We will spare no effort to free our fellow men, women and children from the abject and dehumanizing conditions of extreme poverty, to which more than a billion of them are currently subjected. United Nations Millennium Declaration, September 2000 1 What are the Millennium Development Goals? The Millennium Development Goals (MDGs) promote poverty reduction and human devel- opment as the key to sustaining social and economic progress. In broad terms, the goals aim to cut by half the proportion of people living in poverty by 2015, provide education to all, improve health, and preserve the environment. The Millennium Development Goals grew out of the agreements and resolutions of world conferences organized by the United Nations over the past decade. Brought together as a set of "International Development Goals" in 1996, they have since been refined and are now widely accepted as the framework for measuring development progress. At the Millennium Summit in September 2000, the 189 states of the United Nations reaffirmed their commitment to working toward a world of peace and security for all--a world in which sustaining development and eliminating poverty would have the highest priority. Signed by 147 heads of state, the Millennium Declaration was passed unanimously by the members of the UN General Assembly. The MDGs focus the efforts of the world community on achieving significant, measur- able improvements in people's lives by establishing yardsticks for results. They require action not just by developing countries but by the industrial countries that must assist in implementation. Most of the targets are to be achieved over a 25-year period from 1990 to 2015. The complete Millennium Development Goal framework--comprising 8 goals, 18 tar- gets, and 48 indicators--is set out at the end of this booklet. The first seven goals are directed at reducing poverty in all its forms: hunger, a lack of income, education and health care, gender inequality, and environmental degradation. While each goal is important, collectively they form a comprehensive and mutually rein- forcing approach to alleviating poverty. For example, better health care increases school enrollment and reduces poverty. Better education leads to better health. And increasing incomes gives people more resources to pursue better education The Millennium and health care and a better environment. The eighth goal--building a global partnership Development Goals for development--provides a means for achieving the first seven. This might entail providing 1. Eradicate extreme poverty and hunger additional debt reduction and development 2. Achieve universal primary education assistance--and lowering trade barriers to allow for 3. Promote gender equality and empower women a freer exchange of goods and services. 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria, and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development 2 Europe and Central Asia--An Overview The region designated as Europe and lion), while the Slovak Republic with 5.4 Central Asia (ECA) by the World Bank con- million people represents the median. The tains the Commonwealth of Independent lowest population densities are in States (CIS) and the countries of Central Kazakhstan with 6 people per square kilo- and Eastern Europe - 28 countries in all.1 It meter and the Russian Federation with 9. occupies a land area of 24 million square Armenia, with 135 people per square kilo- kilometers, is home to 500 million people, meter, has the highest. Tajikistan and the and has diverse economic, political and Kyrgyz Republic are the most rural, with social structures. The populations of indi- almost two-thirds of the people in rural vidual countries vary greatly. Estonia, the areas. Russia and Turkey are the most smallest (1.4 million), is a hundredth of the urban, with more than three-fourths of Russian Federation, the largest (144.8 mil- their populations in towns and cities. This map was produced by the Map Design Unit of The World Bank. EUROPE AND CENTRAL The boundaries, colors, denominations ASIA REGION and any other information shown on A R C T I C O C E A N this map do not imply, on the part of The World Bank Group, any judgment on the legal status of any territory, or any endorsement or acceptance of such boundaries. R u s s i a n F e d e r a t i o n Estonia Latvia Russian Federation Lithuania B e l a r u s P o l a n d Czech Rep. U k r a i n e Slovakia K a z a k h s t a n Hungary Moldova Slovenia Sea of Croatia R o m a n i a Azov Aral Bos./Herz. Sea Bulgaria B l a c k S e a Serbia and U z b e k i s ta n Georgia Caspian Montenegro Macedonia Sea Kyrgyz Rep. Albania Armenia Azerbaijan T u r k e y Turkmenistan Tajikistan IBRD 31957R 0 1000 JULY 2003 Mediterranean Sea KILOMETERS 1. The Commonwealth of Independent States (CIS) comprises Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, the Kyrgyz Republic, Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. The countries of Central and Eastern Europe are Albania, Bosnia & Herzegovina, Bulgaria, Croatia, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, the former Republic of Macedonia, Poland, Romania, Serbia & Montenegro (formerly Federal Republic of Yugoslavia), the Slovak Republic, Slovenia, and Turkey. [Note: Slovenia is classi- fied as a high income country (2002 GNI per capita greater than $9,076). The World Development Indicators (WDI) does not include high income countries in its regional aggregates. Therefore regional totals or averages from the WDI for the ECA region exclude Slovenia]. 3 The collapse of the Council for become more pronounced, with incomes Mutual Economic Assistance2 and the ranging from $9,760 per capita in breakup of the former Soviet Union in Slovenia to $180 per capita in Tajikistan.3 1991 led to massive changes in the Meanwhile environmental issues require region's political and economic urgent attention--to reverse the damaging structures. For most people the transition legacy of natural resource exploitation from central planning to the market and polluting industries left over from economy has been protracted--and at central planning. times painful. In many countries, the The prospect of accession to the drastic declines in gross domestic product European Union (EU) has helped anchor (GDP) and trade, the imposition of tough reforms in the better performing states of budget constraints, and the under-devel- Central Europe--and in recent years it has oped infrastructure all contributed to a also been a spur to peace and reconcilia- reduction in the well-being of their peo- tion in South-East Europe.4 ple. During this period, some countries, such as the historically poorer countries of Central Asia, have found it difficult to sustain social infrastructure, such as schools and hospitals. With marked declines in real wages, reduced access to health services, and declines in other determinants of human Real GDP growth--plunging, then recovering development, poverty has become more Percent widespread. Region-wide, it was rising 10.0 faster than anywhere else in the world 7.5 Central Europe and Baltic Countries during most of the 1990s, before begin- 5.0 ning to fall with the resurgence of growth 2.5 ECA Region in almost all ECA countries over the past 0.0 few years. In 2002 the average GDP ­2.5 growth for the whole region was 5.1%. ­5.0 CIS Countries The economic recovery started in the ­7.5 mid-1990s in Central Europe. And South ­10.0 East Europe, Russia (9% in 2000), and ­12.5 Ukraine (9.2% in 2001) have also experi- ­15.0 enced strong growth. Despite this growth, differences within the region have 1990 1991 199219931994 1995 1996 1997 1998 1999 20002001 20022003p Source: National Authorities and World Bank staff estimates. 