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Australia 1
UHC and SDG Country Profile 2018Australia
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201624.1 million GDP per capita (current US$)² 201649 927.80 Income level² 2017High incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20149.4%Total health expenditure per capita (current US$)⁴ 20146031.11General government health expenditure as % of total health expenditure⁴ 201467.0%Life expectancy at birth (in years)⁵ 201582.8
Key Messages
Overall progress towards universal health coverage (UHC)
• The vision of the Department of Health Strategic Intent 2017-2021 is "Better health and wellbeing for all Australians, now and for future generations." The purpose of the strategic intent is to lead and shape Australia’s health and aged care system and support outcomes through evidence based policy, well targeted programs, and best practice regulation. It focuses on three priorities: better health and ageing outcomes and reduced inequality; affordable, accessible, efficient, and high quality health and aged care system; and better sport outcomes.
• Based on estimates of the financial burden for health, more than200 000 people (1% of the population) incurred high out-of-pocket
healthpayments, which suggest gaps in financial protection for health.
People inthe poorest quintile seem to be most vulnerable toout-of-pocket expenses.
The majority of SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, Australia
fared relatively well in reproductive, maternal, newborn
and child health(RMNCH), in infectious diseases, in urban and environmental health, and inhealth system resources and service capacity.
• However, challenges remain in noncommunicable disease (NCD)prevention and control; Australia has one of the highest rates of per capitaalcohol consumption in the Region.
• Disaggregated data relating to some population groups are currentlyunavailable.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
≥ 80Australia
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
1.1%Australia
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
6 tracer indicators > 80
5 tracer indicators 60–80
0 tracer indicators < 60
Reproductive, maternal, newborn and child health4 0 0
Infectious diseases1 2 0
Noncommunicable diseases0 3 0
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
14 indicators > 70%
0 indicators 40–70%
2 indicators < 40%
Reproductive, maternal, newborn and child health7 0 0
Infectious diseases2 0 0
Noncommunicable diseases2 0 1
Urban and environmental health3 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• Compared to other countries in the Western Pacific Region, Australia hashigh coverage of essential services.
Australia 2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Australia ? Financial risk protection by place of residence and economic status
4.0%
0.2% 0.3% 0.1% 0.1%0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2010
How does Australia compare to other countries in the Region?
Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
AUS
KHM CHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
UHC index – coverage of essential health services (SDG 3.8.1)
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, 2010. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201584 84
Antenatal care, 4+ visits (%), 2013
95 95Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
93 93Care-seeking behaviour for child pneumonia (%), 2015
90c 90
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
69 69HIV antiretroviral treatment (%), 2015
79 79Access to improved sanitation (%), 2015
100 100
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201480 60
Mean fasting plasma glucose (mmol/L), 20085.5 79
Tobacco non-use (%), 201585 69
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201437.9 Reference point: 18a
Health worker density (per 10 000 population), 201538.4b Reference point: 10.5a
International Health Regulations compliance (%), 2015100 100
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 3.5 physicians per 1000 pop (2015); 13.7 psychiatrists per 100 000 pop (2015); 20.3 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health90
Infectious diseases82
Noncommunicable diseases69
Service capacity and access100
Australia 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Australia has a value of 88%, meaning it has performed at 88% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Australia from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 6.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2013 3.1.2 99.0% 98%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 3.7 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 2.2 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 94.0% 87%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013
3.7.2 14.2 88%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 94.0% 84%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 2015
3.3.1 0.1 86%e
TB incidence (per 100 000 population)¹⁴ 2016 3.3.2 6.1 100%e
Malaria incidence (per 1000 population at risk)¹⁴ 3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 8.9% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 11.8 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 11.2 7%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 13.1% 77%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 16.7% 100%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 5.4 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 0.4 100%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.1 100%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.5 81%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴
3.b.2Skilled health professionals density (per 10 000 population)²⁵ 2013
3.c.1 157.2 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 100.0 100% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Australia being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Australia 4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Australia was the Household Expenditure Survey (HES), Australian Bureau of Statistics from 2010.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Australia does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/001 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Brunei Darussalam 1
UHC and SDG Country Profile 2018Brunei Darussalam
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016423 196 GDP per capita (current US$)² 201626 938.50 Income level² 2017High incomeIncome Gini coefficient³N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20142.6%Total health expenditure per capita (current US$)⁴ 2014957.61General government health expenditure as % of total health expenditure⁴ 201493.9%Life expectancy at birth (in years)⁵ 201577.7
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, BruneiDarussalam has high coverage of essential services.
• Relatively low out-of-pocket spending suggests a low risk of financialhardship. However, as health services are predominantly governmentsubsidized, further efforts to support sustainable financing are required.
• The UHC index indicates some gaps in tuberculosis (TB) detection andtreatment, as well as concerns with the prevalence of tobacco use andraised blood pressure.
The majority of SDG 3 indicators are close to the target• Compared to other countries in the Region, Brunei Darussalam fared
relatively well with indicators for SDG 3, including those for reproductive,maternal, newborn and child health (RMNCH), for urban andenvironmental health, and for health system resources and capacity.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
≥ 80Brunei Darussalam
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ABrunei Darussalam
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
7 tracer indicators > 80
3 tracer indicators 60–80
1 tracer indicator < 60
Reproductive, maternal, newborn and child health4 0 0
Infectious diseases1 1 1
Noncommunicable diseases1 2 0
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
14 indicators > 70%
0 indicators 40–70%
1 indicator < 40%
Reproductive, maternal, newborn and child health7 0 0
Infectious diseases1 0 0
Noncommunicable diseases3 0 0
Urban and environmental health3 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• The Vision 2035 and Health Strategy aimed to introduce the key elements of the new Ministry of Health strategy, in line with Wawasan Brunei 2035 and focused on – comprehensive healthcare system that emphasises service excellence, embraces and practices healthy lifestyle, sustainability through resource optimization, innovation and excellence, effective policies and regulations that ensure protection for all, and transparent and proactive governance.
Brunei Darussalam2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) noncommunicable diseases (NCDs); and (4) service capacity and access.How is country performance on UHC indicators assessed? Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value). The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Brunei Darussalam?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Brunei Darussalam compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201583c 83
Antenatal care, 4+ visits (%), 2011
100 100Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
99 99Care-seeking behaviour for child pneumonia (%), 2015
86c 86
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
57 57HIV antiretroviral treatment (%), 2015
72c 72Access to improved sanitation (%), 2015
96 96
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201581 62
Mean fasting plasma glucose (mmol/L), 20085.3 88
Tobacco non-use (%), 201584 67
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201527.4 Reference point: 18a
Health worker density (per 10 000 population), 201517.7b Reference point: 10.5a
International Health Regulations compliance (%), 201591 91
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.5 physicians per 1000 pop (2015); 4.3 psychiatrists per 100 000 pop (2015); 22.5 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health92
Infectious diseases73
Noncommunicable diseases72
Service capacity and access97
AUS
BRN
KHM
CHN
COK FJI JPNKIR
LAO MYS
MHL
FSMMNG
NRU
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
Brunei Darussalam 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Brunei Darussalam has a value of 86%, meaning it has performed at 86% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Brunei Darussalam from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 23.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2015 3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 9.9 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 4.4 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 99.0% 98%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2008
3.7.2 16.6 86%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 99.0% 97%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 66.0 89%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 12.6% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 1.3 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 1.3 100%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 3.1% 96%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 29.3% 73%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹3.6.1 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 0.2 100%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.1 100%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.2 95%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴
3.b.2Skilled health professionals density (per 10 000 population)²⁵ 2012
3.c.1 96.6 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 92.0 86% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Brunei Darussalam being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Brunei Darussalam4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Brunei Darussalam does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/002 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Cambodia 1
UHC and SDG Country Profile 2018Cambodia
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201615.8 million GDP per capita (current US$)² 20161269.91 Income level² 2017Lower middle incomeIncome Gini coefficient³ 2013360 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 2014 6.3%Total health expenditure per capita (current US$)⁴ 201469.00General government health expenditure as % of total health expenditure⁴ 201422.0%Life expectancy at birth (in years)⁵ 201568.7
Key Messages
Overall progress towards universal health coverage (UHC) • The vision of the Health Strategic Plan 2016-2020 is for Cambodians to "have better
health and wellbeing, thereby contributing to sustainable socioeconomic development." To achieve this, the plan sets out health development goals including: improving reproductive health and reducing maternal, child, and new-born mortality; reducing morbidity and mortality due to communicable and noncommunicable diseases; and making health system more accountable and responsive to health needs of the population.
• Out-of-pocket spending remains a particular challenge and is high by regional standards, with an estimated 3.8% of households incurring high out‐of‐pocket health payments, which suggests gaps in financial protection for health. The data show a large variation between quintiles, with catastrophic expenditures greatest in the wealthiest quintiles due to seeking services in the private sector and overseas, and limited access to services in the poorest quintiles.
• While service coverage remains relatively high for maternal and child health and for immunization services, key challenges include the provision of noncommunicable disease (NCD) services, tuberculosis (TB) and hepatitis detection and treatment, and access to improved sanitation.
Several SDG 3 indicators are close to the target• Cambodia shows relatively advanced progress towards newborn and child
health indicators and some infectious disease indicators.
• However, significant progress is required to achieve maternal mortality and family planning targets, and relatively large inequities persist in the adolescent birth rate and in neonatal and under‐5 mortality.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
55Cambodia
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
4.8%Cambodia
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
2 tracer indicators > 80
4 tracer indicators 60–80
5 tracer indicators < 60
Reproductive, maternal, newborn and child health1 2 1
Infectious diseases0 1 2
Noncommunicable diseases1 1 1
Service capacity and access0 0 1
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
8 indicators > 70%
6 indicators40–70%
4 indicators < 40%
Reproductive, maternal, newborn and child health5 1 2
Infectious diseases2 0 1
Noncommunicable diseases1 2 0
Urban and environmental health0 3 0
Health system resources and capacity0 0 1
Note: Refer to page 3
• Cambodia has relatively low coverage of many essential services. It continues to face significant challenges in access to and quality of services and capacity for service delivery, compared to other countries in the Western Pacific Region.
Cambodia2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) reproductive, maternal, newborn and child health (RMNCH); (2) infectious diseases; (3) NCDs; and (4) service capacity and access.How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Cambodia? Financial risk protection by place of residence and economic status
5.4%
2.6%1.3%
2.6% 2.5%
7.4%10.0%
0.0%2.0%4.0%6.0%8.0%
10.0%12.0%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2015 2015
How does Cambodia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
UHC index – coverage of essential health services (SDG 3.8.1)
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
AUS
KHMCHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household con-sumption or income, 2015. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559 59
Antenatal care, 4+ visits (%), 2011
76 76Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
89 89Care-seeking behaviour for child pneumonia (%), 2014
69 69
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
55 55HIV antiretroviral treatment (%), 2015
76 76Access to improved sanitation (%), 2015
49 49
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201574 48
Mean fasting plasma glucose (mmol/L), 20104.7c 100
Tobacco non-use (%), 201582 63
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 20158.3 Reference point: 18a
Health worker density (per 10 000 population), 2014–20152.2b Reference point: 10.5a
International Health Regulations compliance (%), 201551 51
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.2 physicians per 1000 pop (2015); 0.3 psychiatrists per 100 000 pop (2014); 0.8 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health72
Infectious diseases59
Noncommunicable diseases67
Service capacity and access33
Cambodia 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Cambodia has a value of 47%, meaning it has performed at 47% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Cambodia from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 161.0 37%d
Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 89.0% 82%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 30.6 86%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 16.2 75%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 20163.3.4 90.0% 78%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2014
3.7.1 56.4% 32%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013
3.7.2 57.0 47%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 90.0% 74%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 2015
3.3.1 0.1 90%e
TB incidence (per 100 000 population)¹⁴ 2016 3.3.2 345.0 39%e
Malaria incidence (per 1000 population at risk)¹⁴ 2015
3.3.3 13.0 89%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 23.3% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 11.9 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 5.3 62%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 2.8% 97%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 44.1% 42%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 17.4 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 71.4 56%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 5.6 60%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.9 62%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 4.27Skilled health professionals density (per 10 000 population)²⁵ 2013
3.c.1 11.2 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 55.0 22% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Cambodia being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)79% 99% 20% 91% 99% 8%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)75 18 307% 52 18 194%
26 12 124% 23 10 135%
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
95% 98% 3% 97% 97% 0%
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)92 33 178% 65 22 198%
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
72% 96% 26% 82% 93% 12%
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: DHS, 2014
Cambodia4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Cambodia National Health Accounts Report, 2014.5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Cambodia was the Cambodia Socioeconomic Survey (CSES), National Institute of Statistics from 2015.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Cambodia, the tool used the Demographic and Health Survey (DHS) conducted in 2014.
Technical notes and sources
WPR/2018/DHS/003 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
China 1
UHC and SDG Country Profile 2018China
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 20161403.5 million GDP per capita (current US$)² 20168123.18 Income level² 2017Upper middle incomeIncome Gini coefficient³ 201342.10 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20145.5%Total health expenditure per capita (current US$)⁴ 2014419.73General government health expenditure as % of total health expenditure⁴ 201455.8%Life expectancy at birth (in years)⁵ 201576.1
Key Messages
Overall progress towards universal health coverage (UHC) • The 13th Five-Year Plan for Health Sector Development (2016–2020) and the 13th Five-
Year Plan on Deepening the Medical System Reform set out China’s strategic direction and define tasks for implementation. The action plan for a Healthy China includes: disease prevention and treatment and basic public healthcare services; promote maternal and infant health; birth defect prevention and treatment; strengthening the provision of community-level medical services; impart and innovate traditional Chinese medicine; smarter healthcare; popular fitness, and food and medicine safety.
• Based on 2007 survey data, 4.8% of the population incurred high out-of-pocket health payments, which suggests gaps in financial protection forhealth; the wealthiest quintiles are more affected by catastrophicexpenditures.
The majority of SDG 3 indicators are close to the target• Compared to other countries in the Region, China fared relatively well
with SDG 3 indicators, particularly in reproductive, maternal, newborn
andchild health (RMNCH).
•
China has made major progress in malaria elimination, but an unfinishedagenda for tuberculosis (TB) and other infectious diseases requiresattention.
• However, challenges remain in noncommunicable disease (NCD)prevention and control and in urban and environmental health,specifically with regard to male smoking, alcohol consumption per capita,and mortality attributed to household and ambient air pollution for whichChina has one of the highest rates in the Region.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
76China
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
4.8%China
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
5 tracer indicators > 80
4 tracer indicators 60–80
2 tracer indicators < 60
Reproductive, maternal, newborn and child health2 2 0
Infectious diseases1 1 1
Noncommunicable diseases1 1 1
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
11 indicators > 70%
0 indicators 40–70%
5 indicators < 40%
Reproductive, maternal, newborn and child health7 0 0
Infectious diseases2 0 0
Noncommunicable diseases1 0 2
Urban and environmental health1 0 2
Health system resources and capacity1 0 0
Note: Refer to page 3
• Compared to other countries in the Western Pacific Region, China hasrelatively high coverage of essential services.
