The following figures and commentary provide an overview of the main trends in country and regional progress toward achieving the Millennium Development Goals. Owing to the limitations of both data and space, the coverage here is selective. An overview of performance can be seen from the figure below showing the shares of all developing countries globally that have achieved or are on track to meet the development goals, are off track and seriously off track to meet them, or countries for which there are insufficient data. It is immediately evident that for these targets many countries simply do not have adequate data to measure their performance, particularly for poverty (over half), malnutrition, gender, and access to improved water. From the available data, those targets for which the greatest progress has been made include gender equality (as measured by gender parity in primary and secondary school enrollment), access to skilled care at birth (a proxy measure for maternal mortality), and reaching 100 percent primary school completion. Those targets lagging most severely include reducing child mortality, halving extreme poverty, and improving child nutrition. The global challenge of meeting the MDGs remains daunting.
Eradicate Extreme Poverty and Hunger
Extreme poverty—the proportion of the population in developing countries living on less than $1 a day—fell from 29 percent in 1990 to 18 percent in 2004. East Asia and Pacific experienced the most impressive reduction in poverty, and South Asia is now on track, but Sub-Saharan Africa lags behind. Over the same period, the number of people in developing countries grew by 20 percent to more than 5 billion, including 1 billion people in extreme poverty. Global poverty is projected to fall to 12 percent by 2015—a striking success.
Approximately 27 percent of the extreme poor in developing countries live in fragile states. Fragile states have consistently grown more slowly than in other low-income countries. Clearly, this has been, and will likely continue to be, an obstacle to the achievement of MDG1 in those countries. A typical fragile state had made negative progress toward MDG1 by 2005, at which point its poverty rate by the $1 per day measure was about twice that of a typical nonfragile state.
TARGET 1: Halve, between 1990 and 2015, the proportion of people who live on less than $1 a day.
TARGET 2: Halve, between 1990 and 2015, the proportion of people who suffer from hunger.
Achieve Universal Primary Education
Globally, the primary completion rate has increased from 63 percent in 1990 to an estimated 83 percent in 2005, and the pace of annual improvement has accelerated significantly since 2000 in the three regions furthest from the goal—North Africa, South Asia, and Sub-Saharan Africa—a sign of the increasing priority given in these regions to universalizing primary education (see figure 2.1). Latin America and the Caribbean, which started from a higher base, has also sustained an exceptionally strong rate of progress. The number of countries that have achieved universal primary completion increased from 37 in 2000 to 52 in 2005, and this includes some low-income countries: Bolivia, Indonesia, and Kenya. Notwithstanding these very positive trends, the goal of universal primary completion by 2015 will be difficult to reach: 57 of the 152 developing countries (38 percent) for which data are available are considered off track—meaning that they will not reach the goal on current trends (figure 2). Most of the 33 countries that lack data are also likely off track. Among African countries, 65 percent are considered seriously off track, defined as unlikely to reach the goal before 2040. Among fragile states, only 11 percent have achieved universal primary completion or are on track to doing so, and 50 percent are considered seriously off track.
TARGET 3: Ensure that by 2015 children everywhere, boys and girls alike, will be able to complete a full course of primary schooling.
Promote Gender Equality and Empower Women
When a country educates its girls, its mortality rates usually fall, fertility rates decline, and the health and education prospects of the next generation improve. Unequal treatment of women—by the state, in the market, and by their community and family—puts them at a disadvantage throughout their lives and stifles the development prospects of their societies. Illiterate and poorly educated mothers are less able to care for their children. Low education levels and responsibilities for household work prevent women from finding productive employment or participating in public decision making. To improve girls’ enrollments, the social and economic obstacles that keep parents from sending their daughters to school must be overcome. For many poor families, the economic value of girls’ work at home exceeds the perceived returns to schooling. Improving the accessibility of schools and their quality and affordability is a first step. Globally, 55 percent of countries achieved the first target by 2005. Latin America and Europe and Central Asia can now focus on the second target. But huge improvement is required in Sub-Saharan Africa and South Asia, where only 20 percent and 35 percent, respectively, of countries reached the 2005 target.
TARGET 4: Eliminate gender disparity in primary and secondary education, preferably by 2005, and at all levels of education no later than 2015.
Reduce Child Mortality
Every year over 10 million children in developing countries die before the age of five. Most die from causes that are readily preventable or curable with existing interventions—such as acute respiratory infections, diarrhea, measles, and malaria. Rapid improvements prior to 1990 provided hope that mortality rates for infants and children under five could be cut by two-thirds in the ensuing 25 years, but progress slowed almost everywhere in the 1990s. Progress on the child mortality MDG lags behind all other goals. While the majority of countries have reduced child mortality since 1990, progress has been insufficient to reach the MDG target—which requires an annual decline of 4.3 percent over the entire period. Only two regions, East Asia and Pacific and Latin America and the Caribbean, are close to achieving the MDG target. But even in those two regions, more than half the countries are off track. Progress has been particularly slow in Sub-Saharan Africa, where civil disturbances and the HIV/AIDS epidemic have driven up rates of infant and child mortality. As of 2005, no Sub-Saharan Africa country was on track to achieve the goal, and only 33 out of 147 (22 percent) of developing countries are making enough progress to achieve the goal on current trends.
TARGET 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
Improve Maternal Health
Death in childbirth is a rare event in rich countries, where there are typically fewer than 10 maternal deaths for every 100,000 live births. But in the poorest countries of Africa and Asia the ratio may be 100 times higher. Ninety-nine percent of maternal deaths occur in developing countries—around 500,000 annually. The MDG target—to reduce by 75 percent the maternal mortality ratio between 1990 and 2015—remains difficult to measure for almost all developing countries. No current direct estimates of the maternal mortality ratio or trends exist. Because few countries are able to measure maternal mortality over time, other indicators are often used instead, such as the skilled health personnel who are needed to deal with the complications of childbirth that can claim mothers’ lives. Survey evidence shows progress in 27 of 32 countries, but also suggests that this is highly concentrated among richer households. While survey data also show progress in coverage for the poorest quintiles in many countries, differences in access to skilled delivery care between the poorest and richest quintiles in most countries represent larger equity gaps than for any other health service.
TARGET 6: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.
Combat HIV/AIDS, Malaria, and Other Diseases
Epidemic diseases exact a huge toll in human suffering and lost opportunities for development. Poverty, armed conflict, and natural disasters contribute to the spread of disease—and recovery, in turn, is often endangered by disease. In Africa, AIDS has reversed decades of improvements in life expectancy and left millions of children orphaned. By end-2006 an estimated 39.5 million people globally were living with HIV, up 2.4 million since 2004, and an estimated three million people had died from AIDS. While the spread of AIDS has slowed in parts of Sub-Saharan Africa, it remains the center of the epidemic; home to just over 10 percent of the world’s people, 64 percent of all HIV-positive people, and 90 percent of all HIV-positive children. About 60 percent of HIV-positive adults in Africa are women.
The largest recent increases in the number of people with HIV have been in Eastern Europe, and Central and East Asia (21 percent higher in 2006 than in 2004). Recent experience in combating the spread of AIDS has demonstrated three important messages: reversing its spread is possible, treatment is effective in the developing world, and prevention remains a crucial challenge. More effective, evidence-based approaches to prevention are required—drawn from careful evaluation of what works in different contexts and the continued tailoring of responses to the changing epidemic.
Increasing the awareness of the impact of malaria and tuberculosis on human development has been matched with a commitment to fight these diseases, and fight them more effectively. There are an estimated 300–500 million new cases of malaria each year, leading to more than 1 million deaths. Nearly all the cases and more than 95 percent of the deaths occur in Sub-Saharan Africa. Tuberculosis (TB) strikes 9 million people each year and kills 2 million. But there has been clear progress in reducing TB prevalence and deaths in recent years. The only region where TB incidence is still growing is Africa, because of the emergence of drug-resistant strains and the greatly reduced resistance to TB among people with HIV.
TARGET 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDS.
TARGET 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases.
Ensure Environmental Sustainability
Sustainable development can be ensured only by protecting the environment and using resources wisely. Less than 20 percent of developing countries are on track or have achieved the 2015 target to increase access to water, and less than 35 percent have increased access to sanitation, but Sub-Saharan African countries are lagging behind other regions. And in the fragile states, the proportion of countries on track to achieve the target for increased access to water and sanitation is 6 percent and 15 percent, respectively.
Around the world, land is being degraded and carbon dioxide (CO2) emissions are driving changes in global climate. Climate change is a grave threat to the developing world and a major obstacle to continued poverty reduction across many dimensions. First, developing regions are at a geographic disadvantage: they are already warmer, on average, than developed regions, and they suffer from high rainfall variability. Second, developing countries—in particular the poorest—are heavily dependent on agriculture, the most climate-sensitive of all economic sectors, and they suffer from inadequate health provision and low quality public services. Third, low incomes and vulnerabilities make adaptation to climate change particularly difficult. Global emissions of CO2 rose by 4 billion metric tons between 1990 and 2003.
TARGET 9: Integrate the principles of sustainable development into country policies and programs and reverse the loss of environmental resources.
TARGET 10: Halve by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation.
TARGET 11: Have achieved a significant improvement by 2020 in the lives of at least 100 million slum dwellers.
Fostering Global Partnerships
Important steps toward global partnership were taken at the international meetings in 2001 in Doha, which launched a new “development round” of trade negotiations, and in 2002 at the International Conference on Financing for Development in Monterrey, Mexico, where high-income and developing countries reached consensus on mutual responsibilities for achieving the Millennium Development Goals. The consensus calls for developing countries to improve governance and policies aimed at increasing economic growth and reducing poverty and for high-income countries to provide more and better aid and greater access to their markets.
Total aid rose in recent years through 2005, and declined 5 percent in 2006. But much of the recent increase was due to debt relief, and this may provide less than full additionality as measured by the current flow of new resources for development.
Owing to the steady reduction of tariffs, overall trade restrictiveness has largely declined in recent years. However, the poorest developing countries faced the highest barriers, notably from developed countries. South-South trade faces a high level of protection. Most of this protection is in agriculture.
TARGET 12: Develop further an open, rule-based, predictable, nondiscriminatory trading and financial system.
TARGET 13: Address the special needs of the least developed countries.
TARGET 14: Address the special needs of landlocked developing countries and small island developing states.
TARGET 15: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term.
TARGET 16: In cooperation with developing countries, develop and implement strategies for decent and productive work for youth.
TARGET 17: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries.
TARGET 18: In cooperation with the private sector, make available the benefits of new technologies, especially information and communications.