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Asia-Pacific MDG Report 2010/11
The Economic and Social Commission for Asia and the Pacific (ESCAP) promotes regional cooperation
for inclusive and sustainable economic and social development in Asia and the Pacific, a dynamic region
characterized by growing wealth, diversity and change, but also challenged with persistent poverty,
environmental degradation, inequality and insecurity. ESCAP supports member States with sound strategic
analysis, policy options and technical cooperation activities to address key development challenges and
to implement innovative solutions for region-wide economic prosperity, social progress and environmental
sustainability. ESCAP, through its conference structure, assists member States in forging a stronger,
coordinated regional voice on global issues by building capacities to dialogue, negotiate and shape
development agenda in an age of globalization, decentralization and problems that transcend borders.
A key modality for this strategy is the promotion of intraregional connectivity and regional integration.
ADB’s vision is an Asia and Pacific region free of poverty. Its mission is to help its developing member
countries substantially reduce poverty and improve the quality of life of their people. Despite the region’s
many successes, it remains home to two-thirds of the world’s poor: 1.8 billion people who live on less than
$2 a day, with 947 million struggling on less than $1.25 a day. ADB is committed to reducing poverty
through inclusive economic growth, environmentally sustainable growth, and regional integration. Based
in Manila, ADB is owned by 67 members, including 48 from the region. Its main instruments for helping
its developing member countries are policy dialogue, loans, equity investments, guarantees, grants, and
technical assistance.
UNDP is the UN’s global development network, an organization advocating for change and connecting
countries to knowledge, experience and resources to help people build a better life. UNDP is on the ground
in 166 counties, working with them on their own solutions to global and national development challenges.
UNDP’s network links and coordinates global and national efforts to achieve the Millennium Development
Goals, including the overarching goal of cutting poverty in half by 2015. UNDP helps developing countries
in building national capacities and sharing solutions to the challenges of: Democratic Governance,
Poverty Reduction, Crisis Prevention and Recovery, Environment and Energy, and HIV/AIDS. UNDP also
helps developing countries attract and use aid effectively.
Cover photographs: Courtesy of UN ESCAP and Kibae Park
Asia-Pacific MDG Report 2010/11
Paths to 2015MDG Priorities in Asia and the Pacific
Contents
Foreword vii
Acknowledgements viii
Abbreviations ix
OVERVIEW Paths to 2015 1 SevendriversforachievingtheMDGs 1 Reducinghungerandbuildingfoodsecurity 2 Improvinghealthandotherbasicservices 2 Priorities in health 3 Strengtheningbasicinfrastructure 3 Tiltingthebalance 3
CHAPTER I
MDGs in Asia and the Pacific – where we stand 4 Thescaleof deprivation 7 Impactof theglobaleconomiccrisis 8 Endnotes 8
CHAPTER II
Seven drivers for achieving the MDGs 9 Strengtheninggrowthbystimulatingdomesticdemandandintra-regionaltrade 9 Makingeconomicgrowthmoreinclusiveandsustainable 10 Strengtheningsocialprotection 10 Reducingpersistentgendergaps 11 Ensuringfinancialinclusion 12 Supportingleastdevelopedandstructurallydisadvantagedcountries 12 Exploitingthepotentialof regionaleconomicintegration 13 Towards2015 14 Endnotes 14
CHAPTER III
Reducing hunger and building food security 15 Creatingjobsandincreasingincomes 16 Boostingagriculturalproduction 17 Maintainingstableandreasonablefoodprices 18 Providingsafetynetsforthepoor 19 Implementingfeedingprogrammes 20 Releasedfromhunger 21 Endnotes 21
CHAPTER IV
Improving health and other basic services 22 Investingmoreinbasicservices 22 Improvinggovernance 23 Ensuringsocialinclusionandequalaccesstosocialservices 25 Diversifyingtherangeof serviceproviders 25 Prioritiesinhealth 26 Increasing public health expenditure and staffing levels 28 Achieving universal health care 29 Aneweraforpublicservices 31 Endnotes 31
CHAPTER V
Strengthening basic infrastructure 32 Mobilizingfinanceforbasicinfrastructureinvestment 34 Stimulatingtheprivatesector 34 Raisingstandardsof qualityandmaintenance 35 Buildinggreenerinfrastructure 36 Extendingregionalinfrastructure 37 Tiltingthebalance 37 Endnotes 37
STATISTICAl APPEnDIx 38
Comparisonof AsiaandthePacificwithotherdevelopingregions 38 Achievementsin$1.25/daypoverty 38 Achievementsinprimaryenrolment 38 Achievementsinbasicsanitation 41 Numberof peopleaffectedif targetsarereached 42 Impactof theglobaleconomicslowdown 42 SelectedMDGIndicators 46
REFEREnCES 54
FIGuRES
FigureI-1 – Asia-Pacificrankingongenderindicators 7FigureI-2 –Asia-Pacific’sshareof thedevelopingworld’sdeprivedpeople 8FigureII-1–NetODAreceiptsperpersonin2008,US$ 13FigureIII-1–Agriculture’sshareof publicexpenditure,percentage. 18FigureIV-1–Spendingonhealthandeducationasapercentageof GDP 23FigureIV-2–Totalgovernmentrevenueasapercentageof GDP 24FigureIV-3–Maternalmortalityratesandnumberof deaths 28FigureA-1 –AsiaandthePacificcomparedwithSub-SaharanAfricaand LatinAmericaandtheCaribbean 39FigureA-2 –Progressinreducingextremeincomepoverty 40FigureA-3 –Progressinexpandingaccesstoprimaryeducation 41FigureA-4 –Progressinexpandingaccesstobasicsanitation 43
TAblES
TableI-1 – Countrygroupson-trackandoff-trackfortheMDGs 5TableI-2 – Countrieson-trackandoff-trackfortheMDGs 6TableIII-1 – UndernourishmentinAsiaandthePacificandotherglobalregions 15TableIII-2–Underweightchildrenunderfive 16TableIII-3–Progressrequiredforoff trackcountriestomeetthe underweightchildrentarget 17TableIII-4– Netimportersandexportersof food 19TableIV-1 –Netenrolmentratioinprimaryeducation,percentage,2007 22TableIV-2 –Progressrequiredforoff-trackcountriestomeetthe under-5mortalitytarget 27TableIV-3 – Healthpersonnel 29TableV-1 –Positiveimpactsof basicinfrastructureonthepoorandMDGs 33TableV-2 – Infrastructurecomparators,AsiaandRestof theWorld,2005 34TableV-3 – Asia’sInfrastructureInvestmentneeds2010-2020 (US$millions,2008) 35TableV-4 – InfrastructurequalityinAsia,ratedfrom0-7 36TableA-1 – Progressrequiredforoff-trackcountriestomeetthe$1.25/day povertytarget 40TableA-2 – Progressrequiredforoff-trackcountriestomeettheprimary enrolmenttarget 42TableA-3 – Progressrequiredforoff-trackcountriestomeetthebasic sanitationtarget 44TableA-4 – Summaryof estimatedpopulationindeprivation, alternativescenarios,thousands 44TableA5 – Numberof peopleprojectedtobeindeprivationin2015 45TableA-6 – Goal1:Eradicateextremepovertyandhunger 46TableA-7 – Goal2:Achieveuniversalprimaryeducation 47TableA-8 – Goal3:Promotegenderequalityandempowerwomen 48TableA-9 – Goal4:Reducechildmortality 49TableA-10 – Goal5:Improvematernalhealth 50TableA-11 – Goal6:CombatHIVandAIDS,malariaandotherdiseases 51TableA-12 – Goal7:Ensureenvironmentalsustainability 52TableA-13 – Goal7:Ensureenvironmentalsustainability 53
bOxES
BoxIV-1 – Newestimatesonmaternalmortality 28BoxV-1 – EnergyforAll 33
viiMDG PRIORITIES In ASIA AnD THE PACIFIC
Foreword
Impendingdeadlinestendtofocusthemind.Backin2000theyear2015,whichisthetargetdatefortheMillenniumDevelopmentGoals,seemedsomewayoff.Nowtwothirdsof thewaytowardsthefinishingline, it isbeginningto lookuncomfortablyclose.Theyear2010isthereforeanappropriatepointtotake
stock–toassesssomeof thelikelyoutcomesonpresenttrends,identifysomeof theweakestareasof performance,andidentifyprioritiesforaction.
Since2004,anESCAP/ADB/UNDPpartnershiphasregularlyproducedreportscarefullytrackingprogressof theAsiaandPacificregiontowardstheGoals.Theyhavedevelopedaconsistentmonitoringsystemforjudgingwhethercountriesandsubregionsareon-trackoroff-tracktomeettheindicatorsforthe2015Goals–presentingthe results in a seriesof distinctive colour-coded ‘traffic-light’ charts.Eachof the reports has focusedon aparticulartheme,suchasMDGconsistentnationaldevelopmentpoliciesorinstitutionalreformstomakethedevelopmentprocessfairerandmoreinclusive,ortheimpactof thefood,fuelandfinancialcrisesonthelikelyachievementof thegoals.
This2010/11reporttakesaslightlydifferentapproach.Asbefore, itrefreshesthesignalstoreflectthelatestinformationfromtheUnitedNationsMDGdatabasetoassesswhichcountriesandsubregionsarelikelytomissorachievetheGoals.Butratherthanaddressinganewtheme,thismoreconcisereportattemptstoencapsulateandupdatethediscussionsandrecommendationsof theearlierreports.Whilethishasthemeritof brevity,italsoof coursehasthedisadvantageof excludingsomedetaileddiscussion.Readerswhowishtoconsidertheissuesmorecloselyareencouragedtoconsultsomeof thepreviousAsia-PacificMDGreports.
ThereportPaths to 2015emphasisestheinter-relationshipsbetweenMDGsbyidentifyingsomeoverallprioritiesandopportunitiesthatcountriescanconsiderforachievingallthegoals.Thenitfocusesspecificallyonthreeareas:hungerandfoodsecurity;healthandbasicservices–areaswheretheAsia-Pacificregionasawholeappearstobefallingshort;andon improvementof basic infrastructurewhich isoftenneglectedbut iscritical if theregionistoachievetheMDGs.Thereporthasbeenpreparedthroughwideconsultationsintheregionandbasedoninputsreceivedfromstaff of allthethreepartnerorganizations,UNagencies,andcommunitiesof practice.Feedbackhasalsobeenreceivedfromcountryparticipantsatsub-regionalandregionalMDGconferencesheldinJulyandAugust2010.ThisreportisbeingproducedtocoincidewiththeUnitedNationsHigh-levelPlenaryMeetingontheMDGsinSeptember2010inNewYork.TheAsia-Pacificregionishometomorethan60percentof humanity,sowhathappensintheregionwillhaveacriticalbearingonglobalMDGachievement.AsiaandthePacifichasmuchtobeproudof,butneedstoredoubleeffortstoreducepovertyandvulnerabilityaffectinghundredsof millionsof peoplelivingintheregion.Wehopethatthisreportwillcontributetoglobalandregionaldebatesandhelpspurthenecessaryactionthatwillenableustoacceleratetowardsthefinishingline.
noeleen HeyzerUnder-Secretary-Generalof the
UnitedNationsandExecutiveSecretaryof ESCAP
ursula Schaefer-PreussVice-President
AsianDevelopmentBank
Ajay ChhibberUNAssistantSecretary-Generaland
UNDPAssistantAdministratorandDirectorforAsiaandthePacific
viii PATHS TO 2015
Acknowledgements
ThisisthefifthreportthathasbeenpreparedundertheESCAP/ADB/UNDPregionalpartnershiponachievingtheMillenniumDevelopmentGoalsinAsiaandthePacificregion.IthasbeenpreparedasacontributionfromAsiaandthePacificregiontotheUnitedNationsSummitonMDGs2010.
The report has been prepared under the direct supervision and guidance of Dr. Noeleen Heyzer, Under-Secretary-Generalof theUnitedNationsandExecutiveSecretaryof ESCAP,Dr.UrsulaSchaefer-Preuss,Vice-President,AsianDevelopmentBankandDr.AjayChhibber,UNAssistantSecretary-General,UNDPAssistantAdministratorandDirectorforAsiaandthePacific.
ESCAP/ADB/UNDPteam,whichcoordinatedandpreparedthereport,consistedof followingmembers: ESCAP:NageshKumar,SyedNuruzzaman,JanSmit,YanhongZhangandHarumiShibata ADB:ShiladityaChatterjeeandGuanghuaWan UNDP:NicholasRosellini,ThangavelPalanivelandTaimurKhilji
The report team met periodically to review the draft chapters and engaged in wider consultations with themembersof theUNDGandUNRegionalCoordinationMechanismbasedinBangkok.
The report team thanks the following for their support and technical inputs: Jiwan Acharya, Ian Anderson,DipaBagai,ArminBauer,RadhikaBehuria,InduBhushan,ThomasBeloe,CarolineBorchard,AlainBorghijs,BakhodirBurkhanov,RyceChanchai,BiploveChoudhary,DomingoCarolaDonner-Reichle,GerardDaly,TyrrellDuncan, Haishan Fu, Jessica Gardner, Fadzai Gwaradzimba, Cherie Hart, Imrana Jalal, Shanti Jagannathan,Jacques Jeugmans,Kaushal Joshi,HiroyukiKonuma,HenrikLarsen, IosefaMaiava,RomanaMaryMargaret,SarammaMathai,RoohiMetcalfe,KhajaMoinnuddin,K.A.MMorshed,AmitavaMukherjee,B.Murali,TariqNiazi,NubokoHoribe,ChellamPalanyandy,MaheshPatel,TamPham,MoniPizani,MudbharyPurushottam,Anuradha Rajivan, Michael Sheinkman, Hiren Sarkar, Jouko Sarvi, Nashida Sattar, Sharad Saxena, WolfgangSchiefer, Michael Sheinkman, Kah Sin, David Smith, Sahba Sobhani, Alexandra Solovieva, Pauline Tamesis,SonomiTanaka,NeschaTeckle,AnilTerway,MyoThant,GuyThijs,HansTroedsson,SachikoYamamotoandYumikoYamamoto.
Theteam’sappreciationgoestotheUNAsiaPacificMDGsCommunitiesof PracticeandADBCommunitiesof PracticeonEducation,Energy,Environment,Gender,GovernanceandPublicManagement,Health,TransportandWaterwhomadesubstantivecontributionsforthepreparationof thisreport.
ThereportwaseditedbyPeterStalker.ItwasdesignedbySusannahDixionandNiphonPenplugsakul.MinyanBaoandWannapornSridamaprovidedalladministrativesupport.
ixMDG PRIORITIES In ASIA AnD THE PACIFIC
Abbreviations
ADB AsianDevelopmentBankADBI AsianDevelopmentBankInstituteAIDS acquiredimmunodeficiencysyndromeASEAN Associationof South-EastAsianNationsASEAN+3 ASEAN+China,JapanandtheRepublicof KoreaBIMSTEC Bayof BengalInitiativeforMulti-SectoralTechnicalandEconomicCooperationCIS Commonwealthof IndependentStatesCMI ChiangMaiInitiativeCO2 CarbondioxideDAC DevelopmentAssistanceCommitteeof theOECDEAS EastAsiaSummitESCAP EconomicandSocialCommissionforAsiaandthePacificFAO FoodandAgricultureOrganizationFDI foreigndirectinvestmentFTA freetradeagreementGDP grossdomesticproductHIV humanimmunodeficiencyvirusID identityILO InternationalLabourOrganizationIMF InternationalMonetaryFundLAC LatinAmericaandtheCaribbeanLDCs leastdevelopedcountriesLLDCs landlockeddevelopingcountriesMDB multilateraldevelopmentbankMDGs MillenniumDevelopmentGoalsNGO non-governmentalorganizationODA officialdevelopmentassistanceOECD OrganisationforEconomicCooperationandDevelopmentPPP purchasingpowerparitySAARC SouthAsianAssociationforRegionalCooperationSIDS SmallislanddevelopingstatesSPC Secretariatof thePacificCommunityTB TuberculosisUNDP UnitedNationsDevelopmentProgrammeUNESCO UnitedNationsEducational,ScientificandCulturalOrganizationUNFPA UnitedNationsPopulationFundUNICEF UnitedNationsChildren’sFundUNIFEM UnitedNationsDevelopmentFundforWomenVAT valueaddedtaxWDI WorldDevelopmentIndicatorsWFP WorldFoodProgrammeWHO WorldHealthOrganizationWTO WorldTradeOrganization
1MDG PRIORITIES In ASIA AnD THE PACIFIC
OVERVIEW
Oneof thegreatestMDGsuccessesinAsiaandthe Pacific has been on poverty reduction.Between1990and2008,thecountriesof the
region reduced the number of people living on lessthan$1.25adayfrom1.5billionto947million,andtheregionisontrackforthepovertygoal.Moreover,forsomeotherindicatorstheAsia-Pacificregionasawholehasalreadyachievedthetargets–forreducinggenderdisparitiesinprimary,secondaryandtertiaryeducationenrolment,forexample,forpreventingarise inHIVprevalence,forstoppingthespreadof tuberculosis,forreducingconsumptionof ozone-depletingsubstances,and for halving the proportion of people withoutaccesstosafedrinkingwater.
Ontheotherhand,theregionisstilllagginginsomemajor areas. It has been slow in reducing the extentof hunger, in ensuring that girls and boys reach thelast grade of primary education, in reducing childmortality,inimprovingmaternalhealthprovisionandinprovidingbasicsanitation.
Seven drivers for achieving the MDGs
EachcountryfocusingontheMDGshastoaddressitsownspecificneedsandopportunities.Andeachof thesocial sectors relevant for theMDGs, suchashealthand education, also has its own specific issues. Butacrosstheregionandacrosssectorsthereareanumberof common concerns and priorities. This reportsingles out seven overall opportunities to strengthentheenvironmentforachievingtheMDGs.
Strengthening growth by stimulating domestic demand and intra-regional trade – Given the importance of economic growth in MDG achievement, countries
affected by the crisis need to recover quickly andexpand theireconomies.But inanerawhenwesternmarkets are likely to import fewer goods, countriesintheregionwillalsoneedtorebalancetheirgrowth,basingitmoreondomesticconsumptionandgreaterlevelsof intra-regionaltrade.SuchchangewouldalsopresentanopportunityforacceleratingMDGprogresswhichdependongreaterspendingonsocial servicesandbasicinfrastructure.Making economic growth more inclusive and sustainable–Economicgrowthalsoneedstobeinclusive–derivedmore from economic activities such as agriculturethat benefit the poor, and especially women. Thefruitsof growthalsoneedtobebetterallocatedsoastocontributetoachievingtheMDGtargets.Governmentswillwanttosettheirsightson‘greengrowth’thatcandecoupleeconomicdevelopmentfromenvironmentalpressures.
Strengthening social protection – Countries will bebetter placed to achieve the MDGs if they offer aminimumsocialfloorthataddressesextremepovertyand hunger and income insecurity. A comprehensivesocial protection programme will help minimize therisks and vulnerability from economic crises andnaturalcalamities.Itwillalsoactasa‘circuitbreaker’for vicious inter-generational cycles of poverty andhungeraswellasreducingwideningdisparitiesbetweentherichandpoor.Thisshouldinvolveatargetedandgender-responsiveoutreachtotheinformalsector.
Reducing persistent gender gaps–Greaterinvestmentsin women and girls have multiplier effects across alltheGoals.Collection and analysis of gender-specificdata should be followed by the legislative and otherchanges needed to ensure that women have greater
Paths to 2015
The Asia-Pacific region has made striking progress towards achieving the Millennium Development Goals. Nevertheless, on present trends many countries are likely to miss a number of the targets. This report focuses on opportunities for making more rapid progress – identifying some of the most promising paths to 2015.
2 PATHS TO 2015
OVERVIEW: Paths to 2015
control and ownership over assets, have equitableaccesstoemploymentandallpublicservices,andarefullyrepresentedinpublicandpoliticallife.
Ensuring financial inclusion–Mostof thebillionorsopoorpeopleinAsiaandthePacifichavelittleaccessto financial services.Nowadays therearemanymoreopportunitiesforachievinggreaterfinancialinclusionforthem.Governmentscanplaytheirpartbyimprovinginfrastructure and the regulatory environment whileencouraging better service provision by NGOs,community-basedgroupsandtheprivatesector.
Supporting least developed and structurally disadvantaged countries–Whilemostof theresourcesforachievingtheMDGsmustcomefromwithinthecountries,manyof thepoorestcountrieswillcontinuetorelyonoverseasdevelopmentassistanceandSouth-Southcooperation.
Exploiting the potential of regional economic integration –Regionaleconomicintegrationcanmaketheregionmoreresilienttofurthercrisesandbolsterthecapacityof the poorest countries to achieve the MDGs.Agreements on economic integration, for example,couldenablesmallercountriesinparticulartoextendtheirmarketsandreapefficiencygains.Opportunitiesforfruitfulcooperationexistinfinanceandotherareas.
Thereportalsolooksmorecloselyatsomeof thekeyissues for goals on which the region is falling short:reducinghungerandbuildingfoodsecurity,improvingbasic services,andstrengtheningbasic infrastructure.The report highlights the opportunities for buildingfood security, stronger basic services and improvedbasicinfrastructures.
Reducing hunger and building food security
Despite rapid economic growth and falling levelsof poverty, Asia and the Pacific still has widespreadhunger and malnutrition. About one person in sixsuffersfrommalnourishmentandonechildinthreeisunderweight.Toensurethatpoorpeoplehaveaccesstothefoodtheyneedtoleadhealthyandproductivelives,experienceacrosstheregionsuggestsfiveoverallpolicypriorities.
Creating jobs and increasing incomes – The mainresponse should be to ensure that people have thedecent jobs and incomes that will enable them tobuy the food they need. Despite higher economicgrowth,employmentgrowthhasslowedconsiderably.Governmentswillwanttoensurethatgrowthismore
employment intensive while expanding employmentprogrammesforthepoorandvulnerable.
Boosting agricultural production – Over the yearstherehasbeenadeclineinnationalpublicinvestmentin – and international support for – agriculture.Consequently there has been a deceleration in thegrowthof agriculturaloutputandproductivity.Asiangovernments and the international community nowneedthereforetoredirecttheirattentiontoagriculturewhichhasvastunexploitedpotentialforgrowth.
Maintaining stable and reasonable food prices –Foodpricesshouldbewithinrangeof poorconsumers,butitisalsoimportanttohavepricesthatoffersufficientincentivestofarmers.Atthesametimegovernmentsmayneedtoaddressimbalancesinfoodmarketsthatgivegreaterpowertobuyersandretailersthantofoodproducersandconsumers.
Providing safety nets for the poor–Governmentsshouldensure foodsecurity for thepoorwhoareunable toearn their livelihoods, through subsidies,public fooddistributionsystems,orfood-for-workprogrammes.
Implementing feeding programmes – These caninclude school feeding programmes, for example, orprogrammesforpregnantwomen,babies,pre-schoolchildren,ortheelderly,sickorinfirm.
Improving health and other basic services
If the least developed countries are to achieve theMillennium Development Goals they will need tooffer reliablebasic services, especially forhealth andeducation. Most governments have been determinedtoimproveprovisionof servicesbutstillfallshort intermsof coverageandquality,particularlyinruralareas.