China2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in China?
Financial risk protection by place of residence and economic status
4.9% 4.6%3.5%
4.4%5.5% 5.1% 5.3%
0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2007 2007
How does China compare to other countries in the Region?
Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
AUS
KHMCHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
UHC index – coverage of essential health services (SDG 3.8.1)
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household con-sumption or income, 2007. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201595 95
Antenatal care, 4+ visits (%), 2015
74c 74Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
99 99Care-seeking behaviour for child pneumonia (%), 2015
79c 79
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
82 82HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
75c 75
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201581 62
Mean fasting plasma glucose (mmol/L), 20085.5 82
Tobacco non-use (%), 201575 49
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201242.0 Reference point: 18a
Health worker density (per 10 000 population), 2011–201417.2b Reference point: 10.5a
International Health Regulations compliance (%), 201599 99
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.5 physicians per 1000 pop (2011); 1.7 psychiatrists per 100 000 pop (2014); 21.6 surgeons per 100 000 pop (2012)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health86
Infectious diseases63
Noncommunicable diseases63
Service capacity and access100
China 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, China has a value of 96%, meaning it has performed at 96% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is China from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 27.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 9.9 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 5.1 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 99.0% 98%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2011
3.7.2 6.2 96%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 99.0% 97%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 64.0 90%e
Malaria incidence (per 1000 population at risk)¹⁴ 2015
3.3.3 0.0 100%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 18.1% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 10 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 7.8 39%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 1.8% 99%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 47.6% 35%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 18.8 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 161.1 0%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.4 98%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 1.6 29%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 0.06Skilled health professionals density (per 10 000 population)²⁵ 2011
3.c.1 31.5 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 99.0 98% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in China being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)100% 100% 0%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)12 5 58%
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)6 3 49%
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: 2017 China Health and Family Planning Statistical Yearbook
China4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in China was the China Household Income Project Series (CHIP), University of Michigan from 2007.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For China, the tool used the China Health and Family Planning Statistical Yearbook conducted in 2017.
Technical notes and sources
WPR/2018/DHS/004 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Cook Islands 1
UHC and SDG Country Profile 2018Cook Islands
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201617 379 GDP per capita (current US$)² 201415 324.00 Income level² N/AIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20143.4%Total health expenditure per capita (current US$)⁴ 2014517.86General government health expenditure as % of total health expenditure⁴ 201490.1%Life expectancy at birth (in years)⁵ 2006–201276.4
Key Messages
Overall progress towards universal health coverage (UHC) • The Ministry of Health’s new health strategic plan- Takai’anga Angaanga
Tutara A Te Marae Ora: Cook Islands National Health Strategic Plan 2017–2021, aims to "provide accessible, affordable health care and equitable health services of the highest quality, by and for all in order to improve the health status of people living in the Cook Islands."
• Cook Islands has relatively low out-of-pocket spending as a percentageof gross domestic product, which suggests a low risk of financialhardship.
• Based on the UHC index, major challenges remain in NCD preventionand control, specifically tobacco use and the prevalence of raised bloodpressure.
Only a few SDG 3 indicators are reported• Compared to other countries in the Region for SDG 3 indicators,
Cook Islands is relatively close to the targets for RMNCH, except for theadolescent birth rate.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported toWHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
41Cook Islands
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ACook Islands
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
3 tracer indicators > 80
2 tracer indicators 60–80
6 tracer indicators < 60
Reproductive, maternal, newborn and child health2 1 1
Infectious diseases1 0 2
Noncommunicable diseases0 0 3
Service capacity and access0 1 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
6 indicators > 70%
2 indicators 40–70%
1 indicator < 40%
Reproductive, maternal, newborn and child health5 1 0
Infectious diseases1 0 0
Noncommunicable diseases0 1 0
Urban and environmental health0 0 0
Health system resources and capacity0 0 1
Note: Refer to page 3
• Compared to other countries in the Western Pacific Region,Cook Islands has relatively high coverage in reproductive, maternal,newborn and child health (RMNCH) services, except in family planningand noncommunicable disease (NCD) control.
Cook Islands2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Cook Islands?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Cook Islands compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559c 59
Antenatal care, 4+ visits (%), 2015
74c 74Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
99 99Care-seeking behaviour for child pneumonia (%), 2015
86c 86
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
0 0HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
98 98
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201578 56
Mean fasting plasma glucose (mmol/L), 20086.5 29
Tobacco non-use (%), 201574 47
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201578.1 Reference point: 18a
Health worker density (per 10 000 population), 201515.7b Reference point: 10.5a
International Health Regulations compliance (%), 201567 67
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.5 physicians per 1000 pop (2015); 0 psychiatrists per 100 000 pop (2015); 11.2 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health78
Infectious diseases16
Noncommunicable diseases42
Service capacity and access51
AUS
BRN
KHM
CHN
FJI JPNKIR
LAO MYS
MHL
FSMMNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGPCOK
Cook Islands 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Cook Islands has a value of 48%, meaning it has performed at 48% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Cook Islands from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹²
3.1.1Proportion of births attended by skilled health personnel (%)¹³ 2009
3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 7.8 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 4.1 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 99.0% 98%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2011
3.7.2 56.0 48%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 99.0% 97%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 13.0 99%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸
3.4.1 Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴
3.4.2 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 5.1 64%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 24.2 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸
3.9.3
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 2.9Skilled health professionals density (per 10 000 population)²⁵ 2009
3.c.1 69.5 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 56.0 24% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Cook Islands being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Cook Islands4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Cook Islands does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/005 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Japan 1
UHC and SDG Country Profile 2018Japan
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016127.7 million GDP per capita (current US$)² 201638 894.47 Income level² 2017High incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 201410.2%Total health expenditure per capita (current US$)⁴ 20143702.95General government health expenditure as % of total health expenditure⁴ 201483.6%Life expectancy at birth (in years)⁵ 201583.7
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Wester Pacific Region, Japan has highcoverage of esential services.
• Based on 2008 survey data, 4.2% of the population incurred high out-of-pockethealth payments, which suggests gaps in financial protection for
health; furtherstudy is required.
• The UHC index indicates challenges in noncommunicable disease (NCD)prevention and control, specifically a high prevalence of raised blood pressureand tobacco use.
The majority of SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, Japan fared
well in reproductive, maternal, newborn and child health(RMNCH), as well asin infectious diseases and in health system resources and capacity.
• However, challenges remain in NCD prevention and control, especiallyregarding alcohol consumption per capita.
• The equity dimension is not known either because the country may not havedisaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
≥ 80Japan
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
4.2%Japan
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
6 tracer indicators > 80
3 tracer indicators 60–80
2 tracer indicators < 60
Reproductive, maternal, newborn and child health3 1 0
Infectious diseases1 1 1
Noncommunicable diseases1 1 1
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
11 indicators > 70%
1 indicator40–70%
2 indicators < 40%
Reproductive, maternal, newborn and child health6 0 0
Infectious diseases1 0 0
Noncommunicable diseases1 1 1
Urban and environmental health3 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• Health policy in 2017 in Japan has 8 main policies: 1) establishment of amedical care system for the future, 2) promotion of innovations in thepharmaceutical and medical device industries, 3) an attempt at "new medicalcare", 4) enhancing sustainability of health insurance systems to protect asense of security in our daily life, 5) towards realizing improved medical careby the medical fee revision, 6) promoting disease prevention/healthpromotion to optimize medical expenditure, 7) realizing a society in whichpeople can live with a sense of security even though they have cancer, 8)preventing the occurrence/spread of infectious diseases to support the safetyand security of the people
Japan2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure? Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Japan?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Japan compare to other countries in the Region?
Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
UHC index – coverage of essential health services (SDG 3.8.1)
AUS
KHMCHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, 2008. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201565 65
Antenatal care, 4+ visits (%), 2015
97c 97Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
96 96Care-seeking behaviour for child pneumonia (%), 2015
89c 89
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
46 46HIV antiretroviral treatment (%), 2015
72c 72Access to improved sanitation (%), 2015
100 100
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201583 65
Mean fasting plasma glucose (mmol/L), 20085.3 89
Tobacco non-use (%), 201577 54
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 2012134.0 Reference point: 18a
Health worker density (per 10 000 population), 2012–201425.5b Reference point: 10.5a
International Health Regulations compliance (%), 2015100 100
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 2.3 physicians per 1000 pop (2012); 8.4 psychiatrists per 100 000 pop (2014); 16.8 surgeons per 100 000 pop (2013)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health86
Infectious diseases69
Noncommunicable diseases68
Service capacity and access100
Japan 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Japan has a value of 97%, meaning it has performed at 97% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Japan from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 5.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 2.7 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 0.9 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 3.3.4
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013
3.7.2 4.4 97%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 99.0% 97%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 16.0 98%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 8.8% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 19.7 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 7.8 39%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 10.6% 82%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 33.7% 64%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 4.7 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 24.2 85%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.1 100%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.5 81%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴
3.b.2Skilled health professionals density (per 10 000 population)²⁵ 2012
3.c.1 130.9 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 100.0 100% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Japan being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Japan4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Japan was the Japan Household Panel Survey (JHPS), Panel Data Research Center at Keio University from 2008.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Japan does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/007 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Kiribati 1
UHC and SDG Country Profile 2018Kiribati
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016114 395GDP per capita (current US$)² 20141449.06 Income level² 2017Lower middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 201410.2%Total health expenditure per capita (current US$)⁴ 2014154.17General government health expenditure as % of total health expenditure⁴ 201481.2%Life expectancy at birth (in years)⁵ 201566.3
Key Messages
Overall progress towards universal health coverage (UHC)
•
• The population in Kiribati is at relatively low risk of financial hardship,although this may indicate limited access to health services.
• Based on the UHC index, major challenges remain in the prevention andcontrol of infectious diseases and noncommunicable diseases (NCDs),especially access to improved sanitation and the prevalence of raised bloodpressure.
Majority of SDG 3 indicators are far from the targets• Compared to other countries in the Region, gaps exist in reproductive,
maternal, newborn and child health (RMNCH), except in maternal mortalityrate and skilled birth attendance. Kiribati’s under-5 and neonatal mortalityrates are among the highest in the Region, while the use of family planningis among the lowest rates regionally.
• Gaps exist in the prevention and control of infectious diseases and NCDsand in urban and environmental health. Kiribati has one of the Region’shighest rates of male and female smoking, tuberculosis (TB) incidence andmortality attributed to unintentional poisoning.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
40Kiribati
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/AKiribati
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
1 tracer indicator > 80
4 tracer indicators 60–80
6 tracer indicators < 60
Reproductive, maternal, newborn and child health1 2 1
Infectious diseases0 1 2
Noncommunicable diseases0 0 3
Service capacity and access0 1 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
3 indicators > 70%
3 indicators 40–70%
8 indicators < 40%
Reproductive, maternal, newborn and child health2 3 3
Infectious diseases0 0 1
Noncommunicable diseases1 0 2
Urban and environmental health0 0 1
Health system resources and capacity0 0 1
Note: Refer to page 3
• The primary goal of the Kiribati Health Strategic Plan 2016–2019 is to improve population health and health equity through continuous improvement in the quality and responsiveness of health services, and by making the most effective and efficient use of available resources
Compared to other countries in the Western Pacific Region, Kiribati has relatively low coverage of essential services. The UHC index indicates relatively limited service capacity and access.
Kiribati2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) reproductive, maternal, newborn and child health (RMNCH); (2) infectious diseases; (3) NCDs; and (4) service capacity and access.How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Kiribati?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Kiribati compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201543 43
Antenatal care, 4+ visits (%), 2006
71 71Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
78 78Care-seeking behaviour for child pneumonia (%), 2009
81 81
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
70 70HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
40 40
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201579 57
Mean fasting plasma glucose (mmol/L), 20086.8 16
Tobacco non-use (%), 201551 2
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6 Reference point: 18a
Health worker density (per 10 000 population), 2013–20152.6b Reference point: 10.5a
International Health Regulations compliance (%), 201460 60
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.2 physicians per 1000 pop (2013); 1.8 psychiatrists per 100 000 pop (2015); 3.6 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health66
Infectious diseases48
Noncommunicable diseases13
Service capacity and access62
AUS
BRN
KHM
CHN
COK FJI JPNLAO MYS
MHL
FSM
MNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
KIR
Kiribati 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Kiribati has a value of 53%, meaning it has performed at 53% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Kiribati from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 90.0 86%d
Proportion of births attended by skilled health personnel (%)¹³ 2010 3.1.2 98.0% 97%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 54.3 25%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 22.6 36%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 81.0% 58%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2009
3.7.1 35.8% 0%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2010 3.7.2 49.9 53%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 81.0% 50%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 566.0 0%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 28.2% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 14.3 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 2.7 87%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 40.9% 22%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 63.9% 0%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 2.9 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 2.0 10%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 8.15Skilled health professionals density (per 10 000 population)²⁵ 2013
3.c.1 48.2 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 60.0 31% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Kiribati being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Kiribati4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Kiribati does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/008 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Lao People’s Democratic Republic 1
UHC and SDG Country Profile 2018Lao People’s Democratic Republic
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 20166.8 millionGDP per capita (current US$)² 20162353.15 Income level² 2017Lower middle incomeIncome Gini coefficient³ 201336.70 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 2011–20122.8%Total health expenditure per capita (current US$)⁴ 2011–201235.50General government health expenditure as % of total health expenditure⁴ 201450.5%Life expectancy at birth (in years)⁵ 201565.7
Key MessagesOverall progress towards universal health coverage (UHC) • The Health Sector Reform Framework provides a road map to build a
resilient health system and achieve UHC by 2025, including a consequent increase of domestic spending on health.
• General government health expenditures as a percentage of total government expenditures have been gradually increased from 3.4% to 5.9% over the past four years.
• Access to, coverage of and the use of essential health services areimproving, but remain limited compared to other countries in theWestern Pacific Region.
• The number of health workers per 10 000 people has increased, butremains among the lowest in the Region.
• Challenges include the prevention, detection and management ofinfectious diseases and noncommunicable diseases (NCDs), as well asreproductive, maternal, newborn and child health (RMNCH), in whichprogress has been slow compared to other countries in the Region.
Majority of SDG 3 indicators are far from the targets • Notable progress has been made in improving maternal health and
reaching the Millennium Development Goal (MDG) targets. However,further efforts are required as the maternal, neonatal and under-5mortality rates remain among the highest in the Region, and skilledbirth attendance is among the lowest.
