16.46 per 100,000
Men: 58.8
Women: 57.7
13.82 per 100,000
Men: 56.3
Women: 54.6
In 2018, healthy life expectancy at birth in Slovenia stood at 56.3 years for men and 54.6 years for women. In
the coming years, Slovenia will pay special attention to improving the health of the population in all regions,
especially among the elderly, the socially disadvantaged and the less educated.
Slovenia adopted the Resolution on the National Programme on Healthcare 2016–2025 “Together
for a Health Society”, which addresses key health problems and issues regarding the healthcare system
in Slovenia, laying the foundations for health in all policies. The Resolution acts as the basis for healthcare
development in Slovenia over a period of ten years and as the basis for the preparation and adoption of
relevant legislative acts in the feld of health insurance and healthcare activities, with the vision of providing
quality and accessible public healthcare. It puts the user and the provider at the forefront and strives to
identify specifc needs and healthcare options for vulnerable groups.
Despite the fact that in the last ten years the suicide mortality rate has been declining for both men and
women (in 2018 suicide mortality stood at 13.82 per 100,000 population; men: 22.25; women: 5.96), it
remains unchanged for the over 65 years of age population, amounting to 32.35 deaths per 100,000
population in 2018 (men: 60.93; women: 12.13). To address these issues, Slovenia adopted the Resolution
on the National Mental Health Programme 2018–2028, which covers the entire feld from mental health
promotion from early treatment to psychosocial rehabilitation, monitoring, evaluation and quality control of
the implementation of the set activities and programmes. In addition, a network of mental health services
has been established with 25 new mental health centres for children and adolescents and 25 mental
health centres for adults, including community psychiatric treatment at the primary level.
SLOVENIA AS A RESPONSIBLE GLOBAL CITIZEN
Slovenia contributes to health and well-being in the international community in several ways. Every year
Slovenian doctors and other health professionals exchange examples of good practice and experiences with
developing countries. Slovenia also puts great emphasis on mental health, focusing its development aid
programmes on providing comprehensive psychosocial assistance to victims of confict. Slovenia provided
assistance to victims of the conficts in Gaza and Ukraine. Slovenia also strives to improve the health-related
situation of Belarusian children sufering from the consequences of the Chernobyl nuclear accident in 1986.
For several years now, Slovenia has also supported the operation of the Kabul Polyclinic, with the aim of
providing free healthcare services to Kabul residents in the felds of gynaecology, dentistry, physiotherapy
and psychosocial care. With the support of Slovenia, healthcare services are provided by fve women (a
gynaecology specialist, a dentist, a psychosocial therapist and two physiotherapists), which in particular
brings medical services closer to the female population and children. In addition, in the period between
2011 and 2018, Slovenia supported the project “Integrated Telemedicine and eHealth Programme in Cape
Verde”, which is implemented by ITF Enhancing Human Security in cooperation with IVeH (International
Virtual e-Hospital Foundation).
|
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"country": "svn",
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|
46
Health and well-being
Besides the fact that health and well-being are important rights and goals in
themselves, good health is also a prerequisite for achieving many of the other
goals of the 2030 Agenda. The Government’s starting point for health and
well-being is that a sustainable society must be built on proactive work for
health equity. This work is based on the eleven targets set for the work with
public health. These cover most of the factors that have the greatest significance for people’s health and well-being.
47
The overarching goal of public health policy is to create societal conditions for
good health for the entire population, both women and men. It is particularly
urgent to take measures for the groups that are most vulnerable to ill-health. A
national commission has been appointed to strengthen public health work for
health equity in Sweden34. A series of initiatives are also being taken to counteract the abuse of alcohol, narcotics, tobacco and doping preparations.
The report from the Ministry of Health and Social Affairs indicates a number of
concrete measures to improve public health. Extensive work is in progress to
deal with the growing antibiotic resistance both through national and international initiatives. The Government is preparing structural reforms in healthcare
in order to create sustainable conditions. Special investments are being made
to improve the utilisation of healthcare resources and to create greater equity in
cancer care. The Government has also produced a strategy in the area of mental
health. A national pharmaceutical strategy has been adopted with the aim of
reducing the negative effects on public health resulting from the incorrect use
of medicines.
|
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[
3
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{
"country": "swe",
"file_id": "sdg-03/vnr-report-swe-2017-en-4.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2017
}
|
20
Goal 3
Ensure healthy lives
and promote well-being
for all at all ages
In global comparison, Sweden generally has good results for almost all the
targets included in this goal. Since 2003, there has been a national public
health policy adopted by the Riksdag covering eleven target areas. The
overarching goal adopted is to create societal conditions for good health on
equal terms for the entire population. The Health and Medical Services Act
(2017:30) stipulates that care shall be delivered with respect to the equal
value of all humans and the dignity of every individual. The person with the
greatest need for health care shall be given priority by the health services. In
2015, the average life expectancy for women was 84 years and for men 80.4. In
recent years, there has been a slight upward trend in the life expectancy of both
women and men. The remaining number of years at the age of 30 is increasing
for the population as a whole, but is several years greater in the group with
post-secondary education than in the group with pre-secondary education. This
is true of both women and men. These differences have increased over the past
ten years.
The Government has made several, extensive efforts to raise the quality of
elderly care, increase security for the elderly and to improve the conditions for
a gender-equal, equitable and equivalent care in the entire country. Expanded
protection against age discrimination entered into force in 2013.
21
Sweden’s maternal mortality ratio has long met the target of less than 70 deaths
per 100 000 live births. In 2015, one woman died in connection with pregnancy
or childbirth. Under-5 mortality has long been under five per 1 000 live births,
which means that Sweden meets the global target of less than 12 deaths, within
28 days, per 1 000 live births.
There are structural differences in care and treatment between women and men
in the healthcare system. The Government is therefore making several major
investments to strengthen women’s health and develop the care that is specifically aimed at women, including midwifery.
In 2015, 450 cases of HIV infection were reported in Sweden. Over the last
five years, the level has been an average of 455 new cases annually. Of these,
about 80 per cent are foreign-born persons, of whom a large proportion had the
infection before their arrival in Sweden. Today, approximately 74 persons per
100 000 inhabitants (approximately 0.07 per cent) have HIV, which is among
the lowest rates in Europe. Just over 7 000 people are living with diagnosed HIV
infection. Since 2005, Sweden has had a national strategy on HIV/AIDS and other
infectious diseases. Sweden is the first country in the world to have achieved
one of the UN targets for HIV, the UNAIDS 90-90-90 target10.
In 2015, the incidence of tuberculosis per 100 000 inhabitants was 10 for men
and 7 for women. This was an increase compared with the previous year, which
is not surprising given that about 90 per cent of those who have tuberculosis in
Sweden were infected in another country and as immigration rose markedly in
2015. The incidence of hepatitis B has increased over the past decade and was
at 21.5 per 100 000 inhabitants in 2015. Most of these had been infected abroad.
Cardiovascular diseases and tumours accounted for 61 per cent of deaths in
2015 and have long been the two most common causes of death in the case of
diseases. There is a decreasing trend for both categories. The death rate due to
cardiovascular diseases has decreased by 55 per cent since 1987 and by 13 per
cent for tumours. There are socio-economic differences in onset and mortality
for the major endemic diseases, which are generally more common in people
with a lower level of education.
Since the mid-1990s, suicide rates have decreased in all age groups except the
group 15-24, in which the number of cases has increased somewhat. Suicides
have decreased fastest among the oldest, especially among men, and the
differences between age groups have decreased. Among women, suicide is most
common in the age group 45-64, and among men in the group 65+ (measured
as the number of deaths per 100 000 persons). In 2015, suicide mortality in
Sweden was 12 per 100 000 persons.
As regards the risky use of alcohol, consumption per capita in 2014 and 2015
was at a relatively stable level of just over 9 litres of pure alcohol per inhabitant
aged 15 and older. Between 2005 and 2015, the total consumption of alcohol in
the country decreased by 11 per cent. Alcohol-related mortality also decreased
over the same period11. Sweden has a comprehensive strategy for alcohol, narcotics, doping and tobacco policy 2016–2020.
10 This target means that at least 90 per cent of
those living with HIV will know their HIV status,
that 90 per cent of them will receive effective
medical treatment and that 90 per cent will
achieve radically reduced virus levels.
11 National Board of Health and Welfare (2016):
Statistik om dödsorsaker år 2015.
22
The proportion of people who smoke tobacco daily decreased over the period
2004-2015. In 2015, 11 per cent of women and 9 per cent of men smoked daily.
Daily smoking is most common among the late middle-aged (13 per cent among
45-64-year-olds). The proportion of smokers decreased in all but the oldest age
group.
The number of deaths in road traffic accidents was 270 in 2016, which corresponded to approximately 2.8 persons per 100 000 inhabitants. Of those killed in
2016, 76 per cent were men and 24 per cent women. For 2016, the number of people
seriously injured is calculated to have been approximately 4 500. Through
its Vision Zero initiative, Sweden adopted an approach that has attracted
international interest and led to a great demand for Swedish knowledge and
experience. However, the positive development in traffic safety has stagnated
since 2010.
The number of children born to mothers aged 15-19 has halved since 1990.
However, in the past 15 years, the proportion has been at a relatively constant
level of around 6 births per 1 000 women aged 15-19.
In 2015, Swedish development cooperation to medical studies and primary
health care amounted to approximately SEK 538 million. At the same time, as
part of its development cooperation, Sweden is working to draw greater attention
to non-infectious diseases, internationally and in national health programmes.
Sweden also acts to prioritise financial support for child and maternal care and
for sexual and reproductive health and rights. Increasing antibiotic resistance
is a major and growing health risk and challenge globally. Sweden has a national
strategy to combat such resistance (see Section 7).
The challenges for Sweden lie in taking measures for health equity, including
the reduction of disparities in health and well-being between different groups
in society and improving quick and equal access to healthcare for all who are
in need of it. Furthermore, unhealthy eating habits is one of the greatest risk
factors for ill-health and premature death in Sweden. There are also particular
challenges regarding differences in both mental and physical health between
different groups of the population, mainly between people with different levels
of education and depending on gender. Furthermore, there are differences regarding these factors between LGBT persons, people with disabilities, foreign-born
persons, national minorities and indigenous peoples, and the population as a
whole12. The Government’s goal is to eliminate avoidable health inequalities
within a generation. The Commission for Equity in Health was appointed in 2015
with the task of producing proposals that might contribute to the reduction of
health disparities in society. A gender equality perspective is to be observed in
the Commission’s work.
12 SOU 2016:55.
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{
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|
80 Government Ofces of Sweden
SDG 3 Ensure healthy lives
and promote well-being for all
at all ages
Brief assessment of developments per target
3.1 Sweden has 3.5 deaths per 100 000 live births
per year, which is well below the target for
maternal mortality worldwide.
3.2 Infant mortality is very low and well below the
target.
3.3 There has been a 50% reduction in the number
of new cases of hepatitis B per capita and some
reduction in tuberculosis and malaria. However,
no reduction is seen in new HIV cases.
3.4 Mental health in particular is a challenge.
The highest proportion of people with mental
ill-health is found among younger women aged
16–29.
3.5 Fewer and fewer people smoke, and overall alcohol consumption has decreased. On the other
hand, deaths from accidental poisoning are
increasing.
3.6 The number of people killed and seriously injured in road accidents has halved since the start
of the 21st century.
3.7 Access to sexual and reproductive healthcare
is universal in Sweden. The number of teenage mothers is steadily declining. Sweden has a
national strategy for sexual and reproductive
health and rights (SRHR) that aims to achieve
good, equal and equitable sexual and reproductive health in the population.
3.8 Healthcare is publicly funded and subject to a
high-cost ceiling. The proportion of people who
have needed care but declined to receive it for
financial reasons is close to 0%.
3.9 Sweden has good air quality in global terms. Air
pollution nevertheless causes health problems
that contribute to illness and premature death.
Overview
Sweden’s fulflment of the goal
Public health remains good by international standards, and the health of large parts of the population is improving. Average life expectancy for both
women and men increased between 2000 and 2018,
to 84.3 for women and 80.8 for men. Swedish maternal healthcare is unique, and maternal and infant mortality is very low. Mortality rates from
some non-communicable diseases have fallen since
the early 2000s. Fewer and fewer people smoke,
and overall alcohol consumption is decreasing. Almost all children are vaccinated against the diseases included in the national vaccination programme at the age of two. The negative trend is mainly
related to mental illness. The proportion of pupils
with psychosomatic complaints has increased since
the 1980s. Overall, suicides have decreased slightly since the start of the 21st century but are increasing among both men and women aged 15–29. The
consumption of antibiotics remained virtually unchanged from 2000 to 2012 but has decreased by
21% in recent years. The number of traffic fatalities per year has fallen by around 12% since 2017. In
2020, an estimated 190 people were killed in road
traffic accidents, a historically low number. Sweden
has good air quality in global terms, and emissions
of small particulates have decreased significantly.
Despite this, it is estimated that around 7 600 people died from air pollution in Sweden in 2015.
Sweden’s challenges
Differences in health and in the conditions for good
health persist, between different socio-economic
Government Ofces of Sweden 81
The diagram shows the change
over time in the proportion
of schoolchildren reporting at
least two mental and somatic
problems more than once a week
in the past year. Source: Statistics
Sweden
groups and between men and women. Persons with
disabilities report poorer living conditions, lifestyles
and health. However, there are gaps in the statistics,
which make it difficult to monitor both the health
situation and the care provided. This also applies
to other vulnerable groups. Trends also show that
some differences between groups are increasing
over time. Remaining life expectancy and mortality
for several diagnoses are increasing between groups
with and without post-secondary education. Differences are also widening in the proportion of pupils
completing grade 9 with the grades required to progress to upper secondary education. There is a risk
of the impact of the COVID-19 pandemic widening
the gap further. Foreign-born people have been
more severely affected by COVID-19 than those
born in Sweden.
Sweden’s successes
Sweden has a good track record in meeting SDG 3
thanks to a long-established social welfare system
and an organisation and structure for both public
health and the healthcare system. This work is
based on a clear focus on equity and gender equality perspectives. Sweden has a long history of broad
public health interventions and measures that have
contributed to the positive outcome. The National
Board of Health and Welfare’s national guidelines
on the prevention and treatment of unhealthy lifestyles are an example that contributes mainly to Target 3.4. The guidelines provide recommendations
for patients and are aimed at the healthcare system
and also cover municipal healthcare and dental care.
Sweden’s responsibilities and contributions in a
global perspective
Sweden actively contributes to implementation of
SDG 3 at the global level. Emphasising the importance of a broad perspective on health and how
other objectives contribute to improved health is an
important issue. This work takes the form of health
assistance funding, which includes advocacy, research, business, and international cooperation. Health
assistance accounts for about 10% of Sweden’s total
aid and in 2019 totalled SEK 5.2 billion, up from
SEK 4.2 billion in 2015. Health assistance focuses
particularly on strengthening health systems, sexual and reproductive health, and rights (SRHR), and
improving infant and maternal health. Sweden is
active in international negotiations within the UN
system, especially the WHO, within the EU and on
several boards of international organisations, including Gavi, the Global Fund, UNAIDS, the World
Bank, UNICEF, UNDP and UN Women. Sweden
also contributes to research, both at Swedish universities and internationally. Swedish life science
companies contribute, among other things, to the
development of medicines and technology. In addition, extensive work is carried out to promote good
health in the context of work on the climate and environment and food systems, for example. Sweden
has ratified the WHO Framework Convention on
Tobacco Control and the WHO Protocol to Eliminate Illicit Trade in Tobacco Products.
-10
0
10
20
30
1985/86
1993/94
1997/98
2001/02
2005/06
2009/10
2013/14
2017/18
Boys 11 years
(18.5)
Girls 11 years
(29.9)
Boys 13 years (14.5)
Girls 13 years (24.0)
Boys 15 years (15.0)
Girls 15 years (28.7)
Change in percentage points since 1985/86
Change in the proportion of schoolchildren who report at
least two psychological and somatic disorders more
frequently than once a week in the past year
(The figure in brackets is the proportion who stated disorders in 1985/86)
82 Government Ofces of Sweden
Impact on children and young people related
to SDG 3
The family’s economic position can have an impact
on children’s health and well-being. More girls than
boys report feeling unwell. An estimated 10% of
Swedish children may have been subjected to mental or physical abuse or neglect. Around 3 000 children are hospitalised each year after abuse. Among
pupils in grades 5, 7 and 9 who reported that their
family’s financial situation was not good, 8 out of
10 girls and more than half of boys had both mental
and physical problems several times a week. Regardless of the family’s financial situation, the percentage of people with problems is 20–27 percentage
points higher among girls than boys.
Key national policy initiatives in 2017–2020
In 2018, the Riksdag adopted a reformulated overall
public health objective and a revised goal structure for public health policy. The overarching goal
of public health is “to create the conditions for
good and equitable health among the entire population, and to end avoidable health inequalities
within a generation” (Govt Bill 2017/18:249). In
2020, the Government and the Swedish Association of Local Authorities and Regions signed an
agreement to improve accessibility in child healthcare. In view of the health inequalities that exist,
the regions will therefore implement measures to
increase access to child healthcare for groups at
higher risk of poorer health and dental health and
groups with lower vaccination coverage. In 2017,
the Government appointed an inquiry chair to review the Social Services Act and some of the tasks
of social services. In 2020, the inquiry submitted a
proposal for a new Social Services Act, an underlying principle of which is to strengthen preventive efforts and facilitate early intervention. In 2020,
Sweden hosted an international road safety conference where a declaration was adopted that formed
the basis for the UN resolution “Improving global
road safety”, which replaces Target 3.6. In 2020, the
Government presented Research, Freedom, Future – Knowledge and Innovation for Sweden (Govt
Bill 2020/21:60). A total of half a billion SEK will
be invested in health and welfare in 2021–2024, including two new national research programmes: on
mental health and on viruses and pandemics. Investments are planned in increased research expertise in primary care, research on prevention and
public health, and research on the elderly.
Future measures
• Efforts need to focus on reducing health inequalities between different groups in society. This is
necessary if Sweden is to contribute to the national public health objective and thus achieve most
of the goals of the 2030 Agenda.
• Increased focus on cross-sectoral work where
different policies, sectors and actors work together to improve equity in health and wellbeing, nationally and globally.
• The COVID-19 pandemic has highlighted the
need for preventive and promotion measures,
thus also reducing the burden on health services.
• Actions need to be targeted at lifestyle habits
to enable healthier lifestyles. Monitoring in this
area needs to be enhanced.
• The conditions for local and regional public
health efforts need to be enhanced.
• Sweden’s work at the global level, with a continued broad approach to people’s health and
well-being, including SRHR, needs to continue.
|
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|
22
SDG 3: Ensure healthy lives and promote well-being for all at
all ages.
3.1 Introduction
Ensuring healthy lives and promoting wellbeing for all at all ages is important to
building prosperous societies, as highlighted in goal 3 of the African Union Agenda
2063. The health sector aims to ensure the achievement of SDG 3 by improving
reproductive, maternal and child health; ending the epidemics of major
communicable diseases; reducing non-communicable and environmental diseases;
achieving universal health coverage; and ensuring access to safe, affordable and
effective medicines and vaccines for all. The government is highly committed to
ensuring a healthy and productive population that lives longer, fulfilling and
responsible lives. As a result, the health sector seeks to improve the health of the
people by providing preventative services that are of high quality, relevant,
accessible, affordable, equitable and socially acceptable.
The country revised its National Health Policy (2007) and Health Sector Strategy
to align to emerging global and regional health conventions, thus the National
Health Policy of Eswatini (2017) and second National Health Sector Strategic Plan
(2014 – 2018) are in place. Furthermore, the National Health Financing Policy
(2017) was developed to set out health care financing models and strengthen the
sector’s capacity in health care financing. Disability was mainstreamed into the
health sector. Health infrastructure has increased and is distributed among the
different regions.
The health sector received official development assistance from the following
development partners: European Union, Global Fund, Japan, United States of
23
America, United Nations programme on HIV/AIDS, UNFPA, UNICEF, WFP,
WHO and the World Bank.
3.2 Trends Analysis
a) Reduce the global maternal mortality ratio
• Current updates on the performance of maternal mortality obtained from
the 2017 population census report show a decline from 593/100,000 in 2012
to 474/100,00 and further declined to 452/100000 in 2017 which is
significantly above the target of 120/100,000 maternal deaths in 2022.
Government continues to strengthen maternal health services through
interventions including rehabilitation of maternity units in hospitals and
construction in health centres and clinics. In addition, capacity building of
health care workers to track and improve skilled birth attendance is
ongoing.
b) End preventable deaths of new-borns and children under 5 years.
Eswatini was able to reduce the under 5 mortality rate per 1000 from 104 deaths
per 1000 live births (MICS 2014) to 74/1000 in 2017. This was done through
introduction of new vaccines and increasing immunization coverage for children
under five (5) years of age. In that regard, the interventions are yielding positive
results showing that it will reach a rate of below 60 deaths, which is the target for
2022.
c) End the epidemics of AIDS, tuberculosis and malaria.
Reduction in HIV incidence;
There was a reduction in the incidence rate from 2.1% in 2011 to 1.4% in 2016 for
ages 15 to 49 years. This was as a result of Eswatini’s commitment to provide antiretroviral treatment for all people diagnosed with HIV. In addition, EHIMS 2016
shows that the country has made major progress towards achieving the global 90-
90-90 HIV targets by 2020, currently at 84.7- 87.4 - 91.9. 90-90-90 HIV targets
means that 90% of People Living with HIV (PLHIV) should know their HIV status,
90% of those positive be initiated on ART and 90% be virally suppressed.
This was achieved through initiatives such as provision of anti-retroviral therapy,
Prevention of Mother to Child Transmission (PMTCT), Test and Start, HIV testing
and counselling services and other impact mitigation interventions done through
NERCHA. The number of new HIV infections per 1,000 uninfected population
24
were 2.38 per 1000 in 2016 and reduced to 1.36 per 1000 population in 2017. HIV
incidence among adults was recorded to be 1.4% in 2016.
Tuberculosis
Since 2012 TB case detection rate has improved from 46% to 74% in 2017.
Treatment success rate improved from 77% to 83% in 2017 for ordinary TB, whilst
for MDR - TB the improvement was from 56% to 73% in 2017. The strategy has
been to deploy more than 300 active case finders at the community level to identify
and refer people infected with TB to ensure early treatment for newly identified
cases.
Malaria
Diagnosis and treatment of Malaria cases in accordance with National Diagnosis
and Treatment Guidelines increased from 85% in 2012 to 97% in 2017. This
increase shows major progress towards the country attaining certification of
malaria elimination. Due to these major strides, His Majesty King Mswati III was
elected chairperson of the African Leaders Malaria Alliance (ALMA) from 2017 to
2020.
The improvement is attributed to elements including training of health care
workers on the National Diagnosis and Treatment Guidelines, setting up of a
robust surveillance system which allows for timely case detection and
investigation, collaboration with neighbouring countries through participation in
cross border initiatives and providing a leadership role in the Elimination 8
initiative.
d) Reduce by one third premature mortality from non-communicable
diseases
The five year NCD awareness campaign plan was developed and implemented.
Furthermore, the NCDs monitoring and surveillance systems were strengthened.
Morbidity associated with NCDs and lifestyle related hospital visits show an
increase between 2013 and 2017, as shown in the figure below.
25
Figure 3.1 Mortality from non-communicable diseases
This means the situation worsened, implying that peoples’ lifestyles have not
improved since 2013 and that they have become even more prone to NCDs.
However the increase in deaths means that the system is better able to track these
cases, even though there are challenges in providing better treatment.
e) Ensure universal access to sexual and reproductive health-care
services, including for family planning.
The country has put in place a governmental and non-governmental sexual
reproductive health programme to empower women of reproductive ages 15–49
years. There was an increase of about 10% in the number of women accessing
family planning methods between 2013 and 2016, rising from 4,938 to 5,502
women.
f) Reduce the number of deaths and illnesses from water pollution
The country’s target is to increase access to proper sanitation facilities at the
household level for both rural and urban populations. The construction of pit
latrines continued successfully between 2013 and 2018 to benefit households and
schools. Statistics show that the level of sanitation in rural areas was 78% (55%
improved but not shared and 23% improved shared). The percentage of nonsharing households has declined from 56.7% to 55%. Coverage for urban areas was
94% (47.5% improved non-shared+ 46.5% improved shared). The percentage of
non- sharing declined from 55.6% to 47.5%, indicating limited achievement.
520000
530000
540000
550000
560000
570000
580000
590000
600000
2013 2017
NCDs 546301 598694
Number of deaths
Mortality from NCDs
26
g) Provide access to affordable essential medicines and vaccines
The country provides highly subsidised health care services. The availability of
drugs and pharmaceuticals is heavily dependent on Government’s resource
envelope. The availability of tracer classes of medicine in 2018 was as follows:
i. ARVs improved from 74.1% in 2013 to 96.4% in 2017
ii. Tuberculosis improved from 82.4% in 2015 to 88.7% in 2017
iii. Family planning deteriorated from 92.9% in 2015 to 61.8% in 2017
iv. Malaria remained unchanged from 94.1% in 2015 to 94.1% in 2017
v. Essential medicines current level at Central Medical Stores is 94%
3.2Challenges
a) Absence of national data on youth and adolescent sexual reproductive
health surveillance.
b) Teenage pregnancies are high which accelerates HIV incidence and new
infection among young girls is increasing.
c) Poor behavioural change after awareness of NCDs.
d) Limited friendly services.
e) Poverty is one of the causes of sexual malpractices among the youth.
f) Mothers do not want to breast feed their babies.
g) Criminalization of vulnerable people e.g. sex workers.
h) The quality of care in the health sector is restrained by lack of resources
(skills, equipment and medicinal).
i) Community healthcare workers are limited.
j) There still gaps in transmission from paper work to paper less.
k) Attraction and retraining nurses and doctors in rural areas.
3.3Emerging issues
a) Raising awareness on management of NCDs.
b) Religious beliefs prohibit access to health care.
c) Young people living with HIV especially young girls.
d) Reproductive health education tailored for disabled children.
e) Involvement of the youth in community health motivators’ programme.
3.4Lessons learned
a) Public finance for health and education is inadequate, hence the need to
prioritise within the sector.
b) Health coverage must be accompanied by quality of services.
c) Good partnerships with development partners has increased coverage and
achievements in some social sectors.
d) HIV/AIDS behavioural change is a bigger challenge.
27
3.5Actions that have been taken to address existing gaps and challenges
a) Revised the exiting policy documents.
b) Developed the National Health Financing policy for well-coordinated and
structured financial guidance.
c) Infrastructure development, more maternity units have been constructed
in existing health facilities and all newly constructed facilities have the
maternity wing included.
d) Under Five and neonatal: vaccines are now being procure through UNICEF
(Stock out is minimal).
3.6Areas for support
a) Multi-sectoral approach to address Non communicable diseases (NCDs),
increase technical and financial support towards the social sector
especially the neglected NCDs and decentralization of NCDs services.
b) Early detection of children with disabilities e.g. having psychologist.
c) Strengthen health research.
3.7Key messages
a) Urgent action to combat NCDs prevalence.
b) Need for user friendly services for special groups.
c) There is a shortage of pharmaceuticals and equipment in hospitals.
d) Strategies to retain highly skilled health practitioners in rural health
facilities.
e) Promotion of preventive health services.
|
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Target 3.1
By 2030, reduce
the global maternal
mortality ratio to less
than 70 per 100,000
live births
4.2.1. Goal 3. Ensure Healthy Lives and
Promote Well-Being for All at All Ages
Ensuring healthy lives and promoting wellbeing for all
at all ages is important to building prosperous societies, as highlighted in goal 3 of the African Union
Agenda 2063. The health sector aims to ensure the
achievement of SDG 3 by improving reproductive,
maternal and child health; ending the epidemics of
major communicable diseases; reducing non-communicable and environmental diseases; achieving
universal health coverage; and ensuring access to
safe, affordable and effective medicines and vaccines
for all. The government is highly committed to ensuring a healthy and productive population that lives
longer, fulfilling and responsible lives. As a result, the
health sector seeks to improve the health of the
people by providing preventative services that are of
high quality, relevant, accessible, affordable, equitable and socially acceptable.
The maternal mortality ratio stands at 452per
100,000 live births as recorded in the first VNR in
20195
. By 2023, Eswatini plans to have reduced
MMR to 325 per 100,000 live births. Despite lack of
recent data to measure progress, improvements due
to operationalizing the a Sexual Reproductive and
Maternal Newborn Child Adolescent Health and
Nutrition strategy (2019-2023) and ANC Guidelines in
2020 have been observed.
In the absence of recent data, the proportion of births
attended by skilled health personnel, remains high at
88.3 percent as reported in the first VNR. However,
this may have been affected by COVID-19 due to the
observed increase in home deliveries.
35
CHAPTER FOUR
The maternal mortality ratio stands at 452per
100,000 live births as recorded in the first VNR in
20197
. By 2023, Eswatini plans to have reduced
MMR to 325 per 100,000 live births. Despite lack of
recent data to measure progress, improvements due
to operationalizing the a Sexual Reproductive and
Maternal Newborn Child Adolescent Health and
Nutrition strategy (2019-2023) and ANC Guidelines in
Target 3.2
By 2030, end preventable deaths of newborns and children under 5
years of age, with all countries aiming to reduce neonatal mortality to
at least as low as 12 per 1,000 live births and under 5 mortality to at
least as low as 25 per 1,000 live births
Mortality of children in the country is on the decrease.
The under 5 mortality rate is at 67 per 1 000 live births
which is a decline from 104 per 1 000 . The government continues to strengthen the programme of
immunization and vaccination of children under 5
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
The country has reached the 95-95-95 HIV targets
meaning 95 percent of People Living with HIV (PLHIV)
know their HIV status, 95 percent of those positive
are initiated on ART and 95 percent virally
suppressed . The government committed to provide
anti-retroviral treatment for all people diagnosed with
HIV. HIV incidence among adults aged 15 to 49 is at
0.85 percent declining from 1.36 percent in 2016 . TB
incidence increased from 398 per 100 00 in 2019 to
441 per 100,000 population . The country attained a
certification of malaria elimination. Due to these major
strides, His Majesty King Mswati III was elected chairperson of the African Leaders Malaria Alliance (ALMA)
from 2017 to 2020. The malaria incidence is low at
0.05 per 1 000 population which slightly increased
from 0.03 per 1 000 population in 2020 . The health
care workers are on the National Diagnosis and
Treatment Guidelines, setting up of a robust surveillance system which allows for timely case detection
and investigation, collaboration with neighbouring
countries through participation in cross border initiatives and providing a leadership role in the Elimination
8 initiative.
The country is endemic to two neglected tropical
diseases, namely bilharzia (schistosomiasis) and
intestinal worms (soil transmitted helminths) with a
prevalence of 15.7 percent and 5.67 percent, respectively . Based on these prevalence, it is estimated that
237,579 and 85,409 people require interventions
against bilharzia and intestinal worms, respectively.
With school deworming campaigns frozen due to the
COVID-19 pandemic, these number of people requiring NTD interventions is likely to increase since a few
people are utilizing the routine deworming services
available at health facilities, mainly children under 5
years at immunization (EPI) services and pregnant
women at ANC.
2020 have been observed.
In the absence of recent data, the proportion of
births attended by skilled health personnel,
remains high at 88.37
percent as reported in the first
VNR. However, this may have been affected by
COVID-19 due to the observed increase in home
deliveries.
years. The neonatal mortality rate stands at 20 per 1
000 live births . COVID-19 restriction brought some
interruptions in provision of outreach services such as
the immunization coverage.
36
VOLUNTARY NATIONAL REVIEW REPORT 2022
Target 3.4
By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental
health and well-being
In the fight against NCDs, the country has decentralized NCD services to primary health care together
with implementing a five-year NCD awareness campaign plan. A package of Essential Non-Communicable Disease Interventions for Primary Care in Eswatini
and Kingdom of Eswatini Clinical Guidelines for the
Management of NCDs at Secondary and Tertiary
Care were printed and disseminated to facilities
across all levels of care. The graph shows that
between the baseline and the first VNR, the NCDs
28.1
43
5.5
13.8
24
7
16.6
22
11
5 3.2 1 0.3
5
0
10
20
30
40
50
Baseline 2016 First VNR 2019 Second VNR 2022
Percentages
Years
Cardiovascular Diabetes mellitus
Cancer Chronic Obstructive Pulmonary diseases
Mental Health Epilepsy
mortality rate was on the increase . Under the decentralization NCDs services, the health sector ensured
declassification of medication to be available at lower
level health facilities and the training of health care
workers on all NCD guidelines. The period between
2019 and 2022, the NCDs mortality rate declined. It is
also anticipated that the NCDs mortality rate will
further decline as the government continues to
respond to the COVID-19 pandemic.
Source: MICS 2014 and Population census 2017
Figure 17: Non-communicable Diseases Mortality Rate
37
CHAPTER FOUR
6
Population Census, 2017
7
MICS, 2014
8
MICS, 2014
9
EHMIS,2016 & 2019
10EHMIS, 2016 & 2019
11Annual TB programme report 2017 & 2019
12Malaria Annual report 2020 & 2021
13NTDs Mapping Survey, 2015
14NCD annual report 2019
Source: ERSP Annual reports
Source: ERSP Annual reports
Figure 18: Suicide Mortality
Figure 19: Death due to Road traffic injuries
6
10.1
8.6
13.1
0
2
4
6
8
10
12
14
BASELINE
2016
FIRST VNR
2019
YEAR
2021
SECOND VNR
2022
Per 100 000 population
YEARS
On the other hand, suicide mortality rate is increasing.
It stands 13.1 per 100 000 population which is an
increase from 10.1 per 100 000 in 201915. This is
believed to be linked to the distress caused by the
effects of COVID-19 as a lot of people were affected
by the loss of jobs and loved ones.
Target 3.5
Strengthen the prevention and treatment of substance abuse,
including narcotic drug abuse and harmful use of alcohol
In an effort to prevent and treat substance use disorders, the country has a Psychiatric hospital. It also
has rehabilitation services within health facilities
which help in the control of substance use disorders.
In this regard, harmful use of alcohol amongst male
and female is 25.5 percent and 5.5 percent respectively .
203
178
205
229
150
170
190
210
230
250
Baseline
2016
First VNR
2019
Year
2021
Second VNR
2022
Number of people
Years
38
VOLUNTARY NATIONAL REVIEW REPORT 2022
15Annual Police Reports 2016, 2017, 2018 & 2021
16MICS, 2014
17Annual Police Report 2021
Target 3.6
By 2020, halve the number of global deaths and injuries from road
traffic accidents
Death rate due to road traffic injuries is on the increase. it drastically increased from 178 deaths in 2019 to 229 .
Most of the injuries are caused by high level of speeding which results to deaths of the pedestrians. It is also
observed that the traffic injuries are caused by non-conforming behavior of road users.
To achieve the target halving the number of deaths and injuries, the country needs to put more effort to prevent
the road accidents such as installing surveillance cameras on the country's major roads to monitor speeding and
increase roads fines to enforce conformity.
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
The percentage of demand for contraception satisfied stands at 81.3 percent according to MICS 2014. The
impact of COVID-19 which resulted in stock-outs in some of the family planning methods is yet to be measured.
As reflected in the previous VNR the adolescent birth rate (stands at 87 per 1 000 women girls age 15 to 19
years. The next VNR is expected to show the effect of COVID-19 on the adolescent birth rate.
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
Data for coverage of essential health services (tracer interventions) shows that the country is lagging behind in two
tracer interventions which are cervical cancer and TB with coverage service of 41 percent and 45 percent, respectively.
39
CHAPTER FOUR
18MICS 2014
Source: HMIS 2021
82
84
49
60
85
81
78
41
83
75
82
0 10 20 30 40 50 60 70 80 90
Child health
HIV
TB
Malaria
Cardiovascular Disease
Diabetes
Chronic respiratory diseases
Cervical Cancer
Adolescent Health
Family planning
Comprehensive (reproductive maternal and newborn)
Infectious Diseases N
C
Ds S
R
H
Percentages
Tracer Interventions
Second VNR 2022
Figure 20: Coverage of Essential Health Services
The country does not have a national health insurance which makes it difficult to have a figure on the number of
people covered by health insurance. The lack of national health insurance mostly affects the poorest since they
are unable to pay for their medical expenses.
There is a data challenge in the indicators informing this targets. All the indicators for this target mortality rate
attributed to household and ambient air pollution, mortality rate attributed to unsafe water, unsafe sanitation and
lack of hygiene and mortality rate attributed to unintentional poisoning have no data. However, COVID-19 promoted sanitation improvement and hygiene. The health sector installed hygiene measures in populated areas around
the country.
Target 3.9
By 2030, substantially reduce the number of deaths and illnesses
from hazardous chemicals and air, water and soil pollution and
contamination
40
VOLUNTARY NATIONAL REVIEW REPORT 2022
19MICS 2014
The percentage of people aged 15-49 who smoked a whole cigarette before the age of 15 depicts that males
smoke a whole cigarette more than females 2.9 percent and 0.2 percent, respectively . Similar conduct is
observed in the percentage of people aged 15-49 who smoke cigarette or smokeless tobacco at any time during
the last one month which record 14.7 percent for males and 1.3 percent for female.
Target 3.a
Strengthen the implementation of the World Health Organization
Framework Convention on Tobacco Control in all countries, as
appropriate
It anticipated that the proportion of the population with access to affordable medicines and vaccines on a sustainable basis is nearly 100 percent since every citizen has access to medicines and vaccines. The total net official
development assistance to medical research and basic health sectors stands at US$97.9 million from US$3.0million in 2016.
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
Health systems can only function with health workers and the health workforce is critical in the achievement of the
2030 health and wider development agenda objectives. Data on health worker density and distribution shows that
the density for physicians is at 1.66 per 100,000 and nurses and midwives is 1.46 per 100,000 . This indicator is
poor performing since health workers are not evenly distributed in country. There are still hospitals and clinics with
shortage of health workers mainly in the rural areas.
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
The country is signatory to the 2005 International Health Regulations (IHR) and is committed to strengthening its
core capacities including surveillance and response, including at points of entry, in order to detect, assess, notify
and respond to any potential public health events of international concern.
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
41
CHAPTER FOUR
20SAM, 2013 and Analysis of human resource for health in Swaziland 2017
Eswatini undertook a Joint External Evaluation (JEE)
in response to the International Health Regulations
(IHR) capacity and health emergency preparedness
which yielded an average capacity score of 42
percent in 2018 with an increase to 46 percent in
2022. The JEE was done to identify the country’s
gaps in emergency preparedness, detection and
response and improve on its capacities (strengths) for
health security. There is a need for the country to
strengthened the IHR core capacities ensure that the
health system is resilient to health emergencies.
Key achievements
• Completion of the Mbabane Government Emergency and Referral Complex
• Rehabilitation of Manzini Hospital, formerly TB
hospital, to a full NCD Centre
• Construction of 5 new clinics almost complete
(Tikhuba, Magwanyana, Nkomazi, Luve and
Hlane)
• Construction of BSL3 Laboratory at Lubombo
Regional Hospital
• Achievement of 95:95:95 targets in HIV
• Upfront payment for ARVs and child vaccines
has helped manage stockouts
• Construction and operationalization of the new
maternity wards in the 4 Health Centres
(Dvokolwako, Emkhuzweni, Nhlangano and
Matsanjeni)
• Effective management of COVID-19 pandemic
and introduction of national vaccination
program including establishment of control
room
• Recruitment of personnel during COVID-19
emergency which stabilized and boosted
national response
• Procurement of 9 ambulances and 1 disaster
bus for timely response, 4 regional COVID-19
surveillance vehicles
• Construction of medical oxygen plants at
Lubombo Hospital and The Luke Commission
and installation of bulk oxygen tanks at Mavuso
COVID-19 centre and RFM
Key challenges
• Drugs, Medicines and other medical Supplies
shortage
• Health infrastructures are in a deplorable state
of repair such as; Leaking Roof, Falling Ceiling,
Faulty Utilities, Plumbing Issues, Perimeter
Fencing etc.
Recommendations
• Accelerate the implementation of the integrated
child health programme and improve access to,
and the quality of, primary health services,
particularly in rural areas, by allocating sufficient
human and financial resources for health
infrastructure, and by developing an integrated
medicine supply management system to
improve the availability of and access to medicines
• Ensure that comprehensive sexual and reproductive health education is part of the compulsory school curriculum, with special attention
placed on the prevention of early pregnancy
and sexually transmitted infection, in particular
HIV/AIDS, and ensure access to confidential
counselling
• Establish a government health infrastructure
maintenance fund
• Improve efficiency and effectiveness of resources allocated to health
• Decentralization of health services including the
prevention of NCDs
42
VOLUNTARY NATIONAL REVIEW REPORT 2022
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Voluntary National Review 2020
30
Goal 3: Ensure healthy lives and promote well-being for all at all ages
Since gaining independence in 1976, Seychelles has always adopted a people-centred approach
by placing health very high on the development agenda. Indeed, the right to health is enshrined
in the Constitution of Seychelles: article 29 underscores the commitment of the Government
to health care provision and also highlights the personal responsibility of the citizen in health
matters. Moreover, the main tenet of the National Development Strategy 2019-2023 is personcentred development, and it calls for the attainment of the highest level of health and wellbeing.
As Seychelles has made great strides in economic development over the years, including
achieving high-income status, the country has also acquired better health status. This is primarily
the result of the Government’s continued commitment to the provision of quality healthcare and
its pool of dedicated and well-trained healthcare professionals. One of the country’s most signifcant achievements is
Universal Health Coverage (UHC): all citizens have access to a comprehensive package of health services, free at the
point of use, within the public sector. This also includes overseas treatment for patients whose health needs cannot be
met locally. The Government is the major provider and funder of health care in Seychelles, with investments in health
accounting for at least 10 per cent of the national budget over recent years. Additionally, a growing private sector
complements the health services in specifc areas, but as yet does not ofer certain key primary and secondary health
care services. There is also very active involvement by civil society in the health sector, particularly, in health promotion,
cancer control and care, and HIV and AIDS. There is potential for further improving public health through strengthened
collaboration between the Government, the private sector and civil society.
Case study: Cancer Concern Association
The Cancer Concern Association is an NGO in Seychelles that raises awareness
about cancer and also provides support and counselling services to cancer suferers
and their families. It has been particularly active in educating the public about the
disease and encouraging everyone to develop healthy lifestyles that will reduce the
risk of developing cancer. In 2018, it launched an awareness campaign themed ‘We
Can. I Can’. This was done in collaboration with other NGOs, with the objective of
exploring how everyone – together and individually – can do their part to reduce the
burden of cancer nationally. The campaign outlined actions that communities and
individuals can take to proactively help themselves to become more aware of the
consequences of their lifestyle choices and educate themselves on how to lead
healthier lifestyles. Moreover, guidance was provided on how to recognize the signs
and symptoms of cancer for early detection, and how to support those who are
struggling with the disease. The Association has also partnered with the private sector
and the Government on many of their campaigns.
Overall, the health sector is guided by the National Health Strategic Plan 2016-2020 (NHSP) which aims to achieve all
the national and global health targets focused on promoting, protecting and restoring the health and well-being of all
people in Seychelles throughout the life-course. The main goals of the NHSP are:
• increased expectation of life at birth;
• reduced incidence, prevalence and mortality associated with priority non-communicable and communicable
diseases;
• increased level of satisfaction of the people and of health professionals with the existing health services; and
• improved overall wellbeing of all people in Seychelles.
Republic of Seychelles
31
Life expectancy at birth for both sexes increased from 69.5 years in 1980 to 73.9 years in 2019. However, a signifcant
gap remains in life expectancy between the sexes (Figure 6). The infant mortality rate was 27 per 1,000 live births in
1978 and has decreased steadily over the years but with spikes in 2013 and 2018 (Figure 7). In 2018, a high proportion
of infant deaths (32 per cent) were associated with severe congenital anomalies, much higher than averages for Eastern
and Southern Africa, and closer to the averages for high-income countries. Infection and sepsis contributed to 23 out
of 31 deaths (74 per cent). Almost all the infant deaths with available medical case fles were premature (20 out of 21),
with average gestation of 31 weeks 4 days (in the range 28 to 40 weeks). Although there were overlaps between these
contributory causes to infant deaths, the fact that about a third of infant deaths had one or more severe congenital
anomalies refects a much higher rate than the World Health Organization (WHO) global estimates of 11.3 per cent of
neonatal deaths attributable to congenital anomalies (2000-2015).6
The maternal mortality ratio varies between zero and about 120 per 100,000 live births; the high variability is a result
of the relatively small population and number births per year in Seychelles. To understand why some health outcomes
are poor despite increased investment, it is critical that all dimensions of Universal Health Coverage be measured
and understood to enable targeted interventions, especially for key populations such as women who use drugs (the
problem of heroin use in particular is discussed later in this section).
Source: National Bureau of Statistics and Statistics Unit, Ministry of Health
Source: Department of Health and National Bureau of Statistics
Figure 6: Life expectancy at birth, years, 1980-2019
Figure 7: Neonatal, infant and under-fve mortality rates, 2013-2019
6 Health of our Nation Annual Health Sector Performance Report, 2018, Ministry of Health, Seychelles.
Voluntary National Review 2020
32
In Seychelles, there is wide availability of sexual reproductive health services. However, the adolescent fertility
rate remains high, at 65 births per 1,000 girls and women aged 15-19 years,7
indicating a need for a review of and
improvements to family planning services. This should address the increasing incidence of sexually transmitted
infections, which suggests a rise in unsafe sexual practices.
The country is now at an important crossroads where the shift from communicable to non-communicable diseases
(NCD) is posing new and signifcant challenges. Serial surveys show a reducing trend in smoking in men, while
prevalence of obesity and diabetes is increasing.8
The three main causes of death in order are cardiovascular diseases,
cancer and respiratory infections (Table 1). This leading to an increasing demand for tertiary level care, and possibly to
reallocation of scarce resources from primary prevention.