Investing more in basic services –Governmentshavebeenallocatingmoreresourcestoeducationthoughasaproportionof GDPbut this is still lower than theglobal average. Expenditure on health, however, hasstagnated.Whilemanygovernmentsmaybeconcernedabout deficits they probably have more fiscal policyspacethantheyrealizetoinvestinbetterservices.
Improving governance–Governmentswillbeconcernedto ensure higher quality of services. At present thequality of services is undermined by a number of issues related to governance. These indicate theneed for effective decentralization, achieving greaterpolicy coherence, reducing corruption, strengtheningregulations, generating better data, increasing
3MDG PRIORITIES In ASIA AnD THE PACIFIC
OVERVIEW: Paths to 2015
accountabilityandstakeholderparticipation.
Ensuring social inclusion and equal access to social services –Inprinciple services are available to all, but in practicecertaingroupstendtobeexcludedongenderormanyother characteristics – for example, caste, creed,ethnicity, sexual identity, socio-economic standing,disability, age, HIV status, or geographical location.Exclusion must therefore need to be tackled on abroad front, including through greater communitymobilisation,andinsomecases,affirmativeactionordecriminalization where certain laws could obstructthedeliveryof healthservices.
Diversifying the range of service providers – In thepasttheprincipalprovidershavebeengovernments–particularlyforhealth,education,waterandsanitation.Moreservicesarenowbeingprovidedbycommunityorganizationsandtheprivatesector,butgovernmentsstillneedtoensureaccessforthepoor.
Priorities in health
While governments need to strengthen provisionacross thewhole rangeof public services,manywillneedtopayspecialattentiontothehealthgoals–whereprogress has been particularly slow. Maternal healthneeds special attention as an unacceptable numberof women perish from preventable and treatablecomplications related to pregnancy. Despite thestabilizingof HIVprevalenceintheregion,accesstopreventionandtreatmentservicesstillfallswellbelowuniversal targets. This will require increasing publichealthexpenditure,whileseekingnewhealthinsurancemodelsandincreasingthenumberof primaryhealthcareworkers. In addition,health servicedelivery canbe improvedby involving communitygroupsof keyaffectedpopulations.
Strengthening basic infrastructure
TheMDGframeworkhasfewspecificgoals,targetsorindicatorsforinfrastructure–thusthefocushasbeenon development outcomes while less attention hasbeenpaidtosomeof thebasicconditionsforachievingthem. Asia and the Pacific region needs strongerbasic infrastructure,particularlyroadtransport,watersupplies,sanitation,electricity,informationtechnology,telecommunications and urban low-income housing.Amongtheprioritiesforimprovinginfrastructureare:
Mobilizing finance – For the period 2010-2020 therequiredinfrastructureinvestmentwouldbe$7.7trillionorabout$700billionperannum.Forthispurpose,somecountriesmaybeabletoaccesscapitalmarketsandtap
intoregionalsavings,thoughpoorercountrieswillhavetorelymoreonmultilateraldevelopmentinstitutions.
Stimulating the private investment –Overthepasttwodecades,morethan70percentof Asia’sinvestmentininfrastructurehasbeenmadebythepublicsector.Nowmorespendingwillneedtocomefromprivatesources.Governmentscould,forexample,offerfiscalincentiveswhile multilateral development institutions can helpguidenegotiationsforpublic-privatepartnerships.
Raising standards of quality and maintenance –Except for railways, Asia also lags in the quality of infrastructure, much of which suffers from a lackof commitment to repairs and maintenance. And ina region prone to disasters another important factoris the planning and implementation of measures forrisk reduction. Many of the problems are related togovernance, including corruption. Governments canincrease transparency by using competitive biddingrules, for example, and automated e-billing systems.They will also need to improve qualification andcertificationintheconstructionindustryandenforceregulations more strictly. But one of the best waysof improvingqualityandaccountability is toactivelyinvolve local communities, and particularly women,whocannotonlycontributeinputsbutalsofeelgreaterownershipandbecommittedtomaintenance.
Building greener infrastructure – More attentionmust be given to infrastructure that maximizesequitable socio-economic benefits, while minimizingenvironmental impactsandtheuseof resources.Forexample,wellplannedandintegratedpublictransportsystemsreducecostsfortheurbanpoorwhileputtingcitiesontrajectoriesof greengrowth.
Extending regional infrastructure – There is a cleargaintopublicwelfarefromregionalinfrastructurethathelpsenlargemarkets,reducesthecostsof tradeandusesregionalresourcesmoreefficiently.Oneestimatesuggests that completing regional connectivity inenergy,transportandtelecommunicationswouldboostAsia’snetincomeby$13trillionovertheperiod2010-20andbeyond.
Tilting the balance
As the MDG target date 2015 approaches, it seemslikelythatthepictureacrossAsiaandthePacificwillbe mixed – with some disappointing failures, somenarrow misses, and some striking successes. But thefinalMDG story is yet tobe told.All countries stillhave five years to choose the most promising paths–andtiltthebalancedecisivelyonthesideof success.
4 PATHS TO 2015
CHAPTER I
Oneof thegreatestMDGsuccessesinAsiaandthePacifichasbeenwithpovertyreduction.Between 1990 and 2008, countries in Asia
andthePacificreducedthenumberof peoplelivingonlessthan$1.25adayfrom1.5billionto947million–allthemoreimpressivegiventhatoverthesameperiodtheregion’spopulationincreasedbysome800million.Asaresulttheregionasawholeisontracktoachievethetargetof halvingtheproportionof peoplelivinginextremepoverty.
Moreover, for some other indicators Asia and thePacifichasalreadyachievedthetargets–forreducinggender disparities in primary, secondary and tertiaryeducation,forexample,forbeginningtoreduceHIVprevalence,forstoppingthespreadof tuberculosis,forreducingconsumptionof ozone-depletingsubstances,and for halving the proportion of people withoutaccesstosafedrinkingwater.
Ontheotherhand,AsiaandthePacificregionisstilllagging in some major areas. It has been slow, forexample,inreducingtheextentof hunger,inensuringthat girls and boys reach the last grade of primaryeducation, in reducing child mortality, in improvingmaternalhealth,inprovidingbasicsanitation.
Table I-1 summarizes for 21 indicators the overallstatus based on the most recent internationallycomparable data set, which covers the period up to2008. For details of the classification method, seehttp://www.unescap.org/stat/statpub/mdg-progress-classification/.Forselectedindicators,basedontrends
of progresssince1990,thereportplaceseachcountryorcountrygroupintooneof fourcategories:
Early achiever–Alreadyachievedthe2015target On-track–Expectedtomeetthetargetby2015 Off-track: slow – Expected to meet the target, but after2015 Off-track: no progress/regressing–Stagnatingorslipping backwards
AsTableI-1shows,theestimatesfortheAsia-Pacificregion as a whole inevitably mask considerablevariationsbetweencountrygroupingsandsubregions.Theregion’s14leastdevelopedcountries,forexample,havemadeslowornoprogressonmost indicators–performingwellonlyongenderequalityinprimaryandsecondaryeducation,andstoppingthespreadof HIVandTB.Itisamajorconcernthatinmostsubregionsprogress is slow for reducing child mortality andimprovingprovisionformaternalhealth.
Therearesimilardifferencesbetweensubregions.ThegreatestprogresshasbeeninSouth-EastAsiawhichhasalreadyachievednineof the21assessedindicatorsandisontrackforanotherthree.TheNorthandCentral-Asian countries as a group have already achievedeightof theindicators.Thesamegroupof countries,excludingtheRussianFederation,haveachievedtenof theindicators–thoughtheyareprogressingslowlyonanotherthreeandmakingnoprogressonafurthersix,includingthoserelatedtopoverty,HIVandTB.
TheAsia-Pacificregionincludestheworld’stwomost
MDGs in Asia and the Pacific – where we stand
The Asia-Pacific region has made impressive gains in many MDG indicators, especially in reducing poverty. But it is lagging on some important targets, particularly on reducing hunger and in achieving higher standards of health. To reach the goals, from now to 2015, countries in Asia and the Pacific will need to step up their efforts and focus on some key priorities.
5MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER I: MDGs in Asia and the Pacific – where we stand
Table I-1– Country groups on-track and off-track for the MDGs
Source: Staff calculations based on the United Nations MDG Database
populouscountries–ChinaandIndia–sotheregion’soverallachievementonpoverty,asonotherindicators,willbeswayedbytheirperformance.Toillustratethis,Table I-1 also shows the performance of differentcountrygroupingsthatexcludeAsia’stwogiants.Thus‘Asia and the Pacific excluding China and India’ onsomeindicatorshasperformedworsethantheregionasawhole:ithasprogressedonlyslowlyinreducingthenumberof peoplelivingwithlessthan$1.25perday,andregressedonHIVprevalence.StartingfromalowbaseonmanyMDGindicators,SouthAsiahasmadegoodprogressonsevenindicatorsbut isprogressingonlyslowlyonmanyothers.Giventheweightof Indiainsubregionalaggregates,itisalsousefultoconsider‘SouthAsiawithoutIndia’.Thisgroupingisontrackforpoverty,butprogressingslowlyontheprovisionof cleanwatersupplies,andregressinginHIVprevalenceandforestcover.
As a group, the Pacific Island countries have beensuccessfulinindicatorsrelatedtotuberculosis,protectedareas and the consumption of ozone-depletingsubstances.But theyhavebeenregressingormakingno progress in eight indicators and advancing onlyslowlyinanotherfive,thoseforinfantandunder-fivemortalityandprovidingaccesstoantenatalcare.PapuaNew Guinea is home to almost 70 per cent of the
Pacific Island countries’ population, so estimates forthesubregionareinevitablyaffectedbythiscountry’sperformance. Table I-1 therefore presents estimatesforthePacificIslandcountriesexcludingPapuaNewGuinea. This subgroup shows better progress ongender equality in education and is also movingforward,albeitslowly,onexpandingaccesstoimprovedsanitationfacilitiesandsafedrinkingwater.However,itshouldbenotedthattheaccuracyof PacificIslandaggregates for many indicators is hampered by ashortageof data.Disparitiesinprogressbetweengroupsof countriesintheregionaremirroredatthecountrylevel(TableI-2).Forexample,whereasSouth-EastAsiaasawholeisontrack–orhasachievedthetarget–for12of the21indicatorsconsideredinthisreport,Cambodiamanagesthis for only ten indicators, and Lao PDR for onlynine – a result of insufficient progress in childmalnutrition and primary completion, for example.At the other end of the spectrum, while South Asiaas a whole is on track for, or has achieved only nineindicators, Sri Lanka is on track, or has achieved,the targets, for 14 of the 19 indicators for which ithas data. More details on the variation in progresstowards achieving the MDGs are provided in theStatisticalappendix.
� PATHS TO 2015
CHAPTER I: MDGs in Asia and the Pacific – where we stand
Table I-2 – Countries on-track and off-track for the MDGs
Source: Staff calculations based on the United Nations MDG Database.
�MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER I: MDGs in Asia and the Pacific – where we stand
Itshouldbenotedthattheseon-andoff-trackestimatesarebasedonaglobaldatabasecompiledbytheInter-AgencyExpertGrouponMDGindicatorsledbytheDepartment of Economic and Social Affairs of theUnitedNationsSecretariat.CountriesmeasuringMDGprogressusingdifferentdatasources,orusingdifferentindicators, may arrive at different conclusions. Takethe goal of eradicating extreme poverty and hungerforexample.Theassessmentof progressinthisreportusestheinternationallydeterminedincomepovertyline($1.25aday),whilemanynationalassessmentstendtobebasedonnationallydeterminedpovertylines.Thus,countriessuchasLaoPDR,NepalandTurkey,whichareshowninthereportassloworregressingonthegoalof povertyreduction,wouldbeontrackonthebasis of data estimated from nationally determinedpovertylines.Similarly,countriessuchasMongoliaandPakistanareshownhereasearlyachieveron incomepoverty,althoughtheywouldbeonsloworregressingonthebasisof theirnationalpovertylinesdata.
Moreover,evenincountrieswheresignificantprogresshas been made towards the MDGs, there are oftendisparities within the country – between urban andruralareas,betweenrichandpoor,betweenwomenandmen,andgirlsandboys.Althoughmanycountriesdonotregularlyreportsex-disaggregateddatathatwouldhelptrackthegenderdimensionsof MDGtargetsand
indicators, the available data on outcome indicatorsof poverty, such as education, nutrition, health andchildmortality,andevidencefromcasestudiessuggestgender disparities (Figure I-1). Close to 100 millionwomen inAsiaareestimated tobe ‘missing’becauseof discriminatory treatment in access to health andnutrition or through pure neglect – or because theywerenotallowedtobeborninthefirstplace.1
The scale of deprivation
Compared with other developing regions Asia andthe Pacific is generally ahead of Africa, but behindLatinAmericaandtheCaribbean(Statisticalappendix,FigureA-1).Butbecauseof itslargerpopulationsize,on most indicators, the Asia-Pacific region has thegreatest numbers of people affected. In the case of sanitation,forexample,theregionhasmorethan70percentof thedevelopingworld’speoplewhoareaffected–whichin2008amountedtoalmost1.9billion.Thisis illustrated inFigure I-2 for thisandother selectedindicators. Indeedevenon indicators forwhichAsiaand the Pacific has made significant progress, it stillhasalargenumberof peoplewholiveindeprivation.When it comes to providing people with access tocleanwater,forexample,theregionisanearlyachieveryetstillhas469millionpeopledeprived.
Figure I-1 – Asia-Pacific ranking on gender indicators
Source: Staff calculations based on data available at the World Bank Genderstat.
Lifeexpectancy Adultliteracy Secondary Adultlabourforce Proportionofseats atbirth,2008 rate,2008 enrolment participation heldinnational rate,2007 rate,2008 parliaments,2008
East Asia and the Pacific South Asia Sub-Saharan Africa World Gender parity
1.1
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Rat
ioo
ffem
ale
tom
ale
(F/M
)
8 PATHS TO 2015
CHAPTER I: MDGs in Asia and the Pacific – where we stand
Impact of the global economic crisis
The most recent year for which internationallycomparable data are available in the United NationsMDGdatabaseis2007or2008.Thiswaspriortotheglobal economic slowdownwhich started in2008 sothe data do not yet register the effect of the crisis.In theAsia-Pacific, for example, the economic, foodandfuelcrisesarebeingfeltthroughlowereconomicgrowth, lower government revenues, higher debtburdens,adeclineinthevalueof offshoreinvestments,increasesinthecostof living,joblossesandreducedremittances,2preventingsome21millionpeoplefromescapingpoverty.
Whilethereareinsufficientcurrentdata,itneverthelessis possible to make a rough estimate of the effects,based on the impact of the crisis on economicgrowth–whichisnowbecomingclearer.ThehistoricalrelationshipbetweeneconomicgrowthandchangesinMDGindicatorscanbeusedtoprojectthelikelyeffectsinfuture.ThemethodologyforthisissummarizedintheStatisticalappendix.
Basedonthismodel,inAsiaandthePacificthecrisiswouldresultby2015in:3 • Almost 35 million extra people in extreme incomepoverty • A cumulative number of almost 900,000 extra childrensufferingfrommalnutritionfrom2008 to2015
• 1.7 million births not attended by skilled professionals • 70 more million people without access to improvedsanitation
Note that these numbers are in addition to thoseindicatedinFigureI-2forthenumberof peoplewhowould have been deprived in any case had the crisisnot occurred. Compared with the overall levels of deprivationtheimpactof thecrisismayappearsmall.But they are nevertheless significant and add to thechallengeof achievingthegoals.
All of these estimates assume that historical trendsroughly continue. But history is not destiny. Allcountries in the region still have the opportunity toaccelerate progress to 2015 and achieve many moreof thegoals.Asaguidetohowtheymightdoso,thefollowing chapters highlight some of the paths theycantake.
Figure I-2 – Asia-Pacific’s share of the developing world’s deprived people
Source: Staff calculation based on the United Nations MDG Database.
Endnotes
1 UNDP,2010.2 ESCAP/ADB/UNDP2010;PacificIslandForumSecretariat, 2010;ESCAP(2010a).3 AlsoseeESCAP(2010a)andESCAP(2010b)forfurther discussionof theimpactof theeconomiccrisis.
1990 Latest
1877 1873
141 96
1481 947
11 7
854 469
53 32
– 0.24
7 4
6 5
Without basic sanitation
Under-5 underweight
Living below $1.25/day
Infected with TB
Without safe drinking water
Outofprimaryschool
Maternaldeaths
Under-5 mortality
Living with HIV
0 10 20 30 40 50 60 70 80 90 100
Numberofpeopledeprived(inmillions)
Percent
9MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER II
Each country has to address its own specificneeds and opportunities. And each of thesocialsectorsrelevantfortheMDGs,suchas
healthandeducation,alsohasitsownspecificissues.Butacrosstheregionthereareanumberof commonissues and priorities. Subsequent chapters will lookmore closely at some of the key issues for goals onwhichtheregionisfallingshort:reducinghungerandbuilding food security, improving basic services, andstrengtheningbasicinfrastructure.
AllcountriesintheregionaccepttheirresponsibilitiesasdevelopmentalstatesforachievingtheMDGs.Thischapterpresentssevenopportunitiesforstrengtheningthe overall environment in which they can do so. Itshould be noted that this and subsequent chaptersof thereportdrawheavilyontheprecedingregionalMDG reports – which can be consulted for theanalytical and empirical details that underpin thesectionsthatfollow.1
Strengthening growth by stimulating domestic demand and intra-regional trade
Achieving all theMDGswill dependon acceleratinggrowth and making a strong recovery from theeconomiccrisis.Manycountrieswillbeaimingtodothisbyrebalancingtheireconomiessoastobemoreresilient,basedlessonexportsandmoreonboostingdomestic demand and greater consumption of Asia-Pacificgoodsandservices.2FortheMDGsthispolicychange presents a major opportunity since many of thepoliciesthatwillhelpachievetheMDGswillalso
boostlocaldemand.Theseincludeincreasingspendingonbasicsocialservicesandsocialprotectionandbasicinfrastructure,andboosting the incomeof thepoor,who, compared with wealthier households, are morelikelytospendextraincomethansaveit.While increasing domestic demand, it will also beimportant to boost South-South and intra-regionaltrade and investment flows with more inclusivepatternsof regionalintegrationthatbenefittheLDCs.Since1986, intra-regionalexportshaverisenfrom23to41percentof developingAsiaexports,butmuchof this is intheformof productionnetworking inalimitednumberof partsandcomponentswiththefinalgoodsbeingdestinedforwesternmarkets.Infactonlyaroundone-fifthof exportsgotoEastandSouth-EastAsia; the remaining four-fifths go to the rest of theworld–nearly60percentof whichareheadedfortheEU,theUSandJapan.Sotheslumpinimportsinthesemajor markets, which is likely to continue for sometime,willdefinitelyaffecttheregion.Infuture,amorediversifiedpatternof tradewouldhavetobebuiltupincludingongoodswhichhaveareadymarketintheregionandwhicharealsomorelikelytobeconsumedbythepoor,suchasprocessedfood.
Greater intra-regional trade would require integratedmarkets,lowertariff andnon-tariff barriers,concertedinvestment in physical infrastructure, more robusttransportation networks and information platforms,and better regulatory structures. Regional growthwouldalsobenefitfromabalancedanddevelopment-friendlyoutcomeof theDohaRound that correctedexisting asymmetries in global trade and enhancedmarket access.LDCproducts shouldhaveduty- andquota-freemarketaccessonalastingbasis.
Seven drivers for achieving the MDGs
Achieving the MDG would make a real difference to the lives of millions of people across Asia and the Pacific. This chapter indicates opportunities for strengthening the overall environment in which the Goals can be achieved – enabling them to accelerate progress towards 2015.
10 PATHS TO 2015
CHAPTER II: Seven drivers for achieving the MDGs
Making economic growth more inclusive and sustainable
Economicgrowthnotonlyneedstobederivedmorefromtheregion’sownconsumption,italsohastobemore inclusive–with the fruits sharedmore equallyamongdifferentsocialandeconomicgroups.Thistoowouldrequireadeliberatechangeincourse–bothinthegrowthpatternandingovernmentpolicies.Intheabsence of countervailing policies, across the regionthenational incomeshareof the top20percentof thepopulationhassteadilyincreasedwhilethatof thebottom20percenthasdecreased.Similarly,formostcountries in Asia and the Pacific, the ‘Gini indices’,whicharethestandardmeasuresof inequality,arenotonlyhighbuthavebeenincreasing.3
If inequalitycouldbereduced,oratleastheldconstant,thentheMDGscouldbeachievedmorerapidly.4Thekeyhereistoderivemoreof thegrowthfromeconomicactivitiesthatbenefitthepoor-especiallywomen.Thiswillrequire,forexample,greaterfocusonagriculturewhich provides primary income to over 50 per centof Asia’s population.5 It will also mean promotingproductive employment in the informal sector – byensuring that small enterpriseshave the support andcredittheyneedtoexpandandprovidedecentwork.Enabling greater female labour force participationandbetteraccesstoeconomicassetshasshowngreatbenefit,especiallyinSouthAsia.6
It is also necessary that Governments act decisivelyto ensure that growth offers greater opportunitiesfor the poor and deprived. This involves greateremployment generation and more resources devotedto investments in education, health and other basicservices. Governments must make more efforts toraiseresourcesandreorientprioritizebudgetstowardstheMDGs.7
It isalsovitalthatgrowthbemoresustainable.Eveninclusive growth will eventually grind to a halt if itundulystressestheregion’snaturalresources.Already,unsustainable agricultural and industrial productionhave been liquidating the natural resource base,degradinglandandwaterquality,reducingbiodiversity,and destroying vital natural ecosystems. At the sametime,theregion’scitiesarecomingunderevergreaterstrain as a result of rural-urban migration: Asia andthe Pacific already has fifteen of the world’s largestcities and over the next ten years the region’s urbanpopulationwillgrowbyafurther1.1billion.8Ashortageof availablelandinmanysmallislanddevelopingstates,inparticular,isleadingtogreaterdensityinurbanareasthatlackadequateinfrastructure.Addedtothisisthepotentialadverseimpactof climatechangeonhuman
health,onfoodsecurity,oncoastalinfrastructure,andon the livelihoods of communities that depend onnaturalresources.
Inresponse,governmentsacrossAsiaandthePacificwill need to progressively set their sights on a moreenvironmentally sustainable development that candecouple economic growth from environmentalpressures– for example,by enhancing theefficiencyof natural resource use, reducing energy intensity,preservingbiodiversity,cuttingthegenerationof wasteand adapting to the effects of climate change. Thisneednot,however,necessarilymeanslowergrowthorfewerjobs,sinceintegratingcleanenergyandclimate-resilientpoliciesintodevelopmentplanningandfiscalpolicieswillalsodrivetheeconomiesforwardandcreatequality jobs. In this regard, it will be important thatgovernmentsalsodevelopsoundgreenjobspoliciesaspartof theshifttowardsalow-carbon,environmentallyfriendly,climate-resilienteconomy.Manygovernmentshavealreadysetoutonthispath.Thus,whilemitigatingthe impactof theglobal economiccrisis, somehaveincorporatedenvironment-relatedelements into theirstimulus packages. The Republic of Korea’s ‘greennew deal’ package, for example, allocates over $38billionforgreenprojectsthatwillcreateclosetoonemilliongreenjobsoverafouryearperiod,andChinahasfocused20to30percentof itspackageonlow-carbon production. China has also earmarked $440billiontosupportwindandsolarenergy.9
Strengthening social protection
Countries will be in a better position to achieve theMDGs if they can offer a minimum social floorthat addresses extreme poverty and hunger andincomeinsecurity.Acomprehensivesocialprotectionprogramme will minimize the impact of economiccrises and natural calamities as well as consolidatingdevelopment gains, while also acting as a ‘circuitbreaker’forviciousinter-generationalcyclesof povertyandhunger.
