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Asia-Pacific MDG Report 2010/11

The Economic and Social Commission for Asia and the Pacific (ESCAP) promotes regional cooperation

for inclusive and sustainable economic and social development in Asia and the Pacific, a dynamic region

characterized by growing wealth, diversity and change, but also challenged with persistent poverty,

environmental degradation, inequality and insecurity. ESCAP supports member States with sound strategic

analysis, policy options and technical cooperation activities to address key development challenges and

to implement innovative solutions for region-wide economic prosperity, social progress and environmental

sustainability. ESCAP, through its conference structure, assists member States in forging a stronger,

coordinated regional voice on global issues by building capacities to dialogue, negotiate and shape

development agenda in an age of globalization, decentralization and problems that transcend borders.

A key modality for this strategy is the promotion of intraregional connectivity and regional integration.

ADB’s vision is an Asia and Pacific region free of poverty. Its mission is to help its developing member

countries substantially reduce poverty and improve the quality of life of their people. Despite the region’s

many successes, it remains home to two-thirds of the world’s poor: 1.8 billion people who live on less than

$2 a day, with 947 million struggling on less than $1.25 a day. ADB is committed to reducing poverty

through inclusive economic growth, environmentally sustainable growth, and regional integration. Based

in Manila, ADB is owned by 67 members, including 48 from the region. Its main instruments for helping

its developing member countries are policy dialogue, loans, equity investments, guarantees, grants, and

technical assistance.

UNDP is the UN’s global development network, an organization advocating for change and connecting

countries to knowledge, experience and resources to help people build a better life. UNDP is on the ground

in 166 counties, working with them on their own solutions to global and national development challenges.

UNDP’s network links and coordinates global and national efforts to achieve the Millennium Development

Goals, including the overarching goal of cutting poverty in half by 2015. UNDP helps developing countries

in building national capacities and sharing solutions to the challenges of: Democratic Governance,

Poverty Reduction, Crisis Prevention and Recovery, Environment and Energy, and HIV/AIDS. UNDP also

helps developing countries attract and use aid effectively.

Cover photographs: Courtesy of UN ESCAP and Kibae Park

Asia-Pacific MDG Report 2010/11

Paths to 2015MDG Priorities in Asia and the Pacific

Contents

Foreword vii

Acknowledgements viii

Abbreviations ix

OVERVIEW Paths to 2015 1 SevendriversforachievingtheMDGs 1 Reducinghungerandbuildingfoodsecurity 2 Improvinghealthandotherbasicservices 2 Priorities in health 3 Strengtheningbasicinfrastructure 3 Tiltingthebalance 3

CHAPTER I

MDGs in Asia and the Pacific – where we stand 4 Thescaleof deprivation 7 Impactof theglobaleconomiccrisis 8 Endnotes 8

CHAPTER II

Seven drivers for achieving the MDGs 9 Strengtheninggrowthbystimulatingdomesticdemandandintra-regionaltrade 9 Makingeconomicgrowthmoreinclusiveandsustainable 10 Strengtheningsocialprotection 10 Reducingpersistentgendergaps 11 Ensuringfinancialinclusion 12 Supportingleastdevelopedandstructurallydisadvantagedcountries 12 Exploitingthepotentialof regionaleconomicintegration 13 Towards2015 14 Endnotes 14

CHAPTER III

Reducing hunger and building food security 15 Creatingjobsandincreasingincomes 16 Boostingagriculturalproduction 17 Maintainingstableandreasonablefoodprices 18 Providingsafetynetsforthepoor 19 Implementingfeedingprogrammes 20 Releasedfromhunger 21 Endnotes 21

CHAPTER IV

Improving health and other basic services 22 Investingmoreinbasicservices 22 Improvinggovernance 23 Ensuringsocialinclusionandequalaccesstosocialservices 25 Diversifyingtherangeof serviceproviders 25 Prioritiesinhealth 26 Increasing public health expenditure and staffing levels 28 Achieving universal health care 29 Aneweraforpublicservices 31 Endnotes 31

CHAPTER V

Strengthening basic infrastructure 32 Mobilizingfinanceforbasicinfrastructureinvestment 34 Stimulatingtheprivatesector 34 Raisingstandardsof qualityandmaintenance 35 Buildinggreenerinfrastructure 36 Extendingregionalinfrastructure 37 Tiltingthebalance 37 Endnotes 37

STATISTICAl APPEnDIx 38

Comparisonof AsiaandthePacificwithotherdevelopingregions 38 Achievementsin$1.25/daypoverty 38 Achievementsinprimaryenrolment 38 Achievementsinbasicsanitation 41 Numberof peopleaffectedif targetsarereached 42 Impactof theglobaleconomicslowdown 42 SelectedMDGIndicators 46

REFEREnCES 54

FIGuRES

FigureI-1 – Asia-Pacificrankingongenderindicators 7FigureI-2 –Asia-Pacific’sshareof thedevelopingworld’sdeprivedpeople 8FigureII-1–NetODAreceiptsperpersonin2008,US$ 13FigureIII-1–Agriculture’sshareof publicexpenditure,percentage. 18FigureIV-1–Spendingonhealthandeducationasapercentageof GDP 23FigureIV-2–Totalgovernmentrevenueasapercentageof GDP 24FigureIV-3–Maternalmortalityratesandnumberof deaths 28FigureA-1 –AsiaandthePacificcomparedwithSub-SaharanAfricaand LatinAmericaandtheCaribbean 39FigureA-2 –Progressinreducingextremeincomepoverty 40FigureA-3 –Progressinexpandingaccesstoprimaryeducation 41FigureA-4 –Progressinexpandingaccesstobasicsanitation 43

TAblES

TableI-1 – Countrygroupson-trackandoff-trackfortheMDGs 5TableI-2 – Countrieson-trackandoff-trackfortheMDGs 6TableIII-1 – UndernourishmentinAsiaandthePacificandotherglobalregions 15TableIII-2–Underweightchildrenunderfive 16TableIII-3–Progressrequiredforoff trackcountriestomeetthe underweightchildrentarget 17TableIII-4– Netimportersandexportersof food 19TableIV-1 –Netenrolmentratioinprimaryeducation,percentage,2007 22TableIV-2 –Progressrequiredforoff-trackcountriestomeetthe under-5mortalitytarget 27TableIV-3 – Healthpersonnel 29TableV-1 –Positiveimpactsof basicinfrastructureonthepoorandMDGs 33TableV-2 – Infrastructurecomparators,AsiaandRestof theWorld,2005 34TableV-3 – Asia’sInfrastructureInvestmentneeds2010-2020 (US$millions,2008) 35TableV-4 – InfrastructurequalityinAsia,ratedfrom0-7 36TableA-1 – Progressrequiredforoff-trackcountriestomeetthe$1.25/day povertytarget 40TableA-2 – Progressrequiredforoff-trackcountriestomeettheprimary enrolmenttarget 42TableA-3 – Progressrequiredforoff-trackcountriestomeetthebasic sanitationtarget 44TableA-4 – Summaryof estimatedpopulationindeprivation, alternativescenarios,thousands 44TableA5 – Numberof peopleprojectedtobeindeprivationin2015 45TableA-6 – Goal1:Eradicateextremepovertyandhunger 46TableA-7 – Goal2:Achieveuniversalprimaryeducation 47TableA-8 – Goal3:Promotegenderequalityandempowerwomen 48TableA-9 – Goal4:Reducechildmortality 49TableA-10 – Goal5:Improvematernalhealth 50TableA-11 – Goal6:CombatHIVandAIDS,malariaandotherdiseases 51TableA-12 – Goal7:Ensureenvironmentalsustainability 52TableA-13 – Goal7:Ensureenvironmentalsustainability 53

bOxES

BoxIV-1 – Newestimatesonmaternalmortality 28BoxV-1 – EnergyforAll 33

viiMDG PRIORITIES In ASIA AnD THE PACIFIC

Foreword

Impendingdeadlinestendtofocusthemind.Backin2000theyear2015,whichisthetargetdatefortheMillenniumDevelopmentGoals,seemedsomewayoff.Nowtwothirdsof thewaytowardsthefinishingline, it isbeginningto lookuncomfortablyclose.Theyear2010isthereforeanappropriatepointtotake

stock–toassesssomeof thelikelyoutcomesonpresenttrends,identifysomeof theweakestareasof performance,andidentifyprioritiesforaction.

Since2004,anESCAP/ADB/UNDPpartnershiphasregularlyproducedreportscarefullytrackingprogressof theAsiaandPacificregiontowardstheGoals.Theyhavedevelopedaconsistentmonitoringsystemforjudgingwhethercountriesandsubregionsareon-trackoroff-tracktomeettheindicatorsforthe2015Goals–presentingthe results in a seriesof distinctive colour-coded ‘traffic-light’ charts.Eachof the reports has focusedon aparticulartheme,suchasMDGconsistentnationaldevelopmentpoliciesorinstitutionalreformstomakethedevelopmentprocessfairerandmoreinclusive,ortheimpactof thefood,fuelandfinancialcrisesonthelikelyachievementof thegoals.

This2010/11reporttakesaslightlydifferentapproach.Asbefore, itrefreshesthesignalstoreflectthelatestinformationfromtheUnitedNationsMDGdatabasetoassesswhichcountriesandsubregionsarelikelytomissorachievetheGoals.Butratherthanaddressinganewtheme,thismoreconcisereportattemptstoencapsulateandupdatethediscussionsandrecommendationsof theearlierreports.Whilethishasthemeritof brevity,italsoof coursehasthedisadvantageof excludingsomedetaileddiscussion.Readerswhowishtoconsidertheissuesmorecloselyareencouragedtoconsultsomeof thepreviousAsia-PacificMDGreports.

ThereportPaths to 2015emphasisestheinter-relationshipsbetweenMDGsbyidentifyingsomeoverallprioritiesandopportunitiesthatcountriescanconsiderforachievingallthegoals.Thenitfocusesspecificallyonthreeareas:hungerandfoodsecurity;healthandbasicservices–areaswheretheAsia-Pacificregionasawholeappearstobefallingshort;andon improvementof basic infrastructurewhich isoftenneglectedbut iscritical if theregionistoachievetheMDGs.Thereporthasbeenpreparedthroughwideconsultationsintheregionandbasedoninputsreceivedfromstaff of allthethreepartnerorganizations,UNagencies,andcommunitiesof practice.Feedbackhasalsobeenreceivedfromcountryparticipantsatsub-regionalandregionalMDGconferencesheldinJulyandAugust2010.ThisreportisbeingproducedtocoincidewiththeUnitedNationsHigh-levelPlenaryMeetingontheMDGsinSeptember2010inNewYork.TheAsia-Pacificregionishometomorethan60percentof humanity,sowhathappensintheregionwillhaveacriticalbearingonglobalMDGachievement.AsiaandthePacifichasmuchtobeproudof,butneedstoredoubleeffortstoreducepovertyandvulnerabilityaffectinghundredsof millionsof peoplelivingintheregion.Wehopethatthisreportwillcontributetoglobalandregionaldebatesandhelpspurthenecessaryactionthatwillenableustoacceleratetowardsthefinishingline.

noeleen HeyzerUnder-Secretary-Generalof the

UnitedNationsandExecutiveSecretaryof ESCAP

ursula Schaefer-PreussVice-President

AsianDevelopmentBank

Ajay ChhibberUNAssistantSecretary-Generaland

UNDPAssistantAdministratorandDirectorforAsiaandthePacific

viii PATHS TO 2015

Acknowledgements

ThisisthefifthreportthathasbeenpreparedundertheESCAP/ADB/UNDPregionalpartnershiponachievingtheMillenniumDevelopmentGoalsinAsiaandthePacificregion.IthasbeenpreparedasacontributionfromAsiaandthePacificregiontotheUnitedNationsSummitonMDGs2010.

The report has been prepared under the direct supervision and guidance of Dr. Noeleen Heyzer, Under-Secretary-Generalof theUnitedNationsandExecutiveSecretaryof ESCAP,Dr.UrsulaSchaefer-Preuss,Vice-President,AsianDevelopmentBankandDr.AjayChhibber,UNAssistantSecretary-General,UNDPAssistantAdministratorandDirectorforAsiaandthePacific.

ESCAP/ADB/UNDPteam,whichcoordinatedandpreparedthereport,consistedof followingmembers: ESCAP:NageshKumar,SyedNuruzzaman,JanSmit,YanhongZhangandHarumiShibata ADB:ShiladityaChatterjeeandGuanghuaWan UNDP:NicholasRosellini,ThangavelPalanivelandTaimurKhilji

The report team met periodically to review the draft chapters and engaged in wider consultations with themembersof theUNDGandUNRegionalCoordinationMechanismbasedinBangkok.

The report team thanks the following for their support and technical inputs: Jiwan Acharya, Ian Anderson,DipaBagai,ArminBauer,RadhikaBehuria,InduBhushan,ThomasBeloe,CarolineBorchard,AlainBorghijs,BakhodirBurkhanov,RyceChanchai,BiploveChoudhary,DomingoCarolaDonner-Reichle,GerardDaly,TyrrellDuncan, Haishan Fu, Jessica Gardner, Fadzai Gwaradzimba, Cherie Hart, Imrana Jalal, Shanti Jagannathan,Jacques Jeugmans,Kaushal Joshi,HiroyukiKonuma,HenrikLarsen, IosefaMaiava,RomanaMaryMargaret,SarammaMathai,RoohiMetcalfe,KhajaMoinnuddin,K.A.MMorshed,AmitavaMukherjee,B.Murali,TariqNiazi,NubokoHoribe,ChellamPalanyandy,MaheshPatel,TamPham,MoniPizani,MudbharyPurushottam,Anuradha Rajivan, Michael Sheinkman, Hiren Sarkar, Jouko Sarvi, Nashida Sattar, Sharad Saxena, WolfgangSchiefer, Michael Sheinkman, Kah Sin, David Smith, Sahba Sobhani, Alexandra Solovieva, Pauline Tamesis,SonomiTanaka,NeschaTeckle,AnilTerway,MyoThant,GuyThijs,HansTroedsson,SachikoYamamotoandYumikoYamamoto.

Theteam’sappreciationgoestotheUNAsiaPacificMDGsCommunitiesof PracticeandADBCommunitiesof PracticeonEducation,Energy,Environment,Gender,GovernanceandPublicManagement,Health,TransportandWaterwhomadesubstantivecontributionsforthepreparationof thisreport.

ThereportwaseditedbyPeterStalker.ItwasdesignedbySusannahDixionandNiphonPenplugsakul.MinyanBaoandWannapornSridamaprovidedalladministrativesupport.

ixMDG PRIORITIES In ASIA AnD THE PACIFIC

Abbreviations

ADB AsianDevelopmentBankADBI AsianDevelopmentBankInstituteAIDS acquiredimmunodeficiencysyndromeASEAN Associationof South-EastAsianNationsASEAN+3 ASEAN+China,JapanandtheRepublicof KoreaBIMSTEC Bayof BengalInitiativeforMulti-SectoralTechnicalandEconomicCooperationCIS Commonwealthof IndependentStatesCMI ChiangMaiInitiativeCO2 CarbondioxideDAC DevelopmentAssistanceCommitteeof theOECDEAS EastAsiaSummitESCAP EconomicandSocialCommissionforAsiaandthePacificFAO FoodandAgricultureOrganizationFDI foreigndirectinvestmentFTA freetradeagreementGDP grossdomesticproductHIV humanimmunodeficiencyvirusID identityILO InternationalLabourOrganizationIMF InternationalMonetaryFundLAC LatinAmericaandtheCaribbeanLDCs leastdevelopedcountriesLLDCs landlockeddevelopingcountriesMDB multilateraldevelopmentbankMDGs MillenniumDevelopmentGoalsNGO non-governmentalorganizationODA officialdevelopmentassistanceOECD OrganisationforEconomicCooperationandDevelopmentPPP purchasingpowerparitySAARC SouthAsianAssociationforRegionalCooperationSIDS SmallislanddevelopingstatesSPC Secretariatof thePacificCommunityTB TuberculosisUNDP UnitedNationsDevelopmentProgrammeUNESCO UnitedNationsEducational,ScientificandCulturalOrganizationUNFPA UnitedNationsPopulationFundUNICEF UnitedNationsChildren’sFundUNIFEM UnitedNationsDevelopmentFundforWomenVAT valueaddedtaxWDI WorldDevelopmentIndicatorsWFP WorldFoodProgrammeWHO WorldHealthOrganizationWTO WorldTradeOrganization

1MDG PRIORITIES In ASIA AnD THE PACIFIC

OVERVIEW

Oneof thegreatestMDGsuccessesinAsiaandthe Pacific has been on poverty reduction.Between1990and2008,thecountriesof the

region reduced the number of people living on lessthan$1.25adayfrom1.5billionto947million,andtheregionisontrackforthepovertygoal.Moreover,forsomeotherindicatorstheAsia-Pacificregionasawholehasalreadyachievedthetargets–forreducinggenderdisparitiesinprimary,secondaryandtertiaryeducationenrolment,forexample,forpreventingarise inHIVprevalence,forstoppingthespreadof tuberculosis,forreducingconsumptionof ozone-depletingsubstances,and for halving the proportion of people withoutaccesstosafedrinkingwater.

Ontheotherhand,theregionisstilllagginginsomemajor areas. It has been slow in reducing the extentof hunger, in ensuring that girls and boys reach thelast grade of primary education, in reducing childmortality,inimprovingmaternalhealthprovisionandinprovidingbasicsanitation.

Seven drivers for achieving the MDGs

EachcountryfocusingontheMDGshastoaddressitsownspecificneedsandopportunities.Andeachof thesocial sectors relevant for theMDGs, suchashealthand education, also has its own specific issues. Butacrosstheregionandacrosssectorsthereareanumberof common concerns and priorities. This reportsingles out seven overall opportunities to strengthentheenvironmentforachievingtheMDGs.

Strengthening growth by stimulating domestic demand and intra-regional trade – Given the importance of economic growth in MDG achievement, countries

affected by the crisis need to recover quickly andexpand theireconomies.But inanerawhenwesternmarkets are likely to import fewer goods, countriesintheregionwillalsoneedtorebalancetheirgrowth,basingitmoreondomesticconsumptionandgreaterlevelsof intra-regionaltrade.SuchchangewouldalsopresentanopportunityforacceleratingMDGprogresswhichdependongreaterspendingonsocial servicesandbasicinfrastructure.Making economic growth more inclusive and sustainable–Economicgrowthalsoneedstobeinclusive–derivedmore from economic activities such as agriculturethat benefit the poor, and especially women. Thefruitsof growthalsoneedtobebetterallocatedsoastocontributetoachievingtheMDGtargets.Governmentswillwanttosettheirsightson‘greengrowth’thatcandecoupleeconomicdevelopmentfromenvironmentalpressures.

Strengthening social protection – Countries will bebetter placed to achieve the MDGs if they offer aminimumsocialfloorthataddressesextremepovertyand hunger and income insecurity. A comprehensivesocial protection programme will help minimize therisks and vulnerability from economic crises andnaturalcalamities.Itwillalsoactasa‘circuitbreaker’for vicious inter-generational cycles of poverty andhungeraswellasreducingwideningdisparitiesbetweentherichandpoor.Thisshouldinvolveatargetedandgender-responsiveoutreachtotheinformalsector.

Reducing persistent gender gaps–Greaterinvestmentsin women and girls have multiplier effects across alltheGoals.Collection and analysis of gender-specificdata should be followed by the legislative and otherchanges needed to ensure that women have greater

Paths to 2015

The Asia-Pacific region has made striking progress towards achieving the Millennium Development Goals. Nevertheless, on present trends many countries are likely to miss a number of the targets. This report focuses on opportunities for making more rapid progress – identifying some of the most promising paths to 2015.

2 PATHS TO 2015

OVERVIEW: Paths to 2015

control and ownership over assets, have equitableaccesstoemploymentandallpublicservices,andarefullyrepresentedinpublicandpoliticallife.

Ensuring financial inclusion–Mostof thebillionorsopoorpeopleinAsiaandthePacifichavelittleaccessto financial services.Nowadays therearemanymoreopportunitiesforachievinggreaterfinancialinclusionforthem.Governmentscanplaytheirpartbyimprovinginfrastructure and the regulatory environment whileencouraging better service provision by NGOs,community-basedgroupsandtheprivatesector.

Supporting least developed and structurally disadvantaged countries–Whilemostof theresourcesforachievingtheMDGsmustcomefromwithinthecountries,manyof thepoorestcountrieswillcontinuetorelyonoverseasdevelopmentassistanceandSouth-Southcooperation.

Exploiting the potential of regional economic integration –Regionaleconomicintegrationcanmaketheregionmoreresilienttofurthercrisesandbolsterthecapacityof the poorest countries to achieve the MDGs.Agreements on economic integration, for example,couldenablesmallercountriesinparticulartoextendtheirmarketsandreapefficiencygains.Opportunitiesforfruitfulcooperationexistinfinanceandotherareas.

Thereportalsolooksmorecloselyatsomeof thekeyissues for goals on which the region is falling short:reducinghungerandbuildingfoodsecurity,improvingbasic services,andstrengtheningbasic infrastructure.The report highlights the opportunities for buildingfood security, stronger basic services and improvedbasicinfrastructures.

Reducing hunger and building food security

Despite rapid economic growth and falling levelsof poverty, Asia and the Pacific still has widespreadhunger and malnutrition. About one person in sixsuffersfrommalnourishmentandonechildinthreeisunderweight.Toensurethatpoorpeoplehaveaccesstothefoodtheyneedtoleadhealthyandproductivelives,experienceacrosstheregionsuggestsfiveoverallpolicypriorities.

Creating jobs and increasing incomes – The mainresponse should be to ensure that people have thedecent jobs and incomes that will enable them tobuy the food they need. Despite higher economicgrowth,employmentgrowthhasslowedconsiderably.Governmentswillwanttoensurethatgrowthismore

employment intensive while expanding employmentprogrammesforthepoorandvulnerable.

Boosting agricultural production – Over the yearstherehasbeenadeclineinnationalpublicinvestmentin – and international support for – agriculture.Consequently there has been a deceleration in thegrowthof agriculturaloutputandproductivity.Asiangovernments and the international community nowneedthereforetoredirecttheirattentiontoagriculturewhichhasvastunexploitedpotentialforgrowth.

Maintaining stable and reasonable food prices –Foodpricesshouldbewithinrangeof poorconsumers,butitisalsoimportanttohavepricesthatoffersufficientincentivestofarmers.Atthesametimegovernmentsmayneedtoaddressimbalancesinfoodmarketsthatgivegreaterpowertobuyersandretailersthantofoodproducersandconsumers.

Providing safety nets for the poor–Governmentsshouldensure foodsecurity for thepoorwhoareunable toearn their livelihoods, through subsidies,public fooddistributionsystems,orfood-for-workprogrammes.

Implementing feeding programmes – These caninclude school feeding programmes, for example, orprogrammesforpregnantwomen,babies,pre-schoolchildren,ortheelderly,sickorinfirm.

Improving health and other basic services

If the least developed countries are to achieve theMillennium Development Goals they will need tooffer reliablebasic services, especially forhealth andeducation. Most governments have been determinedtoimproveprovisionof servicesbutstillfallshort intermsof coverageandquality,particularlyinruralareas.

Investing more in basic services –Governmentshavebeenallocatingmoreresourcestoeducationthoughasaproportionof GDPbut this is still lower than theglobal average. Expenditure on health, however, hasstagnated.Whilemanygovernmentsmaybeconcernedabout deficits they probably have more fiscal policyspacethantheyrealizetoinvestinbetterservices.

Improving governance–Governmentswillbeconcernedto ensure higher quality of services. At present thequality of services is undermined by a number of issues related to governance. These indicate theneed for effective decentralization, achieving greaterpolicy coherence, reducing corruption, strengtheningregulations, generating better data, increasing


OVERVIEW: Paths to 2015

accountabilityandstakeholderparticipation.