Communicable diseases, though, remain the prime causes of morbidity. In recent years, the country has seen an
increase in annual reported cases of HIV, and experienced occasional outbreaks of infectious diseases such as dengue.
It is a fact that disease burden and health outcomes are infuenced not just by health care provision but also by the
social determinants of health: the conditions under which people are born, grow, live, work and age, including the
health system. Seychelles has successfully addressed some of these social determinants through policy decisions,
such as providing universal education, maintaining low unemployment and empowering youth.
In addressing the challenges of increasing disease burden – both communicable and non-communicable – as well
as poor health outcomes, health promotion has been greatly reinforced. A number of ongoing media programmes
and appearances have provided information and education on a variety of health issues. The Health of our Nation
(HOON) Campaign was launched in 2013 to promote healthier lifestyles. Since then a number of activities have been
held at national level. These include the Workplace Wellbeing Programme (WWP), which aims to create capacity at
participating workplaces for employee-led, integrated health promotion interventions.
Although access to healthcare services is not an issue, there have been numerous complaints from patients of
dissatisfaction with these services, particularly focused on long waiting times at clinics, and lack of availability of
specialized surgery and treatment for serious diseases and conditions locally. Certain complaints result from poor
communication between health care professionals and patients. The Government is now working hard to improve
the quality of care provided, through the patient-centred care initiative, which aims to ensure that the care provided is
responsive to individual patient needs, preferences and values.
Figure 8: Five leading causes of death, 2013-2018
2013 2014 2015 2016 2017 2018 2019
Deaths (number)
Total deaths (of which) 717 725 703 747 748 818 795
Diseases of the circulatory system 224 202 216 249 289 264 254
Neoplasms 119 125 151 135 130 152 151
Diseases of the respiratory system 123 104 88 91 98 139 138
External causes of morbidity and mortality 47 46 52 57 51 48 53
Infectious and parasitic diseases 58 82 47 54 47 48 40
Deaths (%)
Diseases of the circulatory system 31 28 31 33 39 32 34
Neoplasms 17 17 21 18 17 19 20
Diseases of the respiratory system 17 14 13 12 13 17 18
External causes of morbidity and mortality 7 6 7 8 7 6 7
Infectious and parasitic diseases 8 11 7 7 6 6 5
Progress on Goals
7 National Bureau of Statistics, Statistical Bulletin, March 2019.
8 Public Health Authority (2015): National Survey of Non-communicable Diseases in Seychelles 2013-2014 (Seychelles Heart Study IV): main fndings.
Republic of Seychelles
33
In ensuring the health and well-being of all, there is also steadfast government commitment to combat the alcohol
and illicit drugs epidemics. In 2017, an Integrated Behavioural and Biological Survey (IBBS) revealed an estimated
4,800 persons who use heroin in various ways in Seychelles (5.6 per cent of the country’s population). This was in
parallel to 2,560 persons identifed as persons who inject drugs (the IBBS study suggests that smoking heroin is
common in Seychelles).9
In a strong response from the Government, the Agency for the Prevention of Drug Abuse
and Rehabilitation (APDAR) was created in 2017 to lead the fght against this local epidemic, and to help those who
sufer from the addictions. APDAR is making progress with its programmes. The Methadone Maintenance Programme
(MMP) specifcally targets users who are dependent on heroin. This Programme is provided throughout the community
to all who require it. Methadone is not readily given to under-aged clients. However, APDAR assess on a case by
case basis and if necessary, they are administered on the Buprenorphine Programme, with the consent of parents
only. The MMP has been rapidly scaled up and the country is beginning to see a reduction in cases of viral hepatitis
C and HIV among drug users. The MMP includes both pharmacological and psychosocial interventions: patients are
provided with the appropriate medication (methadone) to address their physical dependence on heroin, as well as with
the appropriate level of counselling and the psychological support necessary to help them maintain their treatment.
Additionally, APDAR, in collaboration with the Department of Employment, has also successfully placed most people
on MMT into gainful employment. As of early 2020, there were approximately 2,500 persons enrolled onto the MMP.
As part of the process of improving rehabilitation of drug users, construction of a dedicated rehabilitation centre will
commence in the latter half of 2020.
As part of its policy to mitigate the efect of alcohol on the health of its nation, the government reinforced existing
measures which included separating the sale of alcohol from other commodities in shops, taxing alcoholic products
on the basis of their alcohol content and placing a moratorium on licences for local production of alcoholic beverages.
Excise tax on alcoholic beverages also increased by 10 per cent across the board, efective from 1 January 2020.
Since January 2019 the Government has increased the rate of excise tax on all imported and manufactured tobacco
products by 10 per cent, in its continued eforts to tackle excessive tobacco consumption in the country. These
measures are in line with the WHO Framework Convention on Tobacco Control, which Seychelles is party to and must
therefore abide by the convention, which aims at limiting the sale of single cigarettes. Additionally, the Government has
introduced a sugar tax, which came into efect in April 2019, with the aim of tackling obesity among children.
Way forward
Although, the health sector in Seychelles is continuing to thrive, it is critical that gaps and challenges are addressed
systematically. There is an urgent need to improve collection, analysis, sharing and use of data for health, in both
the public and private sectors. Moreover, it is critical that the quality of care is further improved by the scaling up of
implementation of patient-centred care. As part of this, an integrated Health Information System will be established to
ensure improvements in health care quality, efciency of delivery and access. As we advance as a country, more new
strategic directions and innovative service delivery approaches will be taken. In further improving, Seychelles commits
to strengthening partnership and coordination within and beyond the health sector, to ensure that all parties work
together to develop and implement solutions to the many socio-economic barriers that infuence health outcomes.
9 Agency for the Prevention of Drug Abuse and Rehabilitation (2018). Seychelles Biological and Behavioural Surveillance of Heroin Users of 2017.
|
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{
"country": "syc",
"file_id": "sdg-03/vnr-report-syc-2020-en-3.pdf",
"language": "en",
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}
|
32
République du Tchad : Examen Natonal Volontaire 2019
ODD 3
Permettre à tous de vivre en bonne santé et
promouvoir le bien-être
Cibles priorisées
3.3 - D’ici à 2030, mettre fin à l’épidémie du 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;
3.7 - 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, d’éducation et de la prise en compte de la
santé procréative dans les stratégies et programmes nationaux;
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, à des
médicaments, des vaccins essentiels sûrs, efficaces, de qualité et d’un coût abordable.
La faim est une préoccupation majeure pour le Tchad tant ses conséquences économique, sociale et
D’une manière générale, on note une nette amélioration des indicateurs de santé maternelle, infantile
et de la santé procréative (Cibles 3.1, 3.2, et 3.7) durant la période 2016-2018. L’analyse des indicateurs
présente les constats suivants :
La tendance est à la baisse pour le taux de mortalité maternelle de 2004 à 2015, qui est passé de
1099 décès maternels pour 100 000 naissances vivantes à 860 (EDS-MICS 2015). Cette amélioration
constatée en matière de santé de la reproduction est attribuable à plusieurs facteurs, notamment
la mise en œuvre de la feuille de route nationale (2009-2015) pour la réduction de la mortalité
maternelle, néonatale et infantile ainsi que la campagne pour l’accélération de la réduction de la
mortalité maternelle en Afrique (CARMMA) lancée au Tchad en 2009 ;
La proportion d’accouchements assistés par un personnel de santé qualifié et dans un établissement
sanitaire est à la hausse. Elle est passée de 22,7% en 2010 (MICS 2010) à 33,9% en 2015. Sur la
même période, les accouchements dans une structure de santé sont passés de 15,8 % à 21,7 % et
la couverture en CPN4 est passée de 23% à 31%. La proportion d’accouchements assistés par du
personnel de santé qualifié varie avec les caractéristiques sociodémographiques de la mère (milieu
de résidence, niveau d’instruction et cadre de vie) ;
Le taux de mortalité infantile a baissé de 106 ‰ en 2010 à 72 ‰ en 2015 et le taux de mortalité des
enfants de moins de 5 ans a diminué, passant de 191‰ en 2004 à 133‰ en 2015, et se stabilise
atour de 131,49‰ en 2017, toutefois, ces taux restent un des plus élevés de la sous-région ;
Situation et tendances
33
République du Tchad: Examen Natonal Volontaire 2019
La proportion des femmes qui utilisent des méthodes modernes de contraception est en nette
augmentation, même si elle est encore faible. En effet, 5,7% utilisaient une méthode moderne de
planification familiale, contre 4,8% en 2010. Les besoins non satisfaits en planification familiale sont
en diminution, passant de 28,3 % en 2010 à 22,9 % en 2015, même si des efforts restent à faire en
termes de sensibilisation et de disponibilité de services, notamment en milieu rural.
Le taux de fécondité des adolescentes est de 179 ‰ en 2015, avec des variations significatives entre
milieux urbain et rural (129 ‰ et 197 ‰ respectivement) alors qu’il était de 194‰ en 1997. Dans la
même période, le taux de grossesses précoces a baissé de 47,4 % à 35,9 %.
Cette amélioration des indicateurs de santé se traduit par une légère augmentation de l'espérance de
vie au cours des dernières années. En 2016, elle était de 52,9 ans et de 53,4 en 2017 pour atteindre
53,8 ans en 2018. En moyenne, les femmes ont une espérance de vie plus élevée que les hommes
(54,14/54,71/55,17 ans contre 51,69/52,14/52,59 ans). Toutefois, la situation est préoccupante, avec
une stagnation ou une tendance à la hausse pour le paludisme, le VIH/SIDA, la tuberculose, l’hépatite
B (cible 3), autres maladies transmissibles tels que les maladies tropicales négligées, ainsi que le taux
de couverture vaccinale des enfants (cible 3.b). En effet l’analyse des indicateurs présente la situation
suivante :
La situation épidémiologique en 2017 est caractérisée par une évolution constante de l’épidémie
du paludisme. En effet, l’incidence du paludisme est passée de 57,57 pour 1 000 habitants en 2015
à 64,8 pour 1 000 habitants en 2017 (annuaire des statistiques sanitaires) et 67 pour 1000 en 2018
(ENIPT). Le nombre de Moustiquaires Imprégnées d’Insecticide de Longue Durée d’Action (MIILDA)
distribuées est pourtant passé de 395 594 en 2015 à 397 674 en 2017. Le pourcentage des femmes
enceintes dormant sous moustiquaires imprégnées (MI) est passé de 9,9 en 2010 à 34,7 %.
L’incidence de la tuberculose a enregistré une baisse, mais le taux de succès thérapeutique est
seulement de 77%. La baisse est d’environ 6% entre 2015 et 2017 pour se situer à 106,22 nouveaux
cas pour 100 000 habitants. Malgré cette performance, le taux de succès thérapeutique reste
insuffisant (77%). L'amélioration de la prise en charge des malades est donc une prioritée ;
On observe une diminution progressive de l’incidence du VIH/SIDA depuis 2001. Toutefois, la valeur
estimée reste assez importante et nécessite une attention particulière. Selon les estimations du
PSLS 0,42 pour 1000 personnes tout âge a été nouvellement infectées en 2015 avec 0,32 pour 1000
personnes de 15 ans et plus (soit 1,9% femmes et 1,2 % hommes) et 0,09 pour 1000 enfants de 0 -14
ans. Le nombre de nouvelles infections au VIH pour 1 000 personnes séronégatives n’a quasiment
pas varié sur une période de 2 ans : 0,42 en 2015 et 0,41 en 2017. Les personnes vivant avec le virus
du VIH qui recevaient un traitement antirétroviral ne représente que 54%. Il convient de noter tout
de même qu’en terme absolu le nombre de nouveaux cas a augmenté entre les 2 années. Ainsi, pour
pouvoir contenir cette épidémie, il faut que les services de santé soient assurés, que le suivi et la
prise en charge des PVV soient réguliers et que les activités de prévention soient développées.
Le Tchad fait face aux dix maladies tropicales négligées sur les onze maladies évitables et guérissables,
affectant 6 138 675 des habitants du Tchad en 2016 ; dont 2,6 millions d’habitants du Tchad ont
bénéficié d’un traitement, et 3,6 millions d’habitants du Tchad ayant besoin d’un traitement n’ont
pas été prises en charge. Depuis 2013, le pays a intégré 10 maladies tropicales négligées sur onze
(11) dans son plan stratégique 2014-2020 pour la lutte contre les maladies tropicales négligées dans
les régions africaines. Compte tenu du nombre élevé des habitants souffrant de ces maladies qui
n’ont pas reçu un traitement, le Gouvernement devrait accroître le budget alloué à leurs prévention
et traitement ;
34
République du Tchad : Examen Natonal Volontaire 2019
L’incidence de l’hépatite B est de 13,74 pour 100 000 habitants en 2015 selon les statistiques
sanitaires de la même année. En 2015, 72 211 poches de sang ont été collectées et testées aux 4
marqueurs (VIH, Syphilis Hépatite B et C) soit 100% dans les laboratoires des hôpitaux du pays. De
l’ensemble de ces poches testées 2,4% s’étaient révélées positives pour le VIH/SIDA, 3,4% positives
à la Syphilis, 9,2% à l’hépatite B et 2,2% à l’Hépatite C. Cette prévalence relativement élevée de
l’hépatite B mérite que les autorités en charge de la santé accordent une attention particulière.
La couverture vaccinale est faible, aucun type d’antigène n’a atteint la cible de 80%. Les vaccinations
contre la polio et antituberculeux (BCG) semblent être les mieux administrés. La couverture du
vaccin contre la diphtérie, le tétanos, la coqueluche et l’Haemophilus influenzae type B (DTC 3) est
la plus faible (33%) des autres antigènes administrés.
La tendance en ce qui concerne les facteurs environnementaux de santé (cible 3.9) est à la hausse.
L’analyse des indicateurs indique que :
Le taux de mortalité attribuable à la pollution de l’air dans les habitations et à la pollution de l’air
ambiant (pour 100 000 habitants) est en hausse. En 2015, ce taux est estimé à 121 décès pour
100.000 habitants selon l’OMS. Cette proportion est en croissance comparée aux estimations de
l’OMS en 2016, elle était à 280 décès pour 100 000 habitants ;
Le taux de mortalité attribuable à l’insalubrité de l’eau, aux déficiences du système d’assainissement
et au manque d’hygiène est estimé à 101 décès pour 100 000 habitants.
En ce qui concerne le renforcement de la prévention et le traitement de l’abus de substances
psychoactives, notamment de stupéfiants et d’alcool (Cible 3.5), le taux d’abus d’alcool de 200 à
2010 se stabilise entre 2015 à 2016, tandis que pour les accidents de la route (cible 3.6) la tendance
est à la baisse.
Le taux d’abus d’alcool, défini 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 est stable. Un habitant de 15
ans ou plus consomme en moyenne 1,5 litre d’alcool par an. La consommation d’alcool pur est en
augmentation depuis les années 2000 pour atteindre son niveau le plus élevé en 2010 avec 4,9 litres
par habitant par an. On observe une stabilisation de la quantité d’alcool consommée entre 2015 et
2016. Parmi les types d’alcool consommés, la bière occupe une proportion de 70%. Quelle que soit
l’année, les hommes consomment cinq fois plus que les femmes ;
La mortalité due aux accidents de la route est passée de 28,5 décès pour 100 000 habitants en 2010
à 24,1 décès pour 100 000 habitants en 2013. Entre 2 000 et 2009, ce taux variait entre 24,8 à 25,9
pour 100 000 habitants chaque année.
La cible 3.4 en rapport avec la réduction d’un tiers, par la prévention et le traitement, le taux de
mortalité prématurée due à des maladies non transmissibles, la promotion de la santé mentale ainsi
que le bien-être et la cible 3.a en rapport avec la lutte antitabac ne seront pas atteint si les tendances
actuelles perdurent. Par exemple, on observe que 13,4% des hommes de plus de 15 ans et 2,7% des
femmes de plus de 15 ans consommaient du tabac en 2015. Parmi les femmes qui consomment le tabac,
on observe que 85% consomment un « autre tabac » que « les cigarettes ».
35
République du Tchad: Examen Natonal Volontaire 2019
Les indicateurs en rapport avec la cible 3.8 portant sur la couverture sanitaire universelle sont encore
très faibles. Selon le rapport 2017 mondial de suivi de l’OMS, l’indice de couverture universelle de santé
est encore très faible (29,0%), il faut une progression de 8,3% chaque année pour atteindre la cible de
100% en 2030. Les indicateurs d’utilisation des services de santé essentiels sont presque tous au rouge
malgré des améliorations par rapport aux années précédentes.
Le montant total net de l’aide publique au développement consacré à la recherche médicale et aux
soins de santé de base est en baisse (cible 3.b). En 2015, le Tchad a reçu 20,2 millions de dollars dans
le secteur de santé de base en matière de recherches médicales. C’est l’un des montants le plus faible
durant les cinq dernières années. Ceci pourrait s’expliquer par la crise financière mondiale.
Densité et répartition du personnel de santé (cible 3.c.1) demeurent inadéquates, mais s’améliorent. En
2015, le ratio habitants/médecin est de 19 641 soit 10 fois plus que la norme de l’OMS. Cette statistique
est très variable selon les districts sanitaires. De même, au niveau national, le ratio habitants par infirmier
qualifié est de 3 837 soit plus d’une fois et demie que la norme de l’OMS, et varie selon les districts
sanitaires. L’amélioration de la prestation des services a été accompagnée d’efforts dans le domaine
des ressources humaines. De 2012 à 2016, le nombre de médecins est passé de 528 à 761, des infirmiers
(IDE+ATS) de 3 375 à 3 922, des SFDE de 416 à 692 et des pharmaciens de 69 à 72.
La cible 3.d en rapport avec l’indice des principales capacités requises selon le règlement sanitaire
international (RSI) progresse lentement. On observe que tous les deux ans, le Tchad gagne 2 points dans
la mise en œuvre du Règlement Sanitaire International. En 2015, il a atteint 40% alors qu’il était en 2011
à 28%.
Politiques, stratégies, et programmes
Soucieux de répondre à la demande croissante des services sociaux, le gouvernement du Tchad, a
adopté la loi 002/PR/2014 portant répartition et gestion des revenus pétroliers. D’après cette loi, 65%
des revenus pétroliers devraient permettre de financer ces secteurs dont la santé qui occupe une place
importante. Depuis, d’autres engagements importants ont été pris :
La Politique nationale de santé 2016-2030 qui vise à améliorer la gouvernance du secteur de la santé
pour une plus grande efficacité dans la fourniture des services de santé ;
L’engagement du Tchad à l’initiative mondiale planification familiale 2020 ;
La Politique et normes des services en matière de planification au Tchad ;
L’Arrêté N° 218 /PR/MSP/DG/DSRV/2018 Portant création d’une Plateforme Technique de
Coordination et de Suivi des Interventions et des Intervenants dans le domaine de la Santé Reproductive,
Maternelle, Néonatale, Infantile, de I ‘Adolescent et de la Nutrition (SRMNIAN) ;
Un plan national de développement sanitaire (PNDS) 2018-2021 ;
Un plan stratégique de lutte contre la tuberculose 2018-2021 ;
Un plan national de lutte contre le paludisme 2016-2020 ;
L’adoption par l’Assemblée nationale de la loi sur la couverture sanitaire universelle.
36
République du Tchad : Examen Natonal Volontaire 2019
La bonne gouvernance du secteur de la santé ;
Accessibilité et qualité des soins sanitaires ;
Les pesanteurs socio-culturelles liées à la fréquentation des établissements
sanitaires.
Existence des facultés de médecine, des écoles publiques et privées de formation
sanitaire ;
Volonté politique manifestée par les réunions mensuelles de toutes les parties prenantes sous le leadership du Président de la république.
Les problèmes de santé liés à l’insécurité ;
Défis futurs, opportunités, et risques
DÉFIS FUTURS
OPPORTUNITÉS
RISQUES
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22
Au niveau national, les actions du Gouvernement pour l’atteinte de cet ODD sont traduites dans le cadre global du PND
2017-2021 et plus spécifquement dans les documents de politique sectorielle. Des progrès ont été enregistrés ces dernières
années grâce à la mise en place des Paquets Minimum d’Activités dans les centres de santé revitalisés et l’amélioration des
services dans les réseaux de formations sanitaires Soins Obstétricaux Néonatals d’Urgence.
SITUATION ET TENDANCES
Cible 3.1 - D’ici à 2030, faire passer le taux mondial de mortalité maternelle au-dessous de 70 pour 100 000
naissances vivantes
Indicateur 3.1.1 : Taux de mortalité maternelle
Le taux de mortalité maternel qui était l’un des plus élevé du monde a connu une baisse, passant de 1099 décès pour 100 000 naissances
vivantes en 2004 à 860 décès pour 100 000 naissances vivantes en 2015. Cette amélioration est loin de satisfaire les cibles que s’est fxées
le pays à l’horizon 2030.
Indicateur 3.1.2 : Proportion d’accouchements assistés par du personnel de santé qualifé
La proportion d’accouchements assistés par du personnel de santé qualifé a, quant à elle aussi, connu une nette amélioration en cinq
années. En 2015, elle était de 24,30% (EDS-MICS 2015) et a atteint 34,5% en 2019 (MICS). La proportion des accouchements dans un
établissement de santé a connu une légère amélioration entre 2015 (EDS-MICS). Elle était de 53% en milieu urbain et 14% en milieu rural
PERMETTRE À TOUS DE VIVRE EN BONNE SANTE ET PROMOUVOIR LE
BIEN-ETRE DE TOUS À TOUT AGE
République du Tchad Examen National Volontaire 2021
23
et 2019 (MICS) pour passer à 60,1% en milieu urbain et 21,1% en milieu rural.
Cible 3.2 - D’ici à 2030, éliminer les décès évitables de nouveau-nés et d’enfants de moins de 5 ans, tous
les pays devant chercher à ramener la mortalité néonatale à 12 pour 1 000 naissances vivantes au plus et la
mortalité des enfants de moins de 5 ans à 25 pour 1 000 naissances vivantes au plus
Indicateur 3.2.1 : Taux de mortalité des enfants de moins de 5 ans
En ce qui concerne le taux de mortalité des enfants de moins de cinq ans, le Tchad a connu une amélioration de 11 points de pourcentage
car il passe de 133‰ en 2015 à 122‰ en 2019.
Indicateur 3.2.2 : Taux de mortalité néonatale
Le taux de mortalité néonatale n’a presque pas bougé entre 2015 et 2019 où il était respectivement de 34‰ et 33‰. Cette situation
est probablement due à l’insuffsance de la prise en charge adéquate des femmes durant la grossesse, à l’accouchement et au post partum.
A cela on peut ajouter la prévalence de l’accouchement à domicile, 72,4% (MICS 2019). Cependant, l’introduction de la stratégie des
réseaux de formations sanitaires SONU qui a pour objectif de réduire la mortalité maternelle aura les mêmes effets sur la réduction de
la mortalité néonatale.
Cible 3.3 - D’ici à 2030, mettre fn à l’épidémie du SIDA, à la tuberculose, au paludisme et aux maladies tropicales
négligées et combattre l’hépatite, les maladies transmises par l’eau et autres maladies transmissibles
Indicateur 3.3.1 : Nombre de nouvelles infections à VIH pour 1 000 personnes séronégatives, par sexe, âge et appartenance à un
groupe de population à risque
L’incidence globale du VIH à partir de 2018 a diminué, passant de 0.49 en 2015 à 0.44 en 2018. Pour les femmes, elle est passée de 0,53
en 2015 à 0, 48 en 2018 (ONUSIDA).
Indicateur 3.3.2 : Incidence de la tuberculose pour 100 000 habitants
L’incidence de la tuberculose est en baisse passant de 113,17 cas en 2015 à 87,76 cas en 2018 pour 100 000 habitants soit une baisse
d’environ 25 points en 3 ans
Indicateur 3.3.3 : Incidence du paludisme pour 1 000 habitants
Le paludisme fait de plus en plus de victimes. En effet, l’on note une détérioration de l’incidence du paludisme qui passe de 58 cas en 2015
à 64,22 cas pour 1000 habitants en 2019.
Indicateur 3.3.4 : Incidence de l’hépatite B pour 100 000 habitants
L’incidence de l’hépatite B est en nette augmentation passant de 14 cas en 2015 à 15 cas pour 100 000 habitants en 2019.
Indicateur 3.3.5 : Nombre de personnes pour lesquelles des interventions contre les maladies tropicales négligées sont nécessaires
Le nombre de personnes pour lesquelles des interventions contre les maladies tropicales négligées sont nécessaires est en légère hausse,
passant de 6 138 675 habitants en 2016 à 6 233 571 en 2018, soit une progression annuelle moyenne de 31 000 personnes.
Cible 3.4 - D’ici à 2030, réduire d’un tiers, par la prévention et le traitement, le taux de mortalité prématurée
due à des maladies non transmissibles et promouvoir la santé mentale et le bien-être
République du Tchad Examen National Volontaire 2021
24
Indicateur 3.4.2 : Taux de mortalité par suicide
Au Tchad, le suicide est culturellement, religieusement et socialement rejeté. En 2015, le taux de mortalité par suicide est de 8,9 pour 100
000 habitants à 8,8% en 2019.
Cible 3.5 - Renforcer la prévention et le traitement de l’abus de substances psychoactives, notamment de
stupéfants et d’alcool
Indicateur 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
Au Tchad, l’abus d’alcool, défni en fonction du contexte national par la consommation d’alcool pur (en litre) par habitant (âgé de 15 ans
ou plus) au cours d’une année civile est en régression, passant de 1,5 litres/an/habitant en 2016 à 1,4 en 2018.
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
Indicateur 3.6.1 : Taux de mortalité lié aux accidents de la route
Le taux de mortalité lié aux accidents de la route a connu une augmentation de 3,5 points de pourcentage. Il est passé de 24,2 décès pour
100 000 habitants en 2013 à 27,6 de décès pour 100 000 habitants en 2018 .
Cible 3.7 - D’ici à 2030, assurer l’accès de tous à des services de soins de santé sexuelle et procréative, y
compris à des fns de planifcation familiale, d’information et d’éducation, et veiller à la prise en compte de la
santé procréative dans les stratégies et programmes nationaux
Indicateur 3.7.1 : Proportion de femmes en âge de procréer (15 à 49 ans) qui utilisent des méthodes modernes de planifcation
familiale
Sur la base des enquêtes (EDS-MICS 2014-2015 et MICS 6 2019), l’on note un progrès en matière de l’utilisation des moyens de
contraception modernes par les femmes en âge de procréer. Particulièrement pour les femmes en union, la proportion de celles utilisant
les méthodes modernes de contraception est passée de 5% en 2015 à 6,7%, soit une hausse de 1,7 point de pourcentage. En milieu urbain,
la proportion des femmes utilisant les méthodes contraceptives modernes a augmenté de 2,8 points de pourcentage entre 2015 et 2019.
En milieu rural, 5,4% de femmes utilisent les méthodes de contraception modernes en 2019, contre 3,8% en 2015.
Indicateur 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
Au Tchad, le taux de natalité chez les adolescentes (15 à 19 ans) a substantiellement baissé passant de 179,4 en 2015 à 138 en 2019 pour
1 000 adolescentes du même groupe d’âge.
Cible 3.8 - Faire en sorte que chacun bénéfcie d’une couverture sanitaire universelle, comprenant une
protection contre les risques fnanciers et donnant accès à des services de santé essentiels de qualité et à des
médicaments et vaccins essentiels sûrs, effcaces, de qualité et d’un coût abordable
Indicateur 3.8.1 : Couverture des services de santé essentiels (défnie comme la couverture moyenne des services essentiels telle que
déterminée par les 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)
République du Tchad Examen National Volontaire 2021
25
Les indicateurs d’utilisation des services de santé essentiels sont presque tous à des niveaux très faibles malgré des améliorations par
rapport aux années précédentes. Selon le rapport de suivi de l’OMS, l’indice de couverture universelle de santé au Tchad est de 27% en
2015 et de 28% en 2019.
Indicateur 3.8.2 : Proportion de la population consacrant une grande part de ses dépenses ou de ses revenus domestiques aux
services de soins de santé
L'accès aux services de santé est diffcile en raison des longues distances, du nombre limité de centres de santé, de la faiblesse numérique
du personnel de santé qualifé, de l'insuffsance des équipements médicaux et de la précarité économique surtout en milieu rural où vit
78% de la population du pays. Les populations nomades en particulier souffrent des conséquences d'un accès limité aux services de santé.
Au niveau national, la proportion de la population consacrant une grande part de ses dépenses ou de ses revenus domestiques aux
services de soins de santé a évolué en hausse passant de 3,5% en 2011 à 9,2 % en 2019. Selon le milieu de résidence, cette proportion
est respectivement de 3,3% en milieu rural et 3,7 en milieu urbain en 2011 contre 9, 9% en milieu rural et 9,7% milieu urbain en 2019
(ECOSIT 4).
Pour améliorer l’utilisation des services de santé, le gouvernement tchadien a institué la couverture santé universelle (CSU) avec
l’adoption de la Loi n°035 du 5 août 2019 enclenchant son processus de mise en place, notamment par l’installation des dispositifs de
coordination et de gestion de services de santé. Le Gouvernement tchadien envisage de démarrer la CSU dans un nombre limité de
districts sanitaires et l’étendre progressivement au reste du pays.
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
Indicateur 3.9.1 : Taux de mortalité attribuable à la pollution de l’air dans les habitations et à la pollution de l’air ambiant
Le taux de mortalité attribuable à la pollution de l’air dans les habitations et à la pollution de l’air ambiant pour 100 000 habitants est
en hausse. En 2015, ce taux est estimé à 121 décès pour 100 000 habitants alors qu’en 2019, il est de 280 décès pour 100 000 habitants
selon l’OMS.
Indicateur 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)
Selon l’observatoire de la santé mondiale, le taux de mortalité attribuable à l’insalubrité de l’eau, aux défciences du système
d’assainissement et au manque d’hygiène est estimé à 101 décès pour 100 000 habitants en 2016.
Indicateur 3.9.3 : Taux de mortalité attribuable à un empoisonnement accidentel
Selon l’observatoire de la santé mondiale de l’OMS, le taux de mortalité attribuable à un empoisonnement accidentel est de 3,6 pour
100 000 en 2016.
Cible 3.a : Renforcer dans tous les pays, selon qu’il convient, l’application de la Convention-cadre de
l’Organisation Mondiale de la Santé pour la lutte antitabac
République du Tchad Examen National Volontaire 2021
26
Indicateur 3.a.1 : Prévalence de la consommation actuelle de tabac chez les personnes de 15 ans ou plus (taux comparatifs par âge)
Selon le rapport EDS-MICS 2014-2015, on observe que 13% des hommes de plus de 15 ans et 3% des femmes de plus de 15 ans consommaient
du tabac. Les hommes consomment environ cinq fois plus de tabac que les femmes. En 2019, la prévalence de la consommation actuelle de
tabac chez les hommes de plus de 15 ans est de 7,2% tandis que chez les femmes, elle est de 0,4%. Ces indicateurs montrent clairement qu’il
y a diminution de la consommation du tabac au Tchad.
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 réaffrme 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
Indicateur 3.b.1 : Proportion de la population cible ayant reçu tous les vaccins prévus par le programme national
La couverture vaccinale est faible, aucun type d’antigène n’a atteint la cible de 80% fxée par le Programme Elargi de Vaccination. Les
vaccinations contre la polio et la tuberculose (BCG) semblent être les mieux administrées. En 2015, cet indicateur était de 25,3%.
Indicateur 3.b.2 : Montant total net de l’aide publique au développement consacré à la recherche médicale et aux soins de santé de base
Le montant total net de l’aide publique au développement consacré à la recherche médicale et aux soins de santé de base est passé de 21,6
millions de dollars américain en 2018 à 49,4 millions de dollars américain en 2019. Ce qui montre que l’aide au développement a plus que
doublé en une année.
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
Indicateur 3.c.1 : Densité et répartition du personnel de santé
En ce qui concerne la densité et la répartition du personnel médical par habitant, il y a une grande disparité entre la capitale, les grandes
villes et le milieu rural. La plupart des spécialistes sont concentrés à la capitale. La situation semble identique pour les sages-femmes qui
se concentrent dans la capitale à cause du regroupement familial. On dénombre un médecin pour 19 641 habitants en 2015 contre 28 401
habitants en 2018 et un infrmier pour 3 837 habitants en 2015 contre 5 092 habitants en 2019.
Cible 3.d : Renforcer les moyens dont disposent tous les pays, en particulier les pays en développement, en
matière d’alerte rapide, de réduction des risques et de gestion des risques sanitaires nationaux et mondiaux
Indicateur 3.d.1 : Application du Règlement sanitaire international (RSI) et préparation aux urgences sanitaires
En ce qui concerne l’application du Règlement Sanitaire International (RSI) et la préparation aux urgences sanitaires, le Tchad a adhéré à
40,5% en 2015 et en 2019 l’adhésion est seulement de 30,3%, soit une baisse de 10 points de pourcentage.
République du Tchad Examen National Volontaire 2021
27
DÉFIS ET OPPORTUNITÉS
Défs :
•La gouvernance du secteur de la santé ;
•L’accessibilité et l’offre de services de santé de qualité ;
•La fréquentation des établissements sanitaires ;
•Le fnancement du secteur de la santé ;
•La disponibilité de données fables et à jour.
Opportunités :
• L’existence des facultés de médecine, des écoles publiques et privées de formation sanitaire ;
• L’existence du décret d’application N° 2021/PR/2020 du 14 octobre 2020 de la Loi 006/PR/2002 sur la
Santé de la Reproduction ;
• L’engagement du Tchad à l’initiative Family Planning 2030 ;
• L’existence d’une Unité de Gestion des Projets centralisée au sein du Ministère ;
• Le Plan National de Développement de la Santé (PNDS 2018-2021),
• La Politique Nationale de la Santé (PNS 2016-2030),
• La Stratégie de Communication en Appui aux Actions de Promotion de la Santé Maternelle, Néonatale et
Infantile au Tchad 2015-2030 ;
• Le Plan National d’Accélération de la Riposte au VIH/SIDA Pédiatrique au Tchad (2019-2023) ;
• Le Plan d’Action Intersectoriel de Nutrition et d’Alimentation (PAINA 2017-2021).
Actions
d’accélération
• La mise en place du réseau des 109 maternités de référence Soins obstétricaux néonatals d’urgence
(SONU) ;
• L’élaboration de la carte sanitaire 2019-2025 avec notamment la projection des dépenses d’investissement
(construction des formations sanitaires, équipement, approvisionnement en produits, Ressource Humaine et
•Agent de Santé Communautaire, chaine de froid) ;
• L’adoption d’un plan de démarrage du régime 3 des personnes économiquement démunies ;
• L’amélioration de la gouvernance et de la redevabilité ;
• La création d’une plateforme Santé Maternelle Néonatale Infantile ;
• L’accélération du processus de mise en place de la CSU ;
• L’élaboration d’une Stratégie Nationale de Financement de la Santé ;
• L’intégration de la planifcation familiale dans les programmes de santé sexuelle et reproductive ;
•L’intensifcation des interventions du côté de la demande y compris chez les jeunes et adolescents.
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[
3
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"file_id": "sdg-03/vnr-report-tcd-2021-fr-3.pdf",
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|
High-Level Political Forum on Sustainable Development 25
4.3-SDG3: Ensure healthy lives and promote wellbeing for all at all ages
It is the Government’s vision to ensure a
performing, accessible and equitable health
system able to give meaning to the right to
access health services for all, especially for the
vulnerable groups.
With an average of 50% households caring
for themselves, health facilities are hardly
patronised due to lack of access. Faced with
the challenge of inclusion, the government has,
in 2011, initiated a comprehensive reform in
health fnancing which led to the establishment
of a mandatory national health insurance
scheme. However, there are more rooms for
improvement to guarantee universal access to
quality and free health services especially for
the poor and the vulnerable.
The National Health Development Plan (PNDS
2017-2022) has projected the overall cost, for
fnancing the health sector, between 90 to 100
billion CFA Francs by 2019 and estimates the
state’s participation at 47%.
In order to improve the health condition of the
people, interventions are not only limited to the
reduction in maternal, neonatal and infant and
child mortalities, malaria, the HIV/AIDS and
other communicable and non-communicable
diseases but also to improve on the health
conditions of the aged.
With respect to the fght against maternal and
neonatal mortality, the proportion of pregnant
women having completed at least 4 antenatal
consultations including urine test moved
from 54.9% in 2010 to 25.3% in 2015. The
proportion of HIV/AIDS positive pregnant
women receiving antiretroviral (ARV) for the
prevention of mother-to-child transmission
has increased moving from 52.2% in 2010 to
90.0% in 2015.
In order to end maternal mortality, the
government has instituted a campaign
(CARMMA) to accelerate the process and
has taken measures to subsidise caesarean
sessions with the kit costing 10,000 CFA
Francs (approximately 20 USD). The maternal
mortality rate is 400 deaths for every 100,000
live births in 2015.
There has been some progress in the fght
against HIV/AIDS, malaria and other diseases.
The HIV/AIDS prevalence rate among sexually
active population has moved from 2.5% in 2014
to 2.5% in 2015. Concerning the fght against
malaria, the number of deaths due to malaria
has decreased by 6% in 2015 (1,127 deaths in
2015 as against 1,205 in 2014).
For infant mortality, analysis shows that the fght
against infant and child mortality has not yielded
much results between 2013 and 2015. As a matter
26 High-Level Political Forum on Sustainable Development
fact, there is a decrease in the number of children
between the ages of 12 and 13 months receiving
3 pentavalent doses. The fgure has moved from
92% in 2011 to 87.5% in 2015.
The rate of contraceptive use, the percentage of
women of reproductive age (15-49 years) using
modern contraceptives has moved from 27.9%
in 2010 to 18% in 2015.
The quest for providing equitable access to
quality health services, led to the implementation
of several innovative strategies such as the
training of community health assistants for
proximity care and monitoring. There has
been a signifcant improvement (40% in 2011
and 45.4% in 2015) in the number of rural
communities having the community health
assistants providing health care for diarrhoea,
pneumonia, and malaria.
To ensure a universal access to preventive and
curative services, 174 trainings sessions were
organised from 2013 to 2015. A total number
of 1,386 qualifed community health assistants
were recruited, trained and deployed on the feld.
Moreover, the capacities of the departments in
charge of community health were strengthened in
2016 to include the services of caring for the aged.
From 2016 to 2016, budgetary allocation for the
health sector has experienced a slight increment
moving from 44.96 billion to 51.48 billion.
However, a lot must to be done in terms of
access to essential care of quality and the
sustained provision of quality health services.
The challenges to be met among other things
are : (i) decentralisation of health services ;
(ii) reduction of inequalities among regions and
within regions and social categories in terms
of the provision and access to health services ;
(iii) inequality in the geographical distribution
of human resources ; (iv) limited health trainings
sessions, (v) insuffciency of fnancing allocated
to the health sector and (vi) improvement in the
management of health facilities.
The national health policy defnes strategic
orientations aiming at achieving the following :
(i) acceleration in the reduction of maternal
neonatal and child mortalities and strengthening
of family planning and adolescent health ;
(ii)strengtheningthefghtagainstcommunicable
and non-communicable diseases and the
promotion of good health ; (iii) improvement
of health security and response to epidemics
and other public health emergencies ; and (iv)
beefng up the health system for increased
universal access including community health.
|
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{
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"file_id": "sdg-03/vnr-report-tgo-2017-en-3.pdf",
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}
|
Forum Politique de Haut Niveau sur le Développement Durable 25
4.3-ODD3 : Donner aux individus les moyens de vivre une vie saine et promouvoir
le bien-être de tous à tous les âges
La vision du gouvernement est d’asseoir un
système de santé performant, accessible et
équitable, capable de satisfaire le droit à la santé
pour tous, en particulier en faveur des couches
les plus vulnérables.
Pris en charge à plus de 50 % en moyenne
par les ménages eux-mêmes, les services de
santé demeurent faiblement utilisés faute
d’accessibilité. Face au déf de l’inclusion, le
gouvernement a initié en 2011 une importante
réforme dans le fnancement de la santé qui a
abouti à l’instauration d’un régime obligatoire
d’assurance maladie. Mais du chemin reste
encore à parcourir pour garantir l’accès de tous, y
compris les personnes les plus pauvres et les plus
vulnérables, à des services de santé de qualité,
sans risque de diffcultés fnancières et, au-delà,
pour amener la population togolaise à un état de
santé optimal.
Le Plan national de développement sanitaire
(PNDS 2017-2022) évalue les besoins globaux
de fnancement du secteur de la santé dans une
fourchette allant de 90 à 100 milliards de FCFA
d’ici à 2019 selon les scénarios envisagés, et fait
porter la part de l’Etat dans le fnancement de la
santé à 47 %.
Pour améliorer la santé de la population, les
actions du gouvernement ont permis non
seulement de réduire la mortalité maternelle,
néonatale, infanto-juvénile, le paludisme, la
prévalence du VIH/sida et d’autres maladies
(transmissibles et non transmissibles) mais aussi
d’améliorer la santé des personnes âgées.
En ce qui concerne la lutte contre la mortalité
maternelle et néonatale, la proportion de femmes
enceintes ayant accompli au moins 4 visites de
consultation prénatale incluant le test d’urine est
passée de 54,9% en 2010 à 25,3% en 2015. La
proportion de femmes enceintes séropositives
qui reçoivent des anti-retro-viraux (ARV) pour la
prévention, transmission mère-enfant (PTME) a
progressé passant de 52,2% en 2010 à 90,0% en
2015.
Pour venir à bout de la mortalité maternelle,
le gouvernement a mis en œuvre la campagne
pour l’accélération de la réduction de mortalité
maternelle (CARMMA) et a pris de mesures pour
rendre effective la subvention de la césarienne
dont le kit coûte désormais 10 000 FCFA (environ
20 dollars US). Le taux de mortalité maternelle est
de 400 pour 100 000 naissances vivantes en 2015.
Dans le cadre de la lutte contre le VIH/sida, le
paludisme et d’autres maladies, des progrès ont
été réalisés. Le taux de prévalence du VIH/sida
parmi la population sexuellement active est passé
de 2,5% en 2014 à 2,2% en 2015. En matière de
lutte contre le paludisme, le nombre de décès liés
au paludisme a diminué de 6% en 2015 (1127
décès en 2015 contre 1205 en 2014).
Dans le cadre de la santé infantile, l’analyse des
données permet de constater que la lutte contre la
mortalité infantile et infanto-juvénile s’est un peu
dégradée entre 2013-2015. En effet, on note une
régression de la proportion des enfants de 12-23 mois
ayant reçu les 3 doses de pentavalent. Leur proportion
est passée de 92% en 2011 à 87,5% en 2015.
26 Forum Politique de Haut Niveau sur le Développement Durable
En ce qui le concerne le taux d’utilisation des
méthodes contraceptives, le pourcentage de
femmes en âge de procréer (15-49 ans) utilisant
des méthodes contraceptives modernes est passé
de 27,9% en 2010 à 18% en 2015.
Le souci d’assurer un accès équitable des
populations aux services de santé a été à l’origine
de la mise en œuvre des stratégies novatrices
en l’occurrence la formation d’agent de santé
communautaire (ASC) pour des soins et un suivi de
proximité. En termes de villages ruraux disposant
d’un ASC formé sur les soins intégrés de diarrhée,
pneumonie, paludisme, on note une avancée non
négligeable (40% en 2011 et 45,4% en 2015).
Pour permettre un accès universel aux services
préventifs et curatifs, 174 formations sanitaires
ont été construites ou réhabilitées sur la période de
2013-2015 ; 1386 agents de santé qualifés ont été
recrutés et déployés sur le terrain. Par ailleurs, la
division de la santé communautaire a été renforcée
en 2016 pour s’occuper de la santé des personnes
âgées. Le budget de la santé a connu de légères
progressions entre 2013 et 2016 passant de 44,96
milliards à 51,48 milliards.
Toutefois, des efforts restent à faire en
matière d’accès des populations aux soins
essentiels de qualité et à l’utilisation continue
des services de santé.
Les défs à relever sont entre autres : (i) la
déconcentration des services de santé ; (ii) la
réduction des inégalités entre les régions et à
l’intérieur des régions et les catégories sociales
en matière d’offre et d’accès aux services
de santé ; (iii) l’iniquité dans la répartition
géographique des ressources humaines ; (iv) la
faible fréquentation des formations sanitaires,
(v) l’insuffsance du fnancement accordé au
système de santé et (vi) l’amélioration de la
gestion des structures de santé.
La politique nationale de santé défnit des
orientations stratégiques permettant l’atteinte des
résultats suivants : (i) accélération de la réduction
de la mortalité maternelle, néonatale et infantojuvénile et renforcement de la planifcation
familiale et de la santé des adolescents ;
(ii) renforcement de la lutte contre les maladies
transmissibles et non-transmissibles et promotion
de la santé ; (iii) amélioration de la sécurité
sanitaire et la réponse aux épidémies et autres
urgences de santé publique ; et (iv) renforcement
du système de santé vers la couverture sanitaire
universelle y compris la santé communautaire.
|
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{
"country": "tgo",
"file_id": "sdg-03/vnr-report-tgo-2017-fr-3.pdf",
"language": "fr",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2017
}
|
30
6.3. Objectif 3 : Permettre à tous de vivre en bonne santé et promouvoir le bien-être de
tous à tout âge
Le Gouvernement ambitionne de garantir la santé pour tous à travers la mise en place de
la couverture santé universelle et l’exécution d’un plan de réponse aux urgences sanitaires.
Dans cette optique, il a été élaboré en 2017, le Plan national de développement sanitaire
(PNDS) 2017-2022 en vue de renforcer l’accessibilité des communautés aux services de
santé essentiels.