• There are gaps in NCD prevention and control and urban andenvironmental health. The country has one of the highest rates of malesmoking and of mortality attributed to exposure to unsafe water,sanitation and hygiene (WASH) services.
• Inequities in skilled birth attendance and child immunization areapparent.
Note: Refer to page 2
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
48Lao People’s Democratic Republic
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
0.7%Lao People’s Democratic Republic
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
2 tracer indicators > 80
3 tracer indicators 60–80
6 tracer indicators < 60
Reproductive, maternal, newborn and child health1 1 2
Infectious diseases0 1 2
Noncommunicable diseases1 0 2
Service capacity and access0 1 0
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
2 indicators > 70%
5 indicators 40–70%
10 indicators < 40%
Reproductive, maternal, newborn and child health0 2 6
Infectious diseases1 1 0
Noncommunicable diseases1 1 1
Urban and environmental health0 1 2
Health system resources and capacity0 1 0
Note: Refer to page 3
Lao People’s Democratic Republic2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in the Lao People’s Democratic Republic? Financial risk protection by place of residence and economic status
1.5%1.8%
0.7% 0.9%
1.6%2.1%
3.2%
0.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2007 2007
How does the Lao People’s Democratic Republic compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
AUS
KHM CHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100UHC index – coverage of essential health services (SDG 3.8.1)Fi
nanc
ial r
isk
prot
ecti
on (S
DG
3.8
.2)*
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household con-sumption or income, 2007. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201567 67
Antenatal care, 4+ visits (%), 2010
37 37Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
89 89Care-seeking behaviour for child pneumonia (%), 2011
54 54
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
32 32HIV antiretroviral treatment (%), 2015
35 35Access to improved sanitation (%), 2015
73 73
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201575 51
Mean fasting plasma glucose (mmol/L), 20085.1 100
Tobacco non-use (%), 201570 40
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201215.0 Reference point: 18a
Health worker density (per 10 000 population), 2012–20141.9b Reference point: 10.5a
International Health Regulations compliance (%), 201574 74
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.2 physicians per 1000 pop (2012); 0 psychiatrists per 100 000 pop (2014); 1 surgeon per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health59
Infectious diseases43
Noncommunicable diseases59
Service capacity and access34
Lao People’s Democratic Republic 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Lao People’s Democratic Republic has a value of 11%, meaning it has performed at 11% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is the Lao People’s Democratic Republic from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 197.0 12%d
Proportion of births attended by skilled health personnel (%)¹³ 2012 3.1.2 40.0% 0%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 63.9 0%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 28.7 0%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 82.0% 60%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2012
3.7.1 61.3% 40%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2010 3.7.2 94.0 11%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 82.0% 53%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 175.0 70%e
Malaria incidence (per 1000 population at risk)¹⁴ 2015 3.3.3 20.9 83%e
Are population groups in the Lao People’s Democratic Republic being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
11% 91% 88% 31% 80% 61%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
37% 81% 55% 52% 68% 23%
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: Multiple Indicator Cluster Survey , 2011
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 25.8% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 12.3 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 7.3 43%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 9.1% 85%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 56.6% 15%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 14.3 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 108.3 33%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 13.9 0%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 1.3 43%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 5.65Skilled health professionals density (per 10 000 population)²⁵ 2012
3.c.1 10.4 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 75.0 57% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Lao People’s Democratic Republic4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Lao People’s Democratic Republic National Health Accounts Report (2011–2012).5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in the Lao People’s Democratic Republic was the Lao Expenditure and Consumption Survey (LECS), National Statistics Center from 2007/2008.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For the Lao People’s Democratic Republic, the tool used the Multiple Indicator Cluster Survey (MICS) conducted in 2011.
Technical notes and sources
WPR/2018/DHS/009 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Malaysia 1
UHC and SDG Country Profile 2018Malaysia
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201631.2 million GDP per capita (current US$)² 20169502.57 Income level² 2017Upper middle incomeIncome Gini coefficient³ 201346.20 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20144.2%Total health expenditure per capita (current US$)⁴ 2014455.83General government health expenditure as % of total health expenditure⁴ 201455.2%Life expectancy at birth (in years)⁵ 201575.0
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Malaysia hasrelatively high coverage of essential services.
• Despite Malaysia having relatively high out-of-pocket spending as apercentage of current health expenditures (36%), the population is at low riskof financial hardship.
• The UHC index indicates gaps in family planning, prevalence of raised bloodpressure, and in infectious diseases prevention and control, specifically HIVtreatment and tuberculosis (TB) detection and treatment, for which a recentincrease in incidence might be further monitored. Based on Malaysia’snational health sector strategy, TB detection and treatment is lower than thenational target.
Several SDG 3 indicators are close to the target• Compared to other countries in the Region, Malaysia fared relatively well in
reproductive, maternal, newborn and child health (RMNCH), in urban andenvironmental health, and in health system resources and service capacity.
• However, further efforts are required in noncommunicable disease (NCD)prevention and control, specifically to address male smoking.
• The results also indicate gaps on HIV prevention and control.
• Compared to other countries, Malaysia has a relatively high road-trafficmortality rate.
• The equity dimension is not known either because the country may not havedisaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
70Malaysia
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
0.0%Malaysia
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
4 tracer indicators > 80
3 tracer indicators 60–80
4 tracer indicators < 60
Reproductive, maternal, newborn and child health2 1 1
Infectious diseases1 1 1
Noncommunicable diseases0 1 2
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
14 indicators > 70%
2 indicators 40–70%
1 indicator < 40%
Reproductive, maternal, newborn and child health7 0 0
Infectious diseases2 1 0
Noncommunicable diseases2 1 0
Urban and environmental health3 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• The 11th Malaysia Plan 2016–2020 identified health as a key component of the plan’s major thrust – improving well-being for all. This will focus on addressing underserved populations, improving health system delivery to enhance efficiency and effectiveness, and intensifying collaboration with the private sector and Non-Governmental Organizations (NGOs).
Malaysia2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Malaysia? Financial risk protection by place of residence and economic status
0.03% 0.04%
0.00%0.01%
0.05%
0.08%
0.04%
0.00%
0.02%
0.04%
0.06%
0.08%
0.10%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2004 2004
How does Malaysia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
AUS
KHMCHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
UHC index – coverage of essential health services (SDG 3.8.1)
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household con-sumption or income, 2004. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201553 53
Antenatal care, 4+ visits (%), 2015
80 80Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
99 99Care-seeking behaviour for child pneumonia (%), 2015
87c 87
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
68 68HIV antiretroviral treatment (%), 2015
26 26Access to improved sanitation (%), 2015
100 100
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201577 54
Mean fasting plasma glucose (mmol/L), 20085.7 72
Tobacco non-use (%), 201578 56
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6 Reference point: 18a
Health worker density (per 10 000 population), 2011–201413.6b Reference point: 10.5a
International Health Regulations compliance (%), 201599 99
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.3 physicians per 1000 pop (2011); 0.8 psychiatrists per 100 000 pop (2014); 6.9 surgeons per 100 000 pop (2011)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health78
Infectious diseases56
Noncommunicable diseases60
Service capacity and access89
Malaysia 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Malaysia has a value of 89%, meaning it has performed at 89% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Malaysia from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 40.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 99.0% 98%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 8.3 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 4.4 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 98.0% 96%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2012
3.7.2 12.7 89%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 98.0% 95%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 2015
3.3.1 0.3 53%e
TB incidence (per 100 000 population)¹⁴ 2016 3.3.2 92.0 85%e
Malaria incidence (per 1000 population at risk)¹⁴ 20153.3.3 1.9 98%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 17.1% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 5.8 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 1.5 98%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 1.4% 100%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 43.0% 44%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 24.0 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 21.6 87%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.4 98%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.6 76%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 0.02Skilled health professionals density (per 10 000 population)²⁵ 2011
3.c.1 46.8 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 100.0 100% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Malaysia being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Malaysia4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Malaysia was the Household Expenditure Survey (HES), Department of Statistics Malaysia from 2005.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Malaysia does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/010 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Marshall Islands 1
UHC and SDG Country Profile 2018Marshall Islands
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201653 066GDP per capita (current US$)² 20163448.54 Income level² 2017Upper middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 201417.1%Total health expenditure per capita (current US$)⁴ 2014625.20General government health expenditure as % of total health expenditure⁴ 201484.3%Life expectancy at birth (in years)⁵ 201171.8
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, the Marshall Islandshas relatively low coverage of essential services. The UHC index also indicatesrelatively limited service capacity and access.
• The population in the Marshall Islands faces a relatively high risk of financialhardship.
• Based on the UHC index, major challenges remain in the prevention and control ofinfectious and noncommunicable diseases (NCDs) and in service capacity andaccess, specifically in the prevalence of raised blood pressure, which is highcompared to other countries in the Region.
Only a few SDG 3 indicators are reported• Compared to other countries in the Region, the Marshall Islands is far from
reaching the targets in reproductive, maternal, newborn and child health(RMNCH), except in the rates of skilled birth attendance and of neonatal andunder-5 mortality; immunization and adolescent births might require furthermonitoring.
• Gaps exist in infectious diseases prevention and control and in health systemresources and capacity; the Marshall Islands has one of the highest rates oftuberculosis (TB) incidence compared to other countries in the Region.
• The equity dimension is not known either because the country may not havedisaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
40Marshall Islands
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/AMarshall Islands
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
2 tracer indicators > 80
3 tracer indicators 60–80
6 tracer indicators < 60
Reproductive, maternal, newborn and child health1 2 1
Infectious diseases1 1 1
Noncommunicable diseases0 0 3
Service capacity and access0 0 1
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
3 indicators > 70%
2 indicators 40–70%
4 indicators < 40%
Reproductive, maternal, newborn and child health3 2 2
Infectious diseases0 0 1
Noncommunicable diseases0 0 0
Urban and environmental health0 0 0
Health system resources and capacity0 0 1
Note: Refer to page 3
• The 3-Year Rolling Strategic Plan 2017–2019, focuses on health as a shared responsibility. The mission is "to strengthen the commitment on healthy islands concept in implementing health promotion to protect and promote healthy lifestyles to improve the lives of the people through primary health, and to build the capacity of Ministry of Health, communities, families and partners to actively participate and coordinate preventive services programs and activities as the core resources in primary health care services."
Marshall Islands2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in the Marshall Islands?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does the Marshall Islands compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559c 59
Antenatal care, 4+ visits (%), 2004
77 77Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
85 85Care-seeking behaviour for child pneumonia (%), 2015
62c 62
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
65 65HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
87 87
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201579 58
Mean fasting plasma glucose (mmol/L), 20087.1 1
Tobacco non-use (%), 201575c 49
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2011–20145.7b Reference point: 10.5a
International Health Regulations compliance (%), 201351 51
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.5 physicians per 1000 pop (2012); 0 psychiatrist per 100 000 pop (2014); 11.4 surgeons per 100 000 pop (2011)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health70
Infectious diseases62
Noncommunicable diseases14
Service capacity and access43
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYSFSM
MNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGPMHL
Marshall Islands 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Marshall Islands has a value of 20%, meaning it has performed at 20% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is the Marshall Islands from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹²
3.1.1Proportion of births attended by skilled health personnel (%)¹³ 2011
3.1.2 90.0% 83%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 35.4 73%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 16.4 74%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 73.0% 40%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2007
3.7.1 80.5% 70%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2011 3.7.2 85.0 20%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 71.0% 24%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 422.0 26%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸
3.4.1 Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴
3.4.2 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹
3.5.2Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 5.7 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸
3.9.3
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 3.21Skilled health professionals density (per 10 000 population)²⁵ 2010
3.c.1 40.1 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 51.0 16% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in the Marshall Islands being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Marshall Islands4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Marshall Islands does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/011 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Federated States of Micronesia 1
UHC and SDG Country Profile 2018Federated States of Micronesia
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, the FederatedStates of Micronesia has relatively high coverage of essential services.
• The Federated States of Micronesia has relatively low out-of-pocketspending, which suggests a low risk of financial hardship.
• The UHC index indicates major challenges in infectious andnoncommunicable diseases (NCDs), specifically in tobacco use,prevalence of raised blood pressure and access to improved sanitation.
A few SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, the
Federated States of Micronesia fared relatively well in reproductive,
maternal, newborn and child health (RMNCH).
• However, gaps exist in immunization coverage, with the FederatedStates of Micronesia having one of the lowest coverage rates in theRegion.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016104 937GDP per capita (current US$)² 20163068.51 Income level² 2017Lower middle incomeIncome Gini coefficient³ 201361.10 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 201413.7%Total health expenditure per capita (current US$)⁴ 2014414.99General government health expenditure as % of total health expenditure⁴ 201490.7%Life expectancy at birth (in years)⁵ 201569.4
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
60Federated States of Micronesia
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/AFederated States of Micronesia
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
0 tracer indicators > 80
5 tracer indicators 60–80
6 tracer indicators < 60
Reproductive, maternal, newborn and child health0 3 1
Infectious diseases0 1 2
Noncommunicable diseases0 0 3
Service capacity and access0 1 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
5 indicators > 70%
4 indicators 40–70%
2 indicators < 40%
Reproductive, maternal, newborn and child health4 2 1
Infectious diseases0 1 0
Noncommunicable diseases1 0 0
Urban and environmental health0 1 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• In 2014, the recommendations from a Health Summit were translated into the Framework for Sustainable Health Development (2014-2024). The framework aims to ensure that people and communities are healthy and enjoy universal access to quality health services and essential health services.
Federated States of Micronesia2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in the Federated States of Micronesia
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does the Federated States of Micronesia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559c 59
Antenatal care, 4+ visits (%), 2015
74c 74Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
72 72Care-seeking behaviour for child pneumonia (%), 2015
65c 65
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
75 75HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2014
56 56
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201575 50
Mean fasting plasma glucose (mmol/L), 20086.2 46
Tobacco non-use (%), 201575c 49
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2009–20143.1b Reference point: 10.5a
International Health Regulations compliance (%), 201564 64
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.2 physicians per 1000 pop (2009); 1 psychiatrists per 100 000 pop (2014); 10.6 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health67
Infectious diseases56
Noncommunicable diseases49
Service capacity and access70
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYS
MHL MNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for ÿ
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGPFSM
Federated States of Micronesia 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries. How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Federated States of Micronesia has a value of 70%, meaning it has performed at 70% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is the Federated States of Micronesia from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 100.0 79%d
Proportion of births attended by skilled health personnel (%)¹³ 2009 3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 33.3 79%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 17.2 69%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 76.0% 47%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2010
3.7.2 32.6 70%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 69.0% 18%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 177.0 69%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 25.9% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 11.2 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 2.4 90%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 1.9 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 1.1 52%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 4.13Skilled health professionals density (per 10 000 population)²⁵ 2009
3.c.1 38.0 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 86.0 76% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in the Federated States of Micronesia being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Federated States of Micronesia4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Micronesia (Fed States of) does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/012 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Mongolia 1
UHC and SDG Country Profile 2018Mongolia
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 20163.0 million GDP per capita (current US$)² 20163686.45 Income level² 2017Lower middle incomeIncome Gini coefficient³ 201336.50 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20144.7%Total health expenditure per capita (current US$)⁴ 2014195.33General government health expenditure as % of total health expenditure⁴ 201455.4%Life expectancy at birth (in years)⁵ 201568.8
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Mongoliahas relatively high coverage of essential services.