2. The CMEA was an international organization active between 1956 and 1991 for the coordination of economic policy among certain nations with communist regimes, including Albania (until 1961), Bulgaria, Cuba, Czechoslovakia, East Germany, Hungary, Mongolia, Poland, Romania, and the Soviet Union. 3. According to the FY04 income classifications based on the 2002 GNI per capita estimates using the World Bank's Atlas Method: 6 countries are low income ($735 or less); 13 are lower middle income ($736 to $2,935); 8 are upper middle income ($2,936 - $9,075); and 1 is high income ($9,076 or more). 4. The Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, the Slovak Republic, and Slovenia are set to join the European Union on 1st May 2004. Bulgaria and Romania hope to join the EU by 2007. Accession negotiations will begin with Turkey, possibly as soon as December 2004, once the criteria to begin negotiations are satisfied. Millennium Development Goals and 4 the ECA region This section describes the importance of the targets are less likely to be achieved. For MDGs to the ECA region as a whole. The rest example, in the Czech Republic and the of the booklet will focus on the following Slovak Republic infant mortality rates for predominantly low and lower middle income Roma are double that of non-Roma. countries in the region: Albania, Armenia, Several special features of the ECA Azerbaijan, Belarus, Bosnia & Herzegovina, region need to be kept in mind when apply- Bulgaria, Croatia, Georgia, Kazakhstan, ing the MDG framework. Kyrgyz Republic, FYR Macedonia, Moldova, In 1990, based on the best available data, Romania, Russian Federation, Serbia & social indicators were in reasonable shape for Montenegro, Tajikistan, Turkey, Ukraine, and many ECA countries. These were eroded fast as Uzbekistan. So for the most part, it largely ECA entered a period of rapid socioeconomic excludes the upper middle income countries decline. Even though most ECA countries are scheduled to join the EU in May 2004. The growing again, some indicators are still catch- reason is that these countries, such as the ing up with the 1990 levels. So for ECA Czech and Slovak Republics have already countries, any assessment of progress towards achieved - or are likely to achieve - most of the goals using 1990 as a baseline is likely to the MDG targets at the national level. They conceal a period where social indicators hit are now targeting their health and education their lowest levels. investments to interventions beyond the The very cold climate in many ECA coun- MDGs. Even so, the MDGs remain relevant tries means that spending on heat, winter in these countries because disaggregations of clothing, and food is higher than in other national level data by region, ethnic group, regions. The first MDG calls for halving the or gender may identify pockets where the proportion of people living on less than $1 a day by 2015 (in 1993 international prices). But given the extra spending on heat and food, a Spending on energy can be very high--with cold weather higher poverty line - such as the national poverty line or $2 a day is more appropriate Energy consumption (Kg oil equivalent) per capita per year for the ECA region.5 Recent estimates based on 400 World Bank data suggest that the proportion of Nonpoor the ECA population living below $1 is 5% and 350 that living below $2 a day, is 19.5%. 300 Poor The gender equality goal aims to promote gender equality and to empower women. 250 Internationally, women have borne the brunt 200 of gender inequality, but in the transition countries of Europe and Central Asia, both 150 men and women have paid a price. There are even instances where gender disparity affects 100 males disproportionately. In Russia, Ukraine, 50 and Belarus the life expectancy gap between men and women has increased because the 0 Armenia Kyrgyz Croatia Moldova Tajikistan Lithuania Latvia lifestyle behaviors of men tend to lead to Republic accidents, injuries, and cardio-vascular dis- Source: Coping with the Cold, World Bank, 2002. 5. Actually $2.15 per person per day in 1996 purchasing power parity (PPP). The estimates based on the 1996 PPP rates are considered more reliable than the 1993 rates often used in other regions because they take into account changes in the price structure following periods 5 ease. There are also low and worsening represent the true picture. For example, enrollments for boys relative to girls in sec- in some ECA countries there is a hefty ondary education and, especially in higher charge for parents registering newborn education in many countries. children, not affordable for most of the The goal of halting and beginning to rural poor. Official statistics for infant reverse the spread of HIV/AIDS by 2015 was mortality are thus unlikely to include developed largely with Africa in mind. data from the rural poor and thus There, the epidemic is well advanced, and underrepresent the real situation. progress is measured by the prevalence of · Data from different sources often pres- the disease among 15­24 year-old pregnant ent a different picture. Data for a single women. In Europe and Central Asia the epi- indicator (such as infant mortality) col- demic is still in its early stages, and one of lected from different sources, such as the the main modes of transmission is through country official statistics and country injecting drug users, so key health statistics surveys, may lead to different estimates. from prenatal clinics will not detect the full · Country data may conceal large dis- extent of the epidemic. parities within countries. As mentioned Indeed, using this indicator alone could earlier, some countries in the region lead to the erroneous conclusion that vary greatly in the proportion of people HIV/AIDS is not a particular concern in the living in urban or rural environments. ECA region. In reality, an increase in "risky" In such countries ­ among them, Turkey behaviors, such as drug use and unprotected and Russia ­ collection of data at a sex, in several of the CIS countries means that more disaggregated level is important HIV/AIDS is now spreading rapidly from the because national data may mask subna- high-risk groups, to the "bridge" populations tional trends. Large data variations, eg - and into the general population. Given this between rural and urban populations - difference in the characteristics of the can have potentially large implications epidemics in Africa and ECA, there is a need to for how countries address the MDGs. examine HIV/AIDS indicators that can take account of this dimension, unique to ECA. While not exclusive to the ECA region, In many countries, men are dying earlier several key concerns about data need to be Change in gender gap, 1990­99 kept in mind when assessing the likelihood 3.0 of reaching MDGs: 2.5 Wider gap · Data are often inadequate to measure 2.0 progress and predict trends for some 1.5 MDG indicators. This could be due to a 1.0 Rep. Rep. Rep. lack of capacity or a country's low commit- 0.5 ArmeniaCzechAlbaniaAzerbijanSlovakSloveniaKyrgyz Poland ment to data collection. And, the upheaval 0.0 associated with the transition means that ­0.5 Bulgaria Hungary Moldova Lithuania EstoniaLatvia Ukraine Belarus few data series are historically comparable, ­1.0 KazakhstanRomaniaRussia Turkmenistan making it difficult to assess trends. ­1.5 Narrower gap · Data may not be reliable. There are ­2.0 some instances where the data may not ­2.5 Source: Gender in Transition, World Bank, 2002. of hyperinflation in the early 1990s, trade liberalization and real exchange rate realignment. From World Bank, Making Transition Work for Everyone: Poverty and Inequality in Europe and Central Asia (Washington, DC: The World Bank, 2000). 