En outre, le Togo a procédé au lancement de plusieurs projets et programmes dont le
programme présidentiel de protection sociale en milieu scolaire au Togo (School Assur) en
2017, le projet services de santé essentiels de qualité pour la couverture universelle (SSEQCU)
en 2020, le Projet de mécanisme d’assurance maladie du secteur informel et de prise en
charge des nécessiteux (PMAMSIN) en 2021, le Programme national d’accompagnement
de la femme enceinte et du nouveau-né (PNAFE) dénommé « Wezou » en 2021. Il a été
également procédé à la révision de la cartographie des formations sanitaires SONU19
en 2020, à l’adoption de la loi sur l’assurance maladie en 2021 et à la réalisation en 2022
de l’opération zéro cataracte qui a permis de consulter et de prendre en charge 46 400
personnes sur toute l’étendue du territoire national.
Les actions du Gouvernement ont permis de réduire sensiblement la létalité maternelle de
causes obstétricales directes dans les formations sanitaires (FS) de 1,74% en 2019 à 1,30%
en 202020 tout comme en 2021. De même, la Surveillance des décès maternels et néonatals
et la riposte (SDMNR) a permis d’enregistrer 310 décès maternels dont 190 notifiés (61,29%)
parmi lesquels 130 ont fait objet d’une revue (68,42%) contre 354 décès maternels dont 225
notifiés (63,56%) parmi lesquels 126 ont fait l’objet de revues (56%) en 2020 pour une cible
de 64% de revue en 2021. Ces taux de revue étaient de 34,40% en 2019 et 30,15% en 201821.
Le taux d’accouchement assisté par un personnel qualifié a régressé entre 2020 et 2021
passant de 65,10% en 2020 à 62,4% en 2021 pour une cible de 69,1% du Plan national de
développement sanitaire (PNDS). Il faut noter que les accouchements à domicile sont par
contre en baisse (6 974) soit 3,66% contre 4,45% en 2020 et 4,5% en 2019.
Les couvertures vaccinales ont connu une amélioration en 2021 comparativement aux
résultats de 2020. La couverture du DTD-HepB-Hib 3 est passée de 89% en 2020 à 90% en
2021. Celle du vaccin RR1 est passée de 83% en 2020 à 84% en 2021.
19 Soins obstétricaux et néonatals d’urgence
20 Rapport de performances du MSHPAUS 2020
21 Rapport de performance 2020 du ministère de la santé, de l’hygiène publique et de l’accès universel aux soins
TOGO: FORUM POLITIQUE DE HAUT NIVEAU SUR LE DEVELOPPEMENT DURABLE 31
Par rapport aux maladies transmissibles, la proportion des Personnes vivant avec le VIH (PVVIH)
qui reçoit un traitement ARV est passée de 64% en 2018 à 77% en 2021. Le pourcentage de
femmes séropositives ayant reçu les ARV pour réduire le risque de transmission du VIH de
la mère à l’enfant est de 67,54% (3 565 sur 5 278) en 2021 contre 63,63% en 2020 pour une
cible de 98,30%. En 2021, 81 238 PVVIH dont 4 292 enfants et 76 946 adultes sont inscrites
aux soins et régulièrement suivies dans les structures de prise en charge. Ainsi, la proportion
de PVVIH sous ARV dont on sait qu’elles sont toujours en vie à 12 mois après le début du
traitement est passée de 91% en 2017 à 89,50% en 2020 pour une cible de 94% ; il s’agit d’un
indicateur d’enquête. Le nombre global de PVVIH mises sous ARV en 2021 est de 81 123.
Le Togo continue d’enregistrer une baisse de nouvelles infections (-52% de 2010 à 2020) et
de décès liés au VIH (-54% de 2010 à 2020). La prévalence moyenne du VIH est passée de
2,5% dans la population générale âgée de 15 – 49 ans en 2014 (EDST III 2013-2014) à 1,8%22
en 2021.
Le pourcentage de femmes enceintes ayant reçu trois doses de Sulfadoxine-pyriméthamine
pour le traitement préventif intermittent (TPI 3) pendant la grossesse a progressé de 49,44%
en 2019 à 51,5% en 2020, et 58% en 2021.
La létalité des enfants de moins de 5 ans hospitalisés pour le paludisme est de 2,5% en 2021
contre 3,2% en 2020. Ce taux était de 3,5% en 2018 et de 4,01% en 2019.
Le pourcentage de nouveaux cas de tuberculose confirmés bactériologiquement traités avec
succès est de 84,93% en 2021 (1 669 sur 1 965) contre 86,44% en 2020. Cette valeur était de
82,48% en 2019.
La couverture des maladies tropicales négligées (MTN) est de 85,36% en 2021 contre 83,62%
en 2020 et 82,50% en 2019.
Le pourcentage de personnes vivant avec un handicap pris en charge en réadaptation
physique a progressé de 64,64% en 2019 à 70,61% en 2020 puis à 79,83% en 2021.
Le pourcentage de structures de santé primaires o"rant le paquet essentiel d’interventions
pour la prise en charge intégrée des MTN (WHOPEN) est passé de 25,70% en 2019 à 36,01%
en 2020 puis à 41,48% en 2021. Cette performance pourrait s’expliquer par le renforcement
des capacités des prestataires dans les formations sanitaires sur la prise en charge intégrée
des MTN.
Concernant la couverture santé universelle, on peut noter la réhabilitation et l’extension
de certaines formations sanitaires (FS) existantes faisant passer le nombre de formations
sanitaires de 1 297 en 2019 à 1 320 selon les résultats de la mise à jour de la carte sanitaire
réalisée en 2021. La proportion de villages éloignés d’un centre de santé qui disposent d’un
agent de santé communautaire (ASC) formé sur les soins intégrés (diarrhée, pneumonie et
paludisme) ou Prise en charge intégrée des maladies du nouveau-né et de l’enfant (PCIMNE)
communautaire est passée de 71,90% en 2019 à 79,84% en 2020. Dans le cadre de la mise en
œuvre du PUDC, plus de 2,7 millions de Togolais répartis dans près de 2 675 villages vivant
à plus de 15 km des infrastructures sanitaires ont eu accès à des services de santé de qualité
grâce au déploiement des cliniques mobiles dans toutes les régions du pays. Toutefois, le
taux d’accessibilité géographique des populations aux services de santé est passé de 71,4%
en 2017 à 76,45% en 2020.
22 Rapport ONUSIDA 2020
32
Equipements de prise en charges des cas graves de Covid19 dans le cadre du renforcement du CHR LoméCommune
En ce qui concerne les besoins non satisfaits en concentrés de globules rouges (CGR),
leur proportion est passée de 25,96% en 2019 à 20,53% en 2020 et à 26% en 2021. Cette
régression est liée à une légère baisse de la production notamment au Centre national de
transfusion sanguine (CNTS) avec le maintien de la suspension des collectes mobiles dans
les établissements d’enseignement, combinée à une adaptation de l’activité hospitalières à
la pandémie de Covid-19 ayant fait augmenter les besoins des hôpitaux en produits sanguins
en 2021 par rapport à 2020.
La densité cumulée du personnel traceur du secteur public (médecins, infirmiers, sagesfemmes, techniciens supérieurs de santé) est de 8,41 personnels23 pour 10 000 habitants en
2021 contre 8,24 en 2020 et 7,01 en 2019.
En perspective, le Gouvernement entend faire en sorte que 95% de la population soit à moins
de 5 km/45 mn d’un centre de soins et couvrir les besoins en personnel à 95%, avec pour
objectif de porter la couverture santé universelle de la population à 60% d’ici à 2025. Pour
ce faire, il compte, entre autres, construire 200 unités de soins périphériques ; recenser la
population éligible à la couverture maladie universelle ; établir un plan de gestion de la chaîne
d’approvisionnement en médicaments et produits essentiels pour assurer la disponibilité
d’un panier de médicaments essentiels au dernier kilomètre ; moderniser l’équipement des
hôpitaux et unités de soins périphériques déjà en place et recruter le personnel de santé
nécessaire.
|
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3
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{
"country": "tgo",
"file_id": "sdg-03/vnr-report-tgo-2022-fr-3.pdf",
"language": "fr",
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"size": "l",
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}
|
-13-
Goal 3 Ensure healthy lives and promote well-being for all at all ages
Thailand has progressed considerably in its implementation in achieving
SDG 3. According to the World Bank, the percentage of babies delivered with
assistance of qualified professionals is as high as 99.6 per cent. According to the
Ministry of Public Health, in 2015, the maternal mortality ratio (MMR) is 24.6
maternal deaths per 100,000 live births, and the Infant Mortality Rate (IMR)
and the under-five mortality rate are at 3.5 and 8.6 per 1000 live births,
respectively. In addition, UNAIDS estimated in the year 2014 that the population
rates, per 100,000 people, of new HIV infections ranged from just 0.06 – 0.16
people. In 2016, the World Health Organization (WHO) recognized Thailand as the
first country in Asia and the second country in the world to eliminate the mother-tochild transmission of HIV and syphilis. WHO also has reported a ratio of 171
tuberculosis cases per 100,000 people and a ratio of 37.9 malaria cases per 1,000
people, which were considered decreasing continuously. Nevertheless, it is estimated
that there are many patients with chronic hepatitis B and C. The exact number of the
-14-
patients is still being processed but it is estimated to be more than two million
people.
As for non-communicable diseases and mental health and well-being
supports, WHO has estimated that the death rate from cardiovascular disease,
cancer, diabetes and chronic respiratory diseases in Thai people aged between 30
and 70 is 16.16 per 100,000 people. The suicide rate is 13.08 per 100,000
population. Access to mental health support services for Thais aged 15 years or over
who suffered depression tends to be higher; persons at risk who should be screened
for depression are, for instance, patients with chronic diseases, elderly patients,
women during pregnancy or after delivery, alcoholics and drug addicts. Apart from
this, alcoholics and drug addicts can access comprehensive treatments, both
voluntarily and mandatory: medication, mental health treatments and
rehabilitation and follow-up cares. The statistic of drug addicted patients who stop
using drug for 3 months continuously after the treatment is currently at 88.90 per
cent and tends to increase.
The Ministry of Public Health has implemented action plans to develop the
quality of health services to be provided to citizens, such as the maternal health
care policy which provides quality pregnancy starting with a 5-time antenatal care
to ensure pregnancy quality, setting up plans for quality delivery room and offering
3 times follow-up care after delivery. The infant care policy and the maternal health
care policy provides knowledge to the mother on how to take care of herself during
pregnancy, and how to properly take care of her child after delivery. Apart from that,
health care services have continuously been improved, so that Thailand’s overall
public health care services are globally recognized. SEP has been used as an
implementation approach, for instance, by focusing on preventing and controlling
the spread of diseases and providing health care services to people, all of which
helps lower the nation's treatment cost in the long run. The health care services,
focusing on taking care of one's health, eating properly, exercising, sharing health
care knowledge to people so that they know how to properly take care of
themselves, will also enhance people's physical well-being. Also, the universal
health coverage policy with a focus on prevention will help reduce the nation's
budget in terms of health services and treatments.
Since 2002, all citizens have their rights to health insurance which is a part
of the Universal Health Coverage Service. According to the National Statistical
Office’s survey on the economic and social conditions in households in 2013, the
occurrence of the households indicated as low-income households after paying
for their health treatment was just 0.47 per cent of all households. Moreover,
Thailand also provides health insurance for both documented and
undocumented migrant workers including their dependents, along with a migrant
health volunteer program. The migrant health volunteers are not only interpreters in
health facilities but also provide health knowledge and help inform migrant
communities on their rights and on hygiene and sanitation.
Thai people are capable of accessing necessary and safe medicine and
vaccines. For example, 90.3-100 per cent have received doses of EPI program
vaccine, 78.47 per cent of all targets have received influenza vaccines, 79.89 per
-15-
cent of registered HIV-infected and AIDs patients have access to antiviral drugs,
72.33 per cent of acute myocardial infarction patients, STEMI type, have access to
anticoagulants and/or Primary PCI, and 4.19 per cent of stroke patients have access
to anticoagulants. Thailand considers vaccines as one of the most effective means to
prevent people from diseases, however, the process of developing and producing
vaccines requires high-technology tools and an adequately large amount of budget.
As a consequence, a developing country like Thailand still has few domestically
produced vaccines, moreover, limited budget and other obstacles to buy vaccines
make Thailand face the problems of vaccines in delay and vaccine shortages, both in
normal circumstances and in emergencies, causing low vaccine security. Thailand is
not yet ready to develop and research new medicines. Most domestic pharmaceutical
industries produce generic drugs and are facing difficulties from international
agreements which affects the replacement of generic drugs with original drugs
through monopolizing of the market, and the need to rely on overseas ingredients.
Original drugs that are developed from overseas tend to be more expensive while
implementing a price control mechanism in accordance with the country’s rights as
provided for in the Doha Declaration are still limited.
Apart from diseases, air, water and soil pollution also affect human
health. WHO reported that Thai people died from air pollution in the ratio of 6.48
per 100,000 people in 2013, from chemical hazards, water pollution, and soil
pollution in the ratio of 1.87 per 100,000 people in 2012 and from receiving toxics in
the surroundings at the rate of 0.15 per 100,000 people in 2012. However, tobacco
smoke pollution is more harmful to people's health than air pollution. Therefore, in
order to support the WHO Framework Convention on Tobacco Control (WHO
FCTC), the Royal Thai Government has enacted Tobacco Control Act, combining
the Tobacco Control Act and the Health Care Act for non-smokers and set up
systematic rules in order to appropriately and effectively control tobacco products.
The Act indicates that the lowest age of the tobacco consumer should be 20 instead
of 18 and prohibits tobacco advertising which persuades tobacco consumption.
According to a survey in 2011, the percentage of smokers who are 15-year-old and
over was still around 20.7 per cent.
Despite Thailand's considerable progress in launching the Universal Health
Coverage, there are still some challenges, including family planning. According to a
survey in 2014, birth control in women of reproductive age, 15-49 years old was
89.2 per cent but the rate of teenage pregnancy at 15-19 years old was as high as
47.9 per 1,000 teenage women. The ratio tends to decrease merely slightly. Teenage
pregnancy affects the well-being of individuals, families, communities and society as
well as the overall economy. Therefore, Thailand has enacted the Act for
Prevention and Solution of the Adolescent Pregnancy Problem 2016 as a
mechanism to shape policies and strategies and promote collaboration among all
concerned authorities, including public and private sectors and civil society, in order
to integrate effective methods of prevention and solutions in tackling teenage
pregnancy problems in a more united, concrete, and efficient way.
Another significant challenge falls upon traffic road accidents. The rate of
deaths due to traffic road accidents was 22.3 per 100,000 people in 2015, which
-16-
ranked second highest in the world. This has led the Royal Thai Government to
revise and enforce road safety laws to help drivers to use the road more properly and
to reduce accidents, injuries and deaths, as well as launched a series of campaign to
create awareness and promote proper behaviors by focusing on eliminating risks
such as speed, drunk driving, wearing safety helmets and safety belts.
Case study: Nong Muang Khai Hospital, Phrae Province
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
Dr. Somsak Soloslikit, Director of Nong Muang Khai Hospital, has adopted
SEP and Buddhist principles in hospital management to create a self-sufficiency
hospital. These principles led to reducing chemicals used, improving wastewater
treatment system and soil quality and using a large vacant area of the hospital to
grow trees and organic vegetables. The hospital has formulated its vision as a “selfsufficient hospital with quality and friendly services for a healthy community”. It
provides holistic and integrated health services which cover quality, prevention,
treatment and rehabilitation. The hospital adheres to good governance and educates
its staff in terms of knowledge, skills and an organizational culture, which will help
improve health services, as well as enhance community and health network
contribution to a sustainable healthy society. In addition, the hospital also educates
communities on organic agriculture, safe and clean food consumption, exercise for
good health and health promotion. As such, it focuses on prevention rather than
treatment to reduce the number of patients who would come to the hospital for
health services, allowing people to have good physical and mental health, happiness
and live longer. Activities undertaken by the hospital use knowledge and virtues
based on a middle path and mindfulness, the principles of moderation,
reasonableness and prudence. Therefore, the hospital has been approved as a “health
service learning center based on a Sufficiency Economy Philosophy approach.”
|
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[
3
] |
{
"country": "tha",
"file_id": "sdg-03/vnr-report-tha-2017-en-5.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2017
}
|
- vi -
Goal 3: Universal Health Coverage (UHC) has been a crucial factor in the
improvement of healthcare service in Thailand with current coverage stands at 99.87
per cent. We also attach great importance to preventive medicine. As a result,
maternal and neonatal mortality rates are well below the global targets thanks to
99.6 per cent of birth attended by skilled health personnel. New cases of pandemic
diseases are also on the decline. The government is determined to reduce the
number of road traffic accident through legal measures and promoting safe driving
behavior to bring down the second most cause of death.
|
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3
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{
"country": "tha",
"file_id": "sdg-03/vnr-report-tha-2017-en-6.pdf",
"language": "en",
"locality": null,
"size": "s",
"type": "vnr",
"year": 2017
}
|
- 19 -
Goal 3
Ensure healthy lives and promote well-being for all at all ages
Overview
Thailand’s effective management of the COVID-19 crisis since 2020 is a concrete
example of the country’s success in responding to a new emerging disease. This in turn has
highlighted the strength of Thailand’s public health system and universal health coverage
(UHC). In this regard, Thailand was commended in 2019 for the readiness of its public health
system and capacity in handling new emerging diseases, and was ranked 6th in the world and 1st
in Asia in the same year.
Thailand has achieved several of the targets included under SDG3. In 2019, the
mortality rate of new mothers consisted of 22.5 deaths per 100,000 births3
. Moreover, the death
rate for new-born babies comprised 5.6 deaths per 1,000 births and the death rate of children
under the age of 5 stood at 7.9 deaths per 1,000 children4. The proportion of prospective
mothers who received antenatal care from qualified medical professionals at least once was
98.6 per cent. Furthermore, the number of AIDS and malaria patients in Thailand has remained
stable, standing at 0.08 and 0.01 respectively in 2020. The number of patients suffering from
drug addiction who have had to seek treatment in rehabilitation facilities has been reduced from
48.57 per cent of the total patients in 2018 to 43.53 per cent in 2020.
The country issued the National Health Security Act in 2002, and has committed itself
to improving the effectiveness of its universal health coverage in terms of health services
provided, protection against various diseases, quality patient care, and comprehensive patient
recovery. This has elevated the country’s UHC service coverage index score from 75 per cent
in 2015 to 80 per cent in 2018. As such, Thailand currently has the highest coverage in
Southeast Asia. In addition, only 2.2 per cent of all households pay medical costs that are more
than 10 per cent of all household costs. This is a result of comprehensive universal health
coverage and a low rate of unmet healthcare needs within the country. The percentage of
patients who have not had their medical needs met in the country stand at 1.4 per cent for
outpatients and 0.4 per cent for in-patients.
However, Thailand still faces particular challenges in terms of premature loss of life,
including increasing death rates from tuberculosis, road accidents, 4 non-communicable
diseases (heart disease, cancer, diabetes, and respiratory diseases), and suicide. With regards to
tuberculosis, the infection rate remains at 150 cases per 100,000 people, with a fatality rate of
11,000 in 2019. This is a rate that must be reduced by 90 per cent within 2030. In terms of road
accidents, the fatality rate remains at 30.36 deaths per 100,000 people5
. Both issues represent a
key challenge for Thailand. In 2019, the fatality rate from cardiovascular diseases stood at 43.7
per cent, 25.3 per cent from diabetes, and 14.0 per cent for respiratory diseases per 100,000
people6
. The suicide rate was at 6.64 per 100,000 people7
. The main cause of death for Thais,
however, has been cancer. Statistics from the World Health Organisation show 114,199 deaths
from cancer in Thailand in 2018.
3 Target 3.1 prescribed the reduction of global maternal mortality ratio to less than 70 per 100,000 live births by
2030.
4 Target 3.2 prescribed the reduction of neonatal mortality rate to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per 1,000 live births by 2030. 5 In 2018, the fatality rate stood at 25.2 deaths per 100,000 people. 6 In 2018, the fatality rate from cardiovascular diseases stood at 39.4 per cent, 120.3 per cent from cancer, 21.9
per cent from diabetes, and 13.9 per cent for respiratory diseases per 100,000 people. 7 In 2018, the suicide death was at 6.31 per 100,000 people.
- 20 -
Regarding drug and alcohol addiction, the number of drug addiction patients who
entered rehabilitation facilities dropped from 48.57 per cent in 2018 to 43.53 per cent in 2020.
Alcohol consumption per adult population comprised 8.3 litres per person per year,
representing higher consumption than the target of 6.40 litres per person per year set in 2015.
In addition, Thailand still experiences health risks from pollution. The main pollution
risks stem from PM2.5 particles, PM10 particles, and ozone gases, which continue to increase
beyond the standard amount. This is also exacerbated by water pollution risks in the main
rivers and still water sources. 18 per cent of such water sources are considered polluted.
Imports of various chemicals have also increased.
Policies and Implementation
Thailand has managed to effectively protect against and control transmissions of
COVID-19 with special measures put into place during the pandemic. This has been achieved
through strict protection measures against cases from abroad, in tandem with awareness-raising
measures aimed at the general public. The Ministry of Public Health prepared the country’s
readiness with regards to adequate medical care, healthcare facilities, protective equipment,
medical supplies, and other medical resources. The country also leveraged a whole-of-society
approach from all sectors in order to protect against transmission and to monitor developments,
in accordance with the following approach:
(1) Monitoring and evaluation of the COVID-19 situation and risk of infection: This
was conducted to aid decision-making processes, and included monitoring and evaluation at the
international and national levels, monitoring of the public health situation and public behaviour
through questionnaires and surveys, the identification of phases of infection and at-risk groups,
the use of mathematical models to predict infection scenarios.
(2) Public standards have been developed in a timely and effective manner as a pathway
at the national level. This included international measures such as prevention of international
travel, measures for certain risk groups, and effective management of the situation at the
provincial-level while taking into account the local context and situation.
(3) Public health measures have been implemented in order to provide early warning,
protect against infection, and control transmissions through diagnoses in labs, warning and
investigation systems to track infections, a quarantine and observation system for cases, a
knowledge-raising system for the public on health issues, and a system to support the
application of technology and innovation to improve early warning, protection, and control
measures.
(4) The readiness of the capacity and resources of the health services system was
improved. Measures include effective case management, the monitoring of the readiness of
public health system in accordance with the severity of cases, and the preparation of sufficient
health resources. Thailand also prepared adequate medical supplies and resources and
successfully distributed such supplies to medical facilities without compromising the overall
provision of health services across the country.
(5) The country’s readiness to produce COVID-19 vaccines was also prepared. This was
implemented in order to ensure equal access to safe, quality, and effective vaccines that are able
to effectively protect against infection in the long-term and create confidence in the country.
This, in turn, will lead to economic recovery in the post-COVID era. Efforts have been made to
plan and prepare for the provision and distribution of vaccines in an ordered and phased
manner, with regular progress reports. Such efforts reflect an approach that is based on
equality, scientific evidence, the number of vaccines procured, and the country’s capacity to
manage the vaccination programme.
(6) Thailand has promoted knowledge, research, and development, and has developed a
plan and organized relevant funding in order to boost research and development and innovation
- 21 -
related to new emerging diseases. This includes transforming this knowledge into industrial
production in the future.
(7) The Government has communicated with the public at both the central and local
levels to boost effective management, therefore managing issues such as the transmission of
information, integrated focal points at the provincial level, and the creation of a communication
network at the local level. This has particularly relied on public health volunteers.
(8) An integrated approach to situation management has been applied. Thailand has set
up a central mechanism to ensure an integrated approach to the management of the emergency
situation, with a team in charge of each aspect of situation management at the national and
ministry levels.
In addition, other concrete examples of SDG3 implementation include:
(1) The implementation of a project aimed at protecting new-born babies and mothers:
this project has designated work plans at the regional and national levels, as well as reporting at
the local level and the creation of the Department of Health Dashboard as a means of situation
reporting of the mortality rate of mothers. The project has also promoted the sharing of
knowledge, work plans, public awareness approaches, monitoring and evaluation approaches,
and personnel development methods. Thailand has developed the 5-year Quality Births
project (2017-2021) and developed maternal mortality rate reduction plans for local areas and
provinces. Research on the causes of maternal mortalities is conducted on a continuous basis.
(2) Thailand has advanced the implementation of the 2nd National Reproductive
Health Development Policy Strategy (2017-2026) especially promoting quality birth and
growth: this is aimed at developing several health and social services that aid in quality births,
such as services and rights with regards to pregnancy testing and antenatal care, birth costs,
financial aid for newborn babies, maternity leave and compensation, provision of tax
reductions for costs related to the care of babies, tax reductions for childcare facilities. In
addition, the Government has sought to adequately share information on childbirth and
reproductive rights through online media.
(3) Support for AIDS patients: Thai citizens have the right to get tested for AIDS twice
a year. In cases with positive results, patients are taken into care and provided with anti-viral
medication at no cost under the country’s universal health coverage since 2015. The
Government’s “95-95-95” AIDs Eradication Strategy aims at: (1) supporting 95 per cent of
suspected patients to get tested (as of 2019, 94 per cent of suspected patients have been
diagnosed); (2) supporting at least 95 per cent of patients to be treated with anti-viral
medication (as of 2019, 79 per cent of patients have been treated); and (3) supporting at least
95 per cent of patients being treated with anti-viral medication to continue to receive
medication on a regular basis in order to successfully contain the virus in their blood (in 2019,
this ratio was at 86 per cent).
(4) Reduction of risk of death from various diseases, through monitoring, protection and
control of communicable diseases such as malaria and tuberculosis: Thailand has implemented
the National Tuberculosis Plan of Action (2017-2021), which leverages the cooperation of all
sectors to reduce tuberculosis cases. In particular, the strategy relies on joint implementation
with the private sector and civil society. Measures have included providing knowledge on
tuberculosis to students, testing in penal facilities and youth and children training centres
within youth detention centres, the identification of tuberculosis cases, and support for
telemedicine services. Importance has also been attached to the application of technology in the
treatment of non-communicable diseases, such as organising trainings on cardiovascular
diseases, improving the cardiovascular disease registration system through the Thai Acute
- 22 -
Coronary Syndrome (ACS) Register, and the development of a national cardiovascular diseases
database. With regards to cancer treatment, trainings have been organised to improve the use of
HPV DNA Testing, improve cancer-related surgery methods and treatment, and to improve
treatment for complications for diabetes and hypertension patients.
(5) Treatment for drug addiction: this is specifically aimed at improving treatment
approaches and knowledge for medical personnel involved, as well as the improvement of
rehabilitation centres in line with international standards. Implementation in this regard has
also included the effective application of community-based treatment and rehabilitation. These
approaches, particularly in developing the capacities of personnel, improving approaches, and
applying community-based treatment and rehabilitation, have also been applied to treat alcohol
addiction.
(6) Reduction of deaths and injuries from road accidents by half in line with Target 3.6:
improving road safety has been designated as a National Agenda by Thailand, and the country
has developed a National Road Safety Strategy (2018-2021) in order to improve the
management of private and public transport vehicles on the road, land transport routes, and the
overall environment. Measures have been implemented to reduce roadside injuries, closedcircuit television (CCTV) has been introduced to enforce road traffic regulations, and Traffic
Safety Zones which control vehicle speed have been created. In terms of mechanisms to
implement the strategy, Quality of Life Improvement Committees at the municipality level and
local road safety centres have been set up to coordinate measures. At the international level,
Thailand became a party to the Vienna Convention on Road Traffic (1968) in 2020, which
has been key in elevating road safety standards in the country and ensuring that driving licence
standards conform to international standards. In addition, this has strengthened the possibility
that Thai driving licence holders will be able to use their licences in countries that are also a
party to the Convention.
(7) Designation of the PM2.5 pollution problem as a National Agenda: Thailand has
accelerated the integration of cooperation between all sectors on 3 key measures. Firstly, efforts
have been made to increase the efficiency of area-based crisis management from December
through to April each year. Secondly, pollution is being addressed at the source, including from
crop burning, construction and city planning, factories, and household pollution. Thailand has
sought to improve the tools, approaches, and mechanisms available to address pollution issues,
including through improved research for policy-making and problem-solving. Furthermore, on
1 June 2020, Thailand banned the production, use, and export of two pesticides/herbicides,
namely paraquat and chlorpyrifos, in order to reduce their impact on public health.
(8) Implementation of the Operational Plan to End Tuberculosis: this includes revising
the rights and management of tuberculosis patients under the National Health Coverage Fund in
accordance with the National Tuberculosis Control Programme Guideline (2018). Efforts
have been made to reduce transmissions and increase testing for at-risk groups (particularly
those in contact with diagnosed patients and prisoners), which will improve comprehensive and
inclusive care for all at-risk groups and will lead to the reduction in cases.
Challenges and Way Forward
(1) Loss of life from tuberculosis, road accidents, and non-communicable diseases
remains a challenge for Thailand. This is also exacerbated by new emerging diseases or drugresistant diseases linked to demographic changes, human activity, the development of
technology and innovation, and climate change. As such, this has impacted international public
- 23 -
health security. This has necessitated the continuous development and improvement of
Thailand’s public health systems in all dimensions, including in monitoring cases, diagnoses in
labs, patient care and treatment, and funding in order to achieve a more effective system.
(2) Improvements must be made to the capacity of technology used to produce medical
supplies and equipment, such as medication, vaccines, and medical tools. This also
encompasses the development of quality personnel involved in research and production and the
procurement and transfer of technology from other countries. Such efforts will help to develop
Thailand into a production hub for vaccines, medication, and medical tools at the upstream,
midstream, and end-stream levels. This will foster security and self-reliance, with particular
progress now made in developing labs for medication and medical supplies during the COVID19 crisis.
(3) There is a risk of increased mental stress from the COVID-19 pandemic. In March
2020, the number of people who sought help through the Department of Mental Health’s
hotline increased fifteen-fold, with over 600 telephone consultations. In addition, mental stress
has increased due to the socio-economic impacts of COVID-19, including unemployment and
debt in vulnerable groups. As such, this has been a factor in the suicide rate in 2020. Measures
should be introduced to evaluate mental health, such as support for mental health selfassessment tools aided by technology and support for hospitals to implement a monitoring and
protection system against suicide for vulnerable groups.
(4) The COVID-19 pandemic has exerted wide-ranging impacts, including in the public
health, economic, and social dimensions, and has impacted the lives of the people. As such, the
pandemic has also impeded the implementation of the SDGs. Integration of work should be
increased across implementation efforts from all sectors.
Multi-Stakeholder Case Studies
(1) San Sai Nam Nueng Group: Youth volunteers for child and youth mental health in San
Sai tambon, Fang amphoe, Chiang Mai Province
The San Sai Nam Nueng Group was founded on 4 October 2008 from children and youth
from 18 villages in San Sai tambon, Fang amphoe, Chiang Mai. The group first began with
projects aimed at AIDS prevention in local communities in 2011, before diversifying its projects in
other areas such as community volunteerism, promoting local customs and traditions, and
combating drugs. Youth empowerment activities and advocacy for youth empowerment policies at
all levels within the province also comprise a priority for the group.
Amidst the COVID-19 pandemic, the group, in partnership with the San Sai Public Health
Working Group and Volunteer Service Overseas (VSO) Thailand, found evidence that the
situation had brought an increase in cases of depression within youth and children in the area.
Such cases stemmed from increased stress, psychological issues, relationship and family issues,
and financial stress. The study found that 1850 persons under the age of 25 in the area, amounting
to 17 per cent of the total population of San Sai, had significant mental stress. As such, the group
established the “Leave Sadness, More Happiness” project. The project was supported by 25
volunteer leaders (including 16 women, 8 men, and 1 LGBTI person).
The group initiated a field study on the mental health and stress levels of children and
youth in San Sai, with 289 children and youth (aged between 11-25 years) participating. The study
used the ST5 stress examination process promoted by the Department of Mental Health. 129 were
diagnosed with low levels of stress, 97 with medium levels of stress, and 30 with high levels of
stress. A consultation was subsequently organised with relevant agencies to allow for integrated
- 24 -
planning on work plans to address this issue, in order to develop the plans into a mechanism for
mental health support in the future. The consultation provided the following recommendations:
1) Mental health support must be provided in an integrated and comprehensive approach,
involving mental health professionals, public health personnel, education institutions,
businesses, state agencies, private sector actors, foundations, and religious institutions,
in order to correspond to the needs of those given support.
2) An integrated mechanism, involving all partners, should be established to further
advance mental health support in the area
3) Hospitals should provide training and capacity-building for medical personnel on
mental health support through partnerships with networks and various local groups,
such as local community leaders and village health volunteers, in order to raise the
capacities of personnel in identifying cases which require support
4) Additional early warning measures should be implemented, including the
identification of cases and screening measures in schools and temples in an integrated
and continuous manner. This applies to online and offline measures.
5) Mental health advice should be provided for families, teachers, community leaders,
and relevant stakeholders within the community. This can be provided both at the
group and individual level through creative formats such as board games, print media,
and other means in order to appeal to all ages.
6) Schools should provide training and advice for teachers to screen for and identify
students who require mental health support.
(2) Village Health Volunteers (VHV)
Amidst the COVID-19 challenges, a group of people known as the “Village Health
Volunteers” have played a critical role. They are part of a network that has been operating since
1978, following Thailand’s policy to improve the health system for the health and well-being of all
Thais, for which the Ministry of Public Health would select a handful of villagers with volunteer
spirits to train and educate them on health promotion efforts. After the training, the village health
volunteers would play an important role in converting central policies into local implementation
by disseminating accurate and simplified public health information and giving advice on diseases
and proper health guidelines for other villagers. Over the past 40 years, the Ministry of Public
Health has been determined to improve the work of the village health volunteers.
In 2019, the Government launched a plan to develop the programme and elevate the
volunteers to be “household doctors”. Network presidents from each village were selected to
attend a special training session to learn about endemic diseases and epidemics, prevention
methods, physical and mental health issues, and using Thai folk wisdom and traditional herbs for
medicinal purposes. The Government also supported the village health volunteers to use modern
technology for more efficient health promotion efforts in the communities.
At present, there are approximately 1,040,000 village health volunteers in Thailand and
15,000 public health volunteers in Bangkok. During a period when people travelled back to their
hometowns, many were afraid of a greater wave of COVID-19 transmission in Thailand. District
Health Promoting Hospitals in each area then tasked the village health volunteers and health
authorities with proactive campaigns to raise awareness, urge newly-arrived travellers to stay at
home and refrain from social gatherings, and give self-care advice. They also formed the first line
of defence in their efforts to collect travel information of households under their responsibility,
collect health records of people in the communities for relevant agencies, give knowledge about
COVID-19, and screen high-risk groups for public health authorities to monitor. The village-level
screening effort has proven efficient and produced concrete results.
|
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[
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{
"country": "tha",
"file_id": "sdg-03/vnr-report-tha-2021-en-3.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2021
}
|
Unofficial translation
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It is expected that environmental interventions will also have a positive impact, such as
measures to improve water supply and sanitation, as well as strengthening activities for the
prevention of substance abuse (intravenous drug use).
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It is necessary to significantly reduce the impact on the health of the country’s citizens of such
risk factors as access to water and a balanced diet. The digitalization and greening of healthcare is
becoming an increasingly urgent need.
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Expected towards identifying opportunities for innovative and sustainable healthcare waste
management solutions to reduce CO2 emissions, efforts will be directed towards:
– supporting the widespread use of special technologies for the shredding of medical waste
and the recycling of solid biohazardous waste into household waste;
– installation of technologies and training to work on them;
– overall capacity building of health workers.
In general, the introduction of a circular economy will require systemic changes, including
those based on public-private partnerships.
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14 Voluntary National Review of Turkmenistan
good healTh 3 and well-being
Voluntary National Review of Turkmenistan 15
The national programme "Saglyk” (Health), as
the main document of the country in the health
sector, defnes public health as the primary
objective of socio-economic development,
achieving prosperity, increasing life expectancy
and enhancing well-being of the population. At
the same time, implementation of this objective
will ensure sustainable and inclusive economic
growth, social development and social justice.
maTernal and chIld
healTh care
The maternal and child health care and
reproductive health care are among the priorities
of the national policy of Turkmenistan. The
maternal mortality rate in the country remains
low. This has been made possible by providing
affordable, high-quality and qualifed health care,
and prenatal care.
In order to further improve the quality of health
care and current indicators, the National Strategy
and Action Plan on Maternal, Newborn, Child and
Adolescent Health for 2015-2019 has been adopted
emphasizing the importance of investments
made throughout the life cycle of development.
These policies include capacity-building in health
care system required for the implementation of
an integrated package of basic measures and
services for health care of mothers, newborn,
children and adolescents, and for strengthening
the mechanisms for sustainable fnancing and
rational use of allocated resources.
A tool to evaluate the quality of health services
provided on family planning has been introduced
in 2013 to improve the health of future mothers.
Risk groups were identifed and medical passport
of maternal reproductive health was introduced.
Moreover, in recent years, contraceptive coverage
16 Voluntary National Review of Turkmenistan
doctors and nurses with relevant knowledge
and skills, and implementation of the mentoring
and coaching system, especially for primary
healthcare personnel, improves quality of health
care provided for children and facilitates growth
and development of children under the age of 5.
fIghT agaInsT TuberculosIs and
non-communicable diseases
The epidemiological situation in respect of
tuberculosis in the country shows positive trends.
In recent years there has been a reduction in
morbidity and prevalence of this disease due to
high effectiveness of treatment and diagnosis.
The technology of molecular diagnostic test for
of women at risk has increased from 21% (2013) to
71.4% (2018).6 Thus, the percentage of women in
the country, whose demand for contraception is
satisfed is high, at 81% among women aged 15-49,
which demonstrates active work of reproductive
health care units.7
Particular attention is given to reducing underfve child mortality and neonatal mortality, the
rate of which is slightly higher than the values
indicated under the target 3.2. The analysis has
shown that the main causes of under-fve child
mortality were specifc conditions occurring in the
perinatal period, as well as respiratory diseases.
Congenital malformations, deformations and
chromosome abnormalities were identifed as
the main causes of neonatal deaths. In order to
further prevent the main causes of child mortality
the country is taking measures to improve the
quality of services in the area of early childhood
development and increasing awareness of parents
about the appropriate and timely introduction of
complementary feeding, and nutritional needs
of young children. For example, the Government
fnanced measures on promoting and supporting
breastfeeding, which increased the rate of
breastfeeding among children from 10.9% in 20068
to 58.9% in 2016.9
In addition, to detect the most common
developmental disorders among newborns, the
Instruction on introduction of neonatal screening
has been developed.
The provision of adequate care and ensuring the
continuity of quality health care are important
elements of health policy of Turkmenistan.
Therefore, the introduction of the Integrated
Management of Childhood Illness, providing
6 The Ministry of Health and Medical Industry of Turkmenistan
7 State Statistics Committee of Turkmenistan and UNICEF, Multiple Indicator Cluster Survey 2015-2016; Final report,
January 2017
8 State Statistics Committee of Turkmenistan and UNICEF, Multiple Indicator Cluster Survey 2006: Final report, 2006
9 Multiple Indicator Cluster Survey 2015-2016
2013 2018
21% 71,4%
CONTRACEPTIVE COVERAGE
OF WOMEN AT RISK
HAS INCREASED
15-49
years
old
The percentage of women in
the country, whose demand for
contraception is satisfied,
is HIGH
81%
Voluntary National Review of Turkmenistan 17
rapid detection of drug-resistant tuberculosis
has been introduced throughout the country.
The Tuberculosis Prevention and Care Service
has been integrated into the primary health care
system.
The country has achieved good results on malaria
elimination as well. Through multisectoral
activities, in 2010 Turkmenistan was included
to the list of countries that have achieved
elimination of malaria. There are ongoing activities
to maintain the status of malaria-free country
and prevent cases of malaria importation. This
includes conducting regular studies of previous
malaria transmission cases and carrying out active
and passive epidemiological and entomological
surveillance.
The prevalence rate of hepatitis B virus has
remained low - 0.5 incidents per 100,000
population in 2018.10 The Government is taking
preventive measures through vaccination
coverage against Hepatitis B. Thus, the coverage
with three doses of vaccine against Hepatitis B
among children under 1 year old and teenagers
is 98% and 94% respectively. Procurement of
vaccines and vaccination is done entirely at the
expense of the State and is provided irrespective
of the family’s fnancial situation.
Given the importance of prevention of epidemic
diseases by ensuring the sanitary-epidemiological
safety, the Government of Turkmenistan, as
part of the General Programme "On providing
clean drinking water to population", continues to
expand the population coverage by centralized
water supply (SDG 6.1) and sanitation (SDG 6.2)
among newly detected
tuberculosis cases
TUBERCULOSIS TREATMENT
SUCCESS RATE IS HIGH
81,3%
2017
Fight against noncommunIcable dIseases
Non-communicable diseases (NCDs) have
remained the leading causes of mortality in
Turkmenistan and, according to WHO estimates,
account for 79% of deaths in the country.
Multisectoral approaches are taken at the
governmental level to prevent and control NCDs
effectively: realization of the National Strategy
and Action Plan on the implementation of the
10 The Ministry of Health and Medical Industry of Turkmenistan
LEADING CAUSES OF DEATH (30-69 YEARS)
LEADING CAUSES OF DEATH FROM
CARDIOVASCULAR DISEASES
ISCHEMIC HEART DISEASE 45%
CEREBROVASCULAR DISEASES 35%
ISCHEMIC HEART DISEASE 44%
CEREBROVASCULAR DISEASES 37%
Cardiovascular
diseases
50% 12%
Malignant
neoplasms
LEADING CAUSES OF DEATH FROM
MALIGNANT NORROFORMATION
CANCER OF THE TRACHEA, BRONCHUS AND LUNG
STOMACH CANCER 13%
11%
16%
CANCER OF THE LIVER AND BILE DUCTS
BREAST CANCER 20%
CERVICAL CANCER 13%
and analyze the condition of irrigation systems,
ponds and lands under cultivation. The National
Programme “On safe handling and disposal of
medical waste in health care facilities” is being
implemented throughout the country as well.
18 Voluntary National Review of Turkmenistan
Ashgabat Declaration on prevention and control of
noncommunicable diseases in 2014-2020, aimed
at improving population health by infuencing on
health determinants, promoting healthy lifestyles,
implementing prevention programmes and early
diagnosis of NCDs.
Tobacco control measures are carried out on a large
scale in Turkmenistan; there is a strong legislation
for tobacco control. As a result of these measures,
smoking prevalence and intensity in the country has
been reduced. Currently, according to the fndings of
WHO STEPS survey, the proportion of adult smokers
aged 18-69 years is 3.4%, which is almost 2.5 times
below the level recorded in 2013 (8.3%).
There is also a positive progress in terms of alcohol
consumption level. According to the WHO STEPS
survey, 4.8% of the population consumed alcohol
Unconditional probability of
mortality from cardiovascular
diseases, cancer, diabetes or
chronic respiratory diseases by
gender,%
2015
31,5 30,0 29,9
2016 2017
29,7
2018
2015
20,9 20,3 19,7
2016 2017
20,3
2018
Voluntary National Review of Turkmenistan 19
SMOKING PREVALENCE AND
INTENSITY HAS BEEN REDUCED
According to the findings of WHO
STEPS survey, the proportion of adult
smokers is
Tobacco control measures are
carried out on a large scale in
Turkmenistan; there is a
LEGISLATION FOR TOBACCO
CONTROL
18-69
years
old
2013
8,3%
2018
3,4%
in 2018, which is 1.8 times below the level of 2013.
The National Programme for the Prevention of
Harmful Effects of Alcohol for 2018-2024 and
the Action Plan on its implementation stipulate
measures on pricing and taxation of alcoholic
beverages. Specifcally, value added taxes on
alcohol products is 13% and excise tax is 35%.
Moreover, it is planned to introduce packaging
and labeling requirements for alcoholic beverages.
An important element of the State policy on
prevention and control of non-communicable
diseases is prevention of harmful habits,
promotion of healthy lifestyles and nutrition.
In this regard, identifying and addressing risk
factors is a priority task, the implementation
of which is planned for the short and medium
term. First of all, it is a comprehensive prevention
among the general population, qualitative and
timely treatment and rehabilitation of individuals
of adult population
consumed alcohol
This is 1.8 times below the level of 2013
4,8%
According to the WHO STEPS - 2018 survey,
addicted to psychoactive substances (PAS), as
well as persons with circulatory system diseases,
cancer, diabetes and obstructive pulmonary
diseases. For example, one of the prevention
measures is broadcasting a regular popular
scientifc TV show "Il saglygy-ýurt baýlygy"
("A healthy nation is a wealthy nation”), which
covers such topics as healthy lifestyle, adequate
nutrition, ftness and sports. Ongoing measures
helped to reduce behavioral risk factors among
the population. For example, positive changes
have been observed in nutrition: increased
consumption of vegetables from 5.9 days per
week in 2013 to 6.4 days per week in 2018.
A high objective has been set to achieve
progress that will help to minimize and ideally
eliminate the effects of various risk factors
on human body, including tobacco, alcohol,
stress, irrational and unbalanced nutrition, and
physical inactivity. Educational activities and
certifcation of professionals providing services
on prevention and treatment of health disorders
associated with using psychoactive substances
are implemented through joint projects of the
Government of Turkmenistan and the UN (WHO,
UNODC, UNFPA and others). In particular, the
international programmes including “Family and
school together” and “Strong Family” focused
on promoting healthy lifestyles and improving
family skills among teachers, pupils and their
parents have proved successful. Several protocols
on treatment and rehabilitation, as well as on
application of evidence-based instruments to
evaluate the quality of services provided are
currently being updated.