• Based on 2014 survey data, more than 50 000 people (1.7% of thepopulation) made high out-of-pocket health payments, which indicatesgaps in financial protection for health.
• Based on the UHC index, major challenges remain in the prevention and
control of infectious diseases and noncommunicable diseases (NCDs),
specifically tuberculosis (TB) detection and treatment, HIV antiretroviraltreatment and access to improved sanitation.
Several SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, Mongolia
shows advanced progress in reproductive, maternal, newborn and childhealth (RMNCH), except for family planning.
• Gaps exist in NCD prevention and control and in urban andenvironmental health, specifically in total alcohol consumption, malesmoking, and mortality attributed to unintentional poisoning andhousehold and ambient air pollution.
• Based on the reported indicators, there are no apparent inequitiesacross residence and wealth quintiles.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
63Mongolia
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
1.7%Mongolia
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
3 tracer indicators > 80
3 tracer indicators 60–80
5 tracer indicators < 60
Reproductive, maternal, newborn and child health2 2 0
Infectious diseases0 0 3
Noncommunicable diseases0 1 2
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
10 indicators > 70%
2 indicators 40–70%
5 indicators < 40%
Reproductive, maternal, newborn and child health7 1 0
Infectious diseases1 1 0
Noncommunicable diseases1 0 2
Urban and environmental health1 0 2
Health system resources and capacity1 0 0
Note: Refer to page 3
• The State Policy on Health (2017-2026) was introduced to extend the average life expectancy of Mongolians by improving quality and inclusivity of healthcare services through disease prevention; introducing new evidence-based diagnostics and treatment; and ensuring proper system of health sector financing in order to meet the health needs and demand of the population.
Mongolia2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Mongolia? Financial risk protection by place of residence and economic status
1.5% 1.8%
0.7% 0.9%
1.6%2.1%
3.2%
0.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2014 2014
How does Mongolia compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
AUS
KHMCHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
UHC index – coverage of essential health services (SDG 3.8.1)
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household con-sumption or income, 2014. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201572 72
Antenatal care, 4+ visits (%), 2012
90 90Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
99 99Care-seeking behaviour for child pneumonia (%), 2013
70 70
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
32 32HIV antiretroviral treatment (%), 2015
33c 33Access to improved sanitation (%), 2015
59 59
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201571 42
Mean fasting plasma glucose (mmol/L), 20095.5c 78
Tobacco non-use (%), 201574 47
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201270.0 Reference point: 18a
Health worker density (per 10 000 population), 2011–201330.3b Reference point: 10.5a
International Health Regulations compliance (%), 201586 86
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 2.9 physicians per 1000 pop (2011); 0.5 psychiatrists per 100 000 pop (2011); 14.1 surgeons per 100 000 pop (2013)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health82
Infectious diseases40
Noncommunicable diseases54
Service capacity and access88
Mongolia 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Mongolia has a value of 76%, meaning it has performed at 76% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Mongolia from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 44.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2013 3.1.2 99.0% 98%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 17.9 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 9.7 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 99.0% 98%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2013
3.7.1 68.3% 51%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2014 3.7.2 26.7 76%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 99.0% 97%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 2015
3.3.1 0.0 100%e
TB incidence (per 100 000 population)¹⁴ 2016 3.3.2 183.0 68%e
Malaria incidence (per 1000 population at risk)¹⁴ 3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 29.9% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 28.3 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 7.8 39%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 5.3% 92%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 47.7% 34%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 21.0 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 132.4 18%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 3.1 78%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 2.2 0%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 2.37Skilled health professionals density (per 10 000 population)²⁵ 2011
3.c.1 65.6 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 86.0 76% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Mongolia being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)98% 99% 2% 98% 99% 1%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
91% 96% 5% 91% 94% 3%
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: MICS, 2010
Mongolia4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Mongolia was the Mongolia Household Income and Expenditure Survey (HIES), National Statistical Office from 2014.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Mongoliathe tool used the Multiple Indicator Cluster Survey (MICS) conducted in 2010.
Technical notes and sources
WPR/2018/DHS/013 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Nauru 1
UHC and SDG Country Profile 2018Nauru
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201611 347GDP per capita (current US$)² 20167821.30 Income level² 2017Upper middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20143.3%Total health expenditure per capita (current US$)⁴ 2014516.44General government health expenditure as % of total health expenditure⁴ 201486.2%Life expectancy at birth (in years)⁵ 2011–201361.2
Key Messages
Overall progress towards universal health coverage (UHC)
• Despite relatively high geographic coverage of essential services
provided at theprimary and secondary levels, there are opportunities for further enhancements inoverall service coverage.
• Nauru has relatively low out-of-pocket spending, which suggests a low
risk offinancial hardship.
• Based on the UHC index, major challenges remain in noncommunicable disease(NCD) prevention and control, as well as reproductive, maternal, newborn andchild health (RMNCH), specifically neonatal care and diabetes and itscomplications.
Only a few SDG 3 indicators are reported • Compared to other countries in the Region for SDG 3 indicators,
Nauru showsrelatively close proximity to targets in some aspects of
RMNCH, specifically skilledbirth attendance, under-5 mortality and immunization coverage.
• However, the adolescent birth rate and family planning have some of the highestand lowest values, respectively, in the Western Pacific Region.
• Gaps exist in the prevention and control of NCDs: Nauru has one of the highestrates of male and female smoking prevalence in the Region.
• The equity dimension is not known either because the country may not havedisaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
51Nauru
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ANauru
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
2 tracer indicators > 80
3 tracer indicators 60–80
6 tracer indicators < 60
Reproductive, maternal, newborn and child health1 1 2
Infectious diseases1 1 1
Noncommunicable diseases0 1 2
Service capacity and access0 0 1
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
6 indicators > 70%
1 indicator 40–70%
5 indicators< 40%
Reproductive, maternal, newborn and child health4 0 3
Infectious diseases1 0 0
Noncommunicable diseases1 1 1
Urban and environmental health0 0 0
Health system resources and capacity0 0 1
Note: Refer to page 3
• The vision of the Nauru Health Strategic Plan for 2016-2020 is "a healthy and peaceful nation that values and supports human rights and dignity through the provision of quality care and services." Five key areas have been identified and focus on strengthening health system capacity and capability to meet health service needs, demand and expectations, on strengthening and improving community preventive and health care services, on providing high quality clinical care and services, and supporting the clinical and health programme role and functions of the Ministry.
Nauru2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Nauru?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Nauru compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559c 59
Antenatal care, 4+ visits (%), 2004
40 40Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
91 91Care-seeking behaviour for child pneumonia (%), 2007
69 69
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
87 87HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
66 66
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201580 59
Mean fasting plasma glucose (mmol/L), 20085.9 62
Tobacco non-use (%), 201559 18
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2010–201411.0b Reference point: 10.5a
International Health Regulations compliance (%), 201442 42
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1 physicians per 1000 pop (2010); 0 psychiatrists per 100 000 pop (2011); 9.8 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health62
Infectious diseases62
Noncommunicable diseases40
Service capacity and access43
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYS
MHL
FSM
MNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
NRU
Nauru 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Nauru has a value of 0%, meaning it has performed at 0% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Nauru from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹²
3.1.1Proportion of births attended by skilled health personnel (%)¹³ 2007
3.1.2 97.0% 95%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 34.6 75%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 22.2 39%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 91.0% 80%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2007
3.7.1 42.5% 10%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2011 3.7.2 105.3 0%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 91.0% 76%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 112.0 81%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸
3.4.1 Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴
3.4.2 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 3.6 78%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 52.0% 0%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 43.0% 44%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 3.6.1 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸
3.9.3
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 9.83Skilled health professionals density (per 10 000 population)²⁵ 2008
3.c.1 78.8 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 42.0 0% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Nauru being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Nauru4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Nauru does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/014 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
New Zealand 1
UHC and SDG Country Profile 2018New Zealand
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 20164.7 millionGDP per capita (current US$)² 201639 426.62 Income level² 2017High incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 201411.0%Total health expenditure per capita (current US$)⁴ 20144896.35General government health expenditure as % of total health expenditure⁴ 201482.3%Life expectancy at birth (in years)⁵ 201581.6
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, NewZealand has high coverage of essential services.
• New Zealand has relatively low out-of-pocket spending, which suggests alow risk of financial hardship.
• The UHC index indicates gaps in noncommunicable disease (NCD)prevention and control.
The majority of SDG 3 indicators are close to the target• Compared to other countries in Region for SDG 3 indicators, New
Zealand fared well in reproductive, maternal, newborn and childhealth (RMNCH), as well as in infectious diseases and in urban andenvironmental health.
• Gaps exist in NCD prevention and control, specifically in total alcoholconsumption.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
≥ 80New Zealand
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ANew Zealand
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
6 tracer indicators > 80
5 tracer indicators 60–80
0 tracer indicators< 60
Reproductive, maternal, newborn and child health4 0 0
Infectious diseases1 2 0
Noncommunicable diseases0 3 0
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
11 indicators > 70%
0 indicators 40–70%
2 indicators < 40%
Reproductive, maternal, newborn and child health7 0 0
Infectious diseases1 0 0
Noncommunicable diseases0 0 1
Urban and environmental health3 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• The New Zealand Health Strategy: Future direction 2016-2026 outlines the high-level direction for New Zealand’s health system over the 10 years. It lays out some of the challenges and opportunities the system faces and identifies five strategic themes, including: people-powered; closer to home; value and high performance; one team; and smarter system for the changes that will take them toward this future.
New Zealand2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in New Zealand?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does New Zealand compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201585 85
Antenatal care, 4+ visits (%), 2015
97c 97Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
92 92Care-seeking behaviour for child pneumonia (%), 2015
86c 86
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
71 71HIV antiretroviral treatment (%), 2015
72c 72Access to improved sanitation (%), 2015
100 100
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201584 67
Mean fasting plasma glucose (mmol/L), 20085.6 76
Tobacco non-use (%), 201584 67
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201328.0 Reference point: 18a
Health worker density (per 10 000 population), 2014–201533.8b Reference point: 10.5a
International Health Regulations compliance (%), 201598 98
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 3 physicians per 1000 pop (2015); 18 psychiatrists per 100 000 pop (2015); 18.3 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health90
Infectious diseases80
Noncommunicable diseases70
Service capacity and access99
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYS
MHL
FSM
MNG
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
NZL
New Zealand 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, New Zealand has a value of 83%, meaning it has performed at 83% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is New Zealand from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 11.0 100%e
Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 97.0% 95%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 5.4 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 3.0 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 92.0% 82%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2014
3.7.2 19.1 83%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 92.0% 79%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 7.3 100%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 10.4% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 12.6 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 10.1 17%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 6.0 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 0.5 100%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.6 96%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.3 90%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴
3.b.2Skilled health professionals density (per 10 000 population)²⁵ 2014
3.c.1 135.7 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 96.0 93%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in New Zealand being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
New Zealand4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, New Zealand does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/015 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Niue 1
UHC and SDG Country Profile 2018Niue
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 20161624GDP per capita (current US$)² 201415 608.00 Income level² N/AIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20147.4%Total health expenditure per capita (current US$)⁴ 20141162.20General government health expenditure as % of total health expenditure⁴ 201498.4%Life expectancy at birth (in years)⁵ 2007–201173.2
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Niue has highcoverage of essential services.
• Niue has relatively low out-of-pocket spending as a percentage of grossdomestic product, which suggests a low risk of financial hardship.
• Based on the UHC index, gaps remain in family planning and in theprevalence of raised blood pressure.
Several SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators,
Niue shows close proximity to the targets in reproductive, maternal,newborn and child health (RMNCH), as well as infectious diseases andnoncommunicable diseases (NCDs), except in alcohol consumption percapita.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
64Niue
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ANiue
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
4 tracer indicators > 80
4 tracer indicators 60–80
3 tracer indicators < 60
Reproductive, maternal, newborn and child health1 2 1
Infectious diseases2 0 1
Noncommunicable diseases1 1 1
Service capacity and access0 1 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
9 indicators > 70%
1 indicator 40–70%
1 indicator < 40%
Reproductive, maternal, newborn and child health6 0 0
Infectious diseases1 0 0
Noncommunicable diseases2 1 0
Urban and environmental health0 0 0
Health system resources and capacity0 0 1
Note: Refer to page 3
• The vision of the Niue Health Strategic Plan (NHSP), (2011-2012) is is “a healthy population, well supported by quality health services”. In support of that Vision, the goal of the NHSP is to “ensure that all those living in Niue are encouraged and supported to live healthy lives” and has three objectives: to improve the health of those living in Niue; to continually improve the quality of health services; and to ensure that health services are efficient and value for money.
Niue2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Niue?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Niue compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559c 59
Antenatal care, 4+ visits (%), 2015
74c 74Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
99 99Care-seeking behaviour for child pneumonia (%), 2015
64c 64
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2002
87 87HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
97 97
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201576 52
Mean fasting plasma glucose (mmol/L), 20155.4c 84
Tobacco non-use (%), 201585 69
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2008–201424.6b Reference point: 10.5a
International Health Regulations compliance (%), 201461 61
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.8 physicians per 1000 pop (2008); 0 psychiatrists per 100 000 pop (2011); 62.1 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health72
Infectious diseases70
Noncommunicable diseases67
Service capacity and access51
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYS
MHL
FSM
MNG
NZLPLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
NIU
Niue 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Niue has a value of 88%, meaning it has performed at 88% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Niue from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹²
3.1.1Proportion of births attended by skilled health personnel (%)¹³ 2011
3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 22.2 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 11.6 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 99.0% 98%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2009
3.7.2 14.3 88%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 99.0% 97%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 20.0 98%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸
3.4.1 Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴
3.4.2 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 7.1 45%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 11.4% 80%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 20.3% 92%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 3.6.1 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸
3.9.3
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 6.21Skilled health professionals density (per 10 000 population)²⁵ 2008
3.c.1 116.3 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 61.0 33% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Niue being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Niue4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Niue does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/016 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Palau 1
UHC and SDG Country Profile 2018Palau
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201621 503GDP per capita (current US$)² 201613 626.01 Income level² 2017High incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20149.0%Total health expenditure per capita (current US$)⁴ 20141150.30General government health expenditure as % of total health expenditure⁴ 201472.4%Life expectancy at birth (in years)⁵N/A
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Palau hashigh coverage of essential services.
