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									    AFRICAN UNION                                   UNION AFRICAINE
                                                    UNIÃO AFRICANA

     Addis Ababa, ETHIOPIA      P. O. Box 3243  Tele: +251-115 517 700
           Fax: +251-11-5 517844    Website: www.africa-union.org



SPECIAL SESSION OF THE AFRICAN UNION CONFERENCE OF
MINISTERS OF HEALTH
Geneva, SWITZERLAND
MAY 17, 2008


                                                  MIN/Sp/AU/CAMH3/5




                       MINISTERIAL MEETING




 HEALTH MDGs LINKED TO THE AU COMMEMORATION OF THE
                ALMA ATA DECLARATION


                            (MAY 17, 2008)
Review of the Status of Africa’s Progress towards the
Achievement of Health Millennium Development Goals




                     April 2008
                           Acknowledgement


This report was prepared by the African Union Commission in collaboration
                    with the World Health Organization
                                            ii


ACRONYMS

ACT        Artemisinin Combination Therapy
AIDS       Acquired Immune Deficiency Syndrome
ARVs       Antiretrovirals
CBI        Community Based Initiative
CMH        Commission on Macroeconomics and Health
CSO        Civil Society Organization
DAC        Development Assistance Committee
DAH        Development Assistance for Health
DHS        Demographic and Health Survey
DALY       Disability Adjusted Life Years
DOTS       Directly Observed Treatment, Short course
ECD        Early Child Development
EHP        Essential Health Package
FDI        Foreign Direct Investment
GAVI       Global Alliance for Vaccines and Immunization
GDP        Gross Domestic Product
GFATM      Global Fund to fight AIDS, Tuberculosis and Malaria
GNI        Gross National Income
HIV        Human Immune-Deficiency Virus
HIPC       Heavily Indebted Poor Countries
HSA        Health Surveillance Assistant
HSSP       Health Sector Strategic Plan
IDA        International Development Association
IFF        International Finance Facility
IHP        International Health Partnership
IHS        Integrated Household Survey
IMCI       Integrated Management of Childhood Illness
IMF        International Monetary Fund
IMR        Infant Mortality Rate
ITN        Insecticide Treated Net
MDG        Millennium Development Goal
MMR        Maternal Mortality Ratio
NCD        Non Communicable Disease
NCMH       National Commission on Macroeconomics and Health
NGO        Non Governmental Organization
NHA        National Health Accounts
ODA        Official Development Assistance
OECD       Organization for Economics Co-operation Development
PRSP       Poverty Reduction Strategy Paper
RBM        Roll Back Malaria
STDs       Sexually Transmitted Diseases
SWAP       Sector Wide Approach
TB         Tuberculosis
UN         United Nations
UNAIDS     Joint United Nations Programme on HIV/AIDS
UNCTAD     United Nations Conference on Trade and Development
UNICEF     United Nations Children’s Fund
UNDG       United Nations Development Group
UNDP       United Nations Development Programme
UNFPA      United Nations Fund for Population Activities
U5MR       Under Five Mortality Rate
USAID      United States Agency for International Development
WHO        World Health Organization
WTO        World Trade Organization
                                                      iii
EXECUTIVE SUMMARY
The Global commitment around the Millennium Development Goals (MDGs) is an
initiative to tackle the interlinked problems of poverty, disease and inequalities which are
more rampant in Africa. With only seven years away from the set target (2015) for the
achievement of the MDGs, many African Countries are not on track to meet the MDGs
although some are showing tremendous progress towards achieving some goals. This
document “Review of the status of Africa’s progress towards the Achievement of Health
Millennium Development Goals” is prepared as a follow-up of the AU Heads of States
and Government’s Decision on the review of the MDGs (Assembly/AU/Dec.78 (v))
which was made during the 5th Ordinary Session of the Assembly of the African Union in
July 2005 in Sirte, Libya. The report is also prepared in line with the request of the
African leaders during the Special Summit on HIV/AIDS held in Abuja Nigeria in May
2006 that AU in collaboration with RECs and development partners should conduct in
2008, a consultative review of the status of implementation of the African Common
Position on HIV/AIDS concurrently with reviews of the Abuja call and of the MDGs.

Therefore this report provides an update on the progress made towards the
achievement of the health MDGs in the African continent, highlights the main challenges
and opportunities, and finally makes some appropriate policy recommendations.

Through the analysis of most recent available reports and data from World Health
Organization and some Regional Economic Communities (RECs) and comparing the
present trend to the ideal trend to achieve the health MDGs, the likelihood to attain the
targets was assessed for each African country vis-à-vis each indicator. A summary of
the findings on some countries on each Health MDG is given below:

Poverty and Hunger
Given the link between poverty and ill-health it is important to highlight that most of the
countries on the continent have not been able to make significant progress in reducing
extreme poverty in its many forms1. The overall average of the proportion of
underweight children in sub-Saharan Africa is 28%. In order to address problems
associated with lack of progress, governments are urged to implement policies to
equitably improve agricultural productivity, reduce dependency on food aid and improve
the distribution of food through better domestic and regional channels.

Child Mortality
Currently only 7 countries in Africa are on track in achieving the indicator on this MDG.
Given the many partners working on child survival in countries, the key to making
progress towards attainment of this MDG goal is to reach every newborn and child in
every district with the few priority interventions in a coordinated manner.

Maternal Mortality
Based on 2005 estimates, 37 countries have considerably high maternal mortality rates
of equal to or above 500 deaths per 100,000 live births. The maternal mortality
estimates for 2005 indicate that the decline between 1990 and 2005 in sub-Saharan
Africa was only 0.1% per year and that to achieve the MDG5 there is need for a
decrease of at least 5.5% per year. In order to start reversing this worrisome trend,


1
    Africa and the Millennium Development Goals 2007 Update
                                            iv
maternal and newborn health needs to be integrated into national development plans
and increase the capacity and availability of skilled personnel to meet national needs.

Malaria
Based on overall current trends, a majority of countries in Africa are unlikely to achieve
the MDG targets for malaria control unless a major scale-up effort of proven cost-
effective prevention and control interventions for universal population coverage is
achieved. The 2010 Abuja targets will be critical milestones in this regard.

HIV/AIDS
Although successes in some countries demonstrates that rapid and large-scale
progress towards the MDGs is feasible, much more and urgent efforts need to be taken
to achieve the MDG targets for HIV/AIDS. Interventions need to continue to be
implemented on a large scale, in a sustained manner and integrated with other health
related interventions in order to have the necessary impact.

Tuberculosis
The TB burden in the region is compounded by the HIV/AIDS pandemic and the recent
detection of strains that are resistant to commonly used anti-TB medicines. Although
trends in estimated prevalence, incidence and mortality associated with TB in the region
are increasing, the trends in the proportion of TB cases detected and cases cured are
improving especially in countries where the health system is efficient in health
information system, in laboratory diagnostics network, in management of anti TB
medicines and in involving the communities and the private sector in Directly Observed
Treatment, short course (DOTs).

Safe Water & Sanitation
A majority of countries in Africa are not on track to meet the MDG sanitation target.
Based on 2006 data from WHO-AFRO region, only one country seemed to be on track
to meet the 2015 target. However, 36 countries have experienced an increase in the
population gaining access to drinking water. Apart from increasing investment in this
area countries should continue to interact and collaborate with all partners in order to
ensure adoption of appropriate technologies and the implementation of strategies that
promote healthy environments.

Essential Drugs
Governments in many countries in Africa are progressing towards improving access to
essential medicines particularly for targeted priority diseases such as HIV/AIDS, TB and
malaria. However, absence of clearly defined and agreed upon indicators hinder
adequate measurement and monitoring of progress on proportion of populations
accessing essential medicines as enshrined in the MDGs. Countries are conducting
research and development of traditional medicines used for the management of priority
diseases in order to produce evidence on their safety, efficacy and effectiveness using
WHO guidelines. The development of appropriate indicators will, therefore, facilitate the
assessment and monitoring of progress towards MDG targets.

Many countries in Africa are not on track to meet the MDGs by 2015. But the
achievement of health MDGs is still possible if driven by the combination of a high rate
of economic growth, favorable policy environment and extensive donor support. Health
should be embedded in a broader social-economic development planning and
adequately reflected as a multi-sectoral response in national development plans and
                                             v
Poverty Reduction Strategy Papers (PRSPs) for current achievements to be sustained.
The health systems must be strengthened to implement essential interventions and
deliver essential services in a sustainable manner.
                                                    1
I. INTRODUCTION

1.     In 2000, the world leaders endorsed the Millennium Declaration and the
Millennium Development Goals (MDGs) and set 2015 as the target date for
achievement of most of the Goals. The MDGs put health squarely at the centre of the
international development agenda with three of the eight MDGs directly related to
health. The poverty reduction MDG is also affected when citizens are pushed into
poverty by catastrophic health care expenditures.

2.     During the 5th Ordinary Session of the Assembly of the African Union held in
Sirte, Libya, July 2005, the Heads of State and Government adopted the Common
African Position on the evaluation of the MDGs which was presented at the United
Nations High Level Conference on the MDGs in September 2005.The AUC in
collaboration with the ECA, the AfDB, NEPAD and the RECs was mandated to
monitor the implementation of the MDGs and continue with the pertinent reflections in
order to report to the Assembly at its annual sessions”. (Assembly/AU/Dec.78 (V)
Decision on the Review of the MDGs).

3.     Furthermore a Special Summit of African Heads of States and Government
was held on HIV and AIDS, TB, and Malaria in May 2006 in Abuja, Nigeria. During
this summit the African leaders urged the AU and RECs in collaboration with
development partners to undertake among other issues in 2008 a consultative review
of the status of implementation of the African Common position on HIV/AIDS,
concurrently with reviews of the Abuja call and of the MDGs.

4.     Pursuant to these decisions and to the proposal by the Bureau of the
conference of African Ministers of Health that AU should mark the 30 th anniversary of
the Alma Ata Declaration by having a side event during the Health MDGs Multi Stake
holder consultation whose date and venue will be decided during the Special Session
of the AU CAMH scheduled for 17 May 2008 in Geneva, Switzerland, the AU
Commission in collaboration with World Health Organization prepared a status report
on Africa’s progress towards achieving health MDGs.

5.     For Africa, the attainment of the MDGs is a minimum prerequisite for poverty
reduction and sustainable development. They provide the foundation for meeting the
much higher hopes and ambitions of the African continent, thus the need to scale up
actions towards meeting the MDGs in Africa.

6.     The Commission on Macroeconomics and Health (CMH)2 provided evidence
of the links between health and economic development, and emphasized that the
poorest populations are disproportionately affected by preventable diseases and bear
the brunt of the financial burden of illness. In Africa, the twin effect of poverty and low
investment in health has led to an increasing burden of diseases (notably HIV/AIDS,
malaria, TB), high maternal and child mortality and morbidity, and increasing
prevalence of non-communicable diseases.

7.    At the mid point towards the 2015 target date, there have been tremendous
gains and successes in most parts of the world even in those regions where the

2
 Tough Choices: Investing in Health for development, experiences from national follow-up to the Commission
on Macroeconomics and Health World Health Organization 2006
                                          2
                       3
challenges are greatest . High level forums have been organized to create the most
favorable conditions to reach the MDGs: the International Conference on Financing
for Development in Monterrey 2002, the High level Forum on Harmonization in Rome
2003, the Round Table on Managing for Development Results in Marrakech 2004,
the Paris Declaration on Aid Effectiveness in 2005, the G8 and the World Summit in
2005,all recognized the need to increase the volume and the effectiveness of the
public assistance for African countries.