Ensuring social inclusion and equal access to social services –Inprinciple services are available to all, but in practicecertaingroupstendtobeexcludedongenderormanyother characteristics – for example, caste, creed,ethnicity, sexual identity, socio-economic standing,disability, age, HIV status, or geographical location.Exclusion must therefore need to be tackled on abroad front, including through greater communitymobilisation,andinsomecases,affirmativeactionordecriminalization where certain laws could obstructthedeliveryof healthservices.

Diversifying the range of service providers – In thepasttheprincipalprovidershavebeengovernments–particularlyforhealth,education,waterandsanitation.Moreservicesarenowbeingprovidedbycommunityorganizationsandtheprivatesector,butgovernmentsstillneedtoensureaccessforthepoor.

Priorities in health

While governments need to strengthen provisionacross thewhole rangeof public services,manywillneedtopayspecialattentiontothehealthgoals–whereprogress has been particularly slow. Maternal healthneeds special attention as an unacceptable numberof women perish from preventable and treatablecomplications related to pregnancy. Despite thestabilizingof HIVprevalenceintheregion,accesstopreventionandtreatmentservicesstillfallswellbelowuniversal targets. This will require increasing publichealthexpenditure,whileseekingnewhealthinsurancemodelsandincreasingthenumberof primaryhealthcareworkers. In addition,health servicedelivery canbe improvedby involving communitygroupsof keyaffectedpopulations.

Strengthening basic infrastructure

TheMDGframeworkhasfewspecificgoals,targetsorindicatorsforinfrastructure–thusthefocushasbeenon development outcomes while less attention hasbeenpaidtosomeof thebasicconditionsforachievingthem. Asia and the Pacific region needs strongerbasic infrastructure,particularlyroadtransport,watersupplies,sanitation,electricity,informationtechnology,telecommunications and urban low-income housing.Amongtheprioritiesforimprovinginfrastructureare:

Mobilizing finance – For the period 2010-2020 therequiredinfrastructureinvestmentwouldbe$7.7trillionorabout$700billionperannum.Forthispurpose,somecountriesmaybeabletoaccesscapitalmarketsandtap

intoregionalsavings,thoughpoorercountrieswillhavetorelymoreonmultilateraldevelopmentinstitutions.

Stimulating the private investment –Overthepasttwodecades,morethan70percentof Asia’sinvestmentininfrastructurehasbeenmadebythepublicsector.Nowmorespendingwillneedtocomefromprivatesources.Governmentscould,forexample,offerfiscalincentiveswhile multilateral development institutions can helpguidenegotiationsforpublic-privatepartnerships.

Raising standards of quality and maintenance –Except for railways, Asia also lags in the quality of infrastructure, much of which suffers from a lackof commitment to repairs and maintenance. And ina region prone to disasters another important factoris the planning and implementation of measures forrisk reduction. Many of the problems are related togovernance, including corruption. Governments canincrease transparency by using competitive biddingrules, for example, and automated e-billing systems.They will also need to improve qualification andcertificationintheconstructionindustryandenforceregulations more strictly. But one of the best waysof improvingqualityandaccountability is toactivelyinvolve local communities, and particularly women,whocannotonlycontributeinputsbutalsofeelgreaterownershipandbecommittedtomaintenance.

Building greener infrastructure – More attentionmust be given to infrastructure that maximizesequitable socio-economic benefits, while minimizingenvironmental impactsandtheuseof resources.Forexample,wellplannedandintegratedpublictransportsystemsreducecostsfortheurbanpoorwhileputtingcitiesontrajectoriesof greengrowth.

Extending regional infrastructure – There is a cleargaintopublicwelfarefromregionalinfrastructurethathelpsenlargemarkets,reducesthecostsof tradeandusesregionalresourcesmoreefficiently.Oneestimatesuggests that completing regional connectivity inenergy,transportandtelecommunicationswouldboostAsia’snetincomeby$13trillionovertheperiod2010-20andbeyond.

Tilting the balance

As the MDG target date 2015 approaches, it seemslikelythatthepictureacrossAsiaandthePacificwillbe mixed – with some disappointing failures, somenarrow misses, and some striking successes. But thefinalMDG story is yet tobe told.All countries stillhave five years to choose the most promising paths–andtiltthebalancedecisivelyonthesideof success.

4 PATHS TO 2015

CHAPTER I

Oneof thegreatestMDGsuccessesinAsiaandthePacifichasbeenwithpovertyreduction.Between 1990 and 2008, countries in Asia

andthePacificreducedthenumberof peoplelivingonlessthan$1.25adayfrom1.5billionto947million–allthemoreimpressivegiventhatoverthesameperiodtheregion’spopulationincreasedbysome800million.Asaresulttheregionasawholeisontracktoachievethetargetof halvingtheproportionof peoplelivinginextremepoverty.

Moreover, for some other indicators Asia and thePacifichasalreadyachievedthetargets–forreducinggender disparities in primary, secondary and tertiaryeducation,forexample,forbeginningtoreduceHIVprevalence,forstoppingthespreadof tuberculosis,forreducingconsumptionof ozone-depletingsubstances,and for halving the proportion of people withoutaccesstosafedrinkingwater.

Ontheotherhand,AsiaandthePacificregionisstilllagging in some major areas. It has been slow, forexample,inreducingtheextentof hunger,inensuringthat girls and boys reach the last grade of primaryeducation, in reducing child mortality, in improvingmaternalhealth,inprovidingbasicsanitation.

Table I-1 summarizes for 21 indicators the overallstatus based on the most recent internationallycomparable data set, which covers the period up to2008. For details of the classification method, seehttp://www.unescap.org/stat/statpub/mdg-progress-classification/.Forselectedindicators,basedontrends

of progresssince1990,thereportplaceseachcountryorcountrygroupintooneof fourcategories:

Early achiever–Alreadyachievedthe2015target On-track–Expectedtomeetthetargetby2015 Off-track: slow – Expected to meet the target, but after2015 Off-track: no progress/regressing–Stagnatingorslipping backwards

AsTableI-1shows,theestimatesfortheAsia-Pacificregion as a whole inevitably mask considerablevariationsbetweencountrygroupingsandsubregions.Theregion’s14leastdevelopedcountries,forexample,havemadeslowornoprogressonmost indicators–performingwellonlyongenderequalityinprimaryandsecondaryeducation,andstoppingthespreadof HIVandTB.Itisamajorconcernthatinmostsubregionsprogress is slow for reducing child mortality andimprovingprovisionformaternalhealth.

Therearesimilardifferencesbetweensubregions.ThegreatestprogresshasbeeninSouth-EastAsiawhichhasalreadyachievednineof the21assessedindicatorsandisontrackforanotherthree.TheNorthandCentral-Asian countries as a group have already achievedeightof theindicators.Thesamegroupof countries,excludingtheRussianFederation,haveachievedtenof theindicators–thoughtheyareprogressingslowlyonanotherthreeandmakingnoprogressonafurthersix,includingthoserelatedtopoverty,HIVandTB.

TheAsia-Pacificregionincludestheworld’stwomost

MDGs in Asia and the Pacific – where we stand

The Asia-Pacific region has made impressive gains in many MDG indicators, especially in reducing poverty. But it is lagging on some important targets, particularly on reducing hunger and in achieving higher standards of health. To reach the goals, from now to 2015, countries in Asia and the Pacific will need to step up their efforts and focus on some key priorities.


CHAPTER I: MDGs in Asia and the Pacific – where we stand

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

Source: Staff calculations based on the United Nations MDG Database

populouscountries–ChinaandIndia–sotheregion’soverallachievementonpoverty,asonotherindicators,willbeswayedbytheirperformance.Toillustratethis,Table I-1 also shows the performance of differentcountrygroupingsthatexcludeAsia’stwogiants.Thus‘Asia and the Pacific excluding China and India’ onsomeindicatorshasperformedworsethantheregionasawhole:ithasprogressedonlyslowlyinreducingthenumberof peoplelivingwithlessthan$1.25perday,andregressedonHIVprevalence.StartingfromalowbaseonmanyMDGindicators,SouthAsiahasmadegoodprogressonsevenindicatorsbut isprogressingonlyslowlyonmanyothers.Giventheweightof Indiainsubregionalaggregates,itisalsousefultoconsider‘SouthAsiawithoutIndia’.Thisgroupingisontrackforpoverty,butprogressingslowlyontheprovisionof cleanwatersupplies,andregressinginHIVprevalenceandforestcover.

As a group, the Pacific Island countries have beensuccessfulinindicatorsrelatedtotuberculosis,protectedareas and the consumption of ozone-depletingsubstances.But theyhavebeenregressingormakingno progress in eight indicators and advancing onlyslowlyinanotherfive,thoseforinfantandunder-fivemortalityandprovidingaccesstoantenatalcare.PapuaNew Guinea is home to almost 70 per cent of the

Pacific Island countries’ population, so estimates forthesubregionareinevitablyaffectedbythiscountry’sperformance. Table I-1 therefore presents estimatesforthePacificIslandcountriesexcludingPapuaNewGuinea. This subgroup shows better progress ongender equality in education and is also movingforward,albeitslowly,onexpandingaccesstoimprovedsanitationfacilitiesandsafedrinkingwater.However,itshouldbenotedthattheaccuracyof PacificIslandaggregates for many indicators is hampered by ashortageof data.Disparitiesinprogressbetweengroupsof countriesintheregionaremirroredatthecountrylevel(TableI-2).Forexample,whereasSouth-EastAsiaasawholeisontrack–orhasachievedthetarget–for12of the21indicatorsconsideredinthisreport,Cambodiamanagesthis for only ten indicators, and Lao PDR for onlynine – a result of insufficient progress in childmalnutrition and primary completion, for example.At the other end of the spectrum, while South Asiaas a whole is on track for, or has achieved only nineindicators, Sri Lanka is on track, or has achieved,the targets, for 14 of the 19 indicators for which ithas data. More details on the variation in progresstowards achieving the MDGs are provided in theStatisticalappendix.

� PATHS TO 2015


Table I-2 – Countries on-track and off-track for the MDGs

Source: Staff calculations based on the United Nations MDG Database.

�MDG PRIORITIES In ASIA AnD THE PACIFIC


Itshouldbenotedthattheseon-andoff-trackestimatesarebasedonaglobaldatabasecompiledbytheInter-AgencyExpertGrouponMDGindicatorsledbytheDepartment of Economic and Social Affairs of theUnitedNationsSecretariat.CountriesmeasuringMDGprogressusingdifferentdatasources,orusingdifferentindicators, may arrive at different conclusions. Takethe goal of eradicating extreme poverty and hungerforexample.Theassessmentof progressinthisreportusestheinternationallydeterminedincomepovertyline($1.25aday),whilemanynationalassessmentstendtobebasedonnationallydeterminedpovertylines.Thus,countriessuchasLaoPDR,NepalandTurkey,whichareshowninthereportassloworregressingonthegoalof povertyreduction,wouldbeontrackonthebasis of data estimated from nationally determinedpovertylines.Similarly,countriessuchasMongoliaandPakistanareshownhereasearlyachieveron incomepoverty,althoughtheywouldbeonsloworregressingonthebasisof theirnationalpovertylinesdata.

Moreover,evenincountrieswheresignificantprogresshas been made towards the MDGs, there are oftendisparities within the country – between urban andruralareas,betweenrichandpoor,betweenwomenandmen,andgirlsandboys.Althoughmanycountriesdonotregularlyreportsex-disaggregateddatathatwouldhelptrackthegenderdimensionsof MDGtargetsand

indicators, the available data on outcome indicatorsof poverty, such as education, nutrition, health andchildmortality,andevidencefromcasestudiessuggestgender disparities (Figure I-1). Close to 100 millionwomen inAsiaareestimated tobe ‘missing’becauseof discriminatory treatment in access to health andnutrition or through pure neglect – or because theywerenotallowedtobeborninthefirstplace.1

The scale of deprivation

Compared with other developing regions Asia andthe Pacific is generally ahead of Africa, but behindLatinAmericaandtheCaribbean(Statisticalappendix,FigureA-1).Butbecauseof itslargerpopulationsize,on most indicators, the Asia-Pacific region has thegreatest numbers of people affected. In the case of sanitation,forexample,theregionhasmorethan70percentof thedevelopingworld’speoplewhoareaffected–whichin2008amountedtoalmost1.9billion.Thisis illustrated inFigure I-2 for thisandother selectedindicators. Indeedevenon indicators forwhichAsiaand the Pacific has made significant progress, it stillhasalargenumberof peoplewholiveindeprivation.When it comes to providing people with access tocleanwater,forexample,theregionisanearlyachieveryetstillhas469millionpeopledeprived.

Figure I-1 – Asia-Pacific ranking on gender indicators

Source: Staff calculations based on data available at the World Bank Genderstat.

Lifeexpectancy Adultliteracy Secondary Adultlabourforce Proportionofseats atbirth,2008 rate,2008 enrolment participation heldinnational rate,2007 rate,2008 parliaments,2008

East Asia and the Pacific South Asia Sub-Saharan Africa World Gender parity

1.1

1.0

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0

Rat

ioo

ffem

ale

tom

ale

(F/M

)

8 PATHS TO 2015


Impact of the global economic crisis

The most recent year for which internationallycomparable data are available in the United NationsMDGdatabaseis2007or2008.Thiswaspriortotheglobal economic slowdownwhich started in2008 sothe data do not yet register the effect of the crisis.In theAsia-Pacific, for example, the economic, foodandfuelcrisesarebeingfeltthroughlowereconomicgrowth, lower government revenues, higher debtburdens,adeclineinthevalueof offshoreinvestments,increasesinthecostof living,joblossesandreducedremittances,2preventingsome21millionpeoplefromescapingpoverty.

Whilethereareinsufficientcurrentdata,itneverthelessis possible to make a rough estimate of the effects,based on the impact of the crisis on economicgrowth–whichisnowbecomingclearer.ThehistoricalrelationshipbetweeneconomicgrowthandchangesinMDGindicatorscanbeusedtoprojectthelikelyeffectsinfuture.ThemethodologyforthisissummarizedintheStatisticalappendix.

Basedonthismodel,inAsiaandthePacificthecrisiswouldresultby2015in:3 • Almost 35 million extra people in extreme incomepoverty • A cumulative number of almost 900,000 extra childrensufferingfrommalnutritionfrom2008 to2015

• 1.7 million births not attended by skilled professionals • 70 more million people without access to improvedsanitation

Note that these numbers are in addition to thoseindicatedinFigureI-2forthenumberof peoplewhowould have been deprived in any case had the crisisnot occurred. Compared with the overall levels of deprivationtheimpactof thecrisismayappearsmall.But they are nevertheless significant and add to thechallengeof achievingthegoals.

All of these estimates assume that historical trendsroughly continue. But history is not destiny. Allcountries in the region still have the opportunity toaccelerate progress to 2015 and achieve many moreof thegoals.Asaguidetohowtheymightdoso,thefollowing chapters highlight some of the paths theycantake.

Figure I-2 – Asia-Pacific’s share of the developing world’s deprived people

Source: Staff calculation based on the United Nations MDG Database.

Endnotes

1 UNDP,2010.2 ESCAP/ADB/UNDP2010;PacificIslandForumSecretariat, 2010;ESCAP(2010a).3 AlsoseeESCAP(2010a)andESCAP(2010b)forfurther discussionof theimpactof theeconomiccrisis.

1990 Latest

1877 1873

141 96

1481 947

11 7

854 469

53 32

– 0.24

7 4

6 5

Without basic sanitation

Under-5 underweight

Living below $1.25/day

Infected with TB

Without safe drinking water

Outofprimaryschool

Maternaldeaths

Under-5 mortality

Living with HIV

0 10 20 30 40 50 60 70 80 90 100

Numberofpeopledeprived(inmillions)

Percent


CHAPTER II

Each country has to address its own specificneeds and opportunities. And each of thesocialsectorsrelevantfortheMDGs,suchas

healthandeducation,alsohasitsownspecificissues.Butacrosstheregionthereareanumberof commonissues and priorities. Subsequent chapters will lookmore closely at some of the key issues for goals onwhichtheregionisfallingshort:reducinghungerandbuilding food security, improving basic services, andstrengtheningbasicinfrastructure.

AllcountriesintheregionaccepttheirresponsibilitiesasdevelopmentalstatesforachievingtheMDGs.Thischapterpresentssevenopportunitiesforstrengtheningthe overall environment in which they can do so. Itshould be noted that this and subsequent chaptersof thereportdrawheavilyontheprecedingregionalMDG reports – which can be consulted for theanalytical and empirical details that underpin thesectionsthatfollow.1

Strengthening growth by stimulating domestic demand and intra-regional trade

Achieving all theMDGswill dependon acceleratinggrowth and making a strong recovery from theeconomiccrisis.Manycountrieswillbeaimingtodothisbyrebalancingtheireconomiessoastobemoreresilient,basedlessonexportsandmoreonboostingdomestic demand and greater consumption of Asia-Pacificgoodsandservices.2FortheMDGsthispolicychange presents a major opportunity since many of thepoliciesthatwillhelpachievetheMDGswillalso

boostlocaldemand.Theseincludeincreasingspendingonbasicsocialservicesandsocialprotectionandbasicinfrastructure,andboosting the incomeof thepoor,who, compared with wealthier households, are morelikelytospendextraincomethansaveit.While increasing domestic demand, it will also beimportant to boost South-South and intra-regionaltrade and investment flows with more inclusivepatternsof regionalintegrationthatbenefittheLDCs.Since1986, intra-regionalexportshaverisenfrom23to41percentof developingAsiaexports,butmuchof this is intheformof productionnetworking inalimitednumberof partsandcomponentswiththefinalgoodsbeingdestinedforwesternmarkets.Infactonlyaroundone-fifthof exportsgotoEastandSouth-EastAsia; the remaining four-fifths go to the rest of theworld–nearly60percentof whichareheadedfortheEU,theUSandJapan.Sotheslumpinimportsinthesemajor markets, which is likely to continue for sometime,willdefinitelyaffecttheregion.Infuture,amorediversifiedpatternof tradewouldhavetobebuiltupincludingongoodswhichhaveareadymarketintheregionandwhicharealsomorelikelytobeconsumedbythepoor,suchasprocessedfood.

Greater intra-regional trade would require integratedmarkets,lowertariff andnon-tariff barriers,concertedinvestment in physical infrastructure, more robusttransportation networks and information platforms,and better regulatory structures. Regional growthwouldalsobenefitfromabalancedanddevelopment-friendlyoutcomeof theDohaRound that correctedexisting asymmetries in global trade and enhancedmarket access.LDCproducts shouldhaveduty- andquota-freemarketaccessonalastingbasis.

Seven drivers for achieving the MDGs

Achieving the MDG would make a real difference to the lives of millions of people across Asia and the Pacific. This chapter indicates opportunities for strengthening the overall environment in which the Goals can be achieved – enabling them to accelerate progress towards 2015.

10 PATHS TO 2015

CHAPTER II: Seven drivers for achieving the MDGs

Making economic growth more inclusive and sustainable

Economicgrowthnotonlyneedstobederivedmorefromtheregion’sownconsumption,italsohastobemore inclusive–with the fruits sharedmore equallyamongdifferentsocialandeconomicgroups.Thistoowouldrequireadeliberatechangeincourse–bothinthegrowthpatternandingovernmentpolicies.Intheabsence of countervailing policies, across the regionthenational incomeshareof the top20percentof thepopulationhassteadilyincreasedwhilethatof thebottom20percenthasdecreased.Similarly,formostcountries in Asia and the Pacific, the ‘Gini indices’,whicharethestandard measures of inequality,

been increasing. 3

If inequalitycouldbereduced,oratleastheldconstant,thentheMDGscouldbeachievedmorerapidly.4Thekeyhereistoderivemoreof thegrowthfromeconomicactivitiesthatbenefitthepoor-especiallywomen.Thiswillrequire,forexample,greaterfocusonagriculturewhich provides primary income to over 50 per centof Asia’s population.5 It will also mean promotingproductive employment in the informal sector – byensuring that small enterpriseshave the support andcredittheyneedtoexpandandprovidedecentwork.Enabling greater female labour force participationandbetteraccesstoeconomicassetshasshowngreatbenefit,especiallyinSouthAsia.6

It is also necessary that Governments act decisivelyto ensure that growth offers greater opportunitiesfor the poor and deprived. This involves greateremployment generation and more resources devotedto investments in education, health and other basicservices. Governments must make more efforts toraiseresourcesandreorientprioritizebudgetstowardstheMDGs.7

It isalsovitalthatgrowthbemoresustainable.Eveninclusive growth will eventually grind to a halt if itundulystressestheregion’snaturalresources.Already,unsustainable agricultural and industrial productionhave been liquidating the natural resource base,degradinglandandwaterquality,reducingbiodiversity,and destroying vital natural ecosystems. At the sametime,theregion’scitiesarecomingunderevergreaterstrain as a result of rural-urban migration: Asia andthe Pacific already has fifteen of the world’s largestcities and over the next ten years the region’s urbanpopulationwillgrowbyafurther1.1billion.8Ashortageof availablelandinmanysmallislanddevelopingstates,inparticular,isleadingtogreaterdensityinurbanareasthatlackadequateinfrastructure.Addedtothisisthepotentialadverseimpactof climatechangeonhuman

health,onfoodsecurity,oncoastalinfrastructure,andon the livelihoods of communities that depend onnaturalresources.

Inresponse,governmentsacrossAsiaandthePacificwill need to progressively set their sights on a moreenvironmentally sustainable development that candecouple economic growth from environmentalpressures– for example,by enhancing theefficiencyof natural resource use, reducing energy intensity,preservingbiodiversity,cuttingthegenerationof wasteand adapting to the effects of climate change. Thisneednot,however,necessarilymeanslowergrowthorfewerjobs,sinceintegratingcleanenergyandclimate-resilientpoliciesintodevelopmentplanningandfiscalpolicieswillalsodrivetheeconomiesforwardandcreatequality jobs. In this regard, it will be important thatgovernmentsalsodevelopsoundgreenjobspoliciesaspartof theshifttowardsalow-carbon,environmentallyfriendly,climate-resilienteconomy.Manygovernmentshavealreadysetoutonthispath.Thus,whilemitigatingthe impactof theglobal economiccrisis, somehaveincorporatedenvironment-relatedelements into theirstimulus packages. The Republic of Korea’s ‘greennew deal’ package, for example, allocates over $38billionforgreenprojectsthatwillcreateclosetoonemilliongreenjobsoverafouryearperiod,andChinahasfocused20to30percentof itspackageonlow-carbon production. China has also earmarked $440billiontosupportwindandsolarenergy.9

Strengthening social protection

Countries will be in a better position to achieve theMDGs if they can offer a minimum social floorthat addresses extreme poverty and hunger andincomeinsecurity.Acomprehensivesocialprotectionprogramme will minimize the impact of economiccrises and natural calamities as well as consolidatingdevelopment gains, while also acting as a ‘circuitbreaker’forviciousinter-generationalcyclesof povertyandhunger.

At present, across most of Asia and the Pacific thecoverageof socialprotectionislow,typicallyconfinedtoworkersingovernmentandtheformalsector.Thismeans that inmost countriesmore thanhalf of theworkforce is left without protection, and in mostcountries this involves more women workers thanmen.AccordingtoILO,inEastAsiamorethanhalf theworkforce is inunstable ‘vulnerableemployment’while in South-East Asia and the Pacific and SouthAsia, the proportion rises to 60 per cent or more.Only 30 per cent of Asia’s elderly receive pensions.Only 20per centof theunemployedhave access to

have



unemploymentbenefitsorlabourmarketprogrammes.AndhouseholdsinAsiahavetheworld’shighestratesof out-of-pocket health care expenditure. In thesecircumstances households try to protect themselvesbybuildingupsavings.10ParticularattentionalsoneedstobepaidtohouseholdsimpactedbyHIVwhichareamongthemostvulnerabletoexternalshocks.