At present, across most of Asia and the Pacific thecoverageof socialprotectionislow,typicallyconfinedtoworkersingovernmentandtheformalsector.Thismeans that inmost countriesmore thanhalf of theworkforce is left without protection, and in mostcountries this involves more women workers thanmen.AccordingtoILO,inEastAsiamorethanhalf theworkforce is inunstable ‘vulnerableemployment’while in South-East Asia and the Pacific and SouthAsia, the proportion rises to 60 per cent or more.Only 30 per cent of Asia’s elderly receive pensions.Only 20per centof theunemployedhave access to
11MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER II: Seven drivers for achieving the MDGs
unemploymentbenefitsorlabourmarketprogrammes.AndhouseholdsinAsiahavetheworld’shighestratesof out-of-pocket health care expenditure. In thesecircumstances households try to protect themselvesbybuildingupsavings.10ParticularattentionalsoneedstobepaidtohouseholdsimpactedbyHIVwhichareamongthemostvulnerabletoexternalshocks.
To some extent social protection could be extendedintheshorttermbyimprovingthemanagementanddeliveryof existingprogrammes and ensuringbettertargeting.Butmanycountrieswillneednewservices.Across the region there are good examples of whatcan be achieved, from Thailand’s universal healthcareschemeto conditionalcashtransferschemes inCambodia and Indonesia, to well developed schoolfeedingprogrammesinIndiaandBangladesh.11
Reducing persistent gender gaps
Gender inequality isneither justandsustainable,normorallydefensible.Investinginwomenandgirlsisinitself abreakthroughstrategyforachievingtheMDGsandalmostany investmentmade inwomenandgirlswill have multiplier effects across all the Goals.12
Countries across Asia and the Pacific will thereforeneedtoactonmultiplefrontstoensurethatwomencanexercisetheirrightsandrealizetheirfullpotential.This shouldbebasedonbetterdataoncriticalareassuchasviolenceagainstwomen,onhowgendernormsaffectmenandwomen,andonthedifferentstatusof menandwomeninhouseholds.Analysisof thesedatashould be accompanied by close monitoring, alongwiththechangesinpolicyandlegislation–aswellasin attitudes, perceptions and behaviour – needed toensurethatwomenhavegreatercontrolandownershipover assets and resources, have equitable access toemployment,andhaveaccessto,andbenefitfrom,allpublicservices.
Althoughtheregionhasprogressedonsomegenderindicators, it - particularly SouthAsia, still hasmanydisparities–inlifeexpectancy,educationalattainmentand labour force participation – which are beingpassed relentlessly from one generation to the next.In Bangladesh, for example, women earn only 50per cent of what men earn for similar work, and inMongolia only 80 per cent.13 Similar imbalances areevident in agriculture. Inmost regionsof theworld,womenhead20percentof farms,butinAsiaandthePacifictheproportionisonly7percent,eventhoughagricultureaccountsforoverhalf of theregion’sfemaleemployment.14 Furthermore, the share of women inwage employment in the non-agricultural sector in
South Asia and Western Asia is only around 20 percent,thelowestrateamongtheworld’sregions.Womentendtobepredominantinmanyof theinformalandinsecurejobs.
Girls too have historically been less likely than boystobesenttoschool–insomecasesbecauseparentsconsiderthemalessworthwhileinvestment.Andwhileeducationaldisparitieshavebeenfallingattheprimarylevel, they persist in a number of countries at thesecondarylevel.Parentsmayalsobereluctanttosendgirlstoschoolif theyareworriedabouttheirsecurity.And inhouseholds affectedby theeconomic impactof HIV,girlsaremorelikelythanboystodropoutof school–asshownbystudiesfromChina,CambodiaandIndonesia.15
Women’s persistent lack of power is also reflectedin low representation innational legislatures. InAsiawomenoccupyonly18percentof legislativeseatsandinthePacificonly15percent.Similarly,theygenerallyhavelessinfluenceoverlocalpoliciesandplans–onfood security, for example, and on health and otherbasicservices.
Genderdiscriminationcostslives.Closeto100millionwomen inAsiaareestimated tobe ‘missing’becauseof discriminatory treatment in access to health andnutrition, pure neglect, or pre-birth sex selection.16The region’s highest girl to boy under-five mortalityratiosarefoundinChina(1.41),India(1.10),Pakistan(1.08), Micronesia, Nepal, and Tonga (1.07). And inSouth Asia more women die in childbirth – 500 forevery100,000 livebirths– than inanyotherpartof theworldexceptSub-SaharanAfrica.Theproportionof deliveriesattendedbyskilledstaff isstillaslowas18percentinNepal,20percentinLaoPDR,39percentinPakistan,and46percentinIndia–comparedwith97percentinThailand.17
Many women are also subject to domestic violence,especially when societies are under stress.18 In somecountriesinthePacific,forexample,aroundtwo-thirdsof women have been assaulted by male partners19
and theproportioncanalsobehigh inanumberof countriesinSouthandSouth-EastAsia.20Nearlyhalf thecountriesinSouthAsiaandmorethan60percentof thoseinthePacificdonothavelawsondomesticviolence. Moreover, victims rarely report episodessince enforcement is often slow and ineffective.Gender-basedviolence is also associatedwithhigherrisksforHIVtransmissionandisakeydriverof theepidemicinPapuaNewGuinea.InAsia,between1990and2007thefemaleproportionof adultslivingwithAIDSnearlydoubled–to29percent.21
12 PATHS TO 2015
CHAPTER II: Seven drivers for achieving the MDGs
Ensuring financial inclusion
Mostof thebillionorsopoorpeopleinAsiaandthePacifichave littleaccess to financial services. Insteadthey rely largely on cash or the informal economy,andforcreditlooktofriends,familyormoneylenders.Lacking insurance, they cannot protect their meagreassets and incomes against shocks such as illness,drought or theft. And without transactional bankingservices,theirfinancingisinsecureandexpensiveandtheycannotparticipatefullyintheeconomyeitherasconsumersorpotentialentrepreneurs.22
Nowadays,however,therearemanymoreopportunitiesforwideningfinancialinclusion.Governmentscanplaytheirpartbyimprovinginfrastructureandtheregulatoryenvironment. But they can also encourage serviceprovisionbyNGOs,community-basedgroupsandtheprivatesector.Thisshouldenablemicro-insuranceandmicro-financeinstitutions,forexample,totailortheirprogrammesbettertotheneedsof thepoor.
Serviceproviderscanalsotakeadvantageof advancesin information technology. They can, for example,extendmobilephonebankingtoenablecustomersinremoteareas tosendmoney, receiveremittancesandpayforpurchases.Theyshouldalsobeabletousepre-paidsmartcardstopayforsuchservicesaselectricity.The Reserve Bank of Fiji, for example, recentlyannounced that it will be working closely with twomobile phone companies to provide ‘mobile money’for all. And India is issuing a unique biometric IDthatpoorfamiliescanusetoopenbankaccountsandreceivecashtransfers.
Offering financial services to the poor not onlyallowthemtoescapefrompoverty. Itcanalsomakegood business sense. Companies that cater moreeffectivelytopoorconsumerscanbeveryprofitable.In the Philippines, for example, a company, whichprovidesprepaidphoneservicesmainlytolow-incomeconsumers, has become the most profitable of thecountry’slargestcorporations.23
Supporting least developed and structurally disadvantaged countries
Measures for faster MDG achievement should befinancedasmuchaspossiblefromdomesticresources.However, poorer countries, particularly the leastdeveloped countries, the landlocked developingcountries, and thesmall islanddevelopingstates,willneedtobeassistedthroughexternalresourcessuchasofficialdevelopmentassistance(ODA).
ODA, whether bilateral and multilateral, has playeda key role in supporting the economic developmentand social progress of many developing countriesin the region and it continues to make a significantcontribution to achieving theMDGs.With changingcircumstances,theroleof ODAisalsochangingandit should now primarily be used for supporting thedevelopmenteffortsof theleastdevelopedcountries(LDCs),thelandlockeddevelopingcountries(LLDCs)andthesmallislanddevelopingStates(SIDS)–whichdependonexternalresourcesforfinancingagoodpartof theirdevelopmentprocess.Inparticular,ODAforthese structurally handicapped countries should beusedtobuildtheireconomicandsocialinfrastructure,especially for investing in basic services such aswater, sanitation, energy, transport, shelter, healthand education. ODA can also have a catalytic role– in helping these countries expand their productivecapacities,promoteFDIandtrade,adapttechnologicalinventions and innovations, foster gender equality,ensurefoodsecurity,andreduceincomepoverty.
Atthesametime,itwillbeimportanttoimprovethequalityof ODAandincreaseitsdevelopmentimpact–bybuildingonthefundamentalprinciplesof nationalownership, harmonization, and managing for results.This includes especially aligning aid by sector withinternationallyagreeddevelopmentgoalsandcountrypriorities.
Although Asia and the Pacific has around 60 percentof theworld’sdeprivedpeople, theregionfindsit difficult to attract aid from the traditional donors,particularlyforMDGsectors.Asiareceivesthelowestper capita assistance of all regions – $12 comparedwith$45forAfrica–whichcallsforbetterallocationof flowsaccording toneeds (Figure II-1).Thereforethereisaneedtore-focusODAflows–bothintermsof regionalandsectoralpriorities.
Someof thegreatestconcernsareinthesmallislanddeveloping states of the Pacific. Here it can also bemisleading to consider ODA on a per capita basisbecauseof theirdiseconomiesof scaleandverysmallpopulations.Geographically isolatedandwithlimitedresources they face high development costs and relystronglyonaidtoovercomevulnerabilitiestoexternalshocks.Anyreduction in technicalassistance is likelytherefore to impede development progress. Thissubregion in particular should be looking to boostexternalassistance.Infuture,technicalassistancewillalsoneedtore-engagemorestronglywithagriculturebothtobuildlongertermfoodsecurityandtosupporttheincomesof theruralpoor.
13MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER II: Seven drivers for achieving the MDGs
All these programmes would be more effective if recipient countries improved their institutions andgovernancestructures.Butthereisalsoaneedfordonorstoincreasethepredictabilityof theirsupport,reducefragmentationandinvestwithlong-termnationalgoalsinmind.For thispurpose, thedevelopmentpartnersshouldenablereceivingdevelopingcountriestotaketheleadintheirowndevelopmentpoliciesanddevelopedcountries should align their technical assistanceprogrammes with national development plans toharmonizetheiractivitiesandmakethemmoreopenand accountable. For example, Pacific island leadersand development partners have recently reaffirmedtheir commitment through the Cairns Compact andare working together to improve coordination andaccountability.24
South-South economic assistance – Most ODA stillcomes from the DAC countries. Within the Asia-Pacificregion,thelargestdevelopingcountrysourcesincludeChina,atabout$1.4billion,Indiaatabout$1.0billion,theRussianFederationwitharound$0.2billion.Southernornew sourcesof assistance in the regionare primarily helping their neighbours. For example,ChinamostlyhelpsCambodia,DPRKorea,Indonesia,Lao PDR, Myanmar, Pakistan, Philippines and VietNam.Similarly,IndiaassistsAfghanistan,Bangladesh,Bhutan,MyanmarandNepal,whileThailandprovidesassistancemostly toCambodia,LaoPDR,Myanmar,MaldivesandVietNam.Muchof thisaidthusgoestoLDCswhereitislikelytobeusedinsupportof theMDGs–generallygoingintosectorssuchasinfrastructure,energy,agriculture,health, andeducation.For example,China and India
have helped in building roads, bridges, hospitals,educational institutions and hydro-electric plants inCambodia, Lao PDR, Pakistan, Nepal and Bhutan.Thailand has many cooperative programmes in theareasof agricultureandhealthwithMalaysia,IndonesiaandTimor-Leste.MalaysiahasprovidedassistancetoVietNamforresearchrelatingtorubber.Suchflowscanhelpestablishinstitutions,improvecapacitiesandultimatelyboosttheincomesof thepoor.25
Another priority has been health. Malaysia, forexample, has provided assistance for setting upclinicsinCambodia,whileIndiahasbuilthospitalsinAfghanistan, Nepal, Maldives and Lao PDR. South-Southassistancealsofocusoneducationandtraining– setting up educational institutions in the recipientcountry, funding vocational programmes to developskills that help improve productivity and incomes,andofferingscholarshipsforstudentsfromrecipientcountries to study in the assisting country. China,India, Republic of Korea, Malaysia, Singapore andThailand all have several such programmes. Theseinstancesof cooperation, especially in social sectors,are clearly positive examples of South-South andregionalcooperation.
Exploiting the potential of regional economic integration
Beyond South-South cooperation in sharingdevelopmentexperiencesandcapacitybuilding,regionaleconomicintegrationoffersmanyotheropportunities– particularly for smaller economies – by enablingthemtoextendtheirmarketsandreapefficiencygains
Figure II-1 – net ODA receipts per person in 2008, uS$
Source: OECD-DAC, 2010.
0 20 40 60 80 100 120 140 160 180 200
Oceania 177
Africa 45
Europe 42
All developing countries 24
America 16
Asia 12
SouthandCentralAsia 10
FarEastAsia 4
LDCESCAP 39
LLDCESCAP 74
SIDSESCAP 135
US$
14 PATHS TO 2015
CHAPTER II: Seven drivers for achieving the MDGs
fromspecializationandeconomiesof scaleandscope.This could make the region more resilient to futurecrisesandbolsterthecapacityof manyof thepoorestcountries to achieve the Millennium DevelopmentGoals.
Whenitcomestoexploitingthepotentialof regionaleconomicintegration,AsiaandthePacifichaslaggedbehindotherregions.Thusfar,forhistorical,politicalandtopographicalreasons,theregionhasbeenbetterconnected with Europe and North America thanwithitself.Meanwhile,Europe,NorthAmerica,LatinAmerica andAfricahave allmoved todeeper formsof regionalintegration,withcustomsunionsandevenmonetaryunions.AsiaandthePacificwhichhassomeof theworld’slargestandfastest-growingeconomies,couldbeanevengreatereconomicpowerhouse if ittoodevelopedamoreintegratedregionalmarket.Butitwouldneedtodosousingadevelopmentparadigmthatismoreinclusiveandsustainable.26
Theprocessof regionalcooperationintheAsia-Pacificregionisledbysub-regionalgroupingssuchasASEANinSouth-EastAsia,SAARCinSouthAsia,BIMSTECinSouthandSouth-EastAsia,andthePacificIslandsForum in the Pacific – which have evolved regionaltradingandinvestmentarrangements.Theregionhasdevelopedacomplexnetworkof overlappingregionalandbilateraltradingarrangements.ThetimehascometoconsolidatetheseintoaunifiedAsia-Pacificmarket.With growth poles such as China and India, alongwithothereconomicpowerhouseslikeJapan,aunifiedAsia-Pacificmarketcouldbethecentreof gravityof theworldeconomy.27
For this purpose the countries of the region canaccelerate progress on two current proposals: theEastAsiaFreeTradeAgreementthatbringstogetherthe ASEAN+3 grouping, and the ComprehensiveEconomicPartnershipof EastAsiaunderEastAsiaSummit (EAS) frame work that, in addition to theASEAN+3 grouping, includes Australia, India, andNewZealand.28
An integrated economic space needs to becomplemented, however, by improved physicalconnectivityaswellasbybettertradeandinvestmentfacilitation. Migration policy too could encourageintegration if source anddestination countries couldarriveatbilateralagreements.
Yetanotherareaforfruitfulregionalcooperationisindevelopingaregionalfinancialarchitecture.Thiscouldprovide more efficient intermediation between theregion’slargesavingsanditsunmetinvestmentneedsfor infrastructure and other developmental gaps.29
So far the cooperation in the area has been largelylimitedtotheChiangMaiInitiativethathasnowbeenmultilateralized as a reservepool of $120billion formeetingthetemporary liquidityneedsof ASEAN+3countries.30 At the 66th session held in Incheon inMay 2010, the member States of ESCAP mandatedtheESCAPsecretariattoassistindevelopmentof theelementsof aregionalfinancialarchitecture.31
Towards 2015
Theopportunitiesoutlined in this chapter arebynomeansexhaustive,butif usedvigorously,theycanhelpcountries accelerate progress towards many of thegoals on which they are currently falling short. Thenextchapterlooksmorecloselyatoneof theregion’smost vulnerable areas – hunger – and highlightsopportunitiesforbuildingfoodsecurity.
Endnotes
1 ESCAP/ADB/UNDP,2010.2 Chhibber,GhoshandPalanivel,2009;ADB,2009; ESCAP(2010a).3 ADB,2007;ESCAP(2010b).4 ESCAP(2010a);ESCAP(2010b).5 WorldBank,2009;ESCAP(2010a).6 UNDP,2010a;ESCAP(2010b).7 ESCAP(2010b).8 UnitedNationsPopulationDivision,2010.9 ESCAP(2010a);ESCAP(2010b).10ESCAP/ADB/UNDP,2010.11UNDP,2008;UNDP(2010a);ESCAP/ADB/UNDP,2010.12ESCAP/ADB/UNDP2006.13UNDP,2010.14FAO,2009.15UNDP,2010.16UNDP,2010.17ESCAP/ADB/UNDP,2010.18HeyzerandKhor,1999.19SPC,2009.20UnitedNations,2006.21UNDP,2010.22ESCAP(2010a);ESCAP(2010b).23ESCAP(2010b).24ESCAP/ADB/UNDP,2010.25ESCAP/ADB/UNDP,2010;Kumar(2009).26ESCAP(2010a).27ESCAP(2010a).28ESCAP(2010a).29ESCAP(2010a,2010b).30ADB,2008;ESCAP(2010a);ESCAP(2010b).31ESCAPResolution66/5.
15MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER III
Some of the region’s most disturbing MDGshortfallsconcernhunger.Aroundonepersoninsixsuffersfrommalnourishment,andonechild
inthreeisunderweight.AsiaandthePacifichasabouttwo-thirdsof theworld’shungrypeople.Thisfailurehasahugecost,primarilyinliveslostandinsicknessanddisease,butalsoinstiflingbothhumanandeconomicpotential.Lackof progressonchildnutrition,whichisslowingchildren’sphysicalandmentaldevelopment,iscripplingothercriticaldevelopmenteffortstocontroldisease,boosteducationandspureconomicprogress.1
The two main MDG indicators on hunger andmalnutrition are the proportion of the populationundernourished and the proportion of under-fivechildren who are underweight. For the region as a
whole,between1990-92and2004-06,theproportionof undernourished – those consuming less than thedailyminimumenergyrequirement–fellonlyslightly.Between 1990-92 and 1995-07 it fell from 20 to17percentbutby2004-06haddroppedbyonlyonepercentage point, to 16 per cent (Table III-1). Eventhisreductionwaslargelyoffsetbypopulationincrease,sothetotalnumberof hungrypeoplebarelychanged.FAO’smostrecentestimatesputthenumberof hungrypeopleinAsiaandthePacificat642millionin2009–anincreaseof about75millionduring2006-09.Thisisthehighestnumberintherecentdecades.Forchildrenwhoaremalnourished–weighinglessthantheyshouldfortheirage–thedropintheproportionwassomewhatgreater,from40to31percent,neverthelessthisstillleftalmost100millionchildrenmalnourished.
Reducing hunger and building food security
Despite rapid economic growth and falling levels of poverty, Asia and the Pacific still suffers from widespread hunger and malnutrition. In future, countries across the region will have to pay greater attention to food security, and ensure that poor people have access to the food they need to lead healthy and productive lives.
%ofpopulation Millions 1990-92 2004-06 1990-92 2004-06
AsiaandthePacific 20 16 585.7 566.2
EastAsia 15 10 183.3 136.3 South-EastAsia 24 15 105.7 84.7 SouthAsia 25 23 286.1 336.6 CentralAsia 8 10 4.0 5.8 WesternAsia 38 13 6.1 2.1 PacificIslands(a) 12 13 0.5 0.7
LatinAmericaandtheCaribbean 12 8 52.6 45.3NearEastandNorthAfrica 6 8 19.1 33.8Sub-SaharanAfrica 34 30 168.8 212.3DevelopingWorld 20 16 826.2 857.7World 16 13 845.3 872.9
Table III-1 – undernourishment in Asia and the Pacific and other global regions
Note: (a) Due to limited data, the Pacific Islands includes Papua New Guinea only.Source: FAO. http://www.fao.org/economic/ess/food-security-statistics/en/ and Chatterjee, S., A. Mukherjee and R. Jha (2010).
1� PATHS TO 2015
CHAPTER III: Reducing hunger and building food security
For undernourishment the greatest advance was inEast and South-East Asia. South Asia, on the otherhand made scarcely any progress, and the numberof hungry people increased substantially, from 286million to 337 million. In several countries in SouthAsia, more than one-fifth of the population areundernourished. In thePacific Island states the levelof hungervariesfrom5percentinKiribatito9percentintheSolomonIslands.2
Thesubregionalpatternissimilarforchildmalnutrition.Theworst-performingsubregionisSouthAsiawhichhas an underweight prevalence of 41 per cent andis home to half the world’s underweight children.Several countries in the subregion have the world’shighestnationalunderweightprevalence–worsethancountries such as Ethiopia at 35 per cent.3 In thisregion, theproblem is lessa lackof food thanpoorfood quality and food safety, along with inadequatesanitationcausingenergy-drainingdiarrhoealdiseasesandwomen’slowsocialstatusandearlymarriagewhichleadstolowbirthweights.Butitisstrikingthatdespiterapideconomicgrowth,South-EastAsiastillhasone-quarterof itschildrenmalnourished.Childreninruralareasarenearlytwiceaslikelytobeunderweightasthoseinurbanareas.Insomecasesthisratiohasrisensharply: inEastAsia,for instance,theruraltourbanratiorosebetween1990and2008from2.1to4.8.The2008ratiosforSouthAsiaandSouth-EastAsia in2008were1.4 and1.2 respectively.Theincidenceof underweightchildrenisalsodramaticallyhigher among the poor: in South Asia, for example,among the poor over 60 per cent of children areunderweight.4
AchievingtheMDGchildnutritiongoalwouldbringsignificant dividends. If countries that are currentlyoff trackweretomeetthetargetby2015,thenumberof underweightchildrenwouldfallbymorethanone-third,from74million,onpresenttrends,to47million.India and Nepal are among the countries facing thegreatestchallenge: tomeet the target,bothcountriesneed to accelerate progress about five-fold to over2 percentage points per year. In response, India, forexample,hasbeenintroducinguniversalmid-daymealsforchildren.ThechallengeisevengreaterforTimor-Lestewhichwouldneed toreduce theprevalenceby3.4percentagepointsperyear(TableIII-3).