20 Voluntary National Review of Turkmenistan
In addition, an important element of prevention
is to reduce the infuence of other factors, such
as rapid and unmanaged urbanization, and air
pollution. To this end, Turkmenistan implements
projects to increase green spaces in cities and
create green cities.
affordable and
qualITy healTh care
The Government prioritizes the accessibility of
health services for all segments of the population.
Therefore, publicly accessible packages of health
care services have been designed and are
being provided for pregnant women, mothers,
newborns, children and adolescents, which
include primary, secondary and tertiary health
care. Immunization is compulsory and free for
all children.
Turkmenistan understands that quality of health
care in the country depends on the quality
of services and fnancing in this area. In this
regard, the country pays particular attention to
training and increasing the number of medical
personnel. The implementation of these plans
is supported by increasing the enrollment in
medical specialities of higher and secondary
educational institutions, increasing the number of
professionals studying in foreign universities in the
framework of intergovernmental agreements, and
fnancing continuous professional development
of medical personnel.
InTerlInKage of sdg 3 wITh
oTher susTaInable
deVelopmenT goals
Ensuring healthy lives and promoting well-being
has the cross-cutting nature, positive progress of
which will facilitate economic growth (SDG 8.1),
enhance well-being of the population (SDG 1.2)
and ensure social protection (SDG 1.3). At the same
time, to ensure the achievements under this goal,
issues related to ending all forms of malnutrition
(SDG 2.2), environmental improvement by
reducing the adverse environmental impact
of cities (SDG 11.6), providing access to green
spaces (SDG 11.7), management of chemical
waste (SDG 12.4), waste reduction and reuse (SDG
12.5), strengthening resilience to climate-related
hazards (SDG 13.1) assume a primary importance.
On the other hand, there is a strong link between
SDG 3 and SDG 6: ensuring access to water (SDG
6.1) and sanitation (SDG 6.2) will signifcantly
reduce maternal and child mortality (SDG 3.1
and 3.2) and end the epidemics (SDG 3.3). This, in
turn, will be feasible by reducing water pollution
(SDG 6.3), increasing water-use effciency (SDG
6.4), implementing integrated water resources
management (SDG 6.5), protecting water-related
ecosystems (SDG 6.6 and 15.1) and implementing
effective measures to combat desertifcation (SDG
15.3).
Improving the quality of health services will
be facilitated by the development of domestic
technologies (SDG 9.b), use of high-performance
technologies (SDG 17.8), technological upgrading
(8.2) and transfer of technology (SDG 17.7). The
link between technological upgrading and health
sector should be promoted by developmentoriented State policies (SDG 8.2) and expanding
access of private sector to banking and fnancial
services (SDG 8.10).
Universal health coverage (SDG 3.8) in Turkmenistan enables to support the poorest
segments of the population (SDG 10.1), ensure the
fulflment of reproductive rights and access to
sexual and reproductive health care services (SDG
3.7 and 5.6), eliminate gender discrimination (SDG
5.1), address the issues relating to the reduction
of violence (SDG 5.2 and 16.1), and ensure the
protection of fundamental freedoms of people
(SDG 16.10).
|
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|
Voluntary National Review of Turkmenistan
GOAL 3.
ENSURE HEALTHY LIVES
AND PROMOTE WELL-BEING
FOR ALL AT ALL AGES
63
Voluntary National Review of Turkmenistan
global scale and something much more
than just a health crisis. Contemporary
challenges require strengthening the
correlation of healthcare objectives
with other sustainable development
targets. Identifying the correlation of
SDG 3 with other goals allows Turkmenistan to achieve a multiplicative
effect on individual targets (Figure 13).
The development of the healthcare
sector, which is carried out within the
framework of the “Saglyk” (“Health”)
State Programme is one of the priorities and the most important task of the
state policy of Turkmenistan.
The importance of SDG 3 has increased
in recent years because of the COVID-19
pandemic, which represents a risk of
The Revival in the New Epoch of the Powerful State: National Programme
of Socio-Economic Development of Turkmenistan, 2022–2052
The Programme of the President of Turkmenistan for the Socio-Economic
Development of Turkmenistan, 2022–2028
Ensuring sustainable financing and
improving the
health economy
SDG 3.с
More than 10% of
the budget is
allocated to healthcare
Reorganization of
the primary
healthcare and
provision of
treatment and
preventive care to
patients with
chronic diseases
SDG 3.4
Introduction of
effective methods
of early diagnosis
and treatment
SDG 3.d
Reduction of premature mortality
SDG 3.1, 3.2, 3.4
Achieving 100% coverage of the
population with quality health
services SDG 3.8.1
Reducing regional inequality by
increasing the availability of health
services (SDG 3.8) both geographically (urban settlements and rural
areas) and in socio-economic
terms
SDG 10.1, 10.2
Development
of genomic
medicine
SDG 3.7
National strategy
“Healthy mother -
Healthy child -
Healthy future”
Reduction of the
maternal mortality ratio to 1.7
cases per
100,000 live
births
SDG 3.1.1
Increasing the coverage of the population
with preventive vaccines, increasing the
provision of high-quality, safe medicines
to the population
SDG 3.8, 3.b
88% of the population (2021) of Turkmenistan is covered by basic health services
Improving the surveillance system to
prevent the spread of infectious diseases
SDG 3.3
Saglyk (Health) State
Programme
Figure 13. Correlation between SDG 3 “Good health and well-being”
and other SDGs and policy documents of Turkmenistan
64
Voluntary National Review of Turkmenistan
In order to increase the effectiveness
of the measures taken, the current
policy documents are updated on a
systematic basis. In 2021, the Saglyk
State Programme was approved in a
new edition. It defined the main goals
as shown below in the healthcare development for a ten-year perspective.
The clear recognition of Turkmenistan’s success in addressing public health issues is the international
certificates on the elimination of a
number of infectious diseases in the
country, along with the fact that the
experience of Turkmen doctors in this
field is recommended by the World
Health Organization for dissemination
in the WHO Europe countries.
In recent years, Turkmenistan has
been rewarded with awards and certificates by international organizations such as WHO, UNICEF, etc. for
the prevention of non-communicable
diseases (WHO, 2019), maintaining
high rates of immunization of children
in the country (UNICEF, 2019), for the
efforts of medical and social workers
in the country during the COVID-19
pandemic (WHO, 2022).
The main goal of health policy is to
ensure access to high quality medical services. There are 137 hospitals
in Turkmenistan. A network of health
homes has been developed, new
healthcare institutions are provided
with state-of-the-art and high-precision equipment. More than 30 new
methods of prevention and treatment,
rehabilitation of patients have been
Increasing the immunization of the
population is one of the priorities of
the “Saglyk” State Programme.
The programme attaches special attention to gender equality issues, a
separate section is devoted to men’s
health issues. The section on “Men’s
health” covers the development of genomic medicine and the monitoring of
men’s health by andrologists.
Protecting the health of people at
all stages of their lives, empowering
them, improving the prevention and
treatment of age-related diseases and
launching a geriatric service is a novelty of the State Programme. The Programme provides for palliative care
to patients in need of complex, longterm care.
One of the main directions of the State
Programme is the sustainable fnancing of the healthcare system and the
improvement of the healthcare economy, as well as the improvement of
the state voluntary health insurance
of citizens of Turkmenistan
As part of the implementation of the
“Saglyk” Programme in Turkmenistan,
the task has been set to provide the
population and medical institutions
with all the necessary medicines, primarily from its own production, an increase of which amounted to 58% in
2019–2022.
65
Voluntary National Review of Turkmenistan
In order to achieve the spiritual and
physical health of the population, significantly improve the state of health,
improve the well-being of citizens and
increase life expectancy, the “National
Programme for Ensuring the Healthy
Well-being of the population in Turkmenistan, 2023–2028” was adopted
in April 2023.
Close attention is paid to the training of medical personnel and the increase of their number. A Plan for the
Development of Healthcare Human
Resources for 2019–2025 has been
adopted. The number of specialists
introduced into the national practical
medicine.
Over the past period, the gap in the
level of quality of medical services for
the population residing in urban and
rural areas has been closed.
The development of the healthcare
system in Turkmenistan is accompanied by the digitalization process. In
2019, with the technical assistance
of the UN agencies – UNFPA, UNICEF
and WHO, the “Strategy for the Development of the National Health Information System in Turkmenistan for
2019–2025” was developed and endorsed.
Turkmenistan is building its capacity
in the field of early warning, risk reduction and surveilance of national
and global health risks. The country
annually provides self-assessment
reports (SPAR) on the progress of
the implementation of International
Health Regulations, and in 2021, there
was a significant improvement in this
indicator (Figure 14).
Figure 14. SPAR Indicator for Turkmenistan by year, %
Source: https://extranet.who.int/e-spar/
90%
60%
30%
0%
2018 2019 2020 2021
67 70 68
81
66
Voluntary National Review of Turkmenistan
In order to improve the quality of
medical care and protect the health
of mothers and children, the National Strategy “Healthy mother – healthy
child – healthy future” for the protection of maternal and child health for
2021–2025 was adopted in 2021.
Within this strategy, such important
measures are envisaged as the provision of a package of guaranteed medical care for children and mothers,
early detection and early intervention
services, and the widespread introduction of a programme for the integrated management of childhood diseases. A 5 year Plan and “Roadmap”
for the implementation of the Integrated Management of Childhood Illness have been developed. The introduction of IMCI has led to a decrease
in child morbidity and mortality from
infectious diseases, increased awareness of parents in matters of proper
nutrition of children, care for them.
who have received education in foreign universities is growing, and continuous vocational training of medical
personnel is being funded. Along with
this, the country is training scientific
personnel in postgraduate and doctoral studies, as well as applying for
the academic degree of Candidate
and Doctor of Medical Sciences. The
number of medical workers is in the
range of 6.2–6.4 per 1,000 people of
the population.
8
On measures to reduce maternal
and child mortality
Maternal and child health protection,
as well as reproductive health protection are among the priorities of Turkmenistan’s social policy. The country
maintains a low maternal mortality
rate, which in 2022 amounted to 1.7
per 100,000 live births (figure 15).
9
8 State Committee of Statistics of Turkmenistan
9 The Ministry of Health and Medical Industry of Turkmenistan
Maternal
mortality rate
2015
3.0
2019
2.9
2020
2.4
2021
2.5
2022
1.7
Figure 15. Maternal mortality rate in Turkmenistan, the number
of maternal deaths per 100,000 live births
67
Voluntary National Review of Turkmenistan
troduced in the country to assess the
quality of family planning services,
risk groups have been identified, and
a medical passport of maternal reproductive health has been introduced.
Currently, the provision of reproductive health offices with all methods of
family planning reaches 97%. According to the results of the MICS-6 study
conducted in 2019, the proportion of
women of reproductive age (15-49
years) whose family planning needs
are met by modern methods was
79.6%, which is a good outcome for
work on reproductive health (MICS-5
– 80.5%).
During the period 2015–2022, there
is a positive trend of declining fertility rate among adolescent girls aged
15–19 years. This indicator in 2022
amounted to 22.9 births per 1000
adolescent girls (Figure 16), in urban
areas this indicator was 20.4, and in
rural areas – 25.0.
11
To improve the health of children and
reduce infant mortality, a number of
In Turkmenistan, 99.9% of births are
delivered by qualified medical workers, which is ahead of the target of the
13th WHO General Programme (ODA13) for 2023 (88.6%) and almost completely corresponds to the 2030 target
(100%).
10
In order to improve the health of expectant mothers, a tool has been in10 Ministry of Health and Medical Industry of Turkmenistan
11 State Committee of Statistics of Turkmenistan
Figure 16. Fertility rate among adolescent girls (15–19 years old)
per 1000 adolescent girls
Fertility rate among
adolescent girls
2015
37.5
2019
24.5
2020
21.8
2021
21.4
2022
22.9
68
Voluntary National Review of Turkmenistan
Since 2016, the country has been regularly monitoring the implementation
of the Law of Turkmenistan “On the
Promotion and Support of Breastfeeding”, 95% of all maternity institutions in the country are certified as
child-friendly. In order to reduce preventable deaths of newborns and stillbirths, Turkmenistan joined the WHO
and UNICEF Global Every Newborn Action Plan (ENAP) in 2017.
In Turkmenistan, immunization is
mandatory for all children and is free.
Efforts to ensure the immunization
of all children began long before the
adoption of the SDGs and have since
become a priority as a key aspect of
improving health services for all. Today, the rates of immunization coverage with antigens of the Expanded Immunization Programme remain high:
99% of children received the third
dose of the combined vaccine against
diphtheria-pertussis-tetanus (DPT-3)
in 2019 and 98% in 2022 .
As part of a long-standing partnership
between the Government of Turkmenistan and UNICEF, national funding
for the purchase of vaccines in Turkmenistan has steadily increased and
almost doubled from 2009 to 2020,
covering all costs associated with immunization. In 2020, the Government
of Turkmenistan and UNICEF signed
a Plan within the framework of a Memorandum of Understanding, which
provided additional national funding
and commitment at the highest level
to maintain the current level of immunization during 2021–2025. Within
the framework of this MoU, the Gosystemic measures are being implemented. For example, in order to further prevent the main causes of child
mortality, measures are being taken
to improve the quality of services in
early child development and parents’
awareness of the correct and timely introduction of complementary
foods, about the nutrition of young
children. The National Programme of
Healthy Nutrition of the population
of Turkmenistan, 2020–2025 and the
National Strategy for Early Childhood
Development in Turkmenistan for
2020–2025 are being implemented. In
2021, the Gurbanguly Berdimuhamedov
Charity Fund was established to assist
the children in need of care. With the
support of this foundation, numerous
operations have been successfully
performed in the field of cardiac surgery, traumatology and orthopedics
and neurosurgery.
12 Ministry of Health and Medical Industry of Turkmenistan
69
Voluntary National Review of Turkmenistan
their early detection and treatment.
At the current time, more than 99% of
boys and girls aged 9 years are vaccinated against human papillomavirus
(HPV) (Figure 17).
As part of the screening, standard cytology, PAP testing (PAP test) and PCR
DNA diagnostics for HPV are carried
out free in health homes. Algorithms
for the management and examination
of women, protocols for early diagnosis and treatment of cervical pathology have been developed. In the International Educational and Scientific
Centre of the Ministry of Health and
Medical Industry of Turkmenistan for
the period 2017-2021, a number of
surveys were conducted: 10,712 RAR
tests in 2021 (10,376 in 2017); 221
PCR HPV tests in 2021 (153 in 2017).
Along with this, the logistics of maternity and childhood institutions has
been improved; the principles of regionalization of perinatal care with appropriate provision of equipment and
medicines at each level of perinatal
care have been introduced.
vernment of Turkmenistan allocates
more than 83 million US dollars to ensure vaccination of all children of the
country.
The Programme on “Safe Motherhood”
is being actively implemented. To improve the quality of perinatal care, the
following measures are carried out:
– development and implementation
of a package of ante-, intra- and neonatal care interventions based on evidence-based medicine;
– organization of the system of regionalization of perinatal care;
– development and implementation
of national clinical protocols together
with international experts.
Confidential audit of maternal mortality and audit of perinatal mortality
have been introduced to improve the
quality of care for mothers and newborns in maternity care facilities.
13
One of the important directions of the
health care system in Turkmenistan is
the prevention of cervical neoplasms,
13 Order of the Ministry of Health and Medical Industry of Turkmenistan No. 05 “On the monitoring and evaluation
of the quality of services provided to mothers, newborns and children” (01.01.2019)
14 Ministry of Health and Medical Industry of Turkmenistan
Figure 17. Proportion of boys and girls (9 years old) covered by
immunization with HPV-1, HPV-2 vaccines, %.
14
covered by immuniza -
t ion with HP V - 1, HP V - 2
vaccines
HPV-1
(against human
papillomavirus 1st dose)
HPV-2
(against human
papillomavirus 2nd dose)
Proportion
of boys and girls
(9 years old)
2016 2017 2018 2019 2020 2021
99.2
99.0
99.3
99.0
99.3
99.2
99.0
98.5
99.4
99.1
99.4
99.2
70
Voluntary National Review of Turkmenistan
COVID-19, Turkmenistan received a
loan of 20 million US dollars from the
World Bank. Within the framework of
the project on “Countering COVID-19”,
6,000 medical workers have improved
their qualification.
In 2021, Turkmenistan was given a
special award by the WHO Regional
Office for Europe in recognition of the
efforts of medical and social workers
in the country during the COVID-19
pandemic.
The main strategic document for the
prevention and treatment of tuberculosis is the National Programme to Ensure Effective Control of tuberculosis
in Turkmenistan for 2021–2025. The
tuberculosis service is integrated into
the primary health care system. The
patient-oriented model of treatment
of patients is expanding from the first
days of the appointment of tuberculosis treatment at the place of residence. All these measures have been
contributing to the reduction of the tuberculosis incidence in recent years.
In 2022, the tuberculosis incidence
per 100,000 people was 29.9 cases, in
2019 – 32.9 cases.
15
Immunization in Turkmenistan is carried out according to the principle
“leaving no one behind”. Currently,
more than 98% of the country’s population is vaccinated against 14 infections: tuberculosis, diphtheria, whooping cough, tetanus, polio, hepatitis B,
hemophilic infection type B, pneumococcus, rotavirus, measles, rubella,
mumps, hepatitis A, human papillomavirus (Figure 18).
On measures to combat
infectious and non-infectious
diseases
The year 2020 has become a turning
point in all spheres of society. Coronavirus infection has changed the way
people lived. With the leading coordination of WHO, UN agencies in Turkmenistan and other partners in the
field of health, assistance was provided to the Ministry of Health and Medical Industry of Turkmenistan and other ministries and agencies involved in
countering the pandemic. In 2020, the
Plan to Ensure Turkmenistan’s Readiness to Counteract Acute Infectious
Disease and Take Rapid Response
measures and the Socio-Economic
Rapid Response Plan in Turkmenistan
against the pandemic of acute infectious disease were approved.
In order to regulate and control the
prevention of infectious diseases,
the Law of Turkmenistan “On the Prevention of Infectious Diseases” was
adopted in 2021. In the same year, a
Plan for Preparedness and Response
to Acute Infectious Disease was approved, based on the guidelines of
the WHO Strategic Plan for Preparedness and Response to COVID-19,
which was successfully implemented
by UN agencies in Turkmenistan and
partners. In 2020–2021, advisory and
technical missions of WHO/Europe
experts were held with the issuing of
recommendations.
In order to strengthen the response
measures and increase readiness to
15 Ministry of Health and Medical Industry of Turkmenistan
71
Voluntary National Review of Turkmenistan
Figure 18. The proportion of the target population covered by immunization
with all vaccines included in national programmes, %16
covered by immunization with all
vaccines included in national
programmes
The proportion of the
target population
2015
99.1
2016
98.7
2017
99.0
2018
98.9
2019
98.9
2020
98.8
2021
98.0
2022
98.3
Figure 19. Incidence of hepatitis B per 100,000 people
(without military personnel)
2015
0.6
2019
0.5
2020
0.1
2021
0.03
2022
0.1
Incidence of
hepatitis B
16–17 Ministry of Health and Medical Industry of Turkmenistan
Measures to maintain the status of
a polio-free country and measures to
verify the elimination of measles and
rubella are continuing.
Free vaccination of children against
hepatitis B is carried out in the country.
The incidence rate of viral hepatitis B
per 100,000 people in recent years has
had a stable downward trend: in 2022,
it amounted to 0.1 cases per 100,000
against 0.5 in 201917 (Figure 19).
The country is implementing the Strategic plan to Strengthen Measures to
Combat Viral Hepatitis in Turkmenistan for 2019–2030.
For effective prevention and control
of NCDs, the Law of Turkmenistan “On
Prevention and Control of Non-communicable Diseases” and “National
Strategy for Prevention and Control of
Non-communicable Diseases in Turkmenistan for 2021–2025” were adopted in 2021.
In 2019, the Law of Turkmenistan “On
psychological services” was adopted.
The “National Strategy and Action Plan
for the Protection of Mental Health of
the population in Turkmenistan for
2018–2022” has been implemented.
Within this strategy, with the support
of WHO, mental health services are
72
Voluntary National Review of Turkmenistan
in Turkmenistan. According to the
STEPS survey, the prevalence and intensity of smoking has significantly
dropped. Thus, in 2018, the age-standardized prevalence of tobacco use by
persons aged 15 and over was 3.4% of
the population, which was almost 2.5
times lower than in 2013 (8.3%).
In 2018, the Law of Turkmenistan “On
the Prevention of Harmful Effects of
Alcohol” was adopted. The law introduced requirements for the packaging
and labeling of alcoholic beverages.
The country is successfully implementing the National Programme for
the Prevention of Harmful Effects of
Alcohol, 2018–2024. As a result of
the measures taken, the level of alcohol abuse in liters of pure alcohol in a
calendar year decreased from 8.6% in
2013 to 4.8% in 2018.
18
being integrated at the level of primary health care.
An important element of the state policy in the field of prevention and control of NCDs is the prevention of bad
habits, promotion of a healthy lifestyle
and nutrition. Anti-tobacco measures
are broadly applied in Turkmenistan
backed up by strong legislation to
combat tobacco consumption; and a
National Programme for 2022–2025 is
being implemented to turn Turkmenistan into a tobacco-free country. Turkmenistan may serve as an excellent
example and model for the successful
implementation of tobacco control.
Great progress has been attained in
signing, ratifying and implementing
the WHO FCTC, as well as the WHO
FCTC Protocol on the Elimination of
Illicit Trade in Tobacco Products. The
STEPS survey was conducted twice
18 STEPS Survey 2013, 2018
73
Voluntary National Review of Turkmenistan
cialized medical care is provided on
the ground all over the country; and
transportation and placement to specialized medical centres and hospitals
are carried out as necessary.
The healthcare system also pays great
attention to spa treatment. In order to
further develop sanatorium treatment
in 2020, the National Programme for
the Development of the Sanatorium
system in Turkmenistan, 2021–2025
was adopted and is successfully under way. Currently, resorts and health
resorts are functioning in the country, aimed at providing the population
with recreational and other resort and
sanatorium services of high quality. In 2020, the Bagabat sanatorium
was opened at the foothills of Akhal
velayat, equipped in accordance with
the latest achievements of medical
science and cutting-edge technology.
About road safety measures
and spa treatment
Turkmenistan is taking measures to
ensure road safety with the participation of a broad range of sectors, such
as transport, police, healthcare, education. Following this, the mortality
rate as a result of road accidents in
2015–2022 decreased from 2.2 to 1.5
cases per 100,000 of the population
(Figure 20).
19
The following measures are carried
out to combat injuries:
– specially trained trauma and resuscitation teams are organized in the
Emergency Ambulance Centre;
– ambulances, reanimobiles, and medical helicopters are equipped with
modern specialized medical equipment that meets international standards;
– with the help of MI-8, MI-17, SUPER-PUMA, ANSAT helicopters, spe19 State Committee of Statistics of Turkmenistan
Figure 20. Mortality as a result of road accidents, number
of cases per 100,000 population
2015
2.2
2019
1.4
2020
1.6
2021
1.7
2022
Mortality as a result 1.5
of road accidents
74
Voluntary National Review of Turkmenistan
75
Voluntary National Review of Turkmenistan
UN, its agencies UNDP, WHO, UNICEF,
UNFPA and the Global Fund to Fight
AIDS, Tuberculosis and Malaria.
Follow-up steps for SDG 3
implementation
The Government of Turkmenistan
demonstrates a high political commitment to measures to protect and
improve public health. A solid system of management and leadership
in the field of healthcare has been
established, supported by policy documents and significant state funding
for health care activities, including
prevention and treatment measures.
Concurrently, work will continue on
the further development of the healthcare sector. The preparation of a list
of vital medicines and a package of
free services for mothers and children
will continue. Sanitary and educational work among the population is being enhanced. A third STEPS survey is
planned, after which data on the prevalence of tobacco and alcohol use in
the country will be updated. In 2023, it
is planned to conduct a Multi-cluster
Survey MICS-7, which will provide updated data.
During further improvement the digitalization of medical services will be
in the focus. It is planned to develop
mobile software for access to medical
services and a unified medical system.
The records and reporting system will
be improved taking into account the
latest guidelines, such as the introduction of new diagnostic tools, new
medicines and pharmacovigilance.
Progress
in 2019–2022:
• The immunization targets with all
vaccines included in national programmes have been almost achieved.
• Turkmenistan has been successful
in ensuring the transition of funding
for tuberculosis control activities from
donors to the Government. Diagnosis
and treatment of tuberculosis are part
of the “basic package” of services that
are provided to patients free.
• At the beginning of 2021, an incremental vaccination against COVID-19
was launched. Currently, a vaccination
campaign is being carried out for the
age groups of 18+, as well as revaccination of the population.
• The updated immunization VacBase
as well as the “The Register of Vaccinated Persons against COVID-19”, and
the “Monitoring System for patients
with parenteral viral hepatitis” software is being introduced in the health
care system of Turkmenistan with the
WHO assistance.
• Since 2022, free cervical screening has been carried out everywhere
among women aged 29–59 years.
• The National Programme for Ensuring the Healthy Well-being of the population in Turkmenistan, 2023–2028
has been adopted.
• Productive cooperation is carried
out with external partners, such as the
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|
55
Voluntary National Review Of Timor-Leste 2019
Achievements
The country has made significant progress in improving child and maternal health, bringing down
maternal mortality rates by 80 percent since 1990
(WHO, 2015a). The 2011-2030 National Health Sector
Plan has played a concrete role in strengthening the
quality of, and access to, free universal health services in Timor-Leste, as enshrined in the constitution. In
2016, there were 195 maternal deaths per 100,000 live
births (DHS 2016). However, this rate is still high. Notably, the country achieved Millennium Development
Goal 4 by reducing under-five mortality by two thirds
(72 percent) since 1990 (WHO 2015b). The rate of children who die before their fifth birthday has dropped
dramatically from 64 per 1,000 live births in 2009/10
to 41 per 1,000 live births in 2016 (DHS 2010 and 2016).
These improvements may be attributed to investments in antenatal care and a significant increase in
the proportion of births attended by skilled health personnel, increasing from 30 percent in 2009/2010 to 57
percent in 2016 (DHS 2009/2010 and 2016). More than
3 in 4 (77 percent) women made the recommended
four or more antenatal care visits, an increase from
55 percent in 2009-10 (DHS 2009/2010 and 2016). This
progress is notable not at least because at the time of
the restoration of independence, the majority of the
country’s infrastructure including health facilities had
been destroyed.
Over the past 15 years Timor-Leste has demonstrated a rapid decline in the total fertility rate in women
of reproductive age. Between 2000-2005 the fertility rate was 7.0, reported to be one of the highest in
the world (UN Population Division, 2007). By 2015 the
fertility rate was 4.5 (Census, 2015). This indicates that
the average woman of reproductive age (15–49 years)
could be expected to have 4.5 children. Notably, this is
higher in rural areas (5.1 children per woman) than urban areas (3.2 children per women (Census 2015). This
fertility rate is still quite high, and one of the highest
in Asia. Only 47 percent of women of reproductive age
(15-49 years) say that their demand for family planning
is satisfied by modern methods (DHS 2016).
56
From ashes to reconciliation, reconstruction and sustainable development
Box 10: Demographic dividend and reproductive health
While fertility rates have declined rapidly in Timor-Leste, the rate is still high.
A ‘demographic dividend’ means an accelerated productivity growth that
comes from a decline in a country’s birth rates. This trend in the decline of
birth rates needs to continue for the demographic dividend to take-off. Timor-Leste has one of youngest populations in the world, with 74 percent of its
population under the age of 35 and 39 percent below the age of 15 (Census,
2015). The high fertility rate has led to a population age structure that shows
the nation is at the early stage of a bulge among children and youth.
In 2016 the adolescent birth rate for women aged 15-19 years was 52 per 1,000
(Census, 2015), down from 66 per 1,000 (Census, 2010). This represents 5.6 percent of adolescent women aged 15-19 that have begun childbearing with their
first child, down from 6.4 percent in 2010 (Census, 2015). As thirty-five percent
of women age 20-49 marry when they are teenagers and the median age of
marriage is 21.7, this has a significant impact on early pregnancy (DHS, 2016).
Women with no education have an average of 4.8 children, compared to 3.3
children among women with more than secondary education (DHS 2016). Supporting young women to access reproductive health education will support
their inclusion in education and the labour market and help promote gender
equality. The new pre-secondary and secondary school curricula which are being developed will help contribute to this. Investments in education, health
and reproductive health education will create the right mix of demographic
and social conditions to make a significant contribution to utilising the growing population and reaping the demographic dividend.
The progress in child and maternal health is driven partly by the investment in the
health workforce and the strengthening of health systems in Timor-Leste. The commitment to invest in improving human resources in the health sector is evidenced by
increased numbers of health professionals across most areas. For example, in 2010, the
health workforce consisted of only 233 physicians (including 169 expatriate Doctors). This
constituted a ratio of 0.20 doctors /1000 people. This ratio was expected to dramatically
rise to 1.79/1,000 people in 2018 (Dussault G., et al. 2013). This represents almost a doubling of the ratio of the health workforce (nurses, physicians and midwives) /1,000 people
in just eight years and have been a key driver in improving health outcomes. Despite this
significant increase, there is still a notable skills imbalance and a significant shortage of
health workers in rural areas, and challenges exist in retaining workers in rural areas (Asante, A.D., et al., 2013). Improving equity in the geographical distribution of health professionals will make a critical contribution to addressing disparities between municipalities.
57
Voluntary National Review Of Timor-Leste 2019
58
From ashes to reconciliation, reconstruction and sustainable development
Box 11: Saude na Familia: Bringing healthcare to the doorstop
The Ministry of Health’s flagship comprehensive service package for primary
health care has played an integral role in strengthening rural access to health
care. This programme, Saude na Familia, modelled on the Cuban primary
health care system, aims to deliver key health services to its people at their
doorstep and is designed to ensure that “no one is left behind”. Through ‘domiciliary visits’, health professionals assess, register and follow up the health
status of all household members. By bringing health care to households and
communities and identifying individuals requiring follow up, it should have a
considerable impact on reducing maternal and child mortality. By May 2017,
medical teams had visited an impressive 94 percent of Timor-Leste’s households through the Saude na Familia programme (WHO 2017a).
Timor-Leste is on track to eliminate malaria by 2021 through cutting the incidence
rate by 99 percent in 11 years (WHO, 2017) and achieving a zero-incidence rate in 2016
(Ministry of Health 2018)14. The streak of zero malaria cases has continued well so far
in 2019. This is due to the success of the comprehensive National Malaria Control Programme. Timor-Leste has moved from the ‘control phase’ to the ‘elimination phase’ and
has recently developed and costed the National Malaria Elimination Strategy 2018-2021.
The Ministry of Health is also focused on eliminating neglected tropical diseases, such
as lymphatic filariasis and yaws and targeting the control of soil-transmitted helminths
(worms), which is endemic in Timor. The latter has a notable impact on child nutrition.
The Government has created an integrated plan for the control of Neglected Tropical
Diseases Control and Elimination programme for the period 2016-2021, which will also
contribute to addressing malnutrition. In addition, practices to prevent malaria, worms,
and other tropical diseases are also promoted through the school curricula at all levels.
Challenges
While there has been notable progress in raising vaccination rates of Timorese children, levels have since remained stable since 2009/2010. In 2016, 49 percent of children
(aged 12-23 months) received all basic vaccinations in the Timorese national vaccination
programme, which is a slight reduction from 2009/10 when 53 percent of children received all basic vaccinations (DHS 2010 and 2016). Children living in Baucau (67 percent)
are more than twice as likely as children living in Ermera (31 percent) to receive all basic
vaccinations (DHS 2016), see figure 17. Illustrating the importance of education for child
health, and the interconnection between SDGs, there is a strong link between mother’s
education and vaccinations rates (see figure 16).
Figure 16: Basic vaccination coverage by mother’s education
41% 51% 50% 58%
NO EDUCATION PRIMARY SECONDARY MORE T H A N
SECONDARY
Source: DHS 2016
59
Voluntary National Review Of Timor-Leste 2019
In 2016, the Government of Timor-Leste began accelerating the control of vaccine-preventable diseases. It significantly expanded the immunisation programme through
adding five new vaccinations to the child immunisation schedule. In 2017, a post-introduction evaluation revealed that the new introduced vaccines were well integrated and
accompanied by effective national plans and budget (WHO, 2017a). Remarkably, since
1995 the country is polio free and most recently was certified as measles-free by the
WHO South East Asia Region (WHO, 2017a). Timor-Leste is only the third country in the
region to have achieved this public health feat. This highlights the potential for maintaining the progress that has been made since the restoration of independence in child
immunisation.
Figure 17: Basic vaccination coverage of children under 2 years of age
Box 12: Innovation: Establishing partnerships with other countries to
strengthen Timor-Leste’s immunisation programme
The Governments of Timor-Leste and Sri Lanka signed a two-year ‘twinning
agreement’ in 2017 to share knowledge of Sri Lanka’s highly successful immunisation programme, achieving 99 percent vaccination coverage (WHO,
2017a). This agreement builds knowledge sharing between the two countries
and aims to strengthen the project management skills of health officials in
Timor-Leste that work on the immunisation program. A similar arrangement
between Timor-Leste and Australia was established to build the capacity of
the Timorese National Immunisation Technical Advisory Group (NITAG) which
was also created to guide evidence-based immunisation policy decisions and
recommendations.
Dili
Ermera
Manufahi
Ainaro
Oecussi
Covalima
Bobonaro
Viqueque
Liquica
Lautem
Aileu
Manatuto
Baucau
0% 10% 20% 30% 40% 50% 60% 70%
Source: DHS 2016
60
From ashes to reconciliation, reconstruction and sustainable development
The incidence of tuberculosis (TB) in Timor-Leste is considerable (498 per 100,000)
(WHO, 2017a), and is one of the single highest causes of hospital deaths in the country (WHO, 2017a). The National Tuberculosis Control Programme is devoting significant
resources to address this problem and to help Timor-Leste become a TB-free society
by 2030. As part of the programme, new guidelines for Paediatric and Extra Pulmonary
tuberculosis were developed to support clinical training for medical professionals, in particular, midwives and doctors, to help quick detection of the disease in mothers and children. Currently, the national TB programme is revising the guidelines for tuberculosis as
well as drug-resistant TB treatment.
Timor-Leste has a low prevalence of HIV, less than 1 percent in the general population
(Ministry of Health, 2015), although the number of reported cases continues to increase. The first case of HIV was reported in 2003. In 2018, there were 148 new diagnosed
HIV cases (Ministry of Health, 2018), however, the prevalence rate among “key high risk
populations”, such as commercial sex workers, men who have sex with men, and injecting drug users remains relatively low at 5 percent (DHS, 2016). In order to sustain this
low prevalence rate, it is important to improve knowledge of the disease among young
people who account for more than half of those newly infected with HIV (WHO, 2017b).
Notably, knowledge of HIV/AIDS among students 13-17 years is relatively low with only 65
percent reporting having ever heard about HIV/AIDS (WHO, 2017b). The DHS (2016) also
reveals that the proportion of men and women (15-49 years) who know where to get an
HIV test has declined. In 2009/2010 17 percent of women and 35 percent of men knew
where to get a HIV test (DHS 2009/10). In 2016 this had reduced to 7 percent among
women and 26 percent among men (DHS 2016). Continued effort is therefore required
to improve knowledge of the disease and available testing facilities and to strengthen
access to sexual reproductive health and rights education.
Non-communicable diseases (such as cardiovascular disease, cancer, diabetes or
chronic respiratory disease) account for 45 percent of all deaths in Timor-Leste (WHO,
2018a), highlighting the importance of looking ahead to future health lifestyle challenges facing the country. Linked to this is the very high rate of tobacco smoking among
men, with 70.6 percent of all men smoking compared to 28.9 percent of women (WHO,
2014). In addition, nine out of ten adults are exposed to tobacco smoke in their homes
and 51 per cent were exposed to secondhand smoke in their workplace (WHO, 2014).
With 16.4 years as the mean age of starting smoking (WHO, 2014), tobacco use prevalence among students s is high. 27.6 percent of adolescents aged 13–17 years use tobacco,
with 39.6 percent of boys using tobacco and 15.6 percent of girls (WHO, 2017b). This highlights the need to pay attention and carefully monitor the risk factors associated with
the unhealthy behaviours. Continuing to strengthen strategies to control non-communicable diseases will be vital in reducing the additional burden they place on health systems. Crucially, the MEJD and the Ministry of Health are collaborating to communicate
messages about healthy lifestyle choices in these areas. Non-communicable diseases,
and other issues such as de-worming, are also incorporated in the school curricula, with
support from the Ministry of Health.
Leaving no one behind
Despite facility births doubling from 2009/2010 to 2016, 51 percent of births still occurred at home, and delivery by skilled health personnel differs dramatically by municipality, from 20 percent in Ermera and to 85 percent in Dili (DHS 2016) (see figure
18). Reaching very rural communities with health care services is a challenge with 70
61
Voluntary National Review Of Timor-Leste 2019
percent of the population living in small, dispersed villages isolated by mountainous terrain. A costed improvement plan for emergency obstetric and neonatal care was created
in 2016 to reduce maternal mortality and improve birth outcomes. This plan focuses on
the development of a sustainable training programme for health workers with a focus
on immediate postpartum care. In order to continue making significant advances in
reducing maternal mortality, a Maternal Death Surveillance Review System to count and
investigate every maternal death was established at the National hospital and 5 referral
hospitals. Supporting the full implementation of this plan will be key to maintain and
speed up progress on maternal health. It will be necessary to continue strengthening
antenatal delivery and postnatal care in remote rural areas to continue driving this progress and address disparities.
Figure 18: Skilled assistance during delivery, by Municipality
Despite massive improvements in child mortality, the under-5 mortality rate differs
significantly by municipality, demonstrating the challenge in leaving no one behind.
For example, in Lautem there were 19 deaths per 1,000 live births compared to 76 deaths
per 1,000 live births in Oé-Cusse. More effort will also be needed to address the inequality in health outcomes, as children from the poorest households are more than twice as
likely to die before their fifth birthday as children from the richest households. The main
causes of child mortality are due to preventable diseases, with 18 percent due to pneumonia, 10 percent due to diarrhoea (WHO, 2015b).
Box 13: Using volunteers to ensure no one is left behind
Although the Saude na Familia programme has enabled doctors to reach rural areas, there are still remote locations where doctors do not reach. Saude
Ba Ema Hotu - SABEH (Health for all), a locally registered health association,
was established by a single doctor to fill the gap where domiciliary visits may
miss certain households. Despite the increase in the number of health posts,
there are still a number of remote Sucos (villages) that do not have a doctor
stationed there or have not seen a doctor for a number of years and have ac0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Source: DHS 2016
Dili
Ermera
Manufahi
Ainaro
Oecussi
Covalima
Bobonaro
Viqueque
Liquica
Lautem
Aileu
Manatuto
Baucau
62
From ashes to reconciliation, reconstruction and sustainable development
cess to little or no medicine. Volunteer doctors, midwifes and nurses who all
sign up for a one-year voluntary period, travel to remote mountainous areas,
carrying medicines and equipment on their backs. They provide free medical
services to Sucos with no access to a doctor. The volunteers then provide regular visits twice a month for these Sucos. This is the first long-term voluntary
programme in the country and aims to encourage Timorese doctors to consider working in rural areas. This programme, while only small, has succeeded
in creating partnerships with some private sector companies and individuals
to help raise funds for transportation and medicine.
Although persons with disabilities face a number of health concerns, the Ministry of
Health is developing a number of initiatives to promote an inclusive health service.
The Ministry of Health has recently launched a disability booklet for persons with disabilities in Timor-Leste. The disability booklet helps improve relationships between persons
with disabilities and their medical providers. It provides health staff with disability information they might not be familiar with. It records the diagnosis, as well as treatment and
referrals, helping them understand the needs of individual patients with disabilities.
Data availability
An impressive 96 percent of data for SDG 3 indicators is available. The
World Health Organization collects a lot of data related to SDG 3, which
makes an important contribution. The data that has not been collected
for this SDG relates primarily to the HIV incidence rate. As is common
in many least developed countries, the size of the uninfected population is not known. This data is needed to calculate the HIV incidence rate. There is also
little information on health facilities that have a core set of essential medicines.
62
96%
|
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34 TRINIDAD AND TOBAGO
Goal 3:
Ensure healthy lives and
promote well-being for all
at all ages.
TRINIDAD AND TOBAGO 35
The health and wellbeing of citizens of Trinidad and Tobago is of
paramount importance and critical to national development. Key
focus areas for the country have been the reduction of incidences
of both Communicable and Non-Communicable Diseases (NCDs)
and ensuring that the health sector is responsive to the health
needs of all citizens.
To this end, in addition to focusing on meeting citizens’ immediate
healthcare needs, the Government has worked to modernise
healthcare infrastructure, build capacity and capabilities in
healthcare professionals, improve patient care and service
delivery, and empower citizens to live healthy lifestyles.
Non-Communicable Diseases
To guide its eforts on NCDs, the Ministry of Health developed
the National Strategic Plan for the Prevention and Control of
Non-Communicable Diseases (2017-2021). The plan is founded
on the principles of prevention-focus, equity and inclusiveness. It
is people-centred, evidence-based and results-driven. It outlines
the response to NCDs and desired outcomes and targets for the
period 2017-2021.
GOAL 3
Government is putting people first and nurturing our greatest asset by ensuring healthy lives and
promoting the well-being of everyone
36 TRINIDAD AND TOBAGO
GOAL 3
This Strategic Plan is of critical
importance as NCDs account for
over 60 per cent of annual deaths
in Trinidad and Tobago, with the
most common being cancers,
cardiovascular diseases, chronic
respiratory diseases and diabetes
(see Figure 9). Seven out of ten
NCD-related deaths in Trinidad
and Tobago are considered to be
premature, occurring before age
70. In addition, 40 per cent can
be prevented as they share the
same modifiable behavioural risk
factors, including tobacco use,
harmful use of alcohol, unhealthy
diets and physical inactivity (SDG
3.4).
Over the period 2015–2019 several national indicators showed
mixed progress on NCDs. The NCD Mortality Rate increased from
525 per 100,000 persons in 2015, to 768.9 per 100,000 persons in
2018. The Diabetes Mortality Rate also increased, though less
significantly, from 113.6 per 100,000 persons in 2015, to 122.4 per
100,000 persons in 2019. Good progress was made on the Cancer
Mortality Rate, which fell from 128.8 per 100,000 persons in 2015,
to per 100,000 persons in 2019 (SDG 3.4.1).
10%
13%
14%
25%
0% 5% 10% 15% 20% 25% 30%
Stroke
Cancers
Diabetes
Heart
Disease
Figure 9: Leading causes of mortality in Trinidad and Tobago
Source: National Strategic Plan for the Prevention and Control of NCDs (2017–2021)
Leaving No One Behind
Chronic Disease Assistance Programme (CDAP) –
Ministry of Health (SDG 3.b.1)
CDAP provides citizens with free prescription drugs and
other pharmaceutical items to combat a range of health
conditions. All citizens of Trinidad and Tobago are
eligible to benefit from CDAP, with no age restrictions
or exceptions. Over 2,750 pharmacies across the
country provide access to the drugs available through
CDAP. New prescription drugs are also added
periodically. During 2018 and 2019 patients accessed
the programme on more than 330,000 occasions.
In order to foster greater improvement and
management of CDAP and to allow for possible
cost savings and eficiency, the Government, during
the fiscal year 2018/2019, implemented several
improvements measures to the CDAP including;
1. The reduction of the CDAP dispensing fee paid to
Pharmacies from $10.00 to $8.00 with
efect from May 1st 2018 thereby, generating a cost
savings of $5Mn per year
2. The re-order cycle be reduced from 2 months to
1 month to increase distribution and reduce stock
outs at pharmacies; and
3. The re-establishment of the CDAP Steering
Committee to ensure greater accountability and
value for money spent.
Some of the diseases covered by CDAP include, inter
alia: Arthritis, Asthma, Benign Prostatic Hyperplasia
(Enlarged Prostate), Cardiac Diseases, Diabetes,
Hypertension, Mental Depression and Parkinson’s
disease.
Sources: Ministry of Social Development and Family Services,
Social Sector Investment Programme (2019 and 2020) and
TTConnect.
TRINIDAD AND TOBAGO 37
GOAL 3
Communicable Diseases
Communicable or Infectious Diseases are those that can be spread
directly or indirectly from one person to another, from insect bites
or by ingesting contaminated food or water. Through Trinidad
and Tobago’s immunisation programme, several communicable
diseases have been addressed and significantly reduced. For
example, immunisation coverage was 94 per cent in 2019, steadily
moving toward the target of 97 per cent in 2020. Overall, the
Communicable Disease Mortality Rate decreased from 32.4 per
100,000 persons in 2018, to 31.2 per 100,000 persons in 2019 (SDG
3.3).
Nonetheless, communicable diseases such as, Insect Vector
Diseases, HIV/AIDS, the seasonal flu and the Common Cold
continue to afect the population. In the case of HIV/AIDS,
the multi-sectoral National AIDS Coordinating Committee
(NACC) coordinates the national response, including awareness
campaigns and free HIV testing. The impact of the work done is
reflected in the country having an Adult HIV Prevalence Rate of
only 1.1 per cent (SDG 3.3.1).
Strengthening Healthcare Infrastructure
Trinidad and Tobago has a two-tiered healthcare system,
encompassing a free-of-charge public system, alongside services
provided by private facilities. The public healthcare system ofers
primary, secondary and tertiary level care through a decentralised
system of hospitals, health centres and district health facilities
(SDG 3.8).