To some extent social protection could be extendedintheshorttermbyimprovingthemanagementanddeliveryof existingprogrammes and ensuringbettertargeting.Butmanycountrieswillneednewservices.Across the region there are good examples of whatcan be achieved, from Thailand’s universal healthcareschemeto conditionalcashtransferschemes inCambodia and Indonesia, to well developed schoolfeedingprogrammesinIndiaandBangladesh.11

Reducing persistent gender gaps

Gender inequality isneither justandsustainable,normorallydefensible.Investinginwomenandgirlsisinitself abreakthroughstrategyforachievingtheMDGsandalmostany investmentmade inwomenandgirlswill have multiplier effects across all the Goals.12

Countries across Asia and the Pacific will thereforeneedtoactonmultiplefrontstoensurethatwomencanexercisetheirrightsandrealizetheirfullpotential.This shouldbebasedonbetterdataoncriticalareassuchasviolenceagainstwomen,onhowgendernormsaffectmenandwomen,andonthedifferentstatusof menandwomeninhouseholds.Analysisof thesedatashould be accompanied by close monitoring, alongwiththechangesinpolicyandlegislation–aswellasin attitudes, perceptions and behaviour – needed toensurethatwomenhavegreatercontrolandownershipover assets and resources, have equitable access toemployment,andhaveaccessto,andbenefitfrom,allpublicservices.

Althoughtheregionhasprogressedonsomegenderindicators, it - particularly SouthAsia, still hasmanydisparities–inlifeexpectancy,educationalattainmentand labour force participation – which are beingpassed relentlessly from one generation to the next.In Bangladesh, for example, women earn only 50per cent of what men earn for similar work, and inMongolia only 80 per cent.13 Similar imbalances areevident in agriculture. Inmost regionsof theworld,womenhead20percentof farms,butinAsiaandthePacifictheproportionisonly7percent,eventhoughagricultureaccountsforoverhalf of theregion’sfemaleemployment.14 Furthermore, the share of women inwage employment in the non-agricultural sector in

South Asia and Western Asia is only around 20 percent,thelowestrateamongtheworld’sregions.Womentendtobepredominantinmanyof theinformalandinsecurejobs.

Girls too have historically been less likely than boystobesenttoschool–insomecasesbecauseparentsconsiderthemalessworthwhileinvestment.Andwhileeducationaldisparitieshavebeenfallingattheprimarylevel, they persist in a number of countries at thesecondarylevel.Parentsmayalsobereluctanttosendgirlstoschoolif theyareworriedabouttheirsecurity.And inhouseholds affectedby theeconomic impactof HIV,girlsaremorelikelythanboystodropoutof school–asshownbystudiesfromChina,CambodiaandIndonesia.15

Women’s persistent lack of power is also reflectedin low representation innational legislatures. InAsiawomenoccupyonly18percentof legislativeseatsandinthePacificonly15percent.Similarly,theygenerallyhavelessinfluenceoverlocalpoliciesandplans–onfood security, for example, and on health and otherbasicservices.

Genderdiscriminationcostslives.Closeto100millionwomen inAsiaareestimated tobe ‘missing’becauseof discriminatory treatment in access to health andnutrition, pure neglect, or pre-birth sex selection.16The region’s highest girl to boy under-five mortalityratiosarefoundinChina(1.41),India(1.10),Pakistan(1.08), Micronesia, Nepal, and Tonga (1.07). And inSouth Asia more women die in childbirth – 500 forevery100,000 livebirths– than inanyotherpartof theworldexceptSub-SaharanAfrica.Theproportionof deliveriesattendedbyskilledstaff isstillaslowas18percentinNepal,20percentinLaoPDR,39percentinPakistan,and46percentinIndia–comparedwith97percentinThailand.17

Many women are also subject to domestic violence,especially when societies are under stress.18 In somecountriesinthePacific,forexample,aroundtwo-thirdsof women have been assaulted by male partners19

and theproportioncanalsobehigh inanumberof countriesinSouthandSouth-EastAsia.20Nearlyhalf thecountriesinSouthAsiaandmorethan60percentof thoseinthePacificdonothavelawsondomesticviolence. Moreover, victims rarely report episodessince enforcement is often slow and ineffective.Gender-basedviolence is also associatedwithhigherrisksforHIVtransmissionandisakeydriverof theepidemicinPapuaNewGuinea.InAsia,between1990and2007thefemaleproportionof adultslivingwithAIDSnearlydoubled–to29percent.21

12 PATHS TO 2015


Ensuring financial inclusion

Mostof thebillionorsopoorpeopleinAsiaandthePacifichave littleaccess to financial services. Insteadthey rely largely on cash or the informal economy,andforcreditlooktofriends,familyormoneylenders.Lacking insurance, they cannot protect their meagreassets and incomes against shocks such as illness,drought or theft. And without transactional bankingservices,theirfinancingisinsecureandexpensiveandtheycannotparticipatefullyintheeconomyeitherasconsumersorpotentialentrepreneurs.22

Nowadays,however,therearemanymoreopportunitiesforwideningfinancialinclusion.Governmentscanplaytheirpartbyimprovinginfrastructureandtheregulatoryenvironment. But they can also encourage serviceprovisionbyNGOs,community-basedgroupsandtheprivatesector.Thisshouldenablemicro-insuranceandmicro-financeinstitutions,forexample,totailortheirprogrammesbettertotheneedsof thepoor.

Serviceproviderscanalsotakeadvantageof advancesin information technology. They can, for example,extendmobilephonebankingtoenablecustomersinremoteareas tosendmoney, receiveremittancesandpayforpurchases.Theyshouldalsobeabletousepre-paidsmartcardstopayforsuchservicesaselectricity.The Reserve Bank of Fiji, for example, recentlyannounced that it will be working closely with twomobile phone companies to provide ‘mobile money’for all. And India is issuing a unique biometric IDthatpoorfamiliescanusetoopenbankaccountsandreceivecashtransfers.

Offering financial services to the poor not onlyallowthemtoescapefrompoverty. Itcanalsomakegood business sense. Companies that cater moreeffectivelytopoorconsumerscanbeveryprofitable.In the Philippines, for example, a company, whichprovidesprepaidphoneservicesmainlytolow-incomeconsumers, has become the most profitable of thecountry’slargestcorporations.23

Supporting least developed and structurally disadvantaged countries

Measures for faster MDG achievement should befinancedasmuchaspossiblefromdomesticresources.However, poorer countries, particularly the leastdeveloped countries, the landlocked developingcountries, and thesmall islanddevelopingstates,willneedtobeassistedthroughexternalresourcessuchasofficialdevelopmentassistance(ODA).

ODA, whether bilateral and multilateral, has playeda key role in supporting the economic developmentand social progress of many developing countriesin the region and it continues to make a significantcontribution to achieving theMDGs.With changingcircumstances,theroleof ODAisalsochangingandit should now primarily be used for supporting thedevelopmenteffortsof theleastdevelopedcountries(LDCs),thelandlockeddevelopingcountries(LLDCs)andthesmallislanddevelopingStates(SIDS)–whichdependonexternalresourcesforfinancingagoodpartof theirdevelopmentprocess.Inparticular,ODAforthese structurally handicapped countries should beusedtobuildtheireconomicandsocialinfrastructure,especially for investing in basic services such aswater, sanitation, energy, transport, shelter, healthand education. ODA can also have a catalytic role– in helping these countries expand their productivecapacities,promoteFDIandtrade,adapttechnologicalinventions and innovations, foster gender equality,ensurefoodsecurity,andreduceincomepoverty.

Atthesametime,itwillbeimportanttoimprovethequalityof ODAandincreaseitsdevelopmentimpact–bybuildingonthefundamentalprinciplesof nationalownership, harmonization, and managing for results.This includes especially aligning aid by sector withinternationallyagreeddevelopmentgoalsandcountrypriorities.

Although Asia and the Pacific has around 60 percentof theworld’sdeprivedpeople, theregionfindsit difficult to attract aid from the traditional donors,particularlyforMDGsectors.Asiareceivesthelowestper capita assistance of all regions – $12 comparedwith$45forAfrica–whichcallsforbetterallocationof flowsaccording toneeds (Figure II-1).Thereforethereisaneedtore-focusODAflows–bothintermsof regionalandsectoralpriorities.

Someof thegreatestconcernsareinthesmallislanddeveloping states of the Pacific. Here it can also bemisleading to consider ODA on a per capita basisbecauseof theirdiseconomiesof scaleandverysmallpopulations.Geographically isolatedandwithlimitedresources they face high development costs and relystronglyonaidtoovercomevulnerabilitiestoexternalshocks.Anyreduction in technicalassistance is likelytherefore to impede development progress. Thissubregion in particular should be looking to boostexternalassistance.Infuture,technicalassistancewillalsoneedtore-engagemorestronglywithagriculturebothtobuildlongertermfoodsecurityandtosupporttheincomesof theruralpoor.



All these programmes would be more effective if recipient countries improved their institutions andgovernancestructures.Butthereisalsoaneedfordonorstoincreasethepredictabilityof theirsupport,reducefragmentationandinvestwithlong-termnationalgoalsinmind.For thispurpose, thedevelopmentpartnersshouldenablereceivingdevelopingcountriestotaketheleadintheirowndevelopmentpoliciesanddevelopedcountries should align their technical assistanceprogrammes with national development plans toharmonizetheiractivitiesandmakethemmoreopenand accountable. For example, Pacific island leadersand development partners have recently reaffirmedtheir commitment through the Cairns Compact andare working together to improve coordination andaccountability.24

South-South economic assistance – Most ODA stillcomes from the DAC countries. Within the Asia-Pacificregion,thelargestdevelopingcountrysourcesincludeChina,atabout$1.4billion,Indiaatabout$1.0billion,theRussianFederationwitharound$0.2billion.Southernornew sourcesof assistance in the regionare primarily helping their neighbours. For example,ChinamostlyhelpsCambodia,DPRKorea,Indonesia,Lao PDR, Myanmar, Pakistan, Philippines and VietNam.Similarly,IndiaassistsAfghanistan,Bangladesh,Bhutan,MyanmarandNepal,whileThailandprovidesassistancemostly toCambodia,LaoPDR,Myanmar,MaldivesandVietNam.Muchof thisaidthusgoestoLDCswhereitislikelytobeusedinsupportof theMDGs–generallygoingintosectorssuchasinfrastructure,energy,agriculture,health, andeducation.For example,China and India

have helped in building roads, bridges, hospitals,educational institutions and hydro-electric plants inCambodia, Lao PDR, Pakistan, Nepal and Bhutan.Thailand has many cooperative programmes in theareasof agricultureandhealthwithMalaysia,IndonesiaandTimor-Leste.MalaysiahasprovidedassistancetoVietNamforresearchrelatingtorubber.Suchflowscanhelpestablishinstitutions,improvecapacitiesandultimatelyboosttheincomesof thepoor.25

Another priority has been health. Malaysia, forexample, has provided assistance for setting upclinicsinCambodia,whileIndiahasbuilthospitalsinAfghanistan, Nepal, Maldives and Lao PDR. South-Southassistancealsofocusoneducationandtraining– setting up educational institutions in the recipientcountry, funding vocational programmes to developskills that help improve productivity and incomes,andofferingscholarshipsforstudentsfromrecipientcountries to study in the assisting country. China,India, Republic of Korea, Malaysia, Singapore andThailand all have several such programmes. Theseinstancesof cooperation, especially in social sectors,are clearly positive examples of South-South andregionalcooperation.

Exploiting the potential of regional economic integration

Beyond South-South cooperation in sharingdevelopmentexperiencesandcapacitybuilding,regionaleconomicintegrationoffersmanyotheropportunities– particularly for smaller economies – by enablingthemtoextendtheirmarketsandreapefficiencygains

Figure II-1 – net ODA receipts per person in 2008, uS$

Source: OECD-DAC, 2010.

0 20 40 60 80 100 120 140 160 180 200

Oceania 177

Africa 45

Europe 42

All developing countries 24

America 16

Asia 12

SouthandCentralAsia 10

FarEastAsia 4

LDCESCAP 39

LLDCESCAP 74

SIDSESCAP 135

US$

14 PATHS TO 2015


fromspecializationandeconomiesof scaleandscope.This could make the region more resilient to futurecrisesandbolsterthecapacityof manyof thepoorestcountries to achieve the Millennium DevelopmentGoals.

Whenitcomestoexploitingthepotentialof regionaleconomicintegration,AsiaandthePacifichaslaggedbehindotherregions.Thusfar,forhistorical,politicalandtopographicalreasons,theregionhasbeenbetterconnected with Europe and North America thanwithitself.Meanwhile,Europe,NorthAmerica,LatinAmerica andAfricahave allmoved todeeper formsof regionalintegration,withcustomsunionsandevenmonetaryunions.AsiaandthePacificwhichhassomeof theworld’slargestandfastest-growingeconomies,couldbeanevengreatereconomicpowerhouse if ittoodevelopedamoreintegratedregionalmarket.Butitwouldneedtodosousingadevelopmentparadigmthatismoreinclusiveandsustainable.26

Theprocessof regionalcooperationintheAsia-Pacificregionisledbysub-regionalgroupingssuchasASEANinSouth-EastAsia,SAARCinSouthAsia,BIMSTECinSouthandSouth-EastAsia,andthePacificIslandsForum in the Pacific – which have evolved regionaltradingandinvestmentarrangements.Theregionhasdevelopedacomplexnetworkof overlappingregionalandbilateraltradingarrangements.ThetimehascometoconsolidatetheseintoaunifiedAsia-Pacificmarket.With growth poles such as China and India, alongwithothereconomicpowerhouseslikeJapan,aunifiedAsia-Pacificmarketcouldbethecentreof gravityof theworldeconomy.27

For this purpose the countries of the region canaccelerate progress on two current proposals: theEastAsiaFreeTradeAgreementthatbringstogetherthe ASEAN+3 grouping, and the ComprehensiveEconomicPartnershipof EastAsiaunderEastAsiaSummit (EAS) frame work that, in addition to theASEAN+3 grouping, includes Australia, India, andNewZealand.28

An integrated economic space needs to becomplemented, however, by improved physicalconnectivityaswellasbybettertradeandinvestmentfacilitation. Migration policy too could encourageintegration if source anddestination countries couldarriveatbilateralagreements.

Yetanotherareaforfruitfulregionalcooperationisindevelopingaregionalfinancialarchitecture.Thiscouldprovide more efficient intermediation between theregion’slargesavingsanditsunmetinvestmentneedsfor infrastructure and other developmental gaps.29

So far the cooperation in the area has been largelylimitedtotheChiangMaiInitiativethathasnowbeenmultilateralized as a reservepool of $120billion formeetingthetemporary liquidityneedsof ASEAN+3countries.30 At the 66th session held in Incheon inMay 2010, the member States of ESCAP mandatedtheESCAPsecretariattoassistindevelopmentof theelementsof aregionalfinancialarchitecture.31

Towards 2015

Theopportunitiesoutlined in this chapter arebynomeansexhaustive,butif usedvigorously,theycanhelpcountries accelerate progress towards many of thegoals on which they are currently falling short. Thenextchapterlooksmorecloselyatoneof theregion’smost vulnerable areas – hunger – and highlightsopportunitiesforbuildingfoodsecurity.

Endnotes

1 ESCAP/ADB/UNDP,2010.2 Chhibber,GhoshandPalanivel,2009;ADB,2009; ESCAP(2010a).3 ADB,2007;ESCAP(2010b).4 ESCAP(2010a);ESCAP(2010b).5 WorldBank,2009;ESCAP(2010a).6 UNDP,2010a;ESCAP(2010b).7 ESCAP(2010b).8 UnitedNationsPopulationDivision,2010.9 ESCAP(2010a);ESCAP(2010b).10ESCAP/ADB/UNDP,2010.11UNDP,2008;UNDP(2010a);ESCAP/ADB/UNDP,2010.12ESCAP/ADB/UNDP2006.13UNDP,2010.14FAO,2009.15UNDP,2010.16UNDP,2010.17ESCAP/ADB/UNDP,2010.18HeyzerandKhor,1999.19SPC,2009.20UnitedNations,2006.21UNDP,2010.22ESCAP(2010a);ESCAP(2010b).23ESCAP(2010b).24ESCAP/ADB/UNDP,2010.25ESCAP/ADB/UNDP,2010;Kumar(2009).26ESCAP(2010a).27ESCAP(2010a).28ESCAP(2010a).29ESCAP(2010a,2010b).30ADB,2008;ESCAP(2010a);ESCAP(2010b).31ESCAPResolution66/5.


CHAPTER III

Some of the region’s most disturbing MDGshortfallsconcernhunger.Aroundonepersoninsixsuffersfrommalnourishment,andonechild

inthreeisunderweight.AsiaandthePacifichasabouttwo-thirdsof theworld’shungrypeople.Thisfailurehasahugecost,primarilyinliveslostandinsicknessanddisease,butalsoinstiflingbothhumanandeconomicpotential.Lackof progressonchildnutrition,whichisslowingchildren’sphysicalandmentaldevelopment,iscripplingothercriticaldevelopmenteffortstocontroldisease,boosteducationandspureconomicprogress.1

The two main MDG indicators on hunger andmalnutrition are the proportion of the populationundernourished and the proportion of under-fivechildren who are underweight. For the region as a

whole,between1990-92and2004-06,theproportionof undernourished – those consuming less than thedailyminimumenergyrequirement–fellonlyslightly.Between 1990-92 and 1995-07 it fell from 20 to17percentbutby2004-06haddroppedbyonlyonepercentage point, to 16 per cent (Table III-1). Eventhisreductionwaslargelyoffsetbypopulationincrease,sothetotalnumberof hungrypeoplebarelychanged.FAO’smostrecentestimatesputthenumberof hungrypeopleinAsiaandthePacificat642millionin2009–anincreaseof about75millionduring2006-09.Thisisthehighestnumberintherecentdecades.Forchildrenwhoaremalnourished–weighinglessthantheyshouldfortheirage–thedropintheproportionwassomewhatgreater,from40to31percent,neverthelessthisstillleftalmost100millionchildrenmalnourished.

Reducing hunger and building food security

Despite rapid economic growth and falling levels of poverty, Asia and the Pacific still suffers from widespread hunger and malnutrition. In future, countries across the region will have to pay greater attention to food security, and ensure that poor people have access to the food they need to lead healthy and productive lives.

%ofpopulation Millions 1990-92 2004-06 1990-92 2004-06

AsiaandthePacific 20 16 585.7 566.2

EastAsia 15 10 183.3 136.3 South-EastAsia 24 15 105.7 84.7 SouthAsia 25 23 286.1 336.6 CentralAsia 8 10 4.0 5.8 WesternAsia 38 13 6.1 2.1 PacificIslands(a) 12 13 0.5 0.7

LatinAmericaandtheCaribbean 12 8 52.6 45.3NearEastandNorthAfrica 6 8 19.1 33.8Sub-SaharanAfrica 34 30 168.8 212.3DevelopingWorld 20 16 826.2 857.7World 16 13 845.3 872.9

Table III-1 – undernourishment in Asia and the Pacific and other global regions

Note: (a) Due to limited data, the Pacific Islands includes Papua New Guinea only.Source: FAO. http://www.fao.org/economic/ess/food-security-statistics/en/ and Chatterjee, S., A. Mukherjee and R. Jha (2010).

1� PATHS TO 2015

CHAPTER III: Reducing hunger and building food security

For undernourishment the greatest advance was inEast and South-East Asia. South Asia, on the otherhand made scarcely any progress, and the numberof hungry people increased substantially, from 286million to 337 million. In several countries in SouthAsia, more than one-fifth of the population areundernourished. In thePacific Island states the levelof hungervariesfrom5percentinKiribatito9percentintheSolomonIslands.2

Thesubregionalpatternissimilarforchildmalnutrition.Theworst-performingsubregionisSouthAsiawhichhas an underweight prevalence of 41 per cent andis home to half the world’s underweight children.Several countries in the subregion have the world’shighestnationalunderweightprevalence–worsethancountries such as Ethiopia at 35 per cent.3 In thisregion, theproblem is lessa lackof food thanpoorfood quality and food safety, along with inadequatesanitationcausingenergy-drainingdiarrhoealdiseasesandwomen’slowsocialstatusandearlymarriagewhichleadstolowbirthweights.Butitisstrikingthatdespiterapideconomicgrowth,South-EastAsiastillhasone-quarterof itschildrenmalnourished.Childreninruralareasarenearlytwiceaslikelytobeunderweightasthoseinurbanareas.Insomecasesthisratiohasrisensharply: inEastAsia,for instance,theruraltourbanratiorosebetween1990and2008from2.1to4.8.The2008ratiosforSouthAsiaandSouth-EastAsia in2008were1.4 and1.2 respectively.Theincidenceof underweightchildrenisalsodramaticallyhigher among the poor: in South Asia, for example,among the poor over 60 per cent of children areunderweight.4

AchievingtheMDGchildnutritiongoalwouldbringsignificant dividends. If countries that are currentlyoff trackweretomeetthetargetby2015,thenumberof underweightchildrenwouldfallbymorethanone-third,from74million,onpresenttrends,to47million.India and Nepal are among the countries facing thegreatestchallenge: tomeet the target,bothcountriesneed to accelerate progress about five-fold to over2 percentage points per year. In response, India, forexample,hasbeenintroducinguniversalmid-daymealsforchildren.ThechallengeisevengreaterforTimor-Lestewhichwouldneed toreduce theprevalenceby3.4percentagepointsperyear(TableIII-3).

Hungerisamultidimensionalproblemencompassingmany aspects of human development, includingpoverty,health,education,rights,voice,security,dignityanddecentwork.Inthelongerterm,asmostdevelopedcountries have shown, hunger falls with rising levelsof economic development. Experience across theregionsuggestsfiveoverallpolicyprioritiesfortacklinghunger: i) creating jobs and increasing incomes; ii)boostingagriculturalproduction;iii)maintainingstableandreasonableprices;iv)providingsafetynetsforthepoor;andv)implementingfeedingprogrammes.

Creating jobs and increasing incomes

The main hunger response should be to ensure thatpoorpeoplehavethejobsandincomesthatwillenablethem to buy the food they need. In recent years,however, employment growth has been slower thaneconomic growth and most of the poor have been

Proportion% Millions 1990-94 2003-07 1990-94 2003-07

AsiaandthePacific 40.0 31.0 127.0 98.0

EastAsia 19.0 7.0 17.0 6.0South-EastAsia 34.0 24.0 17.0 12.0SouthAsia 53.0 41.0 92.0 79.0CentralandWestAsia 19.0 7.0 1.3 0.5PacificIslands(a) 29.0 26.0 0.3 0.2

LatinAmericaandtheCaribbean 4.5 MiddleEastandNorthAfrica 12.2 Sub-SaharanAfrica 25.3 World 22.4

Table III-2 – underweight children under five

Note: (a) Due to limited data, the Pacific Islands includes Papua New Guinea only.Source: FAO. http://www.fao.org/economic/ess/food-security-statistics/en/ and Chatterjee, S., A. Mukherjee and R. Jha (2010).