8.     In spite of the achievements made so far, there is still need to commit more
domestic and external resources for health development, improve equity in allocation
of those resources and enhance efficiency in their use to boost the probability of
achieving the MDGs.
                                          3

II. CURRENT STATUS OF INDICATORS

II.1. GOAL 1: ERADICATE EXTREME POVERTY AND HUNGER
II.1.1. Halve, Between 1990 and 2015, The Proportion of People Who Suffer
        From Hunger: Target 2

9.     Millennium Development Goal 1, Eradicate extreme poverty and hunger has
as its target to “Reduce by half the proportion of people who suffer from hunger
between 1990 and 2015”. There are two health related indicators for MDG 1:
Prevalence of children under five who are under weight (moderate and severe) and
Proportion of population below minimum level of dietary energy consumption.

10.    Tracking progress towards the achievement of the goal is faced with the
challenge of absence of data for underweight prevalence in many countries. The
challenges facing countries in relation to achieving the MDG target for proportion of
children under five who are under weight include lack of food security, HIV/AIDS
pandemic, lack of employment and low incomes, hence low purchasing power and
poor early warning systems.

11.    In order to address these problems, governments are urged to implement policies
to improve agricultural productivity, promote income generating activities and address
the problems associated with health system development to increase access to
essential services especially HIV/AIDS care and prevention.

II.1.1.1.Prevalence of underweight children under five years of age: Indicator 4.

12.   The overall regional average of proportion of underweight children in sub-
Saharan Africa is 28%. Detailed data on individual countries are available in the
annexes.

13.   Countries in West and Central Africa have an average annual rate of reduction
(AARR) of 1.6 but this is not sufficient to reach the MDG target. Democratic Republic
of Congo, Congo, Ghana, Guinea, Mali, Nigeria, Senegal and Togo have made
progress but this is not fast enough to achieve the MDG target. Countries that have
stayed the same or deteriorated since the 1990’s include Burkina Faso, Cameroon,
the Central African Republic, Djibouti Niger, Sierra Leone, Somalia, and Sudan.

14.   There has been no change in the indices of most countries in Eastern and
Southern Africa. Seventeen countries have sufficient trend data to assess progress
towards the MDG target.
                                         4
II.1.1.2. Proportion of population below minimum level of dietary energy
consumption: Indicator 5

15.    Data for this indicator is available for 31 countries. The data reveals that some
countries have made adequate progress to enable them achieve the target by 2015
but which is not enough to allow them achieve the target while many more countries
are unlikely to meet the target.

Table I: Proportion of population below minimum level of dietary energy
consumption
          (Indicator 5)

Target achieved or       Progress but                No progress or           Data incomplete or
trend towards            insufficient trend to       decline                  not available
achievement              reach the target
Angola, Benin,           Burkina Faso, Côte          Algeria, Mali, Sénégal   Botswana, Cameroun,
Chad, Congo, Guinea,     d’Ivoire, Central African   Zimbabwe                 Cape Verde, Equatorial
Mauritania, Sao Tome     Republic, Niger             Madagascar, Comores,     Guinea, Ethiopia, Gabon,
and Principe, Eritrea,   Rwanda, Togo                Burundi, Guinea-Bissau   Ghana, Lesotho, Liberia,
Gambia, Kenya, Malawi,                               RDC, Swaziland,          Mauritius, Mozambique,
Seychelles and Zambia.                               Tanzania and Uganda.     Namibia, Nigeria, Sierra
                                                                              Leone, South Africa
                                  5
II.2. GOAL 4: REDUCE CHILD MORTALITY

II.2.1. Reduce By Two-Thirds, Between 1990 and 2015, The Under-Five Mortality
Rate: Target 5

16.     Under-five mortality rates in the African Region dropped from 185 per 1,000
live births in 1990 to 165 per 1,000 in 20054 hardly making a dent in the objective of a
two-thirds reduction by 2015.

17.     In countries where progress is lagging or where child mortality has increased,
AIDS is likely to be a major contributing factor. Malaria, pneumonia and diarrhea too
continue to kill vast numbers of children. In other countries, war and conflict have
been the leading causes of increasing child mortality in the recent past. In many
countries coverage of proven cost-effective interventions is too scanty to result in a
significant impact in mortality reduction.

18.    Current strategies to reduce the unacceptably high under five mortality
include: the implementation at scale of a key package of cost effective interventions
including: Africa Health Strategy, Newborn care; Infant and young child feeding
including micronutrient supplementation; Prevention of malaria using insecticide
treated nets; Immunization; Management of common childhood illnesses, IMCI;
Prevention of Mother-to-Child Transmission of HIV and care & treatment of HIV
exposed or infected children.

II.2.1.1. Under-five mortality rate: Indicator 13

19.    Children in sub-Saharan Africa face the gravest challenges in terms of
survival. The Region accounts for 44 percent of the world’s under-five mortality and
each year over 4.6 million children under the age of 5 years die in Africa. Most of
these deaths are due to common, preventable and treatable conditions occurring
singly or in combination: Neonatal causes (26%), Respiratory infections (21%),
Malaria (17%), Diarrhea diseases (17%), HIV/AIDS (7%), and others (4%).
Malnutrition is associated with at least 50% of deaths. Currently only five African
countries are on track in achieving the MDG. Twenty one (21) countries are making
progress but it is insufficient.

Table II: Trend assessment based on Under-five mortality Rate, 2006

Target achieved or             Progress but                No progress or decline Data incomplete
trend towards                  insufficient trend to                              or not available
achievement                    reach the target
Algeria                        Benin , Côte d'Ivoire       Burkina Faso, Liberia
Cape Verde                     Gambia , Ghana              Mali, Sierra Leone
Eritrea                        Guinea, Guinea Bissau       Angola, Burundi
Mauritius                      Mauritania, Niger           Cameroon
Seychelles                     Senegal, Togo               Central African Republic
                               Comoros, Ethiopia           Chad, Congo, DRC
                               Lesotho, Madagascar         Equatorial Guinea
                               Malawi, Mozambique          Kenya, Gabon, Rwanda
                               Namibia, Nigeria            Sao Tome & Principe


4
    World Health Statistics, 2007, World Health Organization 2007, UNICEF, Child Survival 2004
                                                               6
                                     Tanzania, Uganda              Botswana, South Africa
                                     Zimbabwe                      Swaziland, Zambia

Figure 1: Under five mortality rate / 1000 live births

        Challenge in achieving MDG 4: Sub-Saharan
                           Africa
         U5 Mortality Rate/1000 LB
 200
         185

 175                                                                  166
                                                                                                         167

 150                             AARR = 0.3

                                                                                            AARR = 0.3

 125
                                                               AARR = 8.2
 100


  75                                                                                                       60
                     AARR: Annual Average Reduction Rate
  50


  25
                                                        2002
          Source: HDR 2003, Unicef 2007
   0
       1990                                     2000                                   2010               2015



20.    Although some progress has been made in child mortality reduction, in recent
years it has slowed as seen on the figure above. In 2005, U5MR was estimated at
165 per 1000 live births. To achieve MDG 4, an 8.2% average annual reduction rate
(AARR) of under-five mortality is needed in the African Region.

II.2.1.2. Infant mortality rate: Indicator 14

21.    Countries with high under five mortality rates have also a high infant mortality
rate (IMR). The Infant Mortality rate in the African Region was estimated at 99 per
1000 live birth in 2005. Six countries in the Region have an IMR equal or below 50
per 1000 live birth. This ranges from 12 per 1000 live births to 50 per 1000 live births.
Twenty one countries have an IMR below 100 per live births while 19 have an IMR
above 100 per live births.

II.2.1.3. Proportion of 1 year-old children immunized against measles: Indicator
15

22.    One success story in child survival in recent years is the dramatic decline of
measles deaths in Africa which fell by 91% between 2000 and 2006, from an
estimated 396 000 to 36 000, reaching the United Nations 2010 goal to cut measles
deaths by 90% four years early. The significant decline in measles deaths in Africa
was made possible by the firm commitment of national governments and
development partners to fully implement the measles reduction strategy, which
includes vaccinating all children against measles before their first birthday via routine
                                        7
health services and providing a second opportunity for measles vaccination through
mass vaccination campaigns. This success is a clear demonstration that with
Government commitment, Partners coordination and resource mobilization, other
causes of child death can be addressed successfully.
                                 8
II.3. GOAL 5: IMPROVE MATERNAL HEALTH

II.3.1. Reduce By Three-Quarters, Between 1990 and 2015, The Maternal Mortality Ratio
(Target 6)


23.     The MDG 5 calls for a reduction of 75% of the 1990 levels of maternal
mortality and two indicators were agreed to monitor the progress towards attaining
this goal: (1) maternal mortality ratio (MMR) and (2) proportion of births attended by
skilled health personnel.

24.     To achieve MDG 5 there is need to more than double efforts to scale up
priority interventions and to promote universal access to quality maternal and
newborn care that includes presence of a skilled birth attendant at all births. In the
African Region, despite many multifaceted efforts and activities geared towards the
improvement of maternal and newborn health, the levels of maternal and newborn
morbidity and mortality are still unacceptably high mainly due to the lack of and poor
availability and accessibility to skilled attendants and emergency obstetric care
services.

25.     In 2005, the MMR was estimated at 900 deaths per 100.000 live births
compared to the level of 1990 which was estimated at 920 deaths per 100.000 live
births. With this trend the MDG 5 will not be attained by the vast majority of the
countries in the African Region. There is absolute need for changing this situation by
increasing the investment in maternal health and increase the resources allocated to
it.

26.     The main challenges related to the high maternal and newborn mortality
include the health systems inability to deliver quality care; insufficient and inadequate
allocation of funds; poor coordination and partnership; and poor community
participation. Maternal and newborn health services should be seen as the best
entry point for strengthening health systems because most of the health priorities can
be addressed through this essential service.

II.3.1.1. Maternal mortality ratio: Indicator 16

27.    Out of the estimated total of 536,000 maternal deaths worldwide, slightly more
than half (270,000) occur in the sub-Saharan Africa region and out of the 14
countries that have MMRs of at least 1000, 13 are in the sub-Saharan African region.
The new maternal mortality estimates for 20055 indicate that the decline between
1990 and 2005 in sub Saharan Africa was only 0.1 per cent per year and that to
achieve the MDG5 there is need for a decrease of at least 5.5% per year.

28.    These estimates provide us with general information about trends in the
Region, but are not appropriate for trend analysis using data from individual
countries, because of the difference between the methodologies used in the previous
estimates. It is very difficult to have a more reliable and accurate data on maternal
mortality because of the weak capacity in birth and death registration associated to
the low performance of the health information systems in most of the countries.
5
 “Maternal Mortality in 2005 - Estimates developed by WHO, UNICEF, UNFPA and The World Bank”, World
Health Organization 2007
                                           9

29.     Even if the available data cannot be compared for trend analysis of individual
countries, the two maps presented here provide us with a non encouraging picture of
the situation of maternal health in the region. Twenty five years after the launching of
the safe motherhood initiative, it seems like there were no significant changes in the
risk of dying in childbirth in Africa. Only one country has maternal mortality less than
100 deaths per 100.000 live births in the region. Three countries have moderate
MMR (100-299) and they. Nine have levels between 300 and 549 deaths per
100.000 life births, considered as high maternal mortality level. Thirty one countries
have maternal mortality rates that are considered very high, equal or more that 500
death per 100.00 live births. Among these, thirteen countries have ratios that are
equal or more than 1000 (Table 5 in the Annex presents the MMR WHO, UNICEF,
UNFPA and World Bank estimations from 1990 to 2005)

II.3.1.2. Proportion of births attended by skilled health personnel: Indicator 17

30.      The percentage of birth attended by skilled personnel is still very low in the
African region; the average is 46.5% (varying from 6 to 99%), with 21 countries with
coverage below 50% and 37 below 80%6. Sub-Saharan Africa has the lowest
coverage of skilled birth attendant and there has only been minimal change in the
proportion of births attended by health personnel in the region since 1990s. High
fertility, combined with high maternal mortality risk, makes a woman in sub-Saharan
Africa face a 1-in-26 chance of dying in childbirth, compared with 1-in-7300 in
developed countries.