Significant achievements have also been seen in the area of
women’s health, following the establishment of the Women’s
Health Directorate within the Ministry of Health, in 2017. This body
is charged with the responsibility of implementing policies that
specifically target and bring about improvements to women’s
healthcare. Since its establishment, the Ministry of Health has
worked with the Pan American Health Organisation (PAHO) and
the World Health Organisation (WHO) to implement a Perinatal
Information System, to improve evidence- informed clinical
decision-making, and programme development for maternal and
new-born health services.
These interventions played a key role as the Maternal Mortality
Rate in public institutions fell dramatically from 49.2 per 100,000
in 2015, to 12.3 per 100,000 in
2018, well below the target of
70 per 100,000 live births, set
out in SDG 3.1. Unfortunately,
from 2015 to 2017, the
Neonatal Mortality Rate
increased, however there was
a subsequent improvement
during 2017—2018 (SDG 3.2).
The Under-Five Mortality
Rate marginally declined
but remained at a steady
rate of 11.3 during the same
period(see Figure 10).
11.3
13.9 13.4
11.3
6.3 7.5 8.9 6.5
49.2
33.1
20.2
12.3
0
10
20
30
40
50
0
10
20
30
40
50
2015 2016 2017 2018
Maternal Mortality Rate (per 100,000)
Under- 0
0
0, 1 r e
p
et a R
ytil atr o
Ml at ano
e
N
dna e
vi F
Under-Five Mortality Rate (per 1,000) Neonatal Mortality Rate (per 1,000)
Maternal Mortality Rate (per 100,000)
Figure 10: Maternal, Under-Five and Neonatal Mortality Rates (2015—2018)
Source: Ministry of Health
38 TRINIDAD AND TOBAGO
GOAL 3
Empowering Citizens to Live Healthy Lifestyles
Stakeholders across Trinidad and Tobago have sought to
empower and encourage citizens to lead healthier lifestyles by
introducing programmes, facilities, products and services, geared
towards healthy eating, diet and exercise. These eforts include
the development and refurbishment of community playgrounds,
indoor and outdoor sporting facilities, and swimming pools. In
2017, Government worked in collaboration with the private sector
and other stakeholders to implement a ban on the sale of sugary
drinks in public schools. Despite the above eforts, Trinidad and
Tobago’s Obesity Rate increased from 25.7 per cent to 27.4 per
cent over the period 2015-2019.
The Government continues to run a health and wellness
sensitisation project - Your Wellness is Our Wellness – to raise
awareness and disseminate information on mental health,
nutrition, HIV/AIDS, drug and alcohol abuse, and other risky
behaviours. The objective of this programme is to enable young
people to serve as active change agents towards promoting youth
health and wellbeing, and to emphasise the importance and
benefits of living a healthy lifestyle. To date, almost 1,000 youths
have benefitted from the programme.
Challenges
Trinidad and Tobago continues to face challenges in implementing
SDG 3 and the health-related targets of Vision 2030. These include
a growing demand for healthcare services as a result of a growing
population and recent increase in immigration. The country requires
additional, fully trained healthcare professionals in specialist areas
and additional modern facilities. In particular, the shortage of
resources and expertise impacts on the healthcare system’s ability
to serve, for example, persons in rural communities, and those
with disabilities. Further, the COVID-19 pandemic also tested the
healthcare system’s ability to scale up its service in response to
emergencies. Consequently, work on new healthcare facilities has
been accelerated to ensure suficient capacity is available.
The availability and sharing of data, including historic trend data
covering five- to ten-year periods also pose a challenge. This can
be attributed to, the lack of data collation and analysis processes,
a paucity of locally relevant, peer-reviewed, policy-related
research, and the absence of national communicable disease and
NCD surveillance systems. However, the Government is cognisant
of these challenges faced by the health sector and is working
assiduously towards improving the availability and access to
health data.
Civil Society Interventions
Giving every woman access to a safe, respectful and
natural childbirth experience – Mamatoto Resource and
Birth Centre (SDG 3.2)
Mamatoto Resource and Birth Centre is a communitybased, accessible, equitable and innovative childbirth
centre that ofers family-centred, and individualised
care to women and their families. Its services include
comprehensive counselling, education, and support
during pregnancy, birth and the postpartum period.
It has been recognised locally for its work, including
advocating for healthy birthing alternatives, provision of
education to the public, and healthcare professionals,
and collaboration with other community groups around
women and childbirth issues.
Source: Mamatoto Resource and Birth Centre
Leaving No One Behind
Making Healthcare available to
Non-Nationals – Ministry of Health
The Government is cognisant of the medical needs
of non-nationals, a vulnerable group that has grown
in recent years, mainly as a result of the influx of
immigrants from Venezuela and other neighbouring
countries. The Government has developed a Policy
for Treating with Non-Nationals with respect to the
Provision of Public Healthcare. These include:
• Emergency medical services including: initial
treatment, stabilisation and discharge for acute
medical conditions such as accidents, injuries,
asthma, heart attacks, stroke, diabetic coma; and
relevant diagnostics for acute care.
• All Population and Public Health Services, including
immunisation and treatment of communicable
diseases, Sexually Transmitted Diseases (STDs), and
other high-risk infectious diseases.
Source: Ministry of Health
|
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87
BONNE SANTE ET
BIEN ETRE
PRINCIPAUX AXES DE l’ODD 3
I. Assurer une qualité de vie meilleure des citoyens et améliorer l’espérance de vie à la naissance sans handicap.
II. Réduire le taux de mortalité maternelle,néonatale et infantile et éliminer les décès évitables.
III. Œuvrer à l’éradication des grandes pandémies (sida, tuberculose, paludisme).
IV. Permettre un accès universel et équitable aux soins et aux services de santé.
REALISATIONS ET ENJEUX
I. Promouvoir la santé maternelle, néonatale et infantile.
Même si la cible de faire passer le taux mondial de mortalité maternelle au-dessous de 70 pour cent mille naissances
vivantes a été atteinte par la Tunisie, le Ministère de la santé avec l’appui du système des Nations-Unies (OMS, UNFPA, UNICEF, ONUSIDA) a établi, en 2016, un projet conjoint afin de promouvoir la Santé Maternelle et du Nouveau-né
(SMNN) et d’élaborer une Stratégie Nationale Multisectorielle de SMNN (2019-2023). Dans le cadre de cette stratégie,
Les cibles relatives à la Santé Maternelle et du nouveau-né et de l’enfant ont été contextualisées comme l’indique la
figure suivante.
Figure 14: Stratégie Nationale de Santé Maternelle et du Nouveau-né (SMNN)
03
88
Figure 15 : Plan Stratégique National de la riposte aux VIHSIDA et aux IST83
II. Œuvrer à l’éradication des grandes pandémies (sida, tuberculose, paludisme).
Pour faire face aux maladies transmissibles, la Tunisie, à travers ses structures spécialisées relevant du ministère de la
santé84 , a mis en place des systèmes et des programmes nationaux de dépistage et lutte contre ces maladies.
83Infections sexuellement transmissibles.
84 Dont essentiellement la direction de soins de santé de base, l’observatoire nationale des maladies nouvelles et émergentes,
la direction de l’hygiène du milieu et protection de l’environnement, l’institut national de la santé publique, l’institut pasteur de
recherche épidémiologiques.
89
Figure 16 : Lutter contre les maladies transmissibles
Il est important de souligner que le programme national de lutte contre la tuberculose s’aligne parfaitement avec les
ODD et les cibles y afférentes ainsi qu’avec la stratégie de l’OMS «Mettre fin à la tuberculose». En Tunisie, la tuberculose est classée comme une maladie évitable et curable et le taux de mortalité est faible (inférieur à 1/100.000). Le
programme de prévention de la tuberculose a mis comme objectifs intermédiaires escomptés de continuer à dépister
au moins 70% des cas de tuberculose, et à traiter avec succès au moins 85% des cas de tuberculose à microscopie positive dépistés. L’objectif est de maintenir d’ici 2021, le taux de succès du traitement de la tuberculose à 91% ou plus et
le taux de réussite du traitement de la TB-MR à 65% ou plus et d’agir sur les facteurs de vulnérabilité de la tuberculose
auprès des populations cibles.
III. Réduire la prévalance des maladies non transmissibles.
Face aux mutations démographiques et épidémiologiques accompagnées par le vieillissement de la population et la
propagation des maladies chroniques, la Tunisie s’est engagée dans le programme mondial initié par l’OMS de lutte
contre les maladies non transmissibles (MNT) 2017-2025. La stratégie nationale de prévention et contrôle des MNT 2018-
2025, élaborée selon une approche multisectorielle, projette à l’horizon 2025 d’aboutir à une situation caractérisée par
une vie longue et saine pour tous. Les principaux axes de cette stratégie sont résumés comme suit.
90
Figure 17: Stratégie nationale de prévention et contrôle des maladies non transmissibles
Tableau 1: Cibles de l’année 2025
Objectifs Cibles OMS à 2025 Valeur 2016- 2018
Tunisie
Cible tunisienne
à 2025
Risque de décès prématurés
liés aux MNT Baisse de 25% 15% 11%
Baisse relative d’au moins 10
% de l’usage nocif de l’alcool
Baisse d’au moins
10% <1% <1%
Prévalence du manque de
l’activité physique Baisse de 10% 66% 60%
Apport moyen en sel Baisse de 30% 12 g/j 8 g/j
Prévalence du tabagisme Baisse de 30% 25% 18%
Prévalence de l’HTA Baisse de 25% 29% Stabilité
Prévalence de :
•Diabète
•Obésité
Stabilité
Stabilité
16%
26% Stabilité
PEC des sujets à risque de
MNT (IDM/AVC et autres) dans
les CSB et MG
50% - 50%
91
Parallèlement, d’autres programmes et plans de lutte et de prise en charge des maladies chroniques sont mis en œuvre.
Ces interventions ont permis de faire baisser entre 2010 et 2015 le taux de mortalité attribué aux maladies cardiovasculaires, au cancer, au diabète ou à une maladie respiratoire chronique pour la population âgée entre 30 et 70 ans en
passant de 12,4% à 12,1% pour les femmes et de 22,6% à 21,1% pour les hommes.
Concernant la cible de «Renforcement de la prévention et du traitement de l’abus de substances psychoactives, notamment de stupéfiants et d’alcool», la Tunisie a adopté plusieurs stratégies synthétisées dans la figure suivante.
Malgré toutes ces interventions, la quantité d’alcool consommé (en litres équivalents d’alcool pur) par habitant de 15
ans et plus demeure élevée (1,39 en 2014).
92
IV. Permettre un accès universel et équitable aux soins et aux services de santé.
La Tunisie s’est engagée vers la Couverture Santé Universelle en signant en september 2018 à Salalah le Pacte UHC
2030.
Cet engagement de la Tunisie vers la Couverture Santé Universelle a demarré depuis 2012 a travers le lancement d’un
dialogue sociétal sur la réforme du système de la santé pour élaborer une politique sanitaire à l’horizon 2030 visant un
accès aux services préventifs, curatifs, de réadaptation et de promotion de la santé à l’ensemble de la population, de
qualité suffisante pour être efficaces, sans que leur coût n’entraine des difficultés financières pour les usagers.
V. Assurer un environnement favorable a la Santé.
La cible de réduction du nombre de décès et des maladies dus à des substances chimiques dangereuses et à la pollution et à la contamination de l’air, de l’eau et du sol, est alignée avec la Constitution de 2014. Pour mettre en œuvre ces
dispositions, la Tunisie a procédé à formaliser des axes d’intervention via i) la formalisation, en 1995, d’un programme
de développement durable (Agenda 21 national) qui vise à promouvoir «un mode de développement intégral, fondé sur
l’équité sociale et la garantie du bien-être de chacun dans un environnement sain et préservé» ; ii) la mise en place
d’un système de surveillance en temps réel et à distance de la qualité de l’eau de boisson distribuée par la SONEDE au
Grand Tunis, un système qui va être généralisé progressivement à toutes les régions ; iii) la création du «Centre Technique de la Chimie» qui assure l’assistance technique des industriels opérant dans le secteur chimique ; iv) la mise en
place d’une «Commission Technique interdépartementale de la Santé et de la Sécurité Sanitaire et Environnementale
des Produits Chimiques» qui s’occupe de l’évaluation sanitaire des produits chimiques et la mise en œuvre des plans
et stratégies de contrôle en la matière ainsi qu’à la contribution et la mise en place des stratégies nationales pour la
maitrise des risques sanitaires et environnementales liées aux produits chimiques et v) l’élaboration d’un plan national
de la santé environnementale qui prévoit 11 thématiques pour réduire la mortalité évitable liée à l’exposition à la pollution environnementale. Ce plan est le fruit d’un partenariat entre le Ministère de la santé et le Ministère des affaires
locales et de l’environnement. Toutefois, malgré cette diversité de programmes, les estimations de l’OMS indiquent que
cette cible est loin d’être réalisée. En effet, l’année 2012 était marquée par 4631 morts attribués à la pollution de l’air
ambiant réparties entre 2798 hommes et 1833 femmes.
DEFIS A SURMONTER
Malgré toutes ces réalisations, le système de santé en Tunisie risque d’être remis en question. Ce système fait face à
plusieurs défis résumés en six axes.
93
SYNERGIES ET LIENS AVEC LES AUTRES ODD
Un groupe de travail a été mis en place piloté par le
Ministère de la santé composé des représentants
des structures et ministères suivants :
Ministère de la femme, Ministère de l’agriculture,
MDICI, MAS, Ministère des affaires locales et de
l’environnement, l’INS, Ministère de l’équipement
et le Ministère de l’industrie avec le partenariat
de l’OMS.
BONNES PRATIQUES
1- Un vaste programme de « dialogue sociétal pour les politiques, stratégies et plans nationaux de santé » a été initié
sous l’impulsion du Ministère de la santé. Ce programme comporte trois phases.
Encadré 15 : Dialogue sociétal
- La Première phase 2012-2014 : Cette phase a permis d’évaluer la situation du système de santé tunisien et de
proposer des solutions pour son amélioration,
- Une deuxième phase du dialogue sociétale a été lancée depuis juillet 2017 visant un engagement fort et une
adhésion de toutes les parties prenantes au processus de développement du système de santé pour une nou-
velle politique de santé à l’horizon 2030
- La troisième phase qui commencera vers la fin de 2019 aura pour mission l’élaboration des plans d’action et
de mise en œuvre, de suivi et d’évaluation de cette politique. Un jury citoyen mis en place, depuis la première
phase pour accompagner et appuyer le processus du DS
2- Une expérience en santé sexuelle et reproductive (SSR) assez réussie. Le cadre législatif et réglementaire en
matière de SSR assez étoffé:
- assure la gratuité de la prise en charge, fixe l’âge légal du mariage à 18 ans accorde l’accès aux soins de SSR
à 18 ans ;
- légalise l’avortement ;
- réprime la violence basée sur le sexe ;
- assure la prévention et la prise en charge des IST/VIH ainsi que la protection et le soutien psycho social des
personnes vulnérables.
- parallèlement avec l’intégration de la promotion de la santé sexuelle et reproductive dans le plan
quinquennal de développement et l’introduction à partir de l’année scolaire et universitaire 2019-2020
l’éducation sexuelle et reproductive dans les référentiels de formation scolaire.
|
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TUNISIE : RAPPORT NATIONAL VOLONTAIRE 2021 SUR LE SUIVI ET LA MISE EN ŒUVRE DES
OBJECTIFS DE DEVELOPPEMENT DURABLE 2030
22
• ODD 3. Six des 21 indicateurs renseignés ont été réalisés. Ces résultats ne diminuent en rien les eforts
déployés pour la mise en œuvre des diférentes cibles. La Tunisie vient de se doter d’une Politque
Natonale de la Santé (PNS) qui a été validée par le chef du gouvernement à l’occasion de la célébraton
de la journée mondiale de la santé le 7 avril 2021. La PNS est basée sur une vision 2030 pour la couverture
santé universelle. Elle a été développée dans le cadre de la deuxième phase du dialogue sociétal sur les
politques, les stratégies et les plans natonaux de la santé, suite à un processus partcipatf et inclusif.
L’artcle 38 de la consttuton tunisienne de 2014 stpule que « Chacun a droit à la santé. L’État garantt
la préventon et les soins sanitaires à tout citoyen et fournit les moyens nécessaires pour garantr la
sécurité et la qualité des services de santé. L’État garantt la gratuité des soins pour les personnes sans
souten et à faible revenu. Il garantt le droit à une couverture sociale, conformément à la loi ». En
Tunisie les performances ateintes en matère de couvertures vaccinales ont réduit de façons drastque
la morbidité et la mortalité dues aux maladies évitables par la vaccinaton. Cela a permis au pays
d’adopter avec succès les objectfs mondiaux d’éradicaton et d’éliminaton de certaines maladies telles
que la poliomyélite, le tétanos néonatal et la rougeole3
. Ceci a été rendu possible par la mise en place
d’un calendrier vaccinal obligatoire révisé périodiquement. L’accès à ce calendrier vaccinal est gratuit
dans les établissements publics de santé (les centres de santé de base).
|
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5.3. SDG 3. ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
In the framework of the Health
Transformation Programme
implemented in Turkey since the early
2000s, major changes and reforms
have been achieved in terms of physical
infrastructure, service quality, access
to services and financial support
in the field of healthcare. Through
these developments, there has been
substantial progress in all indicators
under each target, and SDG 3 stands out
as one of the goals on which Turkey has
made most progress.
POLICIES
In addition to NDPs and strategic plans of relevant public
institutions, key policy documents on SDG 3 include the Obesity
Prevention and Control Programme and National Action Plan,
National Cancer Control Programme, National Action Plan
on Mental Health, Rational Medicinal Drug Use Action Plan,
Turkish Pharmaceutical Sector Strategy and Action Plan,
National Tobacco Control Strategy and Action Plan, National
Anti-Drug Strategy and Action Plan, Non-Communicable
Diseases Multi-Stakeholder Action Plan, Healthy Ageing Action
Plan and Implementation Programme, Road Safety Strategy
and Action Plan, and Road Safety Implementation Policy
Document.
The key components of the policy framework in line with SDG 3
are as follows:
• Improving mental health,
• Protecting and improving maternal, child and adolescent
health,
• Improving reproductive health and awareness,
• Combating communicable diseases and risk factors,
• Promoting healthy lifestyles to prevent non-communicable
diseases,
• Strengthening preventive healthcare services,
• Increasing awareness, facilitating access to treatment
and rehabilitation services, scaling up social integration
mechanisms, in the context of combating drug addiction,
• Focusing the policies and practices particularly on children
and youth to reduce the use of tobacco and tobacco
products,
• Ensuring rational use of medicinal drugs,
• Increasing the quality of healthcare services,
• Ensuring accessible, quality, cost-efective and sustainable
provision of healthcare services,
• Enhancing the physical infrastructure for healthcare
services in terms of quality and quantity,
• Strengthening healthcare human resources and improving
their qualifications,
• Developing data and evidence-based healthcare policies,
and to this end, generating quality and standardised data
that would allow for international comparative studies.
LEGISLATION
The current legislation involves regulations aimed at
preventing health risks, and equal, accessible, quality, rapid
and efcient provision of healthcare services across the
country. In this context, preventive, protective, treatment
and rehabilitating mechanisms are addressed holistically to
improve health, with protective and preventive measures in
priority.
Further, the legislation includes restrictions, prohibitions and
sanctions regarding the production, transport, use and sale
of potentially addictive substances as part of the eforts to
combat substance abuse.
IMPORTANT DEVELOPMENTS AND IMPROVEMENT AREAS
SDG 3 is addressed under three main themes: i. Programmes
for preventive healthcare services and ii. Improving healthcare
service provision and infrastructure.
With regard to programs for preventive healthcare services
and promoting healthy lifestyles, comprehensive policies
are in place in Turkey in the fields of maternal-child health;
combating communicable and non-communicable diseases;
mental health; alcohol, tobacco and substance abuse; and
reproductive health.
59
TURKEY’s 2nd VNR 2019
SUSTAINABLE DEVELOPMENT GOALS
“Strong Ground towards Common Goals”
There are many ongoing projects including particularly those
implemented under the Health Transformation Programme.
A significant portion of these projects eventually became
permanent components of the overall structure after being
integrated as major reforms. Programmes for immunisation,
antenatal care, reproductive health, school milk, nutritionfriendly school, cancer control and combating communicable
and non-communicable diseases may be listed as examples
of these projects.
Through the improvements in neonatal screening-care
programme implemented as part of antenatal and postnatal
care services, neonatal mortality rate decreased to 5.8 per
1,000 live births, infant mortality rate to 9.2 per thousand,
and under-5 mortality rate to 11.2 per thousand in 2017.
Maternal mortality ratio is 14.6 per 100,000 live births. On
all these targets, the global goal for 2030 has already been
exceeded.
Designed to reduce maternal and infant mortality rates,
Mother-Friendly Hospital Programme and Guest Mother
Project were launched to monitor pregnant and puerperant
women, and ensure that all births take place at hospitals, and
under safe conditions. Hospitals fulfilling 10 specific criteria
are granted the title of “Mother-Friendly Hospital”. In addition,
the Guest Mother Project involves hosting women going
through a high-risk pregnancy in safe places. As of January
2019, 54 hospitals were named as “Mother-Friendly Hospital”.
The Expanded Programme on Immunisation (EPI) is aimed at
combating Pertussis, Diphtheria, Tetanus, Measles, Rubella,
Mumps, Tuberculosis, Poliomyelitis, Hepatitis-B, Hepatitis-A,
Pneumococcus, Chickenpox, Haemophilus influenzae type
b (Hib), and preventing infant and child deaths and related
disabilities caused by these diseases. All infants are given
free vaccines in accordance with the immunisation schedule.
The term “expanded” refers to administering vaccines to
unvaccinated or partially vaccinated infants and children as
soon as they are identified by also underlining the importance
of homogenously disseminating this practice across the
country. Significant eforts are undertaken jointly with local
administrations to combat communicable diseases. As an
example, Metropolitan Municipality of Mersin as well as
District Municipalities of Besiktas, Konak, Nilüfer, Sisli and
Çankaya have created voluntary testing and counselling
centres.
Non-communicable diseases (NCD) are becoming the main
cause of death, as opposed to communicable diseases, not
only in Turkey, but also globally. In Turkey, the share of NCDs
in total disease burden was 69.7% in 2002, and rose to 82% in
2017. Activities aimed at reducing the risk factors of NCDs are
undertaken as part of the Healthy Life and Activity Priority
Transformation Programme. Work is undertaken to assess
risks of cardio-vascular conditions, and monitor hypertension
and diabetes at primary healthcare level in respect of NCD
early diagnosis, treatment and process management.
The Healthy Nutrition and Active Life Programme, Diabetics
Programme and Reduction of Excessive Salt Consumption
Programme are underway to promote healthy lifestyles,
nutrition and active life habits, and to prevent obesity.
Counselling services on healthy nutrition and obesity
treatment are also provided at Healthy Life Centres and some
Public Health Centres. In 2018, 235,000 persons received such
counselling services.
The Health Risk Screening Programme launched in 2018
involves personal health screening practices for specific
age, sex and risk groups to prevent potential diseases before
they arise. In this context, the Programme includes tests on
blood pressure, blood sugar, cholesterol and fat levels, ECG
(electrocardiogram), urinalysis as well as liver and kidney
function tests. While there were 155 Cancer Early Diagnosis,
Screening and Training Centres back in 2015, the number of
these centres rose to 166 in 2017. Eforts are underway to
further increase the number of these centres.
Implemented since 2010 aiming to prevent malnutrition
among children, the Nutrition-Friendly Schools Programme
became permanent in 2016. Following the introduction of this
programme, the sale of unhealthy foods in school canteens
were prohibited.
Community Mental Health Centres were opened for the first
time in 2014 to ensure that psychological counselling services
were available to patients with psychological disorders as
part of primary healthcare services. Currently there are 163
centres operating across the country.
A range of actions were taken to prevent drug and tobacco
addiction, and reduce deaths and injuries from road trafc
accidents.
As a growing issue, drug addiction is not only a social problem
but also a major health threat. In this context, the National
Anti-Drug Urgent Action Plan was launched in 2015 to keep
the society away from all forms of substance abuse, and
then the National Anti-Drug Strategy and Action Plans were
introduced for the period through 2023.
60
TURKEY’s 2nd VNR 2019
SUSTAINABLE DEVELOPMENT GOALS
“Strong Ground towards Common Goals”
There are ongoing eforts to increase the number and enhance
the quality of treatment centres where drug addicts are
rehabilitated through medical and psychosocial interventions.
There were 3 Addiction Treatment Centres for Children
and Adolescents (ÇEMATEM) in 2014 and rose to 9 in 2019;
24 Residential Alcohol and Substance Addiction Treatment
Centres (AMATEM) were functional in 2014, this number rose
to 39 in 2018, with a total residential bed capacity increasing
from 710 to 1,158. In addition to residential treatment centres,
66 outpatient centres also provide addiction treatment
services.
The project Anti-Addiction Training being implemented since
2014 undertakes education and instruction activities to raise
awareness in the society particularly including students on
tobacco, alcohol, substance and technology addictions.
Local administrations are also involved in anti-drug eforts.
For example, Metropolitan Municipality of Sakarya developed
a Provincial Anti-Drug Action Plan, and provided training to
3,198 individuals. Municipality of Edirne is implementing an
Anti-Drug Project in partnership with the Provincial Police
Department.
As part of the project “No to Drug Addition in Tuzla” led by the
Municipality and District Governorate of Tuzla, and supported
by non-governmental initiatives, voluntary awareness
campaigns were undertaken and, 198 training programmes
were organised where 311 volunteers trained 7,326 people.
Turkey was one the first countries to sign the WHO
Framework Convention on Tobacco Control in 2004. In this
regard, through the legislation introduced in 2008, the number
of places where consuming tobacco products were prohibited
were increased and “all closed public spaces” were covered
under the prohibition. Further, the National Tobacco Control
Programme (2008-2012), National Tobacco Control Action Plan
(2015-2018) and Tobacco Control Strategy and Action Plan
(2018-2023) is under implementation. In addition, through
a new legislative action, the standards on the packaging of
tobacco products were revised, and a number of additional
restrictions were imposed on the places of sale as well as
domains of printed, visual and social media.
The political will, notably the President of the Republic,
central and local governments, NGOs and press are strongly
committed to and engaged in combating tobacco. In addition
to the preventive activities, Helpline 171 for Smokers ofers
support to tobacco users and free services are ofered in
clinics to help people to quit smoking. With its eforts, Turkey
sets an example for the rest of the world.
Despite all these achievements in the field of health, there is
still room for improvement in preventing non-communicable
diseases, provision of preventive healthcare services and
addressing the health problems of growing elderly population
in Turkey as in other countries.
There are ongoing eforts to take measures to reduce
loss of lives and property due to road accidents, a major
socio-economic issue that needs addressing. In spite of the
improvements in highway standards and the positive impact
of the rapid progress in the construction of divided highways,
mortality rate is higher than the average figure of developed
countries.
With regard to improving healthcare service provision and
infrastructure, there have been major strides in the field of
healthcare labour force, funding of investments and services,
universal health coverage, and access to medicines.
Through the positive outcomes achieved as part of the Health
Transformation Programme, remarkable progress was made
in terms of physical infrastructure and human resources.
Although the number of hospital beds per ten thousand
patients was 26.6 in 2015, this number rose to 27.9 in 2017.
In addition, the share of quality beds in the total number of
hospital beds was 67.7 in 2017, representing an increase from
59.7% in 2015.
Through the surge in the number of physicians, nurses and
other healthcare staf across the country, the number of
medical professionals per person is now close to that of
developed countries. Although total number of physicians
and nurses/midwives per 100,000 people were 179 and 261
respectively in 2015, these figures rose to 186 and 272 in
2017.
The number of primary healthcare institutions increased and
the infrastructure of emergency services was substantially
enhanced compared to 2015 when 21,696 Family Practice
Units and 6,902 Family Health Centres existed which
increased to 25,198 and 7,774 respectively. As of 2017, there
was one family practitioner per 3,481 persons. However, the
desired level in terms of average number of patients per family
practitioner has yet to be achieved, and there is still need for a
balanced distribution among provinces.
61
TURKEY’s 2nd VNR 2019
SUSTAINABLE DEVELOPMENT GOALS
“Strong Ground towards Common Goals”
HOME DELIVERY OF HEALTHCARE SERVICES
SDG Targets 3.8
Executing Entity Ministry of Health
Start & End Dates 2010-Ongoing
Medical examination, analyses, treatment, care, monitoring
and rehabilitation services, including social and psychological
counselling services, are provided at own living spaces of
individuals who are restricted to bed and/or home due to physical
or mental conditions. In addition, patients’ relatives are trained on
care. Such services ensure that patients receive quality services,
reduce risk of infection, accelerate recovery, and increase the
quality of life, satisfaction and comfort of both patients and families.
The programme ensures sustainability of services in cooperation
with the central and local governments. As of 2018 end, 1,600
service teams reached out 1.25 million patients. The target is to
reach 1,800 service teams and 1.35 million patients in 2019.
To guarantee access to healthcare services as a fundamental
human right, Universal Health Insurance Scheme (GSS) was
introduced in 2006. Universal Health Coverage implementation
started in 2012 with the payments of the GSS premiums by the
state for those who could not aford it.
Major progress was made in the preventive and therapeutic
healthcare services to refugees and migrants with the same
quality and access conditions as Turkish nationals. In this
regard, improvements are made for the provision of primary
and secondary healthcare services, TACs are established and
MHCs as well in the places densely populated by migrants.
In 29 provinces, a total of 688 migrant health units opened
in 178 MHCs which also employ foreign healthcare staf.
“Regulation on Work Permits of Foreigners under Temporary
Protection” and “Regulation Amending the Working Principles
and Procedures for Foreign Professionals Employed in Private
Healthcare Institutions” were issued to allow healthcare staf
from the same nationalities as the refugees to work in these
centres.
The e-Pulse application, launched in 2015, is a personal
medical record system that provides citizens with access to
their medical histories through online and mobile devices.
Through the e-Pulse system, medical professionals may
access the medical records of patients, which helps increase
the quality and rapidness of diagnosis and treatment
processes, once authorization granted by the respective
patient.
Rational Medicinal Drug Use Action Plan, implemented in
2014-2017, aimed to raise awareness among healthcare staf
and the public, to monitor the quality and the use of drugs
and medical devices as well as the efectiveness of spending
on them. One of the key objectives of the Action Plan was to
reduce the use of antibiotics. During the implementation of the
Action Plan, the daily dosage of antibiotic use per 1000 persons
decreased from 40.5 in 2015 to 35.3 in 2017, respectively.
The Health Institutes of Turkey was established in 2014 to
strengthen and drive R&D activities in the field of health.
Tasked with coordination of pricing, public procurement,
public support funds, commercial and medical technology
policies, data management and dialogue with the private
sector, the Healthcare Industries Steering Committee was set
up in 2015.
In line with the holistic approach taken towards basic
healthcare services, the Programme for Promoting MultiStakeholder Engagement in Health was launched in 2014. It
adopted a multi-stakeholder approach to engage all relevant
actors in healthcare. The first phase of the programme
focused on preventive healthcare and services for improving
well-being while the second phase was designed to
mobilise therapeutic and rehabilitative healthcare services.
Metropolitan Municipalities of Istanbul, Kahramanmaras
and many other municipalities ofer home-based healthcare
services and elderly support programmes. In addition,
Metropolitan Municipality of Istanbul provided 1,200,985 times
home-based nursing care services until today.
As part of healthcare funding, eforts are underway to increase
the share of the private sector in the field of healthcare. As
of 2017, 37% of all hospitals were privately owned; and the
number of private hospitals rose from 47,143 in 2016 to 49,200
in 2017.
Health-Disaster Coordination Centre (SAKOM) was established
to mitigate and manage risks related to external factors
associated with disasters on health. SAKOM made a major
progress achieved in this field.
National Medical Rescue Team (UMKE), composed of
specialised volunteer medical professionals, ofers emergency
medical care and rescue services in times of extraordinary
circumstances and natural disasters. The number of volunteer
medical professionals and the quality of its medical teams
specialising in diferent branches that makes UMKE one of the
world’s leading medical rescue organisations.
62
TURKEY’s 2nd VNR 2019
SUSTAINABLE DEVELOPMENT GOALS
“Strong Ground towards Common Goals”
NEXT STEPS:
The following policies will be implemented in the upcoming
years to achieve SDG 3:
• Keeping up the valuable eforts undertaken in the field of
maternal, child and adolescent health,
• Scaling up training programmes aimed at improving
reproductive health and raise awareness,
• Combating communicable diseases and risk factors,
increasing the number of partnerships with local
administrations in this field,
• Developing programmes and expanding services to promote
preventive healthcare services and healthy lifestyles,
• Increasing awareness, facilitating access to treatment and
rehabilitation services, and scaling up social integration
mechanisms in the context of combating drug addiction,
• Developing projects to reduce the use of tobacco and
tobacco products,
• Improving the quality of healthcare service provision, scaling
up services such as family practice,
• Enhancing the physical infrastructure for healthcare
services in terms of quality and quantity,
• Generating data at international standards and quality to
develop data and evidence-based healthcare policies,
• Efectively maintaining the eforts in multiple sectors to
combat non-communicable diseases,
• Increasing the employment and qualifications of healthcare
professions considering demand and supply,
• Raising awareness among healthcare staf and the public
on rational medicinal drug use, and reducing the use of
antibiotics.
63
TURKEY’s 2nd VNR 2019
SUSTAINABLE DEVELOPMENT GOALS
“Strong Ground towards Common Goals”
|
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{
"country": "tur",
"file_id": "sdg-03/vnr-report-tur-2019-en-3.pdf",
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|
1
Tuvalu First Voluntary National Review (VNR) Report 2022
1
Tuvalu First Voluntary National Review (VNR) Report 2022
SDG 3: Good Health and Well-being
This SPA has a special focus on Non Communicable Diseases (NCDs). The Ministry of Health’s
National Health Strategic Plan 2020-2024 lays out comprehensively what will be done to reduce
the incidence of NCDs, particularly hypertension and diabetes. Government spending on the
aggregate overseas treatment of diabetics (dialysis) runs into tens of millions of dollars since the
late 1980s when the frst patient was evacuated overseas. There have been a lot of lives lost or
limbs removed due to NCDs. The Health Department continues to raise awareness and organizes
public workshops and campaigns against smoking, alcohol consumption and the need to exercise
and eat nutritious food. Alcohol consumption per capita per year for 15 years and older, was 1.3
liters of pure alcohol in 2019 according to ESCAP SDG Indicator Data. In data obtained in 2019,
there were 82.2% of women and 51.2% of men aged 15 to 49 years who did not smoke cigarettes
or any other smoked tobacco product during the last one month.
Tuvalu has low child malnutrition with one of the lowest childhood stunting rates in the Pacifc
islands at 5.7%. Childhood wasting, and overweight prevalence is also low at 2.8% and 4.2%
respectively. However, rates of obesity and associated non-communicable diseases (NCDs) are a
signifcant public health concern for the adult population. Among adults aged 18–69 years, it is
estimated that 55.2% of males and 70.7% of females are obese. Adolescent overweight is
estimated at 58%, noting the absence of physical education in schools21.
Public spending on health is the highest among Pacifc island countries. The budgetary impact of
the referral scheme of cases abroad is signifcant. Health national capacities and emergency
preparedness have been declining. The strength and capability of the Health service is sometimes
measured by the number of staff it employs relative to every ten thousand people in the
population. The Health Worker Density for Tuvalu is 42.6 health workers per 10,000 people in
2018, including 12 which are doctors.
21 MICS 2019/2020
To address the improvement in the quality of curative or secondary health care, the on-going
developments in these branches of the Health ministry include training health professionals
abroad, the provision of supplies and equipment and raising public awareness through campaigns
and workshops. Mental health is also to be improved by working in partnership with relevant
stakeholders inside and outside Tuvalu.
Tuvalu has made progress in improving the health and well-being of children. While the SDG
target for neonatal mortality was achieved, the target for under-fve mortality has yet to be
reached. The latest Multiple Indicator Cluster Survey (MICS) indicated a reduction in neonatal
mortality to 8 per 1,000 live births, while under-fve mortality was estimated at 30 per 1,000 live
births (from a previous estimate of 25). Among all live births with reported birth weights, 3.9%
were considered underweight, which is low by Pacifc island country standards. Adolescent
mortality is estimated at 7.07. Mortality rates are higher among children from the poorest 40% of
households.
Tuvalu’s maternal mortality rate is zero, a fgure that needs to be interpreted with caution, given
the small number of vital events in Tuvalu. Antenatal coverage with 4 visits is estimated at
60.3% while 99.5% of deliveries were attended by a skilled attendant, which indicates near
universal coverage. Tuvalu’s total fertility rate is estimated at 3.3. Adolescent birth rates are the
third lowest in the Pacifc, estimated at 28 per 1,000 women aged 15-19.
Tuvalu has a moderate coverage for all recommended vaccines, estimated at 68.3% and 64.9%
for children 12-23 months and 24-35 months respectively. In 2019, Tuvalu met global targets for
the proportion of children aged 12-23 months vaccinated for Bacillus Calmette–Guérin (BCG)
estimated at 99%, diphtheria, pertussis and tetanus (DPT3) was at 92% while measles containing
vaccine (MCV2) was estimated at 92%. Tuvalu is one of a growing number of Pacifc island
countries that has introduced new vaccines, specifcally Human Papilloma Virus (HPV),
Pneumococcal (PCV) and Rotavirus.
Roughly 55% of caregivers sought care from a health provider for children with diarrhea, and
while most received an Oral Rehydration Solution (ORS), less than 5% received the
recommended treatment of both ORS and zinc. Only a quarter of newborns did not receive any
post-natal care visit and 40% of mothers did not receive any postnatal care visit. Newborns of
Figure 16: Doctors per 100,000 population
54 55
1
Tuvalu First Voluntary National Review (VNR) Report 2022
1
Tuvalu First Voluntary National Review (VNR) Report 2022
mothers who were less than 20 years of age were slightly less likely to receive a postnatal visit.
Another issue of concern is the increase of Tuberculosis incidence from 205 per 100,000 in 2016
to 296 per 100,000 populations in 2019. This may indicate the existence of underlying issues in
the health system, specifcally regarding health education. At 43.8%, the exclusive breastfeeding
prevalence is one of the lowest in the PICT region while early initiation of breastfeeding within
one hour of giving birth occurs among only 39.2% of mothers.
Should a COVID-19 outbreak occur, impacts could be severe due to Tuvalu’s isolation, health
system constraints and high rates of non-communicable diseases and co-morbidities.
Recognizing this risk, the Government of Tuvalu declared a national emergency on 20 March
2020 and locked down its borders. A National COVID-19 Taskforce undertook a full assessment
and developed Tuvalu’s Talaaliki Plan (worst case scenario) to provide a ‘blueprint for action’.
As a result, Tuvalu has had no cases of COVID-19 as of April 2022, reported to WHO. As of 4
April 2022, a total of 12,528 vaccine doses had been administered (WHO data)22.
This SPA also encourages greater use of traditional medicine and healing.
22 https://covid19.who.int/region/wpro/country/tv (accessed 18 May 2022)
56 57
|
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[
3
] |
{
"country": "tuv",
"file_id": "sdg-03/vnr-report-tuv-2022-en-3.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2022
}
|
Voluntary national review on the sustainable development goals INITIATIVES FOR THE ACHIEVEMENT OF THE SDGS
GOAL 3: ENSURE HEALTHY LIVES AND PRO
-
MOTE WELL-BEING FOR ALL AGES
Mortality rates have been reduced significantly in the country
mainly due to the expansion of health facilities at village level. Data
for tracking mortality is available. (Tanzania Demographic and
Health Survey 2015-16 and Malaria Indicator Survey (TDHSMIS);
https://www.dhsprogram.com/pubs/pdf/SR233/SR233.pdf
and https://dhsprogram.com/pubs/pdf/FR321/FR321.pdf)
The baseline for Zanzibar for this indicator was 68.8 percent
according to TDHS 2015/16. The proportion of births attended
by skilled health personnel has risen to 64 percent as reported in
the 2015-16 TDHS-MIS. Under-five mortality rate is declining at
the highest rate, followed by the infant mortality rate. This is due
to the improvements made in health service delivery across the
country. In Zanzibar during 2015/16, the under-five mortality ratio
was 56 per 1,000 live births, neo-natal mortality at 28 per 1,000
live births, post neo-natal mortality at 17 per 1,000 live births,
while infant mortality and child mortality was 45 and 11 per 1,000
live births respectively.
The proportion of women married or in a union of reproductive
age (aged 15-49 years) who have their need for family planning
satisfied with modern methods was at 53 percent of existing
demand. For Zanzibar, the proportion of women achieving
satisfying family planning with modern methods was 28.8 percent.
The total fertility rate in Zanzibar was 5.1.
|
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{
"country": "tza",
"file_id": "sdg-03/vnr-report-tza-2019-en-3.pdf",
"language": "en",
"locality": null,
"size": "s",
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|
VOLUNTARY NATIONAL REVIEW REPORT ON THE IMPLEMENTATION OF THE 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT 26
4.3 GOAL 3: ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL
AGES
Indicators Reported on:
3.1.1 Maternal mortality ratio
3.1.2 Proportion of births attended by skilled health personnel
3.2.1 Under-fve mortality rate
3.2.2 Neonatal mortality rate
3.3.1 Number of new HIV infections per 1,000 uninfected population
3.3.2 Tuberculosis incidence per 100,000 population
3.3.3 Malaria incidence per 1,000 population
3.3.4 Hepatitis B incidence per 100,000 population
3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic
respiratory disease and Indicator
3.4.2 Suicide mortality rate
3.6.1 Death rate due to road traffc injuries
3.7.2 Adolescent birth rate (aged 10–14 years; aged 15–19 years) per 1,000 women in
that age group
3.9.2 Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene
3.9.3 Mortality rate attributed to unintentional poisoning
3.a.1 Age-standardized prevalence of current tobacco use among persons aged 15
years and older
3.b.1 Proportion of the target population covered by all vaccines included in their
national programme
The Maternal Mortality Ratio, Neonatal Mortality Rate, Infant Mortality Rate, Total Fertility Rate, and Adolescent
Pregnancy Rate are the fve health impact indicators in the Health Sector Development Plan that track the sector’s
contribution towards Universal Health Care by providing essential health and related services needed for the
promotion of a healthy and productive life. Nationally representative data on these indicators are measured every
fve years using Uganda Demographic Health Survey (UDHS) data. Some of this analysis uses proxy administrative
data and programmatic reports to estimate progress towards the goal of Universal Health Care.25
Uganda has continued to register gains in several health indicators, owing in part to increasing investment in health
infrastructure, human resources and access to medical services. The Maternal Mortality Rate declined from 438
deaths per 100,000 in 2011 to 336 deaths in 2016 (Figure 5), surpassing the NDPI (2010/11–2014/15) target of
394. However, the estimated annual rate of decline of 5.2 percent is below the 7.5 percent established in the Health
Sector Development Plan (2015/16–2019/20) as the rate required to achieve the SDG target of 140 by 2030. Significant effort is also required to meet the NDPIII target of 211 by 2025.26
25 The Ministry of Health administrative data on health indicators is captured in the DHIS2.
26 Draft NDPIII results framework as at 20 March 2020
27 VOLUNTARY NATIONAL REVIEW REPORT ON THE IMPLEMENTATION OF THE 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT
FIGURE 5: PREGNANCY-RELATED DEATH PER 100,000 LIVE BIRTHS Figure 5: Pregnancy-related death per 100,000 live births
418 438
336
1999-2006
0
100
200
300
400
500
2004-2011 2009-2016 NDP
Source: UDHS, 2016
The leading causes of maternal deaths are obstetric hemorrhage, accounting for 46 percent, hypertensive disorders
(11 percent) and puerperal sepsis (6 percent).27
Improving access to high-quality intrapartum care is a key strategy to address the leading causes of maternal
mortality in Uganda.28 Between 2011 and 2016, the proportion of births attended by skilled health personnel
increased from 58 percent to 74 percent.29 However, delay in the mother seeking help, lack of transport to get to
a health facility and then to referral when needed, as well as lack of blood products, commodities, supplies, and
absence of critical staff, continue to affect the quality of intrapartum care.
FIGURE 6: TRENDS IN CHILDHOOD MORTALITY (1988-2016) Figure 6: Trends in Childhood Mortality (1988-2016)
98
81 88
71
54
43
87
72 69
61
38
22
177
147 151
128
90
64
0
20
40
60
80
100
120
140
160
180
200
UDHS 1988 UDHS 1995 UDHS 2000 UDHS 2006 UDHS 2011 UDHS 2016
Deaths Per 1,000
Infant mortality Child mortality Under-5 mortality
Source: UDHS, 2016
Enhancement in the quality of care has also resulted in a decline in Under Five Mortality from 90 to 64 deaths
per 1,000 live births, and in infant mortality from 54 to 43 per 1,000 live births between 2011 and 2016 (Figure 6).
However, advancement in these indicators has been affected by poverty and regional disparities. Only 44 percent
of mothers in the poorest households receive attention from a skilled attendant at birth, compared with 88 percent in
the richest households, and only 9 percent of newborns in rural areas receive postnatal care within 2 days of birth,
compared with 21 percent in urban areas.30
27 Health Sector Annual Performance report, 2018/19
28 MoH (2018). Mid-term Review Report for the Health Sector Development Plan 2015/16 - 2019/20..
29 UDHS, 2016
30 UNICEF (2020). Maternal and Newborn Health Disparities in Uganda, Available at https://data.unicef.org/wp-content/
uploads/country_profles/Uganda/countrypercent20profle_UGA.pdf
VOLUNTARY NATIONAL REVIEW REPORT ON THE IMPLEMENTATION OF THE 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT 28
The Ministry of Health and its partners have taken steps to implement disability prevention and management
interventions through routine immunization, capacity building, awareness raising, assessment and rehabilitation.