• Palau has relatively low out-of-pocket spending, which suggests a low riskof financial hardship.
• Based on the UHC index, challenges remain in the prevention and controlof infectious and noncommunicable diseases (NCDs), specificallytuberculosis (TB) detection and treatment and the prevalence of raisedblood pressure.
Several SDG 3 indicators are close to target• Compared to other countries in the Region for SDG 3 indicators, Palau fared
relatively well in reproductive, maternal, newborn and child health (RMNCH).
• Several SDG indicators are not reported.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
69Palau
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/APalau
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
4 tracer indicators > 80
2 tracer indicators 60–80
5 tracer indicators< 60
Reproductive, maternal, newborn and child health2 1 1
Infectious diseases1 0 2
Noncommunicable diseases0 1 2
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
7 indicators > 70%
0 indicators 40–70%
1 indicator < 40%
Reproductive, maternal, newborn and child health6 0 0
Infectious diseases1 0 0
Noncommunicable diseases0 0 0
Urban and environmental health0 0 1
Health system resources and capacity0 0 0
Note: Refer to page 3
• The Ministry of Health Strategic Plan 2014–2018 outlines the strategic priorities; toprovide accessible and high quality patient-centred hospital services;provide accessible and high quality primary and preventive services;ensure effective partnerships are developed and maintained; value thepeople and support their growth and development; and ensure that theadministrative and support services are accountable and sustainable.
Palau2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Palau?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Palau compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559c 59
Antenatal care, 4+ visits (%), 2010
81 81Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
90 90Care-seeking behaviour for child pneumonia (%), 2015
79c 79
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
50 50HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
100 100
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201577 54
Mean fasting plasma glucose (mmol/L), 20086.3 40
Tobacco non-use (%), 201584 68
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2010–201515.9b Reference point: 10.5a
International Health Regulations compliance (%), 201591 91
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.4 physicians per 1000 pop (2010); 4.9 psychiatrists per 100 000 pop (2011); 12.5 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health77
Infectious diseases59
Noncommunicable diseases53
Service capacity and access96
AUS
BRN
KHM
CHN
COK FJI JPNKIR
LAO MYS
MHL
FSMMNG
NZL
NIUPNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGPPLW
Palau 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Palau has a value of 76%, meaning it has performed at 76% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Palau from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 3.1.1
Proportion of births attended by skilled health personnel (%)¹³ 2015
3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 15.9 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 8.4 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 98.0% 96%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2010
3.7.2 27.0 76%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 98.0% 95%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 123.0 79%e
Malaria incidence (per 1000 population at risk)¹⁴
3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸
3.4.1 Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴
3.4.2 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹
3.5.2Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 4.8 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸
3.9.3
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 1.42Skilled health professionals density (per 10 000 population)²⁵ 2010
3.c.1 72.8 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 92.0 86%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Palau being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Palau4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017).5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Palau does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/017 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Papua New Guinea 1
UHC and SDG Country Profile 2018Papua New Guinea
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 20168.1 millionGDP per capita (current US$)² 20162182.72 Income level² 2017Lower middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20144.3%Total health expenditure per capita (current US$)⁴ 201492.36General government health expenditure as % of total health expenditure⁴ 201481.3%Life expectancy at birth (in years)⁵ 201562.9
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region,Papua New Guinea has relatively low coverage of essential services. The UHCindex also indicates relatively limited service capacity and access.
• Based on out-of-pocket spending, the population in Papua New Guinea is atrelatively low risk of financial hardship, but this may indicate limited access tohealth services.
• Major challenges remain in the prevention and control of infectious andnoncommunicable diseases (NCDs), as well as reproductive, maternal, newbornand child health (RMNCH).
The majority of SDG 3 indicators are far from the targets• Compared to other countries in the Region for SDG 3 indicators, Papua New Guinea
is far from the targets in RMNCH. Its rates of maternal, neonatal and under-5mortality are among the highest in the Region; whereas, skilled birth attendance,immunization and family planning are among the lowest.
• Major gaps exist in the prevention and control of infectious diseases and NCDs,and in urban and environmental health. Papua New Guinea has a relatively highincidence of malaria and a high mortality rate attributed to exposure to unsafewater, sanitation and hygiene (WASH) services, compared to other countries inthe Region.
• The equity dimension is not known either because the country may not havedisaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
41Papua New Guinea
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/APapua New Guinea
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
0 tracer indicators > 80
3 tracer indicators 60–80
8 tracer indicators< 60
Reproductive, maternal, newborn and child health0 2 2
Infectious diseases0 0 3
Noncommunicable diseases0 0 3
Service capacity and access0 1 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
2 indicators > 70%
0 indicators 40–70%
14 indicators < 40%
Reproductive, maternal, newborn and child health0 0 8
Infectious diseases0 0 3
Noncommunicable diseases1 0 0
Urban and environmental health1 0 2
Health system resources and capacity0 0 1
Note: Refer to page 3
• The National Health Plan 2011–2020 focuses on improving service delivery and primary health care. The priority strategy of the plan is ‘back to basics’, with a focus on: rehabilitation as the foundation of the primary health care system; improving maternal health and child survival, and reducing the burden of communicable diseases. The health sector will also focus on promoting a healthy lifestyle and improving the preparedness for disease outbreaks and emerging population on health issues.
Papua New Guinea2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Papua New Guinea?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Papua New Guinea compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201548 48
Antenatal care, 4+ visits (%), 2004
55 55Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
73 73Care-seeking behaviour for child pneumonia (%), 2006
63 63
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
56 56HIV antiretroviral treatment (%), 2015
48 48Access to improved sanitation (%), 2015
19 19
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201575 49
Mean fasting plasma glucose (mmol/L), 20086.1 52
Tobacco non-use (%), 201563 25
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2010–20140.6b Reference point: 10.5a
International Health Regulations compliance (%), 201464 64
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.1 physicians per 1000 pop (2010); 0.1 psychiatrists per 100 000 pop (2014); 0.5 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health59
Infectious diseases37
Noncommunicable diseases40
Service capacity and access33
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYS
MHL
FSM
MNG
NZL
NIU
PLW
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
PNG
Papua New Guinea 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Papua New Guinea has a value of 39%, meaning it has performed at 39% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Papua New Guinea from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 215.0 0%d
Proportion of births attended by skilled health personnel (%)¹³ 2006
3.1.2 53.0% 22%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 54.3 25%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 23.5 31%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 66.0% 24%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2006
3.7.1 40.6% 7%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2006 3.7.2 65.0 39%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 72.0% 26%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 2015
3.3.1 0.5 0%e
TB incidence (per 100 000 population)¹⁴ 2016 3.3.2 432.0 24%e
Malaria incidence (per 1000 population at risk)¹⁴ 20153.3.3 122.2 0%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 36.1% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 10.3 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 2.4 90%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 16.8 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 46.3 71%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 12.4 11%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 2 10%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 3.41Skilled health professionals density (per 10 000 population)²⁵ 2010
3.c.1 5.9 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 64.0 38%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Papua New Guinea being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Papua New Guinea4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Papua New Guinea does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/018 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Philippines 1
UHC and SDG Country Profile 2018Philippines — PROVISIONAL
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016103.3 million GDP per capita (current US$)² 20162951.07 Income level² 2017Lower middle incomeIncome Gini coefficient³ 2013430 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20144.7%Total health expenditure per capita (current US$)⁴ 2014135.20General government health expenditure as % of total health expenditure⁴ 201434.3%Life expectancy at birth (in years)⁵ 201568.5
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, coverage of someessential services in the Philippines is slightly below the regional average.
• High coverage exists for reproductive, maternal, newborn and child health (RMNCH)services and for some communicable disease prevention and control interventions,compared to other countries in the Region.
• Based on estimates of the financial burden for health, 1.4% of the populationincurred high out-of-pocket health payments, which suggest gaps in financialprotection for health; catastrophic expenditure is greatest in the wealthiestquintile and might require further monitoring.
• Based on the UHC index, major challenges remain in infectious disease preventionand control and in service capacity and access, specifically family planning, maletobacco use and HIV antiretroviral treatment.
Few SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, the Philippines is
far from reaching some targets in RMNCH, noncommunicable diseases (NCDs),and urban and environmental health.
• Gaps exist in infectious diseases prevention and control. The Philippines has oneof the highest rates of tuberculosis incidence in the Region. A recent increase inHIV prevalence might be further monitored.
• Relatively large inequities in skilled birth attendance, neonatal and under-5mortality, and the adolescent birth rate have been identified.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
58Philippines
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
1.4%Philippines
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
3 tracer indicators > 80
4 tracer indicators 60–80
4 tracer indicators < 60
Reproductive, maternal, newborn and child health1 2 1
Infectious diseases0 2 1
Noncommunicable diseases1 0 2
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
6 indicators > 70%
9 indicators 40–70%
3 indicators < 40%
Reproductive, maternal, newborn and child health2 5 1
Infectious diseases2 0 1
Noncommunicable diseases1 2 0
Urban and environmental health1 2 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• In the Philippine Health Agenda 2016–2022, under the motto "All for Health towards Health for All", universal health coverage is the platform for health and development in the Philippines, driven by action within and outside the health sector. Reducing health inequities is singled out as the most important priority among three health guarantees: ensuring financial protection for the poorest people; improving health outcomes with no disparities; and building health service delivery networks for more responsiveness
Philippines2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in the Philippines? Financial risk protection by place of residence and economic status
0.4% 0.5%
1.2%1.6%
3.4%
0.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%
Ru ral Urban Poorest20% (q1)
Secondpoores t20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2015
How does the Philippines compare to other countries in the Region?
Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
UHC index – coverage of essential health services (SDG 3.8.1)
AUS
KHM CHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household con-sumption or income, 2015. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201554 54
Antenatal care, 4+ visits (%), 2010
84 84Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
60 60Care-seeking behaviour for child pneumonia (%), 2013
64 64
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
78 78HIV antiretroviral treatment (%), 2015
27 27Access to improved sanitation (%), 2015
75 75aaa
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201578 55
Mean fasting plasma glucose (mmol/L), 20085.0 100
Tobacco non-use (%), 201575 50
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 20105.0 Reference point: 18a
Health worker density (per 10 000 population), 2004–201511.6b Reference point: 10.5a
International Health Regulations compliance (%), 201584 84
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.1 physicians per 1000 pop (2004); 0.5 psychiatrists per 100 000 pop (2014); 4.3 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health65
Infectious diseases54
Noncommunicable diseases65
Service capacity and access49
Philippines 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Philippines has a value of 47%, meaning it has performed at 47% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 28.6% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 3.4 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 5.6 59%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 8.5% 86%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 43.0% 44%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 10.5 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 88.7 45%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 5.1 64%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.2 95%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 0.59Skilled health professionals density (per 10 000 population)²⁵
3.c.1 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 87.0 78% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in the Philippines being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)46% 97% 52% 68% 85% 20%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)52 16 232% 38 25 53%
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)20 9 127% 18 9 99%
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
72% 75% 3% 76% 79% 3%
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)108 23 374% 67 52 28%
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
79% 93% 16% 85% 88% 4%
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: DHS, 2013
How far is the Philippines from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 114.0 70%d
Proportion of births attended by skilled health personnel (%)¹³ 2013 3.1.2 73.0% 55%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 27.1 95%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 12.6 96%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 86.0% 69%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2013
3.7.1 51.5% 24%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013 3.7.2 57.0 47%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 86.0% 63%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 2015
3.3.1 0.1*TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 554.0 2%e
Malaria incidence (per 1000 population at risk)¹⁴ 2015
3.3.3 0.4*Note: A recent increase in incidence might be further monitored
Philippines4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Philippines was the Philippine Family Income and Expenditure Survey (FIES), Philippine Statistics Authority from 2015.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Philippines, the tool used the Demographic and Health Survey (DHS) conducted in 2013.
Technical notes and sources
WPR/2018/DHS/019 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Republic of Korea 1
UHC and SDG Country Profile 2018Republic of Korea
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201650.8 million GDP per capita (current US$)² 201627 538.81 Income level² 2017High incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20147.4%Total health expenditure per capita (current US$)⁴ 20142060.25General government health expenditure as % of total health expenditure⁴ 201454.1%Life expectancy at birth (in years)⁵ 201582.3
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, theRepublic of Korea has high coverage of essential services.
• Based on estimates of the financial burden for health, slightly less than2 million people (3.9% of the population) incurred high out-of-pockethealth payments, which suggest gaps in financial protection for health.People in the poorest quintiles seem to be most vulnerable toout-of-pocket expenses.
The majority of SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, the
Republic of Korea fared well in reproductive, maternal, newborn andchild health (RMNCH), in infectious disease prevention and control, inurban and environmental health, and in health system resources andservice capacity.
• However, challenges remain in noncommunicable disease (NCD)prevention and control. The Republic of Korea has one of the highestrates of male smoking and alcohol consumption per capita.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
≥ 80Republic of Korea
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
3.9%Republic of Korea
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
6 tracer indicators > 80
4 tracer indicators 60–80
1 tracer indicator < 60
Reproductive, maternal, newborn and child health3 1 0
Infectious diseases1 2 0
Noncommunicable diseases1 1 1
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
13 indicators > 70%
0 indicators 40–70%
3 indicators < 40%
Reproductive, maternal, newborn and child health7 0 0
Infectious diseases2 0 0
Noncommunicable diseases1 0 2
Urban and environmental health3 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• Ministry of Health and Welfare (MoHW) annual work plan for 2018 focuseson three major domains: 1) support for better life, 2) expanding nationalresponsibility in order to improve people's quality of life, and 3)strengthening community engagement.