6 How are most ECA countries doing? The likelihood of reaching the MDGs has Gender equality in school been estimated for those ECA countries not Indicator: Ratio of girls to boys enrolled in scheduled to join the EU by May 2004 primary school. using simple linear trends of progress since Target: Achieve equality in enrollment 1990. These estimates do not state what the ratios by 2005. final outcome will be. Instead they provide a possible endpoint based on current per- Child mortality formance. The assessments are based Indicator: Under-five child mortality (per primarily on data from the World Bank's 1,000 live births). World Development Indicator database, Target: Reduce by two-thirds between 1990 complemented with official and survey data and 2015. from such other sources as Demographic Health Surveys, Living Standards Maternal mortality Measurement Surveys and Multiple Indicator: Maternal deaths per 100,000 live Indicator Cluster Surveys--as well as vari- births. ous World Bank publications. Target: Reduce by three-quarters between The indicators and targets used for each 1990 and 2015. MDG were: Poverty HIV/AIDS and other diseases Indicator: Proportion of population below Indicators: Newly diagnosed cases of HIV $2 a day. per year and incidence of TB per 100,000 Target: To halve between 1990 and 2015, people.6 the proportion of people whose income is Targets: Have halted by 2015 and begun to less than $2 a day. reverse the spread of HIV/AIDS and Note: While the MDG indicator and incidence of malaria and other diseases. target include $1 a day, a higher poverty Note: This study used newly diagnosed line such as $2 a day (actually $2.15) is cases of HIV per year because the MDG considered more appropriate in ECA given indicator for HIV/AIDS -HIV prevalence the extra expenditure on heat, winter cloth- among 15-24-year old pregnant women- is ing, and food. less appropriate in ECA. Universal primary education Ensure environmental sustainability Indicator: Net enrollment ratio in primary Indicator: Proportion of people with access education. to an improved water source, urban & rural. Target: Ensure that by 2015, children every- Target: Halve the proportion of people without where, boys and girls alike, will be able to sustainable access to drinking water by 2015. complete a full course of primary schooling. Note: While the net enrollment ratio is the indicator used here, the primary completion Key findings: rate provides a more comprehensive picture · The Millennium Development Goal because it measures coverage and student framework reinforces concerns about attainment. the poor state of some ECA countries. 6. This indicator is deficient in that it has no denominator and hinges on the data collection methods, which vary. Going forward, more appropriate indicators could include prevalence of HIV among specified groups of high-risk core transmitters, bridge populations and the gen- eral population in accordance with surveillance methods endorsed by WHO and UNAIDS. 7 Countries in Green ­ made progress in the 1990s fast · Based on current trends, around half of enough to attain the target in the specified period and as all ECA countries, primarily the low such are "likely" to meet the goals. and lower middle income countries, are unlikely to meet at least one of the Countries in Yellow ­ made some progress but too diffi- MDGs. cult to tell if the goals will be reached in the time · Several countries of the specified. Rated "maybe" they would need to accelerate Commonwealth of Independent progress to meet the goals. States face a particularly difficult challenge in meeting the MDGs. Countries in Red ­ made much slower progress, if any, or · The application of some MDG conditions have worsened and as such are "unlikely" to targets, such as those for child and meet the goals. maternal mortality, produces a 2015 target for many countries that is dif- Countries in Gray ­ lack adequate data to measure ficult to achieve, if not impossible. progress. · Some MDGs are more relevant than others to the low and lower middle income countries in ECA --as can be seen in the following descriptions for each MDG. Prospects of ECA countries meeting the MDGs MDG1 MDG2 MDG3 MDG4 MDG5 MDG6 MDG7 Poverty School Equality Child Maternal HIV/AIDS and Water enrollment in school mortality mortality TB incidence Access Albania Armenia Azerbaijan Belarus Bosnia and Herzegovina Bulgaria Croatia Georgia Kazakhstan Kyrgyz Republic Macedonia, FYR Moldova Romania Russian Federation Serbia and Montenegro Tajikistan Turkey Ukraine Uzbekistan Key Likely MDG target likely to be achieved Maybe Made some progress, but too hard to tell whether MDG target will be met Unlikely MDG target unlikely to be achieved. No data Inadequate data to predict whether MDG target will be met Source: Achieving the Human Development MDGs in ECA, World Bank, 2003. 8 Goal 1: Eradicate extreme poverty and hunger the increase in poverty was much larger and Targets more persistent than expected at the start of Halve between 1990 and 2015, the proportion the transition. It is estimated that the number of people whose income is less than $1 a day of people in ECA living on less than $2 a day and halve between 1990 and 2015, the increased from 31 million in 1990 to about 90 proportion of people who suffer from hunger million in the late 1990s. But, the resurgence of growth in recent years (particularly in the Poverty has traditionally been measured on CIS countries) and the better financing and the basis of household income or spending. targeting of social protection has reduced During the 1990s the proportion of people poverty in some countries. living on less than $1 a day worldwide fell Recent World Bank projections show that, from 29% to 23%. Most of the progress has for most regions, the poverty reduction goal been in Asia, where sustained growth has can be met if the growth in per capita income lifted nearly 150 million people out of accelerates to an average of 3.6% a year. In poverty since 1990. ECA however, growth alone will not be Poverty in the ECA region rose faster, enough. To meet the goals, poor people must becoming more widespread, than in any other be empowered to take steps to improve their region during the 1990s. The socioeconomic lives. Governments must assist them by transformation substantially affected the struc- developing pro-poor policies. They must rec- ture of the economy. It also hit living standards ognize that the benefits of growth can be and the pretransition gender order. GDP fell, distributed unequally and undertaking neces- and employment and wages plummeted. And sary institutional reforms to ensure that the poor can obtain the services they need. When opinion leaders from six ECA countries were Some staggering poverty rates asked whether they thought reducing poverty Percent of population in absolute poverty by half was likely, only 28% responded that it ($2 per person per day) was very likely or somewhat likely.7 80 As in most regions, many ECA countries 70 have inadequate data. In addition, some tran- sition countries lack a tradition of monitoring 60 outcomes in social spheres on the basis of 50 individual or household data. But the limited poverty data available indicate that several 40 countries are unlikely to meet the first goal. 30 The poverty goal in ECA. Reducing extreme 20 poverty and hunger are important in the ECA 10 region. Even though data are often inadequate to predict trends, there is enough 0 to indicate that in many countries a Rep. Fed. significant proportion of people are living Tajikistan Moldova Armenia Georgia Albania Romania Kyrgyz Azerbaijan Russian below the $2 poverty line. Source: "Making Transition Work for Everyone." Poverty and Inequality in Europe and Central Asia, World Bank 2000. 