1�MDG PRIORITIES In ASIA AnD THE PACIFIC


unabletogainfromthemoredynamicsectorsof theregion’s economies.To counter this trend and fosterdecent employment governments can try to ensurethatgrowthismoreemploymentintensive,particularlywhere the poor work. This will mean, for example,promoting employment-intensive sectors such asagricultureandsmallandmediumenterprises.At the same time they can establish or expandemploymentcreationprogrammesspecificallyforthepoor and the vulnerable. Fortunately in recent yearsmany Asian governments have been adopting suchstrategies. India, for example, as well as directinginvestment into high employment sectors has alsoimplementedtargetedemploymentprogrammesforthepoorandvulnerablesuchastheNationalEmploymentGuarantee Scheme, which provided employment to46millionhouseholdsin2009.5Closetohalf of thoseemployedwerewomenandmorethanhalf werefrommarginalizedgroups.6Otherwaysof raising incomesof thepoorest,currentlybeingdevelopedinanumberof countriesintheregion,areconditionalcashtransferprogrammesalongwithotherpovertyalleviationschemes.

Reducing poverty will make a vital contribution toreducing hunger. But it will not be sufficient on itsown.ExceptinthePacificIslandgroupof countries,the fall in poverty has generally been greater thanthe fall in hunger. This underlines the importanceof tackling hunger on a broad front with additionalinterventions specifically related to food productionandconsumption.

boosting agricultural production

Food insecurity depends to a large extent on foodproductionandavailability.Aworryingtrendisthatoverthelastdecade,whilefoodoutputhasincreased,therehasbeenadeceleration in thegrowthof agriculturaloutputandproductivity.Tosomeextent this reflectsdeclininglevelsof investment.

Most capital investment in agriculture comes fromtheprivatesector,especiallyfromfarmersthemselves.Nevertheless public investment in agriculture isimportant for attracting private-sector investment.Governments can invest in irrigation, research andrural infrastructure, technology generation anddissemination, natural resource conservation andstandard setting and monitoring – which can helpincrease productivity, reduce transaction costs andimprovethecompetitivenessof agriculture.7

In recent years, however, governments have beenspending less on agriculture and have directed moreinvestmenttothemaingrowthsectors–manufacturingand services (Figure III-1). The share of totalgovernment expenditure in agriculture droppedin almost all developing regions. The decline was,however,verysignificantinAsia,fromover14percentinthe1980stolessthan9percentin2002.8

India 51,987 -2.11 33,054Pakistan 9,811 -1.35 5,265Philippines 2,752 -0.90 1,846Myanmar 1,569 -1.30 746Nepal 1,551 -2.29 867Cambodia 598 -1.57 360Indonesia 3,542 -0.93 3,320Afghanistan 1,596 -1.39 1,433LaoPDR 284 -1.68 185Timor-Leste 136 -3.41 51Azerbaijan 67 -0.49 42Turkmenistan 48 -0.50 32Armenia 11 -0.20 5

Total 73,952 47,206

Table III-3 – Progress required for off-track countries to meet the underweight children target

Source: Staff calculations based on the United Nations MDG database.

Affectedpopulationin2015oncurrenttrend

(thousands)

Averageannualchangeneededtoreachtarget

(percentagepoints)

Affectedpopulationin2015iftargetreached

(thousands)Country

18 PATHS TO 2015


Similarly,theattentiontoagriculturehasbeendecliningfrominternationaldonors.Agriculture’sshareof ODAdeclinedfrom18percent in1979to3.5percent in2004.Italsodeclinedinabsolutetermsfallingbetween1984and2004from$8billionto$3.4billion(in2004dollars). In the late 1970s and early 1980s, the bulkof agriculturalODAwenttoAsia,especiallyIndia,insupportof thegreen revolution.9 It couldbearguedthatdecliningaidflowsarelimitingagriculturalgrowthandproductivity.

The firstpriority is therefore to redirect attention toagriculture, since many Asian countries have vastunexploitedpotentialforagriculturalgrowth.Oneof theeasiestwaysof raisingfarmyieldsandacceleratinggrowth is to adopt already available improvedtechnologies. Both public and private investmentsin agricultural research and extension are necessaryto provide a continuous stream of yield-enhancingtechnologiesthatcanbeprofitablyadoptedbyfarmers.Thegreenrevolutionhasrunitscourse;newscientificbreakthroughs, such as those in biotechnology, arenowrequiredtoraiseyieldpotentials.Thisisespeciallyimportant because land and water are increasinglyscarce in Asia and future agricultural growth willincreasinglyhavetocomefromsustainableagriculturetechnology.

Addressing the supply-side factors requires moreinvestment in irrigation and farm-to-market roads,crop diversification, improved marketing, policiesto encourage larger farm sizes and mechanization,increasedmarket access and trade in agriculture, andgreater incentives for food production. At the sametime it will be important that women are supportedfully todeveloptheircapacitiessincemorethanhalf theregion’swomenworkinagriculture.10

Itwillalsobeimportanttooffersufficientincentivestofarmers.Thisnotonlybenefitsfarminghouseholdsbutalsootherruralhouseholdsbyencouraginginvestmentin agriculture and creating additional employment inrural economies. For this purpose, governments intheregionhaveusedavarietyof instruments–suchas fixing minimum support prices for food grains,providing subsidies on key farm inputs such asirrigationwater,fertilizers,seeds,andcredit.Theyhavealsoheldbuffer stocksof foodgrains and regulatedthefoodgrainstrade.Somearguethatthesemeasuresdistort incentives, but they are nevertheless criticalfor ensuring food security in Asia and the Pacific.Indonesia, for example, returned to self-sufficiencyin2009asaresultof activesupporttoagricultureinrecentyears.

Maintaining stable and reasonable food prices

Countriesneedtostrikeabalance.Whilefoodpricesshouldbeatsuchalevelastoencourageproduction,they also need to be within the range of the poor.Highpriceshurtthevastmajorityof urbanandruralhouseholds who purchase most of their food. Thepeople hit hardest are poor people who on averagespendabouttwothirdsof theirbudgetonfood.Richhouseholds,ontheotherhand,spendonlyaboutonethirdof their incomeon food so theycan afford topaymore.

To some extent domestic food prices will reflectinternational prices, especially in countries that arenet food exporters. In Asia and the Pacificwhile 13countriesarenetexportersof cereals,pulses,meat,dairy,vegetables and fruits, 31 countries are net importers

Figure III-1 – Agriculture’s share of public expenditure, percentage

Source: Fan and Saurkar, 2006.

Africa Asia Latin America Developing &Carribean countries

1980

1990

2002

16

14

12

10

8

6

4

2

0

Perc

ent



(Table III- 4).FAOhas estimated that, as a resultof the foodandenergy crises, the totalundernourishedpopulationintheregionincreasedfrom566millionin2004-06to642millionin2009.11

During 2006-08, soaring cereal prices increasedhousehold food costs substantially. On average, inAsiaandthePacific, foodcostsforpoorhouseholdsincreasedby43percent,butforrichhouseholdsonlyby18percent.Asaresult, thepurchasingpowerof poor households decreased by 24 per cent, in AsiaandthePacific,whileforrichhouseholdsitdecreasedonly by 4 per cent. Inthe Philippines and Pakistan,forexample, ithasbeenestimatedthata30percentincreaseinfoodpricesledtoincreasesinthenumberof people living below the national poverty lines of about9millionand22millionrespectively.

12

Keepingfoodpriceslowandstablerequiresareliableandconsistentsupplyof foodgrains.Forfood-deficientcountries, this will mean making efforts wherepossibletoincreasedomesticproductionwhichcanbesupplementedwith imports tobuild adequate stocks.Toguardagainstfoodpricevolatilityandsuddenshortfalls,somegovernmentsinAsiaandthePacifichavetraditionallyheldnationalstocksof riceandotherstaplefoods.

Itisalsoimportanttoensurethatfoodmarketsworkefficiently.Manycountries,particularlygeographicallylargeoneswithinsufficientlydevelopedinfrastructure,can face considerable variability in food prices. InIndia, while the average monthly price of rice inOctober2009wasRs.21perkilogram,thepriceacross78consumptioncentresrangedfromRs.10toRs.31.

13

Anotherconcern is thatmuchof thepower in foodmarketsrestswithbuyersandretailerswhocanpaylowpriceswhilecharginghighpricestoconsumers.Policymakers will therefore need to promote competitiveyet equitable market mechanisms such as improvingtransport,storage,andothernecessaryinfrastructure,andencouragingtheprivatesectortodevelopefficientfoodmarkets.

Regionalcooperationcanhelppromotefoodsecurity,forexamplethroughfoodreserves.Oneoptiontodealwithsuchariskisaregionalricebank.ApermanentEastAsianemergencyricereserve isbeingdiscussedby the13countriesof ASEAN+3as a follow-up toitsongoingEastAsiaEmergencyRiceReservePilotProject – a system for sharing rice stocks. Anotherpositive initiative is the agreement, since 2007, toestablish the South Asian Association for RegionalCooperation (SAARC) Food Bank which needs tobe strengthened and operationalized on an optimalscaleandcouldalsofoster inter-countrypartnershipsand regional integration. Regional agreements toavoidexportrestrictionsandcooperationtobuildupproductioncapacitiescanalsohelp.

14

Providing safety nets for the poor

When the market fails to provide food of sufficientquantityorqualityforthepoor,governmentscantakeresponsibility to ensure food security for the poorthroughsubsidiesorpublicfooddistributionsystems.In India, for example, thepublic distribution systemreaches 160 million families who can buy around

Netimporters Netexporters

EastAsia DPRKorea,RepublicofKorea,Mongolia China

South-WestAsia Afghanistan,Bangladesh,Maldives,Nepal,India, Pakistan,Turkey SriLanka,Bhutan,Iran(IslamicRepof)

South-EastAsia Indonesia,Malaysia,Singapore,LaoPDR, VietNam,Thailand,Myanmar, Cambodia Philippines

Centraland Armenia,Azerbaijan,Georgia,Tajikistan, Kazakhstan,Kyrgyzstan,UzbekistanNorthAsia Turkmenistan,Russia

Pacific Kiribati,Micronesia,CookIslands,Samoa,Nauru, Vanuatu,Tuvalu PapuaNewGuinea,Palau,Fiji,SolomonIslands, Tonga,MarshallIslands

Table III-4 – net importers and exporters of food

Note: The authors use the definition of food in a flexible manner. Source: Francis and Akoy, 2008.

15

20 PATHS TO 2015


10 kilograms of grain per month at about half themarket price. These subsidies have made importantcontributions but have often proved difficult tooperate successfully due to suffering from selectionbias, leakages and poor food quality. They are alsoexpensivetomaintainandoperate.Betweentheearly1990sandthe2000sthecostof thepublicdistributionsysteminIndiarosefrom2.5toalmost6.0percentof governmentexpenditure.

Costsforsuchprogrammesandthepriceof foodforthepoorcanbereduced,forexample,byonlyofferingnutritious but lower cost cereals that the poor canafford. When resources are very limited, however, itmayalsobenecessarytohavemoreprecisetargeting–while taking carenot to exclude thehomeless andilliterate.Measuresalsoneedtobeinplacetoensurewellmanaged storageanddistributionand to reduceleakage, fraud and corruption. In addition, thegovernmenthastohandleitsrelationshipwithfarmerscarefully by setting a purchase price that is fair forproducersaswellasconsumers.

Direct distribution of food is sometimes combinedwithotherprogrammesinvolvingnutrition,education,andhealthservices.Forexample,theVulnerableGroupDevelopment Programme in Bangladesh seeks tointegratefoodandnutritionsecuritywithdevelopmentandincomegeneration.Participantsreceiveamonthlyallocationof wheatinexchangeforattendingtrainingon income-generatingactivities,participating inbasicliteracy,numeracy,andnutritiontraining,andmakingsavingsdeposits.

Analternativetodistributingfoodistooffersubsidiesthrough‘foodstamps’–atermthatcancoverarangeof food-linkedincome-transferschemes.Theseincludetokensordiscountcardsorelectronic transfercards.Foodstampprogrammeshavelowercoststhanfooddistributionsystems.Theycanalsobemoreefficientinaddressinghungerthancashtransfers,astheycanonlybespentonfooditems.However,theseprogrammesalsorequirestrongsupportingarchitecturewithinboththegovernmentandtheprivatesector.

Many governments also have targeted interventionsthrough food-for-work programmes. These schemestoo are self-selecting since only the poor are usuallywilling to undertake the manual labour required.Drought and conflict have led to shortages of foodandwaterinmanypartsof Afghanistanandinrecentyears, the World Food Programme (WFP) has beenproviding food to people in rural areas in exchangeforworkonruralinfrastructure.In2009alone,WFPassistedmorethan4.4millionpeopleinthisway,thus

providingfoodtovulnerableAfghansastheybuiltorrepaired community assets, including roads, bridges,reservoirs and irrigation systems. These projects areagreed upon in consultation with the governmentand localcommunities.

16

Food-for-workprogrammessuffer, however, from many of the same problemsassociatedwithpublicdistributionsystems, includingleakage through corruption, and wastage from poorstorage,andcanbeevenmoreexpensive.

Implementing feeding programmes

Onereasonwhypovertyreductionmaynot translateintobetterlevelsof nutritionisthatthepoordonotnecessarilyspendanyextraincomeonfood.Onestudyof 13countriesfoundthattheextremepooralsospendsignificant amounts on other items.

17

Moreover, asincomesincrease,peoplebuygreatervarietiesof foodthatdonotnecessarilyoffermorecaloriesornutritionalbenefits.Anotherissueisthat,evenif thehouseholdoverallhassufficientfood,itmaynotbereachingthefamilymembers ingreatestneed,particularlywomenandchildren.

In addition to policies on production, prices anddistribution, governments also have to considertargeted interventions for especially vulnerablepopulation of society. These usually involve directfeedingprogrammesforthreespecificgroups:womenof childbearing age, young infants and children, andpopulations in need of emergency food assistance,suchasrefugees.

In general, these programmes hinge on the deliveryof abasicpackageof servicesforenhancingnutritionsupported by necessary primary health care. Theessential nutrition components are breastfeeding,growth monitoring, oral rehydration, immunization,nutrition education, micronutrient supplementation,and treatment and rehabilitation of the severelymalnourished.Inadditiontosupplementsforchildren,such as Vitamin A, for example, governments havealsointroducedfoodfortificationprogrammeslikesaltiodization.

Schoolfeedingprogrammesdistributepreparedfoodtochildreninschool.Food-foreducationprogrammesdistribute free foodgrains to low-income families if theirchildrenattendprimaryschool.Thegraincanbeused to feed all family members or be sold to meetother expenses. Both school feeding and food-for-educationprogrammesprovideimmediatesustenancefor thehungrywhile empowering future generationsbyeducatingtoday’schildren.

18



As well as improving nutrition such programmesbring many secondary benefits. School feedingprogrammes can improve attendance, especially forgirls,reducedrop-outratesandevenimprovechildren’sperformance and behaviour. And programmes forpregnantandlactatingmotherscanreducethenumberof low birthweight babies and maternal mortalityratesand,alongwithpre-schoolfeedingprogrammes,help children develop normally both mentally andphysically.

Another vital contribution to good child nutritionis exclusive breastfeeding along with other basichealth services like disease control, and safe water.These programmes can also incorporate strongcommunications components to empower families –especially women with the information they need tomakebestuseof theavailablefood.

One of the best ways of addressing these issues isthrougheducation,especiallyforwomen,sincebettereducated women are in a stronger position not onlytounderstandnutritionissuesbutwillalsohavemorepowerwithinthehouseholdtoensurethateveryoneisfedadequately.

19

Released from hunger

Releasing people from hunger not only fulfils abasic human right but also contributes towards theachievementof all theotherMDGs.Well nourishedadultswill,forexample,bemoreproductiveandbetterabletoworktheirownwayoutof poverty.Andwellnourished children will grow up healthier and takegreateradvantageof opportunitiesto learnatschoolandfulfiltheiraspirations.

Atthesametime,reducinghungeralsodependstoalargeextentonsimultaneouslyaddressingmostof theother Goals.Educatedwomen, for example,will getbetteremployment thatwillallowthemtobuymorenutritiousfood.Andchildrenwhogrowupwithbetterwatersuppliesandsanitationwillbelessvulnerabletodiarrhoealandotherdiseasesthatpreventthemfromabsorbingvitalnutrients.

Thisunderlinestheimportanceof takinganintegratedapproachthatconsiders theMDGsboth individuallyandasawhole.Thenextchapterthereforebroadensthe discussion to consider how all the goals, andparticularly thoserelatedtohealth,canbesupportedbystrongerbasicservices.

Endnotes1 SeeESCAP(2009)foradetaileddiscussion.2 Chatteriee,MukherjeeandJha,2010.3 WorldBank,2010.4 UN,2010.5 ESCAP(2010a).6 ESCAP(2010a).7 ESCAP(2009).8 ESCAP(2009).9 WorldBank,2008.10FAO,2009b.11FAO,2009a.

13 ADB,2008.14 India,G.O.,2009.15 ESCAP/ADB/UNDP,2010.16 India,G.O.,2002.17 WFP,2010.18 BanerjeeandDuflo,2006.19 Singh,2008.20 MillerandRodgers,2009;MostueandHuttley,2007.

20

12UNDP,2008.

22 PATHS TO 2015

CHAPTER IV

The Asia-Pacific region has made strikingadvances in a number of social indicatorsbut has been making slow progress towards

thehealthgoals.Theregionasawholeisontracktoachieve thegoalof stoppingthespreadof HIVandtuberculosisby2015,butisoff trackformanyof theotherhealthtargets–notablyreducinginfantandchildmortalityandimprovingprovisionformaternalhealth.AlthoughHIVprevalence is stabilizing, the region isnotontracktoachieveuniversalaccesstopreventionandtreatmentforHIVinfectionforthosewhoneedit.

In education, the performance has been somewhatbetter and many countries are close to achievinguniversal primary enrolment (Table IV-1). Many arealsoclosetogenderparityattheprimarylevel,andatthe secondary level girlsmaywell be aheadof boys.Butwhilethequantityof educationhasincreased,thequality is less impressive. School buildings are ofteninadequate,books are scarce, teachers can frequentlyabsent,classsizesmaybelargeandthecurriculamayfail tomeetchildren’sneeds.Discouraged,andunder

pressure towork,manychildrenattend irregularlyordropoutof school,andAsianstudentsoftengetlowscoresininternationalstandardizedtests.

Despite advances in expanding access to primaryschooling,asmanyas14percentof primaryschoolagechildreninSouthandWestAsia–18million–werenotinschoolin2007.InthePacifictheproportionwas16percent–overhalf amillioninthePacific.Girlswereatadisadvantageinbothcases,butparticularlyinSouthandWestAsia.(TableIV-1)

Investing more in basic services

Addressing shortfalls in social indicators will meaninvestingmoreinpublicservices.FigureIV-1comparesspending on education and health in Asia and thePacific with that in other global regions. Despitebudgetpressures,governmentsshouldhavethefundsto increase investment. Indeedcountrieshave largelymaintained or increased expenditure on health and

Improving health and other basic services

If the developing countries of Asia and the Pacific are to achieve the MDGs they will need to offer reliable basic services such as health and education to the people. Most have been determined to improve their provision but many still fall short in terms of coverage and quality, especially in rural areas.

Total Male Female

CentralAsia 92 93 91EastAsiaandthePacific 94 94 93EastAsia 94 94 94Pacific 84 85 83SouthandWestAsia 86 87 84

Table IV-1 – net enrolment ratio in primary education, percentage, 200�

Source: UNESCO, 2010.


CHAPTER IV: Improving health and other basic services

Figure IV-1 – Spending on health and education as a percentage of GDP

Note: All health data – 2007; Education data: Excluding China and India – 2006, South-East Asia – 2007, South Asia – 2006, Excluding India – 2008, North and Central Asia – 2006, Excluding Russia – 2007, LDCs Asia-Pacific – 2004, Latin America & Caribbean – 2007, Sub-Saharan Africa – 2007.

Source: Staff calculations based on education data available at the website of UNESCO Institute for Statistics and health data available at the website of the World Development Indicators of the World Bank.

education.Nevertheless,giventhatmanycountriesarefalling short on MDG achievement, they will clearlyneedtoinvestmore.

When public expenditure is low, households try tomakeupthedifferencethroughprivatespending.Forhealth services, for example, while people in richercountriesareabletoarrangehealthinsuranceorotherformsof pre-paidplan,indevelopingcountriesinAsiaandthePacificahighproportionof privateexpenditureis‘out-of-pocket’:around90percentinIndia,NepalandChina.About78millionpeople inAsia and thePacificendupwithlessthan$1adayaftertheyhavepaid for health care – and can suffer catastrophicexpenditureduringpregnancyandchildbirth.1

One reason why government expenditure on theMDGsmightfallshortisaconcernaboutfiscaldeficits.Asfiscalprudenceisessential,thenecessaryresponsetothis ismaximizingrevenuesthrough improvedtaxcollectionandothersourcesofrevenuebyimposing newinnovativetaxesandthenbyincreasingallocations tothesocialsectorsthatareessentialforachievingthe

2

MDGs.ForManycountriesintheregion,taxtoGDP ratioisratherlowandmaybeincreased.

Improving governance

If they are to increase expenditure, however,governmentswillbeconcernedaboutachievinghigherservice quality. At present the quality of services isundermined by a number of issues, some related togovernance.Thesecouldbeaddressedby:

Improving efficiency – Governments can allocatebudgets wisely so as to spend more where servicesare more urgently needed, such as on teachers inrural areas, and on high productivity inputs such asmedicines and textbooks.3 They may also be able toensure that services better match demand, especiallyfromthepoor,bymovingawayfromoverly-centralizedsystemsof bothfinancingandserviceprovision,anddecentralizingmorefunctionstolocaladministration.

Achieving greater policy coherence–MDGoutcomesdepend not just on expenditure through sectoralministries, such as health or education, but alsoon broader policies on poverty alleviation, oninfrastructure, and on other services such as waterandsanitationwithwhichseveralotherministriesandlevelsof governmentmaybeinvolved.Governments

Asia-Pacific

Excluding China & India

South-East Asia

SouthAsia

Excluding India

Pacific Islands

Excluding Papua New Guinea

NorthandCentralAsia

Excluding Russia

Asia-Pacific LDCs

LatinAmerica&Caribbean

Sub-Saharan Africa

0 1 2 3 4 5 6% of GDP

Education

Health

24 PATHS TO 2015


will therefore want to consider ways of improvingcoordination across sectors and ensuring policycoherenceatdifferentlevelsof government.

Reducing corruption – At present a significantproportion of social investment drains away incorruption. Health and education personnel oftenhavehighabsenteerates,especially inruralareasandtherecanbekickbacksandbribestopublicofficialsinprocurementprocesseswhetherfornewconstructionorsupplies.

Setting standards, strengthening regulations and enforcement –Standardsof deliveryof servicessuchas in education, health and water supply can fall if standards are not set and enforced. Governmentbodiesoftenhaveweakauthorityandpoorproceduresfor regulating the quality of private services andsupplies suchasof pharmaceuticals, for example,orof medicalpractices.Weaknessesinlegalsystemsalsomake itdifficult toenforcecontractsorpursuecasesof medicalnegligence.

Increasing voice and accountability – In principle,peopleinmanycountriesintheregionareentitledtofreeprimaryeducationandprimaryhealthcare.Inpracticetheservicesareusuallymuchbetterfortheprivileged,particularly intheurbanareas.This isbecausehealth

policies,forexample,aretypicallyconceived,directedand implemented by a small group of professionalsinministriesof health–withinadequateinvolvementof civil society including people living with HIVand key affected populations, professional bodies,consumer organizations, or members of parliament.In addition teachers, doctors and health workers areoftendiscouragedbypoorruralservicesfortransport,housing,electricityandwater,andmaynotwishtoliveandworkinremoteareas.4

Ensuring better provision of decentralized services– Basic services are generally provided by local andprovincial governments who often lack capacities.While capacity development is essential, nationalgovernmentsalsoneedtoensurethatqualitystandardsare maintained and set up adequate monitoring andevaluationsystems.Regularfeedbackfrombeneficiariescanhelp identifydeficiencies and spurbetter serviceprovision by encouraging such measures as theBangaloreCitizenReportcardssystem.5

Generating better data–Improvingserviceswillalsomeangatheringdataforevidence-basedpolicymaking.Nationaldatamaynotbedisaggregatedbyregionorbygenderorbycoverageof vulnerablegroups.Andsomesensitivedatarelatedtoissuessuchasviolenceagainstwomenmaynotbecollectedatall.

