i

Asia-Pacific

MDG Study Series

Promoting the Millennium Development Goals in Asia and the Pacific: Meeting the Challenges of Poverty Reduction (2003) A Future Within Reach: Reshaping Institutions in a Region of Disparities to Meet the Millennium Development Goals in Asia and the Pacific (2005) Asia Water Watch 2015: Are Countries in Asia on Track to Meet Target 10 of the Millennium Development Goals? (ADB, 2005) Achieving the MDGs in Asia: Policies and Strategies for Institutional Development in Population and Reproductive Health (UNFPA, 2005) The Role of Population and Reproductive Health Policy in Reaching the Millennium Development Goals in East and South-East Asia (UNFPA, 2005) Pursuing Gender Equality through the Millennium Development Goals in Asia and the Pacific (ADB, 2006) Achieving the MDGs in Asia: A Case for more Aid? (2006) The Millennium Development Goals: Progress in Asia and the Pacific 2006 Access to Basic Services for the Poor: The Importance of Good Governance (2007) Achieving the Health Millennium Development Goals in Asia and the Pacific: Policies and Actions within Health Systems and Beyond (2007) The Millennium Development Goals: Progress in Asia and the Pacific 2007

Unless otherwise indicated, the studies in this series have been published by the ESCAP/ ADB/UNDP joint project on MDGs in Asia and the Pacific.

iii

The Millennium Development Goals: PROGRESS IN ASIA AND THE PACIFIC 2007

Asia-Pacific MDG Study Series

2007

ii iv

ST/ESCAP/2465
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. The views expressed in this publication are those of the authors and do not necessarily reflect the views and policies of the United Nations and the Asian Development Bank, its board of Directors, or the governments they represent. This publication has been issued without formal editing. Mention of firm names and commercial products does not imply endorsement of the United Nations.

For further information on the materials contained in this document, please contact: Mr. Pietro Gennari Director Statistics Division United Nations Economic and Social Commission for Asia and the Pacific United Nations Building Rajadamnern Nok Avenue Bangkok 10200, Thailand Email: stat.unescap@un.org This report can be downloaded from the Millennium Development Goals Asia-Pacific website at http://www.mdgasiapacific.org Readers are encouraged to provide feedback by email: stat.unescap@un.org or by using the readership survey questionnaire available online.
Printed in Bangkok October, 2007

Preface

For the Millennium Development Goals 2007 is a critical year half way towards the target date of 2015. This is therefore a good point to take stock. Are we at least half way towards meeting the goals? This report addresses this question for the Asia-Pacific region, assessing how successful we have been in moving towards each of the goals and their associated targets, and signalling what would be required to turn this historical moment into an historical opportunity to fulfil the spirit and the promises of the Millennium Declaration. This update is the latest in a series of regional progress reports. It builds on earlier assessments: A Future within Reach (2005) and The Millennium Development Goals: Progress in Asia and the Pacific, 2006. In addition, this report has a special focus on disparities identifying some of the groups that are not sharing fully in national progress, and advocating for inclusive growth. The report has been prepared on a tripartite basis between ESCAP, ADB and UNDP an initiative that allows the agencies to speak with a common voice on the MDGs, helping to establish a consolidated regional platform that can support clear and mutually consistent plans of action. We hope that this systematic cross-regional view in this report will serve as a reference point allowing countries to compare their progress with other parts of the region, so that they, along with international, regional and national organizations, can then look behind the numbers, identifying the causes of uneven progress, both between and within countries, and exploring the necessary institutional and policy changes. As this report shows, some of the poorest countries in the region have been able to make significant advances, even in the most difficult circumstances. With sufficient determination and commitment, these experiences can be replicated across all countries and across all the goals so that everyone benefits from MDG progress ensuring that no-one is left behind.

Acknowledgement
The Millennium Development Goals: Progress in Asia and the Pacific 2007 is a joint effort by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP), the Asian Development Bank (ADB), and the United Nations Development Programme (UNDP). The preparation of the report was led by Haishan Fu (ESCAP), Shiladitya Chatterjee (ADB) and Omar Noman (UNDP) who together provided overall direction and coordination. The ESCAP team that prepared this publication includes Pietro Gennari (Director, Statistics Division), Haishan Fu (Project leader), Jan Smit (Advisor), Peter Stalker (Editor), Laksanawadee Klawploadtook (Lay-out design); research and statistics group consisting Sara Duerto, Julie Gotoh, Eric Hermouet, Wei Liu, Andres Montes, Christian Stoff and Yichun Wang with valuable assistance from Daniel Clarke, Margarita Guerrero, Supharat Kaewkhonkaen, Minyoung Kim, Nixie Mabanag, Fabio Pinna, Panpaka Supakalin and Ilpo Survo. The ESCAP/ADB/UNDP partnership gratefully acknowledges substantive inputs received from Herve Berger, Tiziana Bonapace, Jorge Carrillo, Daewon Choi, Edgar Dante, Vanessa Griffen, Aynul Hassan, Masakazu Ichimura, Ritu Kumar, Hak-Fan Lau, Mia Mikic, Syed A.M. Nuruzzaman, Atsuko Okuda, Ying Qiu, Hitomi Rankine, Ravi Ratnayake, Hiren Sarkar, Marie Sicat, Shamika N. Sirimanne, Vanessa Steinmayer, Sirinvas Tata, Le Huu Ti, Kioe Sheng Yap, and Mann Yari from ESCAP; Armin Bauer, J. Salcedo Cain, Michelle Domingo, Rana Hasan, Jacques Jeugmans, David McCauley, Francesco Tornieri and Kallidaikurichi Easwaran Seetharam from ADB; Patricia Alexander, Ricardo Fuentes, Claes Johansson, Christopher Kuonqui, B. Murali and Longyun Peng from UNDP; Anna Azaryeva, Attila Hancioglu and Bastiaan vant Hoff from UNICEF; Ryce Chanchai from the Millennium Campaign; Noureddine Abderrahim, Bridgette James, Guillermo Rojas, and Shea.O. Rustein from Measure DHS, Macro International Inc.; Ericka Rascon from IADB; and Mabel Andalon from Cornell University. The partnership also wishes to thank the following people who provided special assistance with the production of regional aggregates for the MDG indicators and other related data issues: Valentina Stoevska from ILO; Gerald Haberkorn from the Secretariat of the Pacific Community; Karen Stanecki and Sherrie Kelly from UNAIDS; Said Belkachla, Weixin Lu and Jose Pessoa from UNESCO Institute for Statistics; Xiadong Cal, Me Me Khine, Nyein Nyein Lwin, Maryanne Neill and Tessa Wardlaw from UNICEF; Francesca Coullare, Joanna Labos and Francesca Perucci from UNSD; Carla AbouZahr, Ties Boerma, Katherine Floyd, Lale Say and Suzanne Scheele from WHO; Shaohua Chen, William Prince, Changqing Sun, Eric Swanson and Adam Wagstaff from World Bank; and Gareth Jones, an independent consultant. Additional assistance was provided by Krisana Boonpriroje, Nobuko Kajiura, lmae Ann Mojado, Aphitchaya Nguanbanchong, Varaphorn Prapatsakdi, and Prapapan Treeratpituk.

Table of contents
Preface Acknowledgement Table of contents Executive Summary Part 1: MDG progress in Asia and the Pacific A regional snapshot The scale of the opportunity Goal 1 Eradicate extreme poverty and hunger Reduce extreme poverty by half Reduce hunger by half Goal 2 Achieve universal primary education Goal 3 Promote gender equality and empower women Goal 4 Reduce child mortality Goal 5 Improve maternal health Goal 6 Combat HIV and AIDS, malaria and other diseases Halt and begin to reverse the spread of HIV and AIDS Halt and begin to reverse the spread of malaria and other diseases Goal 7 Ensure environmental sustainability Halve the proportion of people without access to safe drinking water Halve the proportion of people without access to basic sanitation From red to green Part 2: Beyond national averages Growing inequality Surviving the first five years Ensuring that children are well nourished The drive for clean water Access to improved sanitation Epilogue: Towards a global partnership Bibliography Index to MDG indicators MDG Indicator tables Technical note MDG progress classification Regional and country group aggregates Within country disparities Classification of countries Key to country codes v vi vii 1 3 3 4 7 9 10 12 13 14 16 19 20 20 21 24 25 26 28 30 31 33 52 52 53 54 55 56

Tables 1-1 1-2 1-3 1-4 2-1 A B Figures 1-1 1-2 1-3a 1-3b 1-4a 1-4b 1-5a 1-5b 1-6a 1-6b 1-7 1-8 1-9a 1-9b 1-10a 1-10b 1-10c 1-11a 1-11b 2-1 2-2 2-3 2-4 2-5 2-6 2-7 2-8 2-9 2-10 2-11 Boxes 1-1 1-2 1-3 1-4 1-5 1-6 2-1 The need for complete and consistent data Timor-Leste: towards education for all Improving data on gender Afghanistan: progress against all odds The rise in environmental poverty The rights to safe water and basic sanitation Health disparities in China 6 9 11 11 16 19 22 People deprived in Asia-Pacific, selected indicators, 1990 and latest year Progress and number of people affected, by region, 1990 and latest year Population living on less than $1/day, by region and country group, 2004 Population living on less than $1/day, by country, latest year Under-five children underweight, by region and country group, 2005 Under-five children underweight, by country, latest year Primary enrolment, by region and country group, 2005 Primary enrolment, by country, latest year Under-five mortality, by region and country group, 2005 Under-five mortality, by country, latest year Maternal mortality, 2000 People living with HIV, 15-49 years old, 2005 Tuberculosis prevalence, by region and country group, 2005 Tuberculosis prevalence, by country, latest year Population with access to improved water sources, rural, by region and country group, 2004 Population with access to improved water sources, urban, by region and country group, 2004 Population with access to improved water sources, urban, by country, latest year Population with access to basic sanitation, rural, by region and country group, 2004 Population with access to basic sanitation, rural, by country, latest year Changes in the Gini Index, 1990s-2000s Under-five mortality rates, urban and rural trends Under-five mortality rate by wealth quintile and the ratio of lowest to highest quintile, latest year The Philippines, under-five mortality rates by residence and wealth quintile, 2003 Proportion of underweight children under-five by wealth quintile, latest year India, underweight children under-five, by residence and wealth quintile, 1999 Access to improved water sources, between 1990 and 2004, by residence Cambodia, access to improved water sources, by residence and wealth quintile, 2000 Access to improved sanitation, urban and rural, 2004 Access to improved sanitation, rural areas, by wealth quintile, latest year Indonesia, access to improved sanitation, by residence and wealth quintile, 2003 4 5 7 7 8 8 9 9 12 12 13 14 15 15 17 17 18 18 18 21 22 23 23 24 24 25 26 26 26 26 Country groups on and off track for the MDGs Maternal mortality ratio and births attended by skilled personnel Malaria prevention and treatment, percentage of under-five children Proportion of urban population living in slums, 10 highest $1/day poverty rates, 1990s-2000s Countries on and off track for the MDGs Data by region and country group 4 13 15 18 21 33 34

Executive summary

1
This report on progress towards the MDGs in Asia and the Pacific has two parts. Part 1 assesses whether countries are on or off track for the various indicators. Part 2 examines disparities within countries. Overall, much of the news is good. Asia and the Pacific is one of the worlds most dynamic regions, and has been forging ahead on many of the MDGs. The main conclusions of the report are: Extreme poverty The region as a whole is on track to reach the target of reducing extreme poverty by half. China, the largest early achiever, has been leading the way and a number of other countries have also hit the target already, but the Least Developing Countries are making slow progress. Children underweight On this indicator, the picture is more mixed. A high number of countries in South Asia and South-East Asia are advancing too slowly. Primary education Here the situation is more encouraging - the region as a whole is on track to achieve the goal. Although South Asia without India is making slow progress, it will nevertheless come quite close to it by 2015. Gender parity in primary enrolment This is another relatively successful area: the region is well on its way towards gender parity at primary and secondary levels and in some cases girls are ahead of boys. Under-five mortality Many more children are surviving beyond their fifth birthday, and SouthEast Asia as a whole is on track, though some countries are advancing too slowly and there are many CIS countries of concern. HIV and AIDS There has been progress in many countries, but a number in North and Central Asia are regressing. Around 6 million people are living with HIV, which represents over a million of new infections over the past two years. Tuberculosis The prevalence and death rates of TB have been falling across the region but rising throughout the CIS countries. Deforestation Many countries are still losing forest cover at alarming rates, particularly the least developed countries in South-East Asia and the Pacific this and rising energy use are also contributing to higher emissions of carbon dioxide. Water and sanitation The region is making slow progress in improving water supplies in urban areas, but doing better in rural areas due largely to rapid progress in South Asia. For sanitation, coverage in most countries lags behind that for water, particularly in rural areas. Since this region is home to 61 per cent of world population the number of those affected is often large. So along with headline trends it is also useful to consider some headline numbers. For example, Asia and the Pacific accounts for 75 per cent of the worlds rural population and 63 per cent of the urban population who do not have access to safe sanitation 1.9 billion in total. We also have quite high shares of people suffering from TB and of underweight children. In addition despite the regions success in reducing poverty we still have 641 million people living on less than $1 per day. The region therefore still faces quite a challenge. Most of the developing countries can point to success in some of the goals, but none is on course to achieve all of them. Of even greater concern, the Asia-Pacific region also includes a number of countries that on present trends are likely to miss many, even most, of the MDGs. Those with the greatest difficulties are often the Least Developed Countries and some of the Landlocked Developing Countries and Small Island Developing States. Part 2 of the report looks at trends in intracountry disparities. One of the most striking developments it notes is the rise in income inequality: in the past decade or so, out of 20 countries in the region, 14 saw inequality rise, while only six saw it
Executive Summary

fall.

This pattern is also reflected in uneven progress towards a number of the MDG goals. The chances of children surviving beyond their fifth birthday, for example, differ significantly according to which part of a country they are born in and to what type of household. Under-five mortality rates are typically far higher in rural than in urban areas, often by over 50 per cent, and these rural-urban gaps have persisted. Moreover in both rural and urban areas, the children least likely to survive are those in the poorest households. The poorest 20 per cent of households typically account for considerably more than 20 per cent of a countrys child deaths for some countries, around 30 per cent. It is possible in some countries to combine these data revealing that the poorest rural quintile can be four times more likely to die than those in the richest urban quintile. A similar pattern is evident for under-five nutrition. Children in the rural areas, and those in the poorest households, are twice as likely to be underweight as those in the urban areas or in the richest households. Households in rural areas are also more deprived when it comes to supplies of safe water. In urban areas, coverage is often above 90 per cent,

but rural areas often lag by 10 to 20 percentage points. Nevertheless there are still serious problems for urban households as a large influx of migrants to cities has caused urban coverage to fall. For basic sanitation, for which provision is lower than that for safe water, the rural-urban gaps can be wider, with rural coverage sometime less than half that in urban areas. Even so there can also be stark contrast within urban areas with very low sanitation coverage in the poorest districts. In the epilogue the report considers the eighth Millennium Development Goal which seeks to build a global partnership for development, complementing the efforts of national governments for mobilizing resources by providing more equitable access to opportunities for trade, growth and development. It emphasizes in particular the value of such a partnership for supporting the regions LDCs. The report concludes by pointing out that the Asia-Pacific region has been setting the pace for the developing world, particularly in economic growth but that it has now the opportunity to focus again on equity, and extend the benefits of rapid economic and social development to all its people.