7. Source - 2002 Multinational survey of ECA opinion leaders conducted for the World Bank by Princeton Survey Research Associates ­ June 2003. 9 Goal 2: Achieve universal primary education education--in higher wage earnings-- Target remained low. Ensure that by 2015, children everywhere, Progress towards the primary education boys and girls alike, will be able to complete MDG target is commonly measured by the a full course of primary schooling net enrollment ratio--the ratio of enrolled children of official school age to the num- Building and maintaining human capital ber of children of the same age in the are fundamental to any country's long-term population. Using official data, it is possible development and crucial for the wider to derive primary school completion rates, process of societal change that underpins which can be used as a core indicator of an responsible reform and economic growth. education system's performance.8 During the socialist period the state of In ECA, there has been a significant human capital was higher than for coun- recovery to pre-transition levels for these tries in other regions at similar levels of indicators in many countries, but universal economic development. Adult literacy was primary education remains some way off generally universal. Participation and com- for Albania, Armenia, Belarus, Georgia, and pletion rates for children and youth were Tajikistan. high at all levels of education. It was more To improve education outcomes for the common for teachers to come to work and region, there needs to be greater focus on students to have textbooks. And repetition improving access and quality. This can be and dropout rates were low. achieved through stronger government With the transition, however, came dra- ownership of reforms, increased implemen- matic changes in the education system of tation capacity, greater emphasis on equity, many countries. The education of more efficiency in spending, and a reorien- thousands of children was severely tation toward lifelong learning. disrupted due to ethnic strife, war, and civil unrest in such countries as Bosnia and Herzegovina, Georgia, Azerbaijan and Tajikistan. In many countries, enrollment rates and public spending on education fell sharply. In Azerbaijan, Bulgaria, and Russia public expenditure declined faster than Universal primary education MDG in ECA. gross domestic product. The decline in While the majority of countries have reached funding for educational materials, the or are on the way to attaining full enrollment, reduced number of teachers, the late pay- trends are constant or deteriorating in such ment of teachers wages and the lack of heat countries as Albania, Armenia, Belarus, and maintenance for schools reduced the Georgia, and Tajikistan, where significant quality of schooling. Meanwhile, the costs work remains to be done in improving access of education, both formal and informal, and quality. went up while the perceived benefits of 8. The primary completion rate is the total number of students successfully completing (or graduating from) the last year of primary school in a given year, divided by the total number of children of official graduation age in the population. Because it measures both system coverage and student attainment, the primary completion rate is a more comprehensive indicator of human capital formation and school sys- tem quality and efficiency than net enrollment ratios or the cohort survival rate (which does not capture the sometimes large share of children who do not have access to schooling). 10 Goal 3: Promote gender equality and empower women Central Asia, and men in the European Target countries of the former Soviet Union. Eliminate gender disparity in primary and One of the indicators used to assess secondary education preferably by 2005 and progress toward the gender equality goal is in all levels of education no later than 2015 the ratio of girls to boys in primary, secondary, and tertiary education. During the 1990s enrollment rates in basic educa- This goal aims to promote gender equality tion remained relatively high, with little and empower women. In the ECA transition evidence of a gender gap, except in countries, gender issues are markedly dif- Tajikistan and Turkey. Despite recent ferent from those in other regions. Gender improvements, girls are still significantly equality--measured by such social indica- underrepresented in primary schools in tors as access to health care, schooling, and these two countries. employment--was one of the major In secondary education in Central achievements of socialism. Europe, boys are dropping out of school Both males and females have paid the faster than girls in some countries. The shift price of economic transition. Clear from vocational to general education is geographical patterns have now emerged partly responsible for this trend, with boys with women at increasing disadvantage in traditionally more likely to seek vocational education. By contrast, fewer girls are enrolling in schools in Central Asia and Azerbaijan, a concern because the enroll- Women in employment ment rates for girls are already low. Any response to gender inequities in Females as a percentage ECA, needs to be tailored to specific coun- of total employment 70 try circumstances. Gender is mostly absent from national policymaking agendas, but 65 possible future directions include strength- 60 ening capacity to measure gender differentials, addressing gender inequalities 55 in access to economic opportunities, and 50 mainstreaming gender in strategies for eco- nomic development and poverty reduction. 45 40 Gender equality goal in ECA. In much of the 35 region, gender inequality in primary school is not an issue. And in some countries, boys are 30 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 leaving school faster than girls. Overall, the Russia Georgia gender equity goal is more likely to be met in Croatia Ukraine Kyrgyz Rep. FYR Macedonia ECA than in other regions. But it should Moldova Albania Serbia and Montenegro continue to be monitored closely, especially in Estonia Bulgaria Azerbaijan, Tajikistan, and Turkey. Source: Gender in Transition, World Bank. 2002. 11 Goal 4: Reduce child mortality Interventions that have proved effective Target: in reducing child mortality include: Reduce the under-five mortality rate by two- · Good care during pregnancy and the thirds between 1990 and 2015 first week after birth. · Breastfeeding and supplementary feed- Even though there have been significant ing in young children. improvements in recent years, more than 10 · Immunization against major endemic million children die each year in the devel- diseases. oping world, the vast majority from causes · Appropriate case management at home preventable through a combination of good and in communities for acute respira- nutrition, care, and medical treatment. tory infection, pneumonia, and diarrhea. Mortality among children under five has · Access to appropriate care, reliable been declining at an average rate of about water, and improved sanitation. 1 percent a year for the past 35 years. ECA's under-five mortality rate of 44 deaths per 1,000 live births in 1990 was Slow progress toward the child mortality goal lower than that in any other region. By Under-five mortality rate (per 1,000 live births) 2001 it had fallen to 36 per 1,000, not fast 180 enough to meet the MDG target of a two- 178 171 thirds reduction by 2015. 