Hungerisamultidimensionalproblemencompassingmany aspects of human development, includingpoverty,health,education,rights,voice,security,dignityanddecentwork.Inthelongerterm,asmostdevelopedcountries have shown, hunger falls with rising levelsof economic development. Experience across theregionsuggestsfiveoverallpolicyprioritiesfortacklinghunger: i) creating jobs and increasing incomes; ii)boostingagriculturalproduction;iii)maintainingstableandreasonableprices;iv)providingsafetynetsforthepoor;andv)implementingfeedingprogrammes.
Creating jobs and increasing incomes
The main hunger response should be to ensure thatpoorpeoplehavethejobsandincomesthatwillenablethem to buy the food they need. In recent years,however, employment growth has been slower thaneconomic growth and most of the poor have been
Proportion% Millions 1990-94 2003-07 1990-94 2003-07
AsiaandthePacific 40.0 31.0 127.0 98.0
EastAsia 19.0 7.0 17.0 6.0South-EastAsia 34.0 24.0 17.0 12.0SouthAsia 53.0 41.0 92.0 79.0CentralandWestAsia 19.0 7.0 1.3 0.5PacificIslands(a) 29.0 26.0 0.3 0.2
LatinAmericaandtheCaribbean 4.5 MiddleEastandNorthAfrica 12.2 Sub-SaharanAfrica 25.3 World 22.4
Table III-2 – underweight children under five
Note: (a) Due to limited data, the Pacific Islands includes Papua New Guinea only.Source: FAO. http://www.fao.org/economic/ess/food-security-statistics/en/ and Chatterjee, S., A. Mukherjee and R. Jha (2010).
1�MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER III: Reducing hunger and building food security
unabletogainfromthemoredynamicsectorsof theregion’s economies.To counter this trend and fosterdecent employment governments can try to ensurethatgrowthismoreemploymentintensive,particularlywhere the poor work. This will mean, for example,promoting employment-intensive sectors such asagricultureandsmallandmediumenterprises.At the same time they can establish or expandemploymentcreationprogrammesspecificallyforthepoor and the vulnerable. Fortunately in recent yearsmany Asian governments have been adopting suchstrategies. India, for example, as well as directinginvestment into high employment sectors has alsoimplementedtargetedemploymentprogrammesforthepoorandvulnerablesuchastheNationalEmploymentGuarantee Scheme, which provided employment to46millionhouseholdsin2009.5Closetohalf of thoseemployedwerewomenandmorethanhalf werefrommarginalizedgroups.6Otherwaysof raising incomesof thepoorest,currentlybeingdevelopedinanumberof countriesintheregion,areconditionalcashtransferprogrammesalongwithotherpovertyalleviationschemes.
Reducing poverty will make a vital contribution toreducing hunger. But it will not be sufficient on itsown.ExceptinthePacificIslandgroupof countries,the fall in poverty has generally been greater thanthe fall in hunger. This underlines the importanceof tackling hunger on a broad front with additionalinterventions specifically related to food productionandconsumption.
boosting agricultural production
Food insecurity depends to a large extent on foodproductionandavailability.Aworryingtrendisthatoverthelastdecade,whilefoodoutputhasincreased,therehasbeenadeceleration in thegrowthof agriculturaloutputandproductivity.Tosomeextent this reflectsdeclininglevelsof investment.
Most capital investment in agriculture comes fromtheprivatesector,especiallyfromfarmersthemselves.Nevertheless public investment in agriculture isimportant for attracting private-sector investment.Governments can invest in irrigation, research andrural infrastructure, technology generation anddissemination, natural resource conservation andstandard setting and monitoring – which can helpincrease productivity, reduce transaction costs andimprovethecompetitivenessof agriculture.7
In recent years, however, governments have beenspending less on agriculture and have directed moreinvestmenttothemaingrowthsectors–manufacturingand services (Figure III-1). The share of totalgovernment expenditure in agriculture droppedin almost all developing regions. The decline was,however,verysignificantinAsia,fromover14percentinthe1980stolessthan9percentin2002.8
India 51,987 -2.11 33,054Pakistan 9,811 -1.35 5,265Philippines 2,752 -0.90 1,846Myanmar 1,569 -1.30 746Nepal 1,551 -2.29 867Cambodia 598 -1.57 360Indonesia 3,542 -0.93 3,320Afghanistan 1,596 -1.39 1,433LaoPDR 284 -1.68 185Timor-Leste 136 -3.41 51Azerbaijan 67 -0.49 42Turkmenistan 48 -0.50 32Armenia 11 -0.20 5
Total 73,952 47,206
Table III-3 – Progress required for off-track countries to meet the underweight children target
Source: Staff calculations based on the United Nations MDG database.
Affectedpopulationin2015oncurrenttrend
(thousands)
Averageannualchangeneededtoreachtarget
(percentagepoints)
Affectedpopulationin2015iftargetreached
(thousands)Country
18 PATHS TO 2015
CHAPTER III: Reducing hunger and building food security
Similarly,theattentiontoagriculturehasbeendecliningfrominternationaldonors.Agriculture’sshareof ODAdeclinedfrom18percent in1979to3.5percent in2004.Italsodeclinedinabsolutetermsfallingbetween1984and2004from$8billionto$3.4billion(in2004dollars). In the late 1970s and early 1980s, the bulkof agriculturalODAwenttoAsia,especiallyIndia,insupportof thegreen revolution.9 It couldbearguedthatdecliningaidflowsarelimitingagriculturalgrowthandproductivity.
The firstpriority is therefore to redirect attention toagriculture, since many Asian countries have vastunexploitedpotentialforagriculturalgrowth.Oneof theeasiestwaysof raisingfarmyieldsandacceleratinggrowth is to adopt already available improvedtechnologies. Both public and private investmentsin agricultural research and extension are necessaryto provide a continuous stream of yield-enhancingtechnologiesthatcanbeprofitablyadoptedbyfarmers.Thegreenrevolutionhasrunitscourse;newscientificbreakthroughs, such as those in biotechnology, arenowrequiredtoraiseyieldpotentials.Thisisespeciallyimportant because land and water are increasinglyscarce in Asia and future agricultural growth willincreasinglyhavetocomefromsustainableagriculturetechnology.
Addressing the supply-side factors requires moreinvestment in irrigation and farm-to-market roads,crop diversification, improved marketing, policiesto encourage larger farm sizes and mechanization,increasedmarket access and trade in agriculture, andgreater incentives for food production. At the sametime it will be important that women are supportedfully todeveloptheircapacitiessincemorethanhalf theregion’swomenworkinagriculture.10
Itwillalsobeimportanttooffersufficientincentivestofarmers.Thisnotonlybenefitsfarminghouseholdsbutalsootherruralhouseholdsbyencouraginginvestmentin agriculture and creating additional employment inrural economies. For this purpose, governments intheregionhaveusedavarietyof instruments–suchas fixing minimum support prices for food grains,providing subsidies on key farm inputs such asirrigationwater,fertilizers,seeds,andcredit.Theyhavealsoheldbuffer stocksof foodgrains and regulatedthefoodgrainstrade.Somearguethatthesemeasuresdistort incentives, but they are nevertheless criticalfor ensuring food security in Asia and the Pacific.Indonesia, for example, returned to self-sufficiencyin2009asaresultof activesupporttoagricultureinrecentyears.
Maintaining stable and reasonable food prices
Countriesneedtostrikeabalance.Whilefoodpricesshouldbeatsuchalevelastoencourageproduction,they also need to be within the range of the poor.Highpriceshurtthevastmajorityof urbanandruralhouseholds who purchase most of their food. Thepeople hit hardest are poor people who on averagespendabouttwothirdsof theirbudgetonfood.Richhouseholds,ontheotherhand,spendonlyaboutonethirdof their incomeon food so theycan afford topaymore.
To some extent domestic food prices will reflectinternational prices, especially in countries that arenet food exporters. In Asia and the Pacificwhile 13countriesarenetexportersof cereals,pulses,meat,dairy,vegetables and fruits, 31 countries are net importers
Figure III-1 – Agriculture’s share of public expenditure, percentage
Source: Fan and Saurkar, 2006.
Africa Asia Latin America Developing &Carribean countries
1980
1990
2002
16
14
12
10
8
6
4
2
0
Perc
ent
19MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER III: Reducing hunger and building food security
(Table III 4).FAOhas estimated that, as a resultof the foodandenergy crises, the totalundernourishedpopulationintheregionincreasedfrom566millionin2004-06to642millionin2009.11
During 2006-08, soaring cereal prices increasedhousehold food costs substantially. On average, inAsiaandthePacific, foodcostsforpoorhouseholdsincreasedby43percent,butforrichhouseholdsonlyby18percent.Asaresult, thepurchasingpowerof poor households decreased by 24 per cent, in AsiaandthePacific,whileforrichhouseholdsitdecreasedonly by 4 per cent. In the Philippines and Pakistan,forexample, ithasbeenestimatedthata30percentincreaseinfoodpricesledtoincreasesinthenumberof people living below the national poverty lines of about9millionand22millionrespectively.12
Keepingfoodpriceslowandstablerequiresareliableandconsistentsupplyof foodgrains.Forfood-deficientcountries, this will mean making efforts wherepossibletoincreasedomesticproductionwhichcanbesupplementedwith imports tobuild adequate stocks.Toguardagainstfoodpricevolatilityandsuddenshortfalls,somegovernmentsinAsiaandthePacifichavetraditionallyheldnationalstocksof riceandotherstaplefoods.
Itisalsoimportanttoensurethatfoodmarketsworkefficiently.Manycountries,particularlygeographicallylargeoneswithinsufficientlydevelopedinfrastructure,can face considerable variability in food prices. InIndia, while the average monthly price of rice inOctober2009wasRs.21perkilogram,thepriceacross78consumptioncentresrangedfromRs.10toRs.31.13
Anotherconcern is thatmuchof thepower in foodmarketsrestswithbuyersandretailerswhocanpaylowpriceswhilecharginghighpricestoconsumers.Policymakers will therefore need to promote competitiveyet equitable market mechanisms such as improvingtransport,storage,andothernecessaryinfrastructure,andencouragingtheprivatesectortodevelopefficientfoodmarkets.
Regionalcooperationcanhelppromotefoodsecurity,forexamplethroughfoodreserves.Oneoptiontodealwithsuchariskisaregionalricebank.ApermanentEastAsianemergencyricereserve isbeingdiscussedby the13countriesof ASEAN+3as a follow-up toitsongoingEastAsiaEmergencyRiceReservePilotProject – a system for sharing rice stocks. Anotherpositive initiative is the agreement, since 2007, toestablish the South Asian Association for RegionalCooperation (SAARC) Food Bank which needs tobe strengthened and operationalized on an optimalscaleandcouldalsofoster inter-countrypartnershipsand regional integration. Regional agreements toavoidexportrestrictionsandcooperationtobuildupproductioncapacitiescanalsohelp.14
Providing safety nets for the poor
When the market fails to provide food of sufficientquantityorqualityforthepoor,governmentscantakeresponsibility to ensure food security for the poorthroughsubsidiesorpublicfooddistributionsystems.In India, for example, thepublic distribution systemreaches 160 million families who can buy around
Netimporters Netexporters
EastAsia DPRKorea,RepublicofKorea,Mongolia China
South-WestAsia Afghanistan,Bangladesh,Maldives,Nepal,India, Pakistan,Turkey SriLanka,Bhutan,Iran(IslamicRepof)
South-EastAsia Indonesia,Malaysia,Singapore,LaoPDR, VietNam,Thailand,Myanmar, Cambodia Philippines
Centraland Armenia,Azerbaijan,Georgia,Tajikistan, Kazakhstan,Kyrgyzstan,UzbekistanNorthAsia Turkmenistan,Russia
Pacific Kiribati,Micronesia,CookIslands,Samoa,Nauru, Vanuatu,Tuvalu PapuaNewGuinea,Palau,Fiji,SolomonIslands, Tonga,MarshallIslands
Table III-4 – net importers and exporters of food
Note: The authors use the definition of food in a flexible manner. Source: Francis and Akoy, 2008.
20 PATHS TO 2015
CHAPTER III: Reducing hunger and building food security
10 kilograms of grain per month at about half themarket price. These subsidies have made importantcontributions but have often proved difficult tooperate successfully due to suffering from selectionbias, leakages and poor food quality. They are alsoexpensivetomaintainandoperate.Betweentheearly1990sandthe2000sthecostof thepublicdistributionsysteminIndiarosefrom2.5toalmost6.0percentof governmentexpenditure.15
Costsforsuchprogrammesandthepriceof foodforthepoorcanbereduced,forexample,byonlyofferingnutritious but lower cost cereals that the poor canafford. When resources are very limited, however, itmayalsobenecessarytohavemoreprecisetargeting–while taking carenot to exclude thehomeless andilliterate.Measuresalsoneedtobeinplacetoensurewellmanaged storageanddistributionand to reduceleakage, fraud and corruption. In addition, thegovernmenthastohandleitsrelationshipwithfarmerscarefully by setting a purchase price that is fair forproducersaswellasconsumers.
Direct distribution of food is sometimes combinedwithotherprogrammesinvolvingnutrition,education,andhealthservices.Forexample,theVulnerableGroupDevelopment Programme in Bangladesh seeks tointegratefoodandnutritionsecuritywithdevelopmentandincomegeneration.Participantsreceiveamonthlyallocationof wheatinexchangeforattendingtrainingon income-generatingactivities,participating inbasicliteracy,numeracy,andnutritiontraining,andmakingsavingsdeposits.
Analternativetodistributingfoodistooffersubsidiesthrough‘foodstamps’–atermthatcancoverarangeof food-linkedincome-transferschemes.Theseincludetokensordiscountcardsorelectronic transfercards.Foodstampprogrammeshavelowercoststhanfooddistributionsystems.Theycanalsobemoreefficientinaddressinghungerthancashtransfers,astheycanonlybespentonfooditems.However,theseprogrammesalsorequirestrongsupportingarchitecturewithinboththegovernmentandtheprivatesector.
Many governments also have targeted interventionsthrough food-for-work programmes. These schemestoo are self-selecting since only the poor are usuallywilling to undertake the manual labour required.Drought and conflict have led to shortages of foodandwaterinmanypartsof Afghanistanandinrecentyears, the World Food Programme (WFP) has beenproviding food to people in rural areas in exchangeforworkonruralinfrastructure.In2009alone,WFPassistedmorethan4.4millionpeopleinthisway,thus
providingfoodtovulnerableAfghansastheybuiltorrepaired community assets, including roads, bridges,reservoirs and irrigation systems. These projects areagreed upon in consultation with the governmentand localcommunities.16Food-for-workprogrammessuffer, however, from many of the same problemsassociatedwithpublicdistributionsystems, includingleakage through corruption, and wastage from poorstorage,andcanbeevenmoreexpensive.
Implementing feeding programmes
Onereasonwhypovertyreductionmaynot translateintobetterlevelsof nutritionisthatthepoordonotnecessarilyspendanyextraincomeonfood.Onestudyof 13countriesfoundthattheextremepooralsospendsignificant amounts on other items.17 Moreover, asincomesincrease,peoplebuygreatervarietiesof foodthatdonotnecessarilyoffermorecaloriesornutritionalbenefits.Anotherissueisthat,evenif thehouseholdoverallhassufficientfood,itmaynotbereachingthefamilymembers ingreatestneed,particularlywomenandchildren.
In addition to policies on production, prices anddistribution, governments also have to considertargeted interventions for especially vulnerablepopulation of society. These usually involve directfeedingprogrammesforthreespecificgroups:womenof childbearing age, young infants and children, andpopulations in need of emergency food assistance,suchasrefugees.
In general, these programmes hinge on the deliveryof abasicpackageof servicesforenhancingnutritionsupported by necessary primary health care. Theessential nutrition components are breastfeeding,growth monitoring, oral rehydration, immunization,nutrition education, micronutrient supplementation,and treatment and rehabilitation of the severelymalnourished.Inadditiontosupplementsforchildren,such as Vitamin A, for example, governments havealsointroducedfoodfortificationprogrammeslikesaltiodization.
Schoolfeedingprogrammesdistributepreparedfoodtochildreninschool.Food-foreducationprogrammesdistribute free foodgrains to low-income families if theirchildrenattendprimaryschool.Thegraincanbeused to feed all family members or be sold to meetother expenses. Both school feeding and food-for-educationprogrammesprovideimmediatesustenancefor thehungrywhile empowering future generationsbyeducatingtoday’schildren.
21MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER III: Reducing hunger and building food security
As well as improving nutrition such programmesbring many secondary benefits. School feedingprogrammes can improve attendance, especially forgirls,reducedrop-outratesandevenimprovechildren’sperformance and behaviour.18 And programmes forpregnantandlactatingmotherscanreducethenumberof low birthweight babies and maternal mortalityratesand,alongwithpre-schoolfeedingprogrammes,help children develop normally both mentally andphysically.
Another vital contribution to good child nutritionis exclusive breastfeeding along with other basichealth services like disease control, and safe water.These programmes can also incorporate strongcommunications components to empower families –especially women with the information they need tomakebestuseof theavailablefood.
One of the best ways of addressing these issues isthrougheducation,especiallyforwomen,sincebettereducated women are in a stronger position not onlytounderstandnutritionissuesbutwillalsohavemorepowerwithinthehouseholdtoensurethateveryoneisfedadequately.19
Released from hunger
Releasing people from hunger not only fulfils abasic human right but also contributes towards theachievementof all theotherMDGs.Well nourishedadultswill,forexample,bemoreproductiveandbetterabletoworktheirownwayoutof poverty.Andwellnourished children will grow up healthier and takegreateradvantageof opportunitiesto learnatschoolandfulfiltheiraspirations.
Atthesametime,reducinghungeralsodependstoalargeextentonsimultaneouslyaddressingmostof theother Goals.Educatedwomen, for example, will getbetteremployment thatwillallowthemtobuymorenutritiousfood.Andchildrenwhogrowupwithbetterwatersuppliesandsanitationwillbelessvulnerabletodiarrhoealandotherdiseasesthatpreventthemfromabsorbingvitalnutrients.
Thisunderlinestheimportanceof takinganintegratedapproachthatconsiders theMDGsboth individuallyandasawhole.Thenextchapterthereforebroadensthe discussion to consider how all the goals, andparticularly thoserelatedtohealth,canbesupportedbystrongerbasicservices.
Endnotes
1 SeeESCAP(2009)foradetaileddiscussion.2 Chatteriee,MukherjeeandJha,2010.3 WorldBank,2010.4 UN,2010.5 ESCAP(2010a).6 ESCAP(2010a).7 ESCAP(2009).8 ESCAP(2009).9 WorldBank,2008.10FAO,2009b.11FAO,2009a.12ADB2008.13India,G.O.,2009.14ESCAP/ADB/UNDP,2010.15India,G.O.,2002.16WFP,2010.17BanerjeeandDuflo,2006.18Singh,2008.19MillerandRodgers,2009;MostueandHuttley,2007.
22 PATHS TO 2015
CHAPTER IV
The Asia-Pacific region has made strikingadvances in a number of social indicatorsbut has been making slow progress towards
thehealthgoals.Theregionasawholeisontracktoachieve thegoalof stoppingthespreadof HIVandtuberculosisby2015,butisoff trackformanyof theotherhealthtargets–notablyreducinginfantandchildmortalityandimprovingprovisionformaternalhealth.AlthoughHIVprevalence is stabilizing, the region isnotontracktoachieveuniversalaccesstopreventionandtreatmentforHIVinfectionforthosewhoneedit.
In education, the performance has been somewhatbetter and many countries are close to achievinguniversal primary enrolment (Table IV-1). Many arealsoclosetogenderparityattheprimarylevel,andatthe secondary level girlsmaywell be aheadof boys.Butwhilethequantityof educationhasincreased,thequality is less impressive. School buildings are ofteninadequate,books are scarce, teachers can frequentlyabsent,classsizesmaybelargeandthecurriculamayfail tomeetchildren’sneeds.Discouraged,andunder
pressure towork,manychildrenattend irregularlyordropoutof school,andAsianstudentsoftengetlowscoresininternationalstandardizedtests.
Despite advances in expanding access to primaryschooling,asmanyas14percentof primaryschoolagechildreninSouthandWestAsia–18million–werenotinschoolin2007.InthePacifictheproportionwas16percent–overhalf amillioninthePacific.Girlswereatadisadvantageinbothcases,butparticularlyinSouthandWestAsia.(TableIV-1)
Investing more in basic services
Addressing shortfalls in social indicators will meaninvestingmoreinpublicservices.FigureIV-1comparesspending on education and health in Asia and thePacific with that in other global regions. Despitebudgetpressures,governmentsshouldhavethefundsto increase investment. Indeedcountrieshave largelymaintained or increased expenditure on health and
Improving health and other basic services
If the developing countries of Asia and the Pacific are to achieve the MDGs they will need to offer reliable basic services such as health and education to the people. Most have been determined to improve their provision but many still fall short in terms of coverage and quality, especially in rural areas.
Total Male Female
CentralAsia 92 93 91EastAsiaandthePacific 94 94 93EastAsia 94 94 94Pacific 84 85 83SouthandWestAsia 86 87 84
Table IV-1 – net enrolment ratio in primary education, percentage, 200�
Source: UNESCO, 2010.
23MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER IV: Improving health and other basic services
Figure IV-1 – Spending on health and education as a percentage of GDP
Note: All health data – 2007; Education data: Excluding China and India – 2006, South-East Asia – 2007, South Asia – 2006, Excluding India – 2008, North and Central Asia – 2006, Excluding Russia – 2007, LDCs Asia-Pacific – 2004, Latin America & Caribbean – 2007, Sub-Saharan Africa – 2007.
Source: Staff calculations based on education data available at the website of UNESCO Institute for Statistics and health data available at the website of the World Development Indicators of the World Bank.
education.Nevertheless,giventhatmanycountriesarefalling short on MDG achievement, they will clearlyneedtoinvestmore.
When public expenditure is low, households try tomakeupthedifferencethroughprivatespending.Forhealth services, for example, while people in richercountriesareabletoarrangehealthinsuranceorotherformsof pre-paidplan,indevelopingcountriesinAsiaandthePacificahighproportionof privateexpenditureis‘out-of-pocket’:around90percentinIndia,NepalandChina.About78millionpeople inAsia and thePacificendupwithlessthan$1adayaftertheyhavepaid for health care – and can suffer catastrophicexpenditureduringpregnancyandchildbirth.1
One reason why government expenditure on theMDGsmightfallshortisaconcernaboutfiscaldeficits.Asfiscalprudenceisessential,thenecessaryresponsetothis ismaximizingrevenuesthrough improvedtaxcollectionbyimposingnewinnovativetaxesandthenbyincreasingallocationstothesocialsectorsthatareessentialforachievingtheMDGs.2Formanycountriesintheregion,taxtoGDPratioisratherlowandmaybeincreased.
Improving governance
If they are to increase expenditure, however,governmentswillbeconcernedaboutachievinghigherservice quality. At present the quality of services isundermined by a number of issues, some related togovernance.Thesecouldbeaddressedby:
Improving efficiency – Governments can allocatebudgets wisely so as to spend more where servicesare more urgently needed, such as on teachers inrural areas, and on high productivity inputs such asmedicines and textbooks.3 They may also be able toensure that services better match demand, especiallyfromthepoor,bymovingawayfromoverly-centralizedsystemsof bothfinancingandserviceprovision,anddecentralizingmorefunctionstolocaladministration.