Republic of Korea2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in the Republic of Korea? Financial risk protection by place of residence and economic status
0.0%1.0%2.0%3.0%4.0%5.0%6.0%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
20152015
4.7%
3.4%3.9%
3.1% 3.2%3.7%
4.5%
How does the Republic of Korea compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
UHC index – coverage of essential health services (SDG 3.8.1)
AUS
KHM CHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household con-sumption or income, 2015. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201583 83
Antenatal care, 4+ visits (%), 2015
98 98Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
98 98Care-seeking behaviour for child pneumonia (%), 2009
80 80
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
76 76HIV antiretroviral treatment (%), 2015
72c 72Access to improved sanitation (%), 2015
100 100
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201588 75
Mean fasting plasma glucose (mmol/L), 20155.4 85
Tobacco non-use (%), 201576 52
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 2015115.3 Reference point: 18a
Health worker density (per 10 000 population), 201529.3b Reference point: 10.5a
International Health Regulations compliance (%), 2014100 100
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 2.2 physicians per 1000 pop (2015); 7 psychiatrists per 100 000 pop (2015); 62 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health89
Infectious diseases82
Noncommunicable diseases69
Service capacity and access100
Republic of Korea 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, the Republic of Korea has a value of 100%, meaning it has performed at 100% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is the Republic of Korea from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 11.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2015 3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 3.4 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 1.5 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 98.0% 96%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013
3.7.2 1.7 100%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 98.0% 95%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 77.0 87%e
Malaria incidence (per 1000 population at risk)¹⁴ 2015
3.3.3 0.8 99%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 8.3% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 28.3 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 11.9 0%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 4.2% 94%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 49.8% 30%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 12.0 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 23.2 86%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.2 99%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.6 76%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴
3.b.2Skilled health professionals density (per 10 000 population)²⁵ 2014
3.c.1 79.0 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 100.0 100% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in the Republic of Korea being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Republic of Korea4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Republic of Korea was the Korea Household Income and Expenditure Survey (HIES), Statistics Korea from 2015.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Republic of Korea does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/020 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Samoa 1
UHC and SDG Country Profile 2018Samoa
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016195 125 GDP per capita (current US$)² 20164027.76 Income level² 2017Upper middle incomeIncome Gini coefficient³N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20147.2%Total health expenditure per capita (current US$)⁴ 2014301.10General government health expenditure as % of total health expenditure⁴ 201490.6%Life expectancy at birth (in years)⁵ 201574.0
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Samoa'soverall progress towards UHC is at the middle range.
• While there is no readily available data to verify the financial protection inhealth, low out-of-pocket spending as a percentage of gross domesticproduct, which suggests a low risk of financial hardship.
• The prevalence of
raised blood pressure, fasting plasma glucose andtobhacco use are among the major risk factors contributing to the NCDburden of disease.
A few SDG 3 indicators are far from the targets• Compared to other countries in the Region for SDG 3 indicators, gaps
remain in immunization coverage and family planning.
• The equity dimension is not known either because the country may nothave disaggregated data or these have not been reported published.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
56Samoa
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ASamoa
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
1 tracer indicator > 80
5 tracer indicators 60–80
5 tracer indicators < 60
Reproductive, maternal, newborn and child health0 3 1
Infectious diseases1 1 1
Noncommunicable diseases0 0 3
Service capacity and access0 1 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
7 indicators > 70%
3 indicators 40–70%
4 indicators < 40%
Reproductive, maternal, newborn and child health4 1 3
Infectious diseases1 0 0
Noncommunicable diseases1 2 0
Urban and environmental health1 0 0
Health system resources and capacity0 1 0
Note: Refer to page 3
• The Health Sector Plan 2008 - 2018 identifies six objectives including:reinforcing health promotion and prevention; improving access andquality of health care delivery; strengthening governance, humanresources, and leadership in the health sector; improving health sectorfinancial management and long term planning of health financing; andincreasing harmonizing donor participation
• While Samoa has an average level of coverage of services for infectiousdisease control and reproductive, maternal, newborn and child health(RMNCH), a coverage of services for noncommunicable disease (NCD)control is a challenge.
Samoa2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201537 37
Antenatal care, 4+ visits (%), 2011
73 73Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
66 66Care-seeking behaviour for child pneumonia (%), 2014
78 78
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
68 68HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
97 97aaa
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201576 52
Mean fasting plasma glucose (mmol/L), 20086.6 23
Tobacco non-use (%), 201572 44
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2008–20144.9b Reference point: 10.5a
International Health Regulations compliance (%), 201575 75
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.5 physicians per 1000 pop (2008); 0.5 psychiatrists per 100 000 pop (2014); 2.6 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health61
Infectious diseases65
Noncommunicable diseases38
Service capacity and access65
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Samoa?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Samoa compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
AUS
BRN
KHM
CHN
COK FJI JPNKIR
LAO MYS
MHL
FSMMNG
NZL
NIU
PLW
PNG
PHL KOR
SLB
40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
VUT
WSM
Samoa 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Samoa has a value of 59%, meaning it has performed at 59% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Samoa from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 51.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 83.0% 72%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 17.3 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 9.2 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 55.0% 0%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2014
3.7.1 39.4% 6%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2007 3.7.2 44.0 59%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 62.0% 0%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 7.7 100%e
Malaria incidence (per 1000 population at risk)¹⁴ 3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 22.0% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 5.7 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 2.8 86%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 18.9% 65%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 41.0% 49%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 15.8 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.7 71%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 5.47Skilled health professionals density (per 10 000 population)²⁵ 2008
3.c.1 23.6 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 76.0 57% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Samoa being left behind?²⁶
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern method
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
71.7% 94.2%
25 18
8 7
21.2% 26.3%
10.8
79.1% 96.9%
4.9
22 13
8 4
23.4% 28.2%
6.5 7.6
5%5%
69%
100%
120%
18%23%
39%
14%
17%
Samoa4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Samoa does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/021 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Singapore 1
UHC and SDG Country Profile 2018Singapore
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 20165.6 millionGDP per capita (current US$)² 201652 960.71 Income level² 2017High incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20144.9%Total health expenditure per capita (current US$)⁴ 20142752.32General government health expenditure as % of total health expenditure⁴ 201441.7%Life expectancy at birth (in years)⁵ 201583.1
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Singaporehas high coverage of essential services.
• Singapore has a relatively low out-of-pocket spending, which suggests arelatively low risk of financial hardship.
• The UHC index indicates gaps in noncommunicable disease (NCD) andinfection disease prevention and control, specifically in the prevalence
ofraised blood pressure and in tobacco use, HIV treatment, and
tuberculosisdetection and treatment.
The majority of SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators,
Singapore fared well in reproductive, maternal, newborn and child health(RMNCH), as well as in progress in infectious diseases, urban andenvironmental health, and health system resources and service capacity.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
≥ 80Singapore
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ASingapore
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
6 tracer indicators > 80
4 tracer indicators 60–80
1 tracer indicator< 60
Reproductive, maternal, newborn and child health3 1 0
Infectious diseases1 1 1
Noncommunicable diseases1 2 0
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
14 indicators > 70%
0 indicators 40–70%
1 indicator < 40%
Reproductive, maternal, newborn and child health7 0 0
Infectious diseases1 0 0
Noncommunicable diseases3 0 0
Urban and environmental health3 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• In 2012, the Ministry of Health launched the Healthcare 2020 Masterplan. Its goals were to improve access, affordability and quality of healthcare services for Singaporeans. A healthy living masterplan was also launched in 2014 and was aimed to promote healthy living as accessible, natural, and effortless for all Singaporeans.
Singapore2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Singapore?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Singapore compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
AUS
BRN
KHM
CHN
COK FJI JPNKIR
LAO MYS
MHL
FSMMNG
NRU
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
TUVVUT
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201577 77
Antenatal care, 4+ visits (%), 2015
97c 97Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
96 96Care-seeking behaviour for child pneumonia (%), 2015
86c 86
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
68 68HIV antiretroviral treatment (%), 2015
53c 53Access to improved sanitation (%), 2015
100 100
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201585 71
Mean fasting plasma glucose (mmol/L), 20085.3 90
Tobacco non-use (%), 201583 67
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201524.0 Reference point: 18a
Health worker density (per 10 000 population), 201545.3b Reference point: 10.5a
International Health Regulations compliance (%), 201599 99
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.1 physicians per 1000 pop (2010); 0.1 psychiatrists per 100 000 pop (2014); 0.5 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health89
Infectious diseases71
Noncommunicable diseases75
Service capacity and access100
Singapore 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Singapore has a value of 99%, meaning it has performed at 99% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Singapore from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 10.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2015
3.1.2 100.0% 100%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 2.8 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 1.1 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 96.0% 91%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵
3.7.1Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013
3.7.2 2.7 99%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 97.0% 92%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 51.0 92%d
Malaria incidence (per 1000 population at risk)¹⁴3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 10.1% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 9.9 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 1.9 94%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 5.0% 93%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 28.0% 76%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 3.6 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 20.7 87%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 0.1 100%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.1 100%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴
3.b.2Skilled health professionals density (per 10 000 population)²⁵ 2013
3.c.1 75.6 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 99.0 98%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Singapore being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Singapore4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Singapore does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/022 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Solomon Islands 1
UHC and SDG Country Profile 2018Solomon Islands
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016599 419GDP per capita (current US$)² 20162005.48 Income level² 2017Lower middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20145.1%Total health expenditure per capita (current US$)⁴ 2014102.24General government health expenditure as % of total health expenditure⁴ 201491.9%Life expectancy at birth (in years)⁵ 201569.2
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to some of the countries in the Western Pacific Region, SolomonIslands has low coverage of essential services. The UHC index indicates relativelylimited service capacity and access.
• Out-of-pocket spending on health at the point of health service delivery is low, asthe private health sector is relatively small and offers limited services. However,indirect expenditures, particularly for transportation to access health care, aresignificantly high.
• Major challenges remain in service capacity and access and in infectious diseaseand noncommunicable disease (NCD) prevention and control, specifically in proxyindicators of the prevalence of raised mean-fasting plasma glucose (mmol/L) andblood pressure levels, tobacco use and access to improved sanitation.
A few SDG 3 indicators are far from the targets• Limited availability of data, including on causes of death, has resulted in
limited evidence for measuring progress towards the NCD targets in theSDGs.
• Major challenges remain in the prevention and control of infectiousdiseases and NCDs, and in urban and environmental health. SolomonIslands has among the highest rates of malaria incidence, of mortalityattributed to exposure to unsafe water, sanitation and hygiene (WASH)services, and of mortality attributed to unintentional poisoning, comparedto other countries in the Region.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
50Solomon Islands
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ASolomon Islands
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
1 tracer indicator > 80
3 tracer indicators 60–80
7 tracer indicators< 60
Reproductive, maternal, newborn and child health1 2 1
Infectious diseases0 1 2
Noncommunicable diseases0 0 3
Service capacity and access0 0 1
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
7 indicators > 70%
5 indicators 40–70%
3 indicators < 40%
Reproductive, maternal, newborn and child health5 2 1
Infectious diseases1 1 0
Noncommunicable diseases1 0 0
Urban and environmental health0 2 1
Health system resources and capacity0 0 1
Note: Refer to page 3
• The vision of the Strategic plan of the Ministry of Health and Medical Services(MHMS) for the period 2016 to 2020 is: “The People of the Solomon Islands will be Healthy, Happy, and Productive." This plan identifies four key result areas that apply across the health sector: improve service coverage; build strong partnerships; improve service quality; and lay the foundation for the future.
Solomon Islands2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Solomon Islands?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Solomon Islands compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201556 56
Antenatal care, 4+ visits (%), 2009
65 65Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
98 98Care-seeking behaviour for child pneumonia (%), 2007
73 73
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
73 73HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
31 31
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201578 56
Mean fasting plasma glucose (mmol/L), 20086.3 42
Tobacco non-use (%), 201575c 49
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201214.0 Reference point: 18a
Health worker density (per 10 000 population), 2011–20142.1b Reference point: 10.5a
International Health Regulations compliance (%), 201557 57
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.2 physicians per 1000 pop (2011); 0.2 psychiatrists per 100 000 pop (2014); 0.9 surgeons per 100 000 pop (2011)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health71
Infectious diseases45
Noncommunicable diseases49
Service capacity and access39
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYS
MHL
FSM
MNG
NZL
NIU
PLW
PNG
PHL KOR
WSM
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
SLB
Solomon Islands 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Solomon Islands has a value of 42%, meaning it has performed at 42% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Solomon Islands from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 114.0 70%d
Proportion of births attended by skilled health personnel (%)¹³ 2007
3.1.2 86.0% 77%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 25.8 98%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 10.4 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 99.0% 98%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2007
3.7.1 60.0% 38%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2008 3.7.2 62.0 42%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 99.0% 97%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 84.0 86%e
Malaria incidence (per 1000 population at risk)¹⁴ 20153.3.3 67.0 45%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 26.4% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 7.9 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 1.4 99%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 19.2 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 54.3 66%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 10.4 25%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 1.3 43%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 9.4Skilled health professionals density (per 10 000 population)²⁵ 2011
3.c.1 22.1 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 57.0 26%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Solomon Islands being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)72% 96% 25% 84% 96% 12%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)23 18 28% 26 23 13%
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)7 8 14% 9 11 22%
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
36% 35% 3% 35% 36% 3%
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)87 51 71%
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
78% 89% 12% 82% 89% 7%
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: DHS
Solomon Islands4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Solomon Islands, the tool used the Demographic and Health Survey (DHS).
Technical notes and sources
WPR/2018/DHS/023 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Tonga 1
UHC and SDG Country Profile 2018Tonga
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016107 122GDP per capita (current US$)² 20163668.87 Income level² 2017Lower middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20145.2%Total health expenditure per capita (current US$)⁴ 2014212.98General government health expenditure as % of total health expenditure⁴ 201482.4%Life expectancy at birth (in years)⁵ 201573.5
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Tonga hashigh coverage of essential services.
• Tonga has relatively low out-of-pocket spending, which suggests a lowrisk of financial hardship.
• Based on the UHC index, major challenges remain in the prevention andcontrol of noncommunicable diseases (NCDs), specifically in tobacco useand the prevalence of raised blood pressure.
Several SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, Tonga
shows relatively advanced progress in reproductive, maternal, newbornand child health (RMNCH) and in infectious diseases, except in familyplanning and immunization.
• However, gaps exist in NCD prevention and control and in urban andenvironmental health. Tonga has one of the highest male smoking rates inthe Region.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
62Tonga
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ATonga
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
2 tracer indicators > 80
4 tracer indicators 60–80
5 tracer indicators< 60
Reproductive, maternal, newborn and child health0 3 1
Infectious diseases2 0 1
Noncommunicable diseases0 0 3
Service capacity and access0 1 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
7 indicators > 70%
3 indicators 40–70%
4 indicators < 40%
Reproductive, maternal, newborn and child health4 3 1
Infectious diseases1 0 0
Noncommunicable diseases2 0 1
Urban and environmental health0 0 1
Health system resources and capacity0 1 0
Note: Refer to page 3
• The vision of the National Health Strategic Plan 2015–2020 is "to be the highest health care provider in the Pacific as judged by international standards in 2020." The mission is "to improve the health of the nation by providing quality care through promotion of good health, reducing morbidity, disability and premature (death) mortality."