150 One problem unique to ECA is the defi- 129 nitional difficulty associated with infant 120 mortality rates. Many CIS countries, when 99 90 recording official data in hospitals, still use 77 the definitions established in the former 60 59 59 53 54 Soviet Union. Contrary to the World Health 44 44 36 34 43 Organization (WHO), the Soviet practice 30 26 20 was not to count as live births the prema- 18 15 0 ture and low-birth-weight babies who die 1990 1995 2000 2005 2010 2015 within seven days. That can lead to under- Goal Under-five mortality 1990 2001 2015 Actual estimations of the true infant mortality rate Sub-Saharan Africa by some 20 percent. South Asia Middle East and North Africa For several ECA countries the applica- East Asia and Pacific tion of a two-thirds reduction to the 1990 Latin America and the Caribbean baseline produces a lower child mortality Europe and Central Asia target than the current mean for high Source: World Development Indicators, World Bank, 2003. income countries. While many countries are unlikely to meet that target, it is possible Reducing child mortality MDG in ECA. Under- that they will reach the level of many high five child mortality rates for several ECA income countries today - and so are judged countries--such as Armenia, Kazakhstan, as having achieved or being likely to and Moldova--have much room for achieve the goal. improvement. 12 Goal 5: Improve maternal health mortality ratio (maternal deaths per Target 100,000 live births) measures how safe it is Reduce the maternal mortality ratio by three- to become pregnant and give birth in a quarters between 1990 and 2015 geographic area or population. Despite being difficult to measure accurately, and More than 50 million women worldwide its limitations as an indicator in measuring suffer from poor reproductive health and progress9 MMR was used in this assessment. serious pregnancy-related illness and Trends in ECA indicate that several CIS disability. And more than 500,000 women countries are unlikely to achieve the MDG die every year from complications of target of a 75% reduction in maternal mor- pregnancy and childbirth, one every minute tality. In fact, the most recent data for of every day, nearly all in the developing Georgia and Kazakhstan indicate that the world. Most deaths occur in Asia, but the ratio is increasing relative to the 1990 base- risk of dying is highest in Africa. Maternal line. And, in some countries, high rural deaths in Europe are relatively low. maternal mortality ratios may be concealed Monitoring progress towards this goal by lower national data. As with child mor- has proved to be problematic because tality, applying the required three-fourths maternal mortality is difficult to measure. reduction in maternal mortality to the 1990 Indicators used for monitoring progress baseline produces for many countries a tar- towards the goal include the percentage of get lower than the mean for high income births assisted by a skilled attendant and countries today. While these countries are maternal mortality ratio (MMR). While unlikely to meet such a target, it is possible there is a strong association between the that their maternal mortality ratio will former and maternal mortality, correlation reach the level of many high income coun- does not imply causation. Percent of tries today, and so were judged to have attended births is rather, an indicator of achieved or to be likely to achieve the goal. access to care, which by itself has an In ECA, as in other regions, most of the impact on reduction of deaths. Maternal deaths could be avoided if women had Estimates of maternal mortality around the world Maternal mortality ratio (maternal deaths Maternal Lifetime risk of UN region per 100,000 live births) deaths maternal death World total 400 515,000 1:75 Africa 1,000 273,000 1:16 Asia 280 217,000 1:110 Europe 28 2,200 1:2,000 Latin America and the Caribbean 190 22,000 1:160 Northern America 11 490 1:3,500 Oceania 260 560 1:260 Note: Japan, Australia and New Zealand have been excluded from the regional averages and totals. Source: Maternal mortality in 1995: estimates developed by WHO, UNICEF, UNFPA. 2001, World Health Organization, Geneva - in - Background paper of the Millennium Project Task Force on Child Health and Maternal Health, April 2003 9. Background Paper of the Millennium Project Task Force on Child Health and Maternal Health, 2003 13 Maternal mortality ratios for five CIS countries Maternal deaths per 100,000 live births 90.0 80.0 70.0 Russia 60.0 50.0 Georgia 40.0 Kazakhstan 30.0 20.0 Kyrgyzstan 10.0 Tajikistan 0.0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Year Source: UNICEF, TransMONEE database. access to adequate care during pregnancy and childbirth. For the maternal mortality Abortions and the Former Soviet Union ratio to be reduced dramatically (certainly, for it to come down by 75%), all women Worldwide, unsafe abortions are estimated to must have access to high-quality delivery account for more than 78,000 deaths a year, about care. That care has three key elements: 13% of all maternal deaths. The risks to women · A skilled attendant at delivery (already common in ECA). arise from a lack of medical skills, hazardous · Access to emergency obstetric care in techniques, and unsanitary facilities. In the former case of a complication. Soviet Union, abortion became the main form of · A referral system to ensure that women who experience complications can birth control soon after it was re-legalized in 1955. reach life-saving treatment in time. From then on, it was available on request and free of charge. Despite the recent decline in the use of abortion and the greater prevalence of Maternal mortality goal in ECA. Most ECA contraceptives, the incidence of abortion in the countries are unlikely to achieve a 75% reduction in the maternal mortality ratio by former Soviet States is still among the highest in 2015. Many may reach the level of many the world. Abortion has remained a well- high income countries today. But in several entrenched part of reproductive practice because of low and lower middle income countries, including Georgia and Kazakhstan, maternal the continuing tradition of unlimited reliance on health remains an issue, and significant abortion and because contraceptives remain in reductions in maternal mortality are still short supply and are relatively expensive. needed. Goal 6: Combat HIV/AIDS, malaria, 14 and other diseases Russian Federation had the highest adult Targets prevalence10 rates in 2001. There are also Halt and begin to reverse the spread of countries, such as Kazakhstan and HIV/AIDS by 2015; halt and begin to reverse Uzbekistan, where the risk is higher for the the incidence of malaria and other major disease's spread, and if not kept in check it diseases by 2015 could increase rapidly. The vast majority of reported infections in ECA are among young people--mainly among injecting HIV/AIDS drug users--and commercial sex workers. Since the human immunodeficiency virus An uncontrolled HIV/AIDS epidemic could (HIV) was first identified some 20 years have devastating consequences for health ago, more than 60 million people have and development in ECA. Fortunately, been infected, 5 million in 2001 alone. global experience shows that early and Some 15,000 new infections occur every effective actions can limit the spread of day. About 42 million adults and children HIV/AIDS. around the world are now living with There is a pressing need to improve the HIV/AIDS, more than 95% in developing effectiveness of disease control through epi- countries and about one third are aged 15- demiological and behavioral surveillance 24. HIV/AIDS is now the leading cause of systems that can identify the status and death in Sub-Saharan Africa and the fourth trends of HIV and its determinants. This largest killer worldwide. would include refining HIV/AIDS indicators The ECA region is experiencing the more appropriate for the stage of the epi- world's fastest-growing HIV/AIDS demic in ECA. epidemic. Estonia, Ukraine, and the Structural factors that influence HIV transmission are deep-seated and complex. They can be addressed in the medium and long term through: HIV ­ spreading rapidly · Sustained, pro-poor economic growth. · Poverty-reduction policies and Cumulative reported cases per million population programs. 