Achieving greater policy coherence–MDGoutcomesdepend not just on expenditure through sectoralministries, such as health or education, but alsoon broader policies on poverty alleviation, oninfrastructure, and on other services such as waterandsanitationwithwhichseveralotherministriesandlevelsof governmentmaybeinvolved.Governments
Asia-Pacific
Excluding China & India
South-East Asia
SouthAsia
Excluding India
Pacific Islands
Excluding Papua New Guinea
NorthandCentralAsia
Excluding Russia
Asia-Pacific LDCs
LatinAmerica&Caribbean
Sub-Saharan Africa
0 1 2 3 4 5 6% of GDP
Education
Health
24 PATHS TO 2015
CHAPTER IV: Improving health and other basic services
will therefore want to consider ways of improvingcoordination across sectors and ensuring policycoherenceatdifferentlevelsof government.
Reducing corruption – At present a significantproportion of social investment drains away incorruption. Health and education personnel oftenhavehighabsenteerates,especially inruralareasandtherecanbekickbacksandbribestopublicofficialsinprocurementprocesseswhetherfornewconstructionorsupplies.
Setting standards, strengthening regulations and enforcement –Standardsof deliveryof servicessuchas in education, health and water supply can fall if standards are not set and enforced. Governmentbodiesoftenhaveweakauthorityandpoorproceduresfor regulating the quality of private services andsupplies suchasof pharmaceuticals, for example,orof medicalpractices.Weaknessesinlegalsystemsalsomake itdifficult toenforcecontractsorpursuecasesof medicalnegligence.
Increasing voice and accountability – In principle,peopleinmanycountriesintheregionareentitledtofreeprimaryeducationandprimaryhealthcare.Inpracticetheservicesareusuallymuchbetterfortheprivileged,particularly intheurbanareas.This isbecausehealth
policies,forexample,aretypicallyconceived,directedand implemented by a small group of professionalsinministriesof health–withinadequateinvolvementof civil society including people living with HIVand key affected populations, professional bodies,consumer organizations, or members of parliament.In addition teachers, doctors and health workers areoftendiscouragedbypoorruralservicesfortransport,housing,electricityandwater,andmaynotwishtoliveandworkinremoteareas.4
Ensuring better provision of decentralized services– Basic services are generally provided by local andprovincial governments who often lack capacities.While capacity development is essential, nationalgovernmentsalsoneedtoensurethatqualitystandardsare maintained and set up adequate monitoring andevaluationsystems.Regularfeedbackfrombeneficiariescanhelp identifydeficiencies and spurbetter serviceprovision by encouraging such measures as theBangaloreCitizenReportcardssystem.5
Generating better data–Improvingserviceswillalsomeangatheringdataforevidence-basedpolicymaking.Nationaldatamaynotbedisaggregatedbyregionorbygenderorbycoverageof vulnerablegroups.Andsomesensitivedatarelatedtoissuessuchasviolenceagainstwomenmaynotbecollectedatall.
Figure IV-2 – Total government revenue as a percentage of GDP
Source: ESCAP, 2010(b).
0 10 20 30 40 50 60
Myanmar
China
Bangladesh
India
Pakistan
Nepal
Philippines
Sri Lanka
Indonesia
Singapore
Kazakhstan
Thailand
Georgia
RepublicofKorea
Fiji
Australia
Bhutan
RussianFederation
Japan
Iran(IslamicRep.of)
Maldives
Percent
25MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER IV: Improving health and other basic services
Ensuring social inclusion and equal access to social services
One reasonwhyachievement is low is that,while inprincipleservicesareavailabletoall,inpracticecertaingroupsareexcluded.Discriminationmaybebasedongender or many other characteristics – caste, creed,sexualidentity,ethnicity,disability,age,socio-economicstanding,geographicallocation,orevenmembershipof stigmatizedgroupssuchassexworkersordrugusers.And if the poor fail to register births their childrenmayfinditmoredifficulttoaccessbasicservices.
Poor households –Evenwhenbasic services such aseducation and health are free, poor households canface out-of-pocket expenses, for schoolbooks forexample,orformedicines,orfamilymembersmaynotbeabletoaffordtotaketimeoff worktoattenddistantfacilities.Bangladesh,forexample,hasbeenaddressingthisissuethroughastipendprogrammeforgirlsthathasimprovedtheirenrolmentinschoolingandreduceddrop-out rates. Demand-led approaches can alsooffset the exclusionary impacts of user charges – asisevidentfromtheexperienceof healthequityfundsinCambodia.Poorfamiliesarealsogenerallyexcludedfromformalbankingandfinancialtransactionsbecausetheylackcollateral.
Migrants–Facedwithmassiverural-urbanmigrationsome countries in Asia and the Pacific region arestruggling to maintain basic services in urban areas,especiallyformigrantswhoareparticularlyvulnerable.Whilesomecountriesstrictlyregulatesuchmigration,othersdonothaveanypolicytomanagemigrationorproperlyprovideformigrants.6
Physically challenged people –Theymaybeconsideredeconomicallyunproductiveandfacediscriminationinemployment.
People living with HIV –PeoplelivingwithHIVandkeyaffectedpopulations–suchassexworkers,peoplewhousedrugsormenhavingsexwithmen–maynothave access topreventionandcare services.Or theymayfearpoliceharassmentorbediscouragedbecausetheybelieve thathealth-careworkerswillnot respecttheirrightsandwilldiscriminateagainstthem.Moreover, each form of exclusion compounds theothers and tends to sustain intergenerational cyclesof poverty. Poorer groups, for example, usually getlowerthanaveragereturnsfromeducationasaresultof discrimination in the job market. And unhealthyworkersare likely tobe lessproductiveandwillearnless.Ontheotherhand,evencreatingmorejobswill
notboostpeople’sincomesif theylackthenecessaryeducation,strengthorskills.
Exclusion needs therefore to be tackled on a broadfront, addressing multiple deprivations and barriers,whetherinaccesstopublicservices,orthedistributionof assetsorof politicalpower.7Theseproblemswillnot be solved by markets alone, but will demandgovernment responses and community mobilization,includinginsomecasesaffirmativeactionandchangesin laws that hamper access. The development of effective partnerships between government and civilsocietyorganizationsisalsocrucial.
One problem is that some social inequalities gounobserved officially because of a lack of relevantdata and analysis. Good data can stimulate action.India, for example established a commission on thesocial,economicandeducationalstatusof theMuslimcommunity. The government has now publishedthe commission’s data and is implementing itsrecommendations.8 Analysis should also respond toqualitativefindings–suchastheneedforpoorwomeninruralareastoconsultfemaledoctors.
Diversifying the range of service providers
Users of services are also likely to have strongerinfluenceif theycanchoosefromarangeof providers.Inthepasttheprincipalproviders inmanycountrieshave been governments – particularly for health,education, water and sanitation. But increasingly, asgovernment budgets have become stretched, moreservices are being provided by NGOs which, alongwith the private sector and other civil societyorganizations, have acquired greater knowledge andexpertise.Howevergovernmentsshouldensurethatthepoorhaveaccesstoservicesfromtheseproviders.9
Communitybasedorganizationscanbebetterplacedtodeliverbasichealthandeducationservicestopoorand vulnerable groups. Often they use microcreditto link income-generating activities with health,education and sanitation services. One of the best-known models is that of the Grameen Bank inBangladeshwhichhasbeenwidelyreplicated.Anotherinnovation ispublic-privatepartnershipssuchas thatof ChiranjeeviYojanaininGujarat,Indiawhichofferspoor and socially excluded women free maternityservices at private hospitals. There are also goodexamplesof howpeer-ledcommunitygroupssuchasthoseinvolvingsexworkersinSonagachi,WestBengal,India, or drug user groups such as Mit Samphan in
2� PATHS TO 2015
CHAPTER IV: Improving health and other basic services
Thailand,whichhavebeenabletoorganisethemselvesto do outreach and deliver health services to theirconstituencies.Programmesarealsobeingsupportedbymanyinternationalfunders–includingtheGlobalFundtoFightAIDS,TuberculosisandMalaria,theBillandMelindaGatesFoundation, theGlobalFundforChildren,andtheTurnerFoundation.Forthesekindsof collaboration, governments have important rolesto play to ensure collaboration and harmonization,setstandardsandestablishappropriateincentivesandlegalenvironments.
Priorities in health
While governments need to strengthen provisionacross thewhole rangeof public services,manywillneedtopaycloseattentiontothehealthgoals–whereprogress has been particularly slow. Asia has a largeshare of global deaths and illnesses – more than 40percentof theworld’sunder-fivedeathsandmaternaldeaths,and52percentof stuntedchildren.10Asia isalso responsible for55per centof unmetneeds forfamilyplanning,56percentof newborndeathsand15percentof thenumberof peoplelivingwithHIV.11
Of thehealthtargetsoneof thepriorityareasischildmortality.South-EastAsiaisontrackforthis,butalltheothersubregionsareprogressingtooslowly.Thisismirroredatthecountrylevel:outof the47countriesforwhichtrenddataareavailable,34areoff track.Therecentfinancialcrisiswillhavehadanimpactanditisproving difficult to reduce neonatal mortality, whichis intrinsically linked tomaternal survival andhealth.Still,thepictureisnotallbleaksincemostcountriesaremakingsomeprogress.Of thecountrieswithunder-5mortality rates in the early 1990sof around100per1,000 livebirthsorhigher,quiteanumber, includingAzerbaijan, Bangladesh, Lao PDR, Mongolia andNepal,havemadeimpressiveprogress,andareclosetotheirtargets,whiletheMaldiveshas,inthemeantime,reacheditstarget.
A significant problem in the Pacific region is theincrease in incidenceof non-communicablediseases,suchasdiabetes,highbloodpressureandcardiovasculardiseases. Many of these health problems are due topreventablefactorssuchaspoordiet,physicalinactivityandalcoholandtobaccouse.PacificIslandcountrieshave carried out awareness-raising programmes butstill havemuchwork ahead if they are to encouragewidespread change towards healthier choices. Inaddition to education, governments need to ensureadequatetreatmentprogrammesandfacilitieswithoutcuttingservicestomeetotherhealthcareneeds.
WithrespecttoHIV,thepictureismixed.Therehasbeen some success in bringing down incidence andprevalence– as inCambodia,Thailand andpartsof India.ButtheincidenceisincreasinginsomecountriesinSouth-EastAsiaaswellasacrosstheregionamongmen who have sex with men. Some countries havescaledupanti-retroviraltreatmentbutregionalcoverageis still lagging behind the global average. And evenwhenHIVmedicineisfree,peoplemaystillfacehighfeesfordiagnostictests,medicationforopportunisticinfections,andnutritionalsupplements.12
Another major health concern is maternal mortality.Whenmothersdieduring childbirth, theirnewbornsare unlikely to survive and their young childrenwill also be at risk. Measuring maternal mortality ischallengingasitisoftenunderreportedormisreported.NeverthelessitisclearthatmanycountriesinAsiaandthePacificareunlikelytoreachthetargetof reducingthematernalmortalityratiobythreequartersbetween1990 and 2015 unless they can accelerate progress.As indicated in Figure IV-3, the problems are mostsevereintheleastdevelopedcountrieswherelevelsof maternalmortality are close to those inSub-SaharanAfrica.Astudyof maternalmortalityratespublishedinThe Lancetin2010suggestedthatprogresshadbeensomewhat more rapid than suggested by the MDGdatabase, but nevertheless even these numbers areunacceptablyhigh(BoxIV-1).
Reflecting theurgencyof theproblem inApril2010theUNSecretary-General announced a JointActionPlan for accelerating progress on maternal andnewbornhealth.
A major determinant of a mother surviving iswhetherornotthebirthisattendedbyaskilledhealthprofessional – doctor, nurse or midwife – who canavertasignificantproportionof maternaldeaths.Allthewomenshouldhaveaccesstolifesavingemergencyobstetric care, including Caesarean sections thoughpoormothersarelesslikelytohavethisoption.
In11countriesoutof the43intheregionforwhichdata are available, less than half of all births wereattendedbytrainedhealthprofessionals.Thesituationwasparticularly stark in countries suchasLaoPDR,Timor-Leste, Nepal, Bangladesh and Afghanistan,where less than one birth in five was attended by askilledprofessional.Inadditiontoashortageof suchworkerstheyarealsopoorlydistributed.
Reducing maternal mortality will also need adequateantenatalcare,whichisparticularlyweakinSouthAsia.Moreover the risks of dying during pregnancy and
2�MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER IV: Improving health and other basic services
Table IV-2 – Progress required for off-track countries to meet the under-5 mortality target
Note: *Cumulative number of deaths from 2009 to 2015.Source: Staff calculations based on the United Nations MDG database.
India 11,644 -4.33 9,310Afghanistan 2,527 -24.33 1,435Pakistan 3,195 -6.52 2,337Myanmar 653 -8.29 427China 2,424 -0.81 2,295Cambodia 230 -7.29 153DPRKorea 127 -5.24 71PapuaNewGuinea 96 -5.52 66Indonesia 973 -1.76 948Philippines 415 -1.67 394Uzbekistan 142 -1.90 120RussianFederation 137 -0.57 116Tajikistan 82 -3.57 69Kazakhstan 56 -1.43 51SriLanka 33 -0.76 29RepublicofKorea 14 -0.29 12Kyrgyzstan 28 -1.86 26Timor-Leste 28 -4.52 26Georgia 9 -2.05 7Turkmenistan 32 -2.14 30SolomonIslands 4 -3.33 2Bhutan 7 -4.52 7Vanuatu 2 -3.43 1Fiji 2 -1.52 1Micronesia(FederatedStatesof) 1 -2.81 0Tonga 0 -1.62 0BruneiDarussalam 0 -0.48 0Samoa 1 -1.33 1CookIslands 0 -1.29 0Kiribati 0 -2.62 0Nauru 0 -5.43 0MarshallIslands 0 -2.81 0Palau 0 -1.14 0Tuvalu 0 -2.62 0
Total 22,862 17,934
childbirtharehigheramongadolescentmotherssoitwillbeimportanttoimproveadolescentreproductivehealth. There are also high unmet needs for familyplanning in countries such as Afghanistan, Timor-Leste, and Papua New Guinea that have very highfertilityrates.
Health outcomes are a function of many factors,economicandpolitical, social andcultural.Generally
speaking, the richer countries will have higherstandardsof health as a result of improvedhousingandoverall livingconditions.Manyof thedeathsof young children, for example, can be prevented byhaving better access to clean water and sanitation.And better road infrastructure and public transportwould make health facilities more accessible. IndeedeconomicgrowthmightbeexpectedtoimprovealltheMDGindicators.ThishasbeenanalyzedforAsiaand
Affectedpopulationin2015oncurrenttrend
(thousands)*
Averageannualchangeneededtoreachtarget(per1,000livebirths)
Affectedpopulationin2015iftargetreached
(thousands)*Country
28 PATHS TO 2015
CHAPTER IV: Improving health and other basic services
thePacificbycalculatingthepercentagechangeineachMDGindicatorforeach1percentincreaseingrowth.Thebeneficialeffectappearstobegreatestforpoverty,withmorethan1percentdecreaseintheincidenceof poverty.But thegrowtheffect is slower forhealth–with a 1 per cent increase in growth only improveshealth indicators by around half of a per cent.13 If governments use the additional resources generatedby growth toprioritize spendingonurgentlyneededsectors suchashealth, risinggrowth levelscanbringaboutbetterhealthoutcomesinthefuture.While overall growth can thus lead to better healthoutcomes,itisclearthatrelyingongrowthalonewillnotdo. Countriesacrosstheregionwillneedtopay
particularattentiontoimprovinghealthservicedelivery.Thiswillinvolveestablishingabalancebetweenstateandprivate-sectorprovision.Insomecases,particularlyforprimaryhealthcare,thegovernmentwillbethemainprovider,but inothers thegovernment should servemoreasthepolicycoordinatorandregulator–establishinga framework within which the government services,theprivatesectorandNGOscanoperateefficiently.
Increasing public health expenditure and staffing levels
Generally health expenditure is higher in richercountries–bothasaproportionof GDPandof totalgovernmentexpenditure.Butnationalwealthisclearly
Figure IV-3 – Maternal mortality rates and number of deaths
Source: Staff calculations based on the United Nations MDG database.
Astudyof maternalmortalityrates in181countriespublishedinThe Lancet inApril2010indicatedthatsignificantprogresshadbeenmadetowardsMDG5.Between1980and2008,worldwidematernaldeathsfellbynearly35percent,from526,300to342,900.Globally,however,only23countriesareontracktoachievea75percentdecreaseinmaternalmortalityrateby2015.InAsiaandthePacifictheprogresshasbeenuneven.Anumberof countriesincludingChinahavemaderapidprogress,andintheMaldivesbetween1980and2008thedeclineintheratewas8.8percentperyear.
Neverthelessaccordingtotheseestimations,unlesstheycanaccelerateprogressitisclearthatmanycountries inAsiaandthePacificareunlikely toreachthe2015target.If thesamemethodologyof classificationwereapplied to thedata fromthisstudy,of the41countries forwhich trenddataareavailable,4wouldberegressingormakingnoprogress,32wouldbeslowandonly3wouldbeontrack–though2wouldbeearlyachievers.
Threeoutof thesixcountriesthataccountedformorethan50percentof allmaternaldeathsin2008wereinAsiaandthePacific.
Source: Hogan M. et al. (2010) “Maternal Mortality for 181 countries 1980 – 2008” in The Lancet, April 12.
box IV-1 – new estimates on maternal mortality
Asia-Pacific
South-East Asia
SouthAsia
Pacific Islands
NorthandCentralAsia
Asia-Pacific LDCs
LatinAmerica&Caribbean
Sub-Saharan Africa
Numberof deaths(inthousands),2005
236
34
187
1
2
55
15
272
0 100 200 300 400 500 600 700 800 900 1,000Maternalmortalityratio,per100,000livebirths
29MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER IV: Improving health and other basic services
nottheonlyfactorsincewithinAsiaandthePacifictherearewidedifferencesevenamong the leastdevelopedcountries.BhutanandCambodia,forexample,devotemorethan10percentof GDPtohealth,whileothersmaydevote4percentorless.Clearly,muchdependsontheprioritiesandcommitmentof governments.
Low public investment in health combined with ahighincidenceof diseasemeansthattoofewstaff arehavingtocopewiththeexpandingneeds–resultinginovercrowdedgovernmenthospitalswithlongqueues,and extended waiting times for specific treatments.Countries such as Bangladesh, Bhutan, Cambodia,Indonesia, Lao PDR and Nepal still have limitedphysicians,andskilledhealthpersonneltoattendbirths(TableIV-3).InthePacific,thePhilippinesandSouthAsia in particular, these shortages are exacerbatedby the emigration of skilled health workers todevelopedcountries.
Neverthelesstheprioritymaynotonlybetoincreasethe number of doctors – who often gravitateto urban areas. More immediate problems mayderive from shortages of nurses, paramedics orskilled birth attendants. Ensuring that staff, andparticularlyfemalestaff,canworkinruralareasandindifficult locations will therefore require appropriatesystemsof incentives.
Achieving universal health care
Morecountriesintheregionarenowconsideringwaysof offeringuniversalhealthcare.Thiscanbeachievedinavarietyof waysandinmultiplecombinations.Themostbasicrequirementistoguaranteehealthtreatmentforthepoorestthroughdifferentformsof socialsafetynetthatcanbefundedentirelyoutof generaltaxation–asinThailand’suniversalhealthcarescheme.
SouthandSouth-WestAsia
Bangladesh 3 18Bhutan <0.5 51India 6 47Iran(IslamicRepublicof) 9 97Nepal 2 19Pakistan 8 39SriLanka 6 99Turkey 15 83
South-EastAsia
Cambodia 2 44Indonesia 1 73LaoPDR 3 20Malaysia 7 100Myanmar 4 57Philippines 12 62Singapore 15 100Thailand 3 99VietNam 6 88
EastandNorth-EastAsia
China 14 98Japan 21 100Mongolia 26 99RepublicofKorea 17 100
Developedcountries
USA 27 99
Table IV-3 – Health personnel
Source: Staff calculations based on the United Nations MDG database.
Physiciansper10,000population
%ofbirthsattendedbyskilledpersonnel
30 PATHS TO 2015
CHAPTER IV: Improving health and other basic services
At the same time countries can also move towardsuniversalhealthschemesthatarebasedatleastpartlyonthepoolingof riskacrossthepopulationthroughthepurchaseof insurance.ThuswhilesomeEuropeancountriesprovidehealthcarebasedonresidencerights,others have much more pluralistic delivery systemsbasedonobligatoryhealthinsurance,withcontributionratesrelatedtosalariesorincomes,andusuallyfundedbyemployersandbeneficiariesjointly.
In Asia, some countries have attempted to providesuchauniversalhealthscheme:
Public health insurance – In the more advancedcountrieswhereahighproportionof workersare inthe formal sector, users of health services can poolrisksthroughpublichealthinsurance.Private health insurance – Even in countries withbasic universal provision people with high incomesoftenprefer touse theprivatesector in thehopeof getting faster or better quality care. Private schemesare becoming more popular in Asia and the Pacific– particularly among middle- and high-incomehouseholds. A variant on this is a public-privatepartnershipwhere thegovernment subsidizesprivatehealthinsurancepremiumsforthepoor.
Community-based health insurance – Rather thanhavinganationalsystemtherecanalsobecommunity-based health insurance schemes in which premiumsfor thepoormightbepaidby the localauthority. In2009, the State Government of Tamil Nadu (India)introduced the Insurance Scheme called “Chief MinisterKalaignar’sInsuranceSchemeforLifeSavingTreatments” for the poor and children. In the firsthalf of 2010,over88,000peoplehadbenefittedfromthisschemeandthestategovernmenthadreleasedasumof Rs2500millionasclaimamount.14Ontopof insuranceandsubsidies,however,usersarestill likelytobepayingforsomeservices,andparticularlydrugs,fromout-of-pocketexpenditure.
China for example, in 2005 introduced aNewRuralCo-operative Medical Care System which by 2007covered around80per centof the rural population.Of theannualcostof 50yuan($7)perperson,20yuanisprovidedbythecentralgovernment,20yuanbytheprovincialgovernmentand10yuancomesintheformof apatientcontribution.
Universalcoverageforhealthcareisusuallyattainedincountrieswherepublicinvestmentinhealthisatleast5percentof GDP.In2007,17developingcountriesinAsiawerespendinglessthanthis.WHOhassuggestedappropriate percentages for the Asia-Pacific region:totalpublichealthexpenditureshouldbeatleast4percentof GDP;forprivateexpenditure,itrecommendsthat over 90 per cent of the population should becovered by some form of prepayment; and out-of-pocket spending should not exceed 40 per cent of totalhealthexpenditure.15 Inaddition, thevulnerablesections of the population should be provided withhealthsafetynets.