Tonga2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Tonga?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Tonga compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201550 50
Antenatal care, 4+ visits (%), 2009
70 70Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
78 78Care-seeking behaviour for child pneumonia (%), 2015
76c 76
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
87 87HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
94 94
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201576 53
Mean fasting plasma glucose (mmol/L), 20086.3 40
Tobacco non-use (%), 201572 43
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2010–20146.0b Reference point: 10.5a
International Health Regulations compliance (%), 201374 74
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.6 physicians per 1000 pop (2010); 1 psychiatrists per 100 000 pop (2014); 2.8 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health67
Infectious diseases69
Noncommunicable diseases45
Service capacity and access71
AUS
BRN
KHM
CHN
COK FJI JPN
KIR
LAO MYS
MHL
FSM
MNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
SGP
TON
Tonga 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Tonga has a value of 73%, meaning it has performed at 73% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Tonga from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 124.0 63%d
Proportion of births attended by skilled health personnel (%)¹³ 2012
3.1.2 96.0% 93%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 16.4 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 6.8 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 78.0% 51%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2012
3.7.1 47.9% 19%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2011 3.7.2 30.0 73%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 78.0% 42%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 8.6 100%d
Malaria incidence (per 1000 population at risk)¹⁴3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 24.1% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 3.5 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 1.4 99%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 13.0% 77%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 47.3% 35%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 7.6 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 1.4 38%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 6.53Skilled health professionals density (per 10 000 population)²⁵ 2010
3.c.1 44.1 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 74.0 55%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Tonga being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Tonga4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017).5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Tonga does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/024 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Tuvalu 1
UHC and SDG Country Profile 2018Tuvalu
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201611 097GDP per capita (current US$)² 20163083.62 Income level² 2017Upper middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 201416.5%Total health expenditure per capita (current US$)⁴ 2014632.84General government health expenditure as % of total health expenditure⁴ 201499.2%Life expectancy at birth (in years)⁵ 201069.6
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Tuvalu hashigh coverage of essential services.
• Tuvalu has relatively low out-of-pocket spending, which suggests a lowrisk of financial hardship.
• Based on the UHC index, challenges remain in the prevention andcontrol of infectious diseases and noncommunicable diseases (NCDs),specifically tuberculosis (TB) detection and treatment, the prevalence ofraised blood pressure and tobacco use.
Several SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, gaps exist
in reproductive, maternal, newborn and child health (RMNCH); Tuvalu has arelatively low proportion of women whose needs for family planning aresatisfied.
• The equity dimension is not known either because the country may nothave disaggregated data or because data have not been reported to WHO.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
64Tuvalu
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/ATuvalu
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
4 tracer indicators > 80
2 tracer indicators 60–80
5 tracer indicators< 60
Reproductive, maternal, newborn and child health1 2 1
Infectious diseases1 0 2
Noncommunicable diseases1 0 2
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
5 indicators > 70%
3 indicators 40–70%
2 indicators < 40%
Reproductive, maternal, newborn and child health4 2 1
Infectious diseases0 1 0
Noncommunicable diseases1 0 0
Urban and environmental health0 0 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• The overall objective of Government in the health service is reflected and outlined in the vision of National Health Reform Strategy 2016-2019, which stated "That all people of Tuvalu will enjoy the highest attainable standard of health, regardless of race, religion, and political belief, economic or social condition".
Tuvalu2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Tuvalu?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Tuvalu compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559c 59
Antenatal care, 4+ visits (%), 2004
67 67Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
96 96Care-seeking behaviour for child pneumonia (%), 2015
69c 69
Infe
ctio
us d
iseas
es9 Tuberculosis detection and treatment (%), 2015
41 41HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
91 91
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201576 53
Mean fasting plasma glucose (mmol/L), 20155.4c 84
Tobacco non-use (%), 201575c 49
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2009–201512.5b Reference point: 10.5a
International Health Regulations compliance (%), 201589 89
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.2 physicians per 1000 pop (2009); 0.5 psychiatrists per 100 000 pop (2015); 2 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health72
Infectious diseases54
Noncommunicable diseases60
Service capacity and access72
AUS
BRN
KHM
CHN
COK FJI JPNKIR
LAO MYS
MHL
FSMMNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
VUT40 NRU 60
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
TUV
Tuvalu 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Tuvalu has a value of 61%, meaning it has performed at 61% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Tuvalu from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹²
3.1.1Proportion of births attended by skilled health personnel (%)¹³ 2007
3.1.2 93.0% 88%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 25.3 99%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 17.2 69%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 94.0% 87%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2007
3.7.1 41.0% 8%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2007 3.7.2 42.0 61%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 94.0% 84%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 207.0 64%e
Malaria incidence (per 1000 population at risk)¹⁴3.3.3
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸
3.4.1 Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴
3.4.2 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 1.9 94%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 3.6.1 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸
3.9.3
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 11.12Skilled health professionals density (per 10 000 population)²⁵ 2009
3.c.1 75.5 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 89.0 81%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Tuvalu being left behind?²⁶NO DATA
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)
Tuvalu4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). Currently, Tuvalu does not report data to this tool.
Technical notes and sources
WPR/2018/DHS/025 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Vanuatu 1
UHC and SDG Country Profile 2018Vanuatu
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 2016270 402GDP per capita (current US$)² 20162860.57 Income level² 2017Lower middle incomeIncome Gini coefficient³ N/A0 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20145.0%Total health expenditure per capita (current US$)⁴ 2014157.51General government health expenditure as % of total health expenditure⁴ 201489.8%Life expectancy at birth (in years)⁵ 201572.0
Key Messages
Overall progress towards universal health coverage (UHC)
• Compared to other countries in the Western Pacific Region, Vanuatu has lowcoverage of essential services. The UHC index also indicates
relatively limitedservice capacity and access.
• Vanuatu has relatively low out-of-pocket spending, which suggests a
low
riskof financial hardship.
• Based on the UHC index, major challenges remain in infectious
disease
andnoncommunicable disease (NCD) prevention and control, particularly in theprevalence of raised blood pressure and access to improved sanitation.
A few SDG 3 indicators are far from the targets
• Compared to other countries in the Region for SDG 3 indicators Vanuatu is farfrom the targets in reproductive, maternal, newborn and child health (RMNCH).Immunization coverage and family planning rates are among the lowest in theRegion; whereas, the adolescent birth rate is one of the highest.
•
Major gaps exist in child health and in health system resources and capacity.Vanuatu has a relatively low density of skilled health professionals, compared toother countries in the Region.
• Moderate inequities in skilled birth attendance and child immunization havebeen identified.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
56Vanuatu
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
N/AVanuatu
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
1 tracer indicator > 80
4 tracer indicators 60–80
6 tracer indicators< 60
Reproductive, maternal, newborn and child health0 2 2
Infectious diseases0 1 2
Noncommunicable diseases1 1 1
Service capacity and access0 0 1
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
7 indicators > 70%
1 indicator40–70%
5 indicators < 40%
Reproductive, maternal, newborn and child health4 0 4
Infectious diseases2 0 0
Noncommunicable diseases1 0 0
Urban and environmental health0 1 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• The health sector development is guided by an overarching National Sustainable Development Plan 2016–2030. Its four health policy objectives are: 1) ensure that the population of Vanuatu has equitable access to affordable, quality health care through the fair distribution of facilities that are suitably resourced and equipped; 2) reduce the incidence of communicable and noncommunicable diseases; 3) promote healthy lifestyle choices and health-seeking behaviour to improve population health and well-being; and 4) build health sector management capacity and systems to ensure the effective and efficient delivery of quality services that are aligned with national directives.
Vanuatu2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) Noncommunicable diseases (NCDs); and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pacific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Vanuatu?
0%10%20%30%40%50%60%70%80%90%
100%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
NO DATA
How does Vanuatu compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
Legend: AUS = Australia, BRN = Brunei Darussalam, KHM = Cambodia, CHN = China, COK = Cook Islands, FJI = Fiji, JPN = Japan, KIR = Kiribati, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MHL = Marshall Islands, FSM = Micronesia, (Federated States of), MNG = Mongolia, NRU = Nauru, NZL = New Zealand, NIU = Niue, PLW = Palau, PNG = Papua New Guinea, PHL = Philippines, KOR = Republic of Korea, WSM = Samoa, SGP = Singapore, SLB = Solomon Islands, TON = Tonga, TUV = Tuvalu, VUT = Vanuatu, VNM = Viet Nam
* OOPS: out-of-pocket expenditure per capita in US$, 2013; GDP: gross domestic product in current US$ per capita, 2013. This indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2). The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201559 59
Antenatal care, 4+ visits (%), 2010
52 52Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
64 64Care-seeking behaviour for child pneumonia (%), 2013
72 72
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
71 71HIV antiretroviral treatment (%), 2015
41c 41Access to improved sanitation (%), 2015
54 54
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201576 52
Mean fasting plasma glucose (mmol/L), 20085.4 86
Tobacco non-use (%), 201581 61
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201518.6c Reference point: 18a
Health worker density (per 10 000 population), 2012–20142.1b Reference point: 10.5a
International Health Regulations compliance (%), 201543 43
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 0.2 physicians per 1000 pop (2012); 0.4 psychiatrists per 100 000 pop (2014); 1.9 surgeons per 100 000 pop (2014)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health61
Infectious diseases54
Noncommunicable diseases65
Service capacity and access46
AUS
BRN
KHM
CHN
COK FJI JPNKIR
LAO MYS
MHL
FSMMNG
NZL
NIU
PLW
PNG
PHL KOR
WSMSLB
40 NRU 60 TUV
VNM
0%
1%
2%
3%
4%
5%
6%
20 80 100
Prox
y mea
sure
for �
nanc
ial
prot
ectio
n (OO
PS/G
DP
per c
apita
, %
)*
UHC index – coverage of essential health services (SDG 3.8.1)
TON
SGP
VUT
Vanuatu 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Vanuatu has a value of 26%, meaning it has performed at 26% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Vanuatu from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 78.0 94%d
Proportion of births attended by skilled health personnel (%)¹³ 2013
3.1.2 89.0% 82%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 27.6 93%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 11.8 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 64.0% 20%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2013
3.7.1 50.7% 23%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013 3.7.2 78.0 26%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 64.0% 5%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷
3.3.1TB incidence (per 100 000 population)¹⁴ 2016
3.3.2 56.0 91%e
Malaria incidence (per 1000 population at risk)¹⁴ 20153.3.3 3.3 97%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 22.3% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 5.8 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 1.3 100%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰
3.a.1Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰
3.a.1
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 16.6 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²²
3.9.1Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000population)²³
3.9.2Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 0.9 62%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 22.25Skilled health professionals density (per 10 000 population)²⁵ 2012
3.c.1 24.0 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 43.0 2%e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Vanuatu being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)55% 90% 39% 72% 87% 18%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
48% 73% 34% 64% 74% 14%
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: MICS, 2007
Vanuatu4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Given the limited number of countries for which SDG indicator 3.8.2 on financial risk protection is available, an alternative proxy measure was used in some analyses to be able to assess financial hardship in a greater number of countries. The proposed measure was out-of-pocket health expenditure per capita as a percentage of GDP per capita. This measure showed a moderate correlation with SDG indicator 3.8.2. In addition, this proxy indicator does not necessarily measure financial risk protection and is not a replacement for the UHC financial risk protection indicator (3.8.2).
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Vanuatuthe tool used the Multiple Indicator Cluster Survey (MICS) conducted in 2007.
Technical notes and sources
WPR/2018/DHS/026 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
Viet Nam 1
UHC and SDG Country Profile 2018Viet Nam
Obje
ctiv
es
Monitoring progress in the Sustainable Development Goals (SDGs) and universal health coverage (UHC) is a priority in the Western Pacific Region. This country profile aims to assist the country-led SDG and UHC monitoring process. Specifically, it will explore the current SDG/UHC situation, guide and direct discussion on possible areas (and population groups) where performance may be low, and foster policy dialogues.
Coun
try s
tati
stic
s
Population¹ 201694.6 million GDP per capita (current US$)² 20162185.69 Income level² 2017Upper middle incomeIncome Gini coefficient³ 201335.60 (equality) – 100 (inequality)
Heal
th sy
stem
Total health expenditure as % of GDP⁴ 20147.1%Total health expenditure per capita (current US$)⁴ 2014142.37General government health expenditure as % of total health expenditure⁴ 201454.1%Life expectancy at birth (in years)⁵ 201576.0
Key Messages
Overall progress towards universal health coverage (UHC) • The Plan for people’s health protection, care, and promotion in the period 2016-2020 has an
overall objective to reduce morbidity and mortality rates caused by diseases and epidemics; contribute to improving people’s life expectancy and core health indicators; to enhance capacity and performance of the health system; to create a solid foundation for the development of an equitable; effective, quality and sustainable health system; meeting people’s health care needs in the course of industrialization and modernization.
• Based on 2008 survey data, more than 4.5 million people (5% of the population)incurred high out-of-pocket health payments, which suggests gaps in financialprotection for health; the wealthiest quintiles seem to be affected more bycatastrophic expenditures.
• Based on the UHC index, challenges remain in the prevention and control ofinfectious diseases and noncommunicable diseases (NCDs), specifically in HIVantiretroviral treatment and the prevalence of raised blood pressure.
Several SDG 3 indicators are close to the target• Compared to other countries in the Region for SDG 3 indicators, Viet Nam shows
relatively advanced progress in reproductive, maternal, newborn and child health(RMNCH), except in family planning and the adolescent birth rate.
• Gaps exist in NCD prevention and control and in urban and environmental health.Viet Nam has a high rate of male smoking, per capita alcohol consumption, andmortality attributed to household and ambient air pollution, compared to othercountries in the Region.
• Based on the reported indicators, relatively moderate inequities across residenceand wealth quintiles have been identified for skilled birth attendance.
UHC Overall ProgressUHC index6 – coverage of essential health services (SDG 3.8.1)0–100 scale (Target: 100)
73Viet Nam
40Region (lowest)
≥ 80Region (highest)
Financial risk protection:7 proportion of population with out-of-pocket health spending exceeding 25% of household’s budget or income (SDG 3.8.2)
5.0%Viet Nam
0.0%Region (lowest)
5.0%Region (highest)
Performance scorecard of 13 UHC index – coverage of essential health services indicators, in relation to a target of 100%
4 tracer indicators > 80
4 tracer indicators 60–80
3 tracer indicators < 60
Reproductive, maternal, newborn and child health2 2 0
Infectious diseases0 2 1
Noncommunicable diseases1 0 2
Service capacity and access1 0 0
Note: Refer to page 2
SDG Overall Progress
Performance scorecard of 23 SDG health indicators, in relation to a target of 100% (as relative proximity to SDG targets)
10 indicators > 70%
5 indicators 40–70%
3 indicators < 40%
Reproductive, maternal, newborn and child health6 2 0
Infectious diseases2 1 0
Noncommunicable diseases1 0 2
Urban and environmental health1 2 0
Health system resources and capacity1 0 0
Note: Refer to page 3
• Compared to other countries in the Western Pacific Region, Viet Nam hasadvanced service capacity and access, and high coverage of essential services.
Viet Nam2
Universal Health CoverageUHC, which is a specific target under SDG 3, is the platform that brings health and development efforts together. UHC ensures that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship. It is measured by a country’s health service coverage and financial protection.