According to the NCPD’s Disability Status report, 2019, the Ministry of Health distributed 300 wheelchairs and other
assistive devices to Persons with Disabilities.
BOX 5: BEST PRACTICE EXAMPLE: SAVING
MOTHERS, GIVING LIFE (SMGL) INITIATIVE
SMGL was a multi-partner/multi-stakeholder initiative
implemented from 2012 to 2017 to improve maternal and
perinatal health in high-mortality settings, especially in
northern Uganda. Through district system strengthening,
integrated services, and community engagement
interventions, the initiative increased emergency obstetric care
coverage and access, and led to demand for improved quality
of care that resulted in rapid declines in district maternal and
perinatal mortality. As the country races towards 2030, it is
critical that such initiatives are scaled up.31
While the country has made commendable strides in reducing HIV/AIDS infections from 7.3 percent in 2011 to 6.0
percent in 2016 among adults aged 15-49 years, the absolute number of infections is still high at approximately
1.3 million. Infection rates are higher among women than men, at 8.3 percent and 6.1 percent, respectively. In
addressing these challenges, the Government stepped up efforts in improving coverage of Anti-Retroviral Treatment (ARV). Among pregnant women, ARV access increased from 91 percent in 2011 to 94 percent in 2016.
In 2016, the Government launched the Test and Treat guidelines that enabled immediate treatment of persons
after testing positive. Emphasis has also been on implementation of comprehensive HIV preventive interventions,
including reactivation of the Abstinence, Behaviour Change and Condom use (ABC) campaign, safe male circumcision, and a campaign against teenage pregnancy, among others. However, the high burden of new infections each
year, over 30 percent of which are among young people, remain a major challenge for ARV coverage. Young people
display the least viral suppression and are the least likely to adhere to ARV guidance. The rise in the burden of other
diseases, such as malaria and tuberculosis, also presents a challenge (Figure 7).
Figure 7: Trends in incidences of Malarial, Tuberculosis and Hepatitis B per 100,000 FIGURE 7: TRENDS IN INCIDENCES OF MALARIAL, TUBERCULOSIS AND HEPATITIS B PER 100,000
Tuberculosis Malaria Hepatitis B
500
106
193
54.4
2015 2016 2017 2018 2019
178
450
400
350
300
250
200
150
100
50
0
Incidence Per 100,000 Population
382
433
162
1.2 1
182
242
308
340
0.6 0.8
Source: UBOS, 2019
31 See Serbanescu F1 et al (2019) Impact of the Saving Mothers, Giving Life Approach on Decreasing Maternal and Perinatal
Deaths in Uganda and Zambia, Glob Health Science Practice 2019 Mar 13;7 (Suppl 1)
Distribution of assistive devices to Persons with Disabilities in
Bunyoro Sub Region
29 VOLUNTARY NATIONAL REVIEW REPORT ON THE IMPLEMENTATION OF THE 2030 AGENDA FOR SUSTAINABLE DEVELOPMENT
FIGURE 8: PATTERN OF DEATH DUE TO ROAD TRAFFIC ACCIDENTS Figure 8: Pattern of death due to road trafc accidents
28
31
18
16 16
0
5
10
15
20
25
30
35
2015 2016 2017 2018 2019
Mortality Rate
Additionally, non-communicable diseases such as cardiovascular illness, cancers, and chronic respiratory conditions are emerging challenges, reaching epidemic level.
Road traffc accidents are a major threat to the health and safety of people of Uganda. Increased road infrastructure has contributed to a rise in road fatalities, which went up from 2,597 in 2015 to 3,503 in 2016, representing an
increase of 25.9 percent.32 Nationally, road traffc deaths stand at 53 per 100,000 of the population (exceeding the
African regional average of 18 deaths per 100,000), with females making up 7 fatalities per 100,000 of the population and males 46 per 100,000. The accident severity index for Uganda is 24 people killed per 100 road traffc
crashes. On average, Uganda loses 10 people per day in road traffc crashes, the highest level of fatalities in East
Africa.
32 Analysis of annual traffc and road safety reports
|
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|
GOAL 3
HEALTHY LIVES
AND WELL-BEING
3.8.1
3.5.1
3.3.1
3.9.1
3.4.1
3.4.4
3.8.2
3.6.2* 3.7.1*
3.6.1
3.5.2
3.1.1 3.4.2
3.2.1 3.4.3
3.3.2
Target will be met, if
respective actions are
taken immediately
Target might be met,
subject to the availability
of sufficient resources
and the commitment
Target might not
be met
Target will
be met,
if substantial
efforts are
taken
SMALL PROBABILITY
MIXED PROGRESS:
MEDIUM / MODERATE PROBABILITY
Goal/Target: progress and estimates of probability of achievement SIGNIFICANT PROGRESS:
CONSIDERABLE
PROBABILITY
Goal has been achieved
or will be achieved
* Indicator 3.6.2, 3.7.1 – expert estimations.
SECTION 2. PROGRESS TOWARDS ACHIEVEMENT OF SDGs Goal 3. HEALTHY LIVES AND WELL-BEING
SUSTAINABLE DEVELOPMENT GOALS: UKRAINE VOLUNTARY NATIONAL REVIEW 31
A series of reforms aimed at enhancing accessibility and quality of medical
services has taken place during the recent !ve years in the health care sector.
In particular, signi!cant changes have occurred in the health care !nancing
system, medical education, public health system, medical procurement,
provision of medical services, and other !elds.
The following progress has been achieved in this goal:
y decline in mortality of children under 5 that was achieved due to
introduction of modern perinatal technologies, reorganization of obstetric
and neonatal departments, and creation of a network of perinatal centres;
y decrease in the number of patients diagnosed with active tuberculosis
for the !rst time due to implementation of new, WHO-recommended
treatment regimens using new specialized tuberculosis drugs;
y reduction of the number of deaths from cerebrovascular diseases among
women and men due to implementing the measures provided for in the
National Action Plan on Non-Communicable Diseases, overcoming the
burden of non-communicable diseases, and countering risk factors such
as tobacco smoking, alcohol abuse, unhealthy diet, low physical activity,
and polluted atmospheric air;
y decrease in the number of deaths from road tra"c accidents and in
the number of persons injured in road tra"c accidents due to the
Government’s e#orts aimed at increasing the transport safety level due
to implementation of the State Programme for Enhancing the Road
Tra"c Safety Level in Ukraine until 2020, particularly measures to improve
performance indicators of motor roads and streets, increase vehicle
operation safety, and enhance the driver training system e"ciency;
y decline in the number of cases of maternal mortality due to implementation
of comprehensive measures and development of obstetric departments;
y reduction of the number of deaths from malignant breast tumours
among women that occurred, inter alia, due to awareness raising aimed
at the disease prevention, early diagnostics and treatment;
SECTION 2. PROGRESS TOWARDS ACHIEVEMENT OF SDGs Goal 3. HEALTHY LIVES AND WELL-BEING
SUSTAINABLE DEVELOPMENT GOALS: UKRAINE VOLUNTARY NATIONAL REVIEW 32
y decrease in the probability of dying at the age of 20-64 among women
from 0.15514 in 2015 to 0.15010 in 2018, which allows expecting
achievement of the target indicator value, 0.15000, in 2020 provided that
such a trend continues.
A number of other positive trends should also be highlighted:
y reduction of the number of deaths from malignant cervical tumours
among women at the age of 30-59 due to awareness raising aimed at
early detection of female reproductive organ cancer and improvement
its diagnostic quality;
y reduction of the share of men who smoke at the age of 16-29 that
occurred, inter alia, due to integration of the key measures provided in
the WHO Framework Convention on Tobacco Control in the Ukrainian
legislation, in particular implementation of non-price measures: fully
prohibiting tobacco advertising and sponsorship, rotating health
warnings on cigarette packs, and protect all public places from exposure
to tobacco smoke. However, to achieve considerable reduction of the
prevalence of smoking among all population segments, the tax policy
needs to be strengthened with legislative and administrative measures,
particularly concerning heated tobacco products and liquids for
electronic devices;
y increase in the preventive immunization coverage of newborns: against
measles, mumps and rubella – 93.2% in 2019 (2015 – 63.2%); pertussis,
diphtheria and tetanus – 85% (2015 – 26.5%); hepatitis B – 77.0% (2015 –
25.4%), tuberculosis – 88.6% (2015 – 39.8%), poliomyelitis – 78.4% (2015 –
63.8%). In the recent 7 years, due to a shift to international procurement,
Ukraine has a su"cient quantity of vaccines to provide immunization
coverage of all the age groups that need it, according to law. The growth
of the population immunization rate (in accordance with the National
Preventive Vaccine Calendar) has been achieved due to: a shift to triennial
planning of vaccine procurement; provision of conditions to fully meet
the health care facilities’ demand for immunobiological preparations
for vaccination; revision of the National Preventive Vaccine Calendar;
and cancelled re-vaccination against tuberculosis at 7 years of age
(which allowed reduction of the number of injections for a child during
preventive immunization).
However, such positive trends are not su"cient and were hindered by:
y under!nancing of the health care system. Budget expenditure
consisted mainly of the health care facilities’ expenses for wages and
utility service payments (about 75%). Such circumstances leave very
few !nancial opportunities for actual service delivery, i.e. treatment of
patients, procurement of medicines and consumables, and renovation
of technological funds. The principles of !nancing in health care have
changed since 2017, and now funds are allocated to health care facilities
subject to the services they provided to their patients, which will allow
providing more a#ordable care to a patient and ensure more e"cient
use of funds based on a preset guaranteed package of services. Stable
!nancing and increase of expenditure on health care is necessary so
that the number of state-guaranteed free services be expanded and the
hospitals’ material and technical facilities be improved further on;
y widespread self-treatment practice among the population. According to
recent sociological survey data, almost 69% of sick persons in Ukraine
engage in self-treatment without applying to doctors for help. This
results in a growing number of complications, especially in chronically
ill patients, and adversely a#ects disability and life reduction indicators;
y ine"ciency of some pharmaceutical drugs sold in the market. According
to !ndings of the WHO surveys, almost 10.5% of all the medical products
used in low- and middle-income countries fail to stand the test and
are counterfeits. Due to lack of a uniform system for medicine turnover
monitoring, it is impossible to determine the amount of counterfeit
medicines in Ukraine. The procedures for admission of pharmaceutical
drugs to the market and endorsement of clinical trials last for 15-25% on
average longer that similar procedures in the EU countries.
The negative trends important to point out include the fact that Ukraine
is currently one of the leaders among countries in the European region in
terms of the number of HIV positive persons. According to expert calculations,
there were 244,000 HIV positive people living in the country as of early 2018.
Moreover, the number of patients diagnosed with HIV for the !rst time per
100,000 population has increased in Ukraine from 37.0 in 2015 to 42.8 in 2018,
which most likely indicates practical unattainability of the target value, 30.9,
by 2020.The rise in the number of patients diagnosed with HIV for the !rst
SECTION 2. PROGRESS TOWARDS ACHIEVEMENT OF SDGs Goal 3. HEALTHY LIVES AND WELL-BEING
SUSTAINABLE DEVELOPMENT GOALS: UKRAINE VOLUNTARY NATIONAL REVIEW 33
time has been caused by wider access to testing and detection of PLWH who
were not aware of their status before. In particular, the share of people living
with HIV (PLWH) unaware of their status has decreased from 50% to less than
30%. The number of PLWH receiving antiretroviral therapy (ART) has grown by
75,000 during 5 years, and current ART coverage is about 72% of the number
of PLWH aware of their status. 93% of the ART-receiving PLWH have a nondeterminative level of viral load.
The global community pledged itself to eliminate mother-to-child HIV
transmission by 2030 as a priority task for public health care. Timely antiretroviral
therapy of HIV-positive pregnant women and their children is known to
allow achieving the elimination goals, namely reducing substantially the risk
of perinatal child infection to 2-1%, or less than 50 per 100,000 live births.
Ukraine is already on the verge of elimination, that being a major advance.
However, the country has not yet attained a stable decrease in the vertical
HIV transmission rate. Representatives of the National Council on Tuberculosis
and HIV/AIDS Control came forwards with an initiative to establish and
organize e#ective work to meet the conditions for submission of Ukraine’s
request to the regional secretariat on EMTCT validation (WHO Regional O"ce
for Europe) for undertaking a EMTCT validation process in Ukraine.
FOR REFERENCE
according to the Ukrainian legislation, children born to HIV-positive women must
be observed during 18 months to establish their final HIV status. According to the
Positive Women CO, percentage of transmission in the cohort of children born in
2017 in Ukraine was 3.3%, the figure for those born in 2019 being 1.6%.
There is still the need to ensure equal access of women living with HIV to
medico-social services, including sexual and reproductive health care, and to
combat a stigmatizing attitude to HIV-positive people in the community.
Other problems hindering progress in the health care sector include
persistence of high gender di#erences in the !gures of life expectancy
and likelihood of premature mortality, especially from external causes
(accidents, suicide, murders). Too high mortality among men of working age
is determined to a great extent by prevalence of risky behaviour patterns, bad
habits, and unwillingness to visit a doctor, which are often associated with
impact of the gender stereotypes that de!ne ‘proper’ behaviour models of
women and men.
TO ACHIEVE THE GOAL, IT IS NECESSARY TO CONTINUE THE HEALTH
CARE SYSTEM REFORM AND IMPLEMENT COMPREHENSIVE MEASURES
TO PREVENT DISEASES, ENSURE THEIR EARLY DETECTION, DIAGNOSTICS
AND TREATMENT, WHICH IS ACCESSIBLE, TIMELY AND OF PROPER
QUALITY, AND CREATE A HEALTH-PROMOTING ENVIRONMENT. OTHER
IMPORTANT OBJECTIVES INCLUDE:
y ensure implementation and realization of measures to prevent noncommunicable diseases that are a cause of 80% of deaths in the
country12. In particular, the National Action Plan on Non-Communicable
Diseases for Achievement of Global Sustainable Development Goals was
approved in 2018, to coordinate e#orts for overcoming the burden of
non-communicable diseases such as blood circulatory system diseases,
neoplasms, chronic obstructive pulmonary diseases, and diabetes, as well
as for countering the risk factors such as tobacco smoking, alcohol abuse,
unhealthy diet, low physical activity, and polluted atmospheric air;
y create an e"cient user-oriented system of mental health care;
y ensure meeting the obligations on prevention of communicable and
non-communicable diseases, in particular the Strategy for development
of immunoprophylaxis and protection of the population against
communicable diseases that can be prevented by immunoprophylaxis,
up to 2022; the Strategy for development of the national blood system
in Ukraine; the Strategy of ensuring biological safety and biological
protection based on the One Health principles up to 2025 and an
action plan for its implementation; the State Strategy for control of HIV/
AIDS, tuberculosis and viral hepatitis up to 2030; the State Strategy for
development of the antituberculosis medical treatment system for the
population; the Action Plan on reducing the population’s exposure to
radon and its decay products, and on minimizing long-term risks caused
by radon proliferation in residential and non-residential buildings and at
workplaces for 2020-2024; National Strategy on physical activity for the
period to 2025 and action plan for its implementation.
12 https://bit.ly/2MyMhyO
SECTION 2. PROGRESS TOWARDS ACHIEVEMENT OF SDGs Goal 3. HEALTHY LIVES AND WELL-BEING
SUSTAINABLE DEVELOPMENT GOALS: UKRAINE VOLUNTARY NATIONAL REVIEW 34
y securing the people’s epidemiological welfare by achieving 95%
preventive vaccination coverage via a sustainable system of
immunobiological preparation procurement as per the vaccine
schedule, which will meet 100% of demand, and ensuring the
operation of e"cient regional teams within regional public health care
facilities that will manage the stock of immunobiological preparations
(vaccines) and medical products used for preventive immunization;
y launching a national blood system as a component of the public health
system, which will ensure circulation of safe donor blood components
on the nationwide level by means of establishing a three-tier Europeantype national blood system, creating a national reference laboratory
of the national blood system, introducing new methods of laboratory
testing, establishing the National Register of blood and component
donors and of persons forbidden to be donors, and implementing a
programme for development of free voluntary blood donation in order
to increase the free voluntary blood donation rate;
y developing a system of delivery of high-quality and timely, evidencebased and patient-oriented medical services at all levels – from
primary, secondary and highly specialized medical aid to rehabilitation
and palliative care.
AMIDTHE COVID-19 PANDEMIC DEVELOPING GLOBALLY AND IN UKRAINE,
THE UKRAINIAN MEDICAL SYSTEM FACES, ONTHE ONE HAND, CHALLENGES
OF RESPONSE TO THE EPIDEMIC, AND, ONTHE OTHER HAND, THE NEED FOR
CONTINUOUS PROVISION OF MEDICAL SERVICES INTHE NEW CONDITIONS.
IN RESPONSE TO THE NEW CHALLENGES, IT IS NECESSARY TO:
y ensure infection control and safe working conditions for physicians
and patients in health care facilities;
y build capacity of laboratories for COVID-19 testing;
y develop the system of health care !nancing further on to provide
high-quality services accessible to patients, and reduce payments “out
of pocket”;
y improve material and technical facilities in health care facilities, and
develop physicians’ capacity to provide high-quality medical aid
according to standards and evidence;
y strengthen the system of medical services, prevent any interruptions
in services and medicines able to endanger human and societal life
and welfare (ART for HIV-positive patients, vaccination, medicines for
cancer and diabetic patients, etc.).
|
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{
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|
31 | Page
SDG 3: SVG’s Progress
Ensure healthy lives and promote well-being for all at all ages
The priorities for the health sector are defined in the National Economic and
Social Development Plan 2013-2025 which states inter alia that access to good quality and
affordable health care is fundamental and that through the implementation of the Plan, focus will
be placed on improving the general health and well-being status of the population, and increasing
life expectancy through the implementation of a wide range of programmes and the enhancement
of existing programmes such as the “Wellness Revolution”.
Basic health indicators for Saint Vincent and the Grenadines are generally positive with an average
life expectancy at birth of 73 years (71 years for men and 75 years for women) and a fertility rate
at a stable 2.1 children per woman, comparable to that of developed countries. Infant and
maternal health, expansion in primary health care coverage has resulted in full immunisation
coverage for the under-5 age group, 98.6 percent of births are attended by skilled personnel and
there is a very low rate of maternal deaths (1.1 per 1,000).
Notwithstanding the above, some of the more pressing challenges facing the health sector in Saint
Vincent and the Grenadines are: fiscal constraints; changing family structures; an ageing
population; an upsurge in chronic non-communicable diseases; relatively high levels of
communicable diseases; and an increase in levels of substance abuse.
Saint Vincent and the Grenadines continues to record a rapid increase in lifestyle-related diseases
over the past two decades. These, primarily chronic Non Communicable Diseases (NCDs) are now
the leading causes of mortality in both males and females. This is seen in a shift away from
traditional diets made up primarily of locally produced whole root, tubers, and vegetables to more
varied energy-dense diets based on more processed foods and beverages, which also has resulted
in a steady rise in overweight persons in the population. The 2012/2013 National Health and
Nutrition Survey indicated that fruits and vegetables were consumed an average of 3.3 days and
3.1 days respectively, per week.
Together with HIV/AIDS, NCDs are the main health threats to the people of Saint Vincent and the
Grenadines and the main focus of the health sector. Although the social and economic impact has
not been fully assessed, the financial burden alone is tremendous, with most human and technical
resources being used in the treatment of these diseases.
These challenges are not confined to Saint Vincent and the Grenadines but represent a wider
regional problem. As such, there is collaboration with countries of the OECS and wider CARICOM
region in attempting to reverse these trends. Primarily, in the case of HIV/AIDS management, the
region has been able to attract international assistance (financial, human and technical resources)
from which Saint Vincent and the Grenadines has benefited. Apart from communicable diseases,
32 | Page
the re-emergence of some vector borne diseases such as Zika and Chikungunya, continue to be
areas of concern.
Key Achievements
Free primary health care services are available to all Vincentians through thirty-nine (39) health
centres in nine (9) health districts in the country. These services include emergency care, medical
care, prenatal and postnatal care, midwifery and child health services including immunization,
school health and family planning services, communicable and non-communicable diseases
control. Mental health services are offered on a visiting basis at all health centres while oral health
services are delivered at selected health centres throughout the state. The launch of the
“Wellness Revolution” in 2008 as part of efforts to promote a holistic approach to health and wellbeing has heightened interest in this regard. Since then, improvements have been made to further
emphasize the importance of healthy diet, exercise, sports and recreational activities in the
promotion of healthier lifestyle choices.
Emphasis also is being placed on investments in health infrastructure throughout the country –
including refurbishing existing facilities and constructing new and modern clinics. Recent
achievements in this area include the opening of the Modern Medical Complex in Georgetown in
2018, state-of-the-art polyclinics in Buccament and Mesopotamia, and a Smart Hospital in
Chateaubelair in 2019. The government continues to strengthen administrative capacity in the
health sector, re-orient the primary health care system to create a more positive impact on the
health status of the nation and expand secondary and tertiary health care services to include new
treatment modalities.
Saint Vincent and the Grenadines has made huge strides in terms of disease reduction and
improved sanitation. Over 93.0 percent of the population has access to clean water and this has
significantly reduced the number of diseases spread by poor water sanitation. Overall, the country
has a low disease spread and sets an excellent example for other developing nations for disease
prevention and reduction. This also is true of COVID-19, in which the country has recorded 27
cases.
In 2019, the Government published its first-ever Charter of Patient Rights and Responsibilities. The
Charter focuses on the right to health as a fundamental human right.
The performance on key health indicators is summarized in the table below.
33 | Page
Table 7: Health Indicators 2016
Health Indicators, 2016
Indicators Estimate
Life Expectancy at Birth (in completed years) 73
Male 71
Female 75
Peri-natal Mortality Rate per 1,000 Live Births 24.9
Infant Mortality Rate per 1,000 Live Births 16.6
Child Mortality Rate per 1,000 Live Births 16.9
Still Births (count) 23
Total Fertility Rate 2.1
Registered Nurses per 1,000 population 4.5
Immunization Coverage in infants less than 1 year (%) 100
Births Attended by Skilled Personnel (%) 98.6
Source: Statistical Office of Saint Vincent and the Grenadines
Focus also continues to be placed on lifting the general health status of the population through
the implementation of a wide range of programmes and the enhancement of existing programmes
such as the “Wellness Revolution”. In 2017, Saint Vincent and the Grenadines ratified the World
Trade Organization’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement,
which will make it easier for the country to have a secure legal pathway to access affordable
medicines.
The country continues to increase the human resource capacity of the health sector, employing
additional doctors and nurses – for example a 71 percent increase in the number of doctors
between 2018 and 2019 and a 29 percent increase in the number of nurses over the same period;
and an increase of 123 percent in the purchase of medicines over 2018 – 2019 as a mechanism to
ensure access to essential medicines.
Dashboard of SDG Targets and Progress
Table 8: Goal 3 Indicator and Progress
SDG Target SVG
Progress
By 2030, reduce the global maternal mortality ratio to less than 70
per 100,000 live births.
By 2030, end the epidemics of AIDS, tuberculosis, malaria and
neglected tropical diseases and combat hepatitis, water-borne
diseases and other communicable diseases.
34 | Page
SDG Target SVG
Progress
By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and
promote mental health and well-being.
Strengthen the prevention and treatment of substance abuse,
including narcotic drug abuse and harmful use of alcohol.
By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and
education, and the integration of reproductive health into national
strategies and programmes.
Achieve universal health coverage, including financial risk
protection, access to quality essential health-care services and
access to safe, effective, quality and affordable essential medicines
and vaccines for all.
Strategies and Actions Needed to Achieve Goal 3
While Saint Vincent and the Grenadines has a relatively good primary health care programme,
there remains many pressing challenges and key to this is allocating scarce resources to support
much needed activities under this goal. Some of these activities that have been prioritized in the
National Development Plan and which are critical to achieving goal 3 are:
• Improving access to affordable primary, secondary and tertiary healthcare services.
• Prevention and control of non-communicable diseases which remain obstacles to good
health.
• Communicable disease surveillance, prevention and mitigation.
• Human capital development and sustainable health care financing.
• Strengthening mental health services.
• Creating the supportive environment for an active, physically and mentally fit nation as
well as the enabling environment to support access to heathy and nutritious diets as part
of these lifestyle changes.
Making the required investments in health infrastructure will be important for advancing the
various health outcomes and increasing life expectancy and also is critical for delivery of quality
health services and care. Equally important is the need to develop health information systems to
assist with tracking the performance of the sector on one hand but also to allow for making more
informed and strategic decisions.
|
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17
Garantizar una vida sana y promover el bienestar de todos a todas las edades
En cuanto al sector salud, vinculado con el ODS N° 3: “Garantizar una vida sana y
promover el bienestar de todos a todas las edades”, En Venezuela la inversión en salud
creció de manera importante, durante el 2015 hubo un incremento del Presupuesto del
MPPS, para una inversión total en USD 232.508.675,00 . Un análisis realizado por el
Ministerio del Poder Popular para la Salud (MPPS) señala que desde 1999 se han sumado
17800 nuevos centros de salud para un total de 23.146. Una referencia clave del impacto de
estas medidas es la reducción en la tasa de mortalidad infantil que se ubica en 14,79% para
el 2015.
De igual manera se ha reducido la mortalidad por ciertas afecciones originadas en el
período perinatal llegando a la cantidad de 859,83 por cada 100.000 habitantes. En
relación, a situaciones de gravedad global como el brote de Zika se tiene que en relación de
casos sospechosos de Zika se registraron 2488 (188 casos sospechosos en gestantes y 2300
casos sospechoso en no gestantes) y de Guillain Barre 271. Otro dato relevante para
caracterizar las fortalezas de la salud en Venezuela es que para 2015 contamos con 12
vacunas contra 18 enfermedades.
La gestión del Ministerio del Poder Popular para la Salud se enmarcan en los lineamientos
establecidos en el Programa del Plan de la Patria 2013-2019, en el cual se señala “Asegurar
la salud de la población, a través de la consolidación del Sistema Público Nacional de
Salud, sobre la base de la profundización de Barrio Adentro, el Poder Popular y la
articulación de todos los niveles y ámbitos del Sistema de Protección, Promoción,
Prevención y Atención Integral a la Salud individual y colectiva. Así se espera: a) Aumentar
en un 100% la cobertura poblacional de Atención Médica Integral, en Atención Primaria
con Barrio Adentro I y II” (Art. 2.2.2.16) y ratificado por el Presidente Nicolás Maduro
Moros.
Uno de los principales avances en salud es el aumento de la cobertura, en 2015 para atender
una población estimada de 7.086.000 habitantes se ha alcanzando una cobertura de 86.8%
gracias a la “Clasificación de los Establecimientos que conforman el Sistema Público
Nacional de Salud (SPNS), en el Primer Nivel de Atención Médica e instauración de la Red
de Atención Comunal de Salud, mediante la unificación de Barrio Adentro y la Red
Ambulatoria (Resolución N. 400, publicada en Gaceta Oficial N. 40.723, del 13 de agosto
de 2.015), con esta nueva clasificación de las instituciones de salud en la red de atención
comunal, denominadas Consultorios Médicos Populares, se incrementaron a 12.011 (4.118
antiguos Ambulatorios Rurales Tipo I y Tipo II, 7.287 Consultorios Médicos Populares de
Barrio Adentro y 606 Ambulatorios Urbanos Tipo I)11. Además se geo referenciaron y
11 Como medidas que impactaran en positivo la ampliación de la cobertura en salud a futuro, tenemos: 1) Priorización e integración de cinco (5)
Programas de Salud Colectiva de promoción de la salud y prevención de enfermedades a la Misión Barrio Adentro permitiendo articular todo el Sistema
Público Nacional de Salud (Resolución N.427 en Gaceta Oficial N. 40.724, del 14 de agosto de 2015): 1) Atención Integral a la Mujer (Salud Sexual y
Reproductiva), 2) Atención Integral al Recién Nacido, Niño, Niña y Adolescente, 3) Programa Ampliado de Inmunización (PAI), 4) Programa de
Enfermedades Transmitidas por Vectores y 5) Programa de Enfermedades Crónicas no Transmisibles; 2) Formación de especialistas con el Postgrado
de Medicina General Integral impartido por el Instituto de Altos Estudios “Dr. Arnoldo Gabaldón” destinado a la Promoción de la Salud y la Prevención
de las enfermedades e incrementar la cobertura de atención (resolución Nº 609 Publicada en Gaceta Oficial Nº 40.791 de Fecha 18 de Noviembre de
2015), en su ampliación en las menciones de Oncología Médica Preventiva, Cardiología Preventiva, Endocrinología Preventiva, Obstetricia y Salud
Reproductiva, Puericultura, Salud Mental y Gerontología y 3) La Humanización de todos los Centros de Salud dirigido a garantizar una atención de
18
fortalecieron las Áreas de Salud Integral Comunitarias (ASIC): en más de un 95% y 590
ASIC del país fueron mapeadas y dentro de ellas ubicados en los 12.011 establecimientos
de salud de la Red de Atención Comunal de Salud.
Asimismo, se ha consolidado de la participación y protagonismo del Poder Popular en la
articulación del Sistema de Agregación Comunal y la contraloría social con la elección de
las 539 vocerías principales y 473 suplentes de las 590 Áreas de Salud Integral Comunitaria
(ASIC) en 24 Estados, 335 municipios y 1.136 parroquias; registro de 34.513 vocerías de
salud en los consejos comunales de 7.000 Comités de salud, se llevaron a cabo 2.567
Asambleas con la participación de 52.931 personas (19.092 integrantes de las comunidades
y 33.839 trabajadores de las instituciones públicas de salud).
En Venezuela tenemos el fortalecimiento de la política de la Promoción de la Salud y
Prevención de Enfermedades, mediante el despliegue en 305 nuevos urbanismos y 425
Base de Misiones y encuentros de pacientes con enfermedades crónicas y actividades
deportivas y de salud con la participación de 137.024 Médicos Integrales Comunitarios,
Médicos Generales Integrales Comunitarios, Enfermeras y Enfermeros, Promotores de
Salud y Comités de Salud, así como la ejecución de 46 supervisiones y evaluaciones sobre
las actuaciones de vigilancia, prevención y control integral de vectores, reservorios y fauna
nociva, beneficiando a 20.586.881 personas y en las coordinaciones regionales de los
programa priorizados se han desarrollado 27.812 actividades de formación y capacitación
dirigida a personal de salud, docentes, comunidades y estudiantes de primaria y secundaria,
alcanzando un total de 236.906 de personas.
Se tiene la Consolidación del Ejército de las Batas Blancas de la Revolución convirtiéndose
en el programa de este nivel más grande de toda América Latina, actualmente se encuentran
en ejercicio de funciones 17.800 Médicos Integrales Comunitarios, distribuidos en las 590
Áreas de Salud Integral Comunitaria (ASIC) a nivel nacional con un promedio de 30 MIC
por cada ASIC; 9.450 Médicos Residentes en la especialidad de Medicina General Integral
(MGI) que se encuentran en Postgrados y en formación 30.000 estudiantes.
Entre 2007 y 2015 han sido aplicadas 142.616.362 dosis de vacunas, cubriéndose en la
semana de vacunación de las Américas del 2015 un 96,83%; en el marco de la Ruta
Materna dirigido a la prevención de la mortalidad materna e infantil y la promoción del
parto humanizado; se han evaluado 26.995 recién nacidos y 52.500 gestantes; de estas
27.426 de alto riesgo obstétrico y 14.223 registradas en el “Sistema de Captación y
Seguimiento Materno Infantil (SICASMI)”; se han atendido 62.225 pacientes con
VIH/SIDA y 155.000 pacientes con ITS, distribuido 5.472.000 preservativos masculinos a
nivel nacional; en Salud Mental se distribuyeron 4.262.162 unidades de medicamentos
Psicotrópicos para la atención de 120.907 personas registradas en el Sistema Integrado de
Acceso a Medicamentos (SIAMED).
En cuanto a la atención integral a los grupos poblacionales vulnerables, tenemos el
fortalecimiento de 12 servicios de rehabilitación en las áreas de neurología,
calidad y de los derechos de los pacientes y familiares a través de resolución Nº 135, publicada en la Gaceta Oficial Nº 40.644, de Fecha 21 de Abril de
2015.
19
musculoesquelética, mental (unidades de autismo), visual, voz–habla–auditivo,
cardiovascular y sensitiva, en las cuales se atendieron a un total de 150.027 pacientes;
atención integral a 1.580 personas con discapacidad por la enfermedad de Parkinson;
atención integral a 109.411 personas en el área musculoesquelética, 1.000 personas con
discapacidad visual, 1.200 personas con discapacidad asociadas al trastorno de del espectro
autista, 34.799 personas con discapacidad; capacitación de 8.857 personas de las
comunidades en Cuidados Básicos para las Personas Con Discapacidad, en el marco de la
estrategia de Atención Comunitaria para Personas Con Discapacidad y entrega de 3.500
prótesis auditivas, beneficiando a 1.600 personas con discapacidad auditiva.
La consolidación del Sistema Público Nacional de Salud se ha logrado a través de la
integración de todos los componentes institucionales que aplican y ejecutan las políticas
públicas de salud, entre ellos el MPP Salud, el IVSS, Salud Militar, Ipasme y PDVSA–
Salud. Para ello se adecúan e implementan estrategias en torno a: Sistema de Información
en Salud (SIS). Proyecto de Digitalización y Automatización del Sistema de Información
Único Nacional de Salud (E-Salud), en el cual se concretó su primera fase. Con este
sistema se cubrirán las necesidades de registro y sistematización de información de:
Gestión Hospitalaria, Gestión Ambulatoria, Historia Clínica Básica Integrada (HCBI),
Imagenología, Epidemiología, Distribución de Insumos, Distribución de Medicamentos y
TeleSalud. Articulación con la Red de Farmacias Públicas y Privadas para la distribución de
medicamentos y evitar el contrabando de extracción de este rubro.
En lo relativo a la Cooperación internacional, se tienen que durante el año 2015, se produjo
un cambio institucional en el enfoque de las relaciones internacionales en salud con la
creación de la Oficina de Integración y Asuntos Internacionales: 1) La creación de un
comité ad hoc de compra conjunta de medicamentos que estableció y concretó el
mecanismo de negociación de precios, sentando un precedente en la región; 2) La
incorporación al ordenamiento jurídico nacional de 79 normas técnicas de MERCOSUR
para fortalecer el entorno productivo nacional, la firma de 5 Declaraciones en los temas de:
Cambio Climático y Salud Humana, Prevención y Control de la Obesidad, Costos
Económicos y Sociales Asociados al Tabaco, Seguridad en el Tránsito y Medidas
Regulatorias para el Control del Consumo de Sodio, la implementación en MERCOSUR
del registro de donación y trasplante (DONASUR) y finalmente la firma de 3 acuerdos
referidos a: Fronteras, Identificación y Priorización de Acciones de Control para la
Epidemia del VIH/SIDA e Impulsar la Estrategia de Salud en Todas las Políticas; 3) En los
Asuntos Internacionales y con la finalidad de afianzar el relacionamiento con el Sistema de
Naciones Unidas, destaca como logro principal el diseño y aprobación de los planes
bianuales período 2016–2017 de la Organización Panamericana de la Salud (OPS), del
Fondo de Población de Naciones Unidas (UNFPA), la UNICEF y la ONUSIDA; 4) El
programa de formación de Médicos Integrales Comunitarios ha integrado estudiantes de 12
países latinoamericanos. Población beneficiada: la población de las 24 entidades federales
del país y la población de 12 países latinoamericanos (Argentina, Bolivia, Brasil, Chile,
Colombia, Ecuador, Nicaragua, Panamá Paraguay, Perú, El Salvador, Surinam, Uruguay).
|
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32
6.3. SDG 3: Ensure healthy lives and promote well-being for all at all ages
(1) Review of policies related to SDG 3
Some current laws relating to the implementation of SDG 3 are the Law on Health Insurance, the Law
on Medical Examination and Treatment, the Law on Children, the Law on HIV/AIDS, the Law on Tobacco
VIET NAM’S VOLUNTARY NATIONAL REVIEW ON
THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS 33
Control, and the Law on the Elderly. A number of important strategies have been issued, i.e., the National
Strategy for Protection, Care and Promotion of People’s Health in 2011-2020 and Vision to 2030, the
National Population and Reproductive Health Strategy in 2011-2020, the Viet Nam Youth Development
Strategy in 2011-2020, the National Strategy on Malaria Elimination and Prevention in Viet Nam in 2011-
2020 and Orientation to 2030, the National Strategy for Prevention and Control of Tuberculosis in Viet
Nam by 2020 and Vision to 2030, the National Strategy on Cancer, Cardiovascular Disease, Diabetes,
Chronic Obstructive Pulmonary Diseases, Bronchial Asthma and Other Non-Communicable Diseases in
2015-2025, the NonCommunicable Disease Prevention Plan in 2015-2020, and the National Road Safety
Strategy to 2020 and Vision to 2030.
In addition, some Resolutions16 and Action Plans of the MOH, other ministries and provinces that guide
the implementation of the Resolutions have set several goals and targets to 2025 and 2030, including
SDG targets on health.
However, the existing policy system has not yet responded to developments in the context relating to
health care needs for the following reasons17: control of communicable diseases remains a challenge
for the health system; the increased impact of out-of-scope health risks (i.e.: climate change and
environmental pollution) and the inability of the health sector to respond; inequalities between regions
and groups of people in terms of health status, burden of disease and limited access to health care
services; limited cross-sectoral coordination in policy development and slow implementation of policies.
(2) Major results of SDG 3
Viet Nam’s most remarkable achievement in terms of health care in recent years has been the improved
capacity to provide and access health services in Viet Nam. Viet Nam is ranked at high level compared
to other countries in the Western Pacifc Region, with 73 per-cent of the population of Viet Nam having
access to essential health services in 2017.
The health service delivery system has been widely developed. Enhanced investments in healthcare
facilities have increased people’s access to health care services. Capacity to forecast, monitor, prevent
and control epidemics has been improved. Major diseases have been prevented and controlled. Human
resources have been developed rapidly in terms of both quantity and quality and the healthcare service
delivery capacity has been improved. Medical technology is growing. Many previously untreatable
diseases have been detected early, promptly treated and cured. Viet Nam is one of 39 countries in the
world that produce vaccines.
The proportion of the Vietnamese population participating in the health insurance system increased
from 5.4 per-cent in 1993 to 86.4 per-cent in 2017. The proportion of out-of-pocket expenditure has
declined signifcantly (from 63 per-cent in 1993 to about 40 per-cent in 2017). Financial support has been
provided for medical examination and treatment of the poor, near poor, children under 6, the elderly,
ethnic minorities in socio-economically disadvantaged regions and other disadvantaged groups.
Population quality has gradually improved. The Human Development Index (HDI) and the average life
expectancy are both rising rapidly. Health indicators of the Vietnamese people are much higher than the
average of countries with the same per capita income.
16 Resolution 20-NQ/TW issued by 25 October 2017 by Central Executive Committee regarding strengthening protection, care and
improvement of people’s health in the new situation; Resolution 21-NQ/TW issued by 25 October 2017 by Central Executive
Committee regarding to population workin the new situation.
17 Report on SDG implementation by MOH.
VIET NAM’S VOLUNTARY NATIONAL REVIEW ON
34 THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS
Viet Nam has successfully completed MDG 5 on reducing maternal mortality. However, gaps in
maternal mortality rates between regions and socio-economic groups remain a big concern. The
maternal mortality rate for ethnic minority women is four times as high as that of Kinh women18. Thus,
disadvantaged groups such as ethnic minority women should be given special attention to improve
their maternal health and not leave them behind.
Figure 6. Percentage of population with health insurance (per-cent)
Source: Viet Nam Social Insurance and MOH19
The under-fve mortality rate per 1,000 live births decreased from 22.1 in 2015 to 21.6 in 2017. Given the
slow decline during 2011-2015, it is expected that the infant mortality rate for under-1 children will be
11.7 per 1,000 live births by 2030, and the under-fve mortality rate will be 17.6 per 1,000 live births by
2030. Viet Nam will face many of challenges to meet SDG 3 on reducing child mortality. Moreover, the
child mortality rate is still high among ethnic minority groups20. Therefore, during the delivery of eforts
to control child mortality in Viet Nam, disadvantaged groups such as ethnic minority communities need
special attention.
Up to 2016, Viet Nam has had 9,912 new HIV infections, 5,976 new AIDS patients and 2,131 AIDS deaths.
Recent statistics on HIV and AIDS cases and related deaths show a declining trend in recent years.
Although the number of new infections has decreased in the whole country, the number of people with
HIV has increased in some areas such as the North Central, Central Coast and South East regions.
Through the National Tuberculosis Program, Viet Nam has realized many achievements in tuberculosis
control, particularly in achieving one of the MDG 6 targets of reducing tuberculosis incidences. New
tuberculosis incidences decreased from 375 per 100,000 in 2000 to 187 per 100,000 in 2015. Following
this success in achieving the MDG 6 targets, Viet Nam is likely to continue to reduce the number of
tuberculosis deaths and cases.
18 Ethnic minority women often cannot access the services as health centres are distant, health service quality is low, the women
have language and cultural barriers and cannot aford medicine and hospital fee. Therefore, the coverage of prenatal health carefor
them remains low. One out of fve does not receive prenatal care; in the Northern mountainous provinces, about 40-60 per-cent of
pregnant women deliver their babies at home.
19 Data between 1993 and 2006, from Report on Health Insurance policy implementation for 15 years (1992 – 2007) by MOH.
20 Some ethnic minority groups have very high mortality rate of under-1 and under-5 children, i.e.,(53.9‰ and 87.1‰ respectively),
Mang (45.3‰ and 71.8‰ respectively), H’mong (27.7‰ and 42.4‰ respectively), mainly due to nutrition factors, prenatal care and
maternal care.
Health insurance coverage
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
10
30
20
40
50
60
70
80
90
1993, 5.4
28.8
60.3
2017, 86.4
%
VIET NAM’S VOLUNTARY NATIONAL REVIEW ON
THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS 35
According to an MOH Survey conducted on the use of cigarettes among adults in Viet Nam (GATS 2015),
the smoking rate in 2015 has decreased compared to 2010. The standardized age-based tobacco use
among people aged 15 and older was 22.5 per-cent, i.e. a slight decline compared to 2010 (23.8 percent). This partly refects the efectiveness of the Tobacco Control Law 2013. By complying with the
goals of implementing the WHO Framework Convention on Tobacco Control, Viet Nam has enjoyed the
reduction of tobacco use rate.
Regarding trafc safety, trafc accidents in Viet Nam have been continuously reduced against three
measures: number of trafc accidents, deaths and injuries21. In 2017, the number of trafc accidents
decreased by 7 per-cent as compared to 2016. In 2017, the country saw 8,279 people killed in trafc
accidents, equivalent to 8.76 deaths per 100,000 people22.
Figure 7. Deaths caused by trafc accidents in Viet Nam in 2007-2017
Source: National Trafc Safety Committee
In relation to SDG Target 3.5 relating to control and reduction of trafc accidents, Viet Nam will be able to
reach the target on all the three criteria i.e. the number of trafc accidents, deaths and injuries, by 2030.
Regarding protection of the health of the elderly, more than one third of provincial hospitals have
geriatric hospitals that serve the growing needs of the elderly. In 2017, MOH also developed and
approved the Scheme of Elderly Health Care for the period 2017-2025.
Although Viet Nam has realized certain achievements in improving people’s health indicators, many
difculties and challenges are currently being faced by Viet Nam, including: the high rate of poor
households, maternal and child mortality in some mountainous areas which is 3-4 times as high as in the
delta and urban areas and nearly twice as high as the national average. The rate of child malnutrition is
still high and life expectancy is low in the North West, and Central Highlands. Public health expenditure
is still limited and the rate of out-of-pocket costs for health care is high. The population is large and
continues to grow. Viet Nam is one of 10 countries with the fastest ageing population in the world
and high levels of gender imbalance at birth. Free migration is not well controlled, resulting in large
pressures on the health care system. The disease pattern in Viet Nam is being transformed with multiple
burdens of communicable and non-communicable diseases, accidents, injuries, poisoning. Some new
and strange diseases are appearing and can become unpredictable.
21 Comparison of trafc accident fgures in 2011 and 2015 shows that the number of trafc accidents declined by 22,144 cases (from
44.548 persons in 2011 to 22,404 cases in 2015), equivalent to -49.7 per-cent. The number of deaths due to trafc accidents was
reduced by 2,724 persons (from 11,395 persons in 2011 to 20,556 persons in 2015), equivalent to -23.9 per-cent. The number of
injuries dropped by 28,178 persons (from 48,734 persons in 2011 to 20,556 persons in 2015), equivalent to -57.8 per-cent.(from
44.548 persons in 2011 to 22,404 cases in 2015).
22 National Transportation Safety Board.
13150
11594 11516 11406 11395
9446 9369 8996 8671 8685 8279
0
2000
4000
6000
8000
10000
12000
14000
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year
Number of deaths due to
tra
fc accidents (person/year)
VIET NAM’S VOLUNTARY NATIONAL REVIEW ON
36 THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS
Box 3. Model of early childhood disability detection and intervention (ECDDI) for children from
0 to 6 years old
The Sustainable Health Development Center (VietHealth), a Vietnamese NGO, works in medical and
public health areas, especially in sexual and reproductive health care, primary health care, mother
and child health care, detection and rehabilitation, special education intervention for children with
disabilities.