Oneestimatesuggeststhattheessentialinterventionsshould cost about $34 per person per year.16 Whilesomeof thiscancomefromgeneraltaxationitmightalso be possible to earmark some tax collectionfor health to ensure that the funds are used for thispurpose.AssumingthattheAsianLDCscouldmobilizeabout 5 per cent of per capita income for healthspending, thiswould amount to $25.7, leaving a gapof $8.3perpersonperyear,oratotalof $2.4billion,thatmightneedtobemetfromoverseasdevelopmentassistanceorsouth-southcooperationwithincountriesof theregion.The2008Reportof theCommissiononAIDSinAsiastatedthatacomprehensiveresponsetoAIDSintheregion would cost about $6.4 billion per year. But atargetedresponsewhichcanhaltandreversethespreadof theHIVepidemicmightneedonly$3.1billion–aninvestmentof $0.50to$1.00percapitaperyear.17
While increasing expenditure on public healthservices governments will also want to minimizecosts,particularlyfordrugs,whichshouldasmuchaspossible come in cheaper generic forms. Somecountries like India have been able to developcapability to produce highly affordable genericdrugs through adapting intellectual property rightregimesandpriceregulations.
Theresponsibilityfortheseandothermeasuresrestswith national governments, but they should also beable to take advantage of regional cooperation. Insomecases, thismight involve transferring resourcesfromricher topoorercountries,butcountriesacrossthe region can also learn from one another throughtheexchangeof bestpracticeswhichreducecostsandimprovedeliveryof healthservices.
31MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER IV: Improving health and other basic services
Endnotes
1 WHO,2009.2 ESCAP(2010b).3 ESCAP/ADB/UNDP,2005.4 WanandFrancisco,2009.5 Ravindra,2004.6 IOM,2005.7 WanandFrancisco,2009.8 Governmentof India,2008.9 ESCAP/ADB/UNDP,2005.10UNICEFandWHO,2010.11WHO,2009.12UNDP(2010b).13ESCAP/ADB/UNDP,2010.14Seehttp://www.newkerala.com/news/fullnews-104256.html15WHO,2010.16JungandTran,2008.17CommissiononAIDSinAsia,2008.
A new era for public services
Improving public services will thus require a greatercommitmentnotjusttospendmorebuttospendwisely–toincreasebothefficiencyandequity.Thiswillmeanopeningupservices toawider rangeof providers–andtogreaterpublicparticipationandscrutiny.
However, another important constraint on serviceprovision, particularly in the rural areas, is the lackof adequate infrastructure, particularly transportcommunicationsandpowersupplies.Thefinalchapterturnsthereforetothisoftenneglectedsubjectwhosedevelopment underpins the achievement of theMDGs.
32 PATHS TO 2015
CHAPTER V
TheMDGframeworkonlyhasafewindicatorsfor infrastructure – for water and sanitationwhicharepartof MDG7andforinformation
and communications technology in MDG8. It thustendstofocusondevelopmentoutcomesratherthanonsomeof thebasicconditionsforachieving them.Even when governments responded to the globaleconomic crisis with stimulus packages that investedin infrastructure they did not generally link thesespecificallywiththeMDGs.
Economicanalysishasestablishedacloserelationshipbetween investment in infrastructure and economicgrowthbuthasnotexamined the impactonpovertyor other MDG outcomes. However the linkage hasbeenexploredinanumberof empiricalstudies.Oneworldwidestudy,forexample,showsthatgrowthandinvestmentare associatedwith reductions inpoverty,infantmortality,incomeinequality,illiteracyandwaterpollution.1Butthisandsimilarstudiesdonotprovethedirectionof causality.Does infrastructure investmentgenerate economic growth and reduce poverty ordo higher growth and lower poverty create a largerresourcespaceforinfrastructureinvestment?2Itseemslikelythatthecausalityrunsbothways.
Indeed the linkage between the two is intuitive.Although all infrastructure would in some way helpinachievingtheMDGs,someformsaremoredirectlyconnected, and these may be considered as ‘basic’infrastructure.Betterruralroadtransport,forexample,should expand access to markets for marginal andsmallfarmersandthusreduceruralpoverty,whilealsoallowing better access to schools and health centres.Better power supplies would mean that householdswouldnotneed to rely somuchonunhealthywoodburningstoves (BoxV-1).SimilarMDGbenefitscan
be expected from other forms of infrastructure, assummarizedinTableV-1.
Whichinvestmentswillbethemoreeffective,however,willdependon localcircumstances.For remote ruralareastheprioritymightberoadsortelecomservices,while in urban areas it might be water supply andsanitation.
It is, however, clear that there is huge room forimprovement. For many forms of infrastructure,Asia and the Pacific as a whole lags behind LatinAmerica (Table V-2). Some 930 million Asians arewithoutelectricity,only3Asiansin10haveaccesstoatelephone,andhalf theregion’sroadsareunpaved.3
Even within Asia and the Pacific there are markeddisparities. Among the subregions, North-East Asiais the most advanced while the landlocked CentralAsian republics and the Pacific Island countriesare some way behind. In fact, the lack of physicalinfrastructureisconsideredamajorimpedimenttothegrowth of Pacific economies, where there is a clearneedtoimprovetransportfacilitiesandmaritimeandaviationinfrastructure.ThemostadvanceddevelopingcountriesintheAsia-PacificregionaretheRepublicof Korea,China, Indiaand the faster-growingcountriesinSouth-EastAsia.
But disparities are also evident within countries.Transport development, for example, tends to bemoreadvancedincoastalareasthatareintegratedintoregional production networks, and less extensive inremoteregionsthatarehometoindigenousgroupsandother marginalized populations. And more generally,services and MDG outcomes are typically better inurbanareas.
Strengthening basic infrastructure
Achieving the MDGs in Asia and the Pacific will require stronger basic infrastructure, particularly better road transport, water supplies, sanitation, electricity, information technology, telecommunications and urban low-income housing.
33MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER V: Strengthening basic infrastructure
box V-1 – Energy for All
1 Note: Energy for All uses the IEA 2009 data that show that 809 million Asians lack access to electricity. This report cites ADB’s Asian Development Outlook 2009 figure of 930 million so we use that here for consistency.2 See www.energyforall.info
Modernenergyisanessentialinputforachievingallof theMDGs,somuchsothatincreasingaccesstoaffordable,reliableenergyisnowwidelyconsideredthe“missingMDG”.YetintheAsia-Pacificregionalone,some930millionpeopledonothaveaccesstoelectricity,andnearlytwicethatnumberdependonburningbiomassforcookingandheating.1
ADB’sEnergyforAllInitiativeisdevelopingnewapproachesforscalingupaccesstoclean,modernenergyamongthepoor.Thisincludesimprovingthedeliveryof energyservicestodeprivedcommunitiesthroughADBinvestments,extendingpolicysupporttogovernmentstodesignandimplementuniversalelectrificationprograms,andbuildingcapacityandpromotingknowledgeexchangeamongawiderangeof practitioners.ADBisalsopursuingregionalcooperationthroughtheEnergyforAllPartnership,amulti-stakeholderplatform launched in2009.2TheEnergy forAllPartnershipbrings together theprivatesector,financialinstitutions,governmentsandcivilsocietytoshareintelligenceandcollaborateonprojects,withatarget toexpandaccesstomodernenergyto100millionpeople inAsiaandthePacificby2015.
Therearenowmanyprovenmethodsforextendingmuch-neededenergyservicestothepoor.ADB’sEnergyforAllisfocusedonreplicatingeffectivemodelsandscalingupexistinginitiatives.InVietNam,for example, an ADB-supported credit facility will build on the country’s ongoing domestic biogasprogramandenableanadditional40,000householdstoaccesscleanercookingfuelfromhouseholdbiogasdigesters.Accesstocleanerfuelssuchasbiogascanreducediseaseburdenandimprovematernaland child health which are among the MDGs. Where appropriate, targeting investment to expandexistinginitiativescanhastenprogresstowardenergyforall.
MoreinformationonADB’sEnergyforAllInitiativecanbefoundat:http://www.adb.org/Clean-Energy/energyforall-initiative.asp
MDGsimpacted
Directimpact:MDG1Indirectimpact:MDGs2,3,4,5
Directimpact:MDG1Indirectimpact:MDGs2,4,5
Directimpact:MDG1Indirectimpact:MDG7
Directimpact:MDGs1,8Indirectimpact:MDGs2,3
Directimpact:MDGs4,5,6,7Indirectimpact:MDG3
Directimpact:MDGs3,4,5,6,7
Table V-1 – Positive impacts of basic infrastructure on the poor and MDGs
Source: Adapted from ADB/JBIC/World Bank, 2005.
Sector
Electricity
Roads
Urbanmasstransit
ICT
Watersupply
Sanitation
Directimpactonpoor
Mainlyforlighting,TV,andradioatlowlevelsofincomeAppliancesforself-employment
AccesstoemploymentandmarketsAccesstoservices(health,education)
Accesstoemploymentopportunities
Bettercommunicationaccess,aidingmigration,informationonopportunities,accesstoknowledgeandpotentialengagementinwidercommunities
Improvedhealthoutcomes;timesavings;lowercosts
Improvedhealthoutcomes
Indirectimpactsonpoor
Reducedenergycostsforenterprises,encouragingemploymentcreationImprovedhealthandotherservices(refrigeration,lighting,etc)ImprovedICTaccess
Reducedtransportcostsandimprovedmarketaccessforenterprisesandserviceproviders,loweringcostsofservingremotecommunities
Employmentcreationfrommoreefficientlabourmarkets
Employmentcreationthroughimprovedknowledgeofmarkets,reducedmanagementsupervisioncosts,accesstowiderknowledgebase
Limited
Improvedhealthoutcomes(e.g.reducedpollutionbynon-poorhouseholdsandothers)
34 PATHS TO 2015
CHAPTER V: Strengthening basic infrastructure
Mobilizing finance for basic infrastructure investment
Meeting infrastructure gapswouldbe expensive.Forthe period 2010-2020 it has been estimated that therequired investment would be $7.7 trillion, or about$700billionperannum–58percentof whichwouldbe inEastAsiaandthePacific,36percent inSouthAsiaand6percentinCentralAsia.Of thetotal,two-thirdswouldbefornewinfrastructureandthebalancefor replacing existing facilities. More than half theinvestmentwouldberequiredforenergy,and30percent for roads (Table V-3). Considering that muchof the investments would be needed to meet largeexisting gaps – such as providing electricity to over22percenthouseholdsintheregioncurrentlywithoutaccessorexpandingthepavedroadnetworksforruralpopulations–of the$7.7trillion,asignificantproportionwould be for basic infrastructure for supporting theMDGs.AcrucialtaskfacingpolicymakersistomakeinfrastructureinvestmentmoreMDG-supporting.
The key challenge is to mobilize finance. In theshort term it should be possible to include essentiallow-cost rural infrastructure projects in ongoingfiscal stimuluspackages. If suchprojects are labour-intensive they can also provide employment safetynets.For thispurpose,poorercountriesmayhave torely more on grants or concessional financing fromODA or multilateral development institutions. Butothercountrieswillbeable toaccesscapitalmarkets
andtapintoregionalsavings.Withcombinedforeignexchangereservesof nearly$5trillion,theregioncouldnow develop an ambitious architecture for mutuallybeneficial deployment of foreign exchange reserves.This architecture could include an infrastructuredevelopmentfund.4If itmobilizedjust5percentof theregion’sreservesitwouldhavestart-upcapitalof $250 billion. The fund could also borrow from theregion’scentralbanks.Byco-financingviableprojectswithothersourcessuchanarchitecturecouldexpediteinvestment in infrastructure development, especiallycross-border connectivity projects linking poorerparts of the Asia-Pacific region with the region’sgrowthcentres.5
Stimulating the private sector
Overthepasttwodecades,morethan70percentof Asia’s investment in infrastructure has come fromthepublic sector.Thepublic sectorwill stillneed toshoulder the main responsibility for improving thedelivery of basic infrastructure for areas that arecommercially unviable. But with rapidly increasingdemandif theregionistotakealeapininfrastructurespending for basic infrastructure more finance willneedtocomefromprivatesources.Privateinvestmentdoes not usually focus on the needs of the poor,particularly in rural areas where perceived risks arehigh.Evenpublic-privatepartnershipsarerareinruralareas,thoughtherehavebeensomepromisingresults,
North-EastAsia 13.72 0.49 99.34 88.11 64.97 5.96 0.366 32.97CentralAsia 16.48 2.55 … 88.66 95.31 2.31 0.003 …SouthAsia 12.78 0.51 61.03 88.06 32.83 1.20 0.010 40.10South-EastAsia 10.51 0.27 71.69 86.39 67.50 3.53 0.031 34.15PacificIslands 3.69 … … 46.19 48.74 0.77 0.043 …
Asia-Pacific 12.83 0.53 77.71 87.72 52.05 3.47 0.154 35.73
Industrialized 207.10 … … 99.58 99.85 13.76 1.553 …countriesOECD 211.68 5.21 99.80 99.63 99.94 13.87 1.608 …LatinAmerica 14.32 2.46 92.70 91.37 78.26 6.11 0.150 25.35Africa … 0.95 28.50 58.38 30.83 1.42 0.003 62.72
Table V-2 – Infrastructure comparators, Asia and Rest of the World, 2005
Note: Paved roads indicator is derived from the indicator on paved roads (as % of total roads) and total road network (km). Source: World Development Indicators, United Nations MDG Database and World Energy Outlook 2009.
Urbanslum
population(%)
Countrygrouping
Pavedroads
(km/10,000people)
Railways(route
km/10,000people)
Householdelectrification
rate,2008
(%)
Accesstoimproved
watersources
(%oftotal)
Accesstoimprovedsanitation
(%oftotal)
Mobileandtelephone
subscribers(per100people)
Broadbandinternet
subscribers(per100people)
35MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER V: Strengthening basic infrastructure
forexampleforfinancingmicro-andmini-hydropowerprojects. Although the chief benefit of expandingprivate sector involvement in infrastructure is likelyto be to release more public-sector funds for MDGachievement, attempts to create more public-privatepartnershipsinpromisingareasof basicinfrastructureshouldcontinue.
Forthistohappen,itwillalsobeimportanttostimulatethe interest of the private sector by developingappropriateregulatoryframeworks.Governmentsmayalsoofferfiscalandotherincentivestoprivate-sectorinvestors, while multilateral development institutionscan help steer governments and private investorsthrough the difficult commercial and cost-sharingnegotiationsforpublic-privatepartnerships.Managingthedebtcomponentof theseprojectscanbenefitfromswaparrangementstoalleviateforeignexchangerisk.
Raising standards of quality and maintenance
Just as important as the extent of infrastructure isits quality. Except for railways, Asia also lags in thisrespect.Arecentstudy,basedontheWorldEconomicForum’s business survey, which rates infrastructuregiving a maximum score of 7 points, found Asia tobe 1.9 points behind the G7 countries (Table V-4).Asia’sweakestperformanceis inelectricityforwhichitisfurthestbehindtheglobalaverage.AmongAsia’ssub-regions, East Asia ranks the highest and SouthAsia the lowest. Nevertheless, some countries in theregionperformwell.Singapore’sratingsforportsandairtransport,forexample,areclosetothemaximumscoreof 7.6
The quality of infrastructure is also affected by thecommitment to repairs and maintenance. Olderinfrastructure may decay and eventually fall intodisuse – and will be particularly vulnerable at timesof disaster. This is usually because governments aremore interested in building new infrastructure, forwhichtheycanclaimcredit,thaninmaintainingassetscreatedbyprevious administrations.Moreover,whilenew major infrastructure is typically created by thecentralgovernment,thetaskof maintenancegenerallyfallstolocaladministrationswhichhavefewerfinancialorhumanresourcestofulfilthisresponsibility.High-quality infrastructure does not necessarily requiresophisticated technology; more important is that itshouldbesimpletomaintain.
Low-quality infrastructure will disproportionatelyaffectthepoor,whoare,forexample,themainvictimsof fatalitiesoccurringonpoorqualityroads.Also,thereisavastgapinqualitybetweenurbanandruralareas–andtheresultingqualityof socialservices,includingwatersupply,educationandhealth.Asaconsequence,progressontheMDGshasslowedinruralareas.
Inmanycountries,mostof infrastructureinvestmentrelatedtotheMDGsislikelytocomefromthepublicsector.Butthiscanonlybeeffectiveif itisaccompaniedby reforms in governance and also by efforts toincrease capacity, especially in local government incountriesthathaveachievedextensivedecentralization.Anotherpriorityisfightingcorruption.Governmentscanincreasetransparencybyusingcompetitivebiddingrules, widely publicizing project information, usingautomatede-billingsystems,andsubjectingprojectstorandomqualitychecks.Theywillalsoneedtoimprovequalification and certification in the constructionindustryandenforceregulationsmorestrictly.
Table V-3 – Asia’s Infrastructure Investment needs 2010-2020 (uS$ millions, 2008)
Source: Derived from ADBI/ADB, 2009.
Sector/Subsector New Capacity Replacement Total
Energe (Electricity) 3,176,437 912,202 4,088,639Telecommunnications 325,353 730,304 1,055,657 Mobilephones 181,763 509,151 690,914 Landlines 143,590 221,153 364,743Transport 1,704,858 674,313 2,378,161 Railways 2,692 35,947 38,639 Roads 1,702,166 638,366 2,340,532Water and Sanitation 155,493 225,797 381,290 Sanitation 107,925 119,573 227,498 Water 47,568 106,224 153,792Total 5,162,131 2,542,616 7,704,747
3� PATHS TO 2015
CHAPTER V: Strengthening basic infrastructure
Oneof thebestwaysof improvingqualityistoactivelyinvolvelocalcommunities,andparticularlywomen.Atthehouseholdandcommunitylevel,womenoftenplayaprimaryroleinmanagingenergyandwateruse.Theirparticipation in the development, implementationand maintenance of infrastructure is more likely tolead to sustainable solutions.7When local people areengaged in planning water systems and other basicinfrastructure they can not only contribute inputs intheformof labourorbuildingmaterialsbutalsofeelgreaterownershipandbecommittedtomaintenance.Theycanalsoparticipateinappraisalsandauditsandincollectingfeesandcharges.Insomecases,thiscanbeaccompaniedbyincreasinginvolvementof NGOs– in such areas as developing water supplies, solidwastedisposal, and school andhealth facilities.Withrelatively lowoverheadsNGOsmaybeable toworkatlowercosts.
Infrastructure investment decisions also need to bewell coordinated – for example, planning rural roadnetworksalongwithmainarterialroads.Thiswillalsomean investing simultaneously inbothhardware and
software–ensuring,forexample,thatawatersupplyfacility will subsequently have operating staff. Thismay be achieved through investment coordinationboards–whichcanalsoensurethatroadprojectsallowadequately formaintenancecosts, and that electricityschemesbuildmaintenancecostsintopowertariffs.
In order to track progress, it will be important toestablish appropriate indicators. Most of thosecommonly used, such as the percentage of thepopulationwithaccesstosafewater,measureoutcomes.Trackinginvestment,however,willneedmoreandbetterindicatorsof outputs, such as the lengthof water anddrainagepipesinstalled.
building greener infrastructure
It will also be important for future investment inbasic infrastructure to pay much closer attention tothe environmental impact – and the implications of climatechange.FortheMDGsitwillbeimportant,forexample,toimprovepowersupplies,particularlyinthe
Regionorcountry Overallinfrastructure Roads Electricitysupply
Worldaverage 3.8 3.8 4.6G7countriesaverage 5.7 5.7 6.4AsiaAverage 3.8 3.7 4.1
CentralAsiaaverage 3.5 3.1 3.6
Azerbaijan 3.9 3.7 3.9Georgia 3.2 3.5 4.4Kazakhstan 3.5 2.5 4.3Tajikistan 3.2 2.6 1.7
EastAsiaaverage 4.6 4.7 5.3
China,People’sRep.of 3.9 4.1 4.7HongKong,China(SAR) 6.3 6.4 6.7Korea,Rep.of 5.6 5.8 6.2Mongolia 1.7 1.4 2.9Taipei,China 5.5 5.6 5.9
SouthAsiaaverage 2.9 3.1 2.8
Bangladesh 2.2 2.8 1.9India 2.9 2.9 3.2Nepal 1.9 1.9 1.7Pakistan 3.1 3.5 2.5
South-EastAsiaaverage 4.2 4.2 4.7
BruneiDarussalam 4.7 5.1 5.4Cambodia 3.1 3.1 2.5Indonesia 2.8 2.5 3.9Malaysia 5.6 5.7 5.8Philippines 2.9 2.8 4.2Singapore 6.7 6.6 6.7Thailand 4.8 5.0 5.5VietNam 2.7 2.6 3.2
Table V-4 – Infrastructure quality in Asia, rated from 0-�
Source: ADBI/ADB, 2009.
3�MDG PRIORITIES In ASIA AnD THE PACIFIC
CHAPTER V: Strengthening basic infrastructure
ruralareas.Thiscanbringbenefitsnotjusttothelocaleconomybutalsoforhealthandtheenvironmentbyreducingtheuseof woodburningstoves.Neverthelesssomepowersources,suchaslargehydropowerprojects,have often had serious consequences both for theenvironmentandforlocalcommunities.
Other formsof infrastructure canhave lessobviousenvironmental implications.Thuspipedwater supplyinurbanareaswillhavetheenvironmentalbenefitof reducinggroundwaterextractionbutwouldalsorequirebetterwastewatertreatmentasgreaterwaterflowsaddtopollutionthroughdrainagesystems.
More attention must be given to services thatmaximize equitable socio-economic benefits, whileminimizing environmental impacts and the use of resources. Governments will want to enhance thecomplementarities between basic infrastructureinvestmentandenvironmentalprotectionandminimizethe conflicts. Investment in low-incomehousing, forexample,willnotbeagreeninitiativewithoutadequatewatersuppliesandsanitation.Infact,therearemanypromisinggreenoptions.Forexample,publictransportsystemsthatarewellplannedandintegratedwithnon-motorized transport can reduce costs for the urbanpoorwhileestablishingcitiesontrajectoriesof greengrowth.Thiswillalsomeanpromotingtheuseof greenenergyandtechnologyalongwithenergyconservationanddemandmanagement.
Extending regional infrastructure
While the most immediate gains for the MDGs arelikely to come from better infrastructure at nationallevelstherearealsohugeopportunitiesforimprovinginfrastructure at regional and subregional levels.A study by ADB and ADBI has concluded thatcompleting regional connectivity in energy, transportandtelecommunicationswouldboostAsia’snetincomeby$13trillionovertheperiod2010-2020andbeyond.8
Forpoor communities someof themost immediatebenefits of better connectivity will be degrees of cross-national integration between neighbouringborder areas which in their respective countries areoften amongst the more remote and poorer regions.Adjacent areas of Thailand, Indonesia and Malaysia,forexample,havebecomepartof a‘growthtriangle’.Brunei Darussalam, Indonesia, Malaysia and thePhilippineshavealsoformedanEastASEANGrowthArea. Recently there has also been an attempt tocreate a new growth triangle between Eastern India,Nepal, Bhutan and Bangladesh. Regional transportinfrastructure has also been developed in the form
of an East West Economic Corridor in the GreaterMekongsubregionaswellasthrougharoadthatlinksChinawithKazakhstan,KyrgyzstanandUzbekistan.It is also important however, that the physical linksbetweencountriesareaccompaniedbyharmonizationof standards such as railway signalling systems orcustoms codes. All these would contribute to fasterpoverty reduction and progress on the MDGs. OnemodelforKyrgyzstan,forexample,showsthatregionalcooperation on integration projects for transport,transitandfacilitationwouldnearlydoubletheincomesof thepoor.9
Attheregionallevel,governmentsshouldpressaheadwithagreementsforpan-Asianconnectivity–through,forexample,anAsianInfrastructureFundandotheraspectsof aregionalfinancialarchitecture,andapan-AsianInfrastructureForumforsharingtheexperiencewith cross-border projects. Cooperation betweencountriesinexchangingknowledgeandbestpracticescan also play an important role in helping expandaccesstobasicinfrastructure.