1200 · Control of drug trafficking. Belarus 1000 · Effective judicial reforms to reduce Estonia overcrowding in prisons. 800 Kazakhstan · Improving employment opportunities 600 for young adults. 400 Latvia · Curtailing human trafficking. 200 Russian Fed · Improving the public health infrastruc- 0 Ukraine ture to support testing, counseling, TB 1995 1996 1997 1998 1999 2000 2001 control, and other population-based Year approaches to HIV/AIDS and TB. Source: HIV/AIDS surveillance in Europe Mid-year report 2002, No. 67. Data compiled by the European Centre for the Epidemiological Monitoring of AIDS. 10. The prevalence rate per 1,000 is the total number of cases of a disease present in the population at a specified time divided by the number of persons in the population at that specified time multiplied by 1,000. The incidence rate per 1,000 is the number of new cases of a disease occurring in the population during a specified period of time divided by the number of persons exposed to the risk of developing the disease during that period multiplied by 1,000. 15 Reducing the risk of becoming infected is more amenable to short-term actions--by reducing transmission among injecting Tuberculosis incidence drug users and using condoms during com- mercial or casual sex. Newly registered cases (per 100,000 population) 180 Malaria and tuberculosis 160 140 Malaria is estimated to kill roughly 120 Romania 1.1 million people worldwide each year, 100 Russia and tuberculosis 2 million. 80 Malaria, though endemic in most tropi- 60 Ukraine cal and subtropical areas, is relatively rare 40 Kazakhstan in ECA. It is either imported from endemic 20 Uzbekistan areas, or transmitted locally in some parts 0 of such countries as Azerbaijan, Georgia, 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Year Tajikistan, Turkey, and Uzbekistan. The Source: UNICEF, TransMONEE database. form of malaria prevalent in ECA is more benign than that in tropical and subtropical countries. More susceptible to relapses, it is also more resistant to control or 95%, emphasizes positive diagnosis eradication. followed by an effective course of Tuberculosis is a large and growing treatment and subsequent care. For problem in parts of ECA. Kazakhstan, multidrug resistant TB, the WHO has Romania, the Russian Federation, Ukraine, endorsed the DOTS-Plus approach, which and Uzbekistan have more than half the uses more powerful drugs. TB cases in the region. And globally, Russia is one of 22 high-burden countries. The disease is fueled by ineffective approaches to diagnosis and treatment, poor coverage of effective treatment pro- tocols and weak, deteriorating health systems. And, in prisons there is a high prevalence of TB amongst prisoners, who serve as epidemiological pumps for the Combating HIV/AIDS and other diseases in spread of the disease. ECA. When the likelihood of reaching this Affected countries need to implement goal is based on whether either the HIV/AIDS effective TB control programs based on the or tuberculosis goal targets are likely to be Directly Observed Treatment, Short-Course met, more than half the low and lower (DOTS), a strategy endorsed by WHO. This middle income countries appear unlikely to approach, which has cure rates of up to achieve it. 16 Goal 7: Ensure environmental sustainability for the institutional capacity of countries to Targets promote such sustainability. On the basis of Integrate the principles of sustainable access to improved water source11 data, the development into country policies and whole region appears to be doing well, with programs and reverse the loss of 91% having access. And all countries in the environmental resources; halve the proportion region seem to be on target to meet this of people without sustainable access to safe goal. But the statistics measure only meas- drinking water by 2015; achieve a significant ure access to an "improved water source," improvement in the lives of at least 100 not to "safe drinking water," as stated in the million slum dwellers by 2020 MDG target. In ECA drinking water frequently does not meet basic biological Sustainable development can be ensured and chemical standards, constituting a only by protecting the environment and major health threat. using its resources wisely. This goal focuses The issue in ECA is thus water quality on some of the environmental conditions as well as access to water. Where is the that need to be closely monitored-- energy water quality problem most serious? In all use, energy efficiency the emission of the CIS countries, particularly in Central greenhouse gases, changes in forest cover- Asia, and in Albania and Romania. In rural age and biological diversity, the plight of Moldova, 60% of water sampled from sup- slum dwellers in rapidly growing cities, and ply systems does not meet standards. The the availability of adequate water and sani- quality problems are significantly worse in tation services. rural areas, where 30% of households lack The environmental sustainability goal is access to piped water. Many urban areas important to the ECA region, primarily for also need urgent action to prevent the col- access to safe drinking water, because of its lapse of delivery systems. links to improved health outcomes, but also Many Eastern European and Central Asian countries have weak institutional capacity for formulating and implementing Access to an improved water source--high in many policies to promote environmental sustain- countries, but is the water safe? ability. Areas needing action and substantial resources include: Percent of households · The legal basis for management. 100 · Monitoring and collection of environ- 80 mental data and its use for decision 60 Target making. 40 2000 · Strengthening environment ministries' 20 capacity to design policies and work 0 with other relevant ministries. ECA Kyrgyz · Developing and implementing a mod- Income Azerbaijan Republic Romania Tajikistan Low/Middle ern, cost-effective, and incentive- Source: Meeting the Environment Millennium Development Goal in Europe and Central Asia, World Bank, June 2003. compatible regulatory framework. 11. Improved water sources include: household connection, public standpipe, borehole, protected dug well, protected spring, rainwater collection. Availability of at least 20 liters of water per person per day from a source within one kilometer of the user's dwelling. Not improved sources include: unpro- tected well, unprotected spring, vendor-provided water, bottled water, tanker truck-provided water. 17 · Facilitating the financing of environmen- tal investments from public and private Protected land--7% on average sources and from financial institutions. Percent of land area protected in 2002 · Improving access to public information, 14 12 including participation in key environ- 10 mental decisions. 