MDGs

Progress in Asia and the Pacific 2007

PART 1

MDG progress in Asia and the Pacific

PART 1

This first part of the report presents progress across the region identifying which countries are on or off track for specific MDG targets. Across such a vast and diverse region the picture is inevitably mixed so the overall story is one of uneven development. As the second part of the report will show, this pattern of disparities is also visible within countries. Hundreds of millions of people are failing to share in the progress of the worlds most dynamic region.

This report uses the latest data from the Millennium Indicators Database to assess recent trends, making simple projections to assess whether countries are on or off track for various MDG targets. This projection, based on the assumption of no change in circumstances or policies, presents only one of the possible scenarios. The challenge for many countries is to break away from the predicted path so as to meet the targets by 2015. The same system for classifying achievement in earlier reports is applied. For each indicator, on the basis of the trend since 1990 the report places countries or country groups into one of four categories: Early achiever : Already achieved the 2015 targettarget target On track: Expected to meet the target by 2015 Off trackSlow: Expected to meet the target, but after 2015 2015 but after Off trackNo progress/regressing: Stagnating or slipping backwards slipping backwards For convenience the overall picture across the region is summarized for a selection of indicators by country group in Table 1-1 and by country in Table A (page 33). This is inevitably a partial perspective because for most of the 48 MDG indicators there are serious data limitations (Box 1-1). For some indicators, such as the primary enrolment rate, most countries offer sufficient data for assessing trends and there is a numerical target against which to measure progress, so all four sym-

bols are possible. For other indicators, the situation may differ. In the case of TB prevalence, for example, for which the target is to halt and to begin to reverse the spread, only three of the four symbols are applicable: if the prevalence is falling the country is an early achiever, if it is constant the country is on track, if it is rising the country is off track. Other indicators had to be excluded from this overall table, primarily because of a lack of comparable cross-country data. For maternal mortality, for example, for which the target is to reduce the rate by three quarters there are currently no internationally comparable trend data. For the country group analysis one or more countries will usually lack data for that indicator. In these cases, regional averages have been estimated with the help of international agencies such as the World Bank or by the ESCAP Statistics Division.

A regional snapshot
Tables 1-1 and Table A are thus a compromise between the ideal and the possible. For some important indicators, particularly in the Pacific, there are many blank areas indicating a data vacuum. Nevertheless the tables do give a useful overall impression. At first glance they are encouraging since they have more of the optimistic green symbols than the pessimistic red ones. Reading down the columns, however, shows how the picture varies by indicator. While Table 1-1 encapsulates some of the regions overall progress, it does not give any sense of the human scale of the achievements, or the problems. Since this region is home to more than half the worlds people the number of those affected can be very large. So along with headline trends that emerge from these tables it is also useful to consider some headline numbers. These are summarized in Figures 1-1 and 1-2, which show

MDG progress in Asia and the Pacific

Table 1-1 Country groups on and off track for the MDGs

MDGs

Progress in Asia and the Pacific 2007

Note: Asia and the Pacific refers to the 55 developing members and associate members of ESCAP (see Classification of countries, page 55).

for various indicators the number of people affected in each region and the changes since 1990. The Asia-Pacific region has 61 per cent of the world population but in some cases our share of people deprived can be higher still. As Figure 1-1 shows, one of the most widespread problems is evidently in sanitation: Asia and the Pacific accounts for 75 per cent of the worlds rural population and 63 per cent of the urban population who do not have access to basic sanitation 1.9
Figure 1-1 People deprived in Asia-Pacific, selected indicators, 1990 and latest year

billion in total. We also have high shares of people suffering from TB and of underweight children. In addition, despite the regions success in reducing poverty we still have 641 million people living on less than $1 per day.

The scale of the opportunity

While the numbers of people deprived look daunting they also give an indication of what the region has to gain by intensifying its efforts to reach the MDGs. We have an enormous opportunity to improve the well-being of many millions of people and also make economic gains: it has been estimated, for example, that persistent gender inequality is costing the region $58 to $77 billion a year (ESCAP, 2007). If the countries that are currently off-track either slow or regressing were to alter their course to a new trajectory that would enable them to meet the target in 2015, this would mean: 196 million more people would be lifted out of poverty 23 million more children would no longer suffer from hunger Close to one million more children would survive beyond their fifth birthday Four million more children would get a basic education

Note: The latest years are as follows: 2000 for maternal mortality; 2004 for $1/ day poverty, and access to water and sanitation; and 2005 for children underweight, primary enrolment, under 5 mortality, HIV prevalence and TB prevalence.

Figure 1-2 Progress and number of people affected, by region, 1990 and latest year In these charts, the size of the bubbles represents the relative size of the population affected, while the colours correspond to those of the progress symbols. The sloping line divides the charts into two parts: above the line the indicators for each bubble have increased since 1990; below the line they have decreased. For latest year see Figure 1-1.

PART 1 MDG progress in Asia and the Pacific

 240 million more people in rural areas would have access to improved sanitation 80 million more people living in cities would have access to improved water supplies How can Asia and the Pacific transform an historic opportunity into an historic achievement? The answer has to be to focus on those countries that are moving too slowly or not making progress,
Box 1-1 The need for complete and consistent data This assessment of country and regional progress towards the MDGs is based on data from the global Millennium Indicators Database, maintained by the United Nations Statistics Division1. The data are prepared by the responsible international agencies, relying largely on official statistics collected through censuses, surveys and administrative records by national statistical agencies in some cases supplemented by surveys sponsored by international agencies, such as the Demographic and Health Surveys and the Multiple Indictor Cluster Surveys (United Nations, 2007). Agencies are continually improving their methodologies and revising and adding to the data. Since the 2005 MDG update ten more countries have added at least one data point for indicators such as the proportion of the population undernourished and the rate of youth unemployment. For this report ten more countries also have trend data for the ratio of female to male enrolment in primary and secondary education and 19 have trend data for the proportion of children in primary school reaching grade 5. At the same time, however, some revisions have caused a reduction in data points as these have subsequently been deemed unreliable or not internationally comparable2. More data should become available later this year. New estimates for infant and child mortality will come from the third round of MICS undertaken in 2005. Similarly there will be new estimates for maternal mortality for 2005 which could be combined with the data for 2000 to allow an assessment of recent trends. For this report, however, there are still large data gaps. For example, currently only 25 countries in the region have data on the $1-a-day poverty indicator, and none provide data that can be used for assessing cross-country trends in maternal mortality. Data availability among 55 Asia-Pacific developing countries, 1990-2005
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and within all countries to concentrate on fulfilling the rights of the poorest and most marginalized especially women. The following sections highlight some cross-country comparisons, goal by goal, though paying particular attention to the goals for which the region is performing less well. In each case we compare the current position of Asia and the Pacific with two other developing regions, Latin America and the Caribbean and SubWhile data availability varies across countries and indicators, some of the greatest problems are in the poorest countries and small island states with weak statistical systems that may not be able to produce reliable and timely data even for the most basic indicators. As a result, these countries are often absent from the international data series and cannot therefore be covered in this regional progress assessment. The same is often true for countries that have emerged only recently from war and civil strife, such as Afghanistan, Timor-Leste and parts of Central Asia. It is even more difficult to obtain data on inequality within countries and especially data that can also be used for cross-country comparisons. For the inequality analysis in the second part of this report we have relied on Demographic and Health Surveys for 13 countries which have been carried out since 1995. Of these, six countries have data from two or more surveys to which a standard methodology can be applied to examine trends in inequalities in child health and in access to water and sanitation. These surveys provide rich information, though they are infrequent and fail to cover some of the most vulnerable groups, such as communities in Nepal and Sri Lanka affected by conflicts. To ensure comparability across countries a regional report has to use international data series. In principle these should match the national official statistics from which they are largely derived. Nevertheless there can be inconsistencies. These may happen, for example, when national definitions for indicators differ from international data requiring international agencies to adjust the data to ensure comparability across countries. Or perhaps the countries do not produce data on a particular indicator so the agencies have to estimate the missing values. Another possibility is that countries have new data they have not made available to international agencies. Whatever their cause, data inconsistencies can raise many questions, lead to serious political concerns and hamper policy dialogue. This underlines the importance of promoting international statistical standards, improving coordination within national statistical systems as well as between national and international data agencies. ESCAP, ADB and UNDP together with other partners are supporting countries in their efforts to build capacity in both the production and use of statistics. Activities include promoting national strategic planning for statistical development, supporting the 2010 round of population and housing censuses, facilitating the use and dissemination of microdata, and improving administrative data systems.
1 http://mdgs.un.org/. Data obtained for this report are as of 27 August 2007. 2 For example, a $1/day poverty estimate of 47.8% for 1991 for Pakistan was included in the Millennium Indicators Database in 2006 but was subsequently dropped. This data revision led to the difference, between this and last years MDG progress report (ESCAP, 2006), in the assessment of Pakistans progress towards poverty reduction.

MDGs

Progress in Asia and the Pacific 2007

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Note: Trend data refer to two data points, three years apart, over 1990-2005.

Saharan Africa. Then we look at various country groupings within the Asia-Pacific region. Because our two most populous countries, China and India, tend to sway the overall averages we show data on these separately while also considering two subtraction groupings: Asia and the Pacific without China and India, and South Asia without India. The other groupings are South-East Asia, the Pacific Islands, the Commonwealth of Independent States (CIS) countries in Asia, and the regions Least Developed Countries (LDCs).

Reduce extreme poverty by half

Income poverty is one of the regions success stories. Based on the $1-a-day measure the region as a whole is on track, due in part to rapid economic growth in many countries, most recently in China: in 1990 one person in three in China lived in poverty while today the number is below one in ten. As indicated in Figure 1-3a, our average poverty rate, at around 17 per cent, is higher than in Latin America and the Caribbean, but we are making faster progress hence the green triangle. The length of the bar indicates the number of people affected, which at 641 million is more than half the worlds extreme poor. Of the country groups, South-East Asia too is doing well. The picture is less positive for the regions LDCs for which the poverty rate at 34 per cent is not far from that of Sub-Saharan Africa. Figure 1-3b highlights the position of selected individual countries. The vertical axis shows the
Figure 1-3b Population living on less than $1 per day, by country, latest year

PART 1 MDG progress in Asia and the Pacific

Goal 1 Eradicate extreme poverty and hunger

This goal has two main components: the first is concerned with income poverty, the second with hunger and malnutrition.

Figure 1-3a Population living on less than $1 per day, by region and country group, 2004

Note on cut-offs: In the case of Turkey (TR) for example, the 1990 starting point was 2.4 per cent and the target was to half this by 2015. But countries are considered to have achieved the target if they have reduced extreme poverty to below 5 per cent. Because Turkey was already below this cut-off point it thus immediately became an early achiever. By its own standards, however, it still has some distance to travel. Note on data: For each bar chart the actual data are listed in Table B on page 34. For the distance travelled charts, the underlying data for each country are in Table A (page 33) and the indicator tables at the end of the report.

current level of poverty, while the horizontal axis indicates the proportion of distance already travelled towards the target, with the starting point and the target serving as the limits of the yellow zone. Since there is not enough room to put the full name,

each country is identified by its two-letter internet country code, a list of which you will find on page 56. The Philippines (PH) for example, had a 1991 poverty rate of 19.8 per cent and a target of 9.9 per cent. Since its latest value for 2003 is 14.8 per

cent it has travelled half the distance towards the target over the period, and as the symbol indicates, it is moving slowly towards the target but will come very close to it by 2015. India (IN), on the other hand, with a 2004 poverty rate of 34 per cent has travelled less than half the distance to its 2015 target, though since Indias subsequent economic growth has been more rapid the country could see a faster decline in poverty. Sri Lanka (LK), with one of the lowest poverty rates in South Asia, has experienced an increase. Of the countries on this figure the one with the greatest difficulties is Bangladesh (BD) whose poverty rate is high and rising. The most successful countries, the early achievers included here, are largely clustered to the bottom right of the figure, showing not just that they have achieved low rates of poverty but that they have overachieved their targets. It is however, also possible for an early achiever to fall within the yellow zone, indicating that it still has some distance to travel. This is related to the cut-off points for each indicator and can happen for countries that were starting out at quite good levels (see Technical note, page 52 and the note to Figure 1-3b). The main reason for applying a cut-off is to avoid labelling countries as regressing when they may only be fluctuating slightly at high levels of achievement. In order to produce visually consistent charts,
Figure 1-4a Under-five children underweight, by region and country group, 2005

the range for distance travelled is limited to -50 per cent to +150 per cent. Countries that fall beyond those ranges are placed at the -50 or +150 position, which in this case accounts for the column of countries at -50 per cent. In the case of Armenia (AM), for example, the actual value is 179 per cent.

Reduce hunger by half

The other indicators for poverty relate to hunger and nutrition. For the purposes of the cross-regional comparison this report uses the proportion of under-five children who are underweight who weigh less than they should for their age. Compared with the success in income poverty the situation here is almost the reverse. This is one of the regions greatest failures 28 per cent of our under-five children are underweight and we are offtarget for 2015 (Figure 1-4a). Indeed Asia and the Pacific accounts for around 65 per cent of the worlds underweight children. This high level is likely to be linked to the poor health and nutrition of women that causes children to be born underweight, as well as to unsafe water supplies and the debilitating effects of infectious diseases, such as diarrhoea and pneumonia, combined with inadequate care. The most severe problems are evidently in South Asia. In India (IN) close to half of underFigure 1-4b Under-five children underweight, by country, latest year

MDGs

Progress in Asia and the Pacific 2007

Prevalence, % (markers) 0
SubSaharan Africa Asia Pacific Latin America & Caribbean India LDC Asia Pacific South Asia (excl. India) SouthEast Asia Asia Pacific w/o China & India China

Prevalence,% 50-

18

26

35

44
40

IN

BD

KH LA PK AF

30

MM Regional average ID

MV PH KP VN

20

10
Cut off AM MN

MY CN TR

20

40

60

80
-50 0 50 100 150 Distance travelled (%)

Millions (bars)

five children are underweight. As is shown in Figure 1-4b, Pakistan (PK) and Bangladesh (BD) also have high levels: both are off track though Pakistan more so than Bangladesh. The rates are high

even in South-East Asia, at 28 per cent, which is close to the level of Sub-Saharan Africa. This appears surprising given the subregions considerable success in reducing income poverty. Indonesia (ID),

for example, is an early achiever on poverty but for this indicator is regressing. The main success story is China (CN) which has reduced its level far below the regional average, and indeed in some cities, as discussed in the second part of this re-

port, the rate is close to zero. Malaysia (MY) too, unlike other countries in South-East Asia, has been reducing its underweight proportion quite rapidly from 23 per cent in 1993 to around 11 per cent in 2003.

Source: Based on World Bank (2004).