Tilting the balance
Inrecentyearscountriesacrosstheregionhavemadesome progress in building new infrastructure. SeenthroughanMDGlens,however,theresultscanatbestbeconsideredpatchy–withfuturisticnewairportsandsmartprivatehospitalsononesideandpotholedruralroadsandcrumblingvillagehealthclinicsontheother.Thechallengenowistochangethecriteriaof success–toachievehigherstandardsof basicinfrastructurethatcanunderpintheMillenniumDevelopmentGoals.AstheMDGtargetdateof 2015approaches,itseemslikely that thepictureacrossAsiaand thePacific fortheGoals themselves is also likelybemixed– somedisappointingfailures,somenarrowmisses,andsomestrikingsuccesses.But the finalMDGstory isyet tobetold.Allcountriesstillhavefiveyearstochoosethemostpromisingpaths–andtiltthebalancedecisivelyonthesideof success.
Endnotes
1 Thomas,2001.2 Chatterjeeetal.,2004.3 ADB,2009.4 ESCAP(2010a),ESCAP(2010b);ADBI/ADB,2009.5 ESCAP(2010a),ESCAP(2010b).6 AlsoseeESCAP(2010a)foracompositeindexof infrastructuredevelopment.7 ADB/JBIC/WorldBank,2005.8 ADBI/ADB,2009.9 ADBI/ADB,2009.
38 PATHS TO 2015
Comparison of Asia and the Pacific with other developing regions
The Asia-Pacific region as a whole has made moreprogressthanSub-SaharanAfricabut less thanLatinAmericaandtheCaribbean.Thecomparisonbetweenthese three global regions is encapsulated in FigureA-1forsixindicators.Inthesecharts,thesizeof thebubbles is in proportion to the population currentlyaffected (on a logarithmic scale). The sloping linedivideseachchartintotwoparts:if thebubbleisabovethe line,since1990thevalueson that indicatorhaveincreased; below the line they have decreased. Thecolours correspond to those of the on- or off-trackprogresssymbols.
Theremainderof thisappendixdiscussesforsomekeyindicatorswhereprogresssofarhasfallenshortforthetargetstobemetby2015,andwhatisrequiredintermsof deviationfromcurrenttrendstostilldoso.Itthenprovides estimates on the extent of reduced humansuffering resulting from theacceleratedprogress andtheachievementof thegoals.
Achievements in $1.25/day poverty
Figure A-2 illustrates the differences in the progressamongcountriesinreducingextremeincomepoverty.The arrows represent the percentage of populationlivingbelow$1.25(PPP)perdayinthelatestyearforwhich data are available. The other end of the linerepresents the data point for the earliest year since1990.DataontheseandotherindicatorsareprovidedinTablesA-6throughA-13inthisappendix.
Intheearly1990s,everysixtosevenoutof 10personsinChina,Turkmenistan,VietNam,Pakistan,Bangladeshand Nepal were living on less than $1.25 per day.Whereasthefirstfourof thesecountriesmanagedtoreducetheprevalenceof povertytofewerthansixtoseven out of 10 persons, and have in the meantimereachedthepovertyreductiontarget,BangladeshandNepalprogressedmuchslowerandstillhavepovertyratesof around50percent.Ontheotherhand,countriessuch as the Philippines, India and Lao PDR hadsomewhatlowerpovertyratesintheearly1990s,havemadeevenslowerprogress.Thusextremepoverty inthesecountriesremainsprevalent.Whereasatthesame
time,inanumberof CentralAsiancountriessuchasGeorgiaandUzbekistanpovertyratesactuallyincreased.
ThegreatestchallengeisforUzbekistan,whichneedstoreducepovertyby2.5percentagepointsperyeartoreach the target; this rate is lower than thehistoricalrateachievedbysixof the11earlyachieversandontrackcountries.
Table A-1 also illustrates the scale of opportunityto reduce human deprivation if currently off trackcountries still manage to hit the target. On presenttrends, the currently off track countries would behometo577millionpoorin2015.Thisfigurewouldbe reduced by 163 million (or 28 per cent) if thecountriesmanagetoaccelerateprogresstotherequiredrate of progress (including reversing the trend forthe regressing countries). The contribution of 131million to this reduction in regional total by India isparticularlynotable.
Achievements in primary enrolment
There were only four countries (out of the 32 withdata) in the early 1990s with net primary enrolmentrates of less than 70 per cent: Bhutan, Pakistan,Solomon Islands and Timor-Leste; the progress oncurrenttrendsof eachof thesecountriesistooslowfor the target to be reached by 2015. Perhaps evenmoreworryingisthesituationintheMarshallIslands,whichsawprimaryenrolmentratesregressfromwellover80percenttobelow70percent.
ThesePacificIslandcountries,togetherwithPakistan,face thegreatest challenge to stillmeet the targetby2015,havingtoincreaseprimaryenrolmentbyatleastthreepercentagepointsperyear.
Oncurrent trends, almost 17million children inoff trackcountrieswouldnotbeattendingschoolin2015;thisnumberwouldbereducedtoalmostfourmillion,a difference of 13 million if the off track countriesmanage to hit the target by 2015. The payoff of Pakistan reaching the target would be tremendous.Onpresenttrends,thecountrywouldhaveoversevenmillionchildrenoutof school in2015.Thisnumberwouldbereducedby5.6millionif Pakistanisabletoachievethetarget.
Statistical appendix
39MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
Figure A-1 – Asia and the Pacific compared with Sub-Saharan Africa and latin America and the Caribbean
Source: Staff calculations based on the United Nations MDG database
40 PATHS TO 2015
STATISTICAl APPEnDIx
Figure A-2 – Progress in reducing extreme income poverty
Source: Staff calculations based on the United Nations MDG database
India 450,986 -1.69 319,665Uzbekistan 22,834 -2.52 4,728Bangladesh 65,359 -1.62 58,523Georgia 2,207 -1.12 92Philippines 17,055 -0.81 15,616SriLanka 2,804 -0.50 1,587Turkey 2,405 -0.07 1,599Nepal 11,699 -1.90 11,116LaoPDR 2,090 -1.24 1,957
Total 577,439 414,883
Table A-1 – Progress required for off-track countries to meet the $1.25/day poverty target
Source: Staff calculations based on the United Nations MDG database
Affectedpopulationin2015iftargetreached
(thousands)Country
Affectedpopulationin2015oncurrenttrend
(thousands)
Averageannualchangeneededtoreachtarget
(points)
|||||||
|||||
||
|||
||
||||||
MalaysiaTurkey
RussianFederationIran(IslamicRep.of)
KazakhstanGeorgia
ThailandSriLanka
AzerbaijanArmenia
KyrgyzstanMongolia
PhilippinesUzbekistan
TajikistanCambodia
India
LaoPDRChina
TurkmenistanVietNamPakistan
BangladeshNepal
0 10 20 30 40 50 60 70Percentageofpopulationbelow$1.25perday(%)
Earlyachiever Slow Regressing/Noprogress
| Target
Timor-Leste
On-track
41MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
Source: Staff calculations based on the United Nations MDG database
Achievements in basic sanitation
Thedifficulty that theAsia-Pacific regionasawholeand – with the exception of South-East Asia – thesubregions within it have to reach the target forsustainableaccesstobasicsanitationismirroredatthecountry level, as illustrated inFigureA-4.Thefigureshowsthatinagroupof 18countries–amongthe48countries for which data is available – less than onein two persons had access to basic sanitation in theearly1990s.Onlyfourof thesecountrieshaveeitherreached the target – Viet Nam and Myanmar – orareontracktodoso–LaoPDRandTimor-Leste.It
shouldbenotedthat in the last twocountriesaccessstoodataround50percent,whichislow.Allinall,30countriesintheregionareoff trackonthistarget.
TableA-3indicateswhat isrequiredof theoff trackcountries to still reach the basic sanitation target by2015,andwhatthiswouldmeanintermsof reduceddeprivation. In order to reach the target, countriessuchasIndia,Afghanistan,Nepal,PapuaNewGuinea,Cambodia, Azerbaijan, Mongolia and Micronesiawouldhavetoreducetheproportionof thepopulationwithout access to basic sanitation by a minimum of 3.5percentagepoints per year. In the caseof India,
Figure A-3 – Progress in expanding access to primary education
||||||||||||||||||||||||||||||||
BhutanPakistan
SolomonIslands
LaoPDRMacao,China
CambodiaIndia
MarshallIslandsTonga
AzerbaijanTurkey
BangladeshVanuatuGeorgia
Iran(IslamicRep.of)Armenia
BruneiDarussalamSamoa
KyrgyzstanKazakhstanPhilippines
MongoliaTajikistan
HongKong,ChinaIndonesiaMalaysiaMaldives
RepublicofKoreaFiji
KiribatiSriLanka
0 20 40 60 80 100Netenrolmentratioinprimaryeducation(%)
Earlyachiever O Slow Regressing/Noprogress
| Target
Timor-Leste
n-track
42 PATHS TO 2015
STATISTICAl APPEnDIx
Table A-2 – Progress required for off-track countries to meet the primary enrolment target
Source: Staff calculations based on the United Nations MDG database
Bangladesh 7,030 1.36 985Pakistan 7,067 4.13 1,430Philippines 1,830 0.41 741LaoPDR 163 1.80 46Cambodia 164 0.91 111Turkey 491 0.04 456Kyrgyzstan 55 0.57 27Fiji 34 0.79 6Timor-Leste 35 2.53 13SolomonIslands 26 3.50 5Armenia 15 0.26 11Macao,China 2 1.25 1Bhutan 6 1.10 6MarshallIslands 0 3.56 0
Total 16,918 3,838
Affectedpopulationin2015oncurrenttrend
(thousands)Country
Affectedpopulationin2015iftargetreached
(thousands)
Averageannualchangeneededtoreachtarget
(points)
thiswouldmeanthat284millionmorepeoplewouldhave access than if current trends were to continue.In Asia and the Pacific as a whole 1.2 billion wouldremainwithoutaccessin2015,ratherthan1.7billiononcurrenttrends,adifferenceof 516million.
number of people affected if targets are reached
Table A-4 provides a summary of the estimateddeprived population in the above two scenarios –current trends continue for the off-track countriesso the targets will be missed in 2015, or progress isaccelerated and these off-track countries reach thetargetin2015.Ascanbeseen,asmanyas892millionpeople in the Asian-Pacific region are projected toremain in extreme income poverty if current trendscontinue, including both countries that have madeprogressand reached the target aswell as those thatare off track. Accelerated progress in the off trackcountriesalonewouldreducethepovertyratesinthesecountriesbyasmuchas28percent,orasmuchas18percentof allthepoorintheentireregion,comparedto the scenario of business as usual. Similarly, if acceleratedprogresstakesplaceinexpandingprimaryenrolment in the off track countries, as many as 13million additional children in these countries wouldhave access to primary education, about half of thechildrenwhowouldremainoutof schoolinthewholeregionif currenttrendscontinue.
Impact of the global economic slowdown
As shown so far, unless accelerated progress takesplace,quiteanumberof countrieswillmissthetargetin2015.Thegeneralviewisthatthechallengetoreachthetargetsinthesecountrieshasbeencompoundedbytheglobaleconomiccrisis thatstarted in2008.Sincethemostrecentyearforwhichdataareavailableintheglobal MDG database is 2008, it is only possible toproject the likely impactof the economic slowdownon the progress towards achieving the MDGs. Suchprojections,however,havetheirowndifficulties.Chief among such difficulties is an accurate understandingof the determinants, including economic growth, of thevariousMDGs.Humandevelopmentoutcomesareinfluencedbyawiderangeof factors,includinginitialsocialandgeographicalconditions,policyinterventionsand,indeed,economicgrowth.
Despite such constraints, it is possible to explorehowprogresstowardsachievingtheMDGsmightbedifferentinthecontextof theglobaleconomiccrisis.To the extent that economic growth can createthe necessary conditions for achieving the humandevelopment outcomes, such projections can provideanindicationof howtheprogresstowardsvariousgoalsmightbeimpacted.
43MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
Figure A-4 –Progress in expanding access to basic sanitation
Source: Staff calculations based on the United Nations MDG database.
||
||
||||||||||
||||
|||||
|||
||||||||||||||||||||||
CambodiaNepalIndia
LaoPDRKiribati
PakistanAfghanistan
Micronesia(F.S.)SolomonIslands
IndonesiaBangladesh
VanuatuVietNam
ChinaPapuaNewGuinea
MyanmarMongolia
AzerbaijanPhilippinesDPRKorea
BhutanMarshallIslands
MaldivesPalau
SriLankaThailand
TuvaluIran(IslamicRep.of)
MalaysiaNorthernMarianaI.
TurkeyUzbekistan
RussianFederationArmenia
TajikistanKyrgyzstan
CookIslandsGeorgia
KazakhstanTonga
FrenchPolynesiaTurkmenistan
SamoaGuam
SingaporeRepublicofKorea
Niue
0 20 40 60 80 100
Earlyachiever Slow Regressing/Noprogress
| Target
Timor-Leste
Proportionofthepopulationusingimprovedsanitationfacilities(%)
On-track
44 PATHS TO 2015
STATISTICAl APPEnDIx
Source: Staff calculations based on the United Nations MDG database.
Table A-4 – Summary of estimated population in deprivation, alternative scenarios, thousands
Note: * Cumulative number of deaths from 2009 to 2015.Source: Staff calculations based on the United Nations MDG database.
Table A-3 – Progress required for off-track countries to meet the basic sanitation target
India 814,909 4.00 530,619China 550,279 2.21 411,819Pakistan 99,607 2.71 73,981Indonesia 97,999 2.07 81,804Bangladesh 68,900 2.00 57,822RussianFederation 17,938 0.93 8,969Afghanistan 19,995 3.93 12,157Iran(IslamicRep.of) 13,507 0.57 6,754DPRKorea 10,004 1.37 5,002Nepal 18,099 3.50 14,464PapuaNewGuinea 4,256 4.07 2,035Cambodia 9,585 3.64 7,443Azerbaijan 4,083 4.79 2,027Mongolia 1,426 3.50 728Turkey 6,689 0.29 6,397Kyrgyzstan 411 0.50 206SolomonIslands 395 3.30 209Georgia 234 0.43 82Armenia 294 0.57 188Bhutan 249 2.29 146Kazakhstan 408 0.14 326Turkmenistan 110 0.14 55Micronesia(F.S.) 88 3.95 40Vanuatu 107 2.21 90FrenchPolynesia 6 0.14 3Tonga 4 0.29 2Guam 2 0.07 1Kiribati 0 2.80 0MarshallIslands 0 1.29 0Tuvalu 0 0.86 0
Total 1,739,584 1,223,369
Affectedpopulationin2015oncurrenttrend
(thousands)Country
Affectedpopulationin2015iftargetreached
(thousands)
Averageannualchangeneededtoreachtarget
(percentagepoints)
$1.25perdaypoverty 577,439 414,883 892,170Underweightchildren 73,952 47,206 85,260Primaryenrolment 16,918 3,838 26,556Under-5mortality* 22,862 17,934 24,873Skilledbirthattendance 20,157 7,305 20,806Basicsanitation 1,739,584 1,223,369 1,786,637
Affectedpopulationin2015oncurrenttrend
Off-trackcountries TotalAsia-Pacific
IndicatorAffectedpopulationin2015oncurrenttrend
Affectedpopulationin2015iftargetreached
45MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
TableA-5summarizestheadditionalnumberof peopleestimatedtobeindeprivationindevelopingcountriesin Asia and the Pacific in 2015 due to economicslowdown.Theestimationwascarriedoutintwosteps.Inthefirststep,thestatisticalrelationshipbetweeneachof theindicatorsandGDPgrowthwasestimatedonthebasisof developmentsthusfar.TheInternationalMonetary Fund (IMF) regularly provides projectionsof anumberof economicindicators,includingGDPgrowth,fortheworld.
ItsforecastspublishedinApril2008wereconsideredto pre-date the global economic crisis. The mostrecentupdateof suchforecastswasinApril2010.Thedifference in the projected GDP for 2015 betweenthe two updates was considered as the impact of the economic crisis. Thus in the second step, thisdifference and the estimated statistical relationshipbetween GDP growth and development indicatorswerecombinedtoarriveattheprojectedimpactof theeconomicslowdownontheprogressasmeasuredbytheindicator.
Twopoints standoutwith regard to theseestimates.First,theyarerelativelysmallincomparisontonumberof estimated deprived population for the region if current trends continue, as shown inTableA-5.Forinstance,morethan892millionpeopleareestimated
toremaininextremeincomepovertyinAsiaandthePacific in 2015 in the scenario of business as usualand no accelerated progress takes place. In contrast,theeconomicslowdownisestimatedtotrap35millionpeople in extreme income poverty, which is notinsignificant but relatively small. This number is justone-fourth of the number of people who could beliftedoutof povertyinthecurrentlyoff-trackcountriesif measures are taken and their countriesmanage toachievethetargetin2015.
Second,theIMF’smostrecentforecastssuggestthatquiteanumberof countriesintheregionwillescapetheeconomicslowdownorthattheslowdownisnotasdeepasoriginallythought.Forinstance,of the41countries for which GDP growth estimates areavailable,for12themostrecentprojections(April2010)for2008-2015areactuallyhigherthantheApril2008projections. For 29 countries, the projections wererevisedupcomparedtothose inOctober2009.Thisispartlythereasonfortherelativelysmallnumberof affectedpeopleduetotheeconomiccrisis.
Theseresultssuggestthatmuchcanbegainedintheregion in reducing human deprivation if effectivepoliciesandprogrammesareputinplacesoastospeeduptheprogressinreachingthevariousMDGtargets.
$1.25perdaypoverty 34,555Underweightchildren 887Under-5mortality* 1,352Skilledbirthattendance 1,730Basicsanitation 70,218
Table A-5 – number of people projected to be in deprivation in 2015
Note: * Commutative number of deaths from 2009 to 2015.Source: Staff calculations based on the United Nations MDG database.
Additionalnumberofpeopleestimatedtobeindeprivationdue
toeconomicslowdown(thousands)Indicator
4� PATHS TO 2015
STATISTICAl APPEnDIx
Table A-� – Goal 1: Eradicate extreme poverty and hunger
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
Selected MDG Indicators
$1.25 per day poverty (%)
Earliest Latest
Underweight children (% under age 5)
Earliest Latest
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
60.2 (90) ... ... ... ...18.8 (95) ...48.6 (94)21.4 (05)55.7 (92) 2.0 (92) ...30.7 (91) ... 5.5 (92)52.9 (01)63.7 (93) ...66.8 (92) ...49.4 (94) 3.9 (90) ...68.4 (96)64.7 (91)15.0 (91) 2.1 (94)17.5 (96)15.6 (95) 4.5 (96) 4.2 (93)18.6 (93) 2.8 (93)44.5 (99)63.5 (93)32.1 (98) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
15.9 (05) ... ... ... ... 2.2 (08) ...25.8 (07)29.4 (07)44.0 (02) 2.0 (04) ...22.6 (06) ... 2.0 (04)37.2 (07)21.5 (06) ...49.6 (05)26.2 (03)41.6 (05) 2.0 (05) ...55.1 (04)22.6 (05)14.0 (02) 2.6 (06) 3.7 (07) 2.0 (05)13.4 (05) 2.0 (07) 3.4 (07) 2.0 (07)21.5 (04)24.8 (98)46.3 (03) ... ... ... ... ... ... ... ... ... ... ... ... ...35.8 (96) ... ... ... ... ...