Health service coverage is measured by the UHC index that is a summary measure that combines 16 tracer categories. It has four main categories, namely: (1) RMNCH; (2) infectious diseases; (3) NCDs; and (4) service capacity and access.
How is country performance on UHC indicators assessed?
Country performance on UHC was assessed based on the distribution of indicator values across Western Pacific Region countries. The overall UHC index coverage of essential health services available for 27 Western Pacific Region countries was used to determine the threshold values. The main threshold was set at the mean (close to 60 points). The other thresholds were set at equal intervals to 20 points (mean value minus lowest value).
The UHC performance scorecard colour code for the Western Pa-cific Region:
What does financial protection measure?
Financial protection (SDG 3.8.2)7 measures direct health payments families incur, typically in the last month, in relation to a household’s budget or income. In general, a higher value means increased financial hardship. The indicator summarizes the percentage of the population in a country for which health spending exceeds 25% of their household’s budget.
How does financial risk protection vary across population groups in Viet Nam? Financial risk protection by place of residence and economic status
2.3%3.2%
5.4%6.6%
7.5%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
Rural Urban Poorest20% (q1)
Secondpoorest
20% (q2)
Middle20% (q3)
Secondrichest
20% (q4)
Richest20% (q5)
2008
How does Viet Nam compare to other countries in the Region? Relationship between UHC coverage of essential health services and financial risk protection in Western Pacific Region countries
AUS
KHM CHN
FJI
JPN
LAOMYS
MNGPHL
KOR
VNM
0%
1%
2%
3%
4%
5%
6%
20 40 60 80 100
Fina
ncia
l ris
k pr
otec
tion
(SD
G 3
.8.2
)*
UHC index – coverage of essential health services (SDG 3.8.1)
Legend: AUS = Australia, KHM = Cambodia, CHN = China, FJI = Fiji, JPN = Japan, KOR = Republic of Korea, LAO = Lao People’s Democratic Republic, MYS = Malaysia, MNG = Mongolia, PHL = Philippines, VNM = Viet Nam
*Proportion of population with out-of-pocket health spending exceeding 25% of total household consumption or income, 2008. The 2% threshold is not a target. It was arbitrarily selected to map countries in a way that allows cross-country comparison and a baseline position for future trend analysis.
What tracer indicators are included in the UHC index6–coverage of essential health services?
Tracer category
Indicator value
Indicator rescaled score, when applicable. Target: 100%
Repr
oduc
tive,
mat
erna
l, ne
wbo
rn
and
child
hea
lth8
Family planning demand satisfied with modern methods (%), 201577 77
Antenatal care, 4+ visits (%), 2012
74 74Child immunization 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine (%), 2015
97 97Care-seeking behaviour for child pneumonia (%), 2014
81 81
Infe
ctio
us d
iseas
es9 Tuberculosis (TB) detection and treatment (%), 2015
72 72HIV antiretroviral treatment (%), 2015
43 43Access to improved sanitation (%), 2015
78 78
Nonc
omm
unica
ble
dise
ases
10
Prevalence of non-raised blood pressure (%), 201577 53
Mean fasting plasma glucose (mmol/L), 20154.7 100
Tobacco non-use (%), 201576 53
Serv
ice ca
pacit
y and
ac
cess
11
Hospital beds per 10 000 population, 201425.6 Reference point: 18a
Health worker density (per 10 000 population), 2013–201512.2b Reference point: 10.5a
International Health Regulations compliance (%), 201599 99
a Minimum rates observed in countries of the Organisation for Economic Co-operation and Development (OECD)
b 1.2 physicians per 1000 pop (2013); 0.9 psychiatrists per 100 000 pop (2014); 3.3 surgeons per 100 000 pop (2015)
c No estimate; regional or imputed value used as placeholder
Quadrant Interpretation
North-westLimited coverage of essential health services, and relatively high risk of financial hardship
South-westLimited coverage of essential health services, and relatively low risk of financial hardship; although this may indicate limited access to health services
North-eastRelatively high coverage of essential health services, and relatively high risk of financial hardship
South-eastRelatively high coverage of essential health services, and relatively low risk of financial hardship
> 80%Average of 27 Western
Pacific Region countries
60–80%Average of 27 Western
Pacific Region countries
< 60%Average of 27 Western
Pacific Region countries
Reproductive, maternal, newborn and child health82
Infectious diseases62
Noncommunicable diseases65
Service capacity and access84
Viet Nam 3
Sustainable Development GoalsWorld leaders committed to achieve the 17 Sustainable Development Goals (SDGs) by 2030 in an effort to end poverty, protect the planet and ensure prosperity for all. SDG 3 covers the unfinished Millennium Development Goal (MDG) agenda and newer challenges such as noncommunicable diseases (NCDs), health security, tobacco and injuries.
How is country performance on the SDG indicators assessed?
There are two values displayed in each country profile: the indicator value and the rescaled value. The first corresponds to the actual value for a country at the baseline year, whereas the rescaled value shows the relative position of a country with respect to other countries in the Western Pacific Region.
The rescaled value measures the relative proximity to a target, i.e. explicit SDG targets or a best-performing country. Specific SDG targets (indicators shaded in grey) were used for the maternal mortality rate (70 per 100 000 live births), the neonatal mortality rate (12 per 1000 live births) and the under-5 mortality rate (25 per 1000 live births). A value of 100% means the indicator value is at the exact target value. The closer to the target the indicator value is, the higher the percentage.
The rescaled data should be interpreted in the following way: using the adolescent birth rate as an example, Viet Nam has a value of 67%, meaning it has performed at 67% of the best-performing country.
For all SDG indicators, rescaled values range from 0 to 100, therefore three equal bands have been used.
The SDG performance scorecard colour code for the Western Pacific Region:
> 70%Proximity from the target
40–70%Proximity from the target
< 40%Proximity from the target
How far is Viet Nam from the SDG targets?
SDG Indicator value
Indicator rescaled score to 0–100%Target: 100%
Reproductive, maternal, newborn and child health
Maternal mortality ratio (per 100 000 live births)¹² 2015
3.1.1 54.0 100%d
Proportion of births attended by skilled health personnel (%)¹³ 2014 3.1.2 94.0% 90%e
Under-5 mortality rate (per 1000 live births)¹⁴ 2016 3.2.1 21.6 100%d
Neonatal mortality rate (per 1000 live births)¹⁴ 2016 3.2.2 11.5 100%d
Infants receiving three doses of hepatitis B vaccine (%) (proxy)14 2016 3.3.4 96.0% 91%e
Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods¹⁵ 2013
3.7.1 69.7% 53%e
Adolescent birth rate (per 1000 women aged 15–19 years)¹⁶ 2013 3.7.2 36.0 67%e
Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)¹⁴ 2016
3.b.1 96.0% 89%e
Infectious diseasesNew HIV infections among adults 15–49 years old (per 1000 uninfected population)¹⁷ 2015
3.3.1 0.3 51%e
TB incidence (per 100 000 population)¹⁴ 2016 3.3.2 133.0 77%e
Malaria incidence (per 1000 population at risk)¹⁴ 2015
3.3.3 0.3 100%e
Noncommunicable diseases
Probability of dying from any of cardiovascular disease (CVD), cancer, diabetes, chronic repiratory disease (CRD) between age 30 and exact age 70 (%)¹⁸ 2015
3.4.1 17.3% Regional Average: 17.1Suicide mortality rate (per 100 000 population)¹⁴ 2015
3.4.2 7.4 Regional Average: 10.8
Total alcohol per capita (≥ 15 years of age) consumption (in litres of pure alcohol), projected estimates¹⁹ 2016
3.5.2 8.6 31%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Female²⁰ 2015
3.a.1 1.3% 100%e
Age-standardized prevalence of tobacco smoking among persons 15 years and older (%) – Male²⁰ 2015
3.a.1 47.1% 36%e
Urban and environmental health
Road traffic mortality rate (per 100 000 population)²¹ 20133.6.1 24.5 Regional Average: 17.3
Mortality rate attributed to household and ambient air pollution (per 100 000 population)²² 2012
3.9.1 83.2 48%e
Mortality rate attributed to exposure to unsafe water, sanitation and hygiene (WASH) services (per 100 000 population)²³ 2012
3.9.2 2.0 86%e
Mortality rate attributed to unintentional poisoning (per 100 000 population)¹⁸ 2015
3.9.3 1 57%e
Health system resources and capacity
Total net official development assistance to medical research and basic health per capita (constant 2014 US$), by recipient country²⁴ 2014
3.b.2 1.05Skilled health professionals density (per 10 000 population)²⁵ 2013
3.c.1 24.1 Regional Average: 42.0
Average of 13 International Health Regulations (2005) core capacity scores¹⁴ 2016
3.d.1 99.0 98% e
d Rescaled based on existing SDG targets. e Rescaled based on targets identified in the Region.
Are population groups in Viet Nam being left behind?²⁶
Poorest20%
Richest20% Diff Rural Urban Diff
SDG 3.1.2 Proportion of births attended by skilled health personnel (%)73% 100% 27% 92% 99% 7%
SDG 3.2.1 Under-5 mortality rate (per 1000 live births)
SDG 3.2.2 Neonatal mortality rate (per 1000 live births)
SDG 3.7.1 Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods
SDG 3.7.2 Adolescent birth rate (per 1000 women aged 15–19 years)
SDG 3.b.1 Diphtheria, tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)
83% 92% 9% 89% 89% 1%
Minor inequalities (< 10%)
Moderate inequalities (10–50%)
Major inequalities (> 50%)Source: MICS, 2013
Viet Nam4
1 World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2017.2 World Development Indicators. Washington (DC): World Bank (http://wdi.worldbank.org, accessed 26 September 2017).3 World Development Indicators 2013. Washington (DC): World Bank (http://data.worldbank.org, accessed October 2013).4 Global health expenditure database [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database/Select/Indicators/en, accessed 26
September 2017). 5 WHO life expectancy (http://www.who.int/gho/mortality_burden_disease/life_tables/en/).6 SDG indicator 3.8.1 and its components have been computed by WHO using publically available data, including existing WHO/UN agency estimates, country data
reported to WHO, and published results from household surveys available in UHC Data Portal (http://apps.who.int/gho/cabinet/uhc.jsp) and in the 2017 Global Monitoring Report on Tracking Universal Health Coverage (http://www.who.int/healthinfo/universal_health_coverage/report/2017_global_monitoring_report.pdf?ua=1).
7 Estimates of indicator SDG 3.8.2 are based on primary household survey data obtained from government statistical agencies directly or indirectly by the World Health Organization or the World Bank. The survey used in Viet Nam was the Vietnam Household Living Standard Survey (VHLSS), General Statistics Office of Vietnam from 2008.
8 Reproductive maternal, newborn and child health measures the extent to which those in need for family planning, pregnancy and delivery care, child immunization and treatment receive the care they need.
9 Infectious diseases measures: (i) the extent to which those in need for TB and HIV treatment and malaria prevention receive the care and services they need; and (ii) access to improved sanitation.
10 Noncommunicable diseases measures the current status of NCD risk factors in the population, including blood pressure, glucose level and tobacco consumption, as a proxy indicator of success of both prevention efforts and screening and treatment programmes.
11 Service capacity and access measures general features of service capacity and access to care within a health system. Measures include hospital beds and health professionals per capita, and a measure of health security for responding to epidemics and other health threats.
12 WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/, accessed 17 March 2017). WHO Member States with a population of less than 100 000 in 2015 were not included in the analysis.
13 WHO/UNICEF joint global database 2017 (http://www.who.int/gho/maternal_health/en/ and https://data.unicef.org/topic/maternal-health/delivery-care). The data are extracted from public available sources and have not undergone country consultation. WHO regional and global figures are for the period 2010–2016.
14 World health statistics [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/en/, accessed 3 November 2017).
15 World contraceptive use 2016 [online database]. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016. Regional aggregates are estimates for the year 2016. Model-based estimates and projections of family planning indicators 2016. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2016 (http://www.un.org/en/development/desa/population/theme/family-planning/cp_model.shtml).
16 World fertility data 2015. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://www.un.org/en/development/desa/population/publications/dataset/fertility/wfd2015.shtml). Regional aggregates are the average of two five-year periods, 2010–2015 and 2015–2020, taken from: World population prospects: the 2015 revision, DVD edition. New York (NY): United Nations, Department of Economic and Social Affairs, Population Division; 2015 (http://esa.un.org/unpd/wpp/Download/Standard/Fertility/, accessed 13 April 2016).
17 UNAIDS/WHO estimates; 2016 (http://www.who.int/gho/hiv/epidemic_status/incidence/en/).18 Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: World Health Organization; 2015 (http://www.who.int/
healthinfo/global_burden_disease/estimates/en/index1).19 WHO global information system on alcohol and health [online database]. Geneva: World Health Organization; 2017 (http://apps.who.int/gho/data/node.main.
GISAH?showonly=GISAH).20 WHO global report on trends in prevalence of tobacco smoking 2015. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/
bitstream/10665/156262/1/9789241564922_eng.pdf, accessed 22 March 2017).21 Global status report on road safety 2015. Geneva: World Health Organization; 2015 (http://www.who.int/violence_injury_prevention/road_safety_status/2015/en/,
accessed 22 March 2017). WHO Member States with a population of less than 90 000 in 2015 who did not participate in the survey for the report were not included in the analysis.
22 Public health and environment [online database]. Global Health Observatory (GHO) data. Geneva: World Health Organization (http://www.who.int/gho/phe/en/). WHO Member States with a population of less than 250 000 population in 2012 were not included in the analysis.
23 Preventing disease through healthy environments. A global assessment of the burden of disease from environmental risks. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed 23 March 2017); and Preventing diarrhoea through better water, sanitation and hygiene. Exposures and impacts in low- and middle-income countries. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf?ua=1&ua=1, accessed 23 March 2017). WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
24 United Nations SDG indicators global database (https://unstats.un.org/sdgs/indicators/database/?indicator=3.b.2, accessed 6 April 2017). Based on the Creditor Reporting System database of the Organisation for Economic Co-operation and Development, 2016.
25 Skilled health professionals refer to the latest available values (2005–2015) in the WHO Global Health Workforce Statistics database (http://who.int/hrh/statistics/hwfstats/en/) aggregated across physicians and nurses/midwives. Refer to the source for the latest values, disaggregation and metadata descriptors.
26 Disaggregated data for SDG indicators on page 3 come from the WHO Health Equity Assessment Toolkit (HEAT), software for exploring and comparing health inequalities in countries.The tool includes reproductive, maternal, newborn and child health indicators, disaggregated by five dimensions of inequality, including economic status, education, place of residence, subnational region and sex (where applicable). For Viet Nam, the tool used the Multiple Indicator Cluster Survey (MICS) conducted in 2013.
Technical notes and sources
WPR/2018/DHS/027 © World Health Organization 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
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