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Millennium Development Goals for Health: What Will It Take to Accelerate Progress?</h1> </div> <div class="leftcol"> <div class="leftblock twocol"> <div style="display:none;visibility:hidden;" id="highlight" class="contentblock searchresults"> <form method="post" action="/web/20091207083857/http://www.dcp2.org/sdirect/_/main/ViewChapterSection,$Form.html" name="Form" id="Form"> <div style="display:none;"><input type="hidden" name="formids" value="highlighting"/> <input type="hidden" name="submitmode" value=""/> <input type="hidden" name="submitname" value=""/> </div> <label class="highlight">highlighting</label> <input type="radio" name="highlighting" value="0" onclick="this.form.submit()" id="highlighton"/>Yes <input type="radio" name="highlighting" checked="checked" value="1" onclick="this.form.submit()" id="highlightoff"/>No </form> </div> </div> <div class="leftblock twocol"> <div class="left_col"> <div class="left_col_block color"> <h3>CHAPTER INFO</h3> <div class="contentblock"> <p> Editors/Authors: Adam Wagstaff, Mariam Claeson, Robert M. Hecht, Pablo Gottret, and Qiu Fang<br/> Pages: 14<br/> </p> <div class="normal"> <ul> <li><a href="https://web.archive.org/web/20091207083857/http://files.dcp2.org/pdf/DCP/DCP09.pdf" target="_blank"> Download PDF Version</a> </li> <li><a href="javascript:popup_window();" id="howtocite"> How To Cite</a></li> </ul> <p> <strong>Region</strong> <br/> <span id="regions"> <a href="/web/20091207083857/http://www.dcp2.org/regions/1/east-asia-and-pacific" id="country_1"> East Asia and Pacific </a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/regions/51/latin-america-and-the-caribbean" id="country_51"> Latin America and the Caribbean </a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/regions/157/south-asia" id="country_157"> South Asia </a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/regions/166/subsaharan-africa" id="country_166"> Sub-Saharan Africa </a> <br/> </span> </p> <p> <strong>Disease / Condition</strong> <br/> <span id="diseases"> <a href="/web/20091207083857/http://www.dcp2.org/diseases/2" id="disease_2"> Adolescent & Childhood Diseases</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/18" id="disease_18"> Diarrheal Disease</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/25" id="disease_25"> Helminth Infections</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/28" id="disease_28"> HIV/AIDS</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/31" id="disease_31"> Infectious Diseases</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/37" id="disease_37"> Learning & Developmental Disabilities</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/42" id="disease_42"> Malaria</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/44" id="disease_44"> Maternal Conditions</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/47" id="disease_47"> Neonatal Conditions</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/50" id="disease_50"> Nutrition</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/55" id="disease_55"> Respiratory Diseases</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/66" id="disease_66"> Tropical Diseases</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/67" id="disease_67"> Tuberculosis</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/69" id="disease_69"> Vaccine-Preventable Diseases</a> <br/> <a href="/web/20091207083857/http://www.dcp2.org/diseases/71" id="disease_71"> Women's Health</a> <br/> </span> </p> </div> </div> </div> <div class="left_col_block color" id="customBookBox"> <h3>CUSTOM BOOKS</h3> <div class="contentblock"> <p>Select, organize, download, and save your choice of chapters into a single PDF file for printing and distribution. This is a free service.</p> <p> <a href="/web/20091207083857/http://www.dcp2.org/page/main/MyDCPP.html" id="link_custombook">My DCPP</a><br/> Log in to view your saved custom books </p> </div> </div> </div> <div class="right_col"> <div class="contentblock"> <div id="content"> <h2 id="_sectiontitle">Scaling Up: Defining Interventions and Removing Constraints</h2> <p>A lack of interventions is not the primary obstacle to faster progress toward the goals, although new interventions that can be delivered by weak health systems could greatly improve progress—for example, malaria or HIV vaccines and effective vaginal microbicides to block the spread of HIV and other sexually transmitted infections. The main obstacle is the low levels of use—especially among the poor—of existing effective interventions. For example, if use of all the proven effective preventive and treatment interventions for childhood illness were to rise from current levels to reach all, the number of under-five deaths worldwide could fall by as much as 63 percent (<a class="text-ref" href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/1000#1055">World Bank 2003b</a>).