In implementing its mission, since 2012, VietHealth has been ultilizing the model of Early Childhood
Disabilities Detection and Intervention for children under six year-old in 100 per-cent communes of
25 selected districts in some provinces including Vinh Long, Thua Thien Hue, Bac Giang, Phu Tho, Yen
Bai, Da Nang, Tay Ninh, Dong Nai and Binh Phuoc. Within fve years, about 100,000 children under
six years old have received physical and development screening at communities. According to local
statistics, there are about 1,5 1.7% of children with disabilities in every 10,000 children being screened,
of which the number of intellectually disabled children Interventions for inclusive education and
specialized education account for about 65-70% and the number of children with mobility disabilities
requiring interventions for surgery and rehabilitation is about 30-35%. Children with disabilities will
be identifed and classifed according to mobility impairments, intellectual disability or multiple
disabilities in four levels from mild to very severe as well as development of fsh intervention plans for
each case. VietHealth conducts trainings for preschool teachers on special education interventions
and trainings for parents to implement interventions for children with disabilities identifed through
screening, evaluation and classifcation of disabilities. of the children with disabilities in rehabilitation
at home and training on rehabilitation training for health workers
By 2018, the greatest success of VietHealth is the Early Detection and Early Intervention model
supported by People’s Committees of provinces and cities, and incorporated in the provincial plan
of supporting people with disabilities and allocating resources to implement. The early detection
and intervention in the localities implementing the model also brought practical results with 84,774
children being screened for the frst time, 5,155 children were screened for the second time and 1,122
children were intervened. With the achievements, early in 2018, the Ministry of Health and Viethealth
signed a cooperation agreement to support VietHealth to implement the model in localities and
coordinate in mobilizing resources for replication of the model.
Source: ECDDI Project Report from Sustainable Health Development Centers (VietHealth)
|
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[
3
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{
"country": "vnm",
"file_id": "sdg-03/vnr-report-vnm-2018-en-5.pdf",
"language": "en",
"locality": null,
"size": "l",
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}
|
VIET NAM’S VOLUNTARY NATIONAL REVIEW ON
THE IMPLEMENTATION OF THE SUSTAINABLE DEVELOPMENT GOALS 15
SDG 3: To achieve SDG 3, a number of key policies have been rolled out, including the Law on Social
Insurance, Law on Medical Examination and Treatment, National Strategy to Protect, Care, and Improve
Public Health in 2011-2020 and Vision to 2030. With great eforts to improve maternal health care
services, Viet Nam achieved MDG 5 with a 75 per-cent reduction in the maternal mortality rate in 2015
compared to 1990. However, Viet Nam may not realize the national target of minimized child mortality
rate by 2030. National statistics on new cases of HIV/AIDS and related deaths have declined in recent
years. Regarding the National Tuberculosis Control Programme, Viet Nam has made great strides in
controlling tuberculosis, with a reduced number of new cases (375 cases per 100,000 people in 2000 to
187 cases per 100,000 people in 2015). Some 73 per-cent of Viet Nam’s population has access to essential
health services, health insurance coverage was as high as 86.4 per-cent in 2017. Positive changes in
the trafc safety have been seen. To the end of 2017, the number of trafc accidents had declined by
7 per-cent as compared to 2016. Although Viet Nam has attained numerous targets regarding health
indicators in recent years, the country also faces a number of challenges.
|
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GOAL 3:
Ensure a healthy life and promote well-being for all at
all ages
UNDER-FIVE MORTALITY RATE INFANT MORTALITY RATE
2015
22.1%
2018
21.4%
2022
18.9%
2015
14.7‰
2018
14.2‰
2022
12.1‰
TRAFFIC ACCIDENTS
0
5,000
10,000
15,000
20,000
25,000
2015 2016 2017 2018 2019 2020 2021 2022
PERCENTAGE OF FULLY VACCINATED INFANTS
NUMBER OF NEW TUBERCULOSIS CASES /
100,000 POPULATION
NUMBER OF MALARIA CASES / 100,000 POPULATION
HEALTH INSURANCE COVERAGE (%)
SUBSTANTIALLY HIGH RATE OF ALCOHOL
CONSUMPTION AMONG MEN
2018
52.5
2020
55.5
2018
5.03
2022
0.46
2021
64% 10%
1 OF EVERY 3 MEN
DRINKS AT HAZARDOUS LEVEL
2015 2016 2017 2018 2019 2020 2021
97.2 96.4
94.8 94.3
96.8
87.1
98
PROPORTION OF HOUSEHOLDS WITH MEDICAL
EXPENDITURES PER TOTAL EXPENDITURE ≥10% OR ≥25%
2016 2018 2020
14,0
3,7 4,0 3,0
14,5
11,7
2022
92.04
The implementation of SDG 3 still faces many
difculties and challenges in terms of maternal
and child health care in ethnic minority and
mountainous areas; diseases and deaths from
non-communicable diseases; and limited
medical facilities and human resources.
Number of trafc accidents
Number of deaths due to trafc accidents (persons)
Number of people injured in trafc accidents (persons)
≥ 10% ≥ 25%
HEALTH INSURANCE CARD
VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION 47
OF THE SUSTAINABLE DEVELOPMENT GOALS
Highlights:
Viet Nam has continued to improve its policy system to ensure a healthy life and promote well-being for
all, the elderly, and the general population. Some outstanding results include the reduction of maternal
mortality per 100,000 live births from 54 cases in 2015 to 46 in 2019; descent of the mortality rate of children
under 5 years old and under 1 year old; the number of people who died or were injured in trafc accidents
decreased continuously; number of new tuberculosis and malaria cases tended to decrease; percentage of
under-1-year fully immunized children reached 96.8% by 2020; etc. However, Viet Nam still faces difculties
and challenges in achieving Goal 3 regarding the indicators of maternal and child health care in ethnic
minority and mountainous areas; unmet need for contraceptives is still high, especially among young
female migrants; suicide is being committed by younger people and showing signs of increasing; The rate
of men drinking alcohol is still relatively high and the rate of drinking at dangerous levels has increased
over the years; etc. Especially, the COVID-19 pandemic in the period of 2020-2021 with social distancing
and quarantine policies have set back achievements in a number of indicators related to people’s health
care and childhood immunization. In 2021, the percentage of children under 1 year of age who are fully
vaccinated decreased to 87.1%.
According to UNESCAP assessment method, various indicators such as the number of new HIV infections,
the birth rate in the 15-19 age group, the percentage of fully vaccinated children with all types of vaccines
are lagging behind compared to 2015; Some indicators have shown slow progress, such as the number of
deaths from non-communicable diseases, household expenses for health care, and density of medical staf.
For these targets, Viet Nam needs to pay attention and speed up the implementation in the coming time.
The other indicators indicated substantial progress, reaching, or exceeding the milestone of 2022. Although
the implementation of SDG 3 has gained many achievements, there are still many difculties and challenges.
Figure 16: The implementation progress of SDG 3 indicators
Progress since 2015 Regression since 2015
2015 2022 Target 2030
3.c.1 Health worker density
3.b.1 Population covered by all vaccines in national programme
3.a.1 Tobacco use
3.8.2 Household expenditures on health
3.8.1 Essential health services coverage
3.7.2 Adolescent births
3.7.1 Family planning satisfed with modern methods
3.6.1 Road trafc deaths
3.4.2 Suicides
3.4.1 Cardiovascular disease, cancer, diabetes or chronic respiratory
disease
3.3.3 Malaria
3.3.1 HIV infections
3.2.2 Neonatal mortality
3.2.1 Infant and under-fve mortality
3.1.2 Births attended by skilled health personnel
3.1.1 Maternal mortality
Source: UNESCAP and MPI
48 VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION
OF THE SUSTAINABLE DEVELOPMENT GOALS
6.3.1. Target 3.1: By 2030, reduce the maternal mortality ratio to less than 45 per 100,000
live births; reduce the under-one child mortality rate to below 10 per 1000 live births
and the under-fve child mortality rate to below 15 per 1,000 live births (Global targets
3.1 and 3.2)
The maternal mortality rate decreased to 46 cases per 100,000 live births in 2019, a reduction of 8 cases per
100,000 live births compared to 201541; equivalent to an average reduction of 2 cases per 100,000 live births
per year. However, this rate in ethnic minority and mountainous areas was still 3 times as high as national
rate42.
The percentage of births that are attended by skilled health workers fuctuated over the years. In 2021 and
2022, this rate remained at 98%, 2 percentage points higher than that in 2020 (96%) but lower than that in
2017 (98.6%).
Figure 17: Percentage of births attended by skilled health workers (%)
97.5
98.6 98.5
96.7
96.0
98.0
94
95
96
97
98
99
2016 2017 2018 2019 2020 2021 2022
98.0
Source: Ministry of Health
At present, there is still a large disparity in this rate between urban areas and rural areas, among diferent
socio-economic regions and among diferent ethnic minority groups. According to the fndings of socioeconomic survey among 53 ethnic minorities in 2019, the percentage of ethnic minority women aged 10-49
years old who gave birth at a health facility was 86.4%, an increase of 22.8 percentage points compared to
2015 (63.6%). However, this rate was still signifcantly lower than that of Kinh women (over 99%). With the
eforts of the grassroots health network, the proportion of ethnic minority women aged 10-49 years old
who delivered birth at home without being attended by skilled people in 2019 declined to 9.5%, a sharp
decrease of 26.8 percentage points compared to 2015. Nevertheless, this rate is still signifcantly higher than
the rate of less than 0.5% among Kinh women43.
In the period 2015-2022, the mortality rate of children under 5 years old tended to decrease but with slow
progress. In 2015, the under-fve mortality rate was 22.1‰, going down to 21.4‰ in 2018 and 18.9‰
in 2022.
41 The 2009 Population and Housing Census and the 2015 Population Change and Family Planning Survey, GSO.
42 Report of the Ministry of Health on the implementation of the national target on GE in 2019.
43 General Statistics Ofce, 2019. Survey on the socio-economic status of 53 ethnic minorities in 2019.
VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION 49
OF THE SUSTAINABLE DEVELOPMENT GOALS
Figure 18: Mortality rate of children under 5 years old (‰)
2010 2012 2014 2016 2018 2019 2020 2021 2022
23.8
23.2 23.1
22.4
22.1 21.8
21.5 21.4
21.0
22.3
20.5
18.9
18
19
20
21
22
23
24
25
Source: Statistical Yearbook 2021, GSO
In 2021, the infant mortality rate was 6‰ (95% confdence interval from 3‰ to 10‰)44. The infant mortality
rate in urban areas was 1.4 times as high as that in rural areas and boys vs girls was almost 1.2 times.
The mortality rate of children under 1 year old tended to go down but the reduction rate was still slow. In
2015, the mortality rate of children under 1 year old per 1,000 live births was 14.7, which decreased to 14.2
in 2018 and 12.1 in 2022; i.e. a minor reduction of 2.6‰ in under-fve mortality rate within seven years.
Figure 19: Mortality rate of children under 1 year old (‰)
15.8
15.5 15.4 15.3
14.9
14.7
14.5 14.4
14.2
14.0 13.9
13.7
12.1
12
12.5
13
13.5
14
14.5
15
15.5
16
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Source: Statistical Yearbook 2021, GSO
6.3.2. Target 3.2: By 2030, end the epidemics of AIDS, tuberculosis, malaria and
neglected tropical diseases; prevent and combat hepatitis, water-borne diseases, and
other communicable diseases (Global target 3.3)
The number of newly detected HIV cases annually tended to rise in the period 2017-2021, from 9.9 thousand
cases in 2017 to 13.2 thousand cases in 2021.
HIV prevalence among men who have sex with men (MSM) continues to increase rapidly, from 10.8% in 2018
to 13.2% in 2020. Some remote areas also have potential risks of HIV transmission in the community because
people do not have enough knowledge about HIV/AIDS prevention and control and the HIV infection rate
in the community is high, but the cases have not been tested and detected45.
44 Findings of the Viet Nam survey on Sustainable Development Goals with Children and Women (SDGCW) in 2020-2021.
45 Ministry of Health, 2021. Report on HIV/AIDS prevention and control in 2020.
50 VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION
OF THE SUSTAINABLE DEVELOPMENT GOALS
Figure 20: Number of newly detected HIV cases per annum
14,113 14,127
12,559
11,680
10,195 9,912 9,920
10,440 10,183
13,995
13,225
0.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14
0.16
0.18
0.20
9,000
10,000
11,000
12,000
13,000
14,000
15,000
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Number of HIV cases - Newly detected (people)
Number of annually detected HIV cases per thousand of non-infected population (parts per thousand)
Source: GSO, Ministry of Health and the research team’s calculations
Similarly, the number of new TB cases decreased in general in the period 2015-2020, but in period 2018-
2020 alone, the number of new TB cases per 100,000 indicated a growing tendency, from 52.5 cases in 2018
to 55.5 cases in 2020.
Figure 21: Number of new TB cases per hundred thousand population (cases/100,000 people)
2015 2016 2017 2018 2019 2020
54.2
61.8
54.1
52.5
54.6
55.5
50
52
54
56
58
60
62
64
Source: Health Statistical Yearbook 2015-2020, Ministry of Health
In contrast, the number of malaria cases per hundred thousand population tended to nosedive in the period
2015-2022, especially after 2017, to only 0.46 cases per hundred thousand population in 2022.
Figure 22: Number of malaria cases per hundred thousand population (cases/100,000 people)
2011 2012 2013 2014 2015 2016 2017 2018 2019 2010 2011 2012
51.6 49.3
39.0
30.3
21.00
11.00 8.80
5.03 4.81
1.47 0.47
0
10
20
30
40
50
60
0.46
Source: Health Statistical Yearbook 2015-2020, Ministry of Health, and expert calculations for 2021-2022
VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION 51
OF THE SUSTAINABLE DEVELOPMENT GOALS
6.3.3. Target 3.3: By 2030, reduce by 20% to 25% the under-70 mortality ratio due to
non-communicable diseases, through prevention and treatment and promote mental
health and well-being (Global target 3.4)
Viet Nam is facing a burden of morbidity and mortality due to non-communicable diseases mainly including
cardiovascular disease, cancer, diabetes, and chronic obstructive pulmonary disease with a rapid increase
in number of cases over the years and the number of cases in the community is remarkably high. Survey
data shows that the prevalence of hypertension in adults in 2021 was 26.2%, equivalent to about 17 million
people; the prevalence of diabetes/hyperglycaemia in adults was 7.06%, equivalent to 4.6 million people.
In 2019, there were an estimated 592,000 deaths from non-communicable diseases, accounting for 81.4%
of all deaths from all causes. In which, deaths were mainly due to cardiovascular diseases, diabetes, cancer
and COPD, accounting for 66.2% of all deaths from all causes. In 2019, the number of deaths from cancer,
cardiovascular diseases, diabetes, and Chronic obstructive pulmonary disease per 100,000 population was
21.2 cases, a reduction of 0.7 cases compared to 2015 (21.9 cases)46.
The number of people dying from suicide per hundred thousand people tended to decrease slightly in
the period 2015-2019, from 5.9 in 2015 to 4.7 in 2019. In 2019, the male mortality rate due to suicide was
more than 2 times as high as women (6.8 men/100,000 male population and 2.7 women/100,000 female
population)47. However, in recent years, the suicide cases in Viet Nam are more committed by younger
people and indicated signs of growth. The number of cases in reality may be higher than the statistics.
In the context of the COVID-19 pandemic in the years 2020-2022, suicide was even more alarming when
depression, anxiety and mental disorders was 3-5 times the normal rate.
6.3.4. Target 3.4: Strengthen the prevention and treatment of substance abuse, including
narcotic drug abuse and harmful use of alcohol (Global target 3.5)
As of December 31, 2021, there are more than 205,818 drug addicts nationwide with managed records
(about 96.2% were men and 3.8% were women), accounting for approximately 0.24% of the population,
reduced by 12.4% compared to 2020 (equivalent to 29,182 people). In the period 2016-2021, detoxifcation
has been arranged for 284,770 people48.
The results of the Non-communicable Disease Risk Factor Survey in 2021 demonstrated that the prevalence
of men drinking alcohol was exceedingly high in Viet Nam. According to statistics, in 2021, up to 64% of
men and 10% of women drank alcohol in the past 30 days. Notably, the rate of drinking at dangerous levels
increased over the years, especially among men. One of every three men drank at dangerous levels. Out of
548,000 deaths year, 40,000 cases were due to alcohol-related causes (over 7%)49.
6.3.5. Target 3.5: By 2030, further control and annually reduce trafc accidents based on
three criteria: the number of accidents, the number of deaths and the number of injuries
(Global target 3.6)
In the period 2015-2022, the trafc safety situation in Viet Nam illustrated positive changes, refected in
indicators such as number of trafc accidents, number of deaths, and number of injuries caused by trafc
46 Ministry of Health. Available at: https://moh.gov.vn/hoat-dong-cua-tinh-dao-bo/-/asset_publisher/TW6LTp1ZtwaN/content/can-quantam-hon-ve-hoat-ong-quan-ly -beh-not-lay-nhiem-va-roi-loan-suc-show-tam-than-tai-tuyen-y-te-co-so.
47 Ministry of Health.
48 Ministry of Public Security.
49 Ministry of Health.
52 VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION
OF THE SUSTAINABLE DEVELOPMENT GOALS
accidents all showing fast decreasing trend with an average annual decrease rate of 10%; 5.6%; and 13.9%
respectively. For the period 2018-2022, number of trafc accidents, number of deaths, and number of injuries
caused by trafc accidents tended to decrease at a faster rate than in the period of 2015-2022 or the period
2015-2017 with the average annual reduction rates in these periods of 13%, 7.5%, and 17.9% respectively.
Figure 23: Number of trafc accidents; number of people killed and injured in trafc accidents
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
0
10,000
20,000
30,000
40,000
50,000
60,000
Number of trafc accidents Number of people killed by trafc accidents (people) Number of people killed by trafc accidents (people)
Source: Statistical Yearbook 2021, GSO and Ministry of Public Security
6.3.6. Target 3.6: 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 relevant national strategies and programmes (Global target 3.7).
The percentage of women aged 15-49 years old who need contraception and are using modern
contraceptives tended to fuctuate during the period 2015-2017, from 65% in 2015, increasing to 66.5% in
2016 but decreased to 65.6% in 2017. However, in the period of 2018-2020, this rate demonstrated a steady
increasing trend over the years, from 66.5% in 2018 to 68.1% in 2021.
Figure 24: Percentage of women aged 15-49 years who need contraception and are using modern
contraceptive methods (%)
2010 2011 2012 2013 2015 2016 2017 2018 2020 2021
67.5
68.6
66.6
67.0
65.0
66.5
65.6
66.5
67.0
68.1
65
66
67
68
69
Source: Population Change and Family Planning Survey, GSO
The total unmet need for family planning among married or partnered women tended to increase, specifcally,
this rate in 2021 was 10.1%, higher than 6.1% 2014. Women living in the Red River Delta experienced the
highest unmet need (up to 14.7%) while women living in the Mekong Delta indicated the lowest unmet
VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION 53
OF THE SUSTAINABLE DEVELOPMENT GOALS
need (6.9%). For women who are sexually active, neither married nor partnered showed much higher unmet
need for family planning than for married women, 40.7 %50.
The percentage of ethnic minority women aged 10-49 years who are using contraception is much lower than
the national rate. It is noteworthy that ethnic minority women living in urban areas, where socio-economic
conditions are better, have a rate of using contraceptive methods that is 8.3 percentage points lower than
rural areas (43.8% in urban areas and 52.1% in rural areas) 51.
The fndings of the 2019 Population and Housing Census show that the national fertility rate of women aged
10-19 (ASFR10) was 11 children per 1,000 women; ASFR10 in rural areas was 3 times as high as that in urban
areas, i.e. 15 children/1,000 women and 5 children/1,000 women, respectively. Research on fertility rate of
women aged 10-19 years old in 5 quantiles of living standards (Poorest; Poor; Medium; Rich and Richest)
showed that ASFR10 of the poorest quantile was the highest, 27 children/1,000 women, 9 times as high
as the richest quantile. ASFR10 gradually decreased as living conditions increased. This demonstrated that
when living conditions are better, women aged 10-19 are able to continue going to school to improve their
qualifcations, have better job opportunities and tend to marry and have children later than women with
difcult living conditions.
6.3.7. Target 3.7: Achieve universal health coverage, including fnancial risk protection,
access to quality essential health-care services and access to safe, efective, quality, and
afordable essential medicines and vaccines for all (Global target 3.8)
Viet Nam has made rapid progress in expanding universal health coverage, with 92.04% of the population
covered by the health insurance scheme by 202252. Preliminary estimates show that the non-participants are
mainly the unemployed or workers in the informal sector, and women make up a high proportion of this group.
According to the Report on Monitoring implementation of universal health care coverage conducted by
WHO and WB in 2021, Viet Nam’s essential service coverage index in 2020 reached 70 points out of 100,
higher than the average level of Southeast Asia (61 points) and of the world (67 points)53.
The proportion of households with medical expenses exceeding 10% of the total household expenditure
tended to increase in the period 2016-2018; from 14% in 2016 to 14.5% in 2018. However, by 2020, this
proportion was 11.7%, down 2.3 percentage points compared to 2016. Similarly, the proportion of
households with health expenditures exceeded 25% of total household expenditures ascended in the
period 2016-2018 but by 2020, this proportion was only 3%, down 1 percentage point compared to 2018.
The reason may be due to the positive impact of the Amended Law on Health Insurance in 201454 when
defning health insurance as a form of compulsory insurance, as a result the participation rate in health
insurance has continuously increased over the years along with the promulgation of policies related to
increasing the benefts of the health insurance participants 55.
50 UNICEF & GSO, 2021. Report on fndings of the Viet Nam Survey on Sustainable Development Goals with Children and Women 2020-2021. 51 UN Women & ILSSA, 2021. Data on women and men of ethnic groups in Viet Nam for the period 2015-2019: from fndings of survey on the
socio-economic status of 53 ethnic minorities in Viet Nam period 2015 - 2019.
52 Ministry of Health.
53 Ministry of Health, 2023. Report on assessment of implementation of Sustainable Development Goals in 2022.
54 Law No. 46/2014/QH13 amending and supplementing a number of articles of the Law on Health Insurance, efective from January 1, 2015. 55 such as: (i) “interoperability” for inpatient and outpatient medical examination and treatment at district hospitals from January 1, 2016; (2)
Regulation on a uniform price of medical examination and treatment services covered by health insurance among hospitals of the same class
across the country; (3) To prescribe the Ministry of Health to issue a package of basic medical services paid for by the health insurance fund,
to issue a list, rates and payment conditions for technical services, drugs and medical supplies; (4) Supplementing regulations of waiving
co-payments for those who have participated in health insurance for 5 consecutive years or more and have paid the co-payment for medical
examination and treatment costs in the year with an amount greater than 6 months’ basic salary. …
54 VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION
OF THE SUSTAINABLE DEVELOPMENT GOALS
Figure 25: Percentage of households with health expenses relative to total expenditure greater than
10% and greater than 25% in the period 2010-2020(%)
2010 2012 2014 2016 2018 2020
14.3
12.5
13.5 14.0 14.5
11.7
3.4 3.5 3.3 3.7 4.0
3.0
0
2
4
6
8
10
12
14
16
Greater than 10% Greater than 25%
Source: Findings of Viet Nam Household Living Standards Survey, GSO
The rate of full vaccination in children under 1 year of age in the period 2015-2020 was always maintaining
at over 94%. However, this rate dropped to 87.1% by 2021 due to the impact of the COVID-19 pandemic and
social distancing measures.
In mountainous areas, ethnic minorities have lower vaccination coverage than the national rate (under 80%).
The lack of physical and technical facilities for vaccination; difcult trafc; language and cultural barriers for
ethnic minorities, etc., are the key reasons preventing ethnic minority parents from knowing or being able
to have their children vaccinated fully as scheduled56.
Figure 26: Proportion of children under 1 year of age fully vaccinated (%)
2010 2013 2014 2015 2016 2017 2018 2019 2020 2021
94.6
91.4
97.1 97.2
98
96.4
94.8
94.3
96.8
87.1
85 85
87
89
91
93
95
97
99
Source: Statistical Yearbook, GSO
In the period 2015-2020, the number of health workers per 10,000 population tended to increase steadily
over the years, from 47.9 in 2015 to 50.6 in 2016 and down to 49.5 in 2018. In 2019, this rate continued to
decrease to 49.2 but by 2020 it returned to 49.5. Indicators such as number of doctors, number of physicians,
number of nurses per 10,000 population also tended to go up, but the growth rate was still quite slow.
According to the Ministry of Health, preliminary data in 2022 indicated the number doctors and number of
nurses per 10,000 population were 11,5 and 14, respectively.
56 GSO, 2020. Findings of the survey on socio-economic status of 53 ethnic minorities in 2019.
VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION 55
OF THE SUSTAINABLE DEVELOPMENT GOALS
Figure 27: Number of health workers per ten thousand population
2010 2010 2010 2010 2010 2010 2010 2010 2010 2010
7.6 7.8 8.0 8.7 9.1 9.8
13.5 13.5 13.8 13.9 14.0 14.3 13.9 13.7 13.7 14.4
10.0 10.4 10.7 10.8 11.1 11.3 11.3 11.4 11.0 10.9
45.7 45.6 47.0 47.2 47.9 50.6 49.9 49.5 49.2 49.5
0
10
20
30
40
50
7.3 7.3 8.6 8.6
Number of doctors per 10,000 population Number of nurses per 10,000 population
Number of physicians per 10,000 population Number of health workers per 10,000 population
Source: Health Statistical Yearbook 2015-2020
6.3.8. Target 3.8: By 2030, substantially reduce the number of deaths and illnesses from
hazardous chemicals and air, water, soil pollution and contamination (Global target 3.9)
According to the World Health Organization, it is estimated that in 2016, Viet Nam had about 60,000 deaths
related to air pollution. Although there have been many positive changes in environmental protection,
in recent years, diseases related to water and air pollution are becoming a major threat to public health.
The successful implementation of other targets such as 6.1, 6.2, 6.3, 11.6, 12.4 and 12.5 will contribute to
reducing morbidity and mortality as a result of toxic chemicals, and air, water, and soil pollution.
6.3.9. Target 3.9: Strengthen the implementation of the World Health Organization
Framework Convention on Tobacco Control (Global target 3.a)
According to the fndings from the survey on tobacco use conducted in 34 provinces and cities by the Tobacco
Harm Prevention Fund in 2019-2020, the overall adult smoking rate was 21.7% which is a reduction from
2015 (22.5%). The percentage of male smokers was 42.3%, reduced compared to 2015 (45.3%). However, the
rate of female smokers increased from 1.1% in 2015 to 1.7% during the survey.
According to fndings of the same survey, the smoking rate among urban men decreased markedly from
38.7% in 2015 to 29.9% in 2020; this rate in rural areas also decreased from 35.7 % in 2015 to 31.0% in 2020.
However, the rate of e-cigarette smoking in 2020 was 18 times as high as that in 2015 (from 0.2% to 3.6%).
This rate among men increased 14 times. (From 0.4% to 5.6%), and among women increased 10 times (from
0.1% to 1%). The rate of using e-cigarettes was highest in the age group of15-24 (7.3%).
56 VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION
OF THE SUSTAINABLE DEVELOPMENT GOALS
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[
3
] |
{
"country": "vnm",
"file_id": "sdg-03/vnr-report-vnm-2023-en-5.pdf",
"language": "en",
"locality": null,
"size": "l",
"type": "vnr",
"year": 2023
}
|
Goal 3: Viet Nam has continued to improve its policy system to ensure a healthy life and enhance welfare
for people at all ages, from infants to children, women and men, the elderly, and the general public. Some
outstanding results include the drop of maternal mortality per 100,000 live births from 54 cases in 2015 to 46
in 2019; the fall of mortality rate of children under 5 years old and under 1 year old; the continuous descent of
6 VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION
OF THE SUSTAINABLE DEVELOPMENT GOALS
number of deaths and injuries as a result of trafc accidents; the downward tendency of the number of new
tuberculosis and malaria cases; the percentage of fully vaccinated infants reached 96.8% by 2020. However,
Viet Nam still faces difculties and challenges in achieving Goal 3 regarding the targets of maternal and
child health care in ethnic minority and mountainous areas; high unmet need for contraceptives, especially
among young female migrants; rising number of suicide cases among younger population; the high rate of
alcohol consumption among men and the increased rate of drinking at dangerous levels over the years;...
Especially, in the context of the COVID-19 epidemic in the period of 2020-2021, the social distancing and
medical blockade have set back a number of indicators related to people’s health care and childhood
immunization. In 2021, the percentage of fully vaccinated infants descended to 87.1%.
VOLUNTARY NATIONAL REVIEW 2023 ON THE IMPLEMENTATION 7
OF THE SUSTAINABLE DEVELOPMENT GOALS
|
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Page 25
SDG 3: Ensure Healthy Lives and Promote Well-Being for all at all Ages
SDG Targets (Goal 3) NSDP Alignment/Policy Objective
Targets (3.1) (3.2) (3.3) (3.4) (3.7) (3.8)
(3.b) (3.c) (3.d)
(SOC 3.1) (SOC 3.2)
(SOC 3.3) (SOC 3.4)
SOC 3.1: Ensure that the population of Vanuatu has equitable access to affordable, quality health care
through the fair distribution of facilities that are suitably resourced and equipped (SDG
Indicators 3.1.1/3.1.2, 3.7.1/3.7.2, 3.8.1), 3.c.1)
Targets in the areas of per capita density of health professionals, maternal mortality rate and the number of
and capacity of health facilities provide insight into progress regarding this target. Vanuatu has set a health
density target for 2030 of 38 Heath Workers, per 10,000 people. Currently this figure stands at slightly over
17 health workers per 10,000. Additionally, Vanuatu as a target for maternal mortality to less than 70 deaths
per 100,000 live births. This currently stands at 122 per 100,000 population (2017). We have also set a target
that by 2030 100% of all Government Health Facilities will be compliant with Role Delineation and essential
health service minimum standards for human resourcing, infrastructure functional space & equipment
requirements. At this time the Ministry of Health (MOH) is developing the baseline for this information
SOC 3.2: Reduced the Incidence of Communicable and Non-Communicable Diseases (SDG Indicators
3.3.2, 3.3.3, 3.3.4, 3.3.5, 3.4.1)
While the Ministry of Health continues to collect information on the whole range of Non-Communicable
Diseases (NCDs), the NSDP focuses on three critical NCD indicators. The first, the number of diabetic related
amputations, next the incidence of TB (per 100,000) and the annual malaria parasite incidence rate. In 2017
the total number of NCD related amputation was 52 while the malaria incidence rate was 3.6 Annual Parasitic
Incidence (API) per 1,000 population. The Ministry is working to set viable targets and information collection
mechanisms for these indicators moving forward to the NSDP Stock Take expected for 2020.
Page 26
SOC 3.3: Promote Healthy Lifestyle Choices and Health Seeking Behaviour to Improve Population Health
and Well Being (SDG Indicators 3.b.1, 3.2.1)
Regarding healthy lifestyle choice, the NSDP targets, immunization rates (DTP3), prevalence of adult obesity
and the under five mortality-rate. Data for obesity and the under five mortality-rate are not available as of
2017, however the targets for 2030 are 25/1000 live births and an obesity rate of less than 33% of the
population. The vaccination rate as of 2017 was 94% for Penta 3 and 88% for the MR vaccine, indicating
positive progress towards the 2030 target of 95%.
SOC 3.4: Build health sector management capacity and systems to ensure the effective and efficient
delivery of quality services that are aligned with national directives (SDG Indicators 3.c.1, 3.d.1)
The Ministry of Health has in place a Health Sector Strategy (HSS) and has indicated that by 2020 all units
should have strategic plans linking to this HSS. In coordination with this HSS the Ministry has a target that by
2030 at least 90% of all MOH corporate positions will be filled on a permanent basis. Additionally, MOH targets
that 100% of IHR Component 2 attributes be met and maintained by 2030.
Summary
With regard to SDG 3, and the focus on health, the results at this early stage of NSDP implementation continue
to be promising and steady progress is evident. The Ministry of Health (MOH) continues to make progress
with regard to both National targets and the SDG targets. Furthermore, ministry planning provides a clear
roadmap for further implementation. The Health Sector Strategy (HSS) is an example of the coordination
between National Planning (NSDP) Ministry Planning and the SDGs. MOH has aligned national, sector and
SDGs in the HSS so that progress can continue to be monitored and evaluated. Additional information
collection is needed to provide a more effective status review of the NSDP and SDG targets and indicators. It
is expected the continued planning efforts and the implementation of the HSS will provide additional insights
into the progress of the SDG targets and the NSDP policy objectives.
|
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|
SDG3 Health and Well-being SDG2: Zero Hunger
Generally, pre-measles and COVID-19, Samoa was on track to achieve
most of its health targets and indicators particularly the Maternal and
Child Health targets. There is increasing levels of physical exercise and
reduction in tobacco use and alcohol use, access to antenatal care has
increased and Total Fertility and Adolescent Fertility rates have decreased.
Communicable diseases are generally under control. The key challenges
for Samoa remain the high levels of premature deaths, illnesses and
increasingly, disabilities from NCDs and the extremely high health care
costs. The twin health crisis of measles and COVID19 highlight the added
risks of health pandemics on the health and socio-economic situation in
Samoa. Measles and COVID 19 are reversing the gains on SDG 3 and many
other SDGs.
Ensure sustainable consumption and production patterns
Ia maua le soifua malōlōina lelei o tagata uma
47
Samoa context – A Healthy Samoa
101. The vision for the Samoa Health sector is to ensure a
healthy Samoa in order to improve the quality of life for its
population. Some of the key challenges the health sector
sought to address in its 2008 – 2018 plan were the rapidly
increasing levels of NCDs; importance of reproductive,
maternal and child health; emerging and re-emerging infec
-
tious diseases and injury as a significant cause of death and
disability.
102. The strategic focus to address these challenges
included emphasis on lifestyle behaviours to tackle the risk
factors of NCDs, improving primary health care, raising the
quality of healthcare services and managing and responding
effectively to natural disasters, disease outbreaks and
other emergencies. In terms of climate change and disaster
resilience every health development project is inclusive of
resilience development. Four of the health organizations,
the Ministry of Health (MOH), the National Health Services
(NHS), the National Kidney Foundation Services (NKFS)
and the Samoa Red Cross Society SRCS50 have developed
Disaster and Emergency Response Plans.
103. The vision for health and the priority given to it in the
National Development Strategy provides direct input into
the implementation of the SDG3 and other related SDGs.
Status and trends
104. The health sector is one of the top three priorities of the
Government of Samoa over the past two decades receiving
the second or third largest allocation from government
averaging around 17% of national budget in 2014/15. Health
expenditure as a percentage of GDP increased from 5%51 in
2006 to 5.7%52 in 2014/15.
105. Generally, pre-measles and COVID-19, Samoa was on
track to achieve most of its health targets and indicators.
There is early achievement of targets for Maternal and Child
Health; there is some good progress on health behaviour
targets for NCDs prevention for the period 2002 to 2013
such as increasing levels of physical exercise (28.5%) and
reduction in tobacco use (13.3%) and alcohol use(12.4%),53
access to antenatal care and contraceptive services has
increased and Total Fertility and Adolescent Fertility rates
have decreased. Results for communicable diseases are
generally positive with overall declining incidence and rates
for HIV, Tuberculosis and Hepatitis B. As noted in Samoa’s
final MDGs report, the biggest health challenge for Samoa
remains the high levels of premature deaths, illnesses and
increasingly, disabilities from NCDs.
Reproductive, maternal, newborn and child
health
106. Samoa continues to make good progress against the
unfinished business of MDGs targets and indicators for
maternal and child health. Less mothers are dying from or as
a complication of pregnancy and childbirth. The rate of chil
-
dren dying at birth or 12 months after birth is also declining
overall.
107. Maternal mortality ratio decreased from 40.2 to 37.6
/100,000 live births in 2011 and 2019 which is less than the
global target of 70/100,000 by 2030.54 Under 5 mortality rate
has been reduced from 22 to 17/1,000 live births in 2011 and
2016 but rose in 2019 (22/1,000 live births). Nevertheless, it
is still below the 2030 U5MR global target of 25/1,000 live
births. But this will change once the post measles data is
made available. Neonatal mortality rate increased from
5/1000 live births in 2009 to 7/1000 live births in 2013 but
reduced to 6.2/1,000 live births in 2019 which is below the
global 2030 target of 12/1,000 live births56. The proportion of
births being attended by skilled health personnel increased
from 81% in 2009 to 83%56 in 2014 and now 94.1%57 in 2019.
108. There is improvement in access to sexual and repro
-
ductive health-care services with a 3% increase (from
36% in 2009 to 39% in 2014) of women of reproductive age
who have their need for family planning satisfied. There is
improvement in adolescent sexual and reproductive health
with a decrease in the adolescent birth rate for women aged
15-19 years (from 39 per 1000 women in 2011 to 31 per 1000
women in 2016). In 2018, the Samoa Family Health Asso
-
ciation which provides public sexual and reproductive
health-care services opened its branches in Motootua and
Savaii improving reproductive health access particularly
for the rural communities. The contraceptive prevalence
rate though has decreased from 29% in 2009 to 27% in 2014
necessitating renewed efforts to ensure access to Sexual
Reproductive Health information and services. All public
health facilities in Samoa provide family planning services,
have providers trained in family planning service delivery,
and have planning guidelines available.58
109. Based on these results, so far Samoa is on track for
global SDGs maternal mortality (SDG 3.1.1) and child health
(SDG 3.2.1, 3.2.2) targets and indicators. Despite these early
achievements, the national measles outbreak in late 2019
unfortunately resulted in the premature deaths of around
80 infants and children and will increase the under 5 and
neonatal mortality rates. This also highlighted gaps in health
systems such as low levels of immunization that require
urgent attention.
110. In terms of proportion of target population covered by
all vaccines included in national programme, it increased
from 53% in 201459 to 95% in 2019.
111. While low overall, the proportion of 1 year old children
immunized against measles increased by 24% from 40.35% in
2009 to 64% in 2014. Rates of coverage of MMR1 increased
from 55.7% in 2009 to 76% in 2014 and MMR2 increased from
25% in 2009 to 52% in 2014. While low, the proportion of chil
-
dren fully immunized doubled between 2009 (25%) and 2014
(53%). After the nation-wide Mass Measles vaccinations
programme in November 2019, with significant support
from the international community immunization rates for
infants is at 95% as of February 2020.
• The health sector is one of the top
three priorities of the government
of Samoa over the past two decades
• The prevalence of communicable
diseases such as HIV/Tuberculosis
and Hepatitis B are generally low.
To address the NCDs crisis, the MOH's
Package of Essential NCDs Interventions
(PEN) Faa Samoa is improving early
detection, referral and increasing public
awareness especially in the villages. The
programme highlights the critical role of
communities in particular
women’s committees can play as they did
decades before, in the promotion and
delivery of critical health interventions.
48 49
Hundreds of volunteers get ready for a country-wide massive vaccination campaign.
CASE STUDY: MEASLES
EPIDEMIC 2019 AND
THE SDGS
Background
Since 2017, there has been a global resurgence
of measles, including in several countries of the
Western Pacific Region. The last declared outbreak
of the measles in the Pacific occurred in 2014.
However, following recent large-scale outbreaks
in neighbouring nations and the significant popu
-
lation movements between these countries and the
Pacific, confirmed measles outbreaks have been
reported in at least five of the Pacific countries and
territories including Samoa.
The 2019 Samoa measles outbreak began in
September 2019. As of 6 January 2020, there were
over 5,700 cases of measles and 83 deaths, out of a
Samoan population of 200,874. Over three percent
of the population were infected. The cause of the
outbreak was attributed to decreased vaccination
rates, from 74% in 2017 to 31-34% in 2018, even
though nearby Pacific countries had rates near 99%.
Samoa’s low vaccination rates were in part due to
the deaths in 2018 of two children given a wrongly
mixed vaccine and the resultant reluctance of some
parents to have children vaccinated.
The measles epidemic will have direct impact on
progress of SDG3 in terms of under 5 mortality rates
and economic growth.
National response
A state of emergency was declared on 15 November
and is the first public health emergency proclaimed
in Samoa. Early closure of all schools, restricted
mobility of children on public transport and discouraging their participation in public gatherings, as
well as mandatory vaccination were ordered under
the declaration of the state of emergency.
On the declaration of the state of emergency, the
National Emergency Operations Centre was acti
-
vated. With the Disaster Management Office as the
secretariat for the Disaster Advisory Council, the
coordination of response agencies and all logis
-
tical arrangements for the national response to the
measles epidemic under the NEOC institutional
framework, came into play with technical advice
and guidance from the Ministry of Health.
Local and International support: Mass vacci
-
nation
On 9 November the first medical team arrived from
Australia. Thereafter, 45 Emergency Medical Teams
rotations from 15 countries and organisations
involving 549 personnel were deployed to support
the national teams under the joint coordination of
WHO and the Government of Samoa. The bulk of
the total vaccines of 265,500 units as well as 100,000
IU of Vitamin D were procured through UNICEF.
Some of the medical teams, provided supplies, of
life-saving equipment and additional infrastructural
space for negative pressure units and additional
wards. A number of individuals from overseas also
volunteered their services in their areas of special
-
isations crucial to the national response. The last
medical teams of Samoan expatriate doctors left in
March 2020.
Prior to the start of the door to door mass vacci
-
nation campaign held over two days, a national
community awareness campaign began to promote
the importance of vaccinations under the lead
-
ership of the Ministry of Women Community and
Social Development in collaboration with the devel
-
opment partners and the private sector. The govern
-
ment then declared a national shut down from 5 - 6
December to facilitate the door to door vaccination
campaign. All unvaccinated families were advised
to display a red flag in front of their houses to indi
-
cate acceptance of the vaccination services. Close
to 150 vaccination teams comprising 5 people each
were mobilized for the mass campaign including
both national and expatriate personnel from the
medical emergency teams. A 70 plus team from
the Hawaiian medical corps were flown in for one
day, specially to assist with the mass vaccination
campaign.
Several other key service providers were important to the mass vaccination and measles response
work. The shipping services, with police to support
overseeing operations and transport between the
two main islands and uplifting of urgent supplies
from American Samoa. The data collection was
supported by the Samoa Bureau of Statistics and
volunteers mostly from other government minis
-
tries, higher learning educational institutions, the
UN, MCIT and Samoa Information and Technology
Association (SITA). The MWCSD led the community
outreach programmes gathering data from approx
-
imately 25,000 households to determine vaccina
-
tion status. The private sector, NGOs and CSOs
also provided support to the service providers and
affected families.
The Samoa Measles Appeal was launched by the
Government of Samoa on December 6 to receive
financial assistance from partners to support
national
efforts to contain the outbreak, to effectively treat
people who contracted measles, achieve herd
immunity for long term protection of the population
50 51
Teams of medical professionals are deployed across the country to vaccinate the population
Teams of medical professionals are deployed across the country to vaccinate the population against measles.
as well as prevent regional migration. The Government had established dedicated accounts for the
public to deposit donations including from outside
the country and in particular from the diasporas all
over the globe.
On 14 December, the state of emergency was
extended for another 14 days until 29 December. By
the end of the State of Emergency about 95% of the
eligible population had been vaccinated.
Recovery Plan
The Measles Recovery Plan approved by Cabinet in
early January 2020 provides for the gaps identified
during the response period, addresses the extensive follow up work needed for those that were
affected by the outbreak as well as the essential
changes that must be implemented for a more effective, well-coordinated and well-resourced response
in the future.
Lessons Learnt: The following priority lessons
learnt are the bases for the Recovery Plan.
1. Placing the focus back on public health – this
includes looking at facilitating community mobilisation, strengthening EPI management and SRH
programs to be aligned with legislation including
improved immunization information systems and
also continuing provision of psychosocial support
and institutionalisation of sustainable services.
This also means strengthening disease surveillance.
2. Follow up and management of post measles
cases – the recovery plan identified the need to
prioritise follow up on the cases especially those
who suffered complications. Look at required clinical care and nutritional and environmental care
management.
3. Address human resource capacity gaps- the
measles epidemic helped push the urgency of
addressing some of the capacity gaps in health
system especially for psychosocial mental health;
emergency and acute Primary care centre Paediatrics;
Medical; laboratory; surgery and public health.
4. Consider accelerating e-health system developments and encourage investment in an effective and
efficient e-health system.
5. Improved infrastructure for an emergency
response looking at isolation wards and essential
lifesaving equipment. These are more relevant now
also with the COVID-19 pandemic.
6. Timely and informed decision making was crucial
to saving lives
Conclusions:
Addressing the gaps: The recovery period will be
focused on identifying the gaps that were evident in
the national response to the measles outbreak and
prioritising the areas to be addressed as outlined in
the recovery plan. The recovery plan will also look
at the immediate and short-medium term needs and
that the outcomes of such will add to long term planning to ensure much improved response should the
need arise.
Sector wide approach : There is room for the
Health sector to work with other sectors such as
Community Development, Agriculture and Fisheries, Education, Communications and Statistics
in order to address the important issues of data
collection/analysis and records digitisation as part
of the e health system, and the emerging needs
that are a result of the impacts of the epidemic
including community mobilisation for public health,
addressing issue of food security and nutritional
status of the country as well as the implementation
of the resultant legislation on school enrolments
conditional on achieving vaccination.
Importance of partnerships: The development
partners have provided valuable assistance in
supporting the significant gaps in the operations
of the hospitals with regards essential lifesaving
equipment and facilities such as isolation wards.
The importance of regular maintenance and adherence to standards is underscored. While new
funding might be available from the international
appeal, development partner funding, fund raising
events and through the supplementary budget, the
intention is that current available support can be
integrated into ongoing as well as approved pipeline initiatives for the health sector.
Applying lessons learnt for COVID-19: The lessons
learnt, and situation of the measles epidemic helped
Samoa prepare better for the COVID-19 pandemic.
Other than improving immediate emergency
response all sectors have provided sector response
plans to the COVID-19 situation looking at the interlinkages also. This will become more important as
we look at addressing the current socio-economic
impacts of the measles and the COVID-19 on Samoa
and on our progress for the SDGs.