II.4. GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

II.4.1. Have Halted By 2015 and Begun To Reverse The Spread Of HIV/AIDS (Target 7)

31.    HIV/AIDS continues to be an enormous barrier for the economic and social
development in sub-Saharan Africa with more than 68% of global HIV infections and
more than 76% of AIDS related deaths. Recent data published by WHO and
UNAIDS shows that in most sub-Saharan Africa countries, national HIV prevalence
has either stabilized or is showing signs of decline. In spite of this, AIDS remains the
leading cause of death.

32.    Constraints that slowed down the response vis à vis the HIV/AIDS epidemic
were mainly due to weak health systems; inadequate human resources; unpredicted
funds; inequality coverage of services between urban and rural areas; poor
harmonization and alignment to national priorities and prevailing AIDS-related stigma
and discrimination. However, there is an increasing high political commitment from
countries, with greater involvement of the civil society in the fight against HIV/AIDS.
The rates of ART coverage by the end of 2007 were of approximately 42% of those in
need, compared with 17 % at the end of 2005, showing a significant improvement.
Although the ART coverage has increased substantially in the region, there is need
to continue to intensify HIV prevention efforts to reduce the number of new infections
(in 2007 an estimated 1.7 million adults and children became infected with HIV in the
sub-Saharan Africa) and to strengthen country’s epidemiological and behavioral


6
    World Health Statistics, 2007
                                      10
surveillance systems to proper monitoring of progress towards HIV/AIDS MDG
targets.

II.4.1.1. HIV prevalence among pregnant women aged 15-24 years: Indicator 18

33.     Few countries, mainly in Southern Africa have started to observe declines or
stabilization in HIV prevalence trends among pregnant women aged 15-24. However,
not many countries are collecting and reporting age specific HIV prevalence
especially among ANC attendees aged 15-24 years, whose HIV prevalence acts as
an indicator of the rate at which new infections ‘incidence’ are occurring.

34.    Results from ANC HIV surveillance indicate substantial variations in HIV
prevalence among young ANC attendees aged 15-24 years between sub regions,
countries and within countries. In 2005-2006, median HIV prevalence among young
ANC attendees aged 15-24 years ranged from <1% and 25.8%.. Countries in
Southern Africa have the highest HIV prevalence among ANC attendees aged 15-24
years exceeding 15%.

Table III: HIV prevalence among pregnant women aged 15-24 years (trend of Indicator
18)

Target achieved or         Progress but            No progress or      Data incomplete or
trend towards              insufficient trend to   decline             not available
achievement                reach the target
Botswana                   Chad                    Benin               Algeria, Angola
Burundi                    Eritrea                 Ghana               Burkina Faso, Cameroon
Ethiopia                                           Swaziland           Cape Verde
Lesotho                                            Senegal             Central African Republic
Malawi                                             South Africa        Congo, Cote d’Ivoire
Namibia                                            Zambia              DRC, Equatorial Guinea
Rwanda                                                                 Gabon, Gambia, Guinea, Guinea-
Zimbabwe                                                               Bissau, Kenya, Liberia,
                                                                       Madagascar, Mauritius,
                                                                       Mozambique, Niger, Nigeria, Sao
                                                                       Tome & Principe, Seychelles
                                                                       Sierra Leone, Togo
                                                                       Uganda, Tanzania
 Countries with no data include countries where only one data point is available

II.4.1.2. Condom use at last high-risk sex: Indicator 19a.

35.    Out of thirteen countries with trend data on condom use at last high risk sex
among 15-24 year olds, seven countries have observed an increase in condom use.
However 4 countries experienced some decline in condom use at high risk sex while
the rest were fluctuating. No one country has achieved fifty percent condom use rate.
Condom use was higher among males than females.

           Figure 5: Trends in condom use at last high risk sex among 15-24 year olds
                                                                                                                                                                                                                                                    11
                                                                                                                                                                                                                                                   Male             Female

            30



            25



            20
      (%)




            15



            10



            5



            0
                                                                                             Cameroon (1998)
                                                                                                               Cameroon (2004)
                                                                       Burkina Faso (2003)
                                               Burkina Faso (1998/9)




                                                                                                                                                                                                                                                                                    Mali (2001)
                                                                                                                                                                     Guinea (1999)
                                                                                                                                                                                     Guinea (2005)




                                                                                                                                                                                                                                                                    Mali (1995/6)




                                                                                                                                                                                                                                                                                                                                                                                                                                               Zambia (1996)
                                                                                                                                                                                                                                                                                                                                                                                                                                                               Zambia (2000)


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Zambia (2003)
                                                                                                                                 Ethiopia (2000)
                                                                                                                                                   Ethiopia (2005)




                                                                                                                                                                                                                                                                                                                                  Tanzania (1996)


                                                                                                                                                                                                                                                                                                                                                                         Tanzania (2004)


                                                                                                                                                                                                                                                                                                                                                                                           Uganda (1995)
                                                                                                                                                                                                                                                                                                                                                                                                           Uganda (2000/1)
                                                                                                                                                                                                                                                                                                                                                                                                                             Uganda (2004/5)




                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Zambia (2001/2)
                                                                                                                                                                                                                                                                                                                                                    Tanzania (2000/01)
                 Benin (1996)
                                Benin (2001)




                                                                                                                                                                                                     Kenya (1998)
                                                                                                                                                                                                                    Kenya (2003)


                                                                                                                                                                                                                                   Malawi (2000)
                                                                                                                                                                                                                                                    Malawi (2004)




                                                                                                                                                                                                                                                                                                  Rwanda (2000)
                                                                                                                                                                                                                                                                                                                  Rwanda (2005)




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Zimbabwe (1999)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Zimbabwe (2005/6)
II.4.1.3. Percentage of population aged 15-24 years with comprehensive correct
knowledge of HIV/AIDS: Indicator 19b.


36.    The levels of comprehensive correct knowledge about AIDS remain very low,
with only one country having more than 50% of 15-24 years olds with comprehensive
and correct knowledge. Generally there were increases in the proportion of youths
with comprehensive and correct knowledge about AIDS in the nine countries with
trend data. .

II.4.1.4. Ratio of school attendance of orphans to school attendance of non-
orphans aged
           10-14 years: Indicator 20.

37.    Data from twenty six countries showed that the ratio of school attendance of
orphans to that of non orphans ranged from 0.7 (1996) to 1.18 (2004). In six
countries the ratio was above 1.0. Fifteen countries have more than one data point
and of these ten had an increase in the ratio of school attendance of orphans to that
of non orphans while four countries were stable and one experienced a decline.

II.4.2. TARGET 8: HAVE HALTED BY 2015 AND BEGUN TO REVERSE THE
INCIDENCE OF MALARIA AND OTHER MAJOR DISEASES

MALARIA

38.     Targets for global malaria control have been set within the framework of the
MDGs. To achieve this goal, the 2006 Abuja Summit resolved that 80% of people at
risk of malaria should have access to prevention and control measures by 2010.The
key malaria control interventions are the use of insecticide treated nets (ITNs), indoor
residual spraying (IRS), intermittent preventive treatment for pregnant women and
prompt and effective case management using ACTs.

39.
                                        12
40.    The global malaria indicators for the MDGs are the proportion of children
under five years sleeping under an ITN, the proportion of children under five years
with fever who receive an appropriate antimalarial, malaria incidence per 100,000
population and malaria deaths per 100,000 populations.

II.4.2.1. Prevalence and death rates associated with malaria: Indicator 21

41.    Interpretation of the trends in malaria incidence and deaths using available
data is difficult due to incomplete reports, non-standardized reporting and reliance
mostly on clinical diagnosis. However, in selected countries that have scaled up
either ITNs or IRS, there have been substantial reductions in malaria morbidity and
mortality as shown in figure 6.
                                               13
Figure 6: Examples of countries with declining malaria cases
          at health facility level 1999 - 2006




II.4.2.2. Proportion of population in malaria-risk areas using effective malaria
prevention and Treatment measures: Indicator 22

42.    Countries have registered moderate progress with on average 10% of children
under-five sleeping under ITNs. All countries in the African Region with trend data
available showed that ITN use among children aged less than 5 years has increased
at least thrice in 19 countries since 2000 as shown in figure 7.

43.    Treatment of malaria using any antimalarial among children is moderately high
as shown in table 12 indicator 21 (in the Annex), but has stagnated at between 40-
60% across the region, since 2000. By end of 2007, all malaria-endemic countries in
the region had adopted an Artemesinin-based combination therapy (ACTs) treatment
policy. However, in 14 countries with recent data that have adopted the ACT policy,
the median proportion of children under five years with fever receiving an ACT was
only 2% (range < 1 to 13).

44.     Figure 7 shows the trend in ITN use. Table IV shows the trend assessment on
the likelihood of countries achieving the MDGs based on use of ITNs.
                                           14
Figure 7: Rapid progress in scaling up insecticide – treated net use across the region
          in countries with trend data.


                                                       Trends In ITN use
  60

  50

  40                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 A ro und
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     2000
  30
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     A ro und
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     2005
  20

  10

   0




                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Gambia ,The (2000,2006)
                                                                                                                                                                                                                                                                                                                                                                                                                                    Sao Tome & Principe (2000,2006)
                                                                                                                                                                                                         Cameroon (2000,2006)
                                                       Côte d'Ivoire (2000,2006)




                                                                                                                                                   Burkina Faso (2003,2006)




                                                                                                                                                                                                                                                                                                                       Ghana (2003,2006)


                                                                                                                                                                                                                                                                                                                                                                Zambia (1999,2006)
                                                                                   Niger (2000,2006)




                                                                                                                                                                                                                                                                                                                                                                                     Togo (2000,2006)
                                                                                                                                                                              Uganda (2000-2001, 2006)




                                                                                                                                                                                                                                                                                                                                                                                                        Guinea-Bissau (2000,2006)
                                                                                                                                                                                                                                                                       Tanzania (1999-2004,2005)
        Kenya (2000,2003)




                                                                                                                                                                                                                                                                                                   Benin (2001,2006)
                                                                                                       Senegal (2000,2005)
                                                                                                                             Burundi (2000,2005)
                            Sierre Leone (2000,2005)




                                                                                                                                                                                                                                Central African Republic (2000,2006)




                                                                                                                                                                                                                                                                                                                                           Malawi (2000,2006)




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Rwanda (2000,2007)
Adapted from UNICEF & RBM (2007) Malaria & children progress in Intervention coverage.
Additional data from unpublished MIS reports.


Table IV: Trend assessment based on estimated ITN use

Target achieved or                                                                                                                  Progress but                                                                                                                                                                       No progress or decline Data incomplete
trend towards                                                                                                                       insufficient trend to                                                                                                                                                                                     or not available
achievement                                                                                                                         reach the target
Algeria                                                                                                                             Benin, Botswana                                                                                                                                                                    Guinea                                                                                                                                                                    Angola, Cape Verde
Eritrea                                                                                                                             Burkina Faso                                                                                                                                                                       Liberia                                                                                                                                                                   Chad, Comoros
Rwanda                                                                                                                              Burundi, Cameroon                                                                                                                                                                  Nigeria                                                                                                                                                                   DRC, Gabon
Sao Tome and Principe                                                                                                               Central African Republic                                                                                                                                                                                                                                                                                                                                     Equatorial Guinea
                                                                                                                                    Congo, Côte d'Ivoire                                                                                                                                                                                                                                                                                                                                         Madagascar, Mali
                                                                                                                                    Ethiopia, Gambia                                                                                                                                                                                                                                                                                                                                             Mauritania
                                                                                                                                    Ghana, Guinea Bissau                                                                                                                                                                                                                                                                                                                                         Mozambique
                                                                                                                                    Kenya, Malawi                                                                                                                                                                                                                                                                                                                                                Namibia, South Africa
                                                                                                                                    Niger, Senegal                                                                                                                                                                                                                                                                                                                                               Swaziland
                                                                                                                                    Sierra Leone, Tanzania                                                                                                                                                                                                                                                                                                                                       Zimbabwe
                                                                                                                                    Uganda, Zambia
                                              15

TUBERCULOSIS

45.      Targets for global TB control have been set within the framework of the MDGs.
However, the two key global indicators adopted by the World Health Assembly are
the detection and treatment of new cases in DOTS programmes. The Stop TB
strategy is WHO’s recommended approach to reducing the burden of TB in line with
the global targets. The Stop TB strategy has six major components: (i) DOTS
expansion and enhancement; (ii) addressing TB/HIV, MDR-TB and other challenges;
(iii) contributing to health systems strengthening; (iv) engaging all care providers; (v)
empowering patients, and communities; and (vi) enabling and promoting research.