Goal 2 Achieve universal primary education

All countries in the region give a high priority to education. For the purpose of this cross-regional comparison, this report focuses on net primary enrolment. To achieve this goal, countries have to enrol children in school and then ensure that they complete the full course of schooling. On this basis, the Asia-Pacific region has done quite well, enrolling nearly 94 per cent of school-age children still
Figure 1-5a Primary enrolment, by region and country group, 2005

behind Latin America and the Caribbean, which with a 97 per cent rate counts as an early achiever, but some way ahead of Sub-Saharan Africas 70 per cent. Nevertheless this region still accounts for one in three of the worlds children out of school. As is evident from Figures 1-5a and 1-5b one of the most significant contributions is from India whose rate of 95 per cent helps drive up the regional average. On the other hand, the rate for South Asia without India is low, despite the impressive achievements of Bangladesh (BD). Pakistan (PK) at a 68 per cent enrolment ratio is moving slowly toward its target, while the Maldives (MV), at 80 per cent, is regressing.
Figure 1-5b Primary enrolment, by country, latest year

Ratio (markers) 0
Latin America & Caribbean Asia Pacific SubSaharan Africa China India SouthEast Asia CIS Asia LDC Asia Pacific Asia Pacific w/o China & India South Asia (excl. India)

20

39

59

78

98

Ratio 100
ID

FJ BN VU

*
BD,TJ,TO

95 90 85 80 75 70

Cut off Regional average PH GE MM MN AZ VN TR

MY

HK IR KG

IN TH RU

MO

AM LA NP

MV

PK

10

20

30

-50

50

100

150

Millions out of school (bars)

Note: China does not have a progress symbol as there are no trend data.

Distance travelled (%)

* KH, KI, KR, KZ, WS

MDG progress in Asia and the Pacific

With almost half its population under 16 years of age, this young nation faces a daunting task in achieving primary education for all. Its education statistics have not made it into the international series so they have not been included in this report. However, a recent World Bank country study has concluded that between 1999 and 2003, the net primary enrolment ratio increased from 51 to 75 per cent, and the net junior secondary school enrolment ratio increased from 24 to 30 per cent. This has been achieved in part by reducing the costs of schooling, which has helped narrow the gap between rich and poor, though there is still a significant disparity:

among the richest quintile only 6 per cent of children are out of school, while for the poorest quintile the proportion is 29 per cent. Like many other LDCs in the region, Timor-Leste has a long way to go to achieve universal primary enrolment and improve the quality of education. Recognizing this, the government has formulated a National Development Plan for Education which sets out ambitious goals for 2020, including a rapid expansion of primary school enrolment, particularly for girls and for children from poor rural households.

PART 1

Box 1-2 Timor-Leste: towards education for all

10

South-East Asia as a whole at 94 per cent has achieved high primary enrolment. Within this subregion, Cambodia (KH) is doing well and is an early achiever. Timor-Leste, though not included in this assessment, has also been making progress (Box 1-2). Others such as Myanmar (MM), the Philippines (PH) and Viet Nam (VN) achieved relatively high level but have made little further progress since early 1990s or are regressing. On the other hand many countries in the Pacific have done well: Fiji (FJ), Kiribati (KI), Samoa (WS), Tonga (TO) and Vanuatu (VU) are all early achievers with current primary enrolment rates of over 95 per cent. Although most children are now enrolling in primary school, a significant proportion is dropping out. While in the CIS around 96 per cent of

enrolled children reach grade 5, in a number of countries elsewhere in the Asia and Pacific region, the proportion is far lower: in Bangladesh, 65 per cent; in Cambodia, 57 per cent; in India, 73 per cent; in Lao PDR, 63 per cent; in Myanmar 70 per cent; in Nauru, 25 per cent; in Nepal, 79 per cent; in Pakistan, 70 per cent; in Papua New Guinea, 58 per cent; and in the Philippines, 72 per cent. Some children will be dropping out for reasons of poverty, but others may be rejecting the education on offer, with underqualified teachers, a lack of textbooks or equipment, or poorly maintained buildings. Some parents may also be concerned about inadequate sanitation facilities particularly for girls.

MDGs

Progress in Asia and the Pacific 2007

Goal 3 Promote gender equality and empower women

The assessment of this goal is based on a fairly narrow range of indicators (Box 1-3). Those with defined targets are concerned with education the aim is to achieve gender parity at all levels. For this indicator, the region as a whole is doing well at the primary and secondary levels: Bangladesh is an early achiever for both as is China, Georgia, Kazakhstan and Kyrgyzstan. Indeed the countries of the region are generally so close to gender parity that this indicator is difficult to represent in diagrams designed to highlight differences. Nevertheless there are still wide gender gaps in some countries, such as Pakistan, which is off track for this goal with a ratio of girls to boys secondary enrolment at 0.7. Tajikistan though at a higher level, is regressing. In Afghanistan, the ratio is even lower at 0.3, though the country is making great efforts in very difficult circumstances (Box 1-4). Along with the rise in enrolment in primary education there have also been reductions in the gap in literacy between men and women. More of this generation of girls are going to school so their rates are likely to be close to those of boys. For those women who missed this opportunity, however, the disadvantage will be greater. In Bangladesh in 2002, for example, for the 15-19 age group the gap in literacy rates for men and women was seven percentage points, while for the 20-24 age group it was 16 percentage points (United Nations, 2005).

Women are still at a significant disadvantage in tertiary education, and in this case, the region is far from achieving gender parity. Not all countries provide the relevant data but, of the 43 that do, only in 21 countries are there equal numbers of young women and young men at higher levels of education. In Nepal, for example, the ratio of girls to boys in primary education in 2006 was 1.0, but in tertiary education it was only 0.4, while in Bangladesh the figures were 1.0 and 0.5 respectively. Girls may be dropping out of school, for example, because their families need them to work and carry out household chores, including fetching water. Adolescent girls will also be discouraged by inadequate school sanitation facilities, and some may have had to leave school because of early marriage. The second MDG gender indicator is womens share of paid non-agricultural employment. On this basis, some countries in the region have done well. Women make up around half the non-agricultural workforce in North and Central Asia as well as in several countries in South-East Asia, including Thailand and Viet Nam. Apart from Sri Lanka, for example, where the proportion is 40 per cent, across South Asia the figure is generally lower: in India 18 per cent, Nepal 15 per cent; and in Pakistan only 10 per cent. The third gender indicator is the proportion of women in national parliaments. Globally the proportion in single or lower houses of parliament tends to be quite low, around only 17 per cent. Some countries in the region have gone beyond this achieving more than one-quarter, for example, in Afghanistan, Timor-Leste and Viet

Nam but in other countries, the rates are surprisingly low, even for countries like India and Sri Lanka that have had women presidents and prime ministers. Nevertheless some countries, such as Afghanistan and Pakistan, have taken measures to imBox 1-3 Improving data on gender

prove womens representation by reserving seats for women in parliament, for example, or other forms of affirmative action such as indicating that party lists should have a certain proportion of women.

Monitoring the MDGs from a gender perspective is hampered by the limited number of indicators and a shortage of data. The only indicator under MDG3 on gender equality and womens empowerment that has a numerical target is parity in educational enrolment which does not take into account either quality or outcome. A second indicator is the proportion of seats held by women in national parliaments though this does not measure their influence when they get there. A third is womens share of paid, nonagricultural employment which is a valuable indicator of participation in the modern sectors of the economy. However, there is no indicator that reflects womens unpaid economic activities, which are a mainstay of the rural sector and of the care economy. Even the data for MDG5 on maternal mortality, valuable as they are, do not capture broader aspects of gender disparities in health. We also need to disaggregate other MDG indicators to explicitly assess progress toward gender equality. MDG3 is not only important in its own right, but also vital for achieving the other MDG goals, while its realization in turn depends on the extent to which each of the other goals addresses gender-based constraints and issues (United Nations, 2005). However, despite recent improvement, sex-disaggregated statistics are often lacking even for basic indicators. For example, many countries in Asia still do not regularly collect data on the labour force and its characteristics or disseminate sex-disaggregated data according to standard definitions that allow for cross-country analyses (United Nations, 2006). National governments and international agencies urgently need to improve the quality and frequency with which they

collect and disseminate sex-disaggregated data. Beyond the technical shortcomings of the MDG3 indicators, there is the issue of widening the coverage of gender equality and womens empowerment. The UN Millennium Project Task Force on Education and Gender Equality is providing some impetus. Consistent with the framework of CEDAW and the Beijing Platform for Action, it has identified seven strategic priorities: strengthening post-primary education; guaranteeing sexual and reproductive health and rights; investing in infrastructure to reduce womens and girls time burdens; guaranteeing property and inheritance rights; eliminating gender inequality in employment; increasing womens share of seats in national parliaments and local government bodies; and combating violence against women (UNDP, 2005d). How could progress on these priorities be measured? For some topics, this could be achieved by replacing some indicators with others that might already have been compiled, such as using the percentage of seats held by women in local government bodies as a broader indicator of political participation. Others, such as those for employment, would involve improving labour force surveys. Indicators related to property rights could come from better use of administrative data. On the other hand, for sexual and reproductive health and rights, as well as for violence against women, we would need new indicators and methodologies, several of which have been used by WHO and UNFPA in global studies on these topics. Some countries in the region have also made efforts to move beyond the MDG indicators to monitor national progress towards gender equality and womens empowerment (ADB, 2006b).

PART 1 MDG progress in Asia and the Pacific

11

Box 1-4 Afghanistan: progress against all odds Because of a lack of data, Afghanistan cannot be included in the assessments for a number of important indicators, though the scant data available reveal the extent of human deprivation: over the period 1990-2004 its under-five mortality rate declined only from 260 to 257 per 1,000 live births. This is the third highest rate in the world, after Sierra Leone and Angola. Its maternal mortality ratio, at an estimated 1,900 per 100,000 live births, is 2.6 times the ratio for Nepal, and 43 times the ratio for Thailand. Its youth literacy rate, at 34 per cent for 2004, is the lowest in the region, almost half that of Bangladesh. Nevertheless, against all the odds, Afghanistan is making respectable progress in some priority areas. It is rebuilding the educational system, restoring health and sanitation facilities, enhancing administrative capacity, and improving basic infrastructure. It has reduced the proportion of under-five children underweight to 40 per cent. It has raised the measles immunization coverage among one year-olds from

20 per cent in 1990 to 64 per cent in 2005 overtaking Lao PDR. There have also been achievements in gender equality and womens empowerment: girls access to education is slowly improving, and womens political participation has been impressive: between 1990 and 2004 womens share of seats in parliament rose from 4 to 27 per cent, the highest proportion in the region, along with Viet Nam. Most impressive is the progress in water and sanitation: between 1990 and 2004, the proportion of people with access to improved drinking water sources increased in rural areas from 3 to 31 per cent and in urban areas from 10 to 63 per cent. The proportion of people in rural areas with access to improved sanitation facilities increased from 2 to 29 per cent and in urban areas from 7 to 49 per cent. As a result, Afghanistan is well on track to achieve the MDG sanitation targets. Afghanistan will clearly need ongoing international support to achieve lasting human security and to move forward on a path of sustainable development progress that should also allow it to be included more fully in future cross-national comparisons.

Goal 4 Reduce child mortality

One of the highest priorities for governments across the region must be to reduce the number of children dying before their fifth birthday. There are two main indicators here, one for infant mortality (under 12 months) and one for under-five mortality. The target is to reduce under-five mortality by two thirds. The Asia-Pacific region is moving too slowly to meet this vital goal. As Figure 1-6a indicates, the
Figure 1-6a Under-five mortality, by region and country group, 2005

12

rate for the region as a whole is still around 60 deaths per thousand live births which is almost double that of Latin America and the Caribbean. Indeed, as is evident from Figure 1-6a, the total number of deaths, 4.3 million, is similar to that for Sub-Saharan Africa, and represents two in five of the worlds under-five deaths. The greatest success story in the region is Viet Nam (VN) which has already more than halved its rate and is an early achiever (Figure1-6b). Indonesia (ID), Lao PDR (LA) and Timor-Leste (TL) have also made significant progress they are either on track or have reached the target.
Figure 1-6b Under-five mortality, by country, latest year

MDGs

Progress in Asia and the Pacific 2007

Per 1,000 live births (markers) 0

SubSaharan Africa Asia Pacific Latin America & Caribbean LDC Asia Pacific South Asia (excl. India) India

Per 1,000 live births 150

KH

(257)

AF

33

66

100

133

166

100
KZ

TM

MM PK AZ PG IN TJ MH MN FM TV VU SB TO FJ BN CK RU IR PH MV ID TR VN LA BT BD, NP TL

KG,UZ Regional average KP GE Cut off NR

KI

CIS Asia Asia Pacific w/o China & India Pacific SouthEast Asia China

50

TH LK MY, PW KR

0 -50 0 50

SG

Deaths, millions (bars)

100

150

Distance travelled (%)

* AM, CN, WS

Note: Many early achievers are in the yellow zone, indicating more distance to travel. This is because of the cut-off, which in this case is 30 deaths per 1,000 live births. Even countries that have achieved this level still have room for further progress.

Some of the most serious problems are in South Asia where most countries are off-track, including India which alone has 1.9 million children dying annually before reaching the age of five, and the rate for Afghanistan is more than 250 deaths per thousand live births (Box 1 4). But the rates are also high in other parts of the region: 143 in Cambodia (KH), for example, which is regressing. The situation is also disturbing in some CIS countries: in Turkmenistan (TM) the rate is over 100 and it too is regressing, as is Kazakhstan (KZ) at a lower level. Other CIS countries, including Azerbaijan (AZ), Tajikistan (TJ), and Kyrgyzstan (KG) are moving too slowly to meet the goal. Around half of child deaths are linked to undernutrition, but many children are also still dying

from diseases for which there are effective immunizations. The MDG indicator for this is the proportion of one-year old children immunized against measles. For the region as a whole the average immunization rate at 75 per cent is still quite low, indeed scarcely different from that in 1990. Good progress in some countries, notably Sri Lanka where the rate is now 99 per cent, has been offset by slippages elsewhere, especially in China where between 1990 and 2005 measles immunization coverage fell from 98 to 86 per cent. There have also been some disturbing reductions in Pacific Island states: from 95 to 62 per cent in Tuvalu, for example, and from 89 to 57 per cent in Samoa.

Goal 5 Improve maternal health

Another important indicator for measuring progress for women is the maternal mortality ratio which is a strong indicator of the attention that is paid to health care for women. Across the region around a quarter of a million women die each year as a result of events as natural as pregnancy and childbirth, and many are left disabled or chronically ill. The target is to have reduced the maternal mortality ratio by three quarters between 1990 and 2015. Unfortunately, this important indicator is difficult to measure accurately, whether through vital registration data or through sample surveys, and few countries have sufficient data to indicate trends. The most recent data, which refer to 2000, are summarized in Figure 1-7. The regions overall maternal mortality ratio, at over 300 per 100,000 live births is over 30 per cent higher than the rate in Latin America and the Caribbean, and maternal deaths in Asia and the Pacific accounts for almost half of the global total. Nor are there indications
Figure 1-7 Maternal mortality, 2000

PART 1 MDG progress in Asia and the Pacific

that the ratio is coming down significantly. Table 1-2 lists the countries with the highest ratios. Afghanistans rate is one of the highest in the region and in the world, but there are also disturbingly high figures in many countries of South and South-East Asia. On the other hand, a number of countries have also achieved ratios that are relatively low for developing countries: Fiji, 75; China, 56; and Thailand, 44.
Table 1-2 Maternal mortality ratios and births attended by skilled personnel

13

0DWHUQDOPRUWDOLW\UDWLR SHUOLYHELUWKV 

%LUWKVDWWHQGHGE\VNLOOHG KHDOWKSHUVRQQHO 

$IJKDQLVWDQ 1HSDO 7LPRU/HVWH /DR3'5 ,QGLD 3DNLVWDQ &DPERGLD %KXWDQ %DQJODGHVK 0\DQPDU

         

         

Per 100,000 live births (markers) 0

Sub Saharan Africa Asia Pacific Latin America & Caribbean LDC Asia Pacific South Asia (excl. India) India Asia Pacific w/o China & India Pacific South East Asia CIS Asia China

182

365

547

729

912

The starting point for improving maternal survival is close attention to womens health and nutrition status generally, including reproductive health care and good antenatal care. But any woman, however healthy or well nourished can suffer complications in pregnancy that may require emergency obstetric care. In such situations, she should have the support of a skilled birth attendant who can recognize any danger signs, take the necessary action, and refer the patient quickly to an appropriate health facility. In many parts of the region, the proportion of births with this assistance is quite high, close to 100 per cent, including the CIS countries and many in the Pacific. But, as indicated in Table 1-3, in the countries with the highest maternal mortality ratios the proportion of women who get this kind of support is often far lower.