52 53
Communicable diseases
112. The monitoring and surveillance of communicable
diseases and neglected tropical diseases have become
more systematized. This led to the rapid elimination of the
chikungunya outbreak in 2015 and dengue outbreak in late
2017. The compliance also of drinking water supplies with
the national Drinking Water Standards has significantly
improved. The prevalence of communicable diseases such
as HIV, Tuberculosis and Hepatitis B are generally low. Two
new HIV infections were recorded in 2018 after 5 years of no
recorded HIV cases bringing the cumulative total since 1990
to 26 with 13 having since passed away and 13 people living
with HIV/AIDS (PLWHA) and a new HIV infections rate of
0.01 per uninfected population. Similarly, incidence of
tuberculosis and Hepatitis B have declined from 10/100,000
population in 2012 to 9.6/100,000 in 2019 for tuberculosis
and from 3% of total population to 1.1% in 2019 for Hepatitis
B in 2012 and 2019, respectively.60
Non-Communicable Diseases
113. Samoa has one of the highest death rates (81%)61 and
illnesses rates from NCDs (Cardiovascular - 34%, Cancers
15%, Chronic Respiratory Diseases 5%, Diabetes 9%, other
NCDs 18%)62 in the world. An estimated 89.1% of Samoans
are overweight and 63.1%63 are obese. Between 2003 and
2013, there was increased prevalence of Diabetes (3.3%),
hypertension (7.7%), overweight (3.5%) and 7.1% increase
in obesity.64 NCDs are responsible for 7 of the 10 premature
deaths in Samoa.65 A recent Care for Hypertension and other
Chronic Conditions in Samoa Survey in 2018 found that the
prevalence rates of NCDs remain high with 9 out of 10 of
the survey participants to be overweight or obese. A key
factor in the high rates of NCDs is poor and over-nutrition,
unhealthy diets, and sedentary lifestyles.
114. The costs of tertiary care for the population with NCDs
in the Samoa National Kidney Foundation or at overseas
health facilities has increased exponentially. The Govern
-
ment of Samoa has over the past decades provided highly
subsidised tertiary care for Samoans in New Zealand and
Australia and more recently in India under the Government
of Samoa and New Zealand Overseas Medical Treatment
Schemes (OVT). The costs for OVT have increased from
SAT$0.3million in 1991 to $SAT4.8 million in 2014/15 equiv
-
alent to 10% of the national health budget. A 2013 Health
Financing for Samoa Report noted that the OVT scheme
absorbed 15% of total public health expenditure in 2009/10,
to the private benefit of less than 0.1 % of the nation’s population. In 2011, OVT budget allocation was higher than allocation to some ministries including the MWCSD, Office of the
Prime Minister and the Ministry of Communications, Information and Technology.66
115. On the other hand, there has been positive progress
in the reduction of alcohol (12.4%) and tobacco (13.3%)
consumption and a significant 28.5% increase in physically
active people between 2002 and 2013. In 2015, government
introduced a 6.5% health levy for soft drinks and alcoholic
beverages as well as a 5% excise tax on tobacco products.67
Health systems and Environmental risks
116. There is an increase in the number of healthcare
workers in various fields, through concerted efforts by the
health sector to address workforce shortages by increasing
opportunities for health targeted scholarships under the
Samoa scholarship scheme, providing more training opportunities under health projects and WHO fellowships. Qualifications of all health workers are at the required standards and skills. There have been reports of improvement in
waiting time in Emergency but still concerns with increase
in waiting time at the general outpatient and triaging as
compared to emergency.68 There continues to be free of
charge service for the standard age (0– 12 years) and free
medical supplies for pensioners (65 years old and over). The
expansion of the National Kidney Foundation of Samoa and
the Samoa Family Health Association services to Savaii
were key milestones for the health sector in terms of taking
health services to the rural areas. The Health information
systems though remain a challenge.
117. Key health organizations with Disaster and Emergency
Response Plans, which are crucial to the response to natural
disasters and the disease outbreaks that affected Samoa
recently. With lessons learnt from the Measles epidemic,
there is room for further improvement to risk management
and response to disasters, emergencies, and climate change
events.
Challenges and opportunities
118. The three most significant health challenges are; i) the
still rising incidence of morbidity and mortality from NCDs
with related exponential impact on health resources; ii)
maintaining the good progress in child and maternal health
in light of the Measles epidemic in late 2019; iii) and coping
with and managing new and re-emerging communicable
diseases including global pandemics such as the COVID-19.
The recent Measles epidemic with high proportion of death
rate among under 5 years old will significantly increase the
infant and under 5 mortality rates undoing decades of good
progress in this area.
119. While overall there are some positive maternal
and child health outcomes and encouraging results in
addressing the risks of NCDs, the challenges of managing
the recent Measles outbreak in Samoa highlighted some
gaps in health administration and service delivery. Despite
the Health Sector and Ministry of Health receiving the
highest or second largest national budget allocation annu
-
ally, the health system still struggles with low numbers of
health professionals, limited medical supplies and services.
While low, the rates of health workers per 1,000 population
in all cadres of health professional have increased slightly
since 2011 with pharmacist and nurses showing the biggest
increase. The rate for physicians has remained almost the
same.
120. There are opportunities available through the measles
recovery plan and ongoing sector partnerships to respond
to the COVID-19 circumstances to help minimise the impact
on the progress on SDGs and on the health of the population.
The e-health project is an important investment that can
improve the service delivery and effectiveness of the heath
sector to ensure a healthy Samoa.
Good practices
121. To address the high rates of deaths and illnesses from
NCDs, the Package of Essential NCDs Interventions (PEN)
Faa Samoa was introduced in Samoan villages in 2016 to
improve early detection, improve referral and increase
public awareness. The Care for Hypertension and other
Chronic Conditions in Samoa Survey, 2018 found that
communities engaging in the PEN Faa Samoa programme
are more likely to be screened and receive treatment. This
highlights the critical role communities in particular
women’s committees can play as they did decades before, in
the promotion and delivery of critical health interventions.
It is also an important way of ensuring that we leave no one
behind.
122. Collaboration of the MOH with NGOs (such as Samoa
Family Health Association, Samoa Faáfafine Association
and Samoa Red Cross) and line ministries such as MWCSD
is a contributing factor in the improvement of reproduc
-
tive and maternal health service delivery and community
engagement and awareness on SRHR. Utilization of family
planning services has improved, the number of current
family planning users increased from 1,552 in 2017 to 8,814
in 2018 and new users increased from 755 in 2017 to 953 in
2018.69 Quality of contraceptive services also improved -
100% of facilities in Samoa provide family planning services,
have providers trained in family planning service delivery,
and have planning guidelines.
Interlinkages
123. Good health and well-being are critical for improved
quality of life. The epidemic of obesity, diabetes, and hypertension is resulting in higher number of pre-mature deaths
and illnesses from NCDs impacting the productive popula
-
tion, causing more disabilities, and lowering quality of life.
Levels of malnutrition, stunting and wasting while low, will
still impact children’s learning capacity,
124. Access to health is important for all the other SDGs
including SDGs 1,2, 5 10 and 16. For example, alcohol and
drugs have been linked to family violence so the positive
interventions through the health sector reducing the prev
-
alence of alcohol consumption can complement the efforts
to address domestic and gender based violence linked to
SDG5. Rehabilitation programs in support of the Drugs and
Alcohol Court are experiencing high intakes of mainly males
for alcohol related offences.
125. In addition, survivors of family violence often suffer
health consequences including forced/unwanted preg
-
nancies and sexually transmitted infections, physical and
psychological injuries, and even death. In many instances,
the health sector is the first entry point for survivors of
family violence to seek support and referral to other multi
-
sectoral services contributing towards SDG 5. Similarly, the
health sector ensures sexual and reproductive health and
rights are realized for all, including youth helping to prevent
early and unintended pregnancies to ensure young people
pursue their educational goals to their highest potential.
Proportion of women of reproductive
age (15-49 years) who have their need for
family planning satisfied with modern
methods increased from 36% in 2009 to
39% in 2014.
54 55
2009
81%
of Samoans
are
obese
60%
7/10premature
deaths caused
by NCDs
2014 2015 2016 2017 201 2019
the proportion of the target
population vaccinated almost
doubled in ve years
53%
95%
13% 12%
decline in tobacco
consumption
*between 2002 and 2013
decline in alcohol
consumption
increase in physically
active people
0any Samoans are making positive lifestyle changes
$dolescent birth
rate declined
%irths attended by a skilled professional increased
2009
81%
2019
9%
28%
EnsVrehealthylivesandpromotewellCeinHforall
atallaHes
SNAPSHOT
:
0aternal mortality
decreased
*per 100k live births
*per 1000
live births
2011 0.2
2019
37.6
2011: 39 2016: 31
56 57
|
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41
4.3 Goal 3: Ensure healthy lives and promote well-being for all and at all
ages
Main messages
Increased access to healthcare has supported reductions in child and
maternal mortality rates, but mortality rates remain high.
Key challenges include improving access to healthcare (particularly in
poor areas), getting better value for money by strengthening
procurement practices (for example, for medicines, vaccines and
medical equipment), improving mental health and disability services,
and increasing funding.
The current situation
South Africa has made considerable progress in improving healthcare and
reducing premature death. The under-5 child mortality rate fell from 71 per
1,000 live births in 2002 to 48 in 2016, and the infant mortality rate, from 48
per 1,000 live births to 34 (Figure 6). Over 70% of mothers and children
received post-natal care within six days of delivery, although this remains well
below the share in upper middle-income countries. Maternal mortality rates are
subject to considerable uncertainty. Teenage maternal mortality is increasing
and there is high teenage pregnancy rates in the country. South Africa
struggles with communicable diseases: around 7.5 million people, and 19% of
adults aged 15-49 were HIV positive in 2018, and 567 per 100 000 population
cases of tuberculosis (TB) were recorded in 2017.
42
Figure 6. Child and infant mortality rates, number of deaths per 1,000 live
births
Source: Stats SA, 2016b
The policy framework
South Africa’s Constitution provides that all South Africans have the right to
equitable healthcare and to the progressive improvement in access to and
quality of care. The Reconstruction and Development Plan (RDP) sets the goal
of providing free health services for mothers and children, followed by free
primary healthcare for all, as well as a clinic-building programme. And the
National Health Act 61 of 2003 provides a legal framework for the health
system, taking into account the obligations imposed by the Constitution and
other laws on health services at the national, provincial and local government
levels.
The NDP gives an overarching policy framework for the health sector,
including policy direction on the key elements of health system strengthening
and governance. The NDP identifies nine health goals, including raising life
expectancy to 70 years, reducing maternal, infant and child mortality, and
significantly reducing non-communicable diseases (NCD), injuries and
violence. Addressing the social determinants of health and disease is identified
as a key priority required to achieve these goals. The NDP also aims to reduce
the cost of private healthcare and addresses the need for improvements in the
quality of care.
71
44
48
34
0
10
20
30
40
50
60
70
80
2002 2016
Child Mortality rate Infant mortality rate
43
The National Strategic Plan (NSP) for HIV, sexually transmitted
infections (STIs) and tuberculosis (TB) 2017–2022 guides the country’s
response to the HIV, TB and STI epidemics. It involves multi-stakeholder
collaboration by the Government, civil society, communities and the private
sector to reduce HIV, TB and STI morbidity and mortality. The Prevention of
Mother to Child Transmission programme played an important role in reducing
infant mortality.
The philosophy of primary healthcare forms the basis of South Africa’s health
policy and provides guidance for healthcare service delivery. The principles
underpinning the delivery of primary healthcare include: equity; community
participation; social and economic development; an integrated referral system
to facilitate a continuum of care; teams of health professionals with specific
and sophisticated biomedical and social skills; adequate resources; a clientcentred approach; and interventions focused on the determinants of poor
health, health promotion, prevention, cure and rehabilitation. The inequities of
apartheid are still prevalent in the health system. Achieving universal health
coverage, getting better value for the money spent on healthcare, and
increasing funding remain a challenge. Access and quality remain poor in
some areas, and services for people with emotional problems or disabilities
are limited. The National Health Insurance (NHI) was approved by Cabinet in
July 2019 for tabling in Parliament. The Bill will give effect to the NDP that
seeks to provide for universal quality health care services to all South Africans
irrespective of social economic background. It will be based on values of
justice, fairness and social solidarity, address the current health system that
serves only 16% of the South African population while excluding the
overwhelming majority.
Strengthening supply chain processes for the procurement of quality
medicines, vaccines, medical equipment and health information management
products is a key step towards achieving the SDG targets on health. South
Africa needs to demonstrate improvements in quality of healthcare services
underpinned by evidence-based clinical practices. It also needs to improve the
operational efficiency and utilization of human resources, supported by
appropriate strategies in recruitment, retention and human resources
forecasting. While the Government has increased the subsidized training of
health professionals, it is difficult to retain trained staff in the public sector
health services, especially at senior levels. South Africa introduced
Occupational Specific Dispensation (OSD) for health professionals in the
public sector to overcome this challenge. The Government is devoting
resources to developing improved healthcare practices (see Box 3).
44
Box 3. Innovation and research to improve healthcare
The Government is investing in innovation to improve health services and in the development
of appropriate medical devices, diagnostics and vaccines to address communicable and noncommunicable diseases. Research and development under the Strategic Health Innovation
Programme (SHIP), a joint effort of the Department of Science and Technology (DST) and the
Department of Health and the Medical Research Council (MRC), focuses on diagnosis,
vaccines, new and improved drugs and medical devices for treatment of HIV, tuberculosis
(TB), diabetes, cancer and neo-natal conditions. DST concentrates on new and improved
drugs, therapeutics and delivery systems, and on ensuring that drugs are adaptable to the
South African context by working with major manufacturers and making an effort to use South
African resources. DST is working with various institutes with similar approaches to vaccines
and biological medicines, and is exploring means of making diagnosis more user-friendly,
easier and faster, and thus able to deliver results rapidly and reduce patients' waiting time at
clinics. Considerable emphasis continues to be placed on harnessing information and
communication technologies (ICTs) to improve administration and the efficiency of primary
healthcare facilities, important for the early detection and rapid response to health challenges.
DST has contributed to product development to strengthen South Africa’s ability to locally
manufacture active pharmaceutical ingredients and to develop the ability to locally
manufacture vaccines and biologics. A Uterine tamponade was introduced for the
management of postpartum haemorrhage to reduce maternal deaths. DST supported the
Tshwane Khulelwe project to evaluate the clinical significance and benefit of routine screening
with Umbiflow, a portable umbilical artery Doppler device developed by the South African
Medical Research Council and the Council for Scientific and Industrial Research. The device
aims to assist in detecting foetuses at risk of stillbirth and is cost-effective compared to similar
devices. DST has contributed to the reduction of under-five mortality by providing the
Extended Programme of Immunisation vaccines via Biovac in which DST holds a 47 per cent
share. DST also supported development of a vaccine for Group B Streptococcus (GBS), a
cause of invasive neonatal diseases as well as of severe infections in the elderly and immunecompromised patients. DST has also supported the development of new prevention and
treatment technologies, including for HIV, tuberculosis and malaria.
In addition, DST:
9 provides a continuous supply of the HIBB vaccine;
9 contributes to the development of diagnostics and treatment regimens for Ebola, and
malaria;
9 supports the development of diagnostics and treatment regimens for non-communicable
diseases, including diabetes, cancer and pneumonia;
9 contributes to the development of medical devices and diagnostics;
9 supports the development of health Apps for Essential Medicine List, HIV and tuberculosis
treatment guidelines, Road to Health and MomConnect;
9 supports the development of house designs that are environmentally friendly, fire-proof
and well ventilated (in conjunction with the Swiss Embassy).
DST also has established international linkages through its participation in the activities of the
Global Programme for Infectious Diseases – Research (GloPID-R), which focuses on
assistance with epidemics and outbreaks of disease.
|
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INTRODUCTION
ZAMBIA
SUSTAINABLE
DEVELOPMENT
GOALS
Zambia recognises that good health is an important determinant of socio-economic development,
being a key contributor to human development, as reflected in the 2017–2021 Zambia National Health
Strategic Plan and the 7NDP. The interventions so undertaken in the health sector are ultimately
expected to contribute towards economic growth.
Some of the interventions contributing towards SDG 3 are:
• Strengthening public health programmes;
• Expanding capacity to increase access to quality health care;
• Enhancing food security and nutrition;
• Promoting private sector participation in health care delivery;
• Accelerating human resource outputs, recruitment and retention.
ENSURE HEALTHY LIVES
AND PROMOTE WELL-BEING
FOR ALL AT ALL AGES
3.1.1 Maternal mortality ratio
Since 2007, maternal mortality has continued to decline from 591 deaths per 100,000 live births in 2007 to 398
deaths per 100,000 live births in 2013/2014 and 278 deaths per 100,000 live births in 2018. The positive maternal
mortality trajectory shows that interventions targeted at improving maternal health are working. According
to the Zambia Demographic and Health Survey (ZDHS), there has been an increase in the proportion of women
whose delivery was attended to by a skilled worker from 64 percent in 2015 to 80 percent in 2018. In addition,
83 percent of deliveries were in a health facility in 2018 as compared to 67 percent in 2015.
The uptake of antenatal services also saw a surge, with the majority of women (97 percent) aged 15-49 who had a live
birth in the 5 years preceding the survey receiving antenatal care from a skilled provider during their most recent
birth. Sixty-four percent had at least four antenatal care visits. In terms of post-natal services, seventy percent
of mothers and seventy-two percent of new-borns had a post-natal check during the frst two days after delivery.
The Zambian Government in collaboration with cooperating partners has been implementing high impact
interventions to improve maternal and child health. Some of the interventions include Safe Motherhood Action
Groups, community-based health, procurement of Emergency Obstetric and Neonatal Care equipment, training
and mentorship of health workers, maternal health reviews for action, access to safe blood transfusion, training
and placement of skilled health workers in health facilities.
SDG 3
− GOOD HEALTH AND WELL-BEING
CHAPTER 05 − PERFORMANCE ASSESSMENT OF THE SDGS
SDG 3
− GOOD HEALTH AND WELL-BEING
VOLUNTARY
NATIONAL
REVIEW
2020
FIGURE 5.5
Maternal Mortality Ratio
1992–2018
Source: CSO (Zambia Demographic and Health
Survey Report, 2018)
800
700
600
500
400
300
200
100
0
1992 1996 2002 2007 2010 2013 2018
3.2.1 Under-five mortality rate skilled health personnel
Overall, child health outcomes have improved over time. The 2018 ZDHS results show that the under-5 mortality
rate declined from 75 deaths per 1,000 live births in 2013-2014, to 61 deaths per 1,000 live births in 2018. Urban
areas had a lower rate (64 deaths per 1,000 live births), compared to rural areas (58 deaths per 1,000 live births).
By province, under-5 mortality is highest in Luapula Province (110 deaths per 1,000 live births) and lowest in North
Western Province (26 deaths per 1,000 live births).
3.2.2 Neonatal mortality rate
Unlike child and maternal mortality, which declined between 2013/14 ZDHS and the 2018 ZDHS, neonatal mortality
increased from 24 deaths to 27 deaths per 1,000 live births. Neonatal deaths were 44 percent of all under-fve deaths
in the 2018 ZDHS, up from 32 percent in the 2013/2014 ZDHS. According to the 2018 Health Information
Management System data, the main causes of neonatal deaths are birth asphyxia (43%), prematurity (29%),
and neonatal sepsis (11%). Factors contributing to these causes can be traced along the reproductive health
spectrum: prior to and during pregnancy (teenage pregnancy, maternal health, antenatal services, nutritional
status); during delivery (quality of care, provider skills, referral systems); and after delivery (postnatal care
for mother and baby, nutritional status).
FIGURE 5.6
Source: CSO (Zambia Demographic and Health
Survey Report, 2018)
Neonatal, Infant and Under-5 Child
Mortality Rates
1992–2018
300
250
200
150
100
50
0
1992 1996 2002 2007 2010 2013 2018
child mortality
under-5 mortality
infant mortality
neonatal mortality
3.1.2 Proportion of births attended by skilled health personnel
As indicated above and in support of the general downward trend in mortality is the observed increase
in the percentage of births attended by skilled providers. In 2013-2014, slightly over two-thirds of births were
attended to by skilled providers; this increased to 80.4 percent in 2018. By province, the percentage of births
delivered by a skilled provider ranged from 70 percent in Northern to 91 percent for the Copperbelt and Lusaka
Provinces. The provinces with the lowest proportion of births attended by skilled health personnel were Northern
Province (70 percent), Western Province (71.1 percent) and Central Province (71.3 percent).
CHAPTER 05 − PERFORMANCE ASSESSMENT OF THE SDGS
INTRODUCTION
ZAMBIA
SUSTAINABLE
DEVELOPMENT
GOALS
SDG 3
− GOOD HEALTH AND WELL-BEING
3.3.1 Number of new HIV infections per 1,000 uninfected population, by sex, age
and key populations
According to the Zambia Population-based HIV Impact Assessment (2016) Zambia had an estimated HIV prevalence
of 12.3 percent among adults (15–49 years) and 1.3 percent among children (0–14 years). The prevalence was higher
in the urban areas at 18.2 percent compared with rural areas at 9.1 percent (ZDHS, 2013/14). HIV incidence was
estimated at 0.7 percent among adults. HIV prevalence was lowest among those aged 15-19 and peaked among those
aged 40-44 for both males and females. Adolescents comprised 23 percent of the total Zambian population,
with 4.8 percent of females and 4.1 percent of males living with HIV. Based on recent estimates and projections
from Spectrum (2015), Zambia had 1.2 million people living with HIV in 2015, and this number is expected
to increase to 1.3 million people in 2020.
According to the Spectrum projections, the estimated number of children living with HIV dropped from 92,000
in 2000 to 89,000 in 2015. New HIV infections among children dropped from 23,000 in 2000 to 8,900 in 2015.
The estimated number of children living with HIV and receiving antiretroviral therapy increased by 59 percent
from 5,400 in 2005 to 51,903 at the end of 2015. The estimated number of deaths among children attributed to AIDS
dropped from 12,000 in 2000 to 4,300.
There has been a long-term trend towards reduction in HIV and AIDS mortality (37 percent since 2010). However,
HIV incidence still remains signifcantly high, with approximately 47,000 new infections every year and 1.2 million
people living with HIV in 2016. At ages 15-59 years, HIV incidence was 0.67 percent, with much higher rates among
women than men (1.02 percent and 0.32 percent, respectively). Under the age of 25 years, females had ten times
(1.07) more new infections than their male counterparts (0.08 percent).
3.3.2 Tuberculosis incidence per 100,000 population
The Government has continued to scale up interventions aimed at reducing the number of deaths associated with
TB. As a result, the TB treatment success rate (new and relapse) increased from 88 percent in 2017 to 90 percent
in 2018, while the TB incidence rate reduced from 391/100,000 population in 2016 to 346/100,0000 population
in 2018. The interventions implemented have included expanding TB diagnostic capacity, conducting intensifed TB
case fnding campaigns, scaling up TB preventive therapy, enhanced infection prevention and control, maintaining
a steady supply chain for TB commodities, rolling out diagnosis and treatment of drug-resistant TB and engaging
all care providers through public and private partnerships. Further, the recruitment of Multi-Drug Resistant (MDR)
TB nurses in ensuring adherence to TB treatment has enhanced the interventions.
3.3.3 Malaria incidence per 1,000 population
The incidence of malaria declined between the periods 2016 to 2018 from 336 per 1,000 in 2016 to 312 per 1,000
population in 2018. The declining incidence rate can be explained by scaled up interventions such as indoor residual
spraying, use of long-lasting insecticide treated nets and intermittent presumptive treatment.
Indicators on malaria refect the impact of these interventions: the percentage of households that were sprayed with
indoor residual spraying increased from 28 percent in 2013-2014 to 35 percent in 2018. Ownership of insecticide
treated nets increased from 68 percent in 2013-2014 to 78 percent in 2018. According to the 2018 ZDHS, there was
a higher (61 percent) level of insecticide treated nets ownership in rural areas compared to urban areas (59 percent).
With regard to the diagnosis and treatment of malaria, testing capacities increased through the availability of testing
kits and reagents to support confrmation of malaria. In addition, the availability of antimalarial drugs such as
Artemisin-based combination therapy and Sulphadoxine Pyrethamine was sustained. Furthermore, the recruitment
and placement of Malaria Elimination Offcers in high malaria incidence districts supported the interventions.
CHAPTER 05 − PERFORMANCE ASSESSMENT OF THE SDGS
3.7.1 Proportion of women of reproductive age (aged 15–49 years) who have their need
for family planning satisfied with modern methods
Knowledge of contraception is nearly universal in Zambia. Accordingly, use of modern methods of family planning by
married women increased from 15 percent in 1992 to 49 percent in 2018, whereas among sexually active unmarried
women, it is 43.9 percent; the corresponding percentage among married women is 49.6 percent. Regional inequities
in contraceptive use have persisted. A regional comparison of contraceptive use unveiled a persistent rural-urban
inequity, with women in rural areas reporting a lower contraceptive prevalence rate than those in urban settings.
The percentages of women with unmet need for family planning was highest in Western (27 percent) and Luapula
(26 percent) and lowest in Muchinga (15 percent) Provinces. Unmet need for family planning among married women
decreases with increasing education, from 24 percent among those with no education to 15 percent among those
with a higher education. Similarly, unmet need decreases with increasing household wealth, from 23 percent among
women in the lowest wealth quintile to 17 percent among those in the highest wealth quintile. Demand satisfed
by modern methods is lowest in Western (52 percent) and Northern (58 percent) and highest in Lusaka (75 percent)
and Central (73 percent) Provinces.
3.7.2 Adolescent birth rate (aged 10–14 years; aged 15–19 years) per 1,000 women in that age
group
Adolescents account for over a quarter of the total population and have unique health concerns. They are susceptible
to both non-communicable and communicable diseases and health risks such as sexually transmitted infections,
including HIV and AIDS, early and unprotected sex, gender-based violence, teenage pregnancies, substance abuse,
accidents and mental illness. Several interventions have been implemented to protect adolescents and improve
their health status. Among the major areas of concentration are efforts to reduce early marriages and teenage
pregnancy. During the 2013/2014 and 2018 period, the country registered a decline in adolescent birth rate
from 141 to 135 per 1,000 adolescent girls aged 15-19. Further, teenage childbearing declined from 34 percent
in 1992 to 29 percent in 2018.
The HIV prevalence rate among adolescents aged between 15-19 years did not change much; it was estimated
at 4.4 percent in 2014 and 3.8 percent in 2018. The adolescence prevalence rate remained twice (2.6 percent) as high
among girls as among boys (1.2 percent). The Government through the Ministry of Health is committed to ensuring
that adolescents have access to health information and youth-friendly services. To this end, the Government
is implementing the Adolescent Health Strategy.
VOLUNTARY
NATIONAL
REVIEW
2020
3.8.1 Coverage of essential health services (defined as the average coverage of essential services
based on tracer interventions that include reproductive, maternal, new-born and child
health, infectious diseases, non-communicable diseases and service capacity and access,
among the general and the most disadvantaged population
During the 2013-2016 period, an annual average of 42 percent (US$30 per capita) of the total health expenditure was
from donors, with the Government accounting for 41 percent (US$28 per capita). The dominance of donor funding
raises sustainability questions. Government health expenditure as a percentage of total Government expenditure
is yet to the reach the WHO recommended threshold of 15 percent. It was estimated at 8.3 percent in 2016, 9 percent
in 2017 and 10 percent in 2018. Household expenditure was estimated at 30, 26, and 24 percent for 2016, 2017
and 2018, respectively.
In the light of the sustainability issues as a result of dwindling cooperating partners’ support to the sector and high
level of household expenditure, the Government introduced the Social Health Insurance Scheme (SHI) in 2019,
which pools risks and ensures access to health care for the population. Having just been introduced, the SHI
currently has a coverage of only 4 percent of the population. The extent to which this will be successful, is dependent
on the contributory capacities and operational effciencies of the delegated managing agency.
SDG 3
− GOOD HEALTH AND WELL-BEING
CHAPTER 05 − PERFORMANCE ASSESSMENT OF THE SDGS
|
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[
3
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|
Ensure healthy lives and promote
well-being for all at all ages
SDG 3 represents beter health for people everywhere. Everyone should
be protected against disease, and have access to quali healthcare
services and medicaton, without experiencing fnancial hardship. ——
3.1.2
——
Proporton of births atended by skilled health personnel
A comparison of 2021 and 2022 shows that the skilled birth
atendance coverage remained stable at 69 percent in 2021
and 68 percent in 2022. However, the performance for both
years is above 90 percent, being 94 percent in 2021 and 93
percent in 2022, when the coverage is calculated out of the
total of instttonal deliveries. These fgures are above the
Natonal Health Strategic Plan, 2022 to 2026 target of
80 percent by the end of 2026. This is mainly atributed
to contnued recruitment of skilled health workers and
constructon of more health facilies.
3.3.1
——
Number of new HIV infectons per 1,000 uninfected populaton, by sex, age and key
populatons
There were 1,238,430 people (93.0 percent of HIV-posive
people) on antretroviral therapy (ART) by the end of
December 2021. In 2021, the annual incidence of HIV among
adults aged 15 and more years in Zambia was estmated at
0.31 percent. This corresponded to approximately 28,000
new cases of HIV per year among adults.
The number of new HIV infectons per 1,000 uninfected
populaton increased to 4.6 in 2021 from 3.7 in 2018. The
number increased for females to 4.57 from 3.71 and for
males to 4.77 from 3.73, during the same period. For the
populaton above 15 years of age, the number increased
to 5.43 in 2021 from 4.36 in 2018.
3.3.3
——
Malaria incidence per 1,000 populaton
Malaria was the highest cause of morbidi and mortali in
2020, contributng to about one-third of the total morbidi
and slightly over one-tenth of the total deaths. Malaria
incidence per 1,000 populaton increased marginally to 313
in 2021 from 312 in 2018, representng 0.3 percent increase.
However, the Case Fatali Rate (CFR) declined by 64
percent and 30 percent in 2021 relatve to the rates in 2000
and 2015, respectvely. Likewise, severe malaria cases as
reported in the Malaria Indicator Surveys declined to
1.1 percent in 2021 from 1.6 percent in 2016; with the lowest
of 0.6 percent reported in 2018. In-patent malaria deaths
declined to 8 per 100,000 in 2021 from 15.2 per 100,000 in
2015, though it was of the target of less than 5 percent CFR.
The marginal increase in the malaria incidence rate can
be atributed to several factors, including sub-optmal
coverage of key, proven malaria preventon and treatment
interventons, such as indoor residual spraying and
insectcide-treated mosquito nets, coupled with limited
utlisaton of interventons, among others.
06 I PROGRESS ON GOALS AND INDICATORS AND EVALUATION OF POLICIES AND MEASURES TAKEN SO FAR 39
3.3.2
——
Tuberculosis (TB) incidence per 100,000 populaton
The Government has introduced several strategies to
eliminate TB. These include, among others: enhancing
universal health coverage integratng patent-centred care
and preventon as well as promotng the use of the Natonal
Health Insurance Scheme. Consequently, the incidence
of TB declined to 319 per 100,000 in 2021 from 346 per
100,0000 populaton in 2018.
The Government has also managed to maintain a relatvely
high TB treatment success rate. In 2021, the country
recorded a 90.1 percent TB treatment success rate, slightly
above the target of 90 percent. In contrast, the country
missed the target, having atained 89 percent in 2020.
The presence of TB treatment adherence supporters in the
communi, early diagnosis and early commencement of
treatment and followup of defaultng patents contributed
to the reported high TB treatment success rate in 2021.
3.4.1
——
Mortali rate atributed to cardiovascular disease, cancer, diabetes or chronic
respiratory disease
In 2020, cardiovascular diseases (CVDs) were the third
leading causes of death recorded in healthcare facilies in
Zambia afer malaria and anaemia. These diseases
accounted for 8.5 percent of total deaths. The total number
of deaths due to CVDs increased to 1,088 in 2020 from 955
in 2017 (see Figure 4). The CVDs were mostly a problem for
those aged 5 years and older and chances of death in a
facili were higher in a rural area compared to an urban
health facili.
Diabetes was among the top 10 causes of death in 2020
and accounted for 3.6 percent of total deaths. However,
between 2018 and 2020 the CFR reduced to 79.3 per 1,000
admissions from 120.9 per 1,000 admissions, respectvely.
With regard to respiratory infectons, pneumonia was
among the top 10 causes of death and accounted for 7.2
percent of the total deaths in 2020. Respiratory infectons
were also among the top three causes of morbidi in
children.
16
14
12
10
8
6
4
2
2016 2017 2018 2019 2020
Source: Road Transport and Safet Authori
and Ministry of Health 0
FIGURE 5
Death Rate Due to Road Trafc Injuries
2016-2020
Death rate due to road trafc injuries
3.6.1
——
Death rate due to road trafc injuries
The road trafc-related death rate reduced to 9 percent in 2020 from 14 percent in 2016 (see Figure 5).
14
12
11
10
9
FIGURE 4
Mortali Due to Cardiovascular Disease
2017-2020
2017 2018 2019 2020
Source: Annual Health Statstcal Report
Mortali rate
8.60%
8.40%
8.20%
8.00%
7.80%
7.60%
7.40%
7.20%
7.00%
6.80%
2017 2018 2019 2020
1100
1050
7.40%
1000
950
900
Deaths
7.80%
8.10%
8.50%
40 ZAMBIA I VOLUNTARY NATIONAL REVIEW 2023
06 I PROGRESS ON GOALS AND INDICATORS AND EVALUATION OF POLICIES AND MEASURES TAKEN SO FAR
3.7.1
——
Proporton of women of reproductve age (aged 15-49 years) who have their need for
family planning satsfed with modern methods
In 2022 the proporton of women of reproductve age
(aged 15-49 years) who had their need for family planning
satsfed with modern methods was 69 percent. This shows
an increase in the use of contraceptves up from 66.2
percent reported in 2018.
3.8.1
——
Coverage of essental health services
(defned as the average coverage of essental services based on tracer interventons
that include reproductve, maternal, new-born and child health, infectous diseases,
non-communicable diseases and service capaci and access, among the general
and the most disadvantaged populaton)
The Government established the Natonal Health Insurance
Scheme, through the enactment of the Natonal Health
Insurance Act (2018). As of December 2021, there were
1,277,960 members registered by the Natonal Health
Insurance Management Authori (NHIMA). NHIMA is
working on growing its membership and improving
performance, to become one of the major sources of health
fnancing in Zambia.
Some of the key achievements of NHIMA in 2022, included
the registraton of 1,996,491 principal members and 814,982
benefciary members. The total number of lives covered
was 2,811,473, representng 12.54 percent of the country’s
total populaton. There was also an increase in
self-employed members registered to 635,207, representng
32 percent of principal registratons. This was a 56 percent
increase in enrolments, predominantly from the informal
sector, between January 2022 and December 2022.
By December 2022, 355 public and private facilies
countrywide, had accredited facilies broken down as
follows; 107 public facilies, 39 faith-based facilies
and 209 private facilies.
Natonal Social Health Insurance Scheme
——
Drug Availabili
In February 2021, the Zambia Medicines and Medical
Supplies Agency (ZAMMSA) was established, through
Act No. 9 of 2019, which transformed the Medical Stores
Limited into ZAMMSA, with an addional mandate of being
responsible for procurement of medicines and medical
supplies for the public health sector. While the desired
stock availabili level of a minimum of 80 percent for key
essental medicines and medical supplies has not been
achieved in the past fve years, the Government has
signifcantly increased the natonal budgetary allocaton to
procurements of medicines, to Zambian Kwacha (K)3.4
billion by 2022 from K1.4 billion in 2019. This development,
coupled with an improved supply chain system, has led to
notable improvements in the availabili of essental
medicines and medical supplies from 62 percent in 2021 to
66 percent in 2022.
——
Infrastructre for Health
During the period 2017-2021 major investments were made
in health infrastructre and medical equipment. By 2021,
four out of six targeted specialised hospitals were
completed and 563 health facilies were constructed,
exceeding the target of 500. The above notwithstanding,
more than 1,200 health posts and 500 health centres are
needed, to enable approximately over 6 million Zambians
have access to primary health services within a 5-kilometre
radius of their dwelling.
——
Human Resource for Health
The World Health Organisaton (WHO) recommended
doctor-to-patent rato is 1 to 5,000 and for the nurse-topatent rato it is 1 to 700. By 2020, Zambia had not
achieved the WHO health worker-to-patent ratos as
shown by the doctor-to-patent rato that was 1 to 12,000
compared to 1 to 5,000 (WHO recommended) and 1
to 14,960 for nurses compared to 1 to 700 (WHO
recommended). However, the sitaton is improving.
For example, in 2022, the doctor-to-patent rato and the
nurse-topatent rato improved to 1 to 7,500 and 1 to 1,590,
respectvely. Major recruitment of health workers in 2022
contributed to this posive development. The Ministry of
Health expanded its establishment to 126,831 posions
from 63,057 in 2016 and flled 63,878 (48 percent) of the
staf posions in its establishment. The Ministry plans to
have 70 percent of its establishment flled by 2026, which is
expected to further improve its health delivery.
41
3.b.1
——
Proporton of the target populaton covered by all vaccines included in their natonal
programme
3.c.1
——
Health worker densi and distributon
In 2022, the natonal core health workforce densi was 1.76
per 10,000 populaton and 11.66 per 10,000 populaton for
physicians and nurses/midwives per 10,000 populaton,
respectvely. However, the Government has intensifed its
eforts to improve the sitaton. To this efect, the Government
in 2022, recruited over 11,000 health workers (see Table 3).
Physicians
per 10,000 populaton
Nurse/midwives
per 10,000 populaton
Natonal 1.76 11.66
Urban locaton 3.59 20.4
Rural locaton 0.65 6.41
TABLE 3
Core Health Workforce Densi
Routne Vaccinaton Programmes
The Zambia Childhood Immunisaton Programme covers
the following vaccines: tberculosis, polio, diphtheria,
whooping cough, tetanus, infuenza, hepatts B, meningis,
pneumonia, measles, diarrhoea, streptococcal pneumonia
and rubella. Assessment of children that have been fully
immunised is done at two stages, the frst is before 1 year
and the other stage is before 2 years. At both tme intervals,
it is assumed that at least 80 percent of children would
have been fully immunised. Full immunisaton has reduced
for both tme-intervals to 77 percent in 2022 from 88
percent in 2020 for the under 1-year age group, while in the
under 2-years age group, it reduced to 62 percent in 2022
from 88 percent in 2020, partly due to the efects of
COVID-19 as some of the funds meant for public health
care were shifed towards fghtng the pandemic.
Covid-19 Vaccinaton
As of May 2023, 9,202,759 of the total eligible populaton
were fully vaccinated; also 4,237,375 and 1,157,862 had
received their dose 1 and booster vaccines, respectvely.
The natonal vaccinaton rate as of May, 2023 was
recorded at 84.4 percent which is higher than the 80
percent target for the country to reach herd immuni.
This coverage could be atributed to scheduled campaigns
and social mobilisaton, sensisaton programmes on
vaccine safet and efectveness.
42 ZAMBIA I VOLUNTARY NATIONAL REVIEW 2023
|
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24
Goal 3: Ensure healthy lives and promote well-being for all at all ages
Policy Environment
Zimbabwe has made positive efforts to create an enabling policy environment to improve
public health. Some of these initiatives include:
Provision for the right to health under Section 76 of the Constitution. Government
developed the National Health Strategy for Zimbabwe 2016-2020 which seeks to
achieve ‘Equity and Quality in Health: Leaving no one behind.’ The Strategy is
anchored by 4 priority areas namely: communicable diseases; non-communicable
diseases (NCDs); reproductive, maternal, new-born, child and adolescents; and
public health surveillance and disaster preparedness and response.
The accession to the WHO Framework Convention on Tobacco Control in 2015 and
has enforced greater compliance with tobacco advertising laws.
A robust HIV/AIDS response strategy. Zimbabwe has also pioneered innovative
approaches including mobilising of domestic resources through the AIDS levy to
ensure sustainability. This is being augmented by donor support to the health sector
through the Health Development Fund and the Global Fund which secured over $400
million for HIV related interventions. The Ministry of Health has adopted the national
consolidated HIV guidelines in line with the 2015 World Health Organisation
guidelines. This has resulted in the development of an HIV Prevention Revitalisation
Roadmap to guide implementation of high impact HIV prevention interventions,
particularly targeting hotspots and key populations.
In January 2017 Government introduced a health fund levy of 5 cents for every
dollar of airtime and mobile data, under the theme, ‘Talk-Surf and Save a Life.’ The
financial resources mobilised are being ring-fenced for the purchase of drugs and
equipment for public hospitals and clinics.
The Revised Gender Policy (2017) has a thematic area on Gender and Health. The
policy recognise that gender inequality is responsible for most of the health issues. It
further acknowledged that poor access to health services (particularly cancer
management services), HIV and AIDS drugs, safe water and sanitation impacts
negatively more on women than men and provide strategies to improve gender
sensitivity in health service delivery
Status and Trends
Despite challenging economic conditions and dwindling allocations of the national budget to
health (see Table 3), Zimbabwe has made significant progress in the health front including:
HIV prevalence has declined from 18 per cent in 2005-06 to 13.8 per cent in 2015
percent among women and men age 15-49. It is still higher among women at 16.7
25
per cent as compared to men (10.5 per cent). HIV prevalence among young people
aged 15-24 is also higher among young women (6.7 percent) compared to 2.9
percent. Owing to a combination of robust HIV prevention programmes that
included social marketing, massive community mobilisation and awareness
campaigns combined with HIV-counselling and testing, condom promotion and
distribution, prevention of mother to child transmission and others, Zimbabwe has
become a global example in HIV prevention.
The scale up of treatment services played a major part in lowering both the HIV
prevalence and incidence. The Global Fund disbursed US$125 million during 2016.
As at September 2016, close to a million people were provided with ART and nearly
two million people were HIV tested, counselled and received their results (women
accounting for 63 per cent of the coverage in each).
Decline in child mortality. Under-5 mortality rate declined from 84 per 1,000 live
births in 2010/11 to 69 per 1,000 live births in 2015. Infant mortality dropped from
57 per 1000 live births in 2010/11 to 50 per 1,000 live births in 2015. The neonatal
mortality declined from 31 per 1,000 live births in 2010/11 to 29 per 1,000 live births
in 2015. These trends are shown in Figure 5.
Government has significantly scaled up vaccinations of children. Coverage for all
basic vaccinations among children age 12-23 months in Zimbabwe was 76 per cent in
2015 up from 65 per cent in 2010-11 (see Figure 6). Female children are somewhat
less likely to have received all basic vaccinations than male children (75 and 77 per
cent, respectively).
A decline of maternal mortality ratio (MMR) estimated at 651 deaths per 100,000
live births during the 7-year period before the 2015 survey, this figure represents a
decline from 960 deaths per 100,000 live births during the 7-year period preceding
the 2010-11 survey. While this decline is positive and commendable, the ratio still
remains unsustainably high (see Figure 7). The high ratio is attributable to a number
of factors that include: refusal to use modern medicine in some communities owing
to religious and traditional attitudes; delays in reaching health care facilities owing to
poor public transport system in some areas; inadequate public health care financing;
and human resource challenges.
Zimbabwe is one of the 22 countries designated by the WHO as the TB ‘high burden’
countries. The 22 TB ‘high burden’ countries accounted for 83 per cent of all
estimated incident cases of TB worldwide in 2014. Notwithstanding, the incidence of
TB (per 100,000 population per year) has been on a declining trend as shown in
Figure 8 in the annex.
There have been some notable improvements in life expectancy and adult mortality
as shown in Tables 4, 5 and 6 in the annex.
26
Source: Zimbabwe Demographic and Health Survey (ZDHS) 2015 Final Report.
Source: Zimbabwe Demographic and Health Survey (ZDHS) 2015 Final Report.
71
77
102
82 84
69
49 53
65
60 57
50
27 24
29
24
31 29
0
20
40
60
80
100
120
1988 1994 1999 2005-06 2010-11 2015
Figure 5: Trends in childhood mortality (Deaths per 1,000 live births in the 5-
year period before the survey)
Under-5 mortality Infant mortality Neonatal mortality
67
80
64
53
65
76
23
4
12
21
12 10
0
10
20
30
40
50
60
70
80
90
1988 1994 1999 2005-06 2010-11 2015
Figure 6: Trends in childhood vaccinations (% of children age 12-23 months
who received all basic vaccinations at any time before the survey)
All basic vaccinations No vaccinations
27
Source: Zimbabwe Demographic and Health Survey (ZDHS) 2015 Final Report.
Challenges
The main challenges affecting the health delivery system include:
Inadequate domestic financing which has made the country dependent on external
funding.
The unavailability of current comprehensive data on the burden of noncommunicable diseases (NCDs) and their risk factors due to failure by the country to
conduct the recommended WHO NCD STEPWISE survey and has impacted negatively
on any meaningful NCD programming.
Closing gaps in coverage and outcomes by eliminating huge income and urban/rural
differentials in key health indicators.
612
960
651
0
200
400
600
800
1000
1200
1998-2006 (7 years preceding the
2005-06 ZDHS)
2003-2011 (7 years preceding the
2010-11 ZDHS)
2008-2015 (7 years preceding the
2015 ZDHS)
Figure 7: Maternal Mortality
|
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0.0216012262,
0.0108803222,
0.0206048582,
0.0172304977,
-0.0100898715,
-0.0334247723,
-0.014493810900000001,
-0.0330793671,
-0.0014480526,
-0.024537185200000002,
-0.047506753400000004
] |
[
3
] |
{
"country": "zwe",
"file_id": "sdg-03/vnr-report-zwe-2017-en-5.pdf",
"language": "en",
"locality": null,
"size": "m",
"type": "vnr",
"year": 2017
}
|
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