II.4.2.3. Prevalence and death rates associated with tuberculosis: Indicator 23

46.    Many countries in Africa have adopted the Stop TB strategy. Currently the
DOTS population coverage averages 91%. The estimated regional prevalence,
incidence and mortality associated with TB have increased compared to the 1990
baseline (Annex, Table 13).

Table V: Trend assessment based on estimated TB prevalence, incidence and deaths
         (Source: WHO TB Global Report 2008)

Target achieved       Progress but            No progress or decline                Data
or trend towards      insufficient trend to                                         incomplete or
achievement           reach the target                                              not available
Algeria               Niger                   Botswana, Burkina Faso, Burundi,
Angola                                        Cameroon, Central African Republic,
Benin                                         Chad, Congo, Cote d’Ivoire, DR
Cape Verde                                    Congo, Equatorial Guinea, Ethiopia,
Comoros                                       Gabon, Gambia, Guinea, Kenya,
Eritrea, Ghana                                Lesotho, Liberia, Madagascar,
Guinea-Bissau                                 Malawi, Mauritania, Mozambique,
Mali, Mauritius                               Namibia, Nigeria, Rwanda, Senegal,
Sao Tome & Principe                           Sierra Leone, South Africa,
Seychelles                                    Swaziland, Togo, Uganda, Tanzania,
                                              Zambia, Zimbabwe




47.     Tuberculosis incidence and mortality is increasing because of high prevalence
of HIV in some countries, the emergence and spread of drug-resistant strains and a
growing number of refugees and internally displaced people. Stepping up the fight
against TB requires improvements in the effectiveness of health systems and in the
management of national TB control programmes. Opportunities exist through the
Global Fund and other donors for countries to access additional resources required
for intensification of the fight against TB.
                                                         16


   Figure 8 : Estimated TB Prevalence and Death rates in WHO African region, for the MDG baseline year 1990 and for
   2006, compared with the MDG target for 2015 and with prevalence and death rates projected for 2015 based on
   current trends




(a) TB prevalence rate per 100 000 population                 (b) TB death rate per 100 000 population

  600                                                   100


  500
                                                        80


  400
                                                        60

  300

                                                        40
  200

                                                        20
  100


    0                                                    0

    1990    2006   2015 (current trends)   MDG target    1990     2006   2015 (current trends)   MDG target

        Source: WHO TB Global Report 2008



        II.4.2.4. Proportion of tuberculosis cases detected and cured under DOTS
        (internationally recommended TB control strategy): Indicator 24

        48.   In order to reduce the TB burden in the region, it is important that countries
        improve on case detection and treatment success rates in line with the Maputo
        declaration, the new Stop TB strategy, and the Abuja call for universal access to
        AIDS, TB and Malaria services.

        49.    Considering the World Health Assembly global targets for TB control in the
        region, 10 countries have attained the 70% case detection rate and 8 have attained
        the 85% treatment success rate. Only 2 member states attained both targets (WHO
        Global TB Report 2008). The trend in these 2 indicators is shown in the figure below
        and country specific data are in Table 14 in the Annex.
                                           17
  Figure 9: Trend of tuberculosis cases detected and cured under DOTS




                 100

                  90

                  80
                                                                                                                                                      74          76
                                                                                                      72          71          73          73
                  70                                                          70
      Rate (%)


                                                                                          69
                                          62                      63
                  60          59
                                                      57
                  50                                                                                                                      49          51          50          48
                                                                                                                              45
                  40                                                                                              39
                                                                                          36          37
                                                                              33
                  30
                                                                  28
                                          22          24
                  20

                  10

                   0
                       1994        1995        1996        1997        1998        1999        2000        2001        2002        2003        2004        2005        2006


                                                                                          Year

                                                           T r eat ment Suc c es s r at e (%)                     Cas e Det ec t i on r at e (%)




                                                               Source: WHO TB Global Report 2008

50.    Generally, Africa is unlikely to achieve the 2015 MDG targets for Tuberculosis
control. However, 5 countries have already achieved the target and a further 7
countries are likely to meet the target. Based on WHO TB Global Report 2008, 10
countries have met the World Health Assembly target of 70% case-detection rate and
8 countries have achieved the treatment-success rate of 85% with only 2 countries
meeting both targets.


II.5. GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY

II.5.1. HALVE, BY 2015, THE PROPORTION OF PEOPLE WITHOUT SUSTAINABLE
ACCESS TO SAFE DRINKING WATER AND BASIC SANITATION: TARGET 10

51.    The Millennium Development Goal 7, Target 7C calls on countries to “Halve,
by 2015, the proportion of people without sustainable access to safe drinking water
and basic sanitation. The indicator used to assess the proportion of people with
access to basic sanitation is the official MDG indicator: The proportion of population
that uses an improved sanitation facility, urban and rural.

52.    The majority of countries in the African region are not on track to meet the
MDG sanitation target. In 2006, only one country seemed to be on track to meet the
sanitation goal by 2015.

II.5.1.1 Proportion of population with sustainable access to an

             Improved water source, urban and rural: Indicator 30

53.    In 2004, 80% of urban and 42% of rural populations had access to drinking
water, while in 1990 it was 82% and 36% of urban and rural populations respectively.
                                          18
During this period there has been an increase of access for rural populations while
there has been a 2% decrease in urban area, even though more people had access
to drinking water than in 1990. The difference can be explained through a
combination of demographic growth and rural to urban migration leading to more than
122 million population increase in towns and cities (Fig.10).

54.    There has been notable increase in people gaining access to drinking water.
Between 2000 and 2004 the percentage of the population with access to drinking
water increased in 32 countries. There was no change in the proportion in 9 countries
while slight declines were recorded in 3 countries. In one country the entire
population had access to drinking water in 2004 (Annex Table 15, Annex).

   Figure 10: Population with access to drinking water

                                                                      WHO - UNICEF
Sub-Saharan Africa                                      Joint Monitoring Programme
Water supply coverage in 1990 and 2004 [total access]




- http://www.wssinfo.org/en/233_wat_africaS.html (JMP is working on 2006 updated data.
Information will be release in May 2008. This data is derived from 2004 report).


II.5.1.2. Proportion of population with access to improved sanitation, urban and
rural: Indicator 31

55.   This information refers to the percentage of population with access to various
categories of sanitation facilities as indicated below.
                                                    19


Table VI: Proportion of population with access to improved sanitation, urban and rural

% Population             % Population       % Population using       % Population             No
using improved           using shared       unimproved               practicing open          information
sanitation               sanitation         sanitation               defecation


Central Africa 33        12                 36                       20
Eastern          29      16                 23                       33
Northern         94      1                  3                        2
Southern         57      21                 8                        13                       1 country
Western          24      22                 23                       31                       1 country


56.    Between 1990 and 2006, 29 countries were showing improvements in the
percentage of population gaining access to improved sanitation. While two (2)
countries were showing no progress, there are signs of decline in five (5) countries.
There are ten (10) countries where there is no information for 1990 to make the
comparison.

Table VI: Population with access to improved sanitation, urban and rural (Trend)
                                                                                       Data incomplete or
   Countries improving access              No progress              Countries          not available
   to improved sanitation                  recorded                 where
   between 1990 and 2006                   between 1990             sanitation
                                           and 2006                 has lessened
                                                                    between
                                                                    1990 and
                                                                    2006

                                        Equatorial Guinea and    Burundi, Liberia,     Congo, Gabon,
 Algeria, Angola, Benin, Botswana,
                                        Mauritius                Rwanda, Togo and      Gambia, Guinea
 Burkina Faso, Cameroon, Cap                                     Tanzania              Bissau, Lesotho,
 Verde, Central African Republic,                                                      Mozambique, Sao
 Chad, Comoros, Cote d’Ivoire,                                                         Tome/Principe,
 Democratic Republic of Congo,                                                         Seychelles, Sierra
 Eritrea, Ethiopia, Ghana, Guinea,                                                     Leone and Swaziland
 Kenya, Madagascar, Malawi, Mali,
 Mauritania, Namibia, Niger, Nigeria,
 Senegal, South Africa, Uganda,
 Zambia and Zimbabwe.



57.    More than 36 countries have experienced an increase in population gaining
access to drinking water even though the urban populations seem to have fewer
gains than rural population in the same period. Where information exists, a
comparison between 1990 and 2006 shows that there has generally been an
increase in the number of countries (62%) where populations are gaining access to
improved sanitation and a decrease in the percentage of population using open
defecation methods. The improvements are not substantial enough to enable
countries in the region to meet the target for MDGs set for 2015 (Annex, Table 16).
                                 20
II.6. GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

II.6.1. IN COOPERATION WITH PHARMACEUTICAL COMPANIES, PROVIDE
       ACCESS TO AFFORDABLE ESSENTIAL DRUGS IN DEVELOPING
       COUNTRIES: TARGET 17

58.    Essential medicines save lives and improve health when they are available,
affordable, of good quality and properly used. Increasing the availability and
affordability of medicines are major challenges for many countries in the African
Region. An increasing number of countries have been implementing national
medicine policies including traditional medicine, with the overall aim of improving
access to quality medicines at affordable price and ensuring their rational use.
Countries are conducting traditional medicines research and development for
producing evidence on safety, efficacy and quality for local production in order to
contribute to improving access to essential medicines. Despite these efforts, access
to medicines remains limited in the region.

59.   One of the specific challenges remain the absence of clearly defined and
agreed up on indicators commensurate with health related MDGs to adequately
measure and monitor progress on proportion of populations’ access to affordable
essential medicines

II.6.1.1. Proportion of population with access to affordable essential drugs on a
sustainable basis: Indicator 46

60.    The increasing burden of HIV/AIDS, Tuberculosis and Malaria continue to
severely impact on public health, deplete limited resources and impede economic
development of the continent. Although cost-effective medicines and technologies
exist to prevent, control and treat these diseases, many people in the region lack
access to these products. With the support from international community, partners,
multilateral and bilateral organizations and the pharmaceutical industry, Governments
in many African countries are progressing towards improving access to essential
medicines including traditional medicine particularly for targeted priority diseases.
Absence of clearly defined and agreed up on indicators hinder adequate
measurement and monitoring progress on proportion of populations’ access to
affordable essential medicines as speculated in the health related MDGs. Existing
data on estimated ARV therapy coverage indicates that provision of antiretroviral
therapy for people living with HIV/AIDS in the region is increasing and it contributes
to the achievement of health related MDGs.
                                                    21

Figure 11: Number of PLWHA on ART, 2004-2007




                               Source: Regional database, WHO/AFRO

61.     Countries in the African region are making progress to increase the coverage
of antiretroviral therapy for people needing ARV therapies. In 2007, the total number
of people accessing ART in the African Region was approximately 2.1 million,
compared to 1.3 million in 2006- representing a 58% increase in just one year.
(Figure 11 above).

62.  Similar increase in coverage for care and treatment in children has been
documented although the overall coverage is still very low at about 11%.


III. CHALLENGES AND OPPORTUNITIES

63.    Some individual countries are on track on some of the health MDG Goals and
targets. However, Africa as a whole is not on track to meet the MDGs by 2015. The
challenges are still many and include: accountable government leadership, weak and
fragmented health systems, inadequate resources for scaling up proven
interventions, limited access to health technologies, poor management of human
resources for health, and recurrent natural and man-made disasters and
emergencies. In addition, internal review of the progress at all levels of national
health systems being made towards the attainment of MDGs during implementation
has been inadequate. As a result, clarification of the expectations on service
providers and managers as to how much they should contribute at operational level
to the overall achievement of the MDGs is lacking.