8 6 One of the indicators used to measure 4 progress toward improving the lives of slum 2 0 dwellers is the proportion of the urban pop- and and Rep. ulation with access to improved sanitation. ECAWorld Average Moldova Georgia AlbaniaUkraine Uzbekistan Serbia TajikistanBulgaria Romania Azerbaijan In ECA the present level of access to basic Bosnia Kazakhstan Herzegovina Montenegro Kyrgyz sanitation is 93% and the target for 2015 is Source: Meeting the Environment Millennium Development Goal in Europe and Central Asia, World Bank, June 95%, a modest challenge. The main problem 2003. is that current sewage systems, in a serious state of disrepair, need immediate attention. As with water quality, access to sanitation is of 30%. And according to official statistics, most problematic in Albania, Romania, and the area under forest is increasing in CIS countries. A lack of further investment absolute terms. But the extent of old- will cause the situation to worsen. growth forests and the shade provided by Despite a 35% increase in energy effi- big trees are declining. Illegal logging is ciency since 1992, the ECA region remains also problematic in some countries. And the least energy-efficient in the world in the deposition of nitrogen acids and heavy GDP per unit of energy used. An efficiency metals exceeds critical levels in some areas. increase of 74% is needed for the region to The land area protected to maintain reach the same energy efficiency as that in biodiversity averages 7% in ECA, com- other countries at similar levels of develop- pared with 11.7% globally in 2002. With ment. the exception of ECA countries soon to Carbon dioxide emissions in ECA join the EU, nearly all are below the have declined 27% since 1992. But com- world average. The average for ECA is pared with the rest of the world, skewed by the large areas for Russia emissions are still high. A decrease of (8.3%). While there is no target for this 67% is needed if the ECA region is to indicator, an increase is seen as desirable. reach the same level of CO2 emissions per capita as other countries at similar levels Ensuring environmental sustainability in of development. Within the region there ECA. The biggest challenge to meeting the is considerable potential for reducing car- environmental targets is in water supply and bon emissions in the larger, more sanitation. Despite official data showing that a industrial economies--but less in the poor large percentage of people have access to countries of Central Asia. improved water supplies, there is a serious Some 40% of the ECA region is cov- issue of water quality, which constitutes a ered with forests, more than world average major health hazard. Goal 8: Develop a global partnership 18 for development Success in achieving the MDGs depends on negotiating their accession to the EU the actions of developing countries, but increased threefold between 1993 and 2001. there is much that developed countries can For the five South East European coun- do to help. Goal 8 commits wealthier coun- tries--Albania, Bosnia & Herzegovina, tries to work with developing countries and Croatia, FR Macedonia, and Serbia & create an environment that makes rapid, sus- Montenegro--the EU granted autonomous tainable development possible. It calls for an trade concessions in 2000 that make it pos- open, rule-based trading and financial sys- sible for around 95% of their exports to tem, more generous aid, and debt relief to enter the community duty-free. The EU countries committed to poverty reduction. eliminated its autonomous quantitative restrictions with most CIS countries in 1995 Reducing barriers to trade and is now the major trading partner for Promoting more efficient allocation of Russia and most of the independent states, resources, international trade has been critical accounting for 40% to 50% of their global in the ECA region's recent economic growth trade. The EU has bilateral steel agreements and increased productivity. One of the most with Russia and Kazakhstan--and is negoti- useful things that neighboring high income ating to renew its agreement with Ukraine. countries can do to promote growth in ECA countries is to reduce their import barriers. Effective development assistance The European Union has various trade Between 1960 and 2001 official arrangements with groups of countries in the development assistance (ODA) from major region. For example, bilateral free trade aid donors declined worldwide from 0.5% between the EU and the 10 ECA countries that of gross national income (GNI) to 0.22%. To have started negotiations to join the EU has reverse this trend, high income countries been agreed for industrial products--and sig- made commitments--at the UN nificant concessions have been negotiated for international conference on Financing for agricultural and processed agricultural prod- Development held at Monterrey, Mexico, in ucts. Trade with all the countries now March 2001--that would increase ODA to an average of 0.26% of GNI by 2006. EU member states committed to raise Exports lead GDP growth ­ up and down their ODA to at least 0.33% of GNI by 2006, with the EU average rising to 0.4% or more. Percent growth rate 16 There have also been pledges to assist spe- cific ECA countries. In late 2002 for 12 example, representatives of governments 8 and international agencies pledged to pro- vide $700 million to the Kyrgyz Republic to 4 help the government implement its reform program, particularly in the banking sector, 0 1995 1996 1997 1998 1999 2000 2001 private sector development, health and edu- cation reform, export development, and rural GDP Exports of goods and services infrastructure. And in early 2003 some $900 Source: Trade Progress Report, World Bank, 2003. million was pledged over three years to 19 Tajikistan (including $200 million in humanitarian create jobs. Its unified trade rules, single tariff, and assistance) as part of an intensified effort by the Tajik administrative procedures will simplify dealings for government and the international community to fight third-country operators in Europe and improve condi- poverty. tions for investment and trade. Donors, neighbors, and international financial Collaborative efforts to enhance economic growth and institutions launched the CIS-7 initiative in 2002 to reduce poverty address the transition difficulties of the poorest For many ECA countries, the prospect of accession to economies.12 The initiative aims to assist the CIS-7 the European Union in the near or distant future has implement their Poverty Reduction Strategies to been a "carrot." Membership offers many potential improve the business and investment climate, reduce benefits, including a better quality of life as members serious spending distortions, maintain macroeconomic adopt EU policies to protect the environment, to fight stability, push forward on structural reforms, improve crime and drugs, and so on. Above all, EU membership regional cooperation, and continue the support of provides an opportunity to boost economic growth and international community for the reform efforts. MDGs and PRSPs--Working together to reduce poverty An operational framework is required at the national level to translate the MDG targets into action. To be effec- tive, this framework needs to set out a country-owned agenda aimed at sustained, shared growth and public action to achieve the goals. For many of the poorest countries, the primary strategic and implementation vehicle to reach the MDGs is the Poverty Reduction Strategy Paper (PRSP). As of mid-2003, 10 countries had completed PRSPs or I-PRSPs (Interim PRSPs) in the ECA region.13 With national ownership as the key, countries will need to set their own targets and timetables in the PRSPs directed at meeting the goals and articulate the policies and pro- grams to attain them. The effectiveness of the PRSP is often enhanced by committing the finances required to meet these medium to long term goals through the use of a Medium Term Expenditure Framework.14 Country governments, the World Bank, the IMF, and other donors, including the UN System, all provide coordinated support to the PRSP process. The UNDP promotes civil society participation and provides advice to the government on the development of national capacity for poverty monitoring and analysis and for pro-poor policy reforms and service delivery. The UN country team, and other development partners, facilitate the expres- sion of the MDGs in national goals and targets in the PRSP. The UN country team also supports the preparation of regular country reports assessing progress toward the goals. These reports are to be a key instrument to inform public debate for setting national targets and to enable all parties to hold each other accountable for the achievement of objectives set out in the PRSP. The MDG coun- try reports and the annual PRSP progress reports will inform policymakers and the wider public of progress in reducing poverty. Both documents should produce good statistics and help strengthen national capacities for poverty monitoring and analysis. Meeting the goals will require a sharper focus on implementation and monitoring results at the country level. This will in turn require more work to establish credible data, perhaps differentiated by region or by rural and urban areas, to identify gaps and set priorities for actions to meet the targets. Some countries that have large internal disparities--geographic, ethnic, urban/rural--should focus on targeting disadvantaged groups. 