50

100

150

200

250

Deaths, thousands (bars)

Note: This chart does not use progress symbols as no trend data are available.

Goal 6 Combat HIV and AIDS, malaria and other diseases

Halt and begin to reverse the spread of HIV and AIDS
MDGs

14

HIV prevalence is lower in the Asia-Pacific region, at 0.3 per cent, than in some other regions 6.2 per cent in Sub-Saharan Africa, and 0.6 per cent in Latin America and the Caribbean. Nevertheless, this still translates into large numbers of people living with HIV around 6 million in total. As is also evident from Figure 1-8, over two million of these are in India alone where the 2006 prevalence of 0.36 per cent represents a downwards revision from earlier estimates, resulting from improvements in data collection. The number of infections is rising fast in some of the CIS countries with an estimated 940,000 people living with HIV in the Russian Federation alone and in a number of other countries in the region, including Bangladesh, China, Indonesia, Nepal, Pakistan and Viet Nam.
Figure 1-8 People living with HIV, 15-49 years old, 2005

Prevalence, % (markers) 0
SubSaharan Africa Latin America & Caribbean Asia Pacific Pacific India SouthEast Asia LDC Asia Pacific Asia Pacific w/o China & India CIS Asia South Asia (excl. India) China

10

15

20

Millions (bars)
Note: For each country or country group, the current prevalence refers to 2005 though for India 2006. The symbols represent current level rather than long-term trends as data are only available for 2003 and 2005 (2006 for India). Even so, during this short period the situation in some countries has deteriorated.

per cent in Cambodia and 1.4 per cent in Thailand, though in both countries it has been coming down. In the high-prevalence countries the numbers of men and women infected are similar, though in Papua New Guinea the number is higher for women. Over the last two years, despite progress in treatment, 640,000 people have died. In a number of other Asian countries, including the CIS countries, the most common way to acquire HIV is through injecting drug use, by sharing needles or syringes with an infected person. In India, Indonesia, Malaysia, Nepal, Thailand and Viet Nam HIV prevalence among injecting drug users averages 20 per cent. Nevertheless, in South and South-East Asia people most often acquire HIV through unprotected sex. As the prevalence rises in the Pacific the epidemic is not confined to these higher-risk groups but is considered to be a generalized epidemic, and almost 60 per cent of those infected are women. Indeed, married women can be at high risk as they acquire the virus from their husbands. In Papua New Guinea they account for half of all new infections. A number of other countries also account for a high proportion of new infections: 39 per cent in Thailand, for example, and 46 per cent in Cambodia (UNAIDS, 2006). One precondition for halting the epidemic is for people to understand how the virus is spread. Although many young people are aware of HIV and AIDS, their knowledge does not usually run very deep. In surveys, people are deemed to have a comprehensive knowledge of HIV and AIDS if they can correctly identify two ways of preventing sexual transmission and can reject three major misconceptions. On this basis, the proportion of men sufficiently well informed among the 15-24 age group varies widely across the region: from over 45 per cent in Cambodia and Viet Nam, to 15 per cent in Armenia, and seven per cent in Uzbekistan. As yet, relatively few people are receiving antiretroviral therapy, largely because of the underinvestment in health-care systems. Asia ranks lower than Africa and Latin America in terms of per capita investment in health.

Progress in Asia and the Pacific 2007

Halt and begin to reverse the spread of malaria and other diseases
Malaria remains a problem in many parts of the region. Asia accounts for around 38 per cent of the global malaria burden with some of the great-

In terms of HIV prevalence the most serious problem is in Papua New Guinea where between 2003 and 2005 the prevalence increased from 1.6 to 1.8 per cent. The prevalence is also high at 1.6

I n d o n e sia L ao PD R T a jik ista n T im o r-L e st e V ie t N a m

2 5 .9 1 7 .7 1 .9 8 .3 1 5 .8

0 .7 8 .7 6 8 .9 1 9 .3 6 .5

Figure 1-9a Tuberculosis prevalence, by region and country group, 2005

Figure 1-9b Tuberculosis prevalence, by country, latest year

Prevalence, per 100,000 (markers) 0

Sub Saharan Africa Asia Pacific Latin America & Caribbean Pacific LDC Asia Pacific India South Asia (excl. India) South East Asia Asia Pacific w/o China & India China CIS Asia

Prevalence, per 100,000 700 600 500 400 300 200

KG KZ,RU UZ KR TM LK TJ Regional average PK

KH

TL

105

210

314

419

524

PG PH BD

TV KI

LA ID

IN

AF

VN CN MY MO NU PW HK BN TR TH BT NR

MH NP MN SB KP MM FM VU MV GU AS

100 0

AM, AZ, GE

TO,WS

FJ

NC,PF

-50

50

100

150

Millions (bars)
* CK, IR, SG

Distance travelled (%)

Note: The assessment presented in these charts are based on the additional targets set by the Stop TB Partnership - to halve prevalence and death rates by 2015 (from 1990 levels).

Another major disease of concern across the region is tuberculosis. As in the rest of the world, both the prevalence and the death rate from tuberculosis have started to decline and most parts of the region are on track to meet the goal. As shown in Figure1-9a, the prevalence is around half that in Sub-Saharan Africa; nevertheless, two out of three people affected by TB live in the AsiaPacific region, where there are around 925,000 deaths each year. Although the prevalence in the CIS countries is lower than in other country groups, this is the only country group in which the prevalence is increasing; these countries are also seeing a rise in multi-drug resistant TB. Within countries, however, the most serious problems are in Cambodia (KH) and Timor-Leste

(TL) with prevalence greater than 700 per 100,000. While the MDG goal is to reverse the spread of TB, to give an indication of the scale of progress, the target selected here is to halve the prevalence by 2015, as set by the Stop TB Partnership. On this basis some countries in Figure 1-9b are off track, though not by too much since most have travelled around 50 per cent of the distance and even Timor-Leste is making progress to be on track. This chart shows an encouraging cluster of early achievers, among which Kiribati stands out since between 1990 and 2005 it reduced the prevalence from 1,175 to 426 per 100,000. The lower left area of the chart has a group of CIS countries, including Tajikistan where between 1990 and 2005 the prevalence increased from 196 to 297.

MDG progress in Asia and the Pacific

est problems in the Pacific. Since 1990 the prevalence has been coming down in many of the countries most seriously affected, but the region still accounts for 10 per cent of malaria deaths at the global level (Roll Back Malaria, 2005). The highest number of reported cases per 100,000 population is in the Solomon Islands, at over 20,000, followed by Vanuatu at nearly 7,500. In South-East Asia the numbers are somewhat lower: 3,000 in Timor-Leste and 1,500 in Myanmar which had the highest number of deaths at around 1,700 in 2004 (WHO, 2007a). In this subregion the disease is often associated with population movements as people move to endemic zones. One of the best ways to protect children against malaria is to provide insecticide-treated bednets. As shown in Table

1-3, in Viet Nam close to 16 per cent of children sleep under such nets and in Lao PDR the proportion is 18 per cent. In Timor-Leste only 8 per cent of children sleep under insecticide-treated bednets as opposed to 26 per cent in Indonesia.
Table 1-3 Malaria prevention and treatment, percentage of underfive children
U se o f in se c tic id e tre a te d b e d n ets (2 0 0 0 -2 0 0 5 ) A z e rb a ija n I n d ia 1 .4 .. T re a tm e n t o f fe v e r w ith a n ti-m ala ria l d ru g s (2 0 0 0 -2 0 0 5 ) 0 .8 1 2 .0

PART 1

15

Goal 7 Ensure environmental sustainability

Environmental sustainability in its many dimensions is becoming an increasingly critical issue for this region whether in terms of the deterioration in the natural environment, or the lack of access to clean water and sanitation. Environmental deterioration is closely linked with poverty indeed, an increasing proportion of the poor in the Asia-Pacific region are poor because they are living in areas where the environment is under stress (Box 15). Some of the economic growth in the region has been at the cost of rapid deforestation notably in Cambodia, Indonesia, Myanmar and the Philippines, and to a lesser extent in Malaysia and Thailand. Between 2000 and 2005 most countries in the region suffered a net loss of forest cover. Nevertheless, thanks to reforestation efforts in a number of countries including Armenia, Azerbaijan, China and Viet Nam, the region as a whole registered a slight increase. However, this masks a stark reality: biodiverse natural forests are being lost across the region, at best being replaced by lower productivity plantation forests. The continued loss of natural forests is reducing critical ecosystem services, including that

16

of carbon sequestration. This has serious implications for global warming since globally deforestation is associated with 18 to 25 per cent of greenhouse gas emissions a higher proportion than for transportation. Nevertheless, efforts in this region need to focus on growing use of energy which is the most important contributor to global and regional CO2 emissions. One of the most important issues is energy efficiency. A number of countries boosted their efficiency between 1990 and 2004, particularly Armenia, Georgia, Kazakhstan, Kyrgyzstan and Tajikistan, which almost doubled their energy efficiency. China also managed to double its energy efficiency over the same period from 470 to 226 kg of oil equivalent per PPP $1,000 of GDP. Both total CO2 emissions and energy use per capita in the developing Asian countries remain far lower than in developed countries. But since emissions are coupled with economic growth they are likely to rise, particularly in South-East Asia. As a result, although an increase in economic expansion has contributed to the progress in achieving other MDG indicators, in 32 of the 52 countries for which data are available it has resulted in increased CO2 emissions. The CIS countries, on the other hand, have reduced emissions, though due more to economic slowdown in the early 1990s than pro-active policymaking.

MDGs

Progress in Asia and the Pacific 2007

Box 1-5 The rise in environmental poverty Across the Asia-Pacific region poverty can increasingly be linked to environmental factors. This is evident from the geographical distribution of the poor. Of the estimated 641 million people in the region who survive on less than $1 per day, around half live in areas that are under environmental stress either in urban slums, in drylands, in flood or disaster prone regions, in remote upland or mountainous areas, or in coastal zones where they depend on depleting marine resources. For some of these people, poverty will be due to other factors, but for the vast majority the principal cause of poverty will be the degraded and deteriorating environment in which they live. Environmental pressures also bear down heavily on the health and livelihoods of the regions vulnerable people just above the poverty line, living on $1 to $2 per day. Taken together the poor and the vulnerable amount to 1.8 billion of whom over half can be said to live in environmental poverty. Further, the number of those living in poverty due to environmental causes is likely to increase by 2020 according to some estimates to two-thirds of the poor. This is principally because the areas under envi-

ronmental stress are likely to become more extensive, with the increase in desertification, for example, though this will be offset to some extent by migration away from the most difficult environments. For many of the people living in environmentally fragile and marginal areas, poverty is exacerbated by threats from natural disasters, including the added risks from climate change. The Asia-Pacific region, since 1990 has seen around 90 per cent of the worlds disaster-related deaths, and these events are becoming more frequent. Between 2000 and 2005, the region suffered from 192 floods a year, but in 2006 the number rose to 226. In 2007 floods displaced over 20 million people in northern India, Bangladesh and Nepal. MDG 7 makes the link between environment and poverty. But given the increasing importance of poverty due to environmental causes, we need better targets and indicators on land degradation, for example, on the poor who depend on wetland, on the depletion of coastal and forest areas, and on the proportion of the poor living in slums. Some countries in the region, such as Viet Nam and China are now reflecting the linkages between poverty and the environment in their national development plans.

Halve the proportion of people without access to safe drinking water

Another vital aim for this region must be to improve supplies of drinking water. The lack of clean water is the largest single cause of child mortality due to diarrhoeal disease and is causing many others to grow up sick or undernourished (Box 1-6). WHO estimates that, on average, each person needs at least 20 litres of drinking water per person per day for hygiene, drinking and cooking. Typically, the households with the greatest difficulty in getting clean sources of water are in rural areas, and that is also the case in the Asia-Pacific

Figure 1-10a Population with access to improved water sources, rural, by region and country group, 2004

Figure 1-10b Population with access to improved water sources, urban, by region and country group, 2004

Proportion, % (markers) 0
Asia Pacific Latin America & Caribbean Sub Saharan Africa India Asia Pacific w/o China & India South Asia (excl. India) South East Asia CIS Asia LDC Asia Pacific
LDC Asia Pacific

Proportion, % (markers)

17

33

50

66

83
Lattin America & Caribbean Asia Pacific Sub Saharan Africa CIS Asia India Asia Pacific w/o China & India China South Asia (excl. India) South East Asia

19

38

58

77

96

China Pacific

Pacific

20

40

60

80

100

200

300

400

500
Millions w/o clean water (bars)

Millions w/o clean water (bars)

Households are more likely to have water from improved sources in urban areas: for the region as a whole the average is around 94 per cent (Figure 1-10b). In some respects, however, the situation is more disturbing in urban areas, since on this indicator the region as a whole is regressing. The Pacific Island countries are a cause for concern since their level of urban provision is lower than in Sub-Saharan Africa and is regressing. In addition, most of the countries falling behind are also experiencing rapid rates of urbanization, suggesting that the difficulties lie primarily in providing services to fast-growing slum populations. India (IN), despite having a high population living in slums, is performing relatively well and is an early achiever, but the rest of South Asia is mov-

ing only slowly towards the target (Figure 1-10b and 1-10c). South Asia excluding India, where the proportion of urban populations living in slums are at the highest levels in the region Afghanistan at 98 per cent, Nepal at 92 per cent and Bangladesh at 84 per cent is finding it difficult to provide access to improved sources of water (Table 1-4). Despite its strong economic growth, SouthEast Asia is regressing and accounts for around one-quarter of the people in the region affected by inadequate access to safe water. In Cambodia and Lao PDR over 65 per cent of urban dwellers live in slums. While these numbers have decreased for Viet Nam and the Philippines, still close to half of their population in cities live in slums.

MDG progress in Asia and the Pacific

region. Across the region, the average coverage is 76 per cent in rural areas, which is higher than in Latin America and the Caribbean, and the region as a whole is on track for this indicator largely because of rapid progress in India which has reached 83 per cent (Figure 1-10a). Other countries are, however, moving more slowly, notably China which alone has almost as many rural people underserved as the whole of Sub-Saharan Africa, and the situation appears to be deteriorating in a number of countries in the Pacific. Across the region, over 560 million people in rural areas lack access to improved water sources. This is a particular burden for women and girls who are almost universally responsible for collecting water.

PART 1

17

Figure 1-10c Population with access to improved water sources, urban, by by country, country, latest latest year year

Table 1-4 Proportion of urban population living in slums, 10 highest

           

Proportion,% 100
CK,MV UZ Cut off

AM, IR KG, TH KR, KZ

RU VN LK,TR NP,PK FM TV GE IN AZ

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CN Regional average

90

WS ID, PH VU MH BD PW KI PG MN

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MDGs

18

80

MM

Progress in Asia and the Pacific 2007

70
AF

-50

50

100

150

Distance travelled (%)

Halve the proportion of people without basic sanitation

The lack of clean water is closely linked to access to sanitation since the pollution of groundwater, rivers and other water sources with faeces further heightens the risks of contaminated drinking waFigure 1-11a Population with access to basic sanitation, rural, by region and country group, 2004

ter. In the Asia-Pacific region, as elsewhere in the world, access to safe sanitation is generally significantly lower than access to clean water. In rural areas the Asia-Pacific average is only 33 per cent (Figure 1-11a). This region, with over 1.5 billion people affected, accounts for three-quarters of the worlds rural population without basic sanitation.
Figure 1-11b Population with access to basic sanitation, rural, by country, latest year

Proportion, % (markers) 0
Latin America & Caribbean Asia Pacific SubSaharan Africa SouthEast Asia CIS Asia Asia Pacific w/o China & India Pacific South Asia (excl. India) LDC Asia Pacific China India

Proportion, % 100

CK,NU,WS GU Cut off TO LK TV PF TH

11

22

33

44

56
GE

80
RU TR MM

60
FJ PW KG,KZ PG ID Regional average NP CN MH

PH VN PK BD AF

UZ

40

20
FM

KI

IN

500

1000

1500

-50

50

100

150

Millions w/o basic sanitation (bars)

Distance travelled (%)

Figure 1-11b shows the extent of the problem by country. China (CN), for example, started with a low level, 7 per cent in 1990, and although it has made progress, has still, at 28 per cent, travelled less than half the distance to its target. It accounts for one-third of the regions people without safe sanitation. Another third of those without access are in India (IN), which has also made progress, from 3 to 22 per cent, again not enough

to stay on track. Bangladesh too is off track. Of the other larger countries in South Asia, Pakistan (PK) is just on track while Sri Lanka (LK) is an early achiever. A number of Pacific countries give cause for concern. While Samoa (WS) is an early achiever and Tuvalu (TV) is on track and at quite a high level, others, such as Fiji (FJ), Palau (PW), Papua New Guinea (PG) and the Federated States of Micronesia (FM), are off track.

Box 1-6 The rights to safe water and basic sanitation MDG 7 on environmental sustainability includes targets on improving peoples access to clean drinking water and basic sanitation. But the wording of these targets does not give full weight to what should be seen as basic human rights. Without safe water and sanitation people are exposed to multiple risks that undermine their standards of health and nutrition and also make them poorer and more vulnerable. Across the region in 2004, some 659 million people did not have access to clean drinking water. In the rural areas, the region as a whole is on track to reach the target, but this is largely due to remarkable progress in India. India has raised rural coverage to 83 per cent, a success story that results from large-scale efforts by the Indian government with support from many international organizations, including ADB and UNICEF. A number of other countries still have very low rural coverage: only 32 per cent in Papua New Guinea, for example. For urban supplies, the region is off track and is struggling to meet the demand created by rapid urbanization. In some cases the lack of access is due to water scarcity, but more often it results from the ways in which water is used and distributed. Richer households in urban areas typically have hundreds of litres of cheap water per person per day while poorer urban household generally pay far more per litre and they, along with most poor rural households, survive on much less than 20 litres per person per day, the minimum quantity required to meet basic human needs (UNDP, 2006). It is also important to address water quality especially given rapid urbanization and increasing pollution in cities. Several countries in the region, includingChina have been raising standards and carrying out more frequent inspections and have significantly im proved the quality of urban water supplies. Probably as a result of these improvements, recent figures for diarrhoea in China are well below those of many other developing countries in the region. For basic sanitation the situation is worse. The AsiaPacific region is some way behind other global regions, with three-quarters of the worlds people without access to basic sanitation 1.9 billion in total. With 2008 as the International Year of Sanitation, national governments and international agencies have an opportunity to intensify their efforts to scale-up sanitation programmes. Meeting the water and sanitation targets will have major implications for achieving many of the other MDGs. Better health allows people to be more productive and thus reduces poverty. In addition, there are direct benefits for the survival and health of children. The report Asia Water Watch 2015 (ADB, 2007a) suggests that achieving the targets for water and sanitation would reduce the number of episodes of diarrhoea by 275 million cases. Providing just two litres per day of clean water for drinking, the average individual requirement, could deliver huge health benefits. This would also greatly improve the standards of nutrition since healthier children are better able to absorb nutrients, which in turn boosts mental capacity allowing them to learn more rapidly at school. Less need to fetch water from long distance particularly benefits girls and women reducing their time and work burden and providing them with more opportunities to go to school or engage in productive work. Improved access to water and sanitation can thus underpin many of the other MDGs.

PART 1 MDG progress in Asia and the Pacific

19

From red to green

This brief overview gives some sense of the scale of MDG progress across the Asia-Pacific region. As these figures have demonstrated, even for the relatively few indicators for which cross-regional data are available, there are far too many red warnings indicating that, on present trends many of the MDG goals could easily be missed. Some of the red symbols appear in unexpected places, often alongside countries that might be expected to have the resources to address these issues more

effectively. On the other hand, green symbols are displayed for many poorer countries which are keeping on track or achieving the goals, sometimes against considerable odds. How do we turn the red symbols green? For many countries, this will require a renewed focus on the goals likely to be missed, reorienting priorities and redirecting national resources towards the areas of greatest weakness. This may require greater attention for an entire sector such as sanitation. Or more commonly it will involve identifying the groups who are being left behind an issue addressed in the second part of this report.

PART 2
MDGs

Beyond national averages

20

Progress in Asia and the Pacific 2007

The first part of this report assessed MDG progress at the national level highlighting the differences in achievement between countries. Just as significant, however, are disparities within countries between the richest and poorest groups for example, between urban and rural areas, or between states or provinces.

Growing inequality
Many countries in the Asia-Pacific region have achieved remarkable reductions in income poverty through strong economic growth. East and South-East Asia took the lead in the 1980s but subsequently countries in South Asia and elsewhere also started to grow more rapidly. In the 1980s the fruits of this growth were distributed fairly equitably, hence the reduction in poverty. Over the past seventeen years, however, the pattern has been changing. Growth has proceeded apace but the benefits are now being skewed towards the better off. Although in many countries the poor continue to see their incomes rise, the richest have seen their incomes rise even faster and as a result, there have been significant increases in inequality. This is clear, for example, from data on shares of national income. In many countries the poorest 20 per cent of the population have seen their share of national income drop steeply. Between 1990 and 2004, in South Asia it fell from 7.2 to 6.7 per cent and in East Asia from 7.1 to 4.5 per cent one of the lowest proportions in the world (United Nations, 2007). These trends are confirmed by a more comprehensive measure of inequality, the Gini-index. For any population the index takes a value between 0, corresponding to absolute equality, and 100 corresponding to one household taking everything. In the past, Ginis across the Asia-Pacific region have been significantly lower than in other parts of the world. This is no longer the case. The bars in Figure 2-1 show that in the past decade or so, out of 20 countries in the region, 14 saw inequality rise, while only six saw it fall. The steepest increases were in Nepal, where the Giniindex increased by more than nine points, and in China where it increased by more than six points.

Intra-country disparities are especially important for the Asia-Pacific region which includes some of the worlds most populous countries. The poorest 20 per cent of the populations in China and India, for example, would on their own represent the worlds fourth and fifth largest countries with populations larger than Indonesia. Countries that are on track for a given indicator can thus still be leaving many millions of people behind. However, all countries, large and small, need to identify those groups and subgroups that are missing out. This chapter looks more closely at intra-country disparities, concentrating on some MDG indicators to which the countries of the region need to pay special attention: the proportion of the population living on less than $1 a day; under-five child mortality; under-five malnutrition, and access to improved water and sanitation. This picture is partial since only a few countries have recent trend data by subgroup emphasising once more the need for better data to track MDG progress. Demographic and Health Surveys are available for some Central Asian countries, though they are not very recent. In the case of the Pacific islands micro data are rarely available and when they are, they are usually not in the standardized manner needed for cross-country comparisons. Nevertheless we highlight the countries for which comparable data are available, since their experience suggests important considerations for other countries.

As the blue markers in this figure indicate, Nepal is now the most unequal of these countries, with China not far behind, both with Ginis close to 50 approaching those in Latin America, usually among the worlds highest. These two countries are certainly not alone in having high levels of inequality. The Philippines and Turkmenistan had smaller increases in their Ginis but these pushed the rates to quite high levels. Even Thailand, which achieved the greatest reduction, still has a high Gini at 42.
Figure 2-1 Changes in the Gini-index, 1990s2000s

A third caveat is that uneven progress can result in vicious cycles of inequality. Educational differences the best indicator of future income show how disparities can endure. In India, around half of those living in a household where the head has no schooling or incomplete primary education, live in poverty, a proportion that has hardly changed since 1993. A child born into such a home is therefore ten times as likely to live in poverty as a child born to a parent with an education level higher than secondary school. Particularly important is the education level of the mother which has a strong influence on childrens prospects of receiving primary education. The Philippines has reduced poverty at the national level, but did so more rapidly for households where the head had completed at least primary education. Hence, in 2003 three out of five people in poverty lived in a household where the head had the lowest education level, a higher proportion than at the beginning of the 1990s. In Viet Nam, two out of three living in such cohorts are poor. For both countries, however, if the head of the household holds at least a college degree their children will be able to break out of the cycle of poverty.
Table 2-1 $1/day poverty rates by education level of household head, 1990s2000s
India 1993 No schooling/ some primary Complete primary Complete secondary Higher 51.5 31.1 14.5 4.9 2004 46.7 26.8 13.1 4.7 Philippines 1994 29.5 19.2 5.7 0.5 2003 27.1 13.3 3.8 0.5 Viet Nam 1993 19.2 15.7 8.1 3.9 2002 7.7 2.5 1.0 0.1

PART 2 Beyond national averages

21

Source: ADB, 2007

It might be argued that if economic growth continues to boost the incomes of the poor an increase in inequality does not really matter, but there are three major caveats. The first caveat is that rising inequality can loosen social cohesion: conspicuous contrasts between rich and poor could lead to social or political instability and undermine future MDG achievements. Second, it represents a missed opportunity for had these countries avoided the increase in inequality, they would have been even more successful in reducing poverty. If Nepal, for example, a strong performer on many of the MDGs, had managed to hold its Gini steady it would now have only half as many people living in poverty (ADB, 2007).

It should be emphasized that these inequalities refer to income, which is not necessarily the most important measure of well-being. Parents living in poverty are likely to be more worried about properly feeding their children or about the quality of services at the nearest health centre. Although income is still a key indicator of these choices, the following sections broaden the picture by considering inequality in other vital aspects of human development and in those indicators for which the region has not performed that well.

Surviving the first five years

One of the most sensitive indicators of progress in human development is childrens chances of survival. Each year across the Asia-Pacific region over

Box 2-1 Health disparities in China

22

Between 1990 and 2004, the proportion of people living on less than $1 a day in China fell from 33 to 10 per cent, with 250 million less people under extreme poverty. However, this growth has been accompanied by widening disparities: between 1982 and 2004 the Gini-index rose from 30 to 47. These disparities are also evident in the nutritional status of children across provinces. Although the percentage of children underweight is close to zero in Beijing and Shanghai, in the province of Qinghai it is almost 6 per cent, and while the proportion has been coming down here and in some other provinces, in others such as Hebei the problem has been getting worse.
China, proportion of children underweight in selected provinces


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China has also made progress in reducing maternal mortality. Between 1994 and 2004, the maternal mortality ratio in urban areas fell from 44 to 26 per 100,000 live births and in the rural areas from 76 to 63 though as a result the rural-urban ratio increased from 1.8 to 2.4 (Ministry of Health of China, 2006). Why is the health gap widening between rural and urban areas? Many cite the collapse of the Cooperative Medical System and the progressive privatization and commercialization of health insurance and medical services. In the late 1970s virtually everyone had some kind of health coverage but by 1990 the proportion covered had dropped to 55 per cent in urban areas and to 10-20 per cent in the rural areas. Health insurance coverage is especially low, at less than 5 per cent, among the poorest quintile of the population (Tandon and Zhuang, 2007). Meanwhile medical costs have been escalating. Between 1990 and 2005, in-patient health expenditure almost tripled exposing millions to potentially catastrophic health crises. Many poor counties and districts, short of tax revenue, now demand payment even for basic immunization and other preventive health services, including antenatal care and reproductive health care. Payments for catastrophic health costs are one of the main reasons why people fall into poverty. The Chinese government has recognized the urgent need to make health care more accesible and affordable and has recently taken further measures, such as improving the coverage of basic health insurance for the rural poor.

MDGs

Progress in Asia and the Pacific 2007

Source: Ministry of Health of China, 2006

four million children die before reaching their fifth birthday. As the first part of this report has shown, the risk of early death varies significantly from one country to another. But childrens chances also differ according to which part of a country they are born in and to what type of household. Even countries that are on track to achieve the under-five mortality MDG can still fall far short in rural areas and in poor households. For those countries for which trend data are available, Figure 2-2 shows that not only are under-five mortality rates typically far higher in rural than in urban areas, by over 50 per cent or more, but that these rural-urban gaps have persisted. The ratios between rural and urban areas are indicated along the bottom of the figure. Of these countries only Bangladesh, which is on track for this goal, managed to reduce the ratio significantly, from 1.4 to 1.1 between 1996 and 2004. Nevertheless, this decline is due less to success in rural areas than to a failure to make much impact in urban areas.

Of Bangladeshs six divisions the greatest progress was in Sylhet, where 85 per cent of the population is rural and between 1996 and 2004 the under-five mortality rate fell by 30 per cent.
Figure 2-2 Under-five mortality rates, urban and rural trends

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Viet Nam, on the other hand, an early achiever that is continuing to make progress, is doing so more rapidly in urban areas; as a result the ruralurban gap has widened. The Philippines too is doing well overall and is on track to meet this goal, but here too the gap is widening. In 2003, for example, in the largely urban National Capital Region, the under-five mortality rate was 31 per thousand live births, while in the largely rural region of Mimaropa the rate was 68. Probably the most striking story is in Nepal, another on-track country. Between 1990 and 2005 the national under-five mortality rate fell from 145 deaths per thousand live births to 74, but regional disparities were still significant: in 2006 in the Eastern region the rate was down to 60 but in the Midwestern region it was 122. Whether they are born in rural or urban areas, the children least likely to survive are those in the poorest households. This is clear from Figure 2-3 which shows that the poorest 20 per cent of households account for considerably more than 20 per cent of a countrys child deaths for Viet Nam and the Philippines around 30 per cent. The number at the end of each bar captures the greatest contrast: the ratio between the rates for the poorest and richest wealth quintiles. These comparisons and subsequent discussions are based on wealth, which is judged on the basis of the quality of housing, for example, or the possession of certain consumer durables, since it is difficult to collect quality data on household income.
Figure 2-3 Under-five mortality rate by wealth quintile and the ratio of poorest to richest quintile, latest year

For both Viet Nam and the Philippines the current ratios of under-5 mortality between the poorest to richest quintile also represent deterioration. Despite their success in achieving or moving towards the under-five survival goals, the gaps between poor and rich have been widening. In Viet Nam between 1997 and 2002 the ratio between the two rates increased from 2.8 to 3.4, and in the Philippines, between 1998 and 2003, from 2.7 to 3.2. On the other hand, for Bangladesh and Indonesia, the ratios between poor and rich decreased slightly from 1.9 to 1.7 and from 3.7 to 3.5 respectively between the 1990s and the 2000s. These two ways of examining disparities, by residence and by income groups can also be applied in sequence, considering first the urban and rural areas and within these, looking at the rates by wealth quintile. Figure 2-4 shows this for the Philippines in 2003; although children in urban areas are more likely to survive, the experience is very different for children in poor and rich households. The greatest contrast is between the poorest households in rural areas and the richest ones in urban areas. Children in the poorest rural quintile are nearly four times as likely to die before reaching the age of five as those in the richest urban quintile.
Figure 2-4 The Philippines, under-five mortality rates by residence and wealth quintile, 2003

PART 2 Beyond national averages

23

Viet Nam Philippines Turkey India Indonesia Kazakhstan Cambodia Uzbekistan Kyrgyzstan Bangladesh Armenia Nepal Turkmenistan 0 low 20 40 percent second third fourth 60 80

3.4 3.2 2.6 3.1 3.5 1.8 2.4 1.4 2.0 1.7 2.1 1.9 1.5 100 high

Note: The latest year refers to the latest DHS in each country (see Technical Note on page 54), except Armenia (2000) and Cambodia (2000).

In addition to disparities based on income or residence, countries also have gender disparities in under-five mortality. In most cases the mortality rates are higher for boys than girls, though in some countries, such as India the rate is marginally higher for girls. Nowadays, across the region more children are surviving to the age of five and beyond. If countries are to reduce the mortality rates still further, they will have to tackle some of the more

24

difficult problems. This will mean, for example, reaching out to children in the more remote rural areas or in urban slums; but it also means making greater efforts to protect the youngest children, for as under-five mortality rates come down the remaining deaths are increasingly concentrated among children aged twelve months or younger. Many infant deaths take place very early - globally one-third occur during the first 28 days of life (WHO, 2005). One of the best ways of helping children to survive their earliest hours and days is to ensure that their births are attended by skilled personnel. More and more women are being supported by skilled birth attendants, but regional disparities remain high. While on average 61 per cent of births in Asia are attended by skilled personnel, this is the case for only 44 per cent in South-Central Asia as opposed to 71 per cent in South-East Asia. Across the region the likelihood of receiving this vital support is far less for the poorest families. Household data from Viet Nam and the Philippines demonstrate the contrasts: for the richest quintile the proportion of births attended by skilled birth attendants is over 90 per cent, but for the poorest quintile the proportions drop to 58 per cent in Viet Nam, and 25 per cent in the Philippines. One of the most challenging places to be born, however, is in a poor household in Nepal, where only four per cent of births in the poorest quintile are attended by skilled personnel.

children underweight was 23 per cent in urban areas but 41 per cent in rural areas. In India, these differences by residence are also reflected by state. In 1999, while in the North-eastern state of Sikkim the proportion of children underweight was only one in five, in the Central state of Madhya Pradesh the proportion was close to three in five. According to some estimates, more than 40 per cent of all underweight children in India live in five of 28 states: Maharashtra, Orissa, Bihar, Madhya Pradesh, Uttar Pradesh (Gragnolati et. al., 2005). These disparities are even starker by wealth quintile. As illustrated in Figure 2-5, in India, Bangladesh and Nepal the rates of children underweight for the poorest quintiles are more than twice those for the richest quintiles. In Cambodia too, rates are over 40 per cent in the poorest quintile in contrast to only half of that in richer households.
Figure 2-5 Proportion of underweight children under-five by wealth quintile, latest year
  

MDGs

Progress in Asia and the Pacific 2007

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Ensuring that children are well nourished

A childs death is usually directly attributable to a specific disease, such as pneumonia, diarrhoea or measles. There are, however, other preventable causes such as malnutrition: around half of under-five deaths are attributable to some extent to undernutrition, which weakens the childs resistance to disease. Despite the Asia-Pacific regions progress in reducing poverty, it has been much less successful in ensuring that its children are well nourished, as indicated by the proportion of children who are underweight. The proportion of under-five children who are underweight is around 28 per cent in Asia and the Pacific and higher still in South Asia at over 40 per cent, a rate considerably higher than that of Sub-Saharan Africa. As with under-five mortality, the problems are typically more severe in rural areas. In Nepal in 2006, for example, the proportion of under-five

For countries that can provide appropriate data it is also possible to break down the rates by wealth quintile within urban and rural areas. This is illustrated in Figure 2-6 for India, showing that while the overall rates are higher in rural areas, the situation is worse in urban areas where disparities are
Figure 2-6 India, underweight children under-five, by residence and wealth quintile, 1999

greater. In the poorest rural quintile the proportion of under-five children underweight is 61 per cent, while in the poorest urban quintile it is 66 per cent.

The drive for clean water

Child health and child nutrition are also closely linked to the availability of clean drinking water. Children drinking contaminated water not only suffer from diseases such as diarrhoea but also find it more difficult to absorb nutrients and thus become more malnourished. In terms of access to drinking water from improved sources the region as a whole has made progress - many countries are early achievers. But there are striking rural and urban differences, not just in overall coverage but in the sources of water. In rural areas improved sources would typically be tube wells, boreholes, protected dug wells or protected springs, while urban households may use similar sources, they are more likely to get water from public standpipes in the streets or have water piped to their homes. The overall rural-urban pattern, as mentioned in the previous section, shows that in urban areas access for most countries is often above 90 per cent, but with rural areas often lagging by 10 to 20 percentage points. Nevertheless there are still serious problems for urban households. In Bangladesh, Indonesia and the Philippines there are signs that as a result of urban population increase, the coverage is falling. Over the period from 1990 to 2005, all three countries saw a large influx of migrants to the cities. The proportion of the total population living in urban areas in Bangladesh rose from 20 to 25 per cent, in the Philippines from 49 to 63 per cent and in Indonesia from 31 to 48 per cent. Many of these new urban dwellers settle in densely populated slum areas, increasing their exposure to contagious diseases, unsanitary conditions and high levels of pollution. In Bangladesh, for example, 85 per cent of urban dwellers live in slums in 2001. Governments have found it difficult to keep up with this rural-urban influx and to provide these new inhabitants with improved water supplies. Between 1990 and 2004, urban access to improved sources of water in Bangladesh decreased from 83 to 82 per cent, while in Indonesia over the same period, coverage dropped from 92 to 87 per cent; both countries are thus regressing

Figure 2-7 Access to improved water sources between 1990 and 2004, by residence
30 25 Change in percentage points 20 15 10 5
1.0 9.0 6.0 3.0 2.0 22.0

21.0

0
-1.0

-5 -10 -15 Nepal Viet Nam

-5.0 -8.0

Indonesia urban

Bangladesh rural

Philippines

When countries achieve high overall levels of coverage the disparities between income groups start to narrow. In countries where coverage is still low, however, there can be wide gaps between rich and poor. Cambodia, for example, has very low coverage of water from improved sources, nationally only 41 per cent, a rate similar to that of Afghanistan. Geographical disparities are also significant since the proportion of urban households with access to improved sources of water is twice that in rural areas, where coverage is only 35 per cent. In Kandal, the region surrounding the capital, Phnom Penh, an estimated 85 per cent of the population had access to water in 2000, while in rural areas the proportion was only around onethird. As Figure 2-8 shows, in urban areas of Cambodia where over 70 per cent of urban residents living in slums, there are much greater disparities between rich and poor. Among the richest quintile, 80 per cent have coverage, but among the poorest quintile the proportion drops to 17 per cent. Although in rural areas disparities are smaller, even for the richest rural quintile access is lower than the urban average.

Beyond national averages

for this MDG target. In some countries progress has been faster in rural areas. Nepal and Viet Nam, for example, have been able to provide rural households with access to improved sources of water more rapidly than other countries in the region, making them early achievers. Between 1990 and 2004, Nepal increased coverage in rural areas by 22 percentage points, from 67 to 89 per cent, compared with only one percentage point in urban areas. Viet Nam increased rural coverage twice as much as it did urban coverage (Figure 2-7).

PART 2

25

Figure 2-8 Cambodia, access to improved water sources, by residence and wealth quintile, 2000

Figure 2-9 Access to improved sanitation, urban and rural, 2004

 

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MDGs

26

Progress in Asia and the Pacific 2007

Figure 2-10 Access to improved sanitation, rural areas, by wealth quintile, latest year


Access to improved sanitation

Access to improved sanitation is usually lower than that for improved water supplies. While families want better sanitation facilities, they tend to give a higher priority to clean water, and national political agendas rarely feature sanitation. This is despite the evident benefits: changing from unimproved to improved sanitation can lead to a 30 per cent reduction in child mortality (UNDP, 2006). Improved sanitation includes, for example, household toilets or latrines connected to a piped sewerage system, septic tanks or pits, ventilated improved pit latrines, or composting toilets. People without these facilities might use open pits, bucket latrines, defecate in fields, or dispose of faeces in plastic bags or in rivers. Improved sanitation facilities are less common in rural areas. For the countries included in Figure 2-9, the ratio between urban and rural provision of improved sanitation ranges from 1.3 in Uzbekistan to 2.7 in India. Even within urban areas there can be stark contrasts, with very low sanitation coverage in the poorest areas. For people in slums it can be difficult to construct even a basic toilet facility, not just because of the cost, but also because of a lack of secure tenure or of supporting infrastructure. Within the rural areas, coverage can by analysed by household wealth. For a number of countries coverage of improved sanitation facilities for the lowest quintile is often less than onequarter that of the richest quintile (Figure 2-10). In countries with high percentages of their total population living in rural areas, for example 84 per cent

  

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in Nepal and 80 per cent in Cambodia in 2005, coverage of improved sanitation facilities for the poorest quintiles is close to zero. The contrasts in access to improved sanitation by both urban-rural areas and wealth quintiles are illustrated for Indonesia in Figure 2-11. Indonesia is moving only slowly towards its target at the national level, and also has a low coverage in
Figure 2-11 Indonesia, access to improved sanitation, by residence and wealth quintile, 2003

PART 2 Beyond national averages

rural areas. Between 1990 and 2004 access to sanitation in rural areas increased only by three percentage points over a 14-year period, moving from 37 to 40 per cent. Although the progress rate was higher for urban areas, there is still a striking gap between rich and poor. Moreover, in urban areas this gap has been widening further; between 1997 and 2002, the ratio in the access of the richest and poorest quintiles increased slightly, from 5.0 to 5.2.

For sanitation, as for the other MDG indicators considered in this part of the report, progress at the national level does not always reduce disparities between rural and urban areas, or between richer and poorer households. This emphasizes the need to adopt more inclusive strategies across all MDG target areas to ensure that the benefits of economic growth are shared equitably, so as to reduce poverty and promote sustainable human development.

27

EPILOGUE
MDGs

Towards a global partnership

28

Progress in Asia and the Pacific 2007 200

The series of MDG reports for Asia and the Pacific has demonstrated how, as a result of national efforts, the region has continued to make significant progress, particularly in primary education and in reducing the number of people living in extreme poverty, on less than $1 per day. Indeed in many countries the development agenda is moving on to address those living on less than $2 per day often called the vulnerable poor. At the same time, however, governments are becoming more concerned about particular groups and regions that are being left behind those living in the slums of major cities, or in environmentally fragile zones. Whatever the sector, the overall aim should be to reduce poverty and vulnerability while improving the delivery of basic services. This will mean pursuing pro-poor growth in a broader sense not just promoting income generation for the poor but also expanding physical and social infrastructure, such as transport, water, energy, and health and education services. These priorities should be reflected in national development strategies. Countries across the region have already demonstrated this approach. Indonesia, for example, has designed specific social sector policies for the poor. China has been investing in pro-poor infrastructure. Viet Nam has been tackling environmental poverty with special programmes for poor people living in upland areas. Countries in Central Asia that have long since achieved high primary enrolment are now looking more to secondary education and vocational training that can help people adjust to changing labour markets. Many countries will be able to follow their own strategies and maintain or renew their momentum for the MDGs by investing from their own resources. But others, particularly the regions least developed countries, do not have the funds to meet all their investment needs. They have a large resource gap the difference between savings

and investment as a percentage of GDP. In 2003, Afghanistan, for example, had a resource gap amounting to 32 per cent of GDP, while in TimorLeste the gap was 77 per cent (ESCAP, 2005c). The eighth Millennium Development Goal seeks to build a global partnership for development, which could help meet such gaps through, for example, official development assistance (ODA). At the global level ODA has reached record amounts but the LDCs in the Asia-Pacific region have been getting a steadily smaller share. Between 2000 and 2003, ODA to LDCs in other global regions increased by 87 per cent but to the Asia-Pacific LDCs by 60 per cent. Also of concern is the situation of the Landlocked Developing Countries (LLDCs) and the Small Island Developing States (SIDS). In 2005 ODA received by the LLDCs ranged from 12 per cent of GNI in Mongolia to 0.45 per cent in Kazakhstan, and ODA received by the SIDS ranged from 71 per cent in the Solomon Islands to 7 per cent in Papua New Guinea. While not many Asia-Pacific countries fall into the category of highly indebted poor countries, some countries would benefit from debt relief. Another component of the eighth goal that would help developing countries fill the resource gap is enhanced market access. The LDCs in this region face, on average, higher tariffs than other LDCs and since 1990 the proportion of developed country imports coming from Asia-Pacific LDCs has declined. The LDCs would benefit greatly from duty- or quota-free access to the developed countries. Other developing countries in the region also face above-average tariff levels for many of the traditional exports in which they have comparative advantage. To some extent these countries have been able to offer mutual support by offering preferential access to each others markets. But the developed and more advanced developing countries need to do much more. The

Towards a global partnership

best way to provide additional momentum would be to conclude the Doha Development Round which would add legal certainty to LDCs dutyand quota-free access to developed-country markets. Preferential access in trade can be complemented by greater south-south cooperation from one developing country to another such as through technical assistance. This now appears to be increasing, with support to poorer countries coming from China, India, the Republic of Korea, Malaysia, Singapore and Thailand. All countries will benefit too from cooperation on information and communications technologies, but particularly the LDCs which at present risk being left behind. Building a global partnership for the MDGs complements the overall responsibility of national

governments for mobilizing resources aligning their budgets towards development strategies aimed at achieving the goals. Indeed, many countries have already done so. As this report has shown, even the poorest countries have been able to make rapid progress on at least some of the indicators, and some of the largest countries have had some striking successes in helping many millions of people emerge from poverty or get basic education and better water supplies. The task is to ensure that these and other advances now take place on a much broader front across all countries, and across all the goals. The AsiaPacific region has in many respects been setting the pace for the developing world, particularly in economic growth. Now it has the opportunity to focus again on equity and extend the benefits of rapid economic and social development to all its people.

EPILOGUE

29

Bibliography
MDGs

30

Progress in Asia and the Pacific 2007

ADB, 2006a. Asia Water Watch 2015: Are countries inAsia on track to meet Target 10 of the Millennium Development goals? ADB, UNDP, ESCAP and WHO. Manila. ADB, 2006b. Pursuing Gender Equality through the Millennium Development Goals in Asia and the Pacific. ADB, UNDP and ESCAP. Manila. ADB, 2007. Inequality in Asia: Key Indicators 2007. Manila. Altinay, Galip, 2004. On measuring average growth rates. Applied economics. London: Routledge. ESCAP, 2005a. A future within reach: reshaping institutions in a region of disparities to meet the Millennium Devlopment Goals in Asia and the Pacific. ESCAP, ADB, UNDP. Bangkok ESCAP, 2005b. State of the environment in Asia and the Pacific 2005: Economic growth and sustainability. Bangkok. ESCAP, 2005c. Voices of the Least Developed Countries of Asia and the Pacific: Achieving the Millennium Development Goals Through a Global Partnership. Bangkok. ESCAP, 2006. The Millennium Development Goals: Progress in Asia and the Pacific 2006. ESCAP, ADB, UNDP. Bangkok. ESCAP, 2007. Economic and social survey 2007. ESCAP, Bangkok. Filmer, Deon, Elisabeth King and Lant Pritchett, 1998. Gender disparity in South Asia: comparisons between and within countries. World Bank. Washington DC. Gragnolati, Michele, Shekarb Meera, Monica Das Gupta, Caryn Bredenkampd and Yi-Kyoung Lee, 2005. Indias undernourished children: A call for reform and action. Health Nutrition and Population Discussion Paper. World Bank. Washington DC. Gwatkin, Davidson, Shea Rustein, Kiersten Johnson, Rohini Pande and Adam Wagstaff, 2004. Socio-Economic Differences in Health, Nutrition and Population. HNP/ Poverty Thematic Group. World Bank. Washington DC. (Various years and countries) Holt, Tim, 2003. Aggregation of national data to regional and global estimates. Report for the CCSA, 2nd session. Geneva. Joint Monitoring Programme for Water Supply and Sanitation. Country files: water and sanitation. WHO and UNICEF. (Various years and countries) Measure DHS, 2006. Demographic and Health Surveys. (various years and countries) Macro International Inc. http:/ /www.measuredhs.com/ Ministry of Health of China, 2006. China Health Yearbook. http://www.moh.gov.cn/12.htm. Beijing. Roll Back Malaria, 2005. World Malaria Report 2005. WHO and UNICEF. Geneva. Rutstein, Shea Oscar and Guillermo Rojas, 2006. Guide to DHS statistics. Demographic and Health Surveys. ORC Macro. Maryland. Stoff, Christian and Adrien Lorenceau, 2007. Estimating regional aggregates in the presence of missing country values: The case of MDG indicators. ESCAP. Bangkok. Tandon, Ajay and Juzhong Zhuang, 2007. Inclusiveness

of Economic Growth in the Peoples Republic of China: What Do Population Health Outcomes Tell Us? ERD Policy Brief No. 47. ADB. Manila. UNAIDS, 2006. AIDS epidemic update: Special report on HIV/ AIDS. WHO library cataloguing-in-publication Data. Geneva. Unterhalter, Eliane, 2006. Measuring gender inequality in education in South Asia. UNICEF and UNGEI. Kathmandu. UNDP, 2005a. China Human Development Report. UNDP and China Development Research Foundation. Beijing. UNDP, 2005b. Human Development Report 2005. International cooperation at a crossroads: Aid, trade and security in an unequal world. New York: Oxford University Press. UNDP, 2005c. Millennium Development Goals country report 2005: Sri Lanka. National Council for Economic Development in Sri Lanka and UNDP. Colombo. UNDP, 2005d. Taking action: achieving gender equality and empowering women. Millennium Project Task Force on Education and Gender Equality. London: Earthscan. UNDP, 2006. Human Development Report 2006. Beyond scarcity: Power, poverty and the global water crisis. New York. Oxford University Press. United Nations, 2005a . Millennium Development Goals: Bangladesh progress report. Government of Bangladesh and United Nations Country Team in Bangladesh. Dhaka. United Nations, 2005b. Nepal Millennium Development Goals: Progress report 2005. HMG Nepal and United Nations Country team in Nepal. Kathmandu. United Nations, 2005c. The World Population Prospects: The 2004 revision population database. Department of Economic and Social Affairs, Population Division. New York. United Nations, 2006. The World's Women 2005: Progress in Statistics. United Nations Department of Economic and Social Affairs, Statistics Division. New York. United Nations, 2007a. The Millennium Development Goals Report 2007. New York. United Nations, 2007b. The World Population Prospects: The 2006 revision population database. Department of Economic and Social affairs, Population Division. New York. World Bank, 2004. Timor-Leste Education, Since Independence: From Reconstruction to Sustainable Improvement. Human Development Sector Unit, East Asia and Pacific Region. Report No. 29784-TP. World Bank. Washington DC. WHO, 2005. World Health Report 2005: Making every mother and child count. Geneva. WHO, 2007a. Malaria: disease burden in the SEA region, http:/ /www.searo.who.int/EN/Section10/Section21/ Section340_4018.htm, accessed on 12 September 2007. WHO Regional Office for South-East Asia. WHO, 2007b. Malaria. Fact-sheet n.94. WHO. Geneva.

Index to MDG indicators

31
Goal 1 - Eradicate extreme poverty and hunger Target 1 - Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day 1. Proportion of population below $1 (PPP) per day i 2. Poverty gap ratio (incidence x depth of poverty) 3. Share of poorest quintile in national consumption 35 35 35 World Bank World Bank World Bank UNICEF FAO
Index to MDG indicators

Millennium Development Goals, targets and indicators

Page

Data Source

Target 2 - Halve, between 1990 and 2015, the proportion of people who suffer from hunger 4. Prevalence of underweight children under-five years of age 36 5. Proportion of population below minimum level of dietary energy 36 consumption Goal 2 - Achieve universal primary education Target 3 - Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary school 6. Net enrolment ratio in primary education 7a. Proportion of pupils starting grade 1 who reach grade 5 ii 7b. Primary completion rate 8. Literacy rate of 15-24 year-olds Goal 3 - Promote gender equality and empower women Target 4 - Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 9. Ratios of girls to boys in primary, secondary and tertiary education 10. Ratio of literate women to men, 15-24 years old 11. Share of women in wage employment in the non-agricultural sector 12. Proportion of seats held by women in national parliament Goal 4 - Reduce child mortality Target 5 - Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate 13. Under-five mortality rate 14. Infant mortality rate 15. Proportion of 1 year-old children immunized against measles Goal 5 - Improve maternal health Target 6 - Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio 16. Maternal mortality ratio 17. Proportion of births attended by skilled health personnel Goal 6 - Combat HIV and AIDS, malaria and other diseases Target 7 - Have halted by 2015 and begun to reverse the spread of HIV and AIDS 18. Percentage of people living with HIV 19. Condom use rate of the contraceptive prevalence rate 19a. Condom use at last high-risk sex 19b. Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV and AIDS 19c. Contraceptive prevalence rate 20. Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years Target 8 - Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases 21. Prevalence and death rates associated with malaria 22. Proportion of population in malaria-risk areas using effective malaria prevention and treatment measures 23. Prevalence and death rates associated with tuberculosis 24. Proportion of tuberculosis cases detected and cured under directly observed treatment short course DOTS (Internationally recommended TB control strategy) Goal 7 - Ensure environmental sustainability Target 9 - Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources 25. Proportion of land area covered by forest 26. Ratio of area protected to maintain biological diversity to surface area

37 37 37 37

UNESCO UNESCO UNESCO UNESCO

38 39 39 39

UNESCO UNESCO ILO IPU

40 40 40

UNICEF UNICEF UNICEF

41 41

WHO/UNICEF/UNFPA UNICEF

42 42 42 43 43 43

UNICEF/UNAIDS/WHO UNFPA UNICEF/UNAIDS/WHO UNICEF/UNAIDS/WHO UNFPA UNICEF/UNAIDS/WHO

N/I 15 44 44

UNICEF WHO WHO

45 45

FAO UNEP

27. Energy use (kg oil equivalent) per $1 GDP (PPP) 28. Carbon dioxide emissions per capita and consumption of ozone-depleting CFCs(ODP tons) 29. Proportion of population using solid fuels Target 10-Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation 30. Proportion of population with sustainable access to an improved water source, urban and rural 31. Proportion of population with access to improved sanitation, urban and rural Target 11-By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers 32. Proportion of households with access to secure tenure

45 46 N/I 47 47

World Bank CDIAC/UNEP

WHO/UNICEF WHO/UNICEF

18

UN-Habitat

32

Goal 8 - Develop a global partnership for development Target 12-Develop further an open, rule-based, predictable, non-discriminatory trading and financial system Target 13-Address the special needs of the least developed countries Target 14-Address the special needs of landlocked developing countries and small island developing States Target 15-Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term 33. Net ODA, total and to the least developed countries, as percentage of OECD/DAC donors gross national income 34. Proportion of total bilateral, sector-allocable ODA of OECD/DAC donors to basic social services (basic education, primary health care, nutrition, safe water and sanitation) 35. Proportion of bilateral official development assistance of OECD/DAC donors that is untied 36. ODA received in landlocked developing countries as a proportion of their gross national incomes 37. ODA received in small island developing States as a proportion of their gross national incomes 38. Proportion of total developed country imports (by value and excluding arms)from developing countries and least developed countries, admitted free of duty 39. Average tariffs imposed by developed countries on agricultural products and textiles and clothing from developing countries 40. Agricultural support estimate for OECD countries as a percentage of their gross domestic product 41. Proportion of ODA provided to help build trade capacity 42. Total number of countries that have reached their HIPC decision points and number that have reached their HIPC completion points (cumulative) 43. Debt relief committed under HIPC Initiative 44. Debt service as a percentage of exports of goods and services Target 16-In cooperation with developing countries, develop and implement strategies for decent and productive work for youth 45. Unemployment rate of young people aged 15-24 years, each sex and total Target 17-In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries 46. Proportion of population with access to affordable essential drugs on a sustainable basis Target 18-In cooperation with the private sector, make available the benefits of new technologies, especially information and communications 47. Telephone lines and cellular subscribers per 100 population 48a. Personal computers in use per 100 population 48b. Internet users per 100 population

MDGs

Progress in Asia and the Pacific 2007

48 48 48 48 48 N/I N/I 49 49 N/A N/A 49 50 N/I

OECD OECD OECD OECD OECD

OECD OECD/WTO World Bank ILO

51 51 51

ITU ITU ITU

Note: Goals, targets and indicators according to the global Millennium Indicators Database (http://mdgs.un.org). At the 2005 World Summit, world leaders committed themselves to achieving four additional targets to the ones included in the Millennium Declaration (2005 World Summit Outcome A/RES/60/1). The Inter-Agency and Expert Group on MDG Indicaotrs subsequently work on the selection of the appropriate indicators for the new targets. This process has led to a revised MDG monitoring framework, to be reflected in future MDG progress assessments. N/I = Not Included due to unavailability of data in the global Millennium Indicators Database N/A = Not Applicable i For monitoring country poverty trends, indicators based on national poverty lines should be used, where available. ii An improved measure of the target for future years is under development by the International Labour Organization.

Abbreviations and acronyms

CDIAC: FAO: ILO: IPU: ITU: OECD: UNAIDS:

Carbon Dioxide Information Analysis Center Food and Agriculture Organization of the United Nations International Labour Organization Inter-Parliamentary Union International Telecommunication Union Organization for Economic Cooperation and Development Joint United Nations Programme on HIV/AIDS

UNEP: UNESCO: UNFPA: UN-Habitat: UNICEF: WHO: WTO:

United Nations Environment Programme United Nations Educational, Scientific and Cultural Organization United Nations Population Fund United Nations Human Settlements Programme United Nations Childrens fund World Health Organization World Trade Organization

Table A Countries on and off track for the MDGs

Goal

1
Underweight children

2
Primary completion rate

7
ODP CFC consumption

TB prevalence rate

Gender secondary

Primary enrolment

Reaching grade 5

Under-5 mortality

Sanitation urban

Gender Primary

HIV prevalence

CO2 emissions

Sanitation rural

Gender tertiary

Protected area

Infant mortality

TB death rate

Forest cover

Water urban

Water rural

$1 poverty

33
MDG indicator tables

East and North-East Asia China Democratic Peoples Republic of Korea Democratic People's Republic of Hong Kong, China Macao, China Mongolia Republic of Korea South-East Asia Brunei Darussalam Cambodia Indonesia Lao People's Democratic Republic Malaysia Myanmar Philippines Singapore Thailand Timor-Leste Viet Nam South and South-West Asia Afghanistan Bangladesh Bhutan India Iran (Islamic Republic of) Maldives Nepal Pakistan Sri Lanka Turkey North and Central Asia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenistan Uzbekistan Pacific American Samoa Cook Islands Fiji French Polynesia Guam Kiribati Marshall Islands Micronesia (Federated States of) Nauru New Caledonia Niue Northern Mariana Islands Palau Papua New Guinea Samoa Solomon Islands Tonga Tuvalu Vanuatu
Early archiever ; On track; Slow;

No progress/Regressing

Table B Data by region and country group

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Goal 1 Eradicate extreme poverty and hunger

Target 1 - Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a day
-------------------------------------------------------------------------------------------------------------------------------------------------------1. Population below $1 a day (%) Earliest East and North-East Asia China DPR Korea Hong Kong, China Japan Macao, China Mongolia Republic of Korea South-East Asia Brunei Darussalam Cambodia Indonesia Lao PDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste Viet Nam South and South-West Asia Afghanistan Bangladesh Bhutan India Iran (Islamic Republic of) Maldives Nepal Pakistan Sri Lanka Turkey North and Central Asia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenistan Uzbekistan Pacific American Samoa Australia Cook Islands Fiji French Polynesia Guam Kiribati Marshall Islands Micronesia (Fed. States of) Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Samoa Solomon Islands Tonga Tuvalu Vanuatu 33.0 ... ... ... ... 13.9 ...
(90)

2. Poverty gap ratio

3. Share of poorest 20% in national income or consumption (%) Earliest

(04)

Latest 9.9 ... ... ... ... 10.8 2.0

(04)

Earliest ... ... ... ... ... 3.1 ...

Latest 2.1 ... ... ... ... 2.2 0.5

Latest 4.3 ... 5.3 10.6 ... 7.5 7.9

a (04)

c,d

(98)

d,e (98)

a,d (98)

... ... 17.4 18.6 2.0 ... 19.8 ... 6.0 ... ...

(93) (92) c (92)

(91)

(92)

... 34.1 7.5 27.0 2.0 ... 14.8 ... 2.0 ... ...

(97) (02) (02) c (97)

(03)

(02)

... ... 2.7 3.0 0.5 ... 4.2 ... 0.5 ... ...

(93) (92) e (92)

(91)

(92)

... 9.7 0.9 6.1 0.5 ... 2.9 ... 0.5 ... ...

(97) (02) (02) e (97)

(03)

(02)

... 6.9 8.3 9.6 4.6 ... 5.9 ... 5.6 ... 7.7

a a a b

(97) (93) (92) (92)

(91)

(92)

(93)

... 6.8 8.4 8.1 4.4 ... 5.4 5.0 6.3 ... 9.0

a a a b

(04) (02) (02) (97)

a b a

(03) (98) (02)

(04)

... 35.9 ... 41.8 2.0 ... 34.4 13.5 3.8 2.4

(92)

(93) c (90)

(96) (99) (90) (94)

... 41.3 ... 34.3 2.0 ... 24.1 17.0 5.6 3.4

(00)

(04) c (98)

(04) (02) (02) (03)

... 8.8 ... 10.7 0.5 ... 9.0 2.4 0.7 0.6

(92)

(93) e (90)

(96) (99) (90) (94)

... 10.3 ... 7.9 0.5 ... 5.4 3.1 0.8 0.8

(00)

(04) e (98)

(04) (02) (02) (03)

... 9.4 ... ... 5.2 ... 7.5 8.8 9.0 5.8

(92)

(90)

a a a

(96) (99) (90) (94)

... 8.6 ... 8.1 5.1 ... 6.0 9.3 7.0 5.3

(00)

a a

(04) (98)

a a a

(04) (02) (02) (03)

6.7 10.9 2.0 2.0 8.0 7.0 13.9 ... 3.3

(96) (95) c c (96) (93) (93) (96) (99)

(93)

2.0 3.7 6.5 2.0 2.0 2.0 7.4 20.7 2.0

(03) (01) (03)

c c c

(03) (03) (02) (03) (93)

(03)

1.5 2.6 1.0 0.5 3.3 1.7 3.4 ... 0.5

(96) (95) (96) e (93) (93) (96) (99)

(93)

0.5 0.6 2.1 0.5 0.5 0.5 1.3 5.3 0.5

(03) (01) (03)

e e e

(03) (03) (02) (03) (93)

(03)

5.4 6.8 6.1 7.5 2.5 4.5 8.1 6.9 7.3

b a a b a a a

(96) (95) (96) (93) (93) (96) (99) (93) (93)

8.5 7.4 5.6 7.4 8.9 6.1 7.9 6.1 7.2

a a a a a a a

(03) (01) (03) (03) (03) (02) (03) (98) (03)

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

... 5.9 ... ... ... ... ... ... ... ... ... 6.4 ... ... ... 4.5 ... ... ... ... ...

(94)

(97)

(96)

Footnotes: The number in parentheses is the year of the data point. a Refers to expenditure share by percentile of population. b Refers to income share by percentile of population. c All 2% poverty headcount estimates indicate that actual values are less than or equal to 2% and should be treated with caution. d Urban area only. e All 0.5% poverty gap estimates indicate that actual values are less than or equal to 0.5% and should be treated with caution.

MDG indicator tables

(95)

(02)

(95)

(02)

... ... ... ... ... 7.3 ...

b a

(96) (93)

35

(95)

(02)

Goal 1 Eradicate extreme poverty and hunger

Target 2 - Halve, between 1990 and 2015, the proportion of people who suffer from hunger
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Goal 2 Achieve universal primary education

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Target 12-15 - Develop a global partnership for development - through more aid, better market access and debt sustainability
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Technical note MDG indicator tables

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51

Technical note
MDGs

52

MDG progress classification

The same classification method is applied for both countries and regions or country groups. The four categories of MDG progress towards the targets are: Early achiever: Already achieved the 2015 target On track: Expected to meet the target by 2015 Off trackSlow: Expected to meet the target, but after 2015 Off trackNo progress/regressing: Stagnating or slipping backwards Two different procedures are used to determine the categories depending on whether or not an indicator has an explicit target value for 2015. For indicators without such a target value, such as HIV prevalence, TB prevalence, TB death rate, forest cover, protected area, CO2 emissions and CFC consumption, only three of the four categories are used: indicators trending in the right direction since 1990 are categorized as Early achiever; indicators showing no change at all over the period are categorized as On track; and finally indicators trending in the wrong direction are categorized as Off trackNo progress/regressing. For indicators with an explicit target value, such as $1/day poverty, mortality rates, school enrolment and the gender parity indices, all four categories are used. To determine the category, the W - by which a country would reach its MDG year .... target if the trend since 1990 continued is estiW /VW as the year with mated (see below). Denote ......... W /VW , the W the latest available value. If ..... is below ....... W lies country is categorized as an Early achiever. If ..... W /VW and 2015, it is categorized as On track. between ...... W If ..... is above 2015, the country is categorized as W can be estimated Off trackSlow. Naturally no ..... if a country has a zero trend or trends in the wrong direction, i.e. away from the target value.

In these cases, the country is categorized as Off trackNo progress/regressing. Estimating the trend. To estimate ..... W , the trend since 1990 is estimated first based on at least two data points, which are at least three years apart. The only exception is HIV prevalence, for which country data are available only for 2003 and 2005 for almost all countries. Two different models are used depending on whether the trend for an indicator is decreasing or increasing. For decreasing time series, a geometric model with annual discrete compounding is applied: ................................................ /VW  )VW 

Progress in Asia and the Pacific 2007

<   U  <)VW denote the latest and first </VW and ......... where ........ available values since 1990 for the years ....... W /VW and U denotes the average ........ W)VW , respectively, and ....... W /VW and ..... growth rate between ........ .. . The average W)VW
W W /VW )VW

<

growth rate is calculated as the geometric mean

U

 W /VW

3
W

 W )VW 


  U 
W

  W /VW

 W )VW 

<  <
/VW )VW

  W /VW

 W )VW 



This specification describes a slope, which decreases with a decreasing rate a reasonable assumption for the indicators considered. For increasing time series, an average geometric rate of change would yield a slope which increases at an increasing rate an unreasonable assumption. Therefore, for increasing indicators, a linear model is applied instead, ....................................................

</VW
<

<)VW  T W /VW  W )VW 

<

T where ........... denotes the average unit W / V W  W ) VW W)VW and ...... increase per period between ....... W /VW . In all cases except for the CIS countries, the first and latest available values are used to estimate the average rate of change. This procedure implicitly takes the intermediate values into account and has the advantage over the widely used leastsquares method in that it covers difference-station-

/VW

)VW

ary as well as trend-stationary time series (see e.g. Altinay, 2004). For CIS countries, the impact of the social changes in the early 1990s on many of the MDG indicators is taken into account. The rate of change for all the available data since 1990 is calculated first and then for all the available data except the first year. If the signs of the two estimated rates differ, the trend estimate excluding the observation for the first year is used. Estimating the year of MDG achievement. For indicators with a target value, the calculation </VW denote the tarof ..... W is as follows. Let ..... < and ..... get value and latest available value, respectively. For decreasing indicators, re-arranging .........................and < <   U adding ....... W /VW gives
W /VW

Regional and country group aggregates

Regions or country groups are categorized with respect to their progress towards the MDGs in the same way as countries. To determine the trend and classify each region or country group accordingly, the aggregate values for 1990 and the latest year, for example. 2004 for $1/day poverty and 2005 for under-5 mortality, are estimated first. For the regions Sub-Saharan Africa, Latin America and the Caribbean, South Asia, and SouthEast Asia, estimates produced by the responsible international data agencies are obtained from the global MDG report (United Nations, 2007) for the following indicators: underweight children, under-5 mortality, forest cover, primary enrolment and CO2 emissions. For $1/day poverty, the estimates for all regions and country groups are estimated by the World Bank through PovCal Net for this repor. The remaining aggregates are estimated by the ESCAP Statistics Division, by using a weighted average of the actual country values, or imputed country values wherever data are missing for the year required. The reference population are obtained from the World Population Prospects: The 2004 Revision (United Nations, 2005) to be consistent with the agency estimates. The estimation of the adversely affected populations is based on population data from the World Population Prospects: The 2006 revision (United Nations, 2007). To impute missing values for 1990 and the latest year for a country, all available data for other years since 1990 are used. If a country has one observation during the period, this value is used for both 1990 and the latest year, as it provides useful information for estimating the aggregate. If a country has two or more observations, the missing values for 1990 and the latest year are replaced with fitted values according to
\
W

53
Technical note

......................................... W

ORJ

<

W /VW

< /VW

ORJ

 U

and for increasing indicators with the linear unit rate of change, it is
t * t Lst Y * YLst q
.

Using cut-off values. Many of the MDG targets require an indicator value to increase or decrease by a certain proportion. In this report, the target is also treated as achieved if a country has reached a certain absolute value. In the case of primary school enrolment, for example, this cutoff value is set at 95 per cent, and for $1/day poverty at 5 per cent. The cut-off values for selected indicators are presented in Table 1 below.
Table 1 Cut-off values for selected MDG indicators
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E  are Ordinary Least Square (OLS) where ..... b0 and ..... estimates from the model ............................................ ORJ \ E  E W  H HW a 1  V H  for decreasing indicator sewith .............................. ries. For increasing indicators, the fitted values from
W W

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5HGXFHE\KDOI 5HGXFHE\KDOI 5HGXFHE\KDOI 5HGXFHE\KDOI

   

t a 0 a1t y

based on y t a 0 a1t et with HW a 1  V H  are used. This approach is discussed in more detail in Stoff and Lorenceau (2007), see also Holt (2003).

54

Regional and country group aggregates are reported only when the countries with more than two available data values between 1990 and the latest year account for more than 50 percent of the total reference population in a region or country group. The estimated aggregates and affected population presented in Figures 1-1 to 1-11b in the report can be found in Table B on page 34 by region and country group.

Table 2 DHS used in analyses of Part 2

Within-country disparities
The $1/day international poverty estimates for India, the Philippines and Viet Nam are based on calculations made by the Development Indicators and Policy Research Division of ADB using country-specific household surveys. For India, the data are from the National Sample Surveys 1993/1994 and 2004/2005; for the Philippines, the Family Income and Expenditures Surveys of 1994 and 2003; and for Viet Nam, the Living Standard Surveys of 1993 and 2002. The poverty line of $32.74 per month in 1993 PPP consumption dollars is converted into current local currency units for all the relevant country-year combinations using the national consumer price indices. The resulting poverty lines are then applied to population-weighted data on monthly per capita expenditures obtained from unit-level data. All the estimates in Part 2, except those for poverty, are based on the global MDG database and the Demographic and Health Surveys (DHS) made available by Macro International Inc. These surveys, which provide data on population, health, and nutrition indicators, are nationally representative and range in size from close to 9,000 households for Nepal 2001, to over 90,000 households for India 1999 (www.measuredhs.com). For the DHS surveys used in this analysis, see Table 2. Under-five mortality and the proportion of underweight children under five are calculated using the methodology described in the DHS reports. Under-five mortality is based on a direct estimation method using a synthetic-cohort life approach (see Rutstein & Rojas, 2006). Under-

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MDGs

Progress in Asia and the Pacific 2007

weight children estimates are based on the reference population which have a weight-for-age rate of two (moderately underweight) and three (severe underweight) standard deviations below those for the corresponding populations. These populations are defined by the U.S. National Centre for Health Statistics, as recommended by WHO. Access to water and sanitation estimates are based on the country files provided by the WHO and UNICEF Joint Monitoring Programme (JMP) for water and sanitation (http://childinfo.org/ eddb/water.htm). The values reported by the JMP in the global MDG database are based on a linear trend for all the data points (surveys) available for a specific country. This report presents the percentages of safe and protected sources reported for each year, for which percentages might differ slightly from those based on the linear trend. The wealth index is a living-standards index composed of different variables which reflect households assets. The index includes variables on ownership of consumer durables such as a radios, televisions, refrigerators, cars, etc., and variables on the households dwelling such as the type of toilet facilities, the sources of drinking water and the building materials used for the house (Filmer & Pritchett, 1998). Weights are constructed using principal components analysis for each country. Comparison between countries should be made with caution because wealth quintiles thus defined may vary from country to country.

Classification of countries

55
Asia-Pacific Region1 Singapore Asia-Pacific Developed Solomon Islands Sri Lanka countries

Australia Japan New Zealand

Tajikistan Thailand Timor-Leste Tonga Asia-Pacific developing Turkey Turkmenistan countries Afghanistan Tuvalu American Samoa Uzbekistan Armenia Vanuatu Azerbaijan Viet Nam Bangladesh Bhutan Asia-Pacific developing Brunei Darussalam Subregions Cambodia North & North-East Asia China China Cook Islands Democratic Peoples RepubDemocratic People's Repub- lic of Korea lic of Korea Hong Kong, SAR of China Fiji Macao, SAR of China French Polynesia Mongolia Georgia Republic of Korea Guam Russian Federation Hong Kong, China India North & Central Asia Indonesia Armenia Iran (Islamic Republic of) Azerbaijan Kazakhstan Georgia Kiribati Kazakhstan Kyrgyzstan Kyrgyzstan Lao People's Democratic Re- Tajikistan public Turkmenistan Macao, China Uzbekistan Malaysia Russia Maldives Marshall Islands South-East Asia Micronesia (Federated States Brunei Darussalam of) Cambodia Mongolia Indonesia Myanmar Lao Peoples Democratic ReNauru public Nepal Malaysia New Caledonia Myanmar Niue Philippines Northern Mariana Islands Singapore Pakistan Thailand Palau Timor-Leste Papua New Guinea Viet Nam Philippines South & South-West Asia2 Republic of Korea Afghanistan Russian Federation Bangladesh Samoa

Bhutan India Iran (Islamic Republic of) Maldives Nepal Pakistan Sri Lanka
Pacific islands

Georgia Kazakhstan Kyrgyzstan Tajikistan Turkmenistan Uzbekistan

Landlocked Developing Countries (LLDCs)

American Samoa Cook Islands Fiji French Polynesia Guam Kiribati Marshall Islands Micronesia (Federated States of) Nauru New Caledonia Niue Northern Mariana Islands Palau Papua New Guinea Samoa Solomon Islands Tonga Tuvalu Vanuatu

Afghanistan Armenia Azerbaijan Bhutan Kazakhstan Kyrgyzstan Lao Peoples Democratic Republic Mongolia Nepal Tajikistan Turkmenistan Uzbekistan
Small Island Developing States

American Samoa Cook Islands Fiji French Polynesia Guam Asia-Pacific developing Kiribati Maldives Special groups Least Developed Countries Marshall Islands Micronesia (Federated (LDCs) Afghanistan States of) Bangladesh Nauru Bhutan New Caledonia Cambodia Niue Kiribati Northern Mariana Islands Lao Peoples Democratic Re- Palau public Papua New Guinea Maldives Samoa Myanmar Singapore Nepal Solomon Islands Timor Leste Samoa Solomon Islands Tonga Tuvalu Timor-Leste Vanuatu Tuvalu Vanuatu ---------------------------------1
Commonwealth Indepen- nomic and Social Commission for Asia and the Pacific in Asia-Pacific region. dent States (CIS) in Asia Countries refers to both countries
Refers to members and associate members of the United Nations Ecoand areas such as Hong Kong, China and Macao, China. Also referred to as South Asia in the Text and regional aggregates.

Armenia Azerbaijan

Classification of countries

Key to country codes

MDGs

56

Progress in Asia and the Pacific 2007

AF AM AS AU AZ BD BN BT CK CN FJ FM GE GU HK ID IN IR JP KG KH KI KP KR KZ LA LK MH MM

Afghanistan Armenia American Samoa Australia Azerbaijan Bangladesh Brunei Darussalam Bhutan Cook Islands China Fiji Federate States of Micronesia Georgia Guam Hong Kong, SAR China Indonesia India Iran (Islamic Republic of) Japan Kyrgyzstan Cambodia Kiribati Democratic People's Republic of Korea Repbulic of Korea Kazakhstan Lao People's Democratic Republic Sri Lanka Marshall Islands Myanmar

MN MO MP MV MY NC NP NR NU NZ PF PG PH PK PW RU SB SG TH TJ TL TM TO TR TV UZ VN VU WS

Mongolia Macao, SAR China Northern Mariana Islands Maldives Malaysia New Caledonia Nepal Nauru Niue New Zealand French Polynesia Papua New Guinea Philippines Pakistan Palau Russian Federation Solomon Islands Singapore Thailand Tajikistan Timor Leste Turkmenistan Tonga Turkey Tuvalu Uzbekistan Viet Nam Vanuatu Samoa