64.    Sub-Saharan countries have not been able to make sufficient progress in
reducing extreme poverty in its many forms7.The MDGs recognize the
interdependence between health and social conditions and without progress in
health, other MDG objectives will also remain beyond reach. The MDG framework
shows that without sustained economic growth and significant gains in poverty
reduction, food security, education, women's empowerment and improved living
conditions in slums, many countries will not attain health targets. Today, an
international development agenda shaped by the MDGs provides a crucial
7
    Africa and the Millennium Development Goals 2007 Update
                                           22
opportunity to promote health policies that tackle the social roots of unfair and
avoidable human suffering. While progress towards the MDGs is possible, the
challenge is to ensure that a pattern that primarily benefits the better off while largely
by-passing the poor is avoided.

65.   The current per capita expenditure on health in most countries in Africa is
below $10 per capita compared to $34 as recommended by the Commission on
Macroeconomics and Health for a basic package of essential health interventions. In
Abuja (2001) the African governments committed to allocate 15% of the national
budget to the health sector. Progress towards this target has been very slow. By
2005, only 33 percent of the countries had allocated 10 percent or more of their
national budgets to the health sector, while another 38 percent had allocated 5 to 10
percent and the remaining 29 percent had allocated below 5 percent 8. The progress
towards reaching this target would be useful in enhancing access to essential health
care services especially by the poor in line with the Primary Health Care agenda.

66.    Efforts to sustain and increase progress towards the MDGs should build on
the lessons and successes of on-going programmes and initiatives such as
Integrated Management of Childhood Illness, Reach Every District, directly-observed
treatment short-course, antiretroviral therapy, polio elimination and guinea-worm
disease eradication, etc. Decentralization to the districts, currently being implemented
through health sector reform, provides an opportunity to promote bottom-up
approaches and contribute to the mobilization of additional resources.

67.    In the recent past, a number of global health initiatives have recognized the
need for strengthening health systems to facilitate delivery of priority interventions.
The Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for
Vaccines and Immunization are providing significant resources to strengthen health
systems. Countries should take advantage of this and several other opportunities to
increase resources

68.    While Development Assistance for Health has grown in recent years it still falls
short of what is required if the MDGs are to be achieved. In 2005, both the G8 and
the World Summit recognized the need for increased development aid to African
countries.9 The challenge is to realize all the commitments that partners have made.

69.     The achievement of the MDGs also calls for and requires comprehensive and
focused partnerships for going to scale on essential health interventions and at the
same time achieving sustainable development. Different international and regional
Partnerships/Initiatives have been launched to support countries towards the
achievement of the health MDGs. While they provide opportunities for more financial
resources, the challenge is to ensure that they are long term, and to harmonize and
align them with country priorities and ensure that the resources are effectively
utilized.




8
  Second ordinary session of the Conference of African Ministers of Health. Progress report on the implementation of the
plans of action of the Abuja Declaration for malaria, HIV/AIDS and tuberculosis. 10-12 October 2005. African Union.
Botswana.
9
  The G8 collectively agreed to increase aid to Sub-Saharan Africa, providing US$18.6 billion.
                                          23
IV. WAY FORWARD

70.    The achievement of the MDGs will require a renewed political commitment to
health development through the Primary Health Care strategy, significant increase in
the level of domestic and external investment and improved aid effectiveness in line
with the Paris Declaration. There is need to address the social determinants of health
through a broader social-economic development planning context and through a
multi-sectoral approach in national development plans and Poverty Reduction
Strategy Papers (PRSPs).

71.    Countries and partners should be relentless in their efforts to strengthen health
systems for delivery and scaling up of proven interventions for quick impact
especially towards marginalized populations. In these efforts focus should be on
improving management and infrastructures, adequate provision of human resources
and medical supplies, sufficient allocation of financial resources, and strong
community involvement. Greater attention should be paid to increase the production
and retention of health personnel.

72.    Monitoring and evaluation plan is a step in the right direction. The
development of evidence- and country-based planning such as Medium Term
Expenditures Framework (MTEF), Sector Wide Approach (SWAP) or Compacts
create the appropriate framework that align external financing for health around
national results-based strategic plans that focus on the attainment of the MDGs.
Such commitment of the countries and the development partners will provide the
basis for mutual accountability and secure long-term predictable financing from
multiple sources for the achievement of the MDGs.


73.    Monitoring regularly the operational progress in achieving the health MDGs is
crucial and the availability of good quality data is at the heart of the development of
policies and strategies to sustain the achievements or to scale up for the countries
which are not on track. In this respect it is important to strengthen health information
systems, and to institutionalize operational reviews of the progress towards the
MDGs
    24




V. ANNEXES
                                                              25
Table.1: Prevalence of underweight children under five years of age ( indicator 4)

Country                                                % of under-five suffering from underweight
                                         1990-199510           1995-2000            2000-200611            2015 estimate
Algeria                                       9                     6                    4                      4.5
Angola                                        -                     41                  31                       -
Benin                                         -                     29                  23                       -
Botswana                                      -                     17                  13                       -
Burkina Faso                                 33                     34                  37                     16.2
Burundi                                       -                      -                  39                       -
Cameroon                                     15                     22                  19                      7.5
Cape Verde                                   14                      -                   -                       7
Central African Republic                      -                     23                  29                       -
Chad                                          -                     39                  37                       -
Comoros                                      19                     26                  25                      9.5
Congo                                         -                      -                  14                       -
Cote d’Ivoire                                24                      -                  20                      12
Democratic Republic of                        -                     34                  31                       -
Congo
Equatorial Guinea                              -                       -                    19                    -
Eritrea                                       41                      44                    40                  20.5
Ethiopia                                      48                      47                    38                   24
Gabon                                          -                      12                    12                    -
Gambia                                         -                      26                    20                    -
Ghana                                         27                      25                    18                  13.5
Guinea                                         -                      33                    26                    -
Guinea-Bissau                                  -                       -                    19                    -
Kenya                                         23                      22                   13x                  11.5
Lesotho                                       21                      16                    20                  10.5
Liberia                                        -                       -                    26                    -
Madagascar                                    45                      40                    42                  22.5
Malawi                                        28                      25                    19                   14
Mali                                           -                      27                    33                    -
Mauritania                                    48                      23                    32                   24
Mauritius                                      -                      15                   15x                    -
Mozambique                                     -                      26                    24                    -
Namibia                                       26                       -                    24                   13
Niger                                         43                      40                    44                  21.5
Nigeria                                       39                      27                    29                  19.5
Rwanda                                        29                      27                    23                  14.5
Sao Tome and Principe                          -                       -                    9                     -
Senegal                                       22                      13                    17                   11
Seychelles                                     -                      6                      -                    -
Sierra Leone                                  29                       -                    30                  14.5
South Africa                                   -                      9                    12x                    -
Swaziland                                      -                       -                    10                    -
Tanzania                                      29                      29                    22                  14.5
Togo                                           -                      25                    26                    -
Uganda                                         -                      23                    20                    -
Zambia                                        25                      24                    20                  12.5
Zimbabwe                                      16                      13                    17                    8

x = Data refers to years or periods other than those specified in the column heading, differ from standard definition or refers
to part of a country. Such data is not included in the calculation of regional and global averages.
- = Data not available




10
     http://ddp-ext.worldbank.org/ext/ddpreports/ViewShareReport?&CF=REPORT_ID. Accessed 23 March 2008
11
     The State of the World’s Children 2008, Child Survival. UNICEF, New York, USA, 2007
                                                                             26
Table 2: Under-five mortality rate indicator 1312

                             1990            2000         2005         Progress       MDG4 Goal   Required             Progress towards
Country                                                                1990-2006      2015        Progress 2007-2015   MDG target
Algeria                      69              50           39           3.7            23          5.6                  On track
Angola                       260             260          260          0              87          12.2                 No progress
Benin                        185             160          150          1.4            62          9.7                  insufficient
Botswana                     58              101          120          -4.7           19          20.7                 No progress
Burkina Faso                 210             198          191          0.1            69          12.1                 No progress
Burundi                      190             190          190          0              63          12.1                 No progress
Cameroon                     139             154          149          -0.4           46          13.0                 No progress
Cape Verde                   45              30           26           3.5            20          5.9                  On track
Central African Rep          168             180          193          -0.1           58          12.3                 No progress
Chad                         203             200          208          -0.2           67          12.6                 No progress
Comoros                      120             82           71           3.5            40          5.9                  Insufficient
Congo                        110             108          108          0.2            37          14.5                 No progress
Cote d’Ivoire                155             173          127          1.2            52          10.1                 Insufficient
Dem. Rep. of Congo           205             205          205          0              68          12.2                 No progress
Equatorial Guinea            206             156          205          0.1            57          14.3                 No progress
Eritrea                      155             114          78           4.3            49          4.6                  On track
Ethiopia                     193             174          164          3.2            68          6.6                  Insufficient
Gabon                        90              90           91           0.1            31          12.1                 No progress
Gambia                       154             128          137          1.9            51          8.8                  Insufficient
Ghana                        126             102          112          1.9            42          12.2                 Insufficient
Guinea                       240             175          150          2.4            84          8.0                  Insufficient
Guinea Bissau                253             245          200          101            80          10.2                 Insufficient
Kenya                        97              120          120          -1.4           32          14.7                 No progress
Lesotho                      148             133          132          1.1            34          9.8                  Insufficient
Liberia                      235             235          235          0              78          12.2                 No progress
Madagascar                   168             139          119          2.4            56          8.0                  Insufficient
Malawi                       241             188          125          3.8            80          5.4                  Insufficient
Mali                         254             233          218          0.9            83          10.6                 No progress
Mauritania                   183             183          125          3.9            61          7.1                  Insufficient
Mauritius                    25              20           15           3.1            8           6.6                  On track
Mozambique                   235             200          145          3.3            78          6.3                  Insufficient
Namibia                      84              69           62           2.1            29          8.4                  Insufficient
Niger                        320             270          259          1.5            107         9.6                  Insufficient
Nigeria                      230             184          194          1.2            77          10.1                 Insufficient
Rwanda                       173             187          160          0.6            59          11.1                 No progress
Sao Tome & Principe          90              75           118          0.3            30          11.8                 No progress
Senegal                      148             138          136          1.6            50          9.4                  Insufficient
Seychelles                   21              17           13           2.4            6           8.0                  On track
Sierra Leone                 302             316          284          0.4            101         11.4                 No progress
South Africa                 60              70           68           -0.9           20          13.8                 No progress
Swaziland                    110             160          160          -2.5           37          16.6                 No progress
Tanzania                     163             165          122          1.9            54          8.7                  Insufficient
Togo                         152             142          139          2.0            51          8.6                  Insufficient
Uganda                       165             127          136          1.1            55          10.2                 Insufficient
Zambia                       192             202          182          0.1            60          12.3                 No progress
Zimbabwe                     80              117          86           0.5            27          8.6                  insufficient




        12
             Source: HDR, 2003, WHO Statistics, 2007, UNICEF,2007, Progress for children Nr 6
                                                           27
                              Table 3:    Infant mortality rate (indicator 14)13
Country                                          1990                 2001         2005
Algeria                                           42                   39           34
Angola                                            166                  154         154
Benin                                             111                  94           89
Botswana                                          45                   80           86
Burkina Faso                                      118                  104          96
Burundi                                           114                  114         114
Cameroon                                           85                  96           87
Cape Verde                                         45                  29           26
Central African Republic                          115                  115         115
Chad                                              118                  117         124
Comoros                                            88                  59           53
Congo                                              83                  81           79
Cote d’Ivoire                                     100                  102         118
Congo Democratic Rep. of                          128                  129         129
Equatorial Guinea                                 122                  101         123
Eritrea                                            92                  72           50
Ethiopia                                          128                  116         109
Gabon                                              60                  60           59
Gambia                                            103                  91           97
Ghana                                              74                  57           68
Guinea                                            145                  109          98
Guinea Bissau                                     153                  130         124
Kenya                                              63                  78           78
Lesotho                                           102                  91          102
Liberia                                           157                  157         157
Madagascar                                        103                  84           72
Malawi                                            146                  114          78
Mali                                              152                  141         120
Mauritania                                        120                  120          78
Mauritius                                         21                   17           13
Mozambique                                        143                  125         100
Namibia                                           65                   55           46
Niger                                             191                  156         150
Nigeria                                           114                  110         101
Rwanda                                            107                  96          118
Sao Tome & Principe                               69                   57           75
Senegal                                           90                   79           77
Seychelles                                        17                   13           12
Sierra Leone                                      185                  182         165
South Africa                                      54                   56           51
Swaziland                                          77                  106         104
Tanzania                                          102                  104          76
Togo                                               88                  79           78
Uganda                                            100                  79           79
Zambia                                            108                  112         104
Zimbabwe                                          53                   78           60




13
     Source: HDR, 2003, WHO Statistics, 2007
                                             28
Table 4: Proportion of 1 year-old children immunized against measles (indicator 15)
 Measles Coverage: African Region, 1990 – 2006 14   ( Source: AFRO Database 2008)
 Country            90      00      01      02      03     04        05        06
 Algeria            53      78      78      81      84     81        83        91
 Angola             38      57      72      72      62     64        45        48
 Benin              73      85      81      88      83     93        85        89
 Botswana           55      84      75      79      90     86        113       121
 Burkina Faso       37      59      69      64      76     78        84        88
 Burundi            75      57      54      68      81     78        80        92
 Cameroon           36      49      47      53      61     64        69        73
 Cape Verde         79      80      72      85      76     69        65        65
 Cen African Rep    67      34      29      31      35     70        65        108
 Chad               23      42      36      55      61     56        70        83
 Comoros            87      70      63      71      72     76        110       66
 Congo              77      34      35      37      46     55        56        64
 Cote d'Ivoire      56      62      61      56      49     49        80        73
 DR Congo           37      46      37      45      54     64        70        73
 Eq. Guinea         18      63      20      63      49     73        24        25
 Eritrea            23      50      52      52      63     62        68        69
 Ethiopia           38      37      40      40      44     56        59        63
 Gabon              76      30      24      30      64     38        30        44
 Gambia             86      87      52      83      67     87        88        80
 Ghana              52      83      75      100     83     83        57        85
 Guinea             25      59      60      51      75     73        82        90
 Guinea-Bissau      53      19      48      61      70     61        51        61
 Kenya              41      46      58      55      69     65        69        77
 Lesotho            87      58      72      53      55     59        67        78
 Liberia            40      52      78      57      53     42        94        94
 Madagascar         57      37      37      50      86     98        84        84
 Malawi             81      73      81      69      77     80        82        79
 Mali               43      55      61      64      68     75        86        86
 Mauritania         38      28      58      81      71     64        61        62
 Mauritius          76      84      90      84      94     90        89        91
 Mozambique         59      97      92      94      96     94        86        96
 Namibia            77      67      58      68      70     70        69        63
 Niger              25      35      52      48      64     74        83        104
 Nigeria            48      30      39      14      25     40        38        114
 Rwanda             55      40      73      69      90     84        89        95
 Sao Tome & Prin    71      59      75      85      87     91        88        84
 Senegal            57      48      42      59      60     57        74        80
 Seychelles         86      88      88      100     100    100       100       100
 Sierra Leone       75      43      40      74      86     64        81        90
 South Africa       79      90      72      72      82     81        82        84
 Swaziland          86      80      72      69      72     70        71        57
 Togo               65      58      33      48      68     70        70        83
 Tanzania           79      78      86      89      97     94        91        89
 Uganda             74      56      61      77      83     91        86        89
 Zambia             68      72      74      83      78     81        79        90
 Zimbabwe           76      66      43      56      82     81        90        90




14
     WHO/AFRO database
                                                       29

          Table 5: Maternal mortality ratio (indicator 16)
                   MMR (Maternal deaths per 100 000 live births), 1990, 1995, 2000 and 200515
                  Country                    1990                 1995            2000          2005
     Algeria                                            160            150              140          180
     Angola                                           1,500           1300             1700        1,400
     Benin                                              990            880              850          840
     Botwana                                            250            480              100          380
     Burkina Faso                                       930           1400             1000          700
     Burundi                                          1,300           1900             1000        1,100
     Cameroon                                           550            720              730        1,000
     Cape Verde                                                        190              150          210
     Central African Republic                           700           1200             1100          980
     Chad                                             1,500           1500             1100        1,500
     Comoros                                            950            570              480          400
     Congo                                              890           1100              510          740
     Côte d'Ivoire                                      810           1200              690          810
     Democratic Republic of Congo                                      940              990        1,100
     Equatorial Guinea                                  820           1400              880          680
     Eritrea                                          1,400           1100              630          450
     Ethiopia                                         1,400           1800              850          720
     Gabon                                              500            620              420          520
     Gambia                                           1,100           1100              540          690
     Ghana                                              740            590              540          560
     Guinea                                           1,600           1200              740          910
     Guinea Bissau                                      910            910             1100        1,100
     Kenya                                              650           1300             1000          560
     Lesotho                                            610            530              550          960
     Liberia                                            560           1000              760        1,200
     Madagascar                                         490            580              550          510
     Malawi                                             560            580             1800        1,100
     Mali                                             1,200            630             1200          970
     Mauritania                                         930            870             1000          820
     Mauritius                                          120             45               24           15
     Mozambique                                       1,500            980             1000          520
     Namibia                                            370            370              300          210
     Niger                                            1,200            920             1600        1,800
     Nigeria                                          1,000           1100              800        1,100
     Rwanda                                           1,300           2300             1400        1,300
     Sao Tome and Principe
     Senegal                                          1,200           1200              690            980
     Seychelles
     Sierra Leone                                     1,800           2100             2000        2,100
     South Africa                                       230            340              230          400
     Swaziland                                          560            370              370          390
     Togo                                               640            980              570          510
     Uganda                                           1,200           1100              880          550
     United Republic of Tanzania                        770           1100             1500          950
     Zambia                                             940            870              750          830
     Zimbabwe                                           570            610             1100          880




15
     WHO/AFRO database
                                                30
                Table 6: Proportion of Birth attended by skilled health personnel (indicator 17)
                          Proportion of Birth attended by skilled health
                                                     16
                                           personnel
                     Algeria                                  90           2002
                     Angola                                   45           2001
                     Benin                                    66           2001
                     Botswana                                 99           2000
                     Burkina Faso                             38           2003
                     Burundi                                  25           2000
                     Cameroon                                 62           2004
                     Cape Verde                               89           1998
                     Central African Republic                 44           2000
                     Chad                                     15           2005
                     Comoros                                  62           2000
                     Congo                                    83           2006
                     Côte d'Ivoire                            63           2000
                     Democratic Republic of the               61           2001
                     Congo
                     Equatorial Guinea                        65           2000
                     Eritrea                                  28           2002
                     Ethiopia                                  6           2005
                     Gabon                                    86           2000
                     Gambia                                   55           2000
                     Ghana                                    47           2003
                     Guinea                                   38           2005
                     Guinea-Bissau                            35           2000
                     Kenya                                    42           2003
                     Lesotho                                  55           2004
                     Liberia                                  51           2000
                     Madagascar                               51           2004
                     Malawi                                   56           2005
                     Mali                                     41           2001
                     Mauritania                               57           2001
                     Mauritius                                99           2005
                     Mozambique                               48           2004
                     Namibia                                  76           2000
                     Niger                                    16           2000
                     Nigeria                                  35           2003
                     Rwanda                                   39           2005
                     Sao Tome and Principe                    79           2000
                     Senegal                                  52           2005
                     Sierra Leone                             42           2000
                     South Africa                             92           2004
                     Swaziland                                70           2000
                     Togo                                     49           2000
                     Uganda                                   39           2001
                     United Republic of Tanzania              46           2005
                     Zambia                                   43           2002
                     Zimbabwe                                 80           2006




16
     Source: WHO/AFRO database
                                                         31
Table 7: Median HIV Prevalence among 15-24 Pregnant Women (indicator 18)17

 Country                            1998   1999   2000    2001   2002   2003   2004   2005   2006   2007
 Algeria
 Angola
 Benin                                                            1.7                  2.0   1.3
 Botswana                                                        32.7   33.6          27.1   25.8
 Burkina Faso                                                     2.3
 Burundi                                   6.4    7.1     5.85    5.1   3.9           15.5
 Cameroon
 Cape Verde
 Central African Rep.
 Chad                                                            5.29   4.2
 Comoros
 Congo                                                                                       2.6
 Cote d'Ivoire                                                   8.4
 Democratic Republic of the Congo                                                            3.1
 Equatorial Guinea
 Eritrea                                                                2.1           1.8
 Ethiopia                                                 12.1          8.6           5.6
 Gabon
 Gambia
 Ghana                              3.7    2.5     3      2.7    3.4    3.0    2.5    2.6
 Guinea
 Guinea-Bissau
 Kenya
 Lesotho                                                                24.2          20.5          13.1
 Liberia
 Madagascar
 Malawi                                                   8.2           18.3          14.3          12.3
 Mali                                                            2.8
 Mauritania
 Mauritius
 Mozambique                                                      14.8
 Namibia                                                         17.9          15.2          14.2
 Niger
 Nigeria
 Reunion
 Rwanda                                                                 4.6    4.5           3.5
 Sao Tome and Principe
 Senegal                                                         0.9    1.2
 Seychelles
 Sierra Leone                                                            2.2
 South Africa                                                    23.5   24.8
 Swaziland                                        35.4           33.4          39.4
 Togo
 Uganda                                                          4.9
 United Republic of Tanzania                                                    7.4
 Zambia                                                          16.2          18.8
 Zimbabwe                                         32.2    25.2   20.8          17.4          13.1




17
     Source: WHO/AFRO database
                                                      32
                   Table 8: Percent of youth aged 15-24 who used a condom at last high risk sex (indicator
19a)18

                              Country (Year)               Male       Female
                              Benin (1996)                        -       2
                              Benin (2001)                    18          4
                              Botswana (2001)                 34         29
                              Burkina Faso (1998/9)           17          5
                              Burkina Faso (2003)             20          7
                              Cameroon (1998)                 17          5
                              Cameroon (2004)                 28         13
                              Chad (2004)                     8           1
                              Congo (2005)                    25          1
                              Cote d’Ivoire (1998)            33          9
                              Eritrea (1995)                  7           -
                              Ethiopia (2000)                 5           1
                              Ethiopia (2005)                 3           0
                              Ghana (2003)                    13          8
                              Guinea (1999)                   16          2
                              Guinea (2005)                   20          5
                              Kenya (1998)                    24          3
                              Kenya (2003)                    18          4
                              Lesotho (2004)                  22         11
                              Madagascar (2003/4)             5           1
                              Malawi (2000)                   16          4
                              Malawi (2004)                   15          3
                              Mali (1995/6)                   11
                              Mali (2001)                     11          2
                              Mozambique (2003)               21          8
                              Namibia (2000)                  36         21
                              Rwanda (2000)                   5           1
                              Rwanda (2005)                   3           1
                              Senegal (2005)                  14          2
                              Tanzania (1996)                 11          3
                              Tanzania (2000/01)              17          6
                              Tanzania (2004)                 20          7
                              Togo (1998)                     18          7
                              Uganda (1995)                   14          3
                              Uganda (2000/1)                 17          7
                              Uganda (2004/5)                 17          8
                              Zambia (1996)                   21          5
                              Zambia (2000)                   13          6
                              Zambia (2001/2)                 21          6
                              Zambia (2003)                   13          6
                              Zimbabwe (1999)                 19          3
                              Zimbabwe (2005/6)               23          4




18
     Source: Measure DHS, HIV/AIDS Survey Indicators Database at http://www.measuredhs.com/hivdata/
                                                   33
Table 9: Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS
(indicator 19b)19
                       Country                                   Male    Female
                       Benin (2001)                            14        8
                       Botswana (2001)                         33        40
                       Burkina Faso (2003)                     23        15
                       Burundi (2000)                          -         24
                       Cameroun (2000)                         -         16
                       Cameroon (2004)                         34        27
                       Chad (2004)                             19        7
                       Congo (2005)                            35        26
                       Cote d'Ivoire (2000)                    -         16
                       Eritrea (2002)                          -         37
                       Ethiopia (2005)                         33        20
                       Gambia (2000)                           -         15
                       Ghana (2003)                            44        38
                       Guinea (2005)                           23        17
                       Guinea-Bissau (2000)                    -         8
                       Kenya (2000)                            -         26
                       Kenya (2003)                            47        34
                       Lesotho (2000)                          -         18
                       Lesotho (2004)                          19        27
                       Madagascar (2003/4)                     16        19
                       Malawi (2000)                           41        34
                       Malawi (2004)                           36        24
                       Mali (2001)                             15        9
                       Mozambique (2003)                       33        20
                       Namibia (2000)                          41        31
                       Niger (2000)                            -         5
                       Nigeria (2003)                          21        18
                       Rwanda (2000)                           20        23
                       Rwanda (2005)                           54        51
                       Sao Tome and Principe (2000)            -         11
                       Senegal (2000)                          -         13
                       Senegal (2005)                          26        21
                       Sierra Leone (2000)                     -         16
                       South Africa (1998)                     -         20
                       Tanzania (1996)                         23        23
                       Tanzania (1999)                         29        26
                       Tanzania (2004)                         40        45
                       Togo (2000)                             -         20
                       Uganda (2000/01)                        40        28
                       Uganda (2004/5)                         35        29
                       Zambia (2001/2)                         33        31
                       Zimbabwe (2005/6)                       46        44




19
     Source: Measure DHS, HIV/AIDS Survey Indicators Database at http://www.measuredhs.com/hivdata/
                                                             34
Table 10: Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years ( indicator 20)20

                                                                  Ratio of orphans to non-
                             Country                              orphans who are in school
                             Benin (1996)                                     0.7
                             Burkina Faso (2003)                              1.03
                             Cameroon (1998)                                  0.94
                             Cameroon (2004)                                  1.01
                             Central African Republic (1994/5)                0.82
                             Chad (2004)                                      1.18
                             Congo (2005)                                     0.92
                             Eritrea (1995)                                   0.87
                             Eritrea (2002)                                   0.92
                             Ethiopia (2000)                                  0.79
                             Ethiopia (2005)                                  0.89
                             Ghana (1993)                                     0.95
                             Ghana (1998)                                     0.89
                             Ghana (2003)                                     0.92
                             Guinea (1999)                                    0.85
                             Guinea (2005)                                    0.98
                             Kenya (1993)                                     0.95
                             Kenya (1998)                                     0.91
                             Kenya (2003)                                     0.96
                             Lesotho (2004)                                   0.96
                             Madagascar (1997)                                0.76
                             Madagascar (2003/4)                              0.86
                             Malawi (2000)                                    0.93
                             Malawi (2004)                                    0.97
                             Mali (1995/6)                                    0.95
                             Mali (2001)                                      1.06
                             Mozambique (1997)                                0.89
                             Mozambique (2003)                                0.9
                             Namibia (2000)                                   1.02
                             Nigeria (2003)                                   1.05
                             Rwanda (2000)                                    0.93
                             Rwanda (2005)                                    0.89
                             Senegal (2005)                                   0.89
                             South Africa (1998)                              0.98
                             Tanzania (1996)                                  0.97
                             Tanzania (1999)                                  0.96
                             Tanzania (2004)                                  0.99
                             Togo (1998)                                      0.92
                             Uganda (1995)                                    0.86
                             Uganda (2000/01)                                 0.95
                             Uganda (2004/5)                                  0.97
                             Zambia (1996)                                    0.87
                             Zambia (2000)                                    0.96
                             Zambia (2001/2)                                  0.92
                             Zambia (2003)                                    0.96
                             Zimbabwe (2005/6)                                0.96
                             Zimbabwe (1999)                                  0.94




20
     Source: Measure DHS, HIV/AIDS Survey Indicators Database at http://www.measuredhs.com/hivdata/
                                                                 35
Table 11: Proportion of children under five years with fever who received an antimalarial (indicator 21)
                                                    Goal 6: Combat HIV/AIDS, malaria and other diseases
      Countries                         Proportion of children under five years with fever who received an antimalarial
                                  <1999     2000        2001       2002        2003       2004       2005       2006      2007
      Western
      Algeria
      Benin                                               60                                                     54
      Burkina Faso                                                              50                               48
      Cape Verde
      Côte d'Ivoire                            58                                                                36
      Gambia                                   55                                                                63
      Ghana                                                                     63                               61
      Guinea                                                                                          44
      Guinea-Bissau                            58                                                     46
      Liberia
      Mali                                                                      36*
      Mauritania                                                                           33
      Niger                                    48                                                                33
      Nigeria                                                                   34
      Senegal                                  36                                                     27
      Sierra Leone                             61                                                     52
      Togo                                     60                                                     48
      Central
      Angola                                                                                                               29
      Burundi                                  31                                                     30
      Cameroon                                 66                                          53                    58
      Central African Republic
      Chad                                     32
      Congo                                                                                           48
      DRC                                                 52
      Equatorial Guinea                        49
      Gabon
      Rwanda                                    9                                                     12                   18
      Sao Tome and Principe                    61                                                                25
      Eastern & Southern
      Botswana
      Comoros                                  63
      Eritrea                                                         4
      Ethiopia                                  3                                                      3
      Kenya                            40      65                               27
      Madagascar                               61
      Malawi                                   27                                          28                    24
      Mozambique                                                                15
      Namibia
      South Africa
      Swaziland                                26
      Tanzania                         53                                                             51
      Uganda                                                                                                     62
      Zambia                           58                             52                                         58
      Zimbabwe                                                                                             6
                      Adapted from UNICEF & RBM (2007) Malaria & children progress in Intervention coverage.
                                                                      36
Table 12: Proportion of children under five years who slept under an ITN (indicator 22)
                                                              Goal 6: Combat HIV/AIDS, malaria and other diseases
 Countries                                                Proportion of children under five years who slept under an ITN
                                        1999       2000     2001         2002         2003         2004         2005       2006   2007
 Western
 Algeria
 Benin                                              7                                                                      20
 Burkina Faso                                       2                                                                      10
 Cape Verde
 Côte d'Ivoire                                      1                                                4                      6
 Gambia                                            15                                                                      49
 Ghana                                                                                  4                                  22
 Guinea                                                                                                           0
 Guinea-Bissau                                      7                                                                      39
 Liberia                                                                                                          3
 Mali                                                                                   8
 Mauritania                                                                                          2
 Niger                                              1                                                                       7
 Nigeria                                                                                1
 Senegal                                            2                                                             7
 Sierra Leone                                       2                                                             5
 Togo                                               2                                                                      38
 Central
 Angola                                                                                                                           18
 Burundi                                            1                                                             8
 Cameroon                                           1                                                1                     13
 Central African Republic                           2                                                                      15
 Chad                                               1
 Congo                                                                                                            6
 DRC                                                          1
 Equatorial Guinea                                  1
 Gabon
 Rwanda                                             5                                                            13               56
 Sao Tome and Principe                             23                                  50                                  42
 Eastern & Southern
 Botswana                                                                                                                          7
 Comoros                                            9
 Eritrea                                            4                                               48
 Ethiopia                                                                                                         2
 Kenya                                              3                                   5
 Madagascar                                         0
 Malawi                                             3                                               15                      23
 Mozambique
 Namibia
 South Africa
 Swaziland                                          0
 Tanzania                                      2                                                                 16
 Uganda                                                       0                                                            10
 Zambia                                        1                           7                                               23
 Zimbabwe                                                                                                                   3

                            Adapted from UNICEF & RBM (2007) Malaria & children progress in Intervention coverage
Table 13: Estimated Prevalence, Incidence and Mortality Rates (per 100,000) Associated with TB indicator 23) Source: WHO TB Global Report 2008
               Country                             Prevalence                                              Incidence                                      Mortality
                                                   All Forms                           All Forms                              Smear +ve           All Forms       All forms
                                            1990                2006            1990               2006                1990               2006       1990           2006
Algeria                                      44                  56              37                 56                  17                 25          2               2
Angola                                       514                 344             203                285                 91                 127        58              29
Benin                                        140                 135             77                 90                  34                 39         15              18
Botswana                                     294                 454             240                551                 98                 218        34              91
Burkina Faso                                 337                 476             159                248                 69                 108        50              71
Burundi                                      307                 714             147                367                 64                 162        38              91
Cameroon                                     193                 237             77                 192                 34                 83         22              29
Cape Verde                                   413                 324             162                168                 73                 76         46              36
Central African Republic                     336                 528             138                345                 60                 149        40              80
Chad                                         254                 570             119                299                 53                 131        29              76
Comoros                                      186                 86              85                 44                  38                 20         15               7
Congo                                        251                 566             161                403                 70                 177        36              80
Cote d’Ivoire                                330                 747             168                420                 73                 183        40             105
DR Congo                                     266                 645             156                392                 69                 173        35              84
Equatorial Guinea                            176                 404             102                256                 45                 112        19              54
Eritrea                                      231                 218             72                 94                  32                 42         20              22
Ethiopia                                     307                 641             151                378                 67                 168        37              83
Gabon                                        383                 428             153                354                 68                 152        44              69
Gambia                                       347                 423             183                257                 82                 114        38              53
Ghana                                        532                 379             224                203                 99                 90         60              48
Guinea                                       254                 466             122                265                 55                 118        29              56
Guinea-Bissau                                403                 313             156                219                 70                 97         39              40
Kenya                                        133                 334             116                384                 45                 153        29              72
Lesotho                                      254                 513             184                635                 77                 255        30              88
Liberia                                      333                 578             132                331                 59                 147        37              70
Madagascar                                   365                 415             176                248                 79                 111        38              45
Malawi                                       321                 322             258                377                 99                 143        75             111
Mali                                         715                 578             302                280                135                 124        80              69
Mauritania                                   576                 606             225                316                101                 142        63              71
Mauritius                                    50                  40              26                 23                  12                 10          4               4
Mozambique                                   298                 624             177                443                 77                 186        36             117
Namibia                                      674                 658             306                767                132                 316        75              96
Niger                                        315                 314             124                174                 55                 78         35              36
Nigeria                                      278                 615             124                311                 55                 137        32              81
Rwanda                                       201                 562             159                397                 62                 162        62             128
Sao Tome & Principe                          345                 252             135                103                 61                 46         38              26
Senegal                                      378                 504             192                270                 86                 121        42              58
Seychelles                                   113                 56              43                 33                  20                 15          9               5
Sierra Leone                                 491                 977             214                517                 96                 230        55             119
South Africa                                 774                 998             301                940                130                 382        78             218
Swaziland                                    665                1,084            267               1,155               113                 458        76             278
Togo                                         775                 787             327                389                145                 171        89             105
Uganda                                       296                 561             163                355                 69                 154        56              84
UR Tanzania                                  270                 459             178                312                 77                 135        36              66
Zambia                                       636                 568             297                553                123                 228        100            102
Zimbabwe                                     246                 597             136                557                 54                 227        47             131
AFR                                   333                547              162               363                70                   155          42           83
                                                                                 40
Table 14: Proportion of Tuberculosis Cases Detected and Cured under DOTS (New Smear Positive) indicator 24 Source: WHO TB Global Report 2008
                           Country                                     Case Detection Rate (%)                               Treatment Success Rate (%)
                                                             1995               2000               2006              1995               2000              2005
Algeria                                                        -                 126               102                 -                 87                87
Angola                                                         -                   -                76                 -                 68                72
Benin                                                         83                  86                86                73                  -                87
Botswana                                                      73                  75                80                67                 77                70
Burkina Faso                                                  11                  17                17                25                 60                71
Burundi                                                       19                   -                24                45                 80                78
Cameroon                                                       -                  31                91                 -                 77                74
Cape Verde                                                     -                   -                33                 -                  -                64
Central African Republic                                       -                   -                69                37                 57                65
Chad                                                          36                   -                 -                47                  -                 -
Comoros                                                       54                  49                42                90                 93                91
Congo                                                         69                  86                51                 -                 69                28
Cote d’Ivoire                                                 50                  32                37                68                  -                75
DR Congo                                                      41                  48                61                80                 78                85
Equatorial Guinea                                             85                   -                 -                89                  -                 -
Eritrea                                                        -                  42                35                 -                 76                88
Ethiopia                                                      15                  30                27                61                 80                78
Gabon                                                          -                   -                58                 -                  -                46
Gambia                                                        74                   -                64                76                  -                87
Ghana                                                         15                  37                38                54                 50                73
Guinea                                                        44                  54                55                78                 68                72
Guinea-Bissau                                                  -                  45                64                 -                  -                69
Kenya                                                         57                  51                70                75                 80                82
Lesotho                                                       59                  72                79                47                  -                73
Liberia                                                        -                  26                55                79                 80                76
Madagascar                                                    52                   -                73                55                 70                74
Malawi                                                        42                  44                42                71                 73                73
Mali                                                          16                  17                26                59                  -                75
Mauritania                                                     -                   -                34                 -                  -                55
Mauritius                                                     89                  90                67                 -                 93                86
Mozambique                                                    57                  45                47                39                 75                79
Namibia                                                       21                  77                83                 -                 56                75
Niger                                                          -                  40                49                 -                 65                74
Nigeria                                                       11                  12                20                49                 79                75
Rwanda                                                        35                  33                27                 -                 61                83
Sao Tome & Principe                                            -                   -                 -                 -                  -                 -
Senegal                                                       62                  53                 -                44                 52                 -
Seychelles                                                     -                  83                 -                89                 82                 -
Sierra Leone                                                  28                  33                35                69                 77                86
South Africa                                                   -                  58                71                 -                 66                71
Swaziland                                                      -                   -                49                 -                  -                42
Togo                                                          13                  11                19                60                  -                71
Uganda                                                         -                  48                44                 -                 63                73
UR Tanzania                                                   57                  49                46                73                 78                82
Zambia                                                         -                   -                53                 -                  -                84
Zimbabwe                                                       -                  45                42                 -                 69                68

AFR                                                           23                 35                 46                62                 72               76
                                                                                   21
Table 15: % Population with access to drinking water per country (1990 – 2006)          indicator 30

Country                     1990                    1995                    2000              2004

Angola                      36                      37                      46                53
 Algeria                    94                      93                      89                85
Benin                       63                      64                      65                67
Burkina Faso                38                      45                      54                61
Burundi                     69                      73                      77                79
Cameroon                    50                      56                      61                66
CA Republic                 52                      59                      70                75
Chad                        19                      26                      35                42
Comoros                     93                      90                      88                86
Cote d’Ivoire               69                      76                      83                84
Congo                       -                       56                      57                58
DR Congo                    43                      44                      45                46
Djibouti                    72                      72                      73                73
Eq. Guinea                  -                       43                      43                43
Eritrea                     43                      46                      54                60
Ethiopia                    23                      23                      22                22
Gabon                       -                       83                      86                88
Gambia                      -                       82                      82                82
Ghana                       55                      63                      70                75
Guinea                      44                      47                      49                50
G Bissau                    -                       57                      58                59
Kenya                       45                      52                      57                61
Lesotho                     -                       79                      79                79
Liberia                     55                      58                      61                61
Madagascar                  40                      42                      45                46
Malawi                      40                      52                      64                73
Mali                        34                      39                      45                50
Mauritania                  38                      40                      47                53
Mauritius                   100                     100                     60                100
Mozambique                  36                      39                      42                43
Namibia                     57                      69                      80                87
Niger                       39                      42                      44                46
Nigeria                     49                      50                      49                48
Rwanda                      59                      64                      70                74
Sao Tome/P                  -                       79                      79                79
Senegal                     65                      69                      73                76
Seychelles                  88                      88                      87                88
Sirerra Leone               -                       56                      57                57
South Africa                83                      84                      87                88
Swaziland                   -                       62                      62                62
Togo                        50                      50                      51                52
Tanzania                    46                      52                      58                62
Uganda                      44                      49                      55                60
Zambia                      50                      53                      55                58
Zimbabwe                    78                      79                      80                81




21
     WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2008
                                            42
Table 16: Proportion of population with access to improved sanitation (indicator 31)22

              Country             Use Improved             Use Shared          Use unimproved       Open
                                                             facility              facility       defecation
                                   1990        2006       1990       2006          1990   2006   1990    2006
       Algeria                       88          94          -          -             3      1      9       5
       Angola                        34          38          -          -            12     17     54      46
       Benin                         12          30          -          -             8      5     79      65
       Botswana                      38          47          2          4            22     34     36      14
       B Faso                         5          13          1          5            16     14     78      69
       Burundi                       44          41          1          5            48     53      3       1
       Cameroon                      39          51          3          7            52     35      4       7
       Cap Verde
       CAR                            11          31          4         17          49     31     35           22
       Chad                            5           9          5          8          10     17     80           66
       Comoros                        18          35          1          2          76     63      5            0
       Congo                           -          20          -         37           -     35      -            9
       Cote d’Ivoire                  20          24         15         18          24     28     41           30
       DRC                            15          31          -          -          65     60     20           10
       E Guinea                       51          51          -          -          49     49      -            -
       Eritrea                         3           5          4          4           4      7     89           85
       Ethiopia                        4          11          3          7           2     18     91           64
       Gabon                           -          36          -         37                 24      -            2
       Gambia                          -          52          -         34                 10      -            4
       Ghana                           6          10         29         51          41     18     24           20
       Guinea                         13          19          8         15          41     40     39            6
       G Bissau                        -          33          -          3                 30      -           34
       Kenya                          39          42         33         37            8    10     20           11
       Lesotho                         -          36          -         11                 10      -           43
       Liberia                        40          32          -          -          60     68      -            -
       Madagascar                      8          12         14         19          12     31     67           37
       Malawi                         46          60         16         22           6      7     31           11
       Mali                           35          45          3          5          34     30     28           21
       Mauritania                     20          24          8          9          39     15     32           52
       Mauritius                      94          94          6          6           0      0      0            0
       Mozambique                      -          31          -          -                 21      -           48
       Namibia                        26          35          5          6           4      7     65           51
       Niger                           3           7          3          6           9      8     84           80
       Nigeria                        26          28         19         24          30     26     25           23
       Rwanda                         29          23         12         11          53     63      6            4
       Sao tome/P                      -          24          -          4                 12      -           59
       Senegal                        26          28         14         15          21     33     39           24
       Seychelles
       S Leone                         -          11          -         26                 36      -           27
       S Africa                       55          59         22         23          12      7     12           10
       Swaziland                       -          50                    23                  7      -           20
       Togo                           13          12         25         22           3     11     59           56
       Uganda                         29          33         12         13          39     40     20           13
       Tanzania                       35          33         11         13          44     43      9           11
       Zambia                         42          52         18         20          12      6     28           22
       Zimbabwe                       44          46         22         23           0      4     34           26




22
     WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2008
                                                        43
Table 17 : indicator 46   ART Coverage (%) Sep 2008

                                 Estimated number of people
                                 needing ART (2006 estimate)                       ART Coverage (%) Sep 2007
                      Number                                          Number
                      of ART    Estimate    Low        High            on ART                   Low        High
AFRO REGION            sites              estimate estimate           by Sep07    Estimate    estimate   Estimate
Algeria                             2 300      1 200       4 200           575         25.0      13.69       47.9
Angola                    19       66 000     38 000     100 000         7 000         10.6       7.00       18.4
Benin                              20 000     12 000      30 000         8 632         43.2      28.77       71.9
Botswana                  38       84 000     70 000     100 000        90 543        107.8      90.54      129.3
Burkina Faso              76       33 000     23 000      45 000        15 888         48.1      35.31       69.1
Burundi                   43       31 000     16 000      43 000         8 983         29.0      20.89       56.1
Cameroon                  95      110 000     84 000     130 000        43 324         39.4      33.33       51.6
Cape Verde                19           …                                   158    …                 …          …
CAR                       29       49 000     21 000      79 000         6 189         12.6       7.83       29.5
Chad                               36 000     17 000      65 000         5 000         13.9       7.69       29.4
Comoros                             <100                   <200              4           …          …          …
Congo                      17      23 000     14 000      35 000         6 675         29.0      19.07       47.7
Côte d'Ivoire             147     110 000     67 000     160 000        50 000         45.5      31.25       74.6
DRC                       167     200 000    100 000     330 000        18 059          9.0       5.47       18.1
Equatorial Guinea                   1 800      1 200       2 300           396         22.0      17.22       33.0
Eritrea                    14      12 000      5 900      20 000         3 050         25.4      15.25       51.7
Ethiopia                  267     242 453     84 000     290 000        92 000         37.9      31.72      109.5
Gabon                              12 000      7 400      18 000         4 321         36.0      24.01       58.4
Gambia                      6       3 500      1 800       6 000           392         11.2       6.53       21.8
Ghana                      48      63 000     46 000      79 000         9 420         15.0      11.92       20.5
Guinea                     14      17 000     11 000      24 000         4 538         26.7      18.91       41.3
Guinea-Bissau               5       6 300      3 300      10 000           266          4.2       2.66        8.1
Kenya                     400     290 000    220 000     350 000       172 764         59.6      49.36       78.5
Lesotho                    59      57 000     49 000      66 000        21 125         37.1      32.01       43.1
Liberia                     4          …                                   715           …          …          …
Madagascar                          8 100      2 900      18 000            89          1.1       0.49        3.1
Malawi                    144     190 000     90 000     300 000        99 583         52.4      33.19      110.6
Mali                       45      27 000     18 000      38 000        10 793         40.0      28.40       60.0
Mauritania                          2 400      1 500       3 600           400         16.7      11.11       26.7
Mauritius                           <200                   <500            120           …          …          …
Mozambique                198     280 000    200 000     380 000        78 236         27.9      20.59       39.1
Namibia                    54      45 000     21 000      73 000        39 723         88.3      54.42      189.2
Niger                              16 000      7 300      28 000           822          5.1       2.94       11.3
Nigeria                   215     550 000    310 000     840 000       166 734         30.3      19.85       53.8
Rwanda                    156      48 000     31 000      60 000        45 206         94.2      75.34      145.8
Sao Tome & Principe                    …                                    17           …          …          …
Senegal                   32       12 000      6 100         20 000      4 200         35.0      21.00       68.9
Seychelles                             …                                    43           …          …          …
Sierra Leone                        9 400      5 200       15 000        1 178         12.5       7.85       22.7
South Africa              352   1 000 000    830 000    1 200 000      371 204         37.1      30.93       44.7
Swaziland                  22      44 000     28 000       62 000       23 896         54.3      38.54       85.3
Tanzania                  204     280 000    220 000      350 000      117 261         41.9      33.50       53.3
Togo                       68      23 000     13 000       36 000        7 822         34.0      21.73       60.2
Uganda                    279     230 000    140 000      320 000      111 307         48.4      34.78       79.5
Zambia                    300     230 000    180 000      280 000      150 000         65.2      53.57       83.3
Zimbabwe                  150    350 000     230 000     480 000        95,000         27.1      19.79       41.3
      TOTAL             3,686   4,464,253   2,996,800   6,010,100     1,893,651        42.4       31.5       63.2
                                Source: Regional database, WHO/AFRO
                                             44
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