</p><a name="953"> </a> <h3>Array of Interventions, Programs, and Service Modalities</h3><br/> <p>The available interventions constitute a powerful arsenal for preventing and treating the main causes of malnutrition and death (<a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Table/9.1">table 9.1</a>).<sup>1</sup> The major diseases and conditions that the MDGs aim to prevent and control are discussed in several chapters (for example, see chapters 15, 19, 21-24, 28-31, 44, and 45). The most cost-effective interventions and programs are also discussed in several chapters (see chapters 59-62 and 65). The chapters dealing with health systems and service delivery issues and other constraints related to the health MDGs are found in the latter part of the book (see chapters 66-68, and 73).</p><br/><a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Table/9.1">[Table .]</a><br/> <p>In the case of child mortality, for example, diarrheal diseases, pneumonia, and malaria account for 52 percent of deaths worldwide (<a class="text-ref" href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/1000#1055">World Bank 2003b</a>). For each of these major causes of childhood mortality, at least one proven effective preventive intervention and at least one proven effective treatment intervention exist, capable of being delivered in a low-income setting. In most cases, several proven effective interventions exist. For diarrhea—the second-leading cause of child deaths—no fewer than five proven preventive interventions and three proven treatment interventions are available.</p><a name="955"> </a> <h3>Effective Interventions Reaching Too Few People</h3><br/> <p>The high rates of malnutrition and death in the developing world have several causes. First, people do not receive the effective interventions that could save their lives or make them well nourished. In middle- and high-income countries, 90 percent of children are fully immunized, more than 90 percent of deliveries are assisted by a medically trained provider (that is, a doctor, nurse, or trained midwife, excluding traditional birth attendants), and more than 90 percent of pregnant women have at least one prenatal visit (<a class="text-ref" href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/1000#1046">UNICEF 2001</a>). In South Asia, fewer than 50 percent of pregnant women receive a prenatal checkup, and only 20 percent of deliveries are assisted by a trained provider.</p> <p>The story is similar for other childhood interventions—and for interventions for other goals. Condom use to prevent transmission of HIV is low in much of Sub-Saharan Africa and South Asia, and inexpensive one-time treatment with antiretroviral medicine to prevent transmission from mother to child covers only a small fraction of at-risk pregnant women in most of the developing world. In Asia, where more than 7 million people are living with HIV/AIDS, no country has yet exceeded 5 percent antiretroviral therapy coverage among those who could benefit from it (<a class="text-ref" href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/1000#1056">World Bank 2003c</a>).</p> <p>Just as shortfalls in coverage vary across countries, so do they vary within countries, with the poor and other deprived groups consistently lagging. These groups are less likely to receive full basic immunization coverage, to have their deliveries attended by a trained provider, and to have at least one prenatal care visit to a medically trained provider. On the positive side, the poor are often making fastest progress in coverage, reflecting in part that the better off already have high coverage rates for many interventions.</p><a name="956"> </a> <h3>Underuse of Effective Interventions Costs Lives</h3><br/> <p>The low use of effective interventions—in the developing world in general and among the poor in particular—translates into rates of mortality, morbidity, and malnutrition that are far higher than necessary. If use of all the proven effective childhood preventive and treatment interventions, for example, were to rise from their current levels to 99 percent—95 percent for breastfeeding—the number of under-five deaths worldwide could fall by as much as 63 percent (<a class="text-ref" href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/1000#1019">Jones and others 2003</a>). Deaths from malaria and measles could be all but eliminated, and deaths from diarrhea, pneumonia, and HIV/AIDS could be reduced dramatically. If coverage rates of the key maternal mortality interventions were increased from current levels to 99 percent, an estimated 391,000 maternal deaths worldwide (74 percent of current maternal deaths) might be averted (<a class="text-ref" href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/1000#1037">Ramana 2003</a>). One intervention stands out as especially important: access to essential obstetric care, which accounts for more than half the maternal deaths averted.</p></div> </div> <div class="contentblock"> <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/940" id="prevSection"> < Previous Section </a>  |  <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/957" id="nextSection"> Next Section > </a> </div> </div>  </div> </div> <div class="rightcol"> <div class="rightblock nextprev"> <div class="contentblock"> <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/8/FullText" id="previous_chapter">< Previous Chapter</a>  |  <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/10/FullText" id="next_chapter">Next Chapter ></a> </div> </div> <div class="rightblock detail"> <div class="contentblock normal"> <h3>Chapter Sections</h3> <ul id="outlines" class="normal"> <li class=""><a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/934" id="link_chapter_section_35314"> Intro </a> </li> <li class=""><a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/940" id="link_chapter_section_34670"> The Millennium Development Goals for Health: Progress and Prospects </a> </li> <li class="on"><a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/952" id="link_chapter_section_34671"> Scaling Up: Defining Interventions and Removing Constraints </a> </li> <li class=""><a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/957" id="link_chapter_section_34672"> What Do Countries Need To Do? </a> </li> <li class=""><a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/982" id="link_chapter_section_34673"> Costing and Financing Additional Spending for the MDGs </a> </li> <li class=""><a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Section/1000" id="link_chapter_section_34674"> References </a> </li> </ul> <div id="chapterparts"> <h3> Boxes </h3> <ul id="boxes" class="normal"> <li> 9.1 <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Box/9.1" id="link_chapterPart_117738"> The Health-related Millennium Development Goals </a> </li><li> 9.2 <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Box/9.2" id="link_chapterPart_117856"> Estimating the Cost of Scaling Up to Achieve the MDGs </a> </li> </ul> <h3> Tables </h3> <ul id="tables" class="normal"> <li> 9.1 <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Table/9.1" id="link_chapterPart_117414"> Effective Interventions to Reduce Illness, Deaths, and Malnutrition </a> </li><li> 9.2 <a href="/web/20091207083857/http://www.dcp2.org/pubs/DCP/9/Table/9.2" id="link_chapterPart_117787"> Alternative Cost Estimates Using Millennium Project and Marginal Budgeting for Bottlenecks Models </a> </li> </ul> </div> </div> </div> </div> </div> <div class="copyright"> <div class="content"> <ul> <li><a href="/web/20091207083857/http://www.dcp2.org/page/main/About.html" id="nav_about-dcpp">About</a>  | </li> <li><a href="/web/20091207083857/http://www.dcp2.org/page/main/ContactUs.html" id="nav_contactus">Contact Us</a>  | </li> <li><a href="/web/20091207083857/http://www.dcp2.org/page/main/Sitemap.html" id="nav_sitemap">Site Map</a>  | </li> <li><a href="/web/20091207083857/http://www.dcp2.org/page/main/Privacy.html" id="nav_privacy">Privacy Policy</a>  | </li> <li><a href="/web/20091207083857/http://www.dcp2.org/page/main/Terms.html" id="nav_terms">Terms Of Use</a>  | </li> <li><a href="/web/20091207083857/http://www.dcp2.org/page/main/Feedback.html" id="nav_feedback">Feedback</a></li> </ul> <span class="rights"> © 2006 The World Bank Group, All Rights Reserved. </span> </div> </div> <div class="footer"> <div class="logos"><img src="/web/20091207083857im_/http://www.dcp2.org/images/logos_bottom.jpg" usemap="#logosMap" alt=""/></div> <map name="logosMap" id="logosMap"> <area shape="rect" target="_blank" coords="10,12,91,65" href="https://web.archive.org/web/20091207083857/http://www.worldbank.org/" alt="The World Bank" title="The World Bank"/> <area shape="rect" target="_blank" coords="102,12,220,65" href="https://web.archive.org/web/20091207083857/http://www.who.int/en" alt="World Health Organization" title="World Health Organization"/> <area shape="rect" target="_blank" coords="228,12,361,65" href="https://web.archive.org/web/20091207083857/http://www.fic.nih.gov/" alt="John E. 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