19.1 (90) ... ...60.0 (98) ...12.3 (92) ...39.8 (93)34.0 (95)44.0 (93)23.3 (93)32.4 (90)33.5 (90) ...18.6 (93)42.6 (02)44.9 (94)48.0 (97)67.4 (92) ...53.4 (93)15.7 (95)38.9 (94)48.7 (95)40.4 (91)37.7 (93)10.4 (93) 3.9 (98)10.1 (96) 3.1 (99) 8.3 (95)11.0 (97) ...17.4 (05)12.0 (00)18.8 (96) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
6.9 (05) ... ...23.4 (04) ... 6.3 (05) ...35.6 (05)28.2 (03)37.1 (06) 8.1 (05)31.8 (03)27.6 (03) 3.4 (00) 9.3 (05)48.6 (07)20.2 (06)39.3 (04)46.3 (07)18.7 (99)47.8 (05) 5.2 (04)30.4 (01)45.0 (06)37.8 (02)29.4 (00) 2.8 (08) 4.0 (05) 9.5 (06) 2.1 (05) 4.0 (06) 3.4 (06) 3.0 (95)17.6 (07)11.0 (05) 5.1 (06) ...10.0 (97) 7.9 (93) ... ...13.0 (99) ...15.0 (97) ... ... ... ... ...26.4 (05) ... ... ... ...15.9 (07)
4�MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
Table A-� – Goal 2: Achieve universal primary education
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
Primaryenrolmentratio(%)
Earliest Latest
Reaching last grade(%)
Earliest Latest
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
...97.5 (01)81.1 (91) ...98.3 (99)95.7 (99)93.4 (91)83.4 (99)97.6 (91)77.5 (99)97.7 (99) ...95.5 (91) ...89.1 (08)68.9 (05)95.8 (99) ...90.5 (05)55.9 (99)85.0 (00)92.9 (99)97.9 (99)67.5 (99)57.0 (01)99.8 (01)90.4 (91)93.2 (01)88.8 (91)92.4 (04)94.8 (00)94.3 (99) ...96.7 (00) ...92.5 (07) ... ...98.7 (99) ... ...99.2 (99)88.1 (01) ... ... ... ... ...96.8 (99) ...94.2 (99)63.2 (03)88.2 (99) ...91.8 (99)
97.4 (91)97.9 (05)87.5 (09) ...99.0 (08)99.2 (08)97.3 (08)88.6 (08)98.7 (08)82.4 (08)96.1 (07) ...92.1 (08) ...90.1 (09)77.3 (08)94.5 (01) ...85.5 (08)88.4 (09)95.5 (07)99.7 (04)96.2 (08)73.6 (00)66.1 (08)99.5 (08)94.7 (08)92.9 (07)96.1 (08)99.0 (08)99.1 (08)91.0 (08) ...97.5 (08) ...90.6 (08) ...86.3 (99)89.5 (08) ... ...99.7 (02)66.5 (07) ...72.3 (07) ...98.5 (99) ...96.4 (00) ...94.1 (09)67.0 (07)99.2 (06) ...98.0 (05)
...99.3 (02) ... ...99.5 (99)87.2 (99)98.0 (03)48.6 (99)85.9 (01)54.3 (99)97.7 (02)55.2 (00)75.3 (01) ... ... ...82.8 (99) ... ...81.3 (99)62.0 (99)97.5 (00) ...58.0 (99) ...93.4 (05)97.8 (03)79.3 (01)96.6 (99)99.4 (99)95.9 (00)94.5 (99)94.8 (99)96.7 (99) ...99.5 (99) ... ...82.1 (99) ... ...69.7 (01) ... ... ... ... ... ... ... ...92.4 (99) ...94.6 (00) ...68.9 (99)
99.6(07)100.0(07) 99.6(08) ... 98.4(07) 94.9(07) 98.4(07) 54.4(07) 80.1(07) 66.8(07) 92.2(06) 73.9(07) 73.2(06) ... ... ... 92.1(05) ... 54.8(05) 90.1(08) 65.8(05) 87.8(02) ... 61.6(07) 69.7(04) 98.0(07) 94.2(07) 97.7(06) 98.4(08) 95.1(07) 99.0(08) 98.3(07) 95.2(07) 99.5(07) ... 98.7(07) ... ... 94.6(07) ... ... 81.4(03) ... ... 25.4(01) ... ... ... ... ... 95.9(00) ... 90.9(05) 62.6(01) 73.4(06)
Primarycompletionrate(%)
Earliest Latest
107.0(91)102.2(91) 96.4(99) ... 99.4(91) 90.0(99)100.0(91) 40.9(99) 93.5(91) 70.7(99) 91.0(91) 73.4(99) 87.5(99) ... 87.0(99) 70.5(07) 96.2(99) ... 59.5(00) 50.8(99) 69.9(99) 87.6(91)148.1(03) 51.1(91) 60.8(05)101.2(91) 90.1(91)100.8(01) 92.2(99) 85.8(99) 94.4(00) 95.2(99) 96.0(99) 95.1(99) ... 96.2(99) ... ...100.4(00) ... ...107.3(99) 97.5(99) ... 90.4(01) ... 85.4(99) ... 99.4(99) ... 95.3(99) ... 98.9(91)113.3(99) 85.2(99)
96.0(08) 95.3(05) 98.8(09) ... 98.7(08) 93.3(08)105.7(08) 79.5(08)106.4(08) 74.7(08) 96.0(07) 99.1(08) 92.3(07) ... 87.5(07) 79.8(08)102.3(01) 38.8(05) 54.5(08) 88.5(09) 93.6(07)116.8(07)112.9(08) 70.0(02) 60.3(08) 98.4(08) 93.4(08) 97.9(07)121.1(08) 99.7(08)106.1(09) 92.1(08) 95.2(08) 97.7(08) ... 94.7(08) ... 87.9(99) 91.8(08) ... ...124.8(05) 90.7(07) ... 79.0(07) ... 96.7(05) ...119.1(04) 46.5(91) 93.5(09) 72.1(91)104.9(06)105.3(06) 79.3(07)
48 PATHS TO 2015
STATISTICAl APPEnDIx
Table A-8 – Goal 3: Promote gender equality and empower women
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
Gender parity index inprimary
Earliest Latest
Gender parity index insecondary
Earliest Latest
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
0.92 (91)1.01 (91)0.96 (91) ...1.01 (91)1.02 (91)0.94 (91)0.87 (99)0.98 (91)0.79 (91)0.99 (91)0.95 (91)0.99 (91) ...0.98 (91)0.93 (04)0.93 (99)0.55 (91)1.04 (05)0.85 (99)0.76 (91)0.90 (91)1.00 (99)0.63 (91)0.68 (00)0.96 (91)0.93 (91)1.01 (01)0.99 (91)1.00 (91)1.01 (99)0.99 (99)1.00 (91)0.98 (91) ...0.98 (91) ... ... (...)1.00 (91) ... ...1.01 (99)0.98 (99)0.99 (04)1.16 (00) ...1.00 (99) ...0.93 (99)0.85 (91)0.98 (99)0.87 (91)0.98 (91)1.02 (99)0.96 (91)
1.04 (08)0.98 (05)0.95 (09) ...0.98 (08)0.99 (08)1.00 (08)0.94 (08)0.97 (08)0.91 (08)1.00 (07)0.99 (08)0.98 (08) ...0.98 (09)0.94 (08)0.95 (01)0.66 (08)1.06 (08)1.01 (09)0.97 (07)1.40 (08)0.94 (08)0.86 (02)0.83 (08)1.00 (08)0.97 (08)1.02 (08)0.99 (08)0.98 (08)1.00 (09)0.99 (08)1.00 (08)0.96 (08) ...0.98 (08) ...0.95 (99)0.99 (08) ... ...1.02 (07)0.97 (07)1.01 (07)1.06 (08) ...0.95 (05) ...1.02 (07)0.84 (06)0.98 (09)0.97 (07)0.97 (06)0.99 (06)0.96 (07)
0.75 (91)1.05 (91)1.11 (91) ...0.96 (91)1.14 (91)1.09 (91)0.53 (99)0.83 (91)0.69 (99)1.05 (91)0.97 (91)1.09 (99) ...0.99 (91)0.99 (04)0.90 (99)0.51 (91)0.98 (99)0.81 (99)0.70 (99)0.75 (91)1.09 (99)0.46 (91)0.48 (91)1.09 (91)0.62 (91)1.12 (91)1.01 (91)0.97 (91)1.00 (99)1.02 (91)1.00 (03)0.86 (99) ... (...)0.98 (99) ... ... (...)0.97 (91) ... ...1.18 (99)1.06 (99)1.05 (04)1.21 (00) ...1.10 (99) ...1.07 (99) ... (...)1.10 (99)0.61 (91)1.03 (91) ... (...)0.80 (91)
Gender parity index intertiary
Earliest Latest
1.05 (08)1.02 (08)0.96 (09) ...0.96 (08)1.08 (08)1.02 (08)0.82 (07)0.99 (08)0.81 (08)1.07 (07)1.01 (07)1.09 (08) ...1.09 (09)1.00 (05)0.92 (01)0.38 (07)1.05 (07)0.99 (09)0.86 (07)0.98 (08)1.05 (06)0.89 (06)0.76 (08)1.02 (04)0.89 (08)1.05 (08)0.98 (08)0.96 (08)0.98 (09)1.01 (08)0.97 (08)0.87 (08)1.02 (91)0.98 (08) ...1.08 (99)1.07 (08) ... ...1.20 (07)1.02 (07)1.07 (05)1.23 (08) ...1.07 (05) ...0.97 (07)0.62 (91)1.13 (09)0.84 (07)1.03 (06)0.93 (01)0.86 (04)
0.83 (03)0.96 (03)0.48 (91) ...0.49 (91)1.89 (91)1.04 (91)0.34 (00)0.76 (01)0.49 (99)1.02 (99) ... (...)1.26 (99) ...0.94 (91)1.27 (02)0.76 (99)0.28 (03)0.49 (99)0.58 (99)0.54 (91)0.40 (91)2.41 (03)0.33 (91)0.81 (02) ... (...)0.53 (91)1.05 (91)0.67 (91)0.91 (91)1.15 (99)1.04 (99)1.27 (91)0.35 (99) ... (...)0.82 (99) ... ...1.20 (03) ... ... ...1.29 (01) ... ... ... ... ...2.35 (00) ... (...)1.04 (99) ...1.30 (99) ...0.57 (02)
1.04 (08)1.02 (07)0.91 (08) ...0.69 (08)1.57 (08)1.99 (08)0.54 (08)0.92 (08)0.78 (08)1.29 (07)1.37 (07)1.24 (08) ...1.24 (09)0.71 (09)0.73 (01)0.28 (04)0.55 (07)0.59 (08)0.70 (07)1.14 (08)2.40 (04)0.40 (04)0.85 (08)0.48 (91)0.78 (08)1.20 (07)0.83 (08)1.19 (08)1.45 (09)1.36 (08)1.36 (08)0.40 (08)1.15 (91)0.68 (08) ... ...1.20 (05) ... ... ...1.30 (03) ... ... ... ... ...2.15 (02)0.55 (99)0.93 (01) ...1.62 (04) ...0.59 (04)
49MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
Table A-9 – Goal 4: Reduce child mortality
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
Under-5 mortality rate(per1,000livebirths)
1990 2008
Infantmortalityrate(per1,000livebirths)
1990 2008
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
46 ... ... 55 9 98 11117 86157 18120 61 7 32184 56260149148116 73111142130 29 84 56 98 47 60 75 27117 99 74 ... 18 22 ... ... 89 49 58 21 (95) ... ... ... 21 91 50 38 23 53 27
21 ... ... 55 5 41
7 90 41 61 6 98 32 3 14 93 14
257 54 81 69 32 28 51 89 15 22
23 36 30 30 38 13 64 48 38
... 15 18 ... ... 48 36 39 45 ... ... ... 15 69 26 36 19 36 33
37 ... ... 42 8 71 9 85 56108 16 85 42 6 26 138 39168103 91 83 55 79 99101 23 69 48 78 41 51 63 23 91 81 61 ... 16 19 ... ... 65 39 45 19 (95) ... ... ... 18 67 40 31 19 42 23
18 ... ... 42 5 34
6 69 31 48 6 71 26 2 13 75 12
165 43 54 52 27 24 41 72 13 20
21 32 26 27 33 12 54 43 34
... 14 16 ... ... 38 30 32 36 ... ... ... 13 53 22 30 17 30 27
50 PATHS TO 2015
STATISTICAl APPEnDIx
Table A-10 – Goal 5: Improve maternal health
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
Skilled birth attendance(%)
Earliest Latest
Antenatal care (≥ 1 visit)(%)
Earliest Latest
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
94.0(90) ... ... 98.0(90) ... 93.6(98) 98.0(94) 34.0(98) 40.7(90) 19.4(01) 92.8(90) 46.3(91) 52.8(93) ... 99.3(00) 25.8(97) 77.1(97) 12.4(00) 9.5(94) 14.9(94) 34.2(93) 86.1(97) 90.0(94) 7.4(91) 18.8(91) 94.1(93) 75.9(93) 96.4(97) 99.8(98) 96.6(90) 99.6(95) 98.1(97) 99.2(90) 79.0(96) 95.8(96) 97.5(96) ... 99.0(91)100.0(98) ... ... 72.0(94) 94.9(98) 92.8(99) ... ... 99.0(90) ... 99.0(90) 53.2(96) 76.0(90) 85.0(94) 92.0(91)100.0(90) 87.0(94)
98.4(07) ... ... 97.1(04)100.0(97) 99.2(06) 99.0(99) 43.8(05) 79.4(07) 20.3(06) 98.0(05) 57.0(01) 61.8(08)100.0(98) 97.3(06) 18.4(03) 87.7(06) 14.3(03) 18.0(07) 71.4(07) 46.6(06) 97.3(05) 84.0(04) 18.7(06) 38.8(07) 98.5(07) 91.3(08) 99.9(07) 88.0(06) 98.3(05) 99.8(06) 97.6(06) 99.5(06) 88.4(07) 99.5(06) 99.9(06) ... 98.0(01) 99.0(00) ... ... 63.0(05) 86.2(07) 87.7(01) 97.4(07) ...100.0(06) ...100.0(02) 53.0(06)100.0(98) 70.1(07) 95.0(01) 97.9(07) 74.0(07)
78.7 (95) ... ... ... ...89.8 (98) ...34.3 (98)76.3 (91)26.5 (01)73.6 (03)75.8 (97)83.1 (93) ...85.9 (96)70.9 (97)70.6 (97)36.9 (00)25.7 (94)51.0 (00)61.9 (93)76.5 (97) ...15.4 (91)25.6 (91)80.2 (93)62.3 (93)82.0 (97)98.3 (97)74.0 (97)92.5 (95)97.3 (97) ...71.3 (00)98.1 (00)94.9 (96) ... ... ... ... ... ... ... ... ... ... ... ... ...77.5 (96) ... ... ... ... ...
90.9(07) ... ... ... ... 98.9(05)100.0(94) 69.3(05) 93.3(07) 35.1(06) 78.8(05) 75.6(01) 91.0(08) ... 97.8(06) 60.5(03) 90.8(06) 16.1(03) 51.2(07) 88.0(07) 74.2(06) 98.3(05) 81.0(01) 43.7(06) 60.9(07) 99.4(07) 92.0(08) 93.0(05) 76.6(06) 94.3(05) 99.9(06) 96.9(06) ... 88.8(07) 99.1(06) 99.0(06) ... ... ... ... ... 88.0(94) 81.2(07) ... 94.5(07) ... ... ... ... 78.8(06) ... 73.9(07) ... 97.4(07) 84.3(07)
51MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
Table A-11 – Goal �: Combat HIV and AIDS, malaria and other diseases
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
HIV prevalence(% ages 15-49)
2001 2007
TB incidence rate(per100,000)
1990 2008
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
0.1 ... ... 0.1 0.1 0.1
... 1.8 0.1 0.1 0.3 0.9 0.1 0.1 1.7 ... 0.3
... 0.1 0.1 0.5 0.1 0.1 0.5 0.1 0.1 ...
0.1 0.1 0.1 ... 0.1 0.5 0.1 ... 0.1
... ... 0.1 ... ... ... ... ... ... ... ... ... ... 0.3 ... ... ... ... ...
0.1 ... ... 0.1 0.1 0.1
... 0.8 0.2 0.2 0.5 0.7 0.1 0.2 1.4 ... 0.5
... 0.1 0.1 0.3 0.2 0.1 0.5 0.1 0.1 ...
0.1 0.2 0.1 ... 0.1 1.1 0.3 ... 0.1
... ... 0.1 ... ... ... ... ... ... ... ... ... ... 1.5 ... ... ... ... ...
120140120340190210 70590190180120400390 66140500200190220310170 36150160230 66 58 33110110140140110 92 64130 21 0 51 38 52 (92)510300190 85100 59 80 64250 32310 34300140
TB prevalence rate(per100,000)
1990 2008
97 91 78340 88210
65490190150100400280 39140500200
190220160170 20 42160230 66 30
73110110180160110200 68130
3 20 20 22 58360210 93 12 21 0 38 63250 18120 24160 74
260 120 100 890 170 410
551,400 460 410 1801,1001,000 43 180 620 380
280 550 380 340 48 270 350 660 96 53
47 230 240 230 270 230 160 20 260
29 1 59 38 111,200 750 94 44 88 180 64 83 550 21 630 39 76 82
88 58 49270 50140
43680210260120470550 27160660280
270410 96190 23 13170310 73 22
67140 42 98140 69330 18190
1 32 25 6 61110 59 34 10 10 0 11110130 36150 22 44 88
52 PATHS TO 2015
STATISTICAl APPEnDIx
Table A-12 – Goal �: Ensure environmental sustainability
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
Forestcover(%landarea)
1990 2005
Protectedarea(%territorialarea)
1990 2009
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
16.8 a ... ...68.164.5 7.359.473.364.375.068.159.635.5 3.431.265.028.8 2.0 6.864.621.5 6.8 3.033.7 3.336.412.612.311.339.7 1.3 4.447.92.9 8.8 7.491.963.953.628.747.1 3.0 ...90.6 ...39.266.275.382.969.645.998.9 5.033.336.1
21.2 a ... ...51.463.5 6.552.859.248.869.963.649.024.0 3.428.453.739.7 1.3 6.768.022.8 6.8 3.025.4 2.529.913.210.011.339.7 1.2 4.547.9 2.9 8.8 8.089.466.554.728.747.13.0...90.6...39.254.272.487.665.060.477.65.033.336.1
13.0741.09 ... 2.71 3.29 4.10
23.57 0.03 3.96 0.8413.57 2.58 1.86 2.5912.45 0.00 3.12
0.43 1.2814.25 4.79 5.06 ... 7.69 9.9913.35 1.78
6.93 6.18 2.55 2.40 6.36 7.82 1.94 2.99 2.12
2.02 0.00 0.15 0.01 3.29 0.34 0.00 0.06 ... 1.06 0.00 0.03 0.45 0.93 0.94 0.01 0.01 0.00 0.39
CO2emissions(metrictonspercapita)
1990 2007
16.0641.79 ... 2.73 3.5413.39
28.3922.16 6.3916.3214.50 5.20 3.29 3.5516.92 6.36 4.85
0.43 1.4628.35 5.12 6.84 ...17.0010.0014.48 1.94
7.99 7.15 3.39 2.52 6.94 9.02 4.14 2.99 2.26
2.03 0.05 0.18 0.07 3.5620.21 0.62 0.09 ... 1.10 1.86 0.08 4.80 1.37 1.18 0.12 2.53 0.19 0.47
2.15 4.85 2.7812.15 5.62 4.5324.98 0.05 0.84 0.06 3.13 0.10 0.7115.56 1.69 0.19(02) 0.32 0.21 0.13 0.23 0.80 4.00 0.71 0.03 0.59 0.22 2.69 1.07(92) 5.93(92) 2.87(92)15.90(92) 2.47(92)13.96(92) 3.86(92) 7.23(92) 5.30(92) ... 1.24 1.13 3.23 ... 0.31 1.02 0.51(99)14.43 9.49 1.74 ...15.74 0.52 0.77 0.51 0.81 ... 0.47
4.92 5.75 3.03 2.9810.49 4.05
19.76 0.31 1.77 0.25 7.32 0.27 0.8012.08 4.14 0.17 1.29
0.03 0.28 0.86 1.38 6.85 2.99 0.12 0.90 0.62 3.95
1.65 3.68 1.3814.76 1.1410.83 1.07 9.20 4.32
... 3.38 1.74 3.08 ... 0.35 1.67 0.5614.0911.75 2.57 ...10.49 0.52 0.90 0.40 1.71 ... 0.45
53MDG PRIORITIES In ASIA AnD THE PACIFIC
STATISTICAl APPEnDIx
Table A-13 – Goal �: Ensure environmental sustainability
Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.
ODPsubstanceconsumption(ODPmetrictons)
Earliest 2008
Safe drinking water(%population)
1990 2008
East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu
59,674.0 (90) ... ... 192.0 (91) 0.0 (91) 0.0 (91) 0.0 (91) 0.0 (91) 80.8 (91) 0.0 (90) 4,193.7 (90) 16.6 (92) 3,477.2 (90) 4,855.2 (90) 6,984.2 (90) 0.3 (91) 430.0 (91) 0.0 (91) 202.1 (90) 0.0 (91) 0.0 (90) 1,393.9 (90) 4.5 (90) 25.0 (91) 1,455.8 (90) 218.2 (90) 4,361.0 (90) 0.0 (91) 2.8 (91) 94.8 (91) 2,355.9 (90) 133.5 (91)130,578.5 (90) 93.3 (91) 145.2 (90) 4.4 (91) ... 0.1 (91) 41.8 (90) ... ... 0.0 (91) 1.2 (90) 0.0 (91) 0.0 (91) ... 0.0 (91) ... 0.0 (91) 28.5 (91) 4.0 (91) 2.1 (90) 0.4 (91) 0.0 (91) 0.0 (91)
67 ... ... 100 90 (95) 58 ... 35 71 44 (95) 88 57 84 100 91 52 (00) 58 3 (95) 78 91 (00) 72 91 90 76 86 67 85 92 (95) 70 81 96 78 (95) 93 58 (95) 83 (95) 90 ... 94 ... 100 100 48 95 89 ... ... 100 98 81 41 91 69 (95) 100 (95) 90 57
Basic sanitation(%population)
1990 2008
89 ... ... 100 98 76 ... 61 80 57 100 71 91 100 98 69 94 48 80 92 88 93 (00) 91 88 90 90 99 96 80 98 95 90 96 70 84 (05) 87 ... 95 (05) ... 100 100 64 (05) 94 94 (05) ... ... 100 98 84 (05) 40 88 (05) 70 (05) 100 97 83
41 ... ... 59(95) 100 49(95) ... 9 33 18(95) 84 49(95) 58 99 80 32(00) 35 29(95) 34 62(00) 18 83 69 11 28 70 84 88(95) 57(95) 96 96 93(95) 87 89(95) 98 84 ... 96 ... 98 99 26 64 29 ... ... 100 84 69 47 98 30(95) 96 80 35(95)
55 ... ... 59 (00) 100 50 ... 29 52 53 96 81 76 100 96 50 75 37 53 65 31 83 (00) 98 31 45 91 90 90 45 95 97 93 87 94 98 100 ... 100 ... 98 99 35 (05) 73 25 (05) ... ... 100 94 (05) 83 (05) 45 100 32 (05) 96 84 52
17,386.3 ... ... 91.2 4,050.2 2.6 7.6 9.3 299.9 3.6 571.2 2.0 397.4 149.5 1,197.5 2.7(07) 277.5 47.9 223.1 0.1 2,904.9 508.6 3.7 1.4 356.9 10.3 762.5 18.4 0.8 5.9 128.8 12.4 1,457.6 3.9 10.1 2.3 ... 0.0 4.8 ... ... 0.2 0.2 0.2 0.0(07) ... 0.0 ... 0.1 1.5 0.1 1.2 0.2 0.0 1.0
54 PATHS TO 2015
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ADB (2008). The emerging Asian Regionalism, Manila,ADB.
ADB/JBIC/WorldBank (2005).Connecting East Asia: A New Framework for Infrastructure.Manila,ADB.
ADBI/ADB (2009). Infrastructure for a seamless Asia.Tokyo,ADBI/ADB.
Banerjee,A.andE.Duflo. (2006).The Economic Lives of the Poor.MITDepartmentof EconomicsWorkingPaperSeries.No.06-29.
Chand, R. (2008). “The State of Indian AgricultureandProspectsfortheFuture”,inKanchanChopraandC.H.HanumanthaRao(Ed)Growth Equity, Environment and Population,NewDelhi,SagePublicationsIndia.
Chatterjee, S., A. Mukherjee and R. Jha (2010).Approaches to Combat Hunger in Asia and the Pacific, Sustainable Development Working Paper Series. No.11,August.Manila,ADB.
Chatterjee, S. et.al. (2004) Scaling up Poverty Reduction Potential of Infrastructure Projects: Lessons From the Asia Pacific Region,Manila,ADB.
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Printed in BangkokSeptember 2010
United Nations publicationSales No. E.10.II.F.20Copyright © United Nations 2010ISBN: 978-92-120618-0
www.unescap.org www.undp.orgwww.adb.org
There are only five years left to reach 2015 in achieving the MDGs. World leaders are once again gathering at
the United Nations High-level Plenary Meeting on the MDGs in September 2010 in New York to assess some
of the likely outcomes on present trends, identify some of the weakest areas of performance, and identify
priorities for accelerated action.
This report on Paths to 2015 is the Asia-Pacific region’s contribution to that assessment. It uses the latest
information from the United Nations MDG database to assess which countries and subregions are likely to
miss or achieve the Goals. It attempts to encapsulate and update the discussions and recommendations of
the earlier reports on MDGs, jointly published by ESCAP, ADB and UNDP since 2004. It looks at some of
the key drivers which have propelled MDG achievement in the region, and which are likely to remain as
important as before in the region’s quest for reaching the Goals by 2015. It focuses specifically on three areas
where increased and sustained policy attention would be required: hunger and food security; health and
basic services; and basic infrastructure – areas where many of the countries in the region appear to be
facing significant challenges.
This report is the fifth in the series published by ESCAP, ADB and UNDP on MDG achievement. It is a resource
which policy makers, development practitioners and other stakeholders should find useful in addressing
the remaining challenges in achieving the MDGs.