12. Armenia, Azerbaijan, Georgia, the Kyrgyz Republic, Moldova, Tajikistan and Uzbekistan 13. Albania, Azerbaijan, Kyrgyz Republic, and Tajikistan have a full PRSP, Armenia, Bosnia & Herzegovina, Georgia, Macedonia, Moldova, and Serbia & Montenegro, have an interim PRSP 14. The MTEF is a transparent planning and budget formulation process within which a country's cabinet and central agencies establish credible contracts for allocating public resources to their strategic priorities while ensuring overall fiscal discipline. The process entails two main objectives: setting fiscal targets, and allocating resources to strategic priorities within these targets. 20 Millennium Development Goals Goals and targets from the Millennium Declaration Indicators for monitoring progress Goal 1 Eradicate extreme poverty and hunger Halve, between 1990 and 2015, the proportion of · Proportion of population below $1 a daya people whose income is less than $1 a day · Poverty gap ratio (incidence times depth of poverty) · Share of poorest quintile in national consumption Halve, between 1990 and 2015, the proportion of · Prevalence of underweight children (under five years of age) people who suffer from hunger · Proportion of population below minimum level of dietary energy consumption Goal 2 Achieve universal primary education Ensure that, by 2015, children everywhere, boys and · Net enrollment ratio in primary education girls alike, will be able to complete a full course of · Proportion of pupils starting grade 1 who reach grade 5 primary schooling · Literacy rate of 15- to 24-year-olds Goal 3 Promote gender equality and empower women Eliminate gender disparity in primary and secondary · Ratios of girls to boys in primary, secondary, and tertiary education education preferably by 2005 and in all levels of · Ratio of literate females to males among 15- to 24-year-olds education no later than 2015 · Share of women in wage employment in the nonagricultural sector · Proportion of seats held by women in national parliament Goal 4 Reduce child mortality Reduce by two-thirds, between 1990 and 2015, · Under-five mortality rate the under-five mortality rate · Infant mortality rate · Proportion of one-year-old children immunized against measles Goal 5 Improve maternal health Reduce by three-quarters, between 1990 and 2015, · Maternal mortality ratio the maternal mortality ratio · Proportion of births attended by skilled health personnel Goal 6 Combat HIV/AIDS, malaria, and other diseases Have halted by 2015 and begun to reverse the spread · HIV prevalence among 15- to 24-year-old pregnant women of HIV/AIDS · Condom use rate of the contraceptive prevalence rateb · Number of children orphaned by HIV/AIDSc Have halted by 2015 and begun to reverse the · Prevalence and death rates associated with malaria incidence of malaria and other major diseases · Proportion of population in malaria-risk areas using effective malaria prevention and treatment measuresd · Prevalence and death rates associated with tuberculosis · Proportion of tuberculosis cases detected and cured under directly observed treatment short course (DOTS) Goal 7 Ensure environmental sustainability Integrate the principles of sustainable development · Proportion of land area covered by forest into country policies and programs and reverse the · Ratio of area protected to maintain biological diversity to loss of environmental resources surface area · Energy use per unit of GDP · Carbon dioxide emissions (per capita) and consumption of ozone-depleting chlorofluorocarbons · Proportion of population using solid fuels Halve by 2015 the proportion of people without · Proportion of population with sustainable access to an sustainable access to safe drinking water improved water source, urban and rural Goals and targets from the Millennium Declaration Indicators for monitoring progress Goal 7 Continued Have achieved by 2020 a significant improvement · Proportion of population with access to improved sanitation in the lives of at least 100 million slum dwellers · Proportion of households with access to secure tenure Goal 8 Develop a global partnership for development Develop further an open, rule-based, predictable, Some of the indicators listed below will be monitored separately for the least devel- nondiscriminatory trading and financial system oped countries, Africa, landlocked countries, and small island developing states. (includes a commitment to good governance, Official development assistance (ODA) development, and poverty reduction--both nationally · Net ODA, total and to least developed countries, as a percentage of DAC donors' and internationally) gross national income (GNI) · Proportion of bilateral ODA for basic social services (basic education, primary Address the special needs of the least developed health care, nutrition, safe water, and sanitation) countries (includes tariff- and quota-free access for · Proportion of bilateral ODA that is untied exports, enhanced program of debt relief for and · ODA received by landlocked countries as a proportion of their GNI cancellation of official bilateral debt, and more · ODA received by small island developing states as a proportion of their GNI generous ODA for countries committed to poverty Market access reduction) · Proportion of total developed country imports (excluding arms) from developing countries and least developed countries admitted free of duties Address the special needs of landlocked countries · Average tariffs imposed by developed countries on agricultural products and tex- and small island developing states (through the tiles and clothing Program of Action for the Sustainable Development of · Agricultural support estimate for OECD countries as a percentage of their GDP Small Island Developing States and 22nd General · Proportion of ODA provided to help build trade capacitye Assembly provisions) Debt sustainability · Total number of countries that have reached their HIPC decision points and com- pletion points (cumulative) Deal comprehensively with the debt problems of · Debt relief committed under HIPC initiative developing countries through national and international · Debt service as a percentage of exports of goods and services measures in order to make debt sustainable in the long term In cooperation with developing countries, develop and · Unemployment rate of 15- to 24-year-olds, male and female implement strategies for decent and productive work and totalf for youth In cooperation with pharmaceutical companies, · Proportion of population with access to affordable, essential provide access to affordable essential drugs in drugs on a sustainable basis developing countries In cