Poverty and Hunger

The first of the MDGs calls for cutting the proportion of people living in extreme poverty and those suffering from hunger to half the 1990 level by 2015. Children experience malnutrition when they consume too little food energy to meet the body’s needs. Adding to the problem are diets that lack essential nutrients, illnesses that deplete those nutrients, and undernourished mothers who give birth to underweight children. Regional trends show high malnutrition rates in South Asia and rising rates in Sub-Saharan Africa. Many countries in these regions may have difficulty achieving the target based on current trends. (See figure 3.1.)

Universal Primary Education

Figure 3.2 shows progress toward universal primary education, measured by primary school completion rates: the proportion of children successfully completing the last year of primary school. Three regions—East Asia and Pacific, Europe and Central Asia, and Latin America and the Caribbean—are close to being on track for achieving the goal of universal primary education. But three more regions, with 150 million primary-school-age children, are in danger of falling short. Sub-Saharan Africa lags farthest behind, with little progress made since 1990. South Asia has had chronically low enrollment and completion rates, and the Middle East and North Africa has made little progress since 1990, although a few countries in both regions have made large gains. Removing impediments and reducing costs can help boost enrollments.

Gender Equality

Gender disparities exist everywhere in the world. Women are underrepresented in local and national decision-making bodies. They earn less than men and are less likely to participate in paid employment. And in many low-income countries girls are less likely to attend school. All regions, except Latin America and the Caribbean, are still short of the target, which is set for 2005. (See figure 3.3.) The differences between boys’ and girls’ schooling are greatest in regions with the lowest primary school completion rates and lowest average incomes. In Sub-Saharan Africa the ratio of girls’ to boys’ enrollments in primary and secondary school has barely changed since 1990. In 1998 it stood at 80 percent. Progress has been greater in South Asia, but girls’ enrollments reached only 78 percent of those of boys in 1998.

Child Mortality

Rapid improvements before 1990 gave hope that mortality rates for children under five could be cut by two-thirds in the following 25 years. But progress slowed almost everywhere in the 1990s. And no region, except possibly Latin America and the Caribbean, is on track to achieve that target. (See figure 3.4.) Progress has been particularly slow in Sub-Saharan Africa, where civil disturbances and the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) epidemic have driven up child mortality rates in several countries. In 2001 the average under-five mortality rate was 121 deaths per 1,000 live births in low-income countries, 41 in lower-middle-income countries, and 27 in upper-middle-income countries. In high-income countries the rate was less than 7. Improvements in infant and child mortality have come slowly in low-income countries, where mortality rates have fallen by only 12 percent since 1990. Upper-middle-income countries have made the greatest improvement, reducing average mortality rates by 36 percent. But even this falls short of the rate needed to reach the target.

Maternal Health

To reduce maternal mortality rates women need access to modern health services. The share of births attended by skilled health staff provides a good index of where the need is greatest. Only 58 percent of women in developing countries give birth with the assistance of a trained midwife or doctor. In Latin America, where the share of births attended by skilled health personnel is high, maternal mortality is relatively low. And many countries in Europe and Central Asia and in the Middle East and North Africa appear to be making progress fast enough to achieve the target. But in Africa, where skilled attendants and health facilities are not readily available, maternal mortality is very high and progress toward the target is slow. (See figure 3.5.)

HIV/AIDS

In Africa the spread of HIV/AIDS has reversed decades of improvements in life expectancy and left millions of children orphaned. It is draining the supply of teachers and eroding the quality of education. In 2002, 42 million people, including 3.2 million children, were living with HIV/AIDS—more than 95 percent of them in developing countries and 70 percent in Sub-Saharan Africa. There were almost a million new cases in South and East Asia, where more than 7 million people are now living with HIV/AIDS. Current projections suggest that, by 2010, 45 million more people in low- and middle-income countries will become infected unless the world mounts an effective campaign to halt the disease’s spread. (See figure 3.6.)

Environmental Sustainability

An improved water source is any form of water collection or piping used to make water regularly available. It is not the same as “safe water,” but there is no practical measure of whether water supplies are safe. Connecting all households to a reliable source of water that is reasonably protected from contamination would be an important step toward improving health and reducing the time spent collecting water. In 2000, 1.2 billion people still lacked access to an improved water source, 40 percent of them in East Asia and the Pacific region and 25 percent in Sub-Saharan Africa. Meeting the MDGs will require providing about 1.5 billion people with access to safe water between 2000 and 2015. Although many countries in South Asia appear to be on track to achieve the goal, the Middle East and North Africa—with water a scarce resource—will struggle. (See figure 3.7.)

Global Partnership

Goal eight complements the first seven. It commits wealthy countries to work with developing countries to create an environment in which rapid, sustainable development is possible. It calls for an open, rule-based trading and financial system, more generous aid to countries committed to poverty reduction, and relief for the debt problems of developing countries. Aid is most effective in reducing poverty when it goes to poor countries with good economic policies and sound governance. Aid levels have been falling, both in comparison with the size of donor country economies and in nominal terms. (See figure 3.8.) To help the poorest countries reach the MDGs, official development assistance will need to double from its current level of $52 billion a year.



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Case Studies - During fiscal 2003 the Bank conducted case studies in a number of countries to examine progress on three important initiatives: Education for All, HIV/AIDS programs, and water delivery in rural communities. The results are summarized here.