Figure IV-2 – Total government revenue as a percentage of GDP

Source: ESCAP, 2010(b).

0 10 20 30 40 50 60

Myanmar

China

Bangladesh

India

Pakistan

Nepal

Philippines

Sri Lanka

Indonesia

Singapore

Kazakhstan

Thailand

Georgia

RepublicofKorea

Fiji

Australia

Bhutan

RussianFederation

Japan

Iran(IslamicRep.of)

Maldives

Percent



Ensuring social inclusion and equal access to social services

One reasonwhyachievement is low is that,while inprincipleservicesareavailabletoall,inpracticecertaingroupsareexcluded.Discriminationmaybebasedongender or many other characteristics – caste, creed,sexualidentity,ethnicity,disability,age,socio-economicstanding,geographicallocation,orevenmembershipof stigmatizedgroupssuchassexworkersordrugusers.And if the poor fail to register births their childrenmayfinditmoredifficulttoaccessbasicservices.

Poor households –Evenwhenbasic services such aseducation and health are free, poor households canface out-of-pocket expenses, for schoolbooks forexample,orformedicines,orfamilymembersmaynotbeabletoaffordtotaketimeoff worktoattenddistantfacilities.Bangladesh,forexample,hasbeenaddressingthisissuethroughastipendprogrammeforgirlsthathasimprovedtheirenrolmentinschoolingandreduceddrop-out rates. Demand-led approaches can alsooffset the exclusionary impacts of user charges – asisevidentfromtheexperienceof healthequityfundsinCambodia.Poorfamiliesarealsogenerallyexcludedfromformalbankingandfinancialtransactionsbecausetheylackcollateral.

Migrants–Facedwithmassiverural-urbanmigrationsome countries in Asia and the Pacific region arestruggling to maintain basic services in urban areas,especiallyformigrantswhoareparticularlyvulnerable.Whilesomecountriesstrictlyregulatesuchmigration,othersdonothaveanypolicytomanagemigrationorproperlyprovideformigrants.6

Physically challenged people –Theymaybeconsideredeconomicallyunproductiveandfacediscriminationinemployment.

People living with HIV –PeoplelivingwithHIVandkeyaffectedpopulations–suchassexworkers,peoplewhousedrugsormenhavingsexwithmen–maynothave access topreventionandcare services.Or theymayfearpoliceharassmentorbediscouragedbecausetheybelieve thathealth-careworkerswillnot respecttheirrightsandwilldiscriminateagainstthem.Moreover, each form of exclusion compounds theothers and tends to sustain intergenerational cyclesof poverty. Poorer groups, for example, usually getlowerthanaveragereturnsfromeducationasaresultof discrimination in the job market. And unhealthyworkersare likely tobe lessproductiveandwillearnless.Ontheotherhand,evencreatingmorejobswill

notboostpeople’sincomesif theylackthenecessaryeducation,strengthorskills.

Exclusion needs therefore to be tackled on a broadfront, addressing multiple deprivations and barriers,whetherinaccesstopublicservices,orthedistributionof assetsorof politicalpower.7Theseproblemswillnot be solved by markets alone, but will demandgovernment responses and community mobilization,includinginsomecasesaffirmativeactionandchangesin laws that hamper access. The development of effective partnerships between government and civilsocietyorganizationsisalsocrucial.

One problem is that some social inequalities gounobserved officially because of a lack of relevantdata and analysis. Good data can stimulate action.India, for example established a commission on thesocial,economicandeducationalstatusof theMuslimcommunity. The government has now publishedthe commission’s data and is implementing itsrecommendations.8 Analysis should also respond toqualitativefindings–suchastheneedforpoorwomeninruralareastoconsultfemaledoctors.

Diversifying the range of service providers

Users of services are also likely to have strongerinfluenceif theycanchoosefromarangeof providers.Inthepasttheprincipalproviders inmanycountrieshave been governments – particularly for health,education, water and sanitation. But increasingly, asgovernment budgets have become stretched, moreservices are being provided by NGOs which, alongwith the private sector and other civil societyorganizations, have acquired greater knowledge andexpertise.Howevergovernmentsshouldensurethatthepoorhaveaccesstoservicesfromtheseproviders.9

Communitybasedorganizationscanbebetterplacedtodeliverbasichealthandeducationservicestopoorand vulnerable groups. Often they use microcreditto link income-generating activities with health,education and sanitation services. One of the best-known models is that of the Grameen Bank inBangladeshwhichhasbeenwidelyreplicated.Anotherinnovation ispublic-privatepartnershipssuchas thatof ChiranjeeviYojanaininGujarat,Indiawhichofferspoor and socially excluded women free maternityservices at private hospitals. There are also goodexamplesof howpeer-ledcommunitygroupssuchasthoseinvolvingsexworkersinSonagachi,WestBengal,India, or drug user groups such as Mit Samphan in

2� PATHS TO 2015


Thailand,whichhavebeenabletoorganisethemselvesto do outreach and deliver health services to theirconstituencies.Programmesarealsobeingsupportedbymanyinternationalfunders–includingtheGlobalFundtoFightAIDS,TuberculosisandMalaria,theBillandMelindaGatesFoundation, theGlobalFundforChildren,andtheTurnerFoundation.Forthesekindsof collaboration, governments have important rolesto play to ensure collaboration and harmonization,setstandardsandestablishappropriateincentivesandlegalenvironments.

Priorities in health

While governments need to strengthen provisionacross thewhole rangeof public services,manywillneedtopaycloseattentiontothehealthgoals–whereprogress has been particularly slow. Asia has a largeshare of global deaths and illnesses – more than 40percentof theworld’sunder-fivedeathsandmaternaldeaths,and52percentof stuntedchildren.10Asia isalso responsible for55per centof unmetneeds forfamilyplanning,56percentof newborndeathsand15percentof thenumberof peoplelivingwithHIV.11

Of thehealthtargetsoneof thepriorityareasischildmortality.South-EastAsiaisontrackforthis,butalltheothersubregionsareprogressingtooslowly.Thisismirroredatthecountrylevel:outof the47countriesforwhichtrenddataareavailable,34areoff track.Therecentfinancialcrisiswillhavehadanimpactanditisproving difficult to reduce neonatal mortality, whichis intrinsically linked tomaternal survival andhealth.Still,thepictureisnotallbleaksincemostcountriesaremakingsomeprogress.Of thecountrieswithunder-5mortality rates in the early 1990sof around100per1,000 livebirthsorhigher,quiteanumber, includingAzerbaijan, Bangladesh, Lao PDR, Mongolia andNepal,havemadeimpressiveprogress,andareclosetotheirtargets,whiletheMaldiveshas,inthemeantime,reacheditstarget.

A significant problem in the Pacific region is theincrease in incidenceof non-communicablediseases,suchasdiabetes,highbloodpressureandcardiovasculardiseases. Many of these health problems are due topreventablefactorssuchaspoordiet,physicalinactivityandalcoholandtobaccouse.PacificIslandcountrieshave carried out awareness-raising programmes butstill havemuchwork ahead if they are to encouragewidespread change towards healthier choices. Inaddition to education, governments need to ensureadequatetreatmentprogrammesandfacilitieswithoutcuttingservicestomeetotherhealthcareneeds.

WithrespecttoHIV,thepictureismixed.Therehasbeen some success in bringing down incidence andprevalence– as inCambodia,Thailand andpartsof India.ButtheincidenceisincreasinginsomecountriesinSouth-EastAsiaaswellasacrosstheregionamongmen who have sex with men. Some countries havescaledupanti-retroviraltreatmentbutregionalcoverageis still lagging behind the global average. And evenwhenHIVmedicineisfree,peoplemaystillfacehighfeesfordiagnostictests,medicationforopportunisticinfections,andnutritionalsupplements.12

Another major health concern is maternal mortality.Whenmothersdieduring childbirth, theirnewbornsare unlikely to survive and their young childrenwill also be at risk. Measuring maternal mortality ischallengingasitisoftenunderreportedormisreported.NeverthelessitisclearthatmanycountriesinAsiaandthePacificareunlikelytoreachthetargetof reducingthematernalmortalityratiobythreequartersbetween1990 and 2015 unless they can accelerate progress.As indicated in Figure IV-3, the problems are mostsevereintheleastdevelopedcountrieswherelevelsof maternalmortality are close to those inSub-SaharanAfrica.Astudyof maternalmortalityratespublishedinThe Lancetin2010suggestedthatprogresshadbeensomewhat more rapid than suggested by the MDGdatabase, but nevertheless even these numbers areunacceptablyhigh(BoxIV-1).

Reflecting theurgencyof theproblem inApril2010theUNSecretary-General announced a JointActionPlan for accelerating progress on maternal andnewbornhealth.

A major determinant of a mother surviving iswhetherornotthebirthisattendedbyaskilledhealthprofessional – doctor, nurse or midwife – who canavertasignificantproportionof maternaldeaths.Allthewomenshouldhaveaccesstolifesavingemergencyobstetric care, including Caesarean sections thoughpoormothersarelesslikelytohavethisoption.

In11countriesoutof the43intheregionforwhichdata are available, less than half of all births wereattendedbytrainedhealthprofessionals.Thesituationwasparticularly stark in countries suchasLaoPDR,Timor-Leste, Nepal, Bangladesh and Afghanistan,where less than one birth in five was attended by askilledprofessional.Inadditiontoashortageof suchworkerstheyarealsopoorlydistributed.

Reducing maternal mortality will also need adequateantenatalcare,whichisparticularlyweakinSouthAsia.Moreover the risks of dying during pregnancy and



Table IV-2 – Progress required for off-track countries to meet the under-5 mortality target

Note: *Cumulative number of deaths from 2009 to 2015.Source: Staff calculations based on the United Nations MDG database.

India 11,644 -4.33 9,310Afghanistan 2,527 -24.33 1,435Pakistan 3,195 -6.52 2,337Myanmar 653 -8.29 427China 2,424 -0.81 2,295Cambodia 230 -7.29 153DPRKorea 127 -5.24 71PapuaNewGuinea 96 -5.52 66Indonesia 973 -1.76 948Philippines 415 -1.67 394Uzbekistan 142 -1.90 120RussianFederation 137 -0.57 116Tajikistan 82 -3.57 69Kazakhstan 56 -1.43 51SriLanka 33 -0.76 29RepublicofKorea 14 -0.29 12Kyrgyzstan 28 -1.86 26Timor-Leste 28 -4.52 26Georgia 9 -2.05 7Turkmenistan 32 -2.14 30SolomonIslands 4 -3.33 2Bhutan 7 -4.52 7Vanuatu 2 -3.43 1Fiji 2 -1.52 1Micronesia(FederatedStatesof) 1 -2.81 0Tonga 0 -1.62 0BruneiDarussalam 0 -0.48 0Samoa 1 -1.33 1CookIslands 0 -1.29 0Kiribati 0 -2.62 0Nauru 0 -5.43 0MarshallIslands 0 -2.81 0Palau 0 -1.14 0Tuvalu 0 -2.62 0

Total 22,862 17,934

childbirtharehigheramongadolescentmotherssoitwillbeimportanttoimproveadolescentreproductivehealth. There are also high unmet needs for familyplanning in countries such as Afghanistan, Timor-Leste, and Papua New Guinea that have very highfertilityrates.

Health outcomes are a function of many factors,economicandpolitical, social andcultural.Generally

speaking, the richer countries will have higherstandardsof health as a result of improvedhousingandoverall livingconditions.Manyof thedeathsof young children, for example, can be prevented byhaving better access to clean water and sanitation.And better road infrastructure and public transportwould make health facilities more accessible. IndeedeconomicgrowthmightbeexpectedtoimprovealltheMDGindicators.ThishasbeenanalyzedforAsiaand


(thousands)*

Averageannualchangeneededtoreachtarget(per1,000livebirths)


(thousands)*Country

28 PATHS TO 2015


thePacificbycalculatingthepercentagechangeineachMDGindicatorforeach1percentincreaseingrowth.Thebeneficialeffectappearstobegreatestforpoverty,withmorethan1percentdecreaseintheincidenceof poverty.But thegrowtheffect is slower forhealth–with a 1 per cent increase in growth only improveshealth indicators by around half of a per cent.13 If governments use the additional resources generatedby growth toprioritize spendingonurgentlyneededsectors suchashealth, risinggrowth levelscanbringaboutbetterhealthoutcomesinthefuture.While overall growth can thus lead to better healthoutcomes,itisclearthatrelyingongrowthalonewillnotdo. Countriesacrosstheregionwillneedtopay

particularattentiontoimprovinghealthservicedelivery.Thiswillinvolveestablishingabalancebetweenstateandprivate-sectorprovision.Insomecases,particularlyforprimaryhealthcare,thegovernmentwillbethemainprovider,but inothers thegovernment should servemoreasthepolicycoordinatorandregulator–establishinga framework within which the government services,theprivatesectorandNGOscanoperateefficiently.

Increasing public health expenditure and staffing levels

Generally health expenditure is higher in richercountries–bothasaproportionof GDPandof totalgovernmentexpenditure.Butnationalwealthisclearly

Figure IV-3 – Maternal mortality rates and number of deaths


Astudyof maternalmortalityrates in181countriespublishedinThe Lancet inApril2010indicatedthatsignificantprogresshadbeenmadetowardsMDG5.Between1980and2008,worldwidematernaldeathsfellbynearly35percent,from526,300to342,900.Globally,however,only23countriesareontracktoachievea75percentdecreaseinmaternalmortalityrateby2015.InAsiaandthePacifictheprogresshasbeenuneven.Anumberof countriesincludingChinahavemaderapidprogress,andintheMaldivesbetween1980and2008thedeclineintheratewas8.8percentperyear.

Neverthelessaccordingtotheseestimations,unlesstheycanaccelerateprogressitisclearthatmanycountries inAsiaandthePacificareunlikely toreachthe2015target.If thesamemethodologyof classificationwereapplied to thedata fromthisstudy,of the41countries forwhich trenddataareavailable,4wouldberegressingormakingnoprogress,32wouldbeslowandonly3wouldbeontrack–though2wouldbeearlyachievers.

Threeoutof thesixcountriesthataccountedformorethan50percentof allmaternaldeathsin2008wereinAsiaandthePacific.

Source: Hogan M. et al. (2010) “Maternal Mortality for 181 countries 1980 – 2008” in The Lancet, April 12.

box IV-1 – new estimates on maternal mortality

Asia-Pacific

South-East Asia

SouthAsia

Pacific Islands

NorthandCentralAsia

Asia-Pacific LDCs

LatinAmerica&Caribbean

Sub-Saharan Africa

Numberof deaths(inthousands),2005

236

34

187

1

2

55

15

272

0 100 200 300 400 500 600 700 800 900 1,000Maternalmortalityratio,per100,000livebirths



nottheonlyfactorsincewithinAsiaandthePacifictherearewidedifferencesevenamong the leastdevelopedcountries.BhutanandCambodia,forexample,devotemorethan10percent ofgovernmentexpenditureto

health,whileothersmaydevote4percentorless. Clearly,muchdependsontheprioritiesand

Low public investment in health combined with ahighincidenceof diseasemeansthattoofewstaff arehavingtocopewiththeexpandingneeds–resultinginovercrowdedgovernmenthospitalswithlongqueues,and extended waiting times for specific treatments.Countries such as Bangladesh, Bhutan, Cambodia,Indonesia, Lao PDR and Nepal still have limitedphysicians,andskilledhealthpersonneltoattendbirths(TableIV-3).InthePacific,thePhilippinesandSouthAsia in particular, these shortages are exacerbatedby the emigration of skilled health workers to

developedcountries.

Neverthelesstheprioritymaynotonlybetoincreasethe number of doctors – who often gravitateto urban areas. More immediate problems mayderive from shortages of nurses, paramedics orskilled birth attendants. Ensuring that staff, andparticularlyfemalestaff,canworkinruralareasandindifficult locations will therefore require appropriatesystemsof incentives.

Achieving universal health careMorecountriesintheregionarenowconsideringwaysof offeringuniversalhealthcare.Thiscanbeachievedinavarietyof waysandinmultiplecombinations.Themostbasicrequirementistoguaranteehealthtreatmentforthepoorestthroughdifferentformsof socialsafetynetthatcanbefundedentirelyoutof generaltaxation–asinThailand’suniversalhealthcarescheme.

SouthandSouth-WestAsia

Bangladesh 3 18Bhutan <0.5 51India 6 47Iran(IslamicRepublicof) 9 97Nepal 2 19Pakistan 8 39SriLanka 6 99Turkey 15 83

South-EastAsia

Cambodia 2 44Indonesia 1 73LaoPDR 3 20Malaysia 7 100Myanmar 4 57Philippines 12 62Singapore 15 100Thailand 3 99VietNam 6 88

EastandNorth-EastAsia

China 14 98Japan 21 100Mongolia 26 99RepublicofKorea 17 100

Developedcountries

USA 27 99

Table IV-3 – Health personnel


Physiciansper10,000population

%ofbirthsattendedbyskilledpersonnel

commitmentofgovernments.

30 PATHS TO 2015


At the same time countries can also move towardsuniversalhealthschemesthatarebasedatleastpartlyonthepoolingof riskacrossthepopulationthroughthepurchaseof insurance.ThuswhilesomeEuropeancountriesprovidehealthcarebasedonresidencerights,others have much more pluralistic delivery systemsbasedonobligatoryhealthinsurance,withcontributionratesrelatedtosalariesorincomes,andusuallyfundedbyemployersandbeneficiariesjointly.

In Asia, some countries have attempted to providesuchauniversalhealthscheme:

Public health insurance – In the more advancedcountrieswhereahighproportionof workersare inthe formal sector, users of health services can poolrisksthroughpublichealthinsurance.Private health insurance – Even in countries withbasic universal provision people with high incomesoftenprefer touse theprivatesector in thehopeof getting faster or better quality care. Private schemesare becoming more popular in Asia and the Pacific– particularly among middle- and high-incomehouseholds. A variant on this is a public-privatepartnershipwhere thegovernment subsidizesprivatehealthinsurancepremiumsforthepoor.

Community-based health insurance – Rather thanhavinganationalsystemtherecanalsobecommunity-based health insurance schemes in which premiumsfor thepoormightbepaidby the localauthority. In2009, the State Government of Tamil Nadu (India)introduced the Insurance Scheme called “Chief MinisterKalaignar’sInsuranceSchemeforLifeSavingTreatments” for the poor and children. In the firsthalf of 2010,over88,000peoplehadbenefittedfromthisschemeandthestategovernmenthadreleasedasumof Rs2500millionasclaimamount.14Ontopof insuranceandsubsidies,however,usersarestill likelytobepayingforsomeservices,andparticularlydrugs,fromout-of-pocketexpenditure.

China for example, in 2005 introduced aNewRuralCo-operative Medical Care System which by 2007covered around80per centof the rural population.Of theannualcostof 50yuan($7)perperson,20yuanisprovidedbythecentralgovernment,20yuanbytheprovincialgovernmentand10yuancomesintheformof apatientcontribution.

Universalcoverageforhealthcareisusuallyattainedincountrieswherepublicinvestmentinhealthisatleast5percentof GDP.In2007,17developingcountriesinAsiawerespendinglessthanthis.WHOhassuggestedappropriate percentages for the Asia-Pacific region:totalpublichealthexpenditureshouldbeatleast4percentof GDP;forprivateexpenditure,itrecommendsthat over 90 per cent of the population should becovered by some form of prepayment; and out-of-pocket spending should not exceed 40 per cent of totalhealthexpenditure.15 Inaddition, thevulnerablesections of the population should be provided withhealthsafetynets.

Oneestimatesuggeststhattheessentialinterventionsshould cost about $34 per person per year.16 Whilesomeof thiscancomefromgeneraltaxationitmightalso be possible to earmark some tax collectionfor health to ensure that the funds are used for thispurpose.AssumingthattheAsianLDCscouldmobilizeabout 5 per cent of per capita income for healthspending, thiswould amount to $25.7, leaving a gapof $8.3perpersonperyear,oratotalof $2.4billion,thatmightneedtobemetfromoverseasdevelopmentassistanceorsouth-southcooperationwithincountriesof theregion.The2008Reportof theCommissiononAIDSinAsiastatedthatacomprehensiveresponsetoAIDSintheregion would cost about $6.4 billion per year. But atargetedresponsewhichcanhaltandreversethespreadof theHIVepidemicmightneedonly$3.1billion–aninvestmentof $0.50to$1.00percapitaperyear.17

While increasing expenditure on public healthservices governments will also want to minimizecosts,particularlyfordrugs,whichshouldasmuchaspossible come in cheaper generic forms. Somecountries like India have been able to developcapability to produce highly affordable genericdrugs through adapting intellectual property rightregimesandpriceregulations.

Theresponsibilityfortheseandothermeasuresrestswith national governments, but they should also beable to take advantage of regional cooperation. Insomecases, thismight involve transferring resourcesfromricher topoorercountries,butcountriesacrossthe region can also learn from one another throughtheexchangeof bestpracticeswhichreducecostsandimprovedeliveryof healthservices.



Endnotes

1 WHO,2009.2 ESCAP(2010b).3 ESCAP/ADB/UNDP,2005.4 WanandFrancisco,2009.5 Ravindra,2004.6 IOM,2005.7 WanandFrancisco,2009.8 Governmentof India,2008.9 ESCAP/ADB/UNDP,2005.10UNICEFandWHO,2010.11WHO,2009.12UNDP(2010b).13ESCAP/ADB/UNDP,2010.14Seehttp://www.newkerala.com/news/fullnews-104256.html15WHO,2010.16JungandTran,2008.17CommissiononAIDSinAsia,2008.

A new era for public services

Improving public services will thus require a greatercommitmentnotjusttospendmorebuttospendwisely–toincreasebothefficiencyandequity.Thiswillmeanopeningupservices toawider rangeof providers–andtogreaterpublicparticipationandscrutiny.

However, another important constraint on serviceprovision, particularly in the rural areas, is the lackof adequate infrastructure, particularly transportcommunicationsandpowersupplies.Thefinalchapterturnsthereforetothisoftenneglectedsubjectwhosedevelopment underpins the achievement of theMDGs.

32 PATHS TO 2015

CHAPTER V

TheMDGframeworkonlyhasafewindicatorsfor infrastructure – for water and sanitationwhicharepartof MDG7andforinformation

and communications technology in MDG8. It thustendstofocusondevelopmentoutcomesratherthanonsomeof thebasicconditionsforachieving them.Even when governments responded to the globaleconomic crisis with stimulus packages that investedin infrastructure they did not generally link thesespecificallywiththeMDGs.

Economicanalysishasestablishedacloserelationshipbetween investment in infrastructure and economicgrowthbuthasnotexamined the impactonpovertyor other MDG outcomes. However the linkage hasbeenexploredinanumberof empiricalstudies.Oneworldwidestudy,forexample,showsthatgrowthandinvestmentare associatedwith reductions inpoverty,infantmortality,incomeinequality,illiteracyandwaterpollution.1Butthisandsimilarstudiesdonotprovethedirectionof causality.Does infrastructure investmentgenerate economic growth and reduce poverty ordo higher growth and lower poverty create a largerresourcespaceforinfrastructureinvestment?2Itseemslikelythatthecausalityrunsbothways.

Indeed the linkage between the two is intuitive.Although all infrastructure would in some way helpinachievingtheMDGs,someformsaremoredirectlyconnected, and these may be considered as ‘basic’infrastructure.Betterruralroadtransport,forexample,should expand access to markets for marginal andsmallfarmersandthusreduceruralpoverty,whilealsoallowing better access to schools and health centres.Better power supplies would mean that householdswouldnotneed to rely somuchonunhealthywoodburningstoves (BoxV-1).SimilarMDGbenefitscan

be expected from other forms of infrastructure, assummarizedinTableV-1.

Whichinvestmentswillbethemoreeffective,however,willdependon localcircumstances.For remote ruralareastheprioritymightberoadsortelecomservices,while in urban areas it might be water supply andsanitation.

It is, however, clear that there is huge room forimprovement. For many forms of infrastructure,Asia and the Pacific as a whole lags behind LatinAmerica (Table V-2). Some 930 million Asians arewithoutelectricity,only3Asiansin10haveaccesstoatelephone,andhalf theregion’sroadsareunpaved.3

Even within Asia and the Pacific there are markeddisparities. Among the subregions, North-East Asiais the most advanced while the landlocked CentralAsian republics and the Pacific Island countriesare some way behind. In fact, the lack of physicalinfrastructureisconsideredamajorimpedimenttothegrowth of Pacific economies, where there is a clearneedtoimprovetransportfacilitiesandmaritimeandaviationinfrastructure.ThemostadvanceddevelopingcountriesintheAsia-PacificregionaretheRepublicof Korea,China, Indiaand the faster-growingcountriesinSouth-EastAsia.

But disparities are also evident within countries.Transport development, for example, tends to bemoreadvancedincoastalareasthatareintegratedintoregional production networks, and less extensive inremoteregionsthatarehometoindigenousgroupsandother marginalized populations. And more generally,services and MDG outcomes are typically better inurbanareas.

Strengthening basic infrastructure

Achieving the MDGs in Asia and the Pacific will require stronger basic infrastructure, particularly better road transport, water supplies, sanitation, electricity, information technology, telecommunications and urban low-income housing.


CHAPTER V: Strengthening basic infrastructure

box V-1 – Energy for All

1 Note: Energy for All uses the IEA 2009 data that show that 809 million Asians lack access to electricity. This report cites ADB’s Asian Development Outlook 2009 figure of 930 million so we use that here for consistency.2 See www.energyforall.info

Modernenergyisanessentialinputforachievingallof theMDGs,somuchsothatincreasingaccesstoaffordable,reliableenergyisnowwidelyconsideredthe“missingMDG”.YetintheAsia-Pacificregionalone,some930millionpeopledonothaveaccesstoelectricity,andnearlytwicethatnumberdependonburningbiomassforcookingandheating.1

ADB’sEnergyforAllInitiativeisdevelopingnewapproachesforscalingupaccesstoclean,modernenergyamongthepoor.Thisincludesimprovingthedeliveryof energyservicestodeprivedcommunitiesthroughADBinvestments,extendingpolicysupporttogovernmentstodesignandimplementuniversalelectrificationprograms,andbuildingcapacityandpromotingknowledgeexchangeamongawiderangeof practitioners.ADBisalsopursuingregionalcooperationthroughtheEnergyforAllPartnership,amulti-stakeholderplatform launched in2009.2TheEnergy forAllPartnershipbrings together theprivatesector,financialinstitutions,governmentsandcivilsocietytoshareintelligenceandcollaborateonprojects,withatarget toexpandaccesstomodernenergyto100millionpeople inAsiaandthePacificby2015.

Therearenowmanyprovenmethodsforextendingmuch-neededenergyservicestothepoor.ADB’sEnergyforAllisfocusedonreplicatingeffectivemodelsandscalingupexistinginitiatives.InVietNam,for example, an ADB-supported credit facility will build on the country’s ongoing domestic biogasprogramandenableanadditional40,000householdstoaccesscleanercookingfuelfromhouseholdbiogasdigesters.Accesstocleanerfuelssuchasbiogascanreducediseaseburdenandimprovematernaland child health which are among the MDGs. Where appropriate, targeting investment to expandexistinginitiativescanhastenprogresstowardenergyforall.

MoreinformationonADB’sEnergyforAllInitiativecanbefoundat:http://www.adb.org/Clean-Energy/energyforall-initiative.asp

MDGsimpacted

Directimpact:MDG1Indirectimpact:MDGs2,3,4,5

Directimpact:MDG1Indirectimpact:MDGs2,4,5

Directimpact:MDG1Indirectimpact:MDG7

Directimpact:MDGs1,8Indirectimpact:MDGs2,3

Directimpact:MDGs4,5,6,7Indirectimpact:MDG3

Directimpact:MDGs3,4,5,6,7

Table V-1 – Positive impacts of basic infrastructure on the poor and MDGs

Source: Adapted from ADB/JBIC/World Bank, 2005.

Sector

Electricity

Roads

Urbanmasstransit

ICT

Watersupply

Sanitation

Directimpactonpoor

Mainlyforlighting,TV,andradioatlowlevelsofincomeAppliancesforself-employment

AccesstoemploymentandmarketsAccesstoservices(health,education)

Accesstoemploymentopportunities

Bettercommunicationaccess,aidingmigration,informationonopportunities,accesstoknowledgeandpotentialengagementinwidercommunities

Improvedhealthoutcomes;timesavings;lowercosts

Improvedhealthoutcomes

Indirectimpactsonpoor

Reducedenergycostsforenterprises,encouragingemploymentcreationImprovedhealthandotherservices(refrigeration,lighting,etc)ImprovedICTaccess

Reducedtransportcostsandimprovedmarketaccessforenterprisesandserviceproviders,loweringcostsofservingremotecommunities

Employmentcreationfrommoreefficientlabourmarkets

Employmentcreationthroughimprovedknowledgeofmarkets,reducedmanagementsupervisioncosts,accesstowiderknowledgebase

Limited

Improvedhealthoutcomes(e.g.reducedpollutionbynon-poorhouseholdsandothers)

34 PATHS TO 2015


Mobilizing finance for basic infrastructure investment

Meeting infrastructure gapswouldbe expensive.Forthe period 2010-2020 it has been estimated that therequired investment would be $7.7 trillion, or about$700billionperannum–58percentof whichwouldbe inEastAsiaandthePacific,36percent inSouthAsiaand6percentinCentralAsia.Of thetotal,two-thirdswouldbefornewinfrastructureandthebalancefor replacing existing facilities. More than half theinvestmentwouldberequiredforenergy,and30percent for roads (Table V-3). Considering that muchof the investments would be needed to meet largeexisting gaps – such as providing electricity to over22percenthouseholdsintheregioncurrentlywithoutaccessorexpandingthepavedroadnetworksforruralpopulations–of the$7.7trillion,asignificantproportionwould be for basic infrastructure for supporting theMDGs.AcrucialtaskfacingpolicymakersistomakeinfrastructureinvestmentmoreMDG-supporting.

The key challenge is to mobilize finance. In theshort term it should be possible to include essentiallow-cost rural infrastructure projects in ongoingfiscal stimuluspackages. If suchprojects are labour-intensive they can also provide employment safetynets.For thispurpose,poorercountriesmayhave torely more on grants or concessional financing fromODA or multilateral development institutions. Butothercountrieswillbeable toaccesscapitalmarkets

andtapintoregionalsavings.Withcombinedforeignexchangereservesof nearly$5trillion,theregioncouldnow develop an ambitious architecture for mutuallybeneficial deployment of foreign exchange reserves.This architecture could include an infrastructuredevelopmentfund.4If itmobilizedjust5percentof theregion’sreservesitwouldhavestart-upcapitalof $250 billion. The fund could also borrow from theregion’scentralbanks.Byco-financingviableprojectswithothersourcessuchanarchitecturecouldexpediteinvestment in infrastructure development, especiallycross-border connectivity projects linking poorerparts of the Asia-Pacific region with the region’sgrowthcentres.5

Stimulating the private sector

Overthepasttwodecades,morethan70percentof Asia’s investment in infrastructure has come fromthepublic sector.Thepublic sectorwill stillneed toshoulder the main responsibility for improving thedelivery of basic infrastructure for areas that arecommercially unviable. But with rapidly increasingdemandif theregionistotakealeapininfrastructurespending for basic infrastructure more finance willneedtocomefromprivatesources.Privateinvestmentdoes not usually focus on the needs of the poor,particularly in rural areas where perceived risks arehigh.Evenpublic-privatepartnershipsarerareinruralareas,thoughtherehavebeensomepromisingresults,

North-EastAsia 13.72 0.49 99.34 88.11 64.97 5.96 0.366 32.97CentralAsia 16.48 2.55 … 88.66 95.31 2.31 0.003 …SouthAsia 12.78 0.51 61.03 88.06 32.83 1.20 0.010 40.10South-EastAsia 10.51 0.27 71.69 86.39 67.50 3.53 0.031 34.15PacificIslands 3.69 … … 46.19 48.74 0.77 0.043 …

Asia-Pacific 12.83 0.53 77.71 87.72 52.05 3.47 0.154 35.73

Industrialized 207.10 … … 99.58 99.85 13.76 1.553 …countriesOECD 211.68 5.21 99.80 99.63 99.94 13.87 1.608 …LatinAmerica 14.32 2.46 92.70 91.37 78.26 6.11 0.150 25.35Africa … 0.95 28.50 58.38 30.83 1.42 0.003 62.72

Table V-2 – Infrastructure comparators, Asia and Rest of the World, 2005

Note: Paved roads indicator is derived from the indicator on paved roads (as % of total roads) and total road network (km). Source: World Development Indicators, United Nations MDG Database and World Energy Outlook 2009.

Urbanslum

population(%)

Countrygrouping

Pavedroads

(km/10,000people)

Railways(route

km/10,000people)

Householdelectrification

rate,2008

(%)

Accesstoimproved

watersources

(%oftotal)

Accesstoimprovedsanitation

(%oftotal)

Mobileandtelephone

subscribers(per100people)

Broadbandinternet

subscribers(per100people)



forexampleforfinancingmicro-andmini-hydropowerprojects. Although the chief benefit of expandingprivate sector involvement in infrastructure is likelyto be to release more public-sector funds for MDGachievement, attempts to create more public-privatepartnershipsinpromisingareasof basicinfrastructureshouldcontinue.

Forthistohappen,itwillalsobeimportanttostimulatethe interest of the private sector by developingappropriateregulatoryframeworks.Governmentsmayalsoofferfiscalandotherincentivestoprivate-sectorinvestors, while multilateral development institutionscan help steer governments and private investorsthrough the difficult commercial and cost-sharingnegotiationsforpublic-privatepartnerships.Managingthedebtcomponentof theseprojectscanbenefitfromswaparrangementstoalleviateforeignexchangerisk.

Raising standards of quality and maintenance

Just as important as the extent of infrastructure isits quality. Except for railways, Asia also lags in thisrespect.Arecentstudy,basedontheWorldEconomicForum’s business survey, which rates infrastructuregiving a maximum score of 7 points, found Asia tobe 1.9 points behind the G7 countries (Table V-4).Asia’sweakestperformanceis inelectricityforwhichitisfurthestbehindtheglobalaverage.AmongAsia’ssub-regions, East Asia ranks the highest and SouthAsia the lowest. Nevertheless, some countries in theregionperformwell.Singapore’sratingsforportsandairtransport,forexample,areclosetothemaximumscoreof 7.6

The quality of infrastructure is also affected by thecommitment to repairs and maintenance. Olderinfrastructure may decay and eventually fall intodisuse – and will be particularly vulnerable at timesof disaster. This is usually because governments aremore interested in building new infrastructure, forwhichtheycanclaimcredit,thaninmaintainingassetscreatedbyprevious administrations.Moreover,whilenew major infrastructure is typically created by thecentralgovernment,thetaskof maintenancegenerallyfallstolocaladministrationswhichhavefewerfinancialorhumanresourcestofulfilthisresponsibility.High-quality infrastructure does not necessarily requiresophisticated technology; more important is that itshouldbesimpletomaintain.

Low-quality infrastructure will disproportionatelyaffectthepoor,whoare,forexample,themainvictimsof fatalitiesoccurringonpoorqualityroads.Also,thereisavastgapinqualitybetweenurbanandruralareas–andtheresultingqualityof socialservices,includingwatersupply,educationandhealth.Asaconsequence,progressontheMDGshasslowedinruralareas.

Inmanycountries,mostof infrastructureinvestmentrelatedtotheMDGsislikelytocomefromthepublicsector.Butthiscanonlybeeffectiveif itisaccompaniedby reforms in governance and also by efforts toincrease capacity, especially in local government incountriesthathaveachievedextensivedecentralization.Anotherpriorityisfightingcorruption.Governmentscanincreasetransparencybyusingcompetitivebiddingrules, widely publicizing project information, usingautomatede-billingsystems,andsubjectingprojectstorandomqualitychecks.Theywillalsoneedtoimprovequalification and certification in the constructionindustryandenforceregulationsmorestrictly.

Table V-3 – Asia’s Infrastructure Investment needs 2010-2020 (uS$ millions, 2008)

Source: Derived from ADBI/ADB, 2009.

Sector/Subsector New Capacity Replacement Total

Energe (Electricity) 3,176,437 912,202 4,088,639Telecommunnications 325,353 730,304 1,055,657 Mobilephones 181,763 509,151 690,914 Landlines 143,590 221,153 364,743Transport 1,704,858 674,313 2,378,161 Railways 2,692 35,947 38,639 Roads 1,702,166 638,366 2,340,532Water and Sanitation 155,493 225,797 381,290 Sanitation 107,925 119,573 227,498 Water 47,568 106,224 153,792Total 5,162,131 2,542,616 7,704,747

3� PATHS TO 2015


Oneof thebestwaysof improvingqualityistoactivelyinvolvelocalcommunities,andparticularlywomen.Atthehouseholdandcommunitylevel,womenoftenplayaprimaryroleinmanagingenergyandwateruse.Theirparticipation in the development, implementationand maintenance of infrastructure is more likely tolead to sustainable solutions.7When local people areengaged in planning water systems and other basicinfrastructure they can not only contribute inputs intheformof labourorbuildingmaterialsbutalsofeelgreaterownershipandbecommittedtomaintenance.Theycanalsoparticipateinappraisalsandauditsandincollectingfeesandcharges.Insomecases,thiscanbeaccompaniedbyincreasinginvolvementof NGOs– in such areas as developing water supplies, solidwastedisposal, and school andhealth facilities.Withrelatively lowoverheadsNGOsmaybeable toworkatlowercosts.

Infrastructure investment decisions also need to bewell coordinated – for example, planning rural roadnetworksalongwithmainarterialroads.Thiswillalsomean investing simultaneously inbothhardware and

software–ensuring,forexample,thatawatersupplyfacility will subsequently have operating staff. Thismay be achieved through investment coordinationboards–whichcanalsoensurethatroadprojectsallowadequately formaintenancecosts, and that electricityschemesbuildmaintenancecostsintopowertariffs.

In order to track progress, it will be important toestablish appropriate indicators. Most of thosecommonly used, such as the percentage of thepopulationwithaccesstosafewater,measureoutcomes.Trackinginvestment,however,willneedmoreandbetterindicatorsof outputs, such as the lengthof water anddrainagepipesinstalled.

building greener infrastructure

It will also be important for future investment inbasic infrastructure to pay much closer attention tothe environmental impact – and the implications of climatechange.FortheMDGsitwillbeimportant,forexample,toimprovepowersupplies,particularlyinthe

Regionorcountry Overallinfrastructure Roads Electricitysupply

Worldaverage 3.8 3.8 4.6G7countriesaverage 5.7 5.7 6.4AsiaAverage 3.8 3.7 4.1

CentralAsiaaverage 3.5 3.1 3.6

Azerbaijan 3.9 3.7 3.9Georgia 3.2 3.5 4.4Kazakhstan 3.5 2.5 4.3Tajikistan 3.2 2.6 1.7

EastAsiaaverage 4.6 4.7 5.3

China,People’sRep.of 3.9 4.1 4.7HongKong,China(SAR) 6.3 6.4 6.7Korea,Rep.of 5.6 5.8 6.2Mongolia 1.7 1.4 2.9Taipei,China 5.5 5.6 5.9

SouthAsiaaverage 2.9 3.1 2.8

Bangladesh 2.2 2.8 1.9India 2.9 2.9 3.2Nepal 1.9 1.9 1.7Pakistan 3.1 3.5 2.5

South-EastAsiaaverage 4.2 4.2 4.7

BruneiDarussalam 4.7 5.1 5.4Cambodia 3.1 3.1 2.5Indonesia 2.8 2.5 3.9Malaysia 5.6 5.7 5.8Philippines 2.9 2.8 4.2Singapore 6.7 6.6 6.7Thailand 4.8 5.0 5.5VietNam 2.7 2.6 3.2

Table V-4 – Infrastructure quality in Asia, rated from 0-�

Source: ADBI/ADB, 2009.



ruralareas.Thiscanbringbenefitsnotjusttothelocaleconomybutalsoforhealthandtheenvironmentbyreducingtheuseof woodburningstoves.Neverthelesssomepowersources,suchaslargehydropowerprojects,have often had serious consequences both for theenvironmentandforlocalcommunities.

Other formsof infrastructure canhave lessobviousenvironmental implications.Thuspipedwater supplyinurbanareaswillhavetheenvironmentalbenefitof reducinggroundwaterextractionbutwouldalsorequirebetterwastewatertreatmentasgreaterwaterflowsaddtopollutionthroughdrainagesystems.

More attention must be given to services thatmaximize equitable socio-economic benefits, whileminimizing environmental impacts and the use of resources. Governments will want to enhance thecomplementarities between basic infrastructureinvestmentandenvironmentalprotectionandminimizethe conflicts. Investment in low-incomehousing, forexample,willnotbeagreeninitiativewithoutadequatewatersuppliesandsanitation.Infact,therearemanypromisinggreenoptions.Forexample,publictransportsystemsthatarewellplannedandintegratedwithnon-motorized transport can reduce costs for the urbanpoorwhileestablishingcitiesontrajectoriesof greengrowth.Thiswillalsomeanpromotingtheuseof greenenergyandtechnologyalongwithenergyconservationanddemandmanagement.

Extending regional infrastructure

While the most immediate gains for the MDGs arelikely to come from better infrastructure at nationallevelstherearealsohugeopportunitiesforimprovinginfrastructure at regional and subregional levels.A study by ADB and ADBI has concluded thatcompleting regional connectivity in energy, transportandtelecommunicationswouldboostAsia’snetincomeby$13trillionovertheperiod2010-2020andbeyond.8

Forpoor communities someof themost immediatebenefits of better connectivity will be degrees of cross-national integration between neighbouringborder areas which in their respective countries areoften amongst the more remote and poorer regions.Adjacent areas of Thailand, Indonesia and Malaysia,forexample,havebecomepartof a‘growthtriangle’.Brunei Darussalam, Indonesia, Malaysia and thePhilippineshavealsoformedanEastASEANGrowthArea. Recently there has also been an attempt tocreate a new growth triangle between Eastern India,Nepal, Bhutan and Bangladesh. Regional transportinfrastructure has also been developed in the form

of an East West Economic Corridor in the GreaterMekongsubregionaswellasthrougharoadthatlinksChinawithKazakhstan,KyrgyzstanandUzbekistan.It is also important however, that the physical linksbetweencountriesareaccompaniedbyharmonizationof standards such as railway signalling systems orcustoms codes. All these would contribute to fasterpoverty reduction and progress on the MDGs. OnemodelforKyrgyzstan,forexample,showsthatregionalcooperation on integration projects for transport,transitandfacilitationwouldnearlydoubletheincomesof thepoor.9

Attheregionallevel,governmentsshouldpressaheadwithagreementsforpan-Asianconnectivity–through,forexample,anAsianInfrastructureFundandotheraspectsof aregionalfinancialarchitecture,andapan-AsianInfrastructureForumforsharingtheexperiencewith cross-border projects. Cooperation betweencountriesinexchangingknowledgeandbestpracticescan also play an important role in helping expandaccesstobasicinfrastructure.

Tilting the balance

Inrecentyearscountriesacrosstheregionhavemadesome progress in building new infrastructure. SeenthroughanMDGlens,however,theresultscanatbestbeconsideredpatchy–withfuturisticnewairportsandsmartprivatehospitalsononesideandpotholedruralroadsandcrumblingvillagehealthclinicsontheother.Thechallengenowistochangethecriteriaof success–toachievehigherstandardsof basicinfrastructurethatcanunderpintheMillenniumDevelopmentGoals.AstheMDGtargetdateof 2015approaches,itseemslikely that thepictureacrossAsiaand thePacific fortheGoals themselves is also likelybemixed– somedisappointingfailures,somenarrowmisses,andsomestrikingsuccesses.But the finalMDGstory isyet tobetold.Allcountriesstillhavefiveyearstochoosethemostpromisingpaths–andtiltthebalancedecisivelyonthesideof success.

Endnotes

1 Thomas,2001.2 Chatterjeeetal.,2004.3 ADB,2009.4 ESCAP(2010a),ESCAP(2010b);ADBI/ADB,2009.5 ESCAP(2010a),ESCAP(2010b).6 AlsoseeESCAP(2010a)foracompositeindexof infrastructuredevelopment.7 ADB/JBIC/WorldBank,2005.8 ADBI/ADB,2009.9 ADBI/ADB,2009.

38 PATHS TO 2015

Comparison of Asia and the Pacific with other developing regions

The Asia-Pacific region as a whole has made moreprogressthanSub-SaharanAfricabut less thanLatinAmericaandtheCaribbean.Thecomparisonbetweenthese three global regions is encapsulated in FigureA-1forsixindicators.Inthesecharts,thesizeof thebubbles is in proportion to the population currentlyaffected (on a logarithmic scale). The sloping linedivideseachchartintotwoparts:if thebubbleisabovethe line,since1990thevalueson that indicatorhaveincreased; below the line they have decreased. Thecolours correspond to those of the on- or off-trackprogresssymbols.

Theremainderof thisappendixdiscussesforsomekeyindicatorswhereprogresssofarhasfallenshortforthetargetstobemetby2015,andwhatisrequiredintermsof deviationfromcurrenttrendstostilldoso.Itthenprovides estimates on the extent of reduced humansuffering resulting from theacceleratedprogress andtheachievementof thegoals.

Achievements in $1.25/day poverty

Figure A-2 illustrates the differences in the progressamongcountriesinreducingextremeincomepoverty.The arrows represent the percentage of populationlivingbelow$1.25(PPP)perdayinthelatestyearforwhich data are available. The other end of the linerepresents the data point for the earliest year since1990.DataontheseandotherindicatorsareprovidedinTablesA-6throughA-13inthisappendix.

Intheearly1990s,everysixtosevenoutof 10personsinChina,Turkmenistan,VietNam,Pakistan,Bangladeshand Nepal were living on less than $1.25 per day.Whereasthefirstfourof thesecountriesmanagedtoreducetheprevalenceof povertytofewerthansixtoseven out of 10 persons, and have in the meantimereachedthepovertyreductiontarget,BangladeshandNepalprogressedmuchslowerandstillhavepovertyratesof around50percent.Ontheotherhand,countriessuch as the Philippines, India and Lao PDR hadsomewhatlowerpovertyratesintheearly1990s,havemadeevenslowerprogress.Thusextremepoverty inthesecountriesremainsprevalent.Whereasatthesame

time,inanumberof CentralAsiancountriessuchasGeorgiaandUzbekistanpovertyratesactuallyincreased.

ThegreatestchallengeisforUzbekistan,whichneedstoreducepovertyby2.5percentagepointsperyeartoreach the target; this rate is lower than thehistoricalrateachievedbysixof the11earlyachieversandontrackcountries.

Table A-1 also illustrates the scale of opportunityto reduce human deprivation if currently off trackcountries still manage to hit the target. On presenttrends, the currently off track countries would behometo577millionpoorin2015.Thisfigurewouldbe reduced by 163 million (or 28 per cent) if thecountriesmanagetoaccelerateprogresstotherequiredrate of progress (including reversing the trend forthe regressing countries). The contribution of 131million to this reduction in regional total by India isparticularlynotable.

Achievements in primary enrolment

There were only four countries (out of the 32 withdata) in the early 1990s with net primary enrolmentrates of less than 70 per cent: Bhutan, Pakistan,Solomon Islands and Timor-Leste; the progress oncurrenttrendsof eachof thesecountriesistooslowfor the target to be reached by 2015. Perhaps evenmoreworryingisthesituationintheMarshallIslands,whichsawprimaryenrolmentratesregressfromwellover80percenttobelow70percent.

ThesePacificIslandcountries,togetherwithPakistan,face thegreatest challenge to stillmeet the targetby2015,havingtoincreaseprimaryenrolmentbyatleastthreepercentagepointsperyear.

Oncurrent trends, almost 17million children inoff trackcountrieswouldnotbeattendingschoolin2015;thisnumberwouldbereducedtoalmostfourmillion,a difference of 13 million if the off track countriesmanage to hit the target by 2015. The payoff of Pakistan reaching the target would be tremendous.Onpresenttrends,thecountrywouldhaveoversevenmillionchildrenoutof school in2015.Thisnumberwouldbereducedby5.6millionif Pakistanisabletoachievethetarget.

Statistical appendix


STATISTICAl APPEnDIx

Figure A-1 – Asia and the Pacific compared with Sub-Saharan Africa and latin America and the Caribbean

Source: Staff calculations based on the United Nations MDG database

40 PATHS TO 2015


Figure A-2 – Progress in reducing extreme income poverty


India 450,986 -1.69 319,665Uzbekistan 22,834 -2.52 4,728Bangladesh 65,359 -1.62 58,523Georgia 2,207 -1.12 92Philippines 17,055 -0.81 15,616SriLanka 2,804 -0.50 1,587Turkey 2,405 -0.07 1,599Nepal 11,699 -1.90 11,116LaoPDR 2,090 -1.24 1,957

Total 577,439 414,883

Table A-1 – Progress required for off-track countries to meet the $1.25/day poverty target



(thousands)Country


(thousands)


(points)

|||||||

|||||

||

|||

||

||||||

MalaysiaTurkey

RussianFederationIran(IslamicRep.of)

KazakhstanGeorgia

ThailandSriLanka

AzerbaijanArmenia

KyrgyzstanMongolia

PhilippinesUzbekistan

TajikistanCambodia

India

LaoPDRChina

TurkmenistanVietNamPakistan

BangladeshNepal

0 10 20 30 40 50 60 70Percentageofpopulationbelow$1.25perday(%)

Earlyachiever Slow Regressing/Noprogress

| Target

Timor-Leste

On-track




Achievements in basic sanitation

Thedifficulty that theAsia-Pacific regionasawholeand – with the exception of South-East Asia – thesubregions within it have to reach the target forsustainableaccesstobasicsanitationismirroredatthecountry level, as illustrated inFigureA-4.Thefigureshowsthatinagroupof 18countries–amongthe48countries for which data is available – less than onein two persons had access to basic sanitation in theearly1990s.Onlyfourof thesecountrieshaveeitherreached the target – Viet Nam and Myanmar – orareontracktodoso–LaoPDRandTimor-Leste.It

shouldbenotedthat in the last twocountriesaccessstoodataround50percent,whichislow.Allinall,30countriesintheregionareoff trackonthistarget.

TableA-3indicateswhat isrequiredof theoff trackcountries to still reach the basic sanitation target by2015,andwhatthiswouldmeanintermsof reduceddeprivation. In order to reach the target, countriessuchasIndia,Afghanistan,Nepal,PapuaNewGuinea,Cambodia, Azerbaijan, Mongolia and Micronesiawouldhavetoreducetheproportionof thepopulationwithout access to basic sanitation by a minimum of 3.5percentagepoints per year. In the caseof India,

Figure A-3 – Progress in expanding access to primary education

||||||||||||||||||||||||||||||||

BhutanPakistan

SolomonIslands

LaoPDRMacao,China

CambodiaIndia

MarshallIslandsTonga

AzerbaijanTurkey

BangladeshVanuatuGeorgia

Iran(IslamicRep.of)Armenia

BruneiDarussalamSamoa

KyrgyzstanKazakhstanPhilippines

MongoliaTajikistan

HongKong,ChinaIndonesiaMalaysiaMaldives

RepublicofKoreaFiji

KiribatiSriLanka

0 20 40 60 80 100Netenrolmentratioinprimaryeducation(%)

Earlyachiever O Slow Regressing/Noprogress

| Target

Timor-Leste

n-track

42 PATHS TO 2015


Table A-2 – Progress required for off-track countries to meet the primary enrolment target


Bangladesh 7,030 1.36 985Pakistan 7,067 4.13 1,430Philippines 1,830 0.41 741LaoPDR 163 1.80 46Cambodia 164 0.91 111Turkey 491 0.04 456Kyrgyzstan 55 0.57 27Fiji 34 0.79 6Timor-Leste 35 2.53 13SolomonIslands 26 3.50 5Armenia 15 0.26 11Macao,China 2 1.25 1Bhutan 6 1.10 6MarshallIslands 0 3.56 0

Total 16,918 3,838


(thousands)Country


(thousands)


(points)

thiswouldmeanthat284millionmorepeoplewouldhave access than if current trends were to continue.In Asia and the Pacific as a whole 1.2 billion wouldremainwithoutaccessin2015,ratherthan1.7billiononcurrenttrends,adifferenceof 516million.

number of people affected if targets are reached

Table A-4 provides a summary of the estimateddeprived population in the above two scenarios –current trends continue for the off-track countriesso the targets will be missed in 2015, or progress isaccelerated and these off-track countries reach thetargetin2015.Ascanbeseen,asmanyas892millionpeople in the Asian-Pacific region are projected toremain in extreme income poverty if current trendscontinue, including both countries that have madeprogressand reached the target aswell as those thatare off track. Accelerated progress in the off trackcountriesalonewouldreducethepovertyratesinthesecountriesbyasmuchas28percent,orasmuchas18percentof allthepoorintheentireregion,comparedto the scenario of business as usual. Similarly, if acceleratedprogresstakesplaceinexpandingprimaryenrolment in the off track countries, as many as 13million additional children in these countries wouldhave access to primary education, about half of thechildrenwhowouldremainoutof schoolinthewholeregionif currenttrendscontinue.

Impact of the global economic slowdown

As shown so far, unless accelerated progress takesplace,quiteanumberof countrieswillmissthetargetin2015.Thegeneralviewisthatthechallengetoreachthetargetsinthesecountrieshasbeencompoundedbytheglobaleconomiccrisis thatstarted in2008.Sincethemostrecentyearforwhichdataareavailableintheglobal MDG database is 2008, it is only possible toproject the likely impactof the economic slowdownon the progress towards achieving the MDGs. Suchprojections,however,havetheirowndifficulties.Chief among such difficulties is an accurate understandingof the determinants, including economic growth, of thevariousMDGs.Humandevelopmentoutcomesareinfluencedbyawiderangeof factors,includinginitialsocialandgeographicalconditions,policyinterventionsand,indeed,economicgrowth.

Despite such constraints, it is possible to explorehowprogresstowardsachievingtheMDGsmightbedifferentinthecontextof theglobaleconomiccrisis.To the extent that economic growth can createthe necessary conditions for achieving the humandevelopment outcomes, such projections can provideanindicationof howtheprogresstowardsvariousgoalsmightbeimpacted.



Figure A-4 –Progress in expanding access to basic sanitation


||

||

||||||||||

||||

|||||

|||

||||||||||||||||||||||

CambodiaNepalIndia

LaoPDRKiribati

PakistanAfghanistan

Micronesia(F.S.)SolomonIslands

IndonesiaBangladesh

VanuatuVietNam

ChinaPapuaNewGuinea

MyanmarMongolia

AzerbaijanPhilippinesDPRKorea

BhutanMarshallIslands

MaldivesPalau

SriLankaThailand

TuvaluIran(IslamicRep.of)

MalaysiaNorthernMarianaI.

TurkeyUzbekistan

RussianFederationArmenia

TajikistanKyrgyzstan

CookIslandsGeorgia

KazakhstanTonga

FrenchPolynesiaTurkmenistan

SamoaGuam

SingaporeRepublicofKorea

Niue

0 20 40 60 80 100

Earlyachiever Slow Regressing/Noprogress

| Target

Timor-Leste

Proportionofthepopulationusingimprovedsanitationfacilities(%)

On-track

44 PATHS TO 2015



Table A-4 – Summary of estimated population in deprivation, alternative scenarios, thousands

Note: * Cumulative number of deaths from 2009 to 2015.Source: Staff calculations based on the United Nations MDG database.

Table A-3 – Progress required for off-track countries to meet the basic sanitation target

India 814,909 4.00 530,619China 550,279 2.21 411,819Pakistan 99,607 2.71 73,981Indonesia 97,999 2.07 81,804Bangladesh 68,900 2.00 57,822RussianFederation 17,938 0.93 8,969Afghanistan 19,995 3.93 12,157Iran(IslamicRep.of) 13,507 0.57 6,754DPRKorea 10,004 1.37 5,002Nepal 18,099 3.50 14,464PapuaNewGuinea 4,256 4.07 2,035Cambodia 9,585 3.64 7,443Azerbaijan 4,083 4.79 2,027Mongolia 1,426 3.50 728Turkey 6,689 0.29 6,397Kyrgyzstan 411 0.50 206SolomonIslands 395 3.30 209Georgia 234 0.43 82Armenia 294 0.57 188Bhutan 249 2.29 146Kazakhstan 408 0.14 326Turkmenistan 110 0.14 55Micronesia(F.S.) 88 3.95 40Vanuatu 107 2.21 90FrenchPolynesia 6 0.14 3Tonga 4 0.29 2Guam 2 0.07 1Kiribati 0 2.80 0MarshallIslands 0 1.29 0Tuvalu 0 0.86 0

Total 1,739,584 1,223,369


(thousands)Country


(thousands)


(percentagepoints)

$1.25perdaypoverty 577,439 414,883 892,170Underweightchildren 73,952 47,206 85,260Primaryenrolment 16,918 3,838 26,556Under-5mortality* 22,862 17,934 24,873Skilledbirthattendance 20,157 7,305 20,806Basicsanitation 1,739,584 1,223,369 1,786,637


Off-trackcountries TotalAsia-Pacific

IndicatorAffectedpopulationin2015oncurrenttrend




TableA-5summarizestheadditionalnumberof peopleestimatedtobeindeprivationindevelopingcountriesin Asia and the Pacific in 2015 due to economicslowdown.Theestimationwascarriedoutintwosteps.Inthefirststep,thestatisticalrelationshipbetweeneachof theindicatorsandGDPgrowthwasestimatedonthebasisof developmentsthusfar.TheInternationalMonetary Fund (IMF) regularly provides projectionsof anumberof economicindicators,includingGDPgrowth,fortheworld.

ItsforecastspublishedinApril2008wereconsideredto pre-date the global economic crisis. The mostrecentupdateof suchforecastswasinApril2010.Thedifference in the projected GDP for 2015 betweenthe two updates was considered as the impact of the economic crisis. Thus in the second step, thisdifference and the estimated statistical relationshipbetween GDP growth and development indicatorswerecombinedtoarriveattheprojectedimpactof theeconomicslowdownontheprogressasmeasuredbytheindicator.

Twopoints standoutwith regard to theseestimates.First,theyarerelativelysmallincomparisontonumberof estimated deprived population for the region if current trends continue, as shown inTableA-5.Forinstance,morethan892millionpeopleareestimated

toremaininextremeincomepovertyinAsiaandthePacific in 2015 in the scenario of business as usualand no accelerated progress takes place. In contrast,theeconomicslowdownisestimatedtotrap35millionpeople in extreme income poverty, which is notinsignificant but relatively small. This number is justone-fourth of the number of people who could beliftedoutof povertyinthecurrentlyoff-trackcountriesif measures are taken and their countriesmanage toachievethetargetin2015.

Second,theIMF’smostrecentforecastssuggestthatquiteanumberof countriesintheregionwillescapetheeconomicslowdownorthattheslowdownisnotasdeepasoriginallythought.Forinstance,of the41countries for which GDP growth estimates areavailable,for12themostrecentprojections(April2010)for2008-2015areactuallyhigherthantheApril2008projections. For 29 countries, the projections wererevisedupcomparedtothose inOctober2009.Thisispartlythereasonfortherelativelysmallnumberof affectedpeopleduetotheeconomiccrisis.

Theseresultssuggestthatmuchcanbegainedintheregion in reducing human deprivation if effectivepoliciesandprogrammesareputinplacesoastospeeduptheprogressinreachingthevariousMDGtargets.

$1.25perdaypoverty 34,555Underweightchildren 887Under-5mortality* 1,352Skilledbirthattendance 1,730Basicsanitation 70,218

Table A-5 – number of people projected to be in deprivation in 2015

Note: * Commutative number of deaths from 2009 to 2015.Source: Staff calculations based on the United Nations MDG database.

Additionalnumberofpeopleestimatedtobeindeprivationdue

toeconomicslowdown(thousands)Indicator

4� PATHS TO 2015


Table A-� – Goal 1: Eradicate extreme poverty and hunger

Note: The number in parenthesis is the year of the data point. Source: United Nations MDG database.

Selected MDG Indicators

$1.25 per day poverty (%)

Earliest Latest

Underweight children (% under age 5)

Earliest Latest

East and North-East Asia China HongKong,China Macao,China DPRKorea RepublicofKorea MongoliaSouth-East Asia BruneiDarussalam Cambodia Indonesia LaoPDR Malaysia Myanmar Philippines Singapore Thailand Timor-Leste VietNamSouth and South-West Asia Afghanistan Bangladesh Bhutan India Iran(IslamicRep.of) Maldives Nepal Pakistan SriLanka TurkeyNorthandCentralAsia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan RussianFederation Tajikistan Turkmenistan UzbekistanPacific AmericanSamoa CookIslands Fiji FrenchPolynesia Guam Kiribati MarshallIslands Micronesia(F.S.) Nauru NewCaledonia Niue NorthernMarianaI. Palau PapuaNewGuinea Samoa SolomonIslands Tonga Tuvalu Vanuatu

60.2 (90) ... ... ... ...18.8 (95) ...48.6 (94)21.4 (05)55.7 (92) 2.0 (92) ...30.7 (91) ... 5.5 (92)52.9 (01)63.7 (93) ...66.8 (92) ...49.4 (94) 3.9 (90) ...68.4 (96)64.7 (91)15.0 (91) 2.1 (94)17.5 (96)15.6 (95) 4.5 (96) 4.2 (93)18.6 (93) 2.8 (93)44.5 (99)63.5 (93)32.1 (98) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

15.9 (05) ... ... ... ... 2.2 (08) ...25.8 (07)29.4 (07)44.0 (02) 2.0 (04) ...22.6 (06) ... 2.0 (04)37.2 (07)21.5 (06) ...49.6 (05)26.2 (03)41.6 (05) 2.0 (05) ...55.1 (04)22.6 (05)14.0 (02) 2.6 (06) 3.7 (07) 2.0 (05)13.4 (05) 2.0 (07) 3.4 (07) 2.0 (07)21.5 (04)24.8 (98)46.3 (03) ... ... ... ... ... ... ... ... ... ... ... ... ...35.8 (96) ... ... ... ... ...

19.1 (90) ... ...60.0 (98) ...12.3 (92) ...39.8 (93)34.0 (95)44.0 (93)23.3 (93)32.4 (90)33.5 (90) ...18.6 (93)42.6 (02)44.9 (94)48.0 (97)67.4 (92) ...53.4 (93)15.7 (95)38.9 (94)48.7 (95)40.4 (91)37.7 (93)10.4 (93) 3.9 (98)10.1 (96) 3.1 (99) 8.3 (95)11.0 (97) ...17.4 (05)12.0 (00)18.8 (96) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

6.9 (05) ... ...23.4 (04) ... 6.3 (05) ...35.6 (05)28.2 (03)37.1 (06) 8.1 (05)31.8 (03)27.6 (03) 3.4 (00) 9.3 (05)48.6 (07)20.2 (06)39.3 (04)46.3 (07)18.7 (99)47.8 (05) 5.2 (04)30.4 (01)45.0 (06)37.8 (02)29.4 (00) 2.8 (08) 4.0 (05) 9.5 (06) 2.1 (05) 4.0 (06) 3.4 (06) 3.0 (95)17.6 (07)11.0 (05) 5.1 (06) ...10.0 (97) 7.9 (93) ... ...13.0 (99) ...15.0 (97) ... ... ... ... ...26.4 (05) ... ... ... ...15.9 (07)



Table A-� – Goal 2: Achieve universal primary education


Primaryenrolmentratio(%)

Earliest Latest

Reaching last grade(%)

Earliest Latest


...97.5 (01)81.1 (91) ...98.3 (99)95.7 (99)93.4 (91)83.4 (99)97.6 (91)77.5 (99)97.7 (99) ...95.5 (91) ...89.1 (08)68.9 (05)95.8 (99) ...90.5 (05)55.9 (99)85.0 (00)92.9 (99)97.9 (99)67.5 (99)57.0 (01)99.8 (01)90.4 (91)93.2 (01)88.8 (91)92.4 (04)94.8 (00)94.3 (99) ...96.7 (00) ...92.5 (07) ... ...98.7 (99) ... ...99.2 (99)88.1 (01) ... ... ... ... ...96.8 (99) ...94.2 (99)63.2 (03)88.2 (99) ...91.8 (99)

97.4 (91)97.9 (05)87.5 (09) ...99.0 (08)99.2 (08)97.3 (08)88.6 (08)98.7 (08)82.4 (08)96.1 (07) ...92.1 (08) ...90.1 (09)77.3 (08)94.5 (01) ...85.5 (08)88.4 (09)95.5 (07)99.7 (04)96.2 (08)73.6 (00)66.1 (08)99.5 (08)94.7 (08)92.9 (07)96.1 (08)99.0 (08)99.1 (08)91.0 (08) ...97.5 (08) ...90.6 (08) ...86.3 (99)89.5 (08) ... ...99.7 (02)66.5 (07) ...72.3 (07) ...98.5 (99) ...96.4 (00) ...94.1 (09)67.0 (07)99.2 (06) ...98.0 (05)

...99.3 (02) ... ...99.5 (99)87.2 (99)98.0 (03)48.6 (99)85.9 (01)54.3 (99)97.7 (02)55.2 (00)75.3 (01) ... ... ...82.8 (99) ... ...81.3 (99)62.0 (99)97.5 (00) ...58.0 (99) ...93.4 (05)97.8 (03)79.3 (01)96.6 (99)99.4 (99)95.9 (00)94.5 (99)94.8 (99)96.7 (99) ...99.5 (99) ... ...82.1 (99) ... ...69.7 (01) ... ... ... ... ... ... ... ...92.4 (99) ...94.6 (00) ...68.9 (99)

99.6(07)100.0(07) 99.6(08) ... 98.4(07) 94.9(07) 98.4(07) 54.4(07) 80.1(07) 66.8(07) 92.2(06) 73.9(07) 73.2(06) ... ... ... 92.1(05) ... 54.8(05) 90.1(08) 65.8(05) 87.8(02) ... 61.6(07) 69.7(04) 98.0(07) 94.2(07) 97.7(06) 98.4(08) 95.1(07) 99.0(08) 98.3(07) 95.2(07) 99.5(07) ... 98.7(07) ... ... 94.6(07) ... ... 81.4(03) ... ... 25.4(01) ... ... ... ... ... 95.9(00) ... 90.9(05) 62.6(01) 73.4(06)

Primarycompletionrate(%)

Earliest Latest

107.0(91)102.2(91) 96.4(99) ... 99.4(91) 90.0(99)100.0(91) 40.9(99) 93.5(91) 70.7(99) 91.0(91) 73.4(99) 87.5(99) ... 87.0(99) 70.5(07) 96.2(99) ... 59.5(00) 50.8(99) 69.9(99) 87.6(91)148.1(03) 51.1(91) 60.8(05)101.2(91) 90.1(91)100.8(01) 92.2(99) 85.8(99) 94.4(00) 95.2(99) 96.0(99) 95.1(99) ... 96.2(99) ... ...100.4(00) ... ...107.3(99) 97.5(99) ... 90.4(01) ... 85.4(99) ... 99.4(99) ... 95.3(99) ... 98.9(91)113.3(99) 85.2(99)

96.0(08) 95.3(05) 98.8(09) ... 98.7(08) 93.3(08)105.7(08) 79.5(08)106.4(08) 74.7(08) 96.0(07) 99.1(08) 92.3(07) ... 87.5(07) 79.8(08)102.3(01) 38.8(05) 54.5(08) 88.5(09) 93.6(07)116.8(07)112.9(08) 70.0(02) 60.3(08) 98.4(08) 93.4(08) 97.9(07)121.1(08) 99.7(08)106.1(09) 92.1(08) 95.2(08) 97.7(08) ... 94.7(08) ... 87.9(99) 91.8(08) ... ...124.8(05) 90.7(07) ... 79.0(07) ... 96.7(05) ...119.1(04) 46.5(91) 93.5(09) 72.1(91)104.9(06)105.3(06) 79.3(07)

48 PATHS TO 2015


Table A-8 – Goal 3: Promote gender equality and empower women


Gender parity index inprimary

Earliest Latest

Gender parity index insecondary

Earliest Latest


0.92 (91)1.01 (91)0.96 (91) ...1.01 (91)1.02 (91)0.94 (91)0.87 (99)0.98 (91)0.79 (91)0.99 (91)0.95 (91)0.99 (91) ...0.98 (91)0.93 (04)0.93 (99)0.55 (91)1.04 (05)0.85 (99)0.76 (91)0.90 (91)1.00 (99)0.63 (91)0.68 (00)0.96 (91)0.93 (91)1.01 (01)0.99 (91)1.00 (91)1.01 (99)0.99 (99)1.00 (91)0.98 (91) ...0.98 (91) ... ... (...)1.00 (91) ... ...1.01 (99)0.98 (99)0.99 (04)1.16 (00) ...1.00 (99) ...0.93 (99)0.85 (91)0.98 (99)0.87 (91)0.98 (91)1.02 (99)0.96 (91)

1.04 (08)0.98 (05)0.95 (09) ...0.98 (08)0.99 (08)1.00 (08)0.94 (08)0.97 (08)0.91 (08)1.00 (07)0.99 (08)0.98 (08) ...0.98 (09)0.94 (08)0.95 (01)0.66 (08)1.06 (08)1.01 (09)0.97 (07)1.40 (08)0.94 (08)0.86 (02)0.83 (08)1.00 (08)0.97 (08)1.02 (08)0.99 (08)0.98 (08)1.00 (09)0.99 (08)1.00 (08)0.96 (08) ...0.98 (08) ...0.95 (99)0.99 (08) ... ...1.02 (07)0.97 (07)1.01 (07)1.06 (08) ...0.95 (05) ...1.02 (07)0.84 (06)0.98 (09)0.97 (07)0.97 (06)0.99 (06)0.96 (07)

0.75 (91)1.05 (91)1.11 (91) ...0.96 (91)1.14 (91)1.09 (91)0.53 (99)0.83 (91)0.69 (99)1.05 (91)0.97 (91)1.09 (99) ...0.99 (91)0.99 (04)0.90 (99)0.51 (91)0.98 (99)0.81 (99)0.70 (99)0.75 (91)1.09 (99)0.46 (91)0.48 (91)1.09 (91)0.62 (91)1.12 (91)1.01 (91)0.97 (91)1.00 (99)1.02 (91)1.00 (03)0.86 (99) ... (...)0.98 (99) ... ... (...)0.97 (91) ... ...1.18 (99)1.06 (99)1.05 (04)1.21 (00) ...1.10 (99) ...1.07 (99) ... (...)1.10 (99)0.61 (91)1.03 (91) ... (...)0.80 (91)

Gender parity index intertiary

Earliest Latest

1.05 (08)1.02 (08)0.96 (09) ...0.96 (08)1.08 (08)1.02 (08)0.82 (07)0.99 (08)0.81 (08)1.07 (07)1.01 (07)1.09 (08) ...1.09 (09)1.00 (05)0.92 (01)0.38 (07)1.05 (07)0.99 (09)0.86 (07)0.98 (08)1.05 (06)0.89 (06)0.76 (08)1.02 (04)0.89 (08)1.05 (08)0.98 (08)0.96 (08)0.98 (09)1.01 (08)0.97 (08)0.87 (08)1.02 (91)0.98 (08) ...1.08 (99)1.07 (08) ... ...1.20 (07)1.02 (07)1.07 (05)1.23 (08) ...1.07 (05) ...0.97 (07)0.62 (91)1.13 (09)0.84 (07)1.03 (06)0.93 (01)0.86 (04)

0.83 (03)0.96 (03)0.48 (91) ...0.49 (91)1.89 (91)1.04 (91)0.34 (00)0.76 (01)0.49 (99)1.02 (99) ... (...)1.26 (99) ...0.94 (91)1.27 (02)0.76 (99)0.28 (03)0.49 (99)0.58 (99)0.54 (91)0.40 (91)2.41 (03)0.33 (91)0.81 (02) ... (...)0.53 (91)1.05 (91)0.67 (91)0.91 (91)1.15 (99)1.04 (99)1.27 (91)0.35 (99) ... (...)0.82 (99) ... ...1.20 (03) ... ... ...1.29 (01) ... ... ... ... ...2.35 (00) ... (...)1.04 (99) ...1.30 (99) ...0.57 (02)

1.04 (08)1.02 (07)0.91 (08) ...0.69 (08)1.57 (08)1.99 (08)0.54 (08)0.92 (08)0.78 (08)1.29 (07)1.37 (07)1.24 (08) ...1.24 (09)0.71 (09)0.73 (01)0.28 (04)0.55 (07)0.59 (08)0.70 (07)1.14 (08)2.40 (04)0.40 (04)0.85 (08)0.48 (91)0.78 (08)1.20 (07)0.83 (08)1.19 (08)1.45 (09)1.36 (08)1.36 (08)0.40 (08)1.15 (91)0.68 (08) ... ...1.20 (05) ... ... ...1.30 (03) ... ... ... ... ...2.15 (02)0.55 (99)0.93 (01) ...1.62 (04) ...0.59 (04)



Table A-9 – Goal 4: Reduce child mortality


Under-5 mortality rate(per1,000livebirths)

1990 2008

Infantmortalityrate(per1,000livebirths)

1990 2008


46 ... ... 55 9 98 11117 86157 18120 61 7 32184 56260149148116 73111142130 29 84 56 98 47 60 75 27117 99 74 ... 18 22 ... ... 89 49 58 21 (95) ... ... ... 21 91 50 38 23 53 27

21 ... ... 55 5 41

7 90 41 61 6 98 32 3 14 93 14

257 54 81 69 32 28 51 89 15 22

23 36 30 30 38 13 64 48 38

... 15 18 ... ... 48 36 39 45 ... ... ... 15 69 26 36 19 36 33

37 ... ... 42 8 71 9 85 56108 16 85 42 6 26 138 39168103 91 83 55 79 99101 23 69 48 78 41 51 63 23 91 81 61 ... 16 19 ... ... 65 39 45 19 (95) ... ... ... 18 67 40 31 19 42 23

18 ... ... 42 5 34

6 69 31 48 6 71 26 2 13 75 12

165 43 54 52 27 24 41 72 13 20

21 32 26 27 33 12 54 43 34

... 14 16 ... ... 38 30 32 36 ... ... ... 13 53 22 30 17 30 27

50 PATHS TO 2015


Table A-10 – Goal 5: Improve maternal health


Skilled birth attendance(%)

Earliest Latest

Antenatal care (≥ 1 visit)(%)

Earliest Latest


94.0(90) ... ... 98.0(90) ... 93.6(98) 98.0(94) 34.0(98) 40.7(90) 19.4(01) 92.8(90) 46.3(91) 52.8(93) ... 99.3(00) 25.8(97) 77.1(97) 12.4(00) 9.5(94) 14.9(94) 34.2(93) 86.1(97) 90.0(94) 7.4(91) 18.8(91) 94.1(93) 75.9(93) 96.4(97) 99.8(98) 96.6(90) 99.6(95) 98.1(97) 99.2(90) 79.0(96) 95.8(96) 97.5(96) ... 99.0(91)100.0(98) ... ... 72.0(94) 94.9(98) 92.8(99) ... ... 99.0(90) ... 99.0(90) 53.2(96) 76.0(90) 85.0(94) 92.0(91)100.0(90) 87.0(94)

98.4(07) ... ... 97.1(04)100.0(97) 99.2(06) 99.0(99) 43.8(05) 79.4(07) 20.3(06) 98.0(05) 57.0(01) 61.8(08)100.0(98) 97.3(06) 18.4(03) 87.7(06) 14.3(03) 18.0(07) 71.4(07) 46.6(06) 97.3(05) 84.0(04) 18.7(06) 38.8(07) 98.5(07) 91.3(08) 99.9(07) 88.0(06) 98.3(05) 99.8(06) 97.6(06) 99.5(06) 88.4(07) 99.5(06) 99.9(06) ... 98.0(01) 99.0(00) ... ... 63.0(05) 86.2(07) 87.7(01) 97.4(07) ...100.0(06) ...100.0(02) 53.0(06)100.0(98) 70.1(07) 95.0(01) 97.9(07) 74.0(07)

78.7 (95) ... ... ... ...89.8 (98) ...34.3 (98)76.3 (91)26.5 (01)73.6 (03)75.8 (97)83.1 (93) ...85.9 (96)70.9 (97)70.6 (97)36.9 (00)25.7 (94)51.0 (00)61.9 (93)76.5 (97) ...15.4 (91)25.6 (91)80.2 (93)62.3 (93)82.0 (97)98.3 (97)74.0 (97)92.5 (95)97.3 (97) ...71.3 (00)98.1 (00)94.9 (96) ... ... ... ... ... ... ... ... ... ... ... ... ...77.5 (96) ... ... ... ... ...

90.9(07) ... ... ... ... 98.9(05)100.0(94) 69.3(05) 93.3(07) 35.1(06) 78.8(05) 75.6(01) 91.0(08) ... 97.8(06) 60.5(03) 90.8(06) 16.1(03) 51.2(07) 88.0(07) 74.2(06) 98.3(05) 81.0(01) 43.7(06) 60.9(07) 99.4(07) 92.0(08) 93.0(05) 76.6(06) 94.3(05) 99.9(06) 96.9(06) ... 88.8(07) 99.1(06) 99.0(06) ... ... ... ... ... 88.0(94) 81.2(07) ... 94.5(07) ... ... ... ... 78.8(06) ... 73.9(07) ... 97.4(07) 84.3(07)



Table A-11 – Goal �: Combat HIV and AIDS, malaria and other diseases


HIV prevalence(% ages 15-49)

2001 2007

TB incidence rate(per100,000)

1990 2008


0.1 ... ... 0.1 0.1 0.1

... 1.8 0.1 0.1 0.3 0.9 0.1 0.1 1.7 ... 0.3

... 0.1 0.1 0.5 0.1 0.1 0.5 0.1 0.1 ...

0.1 0.1 0.1 ... 0.1 0.5 0.1 ... 0.1

... ... 0.1 ... ... ... ... ... ... ... ... ... ... 0.3 ... ... ... ... ...

0.1 ... ... 0.1 0.1 0.1

... 0.8 0.2 0.2 0.5 0.7 0.1 0.2 1.4 ... 0.5

... 0.1 0.1 0.3 0.2 0.1 0.5 0.1 0.1 ...

0.1 0.2 0.1 ... 0.1 1.1 0.3 ... 0.1

... ... 0.1 ... ... ... ... ... ... ... ... ... ... 1.5 ... ... ... ... ...

120140120340190210 70590190180120400390 66140500200190220310170 36150160230 66 58 33110110140140110 92 64130 21 0 51 38 52 (92)510300190 85100 59 80 64250 32310 34300140

TB prevalence rate(per100,000)

1990 2008

97 91 78340 88210

65490190150100400280 39140500200

190220160170 20 42160230 66 30

73110110180160110200 68130

3 20 20 22 58360210 93 12 21 0 38 63250 18120 24160 74

260 120 100 890 170 410

551,400 460 410 1801,1001,000 43 180 620 380

280 550 380 340 48 270 350 660 96 53

47 230 240 230 270 230 160 20 260

29 1 59 38 111,200 750 94 44 88 180 64 83 550 21 630 39 76 82

88 58 49270 50140

43680210260120470550 27160660280

270410 96190 23 13170310 73 22

67140 42 98140 69330 18190

1 32 25 6 61110 59 34 10 10 0 11110130 36150 22 44 88

52 PATHS TO 2015


Table A-12 – Goal �: Ensure environmental sustainability


Forestcover(%landarea)

1990 2005

Protectedarea(%territorialarea)

1990 2009


16.8 a ... ...68.164.5 7.359.473.364.375.068.159.635.5 3.431.265.028.8 2.0 6.864.621.5 6.8 3.033.7 3.336.412.612.311.339.7 1.3 4.447.92.9 8.8 7.491.963.953.628.747.1 3.0 ...90.6 ...39.266.275.382.969.645.998.9 5.033.336.1

21.2 a ... ...51.463.5 6.552.859.248.869.963.649.024.0 3.428.453.739.7 1.3 6.768.022.8 6.8 3.025.4 2.529.913.210.011.339.7 1.2 4.547.9 2.9 8.8 8.089.466.554.728.747.13.0...90.6...39.254.272.487.665.060.477.65.033.336.1

13.0741.09 ... 2.71 3.29 4.10

23.57 0.03 3.96 0.8413.57 2.58 1.86 2.5912.45 0.00 3.12

0.43 1.2814.25 4.79 5.06 ... 7.69 9.9913.35 1.78

6.93 6.18 2.55 2.40 6.36 7.82 1.94 2.99 2.12

2.02 0.00 0.15 0.01 3.29 0.34 0.00 0.06 ... 1.06 0.00 0.03 0.45 0.93 0.94 0.01 0.01 0.00 0.39

CO2emissions(metrictonspercapita)

1990 2007

16.0641.79 ... 2.73 3.5413.39

28.3922.16 6.3916.3214.50 5.20 3.29 3.5516.92 6.36 4.85

0.43 1.4628.35 5.12 6.84 ...17.0010.0014.48 1.94

7.99 7.15 3.39 2.52 6.94 9.02 4.14 2.99 2.26

2.03 0.05 0.18 0.07 3.5620.21 0.62 0.09 ... 1.10 1.86 0.08 4.80 1.37 1.18 0.12 2.53 0.19 0.47

2.15 4.85 2.7812.15 5.62 4.5324.98 0.05 0.84 0.06 3.13 0.10 0.7115.56 1.69 0.19(02) 0.32 0.21 0.13 0.23 0.80 4.00 0.71 0.03 0.59 0.22 2.69 1.07(92) 5.93(92) 2.87(92)15.90(92) 2.47(92)13.96(92) 3.86(92) 7.23(92) 5.30(92) ... 1.24 1.13 3.23 ... 0.31 1.02 0.51(99)14.43 9.49 1.74 ...15.74 0.52 0.77 0.51 0.81 ... 0.47

4.92 5.75 3.03 2.9810.49 4.05

19.76 0.31 1.77 0.25 7.32 0.27 0.8012.08 4.14 0.17 1.29

0.03 0.28 0.86 1.38 6.85 2.99 0.12 0.90 0.62 3.95

1.65 3.68 1.3814.76 1.1410.83 1.07 9.20 4.32

... 3.38 1.74 3.08 ... 0.35 1.67 0.5614.0911.75 2.57 ...10.49 0.52 0.90 0.40 1.71 ... 0.45



Table A-13 – Goal �: Ensure environmental sustainability


ODPsubstanceconsumption(ODPmetrictons)

Earliest 2008

Safe drinking water(%population)

1990 2008


59,674.0 (90) ... ... 192.0 (91) 0.0 (91) 0.0 (91) 0.0 (91) 0.0 (91) 80.8 (91) 0.0 (90) 4,193.7 (90) 16.6 (92) 3,477.2 (90) 4,855.2 (90) 6,984.2 (90) 0.3 (91) 430.0 (91) 0.0 (91) 202.1 (90) 0.0 (91) 0.0 (90) 1,393.9 (90) 4.5 (90) 25.0 (91) 1,455.8 (90) 218.2 (90) 4,361.0 (90) 0.0 (91) 2.8 (91) 94.8 (91) 2,355.9 (90) 133.5 (91)130,578.5 (90) 93.3 (91) 145.2 (90) 4.4 (91) ... 0.1 (91) 41.8 (90) ... ... 0.0 (91) 1.2 (90) 0.0 (91) 0.0 (91) ... 0.0 (91) ... 0.0 (91) 28.5 (91) 4.0 (91) 2.1 (90) 0.4 (91) 0.0 (91) 0.0 (91)

67 ... ... 100 90 (95) 58 ... 35 71 44 (95) 88 57 84 100 91 52 (00) 58 3 (95) 78 91 (00) 72 91 90 76 86 67 85 92 (95) 70 81 96 78 (95) 93 58 (95) 83 (95) 90 ... 94 ... 100 100 48 95 89 ... ... 100 98 81 41 91 69 (95) 100 (95) 90 57

Basic sanitation(%population)

1990 2008

89 ... ... 100 98 76 ... 61 80 57 100 71 91 100 98 69 94 48 80 92 88 93 (00) 91 88 90 90 99 96 80 98 95 90 96 70 84 (05) 87 ... 95 (05) ... 100 100 64 (05) 94 94 (05) ... ... 100 98 84 (05) 40 88 (05) 70 (05) 100 97 83

41 ... ... 59(95) 100 49(95) ... 9 33 18(95) 84 49(95) 58 99 80 32(00) 35 29(95) 34 62(00) 18 83 69 11 28 70 84 88(95) 57(95) 96 96 93(95) 87 89(95) 98 84 ... 96 ... 98 99 26 64 29 ... ... 100 84 69 47 98 30(95) 96 80 35(95)

55 ... ... 59 (00) 100 50 ... 29 52 53 96 81 76 100 96 50 75 37 53 65 31 83 (00) 98 31 45 91 90 90 45 95 97 93 87 94 98 100 ... 100 ... 98 99 35 (05) 73 25 (05) ... ... 100 94 (05) 83 (05) 45 100 32 (05) 96 84 52

17,386.3 ... ... 91.2 4,050.2 2.6 7.6 9.3 299.9 3.6 571.2 2.0 397.4 149.5 1,197.5 2.7(07) 277.5 47.9 223.1 0.1 2,904.9 508.6 3.7 1.4 356.9 10.3 762.5 18.4 0.8 5.9 128.8 12.4 1,457.6 3.9 10.1 2.3 ... 0.0 4.8 ... ... 0.2 0.2 0.2 0.0(07) ... 0.0 ... 0.1 1.5 0.1 1.2 0.2 0.0 1.0

54 PATHS TO 2015

ADB(2009).Asian Development Outlook 2009: Rebalancing Asia’s Growth.Manila,ADB.

ADB(2007).Inequality in Asia, Key Indicators 2007,Vol38,Manila,ADB.

ADB (2008). The emerging Asian Regionalism, Manila,ADB.

ADB/JBIC/WorldBank (2005).Connecting East Asia: A New Framework for Infrastructure.Manila,ADB.

ADBI/ADB (2009). Infrastructure for a seamless Asia.Tokyo,ADBI/ADB.

Banerjee,A.andE.Duflo. (2006).The Economic Lives of the Poor.MITDepartmentof EconomicsWorkingPaperSeries.No.06-29.

Chand, R. (2008). “The State of Indian AgricultureandProspectsfortheFuture”,inKanchanChopraandC.H.HanumanthaRao(Ed)Growth Equity, Environment and Population,NewDelhi,SagePublicationsIndia.

Chatterjee, S., A. Mukherjee and R. Jha (2010).Approaches to Combat Hunger in Asia and the Pacific, Sustainable Development Working Paper Series. No.11,August.Manila,ADB.

Chatterjee, S. et.al. (2004) Scaling up Poverty Reduction Potential of Infrastructure Projects: Lessons From the Asia Pacific Region,Manila,ADB.

Chhibber, A., J. Ghosh and T. Palanivel (2009).Asia Rebounds But Lasting Recovery Needs New Paradigm: A Synthesis Study Incorporating Evidence from Country Case Studies.Bangkok,UNDPRegionalCentreinAsiaandthePacific.

CommissiononAIDSinAsia(2008).Redefining AIDS in Asia: Crafting an Effective Response,NewDelhi,OxfordUniversityPress.

ESCAP (2009).Sustainable Agriculture and Food Security in Asia and the Pacific(UnitedNationspublication,SalesNo.E.09.II.F.12).

ESCAP(2010a).Economic and Social Survey of Asia and the Pacific 2010.

ESCAP(2010b).Financing an Inclusive and Green Future. A Supportive Financial System and Green Growth for Achieving the Millennium Development Goals in Asia and the Pacific,Bangkok,UnitedNations.

ESCAP/ADB/UNDP(2005).A Future Within Reach: Reshaping institutions in a region of disparities to meet the MDGs.Bangkok,UnitedNations.

ESCAP/ADB/UNDP(2006).Pursuing Gender Equality through the Millennium Development Goals in Asia and the Pacific.Manila,ADB.

ESCAP/ADB/UNDP (2010). Achieving the MDGs in an Era of Global Uncertainty.Bangkok,UnitedNations.

Fan,S.andA.Saurkar.(2006).Public Spending in Developing Countries: Trends, Determination and Impact(mimeo).

FAO (2009a). The State of Food Insecurity in the World.Rome,FAO.

FAO (2009b). Women, Agriculture and Food Security.Rome,FAO.

Francis,N.G.andM.A.Akoy(2008).Who Are the Net Food Importing Countries,PolicyResearchWorkingPaper4457,WashingtonDC,WorldBank.

Heyzer, N. and M. Khor (1999) “Globalization andthewayforward”,DevelopmentOutreach“Speaker’sCorner”Washington,D.C.:WorldBank.

Hogan M. et al. (2010) “Maternal Mortality for 181countries1980–2008”inThe Lancet.April12.

India,G.O.(2002).The Tenth Five Year Plan, 2002-2007.NewDelhi,Governmentof India.

India, G. O. (2009). Government of India, LabourBureau.http://labourbureau.nic.in

International Organization for Migration (2005).Migration, Development and Poverty Reduction in Asia.Geneva,IOM.

Jung, J. and C. Tran (2008). The Macroeconomics of Health Savings Accounts, CAEPR Working PaperNo.2007-023.

References


REFEREnCES

Kumar, N. (2009). “South-South and TriangularCooperationinAsia-Pacific:TowardsaNewParadigmin Development Cooperation”, UNESCAP WorkingPaper(WP/09/05).

Miller,J.andY.Rodgers(2009).“Mother’sEducationand Children’s Nutritional Status: New Evidencefrom Cambodia” In Asian Development Review. 26 (1).pp.117-138.

Moestue,H.andS.Huttly(2007).“AdultEducationandChildNutrition:TheRoleof FamilyandCommunity”inJournal of Epidomology and Community Health.62.pp.153-159).

OECD-DAC (2010). Development Cooperation Report.Paris,OECD-DAC.

Pacific Island Forum Secretariat (2010). 22nd Post Forum Dialogue, Thematic Discussion: Global Challenges.Suva,PacificIslandForum.

Ravindra A. (2004), An Assessment of the Impact of Bangalore Citizen Report Cards on the Performance of Public Agencies,OEDECDWorkingPaperNo12.WashingtonDC,WorldBank.

Singh, A. (2008). Do School Meals Work? Treatment Evaluation of the Midday Meal Scheme in India. YoungLivesStudentPaper.Oxford,Universityof Oxford.

SPC(2009).Solomon Islands Family Health and Safety Study: a study on violence against women and children, Secretariatof thePacificCommunity(SPC).

Thomas, V. (2001). “Revisiting the Challenge of Development”, in Frontiers of Development Economics,G.M.MeierandJ.Stiglitz(ed),2001.NewYork,OxfordUniversityPress.

UNDP(2008).Technical Report, Rising Food and Fuel Prices in Asia and the Pacific: Causes, Impacts and Policy Responses.Bangkok,UNDP.

UNDP(2010a).Power Voice and Rights: A Turning Point for Gender Equality in Asia and the Pacific. Asia-PacificHumanDevelopmentReport.NewDelhi,MacmillanIndia.

UNDP(2010b).ProgressonMDG6and3:Perspectivesof women livingwithHIV in India,Philippines andPapuaNewGuinea,Bangkok,Thailand.

UNESCO(2010).EFA Global Monitoring Report 2010,Paris,UNESCO.

United Nations (2010). Millennium Development Goals Report 2010.NewYork,UnitedNations.

United Nations Population Division (2010). World Urbanization Prospects: The 2009 Revision. New York,UnitedNationsPopulationDivision.

Wan,G.andR.Francisco(2009).Why is Access to Basic Services Not Inclusive? A Synthesis with a Special Focus on Developing Asia. ADB Sustainable DevelopmentWorkingPaperSeriesNo.6.Manila,ADB.

WFP(2010).Countries:Afghanistan.http://www.wfp.org/countries/afghanistan

WHO (2009). Investing in maternal, newborn and child health: The case for Asia and the Pacific.Geneva,WHO.

WHO(2010).Health Financing Strategy for the Asia Pacific Region.Geneva,WHO.

WHOandUNICEF(2010).Countdown to 2015: Decade report (2000–2010). Taking stock of maternal, newborn and child survival.Geneva,WHO.

World Bank (2008). World Development Report. WashingtonDC:TheWorldBank.

World Bank (2009).World Development Indicators 2009.WashingtonDC:TheWorldBank.

World Bank (2010).World Development Indicators 2010.WashingtonDC:TheWorldBank.

Printed in BangkokSeptember 2010

United Nations publicationSales No. E.10.II.F.20Copyright © United Nations 2010ISBN: 978-92-120618-0

www.unescap.org www.undp.orgwww.adb.org

There are only five years left to reach 2015 in achieving the MDGs. World leaders are once again gathering at

the United Nations High-level Plenary Meeting on the MDGs in September 2010 in New York to assess some

of the likely outcomes on present trends, identify some of the weakest areas of performance, and identify

priorities for accelerated action.

This report on Paths to 2015 is the Asia-Pacific region’s contribution to that assessment. It uses the latest

information from the United Nations MDG database to assess which countries and subregions are likely to

miss or achieve the Goals. It attempts to encapsulate and update the discussions and recommendations of

the earlier reports on MDGs, jointly published by ESCAP, ADB and UNDP since 2004. It looks at some of

the key drivers which have propelled MDG achievement in the region, and which are likely to remain as

important as before in the region’s quest for reaching the Goals by 2015. It focuses specifically on three areas

where increased and sustained policy attention would be required: hunger and food security; health and

basic services; and basic infrastructure – areas where many of the countries in the region appear to be

facing significant challenges.

This report is the fifth in the series published by ESCAP, ADB and UNDP on MDG achievement. It is a resource

which policy makers, development practitioners and other stakeholders should find useful in addressing

the remaining challenges in achieving the MDGs.

asia-pacific mdg report 2010/11 - united nations … priorities in asia and the pacific ... guidance...

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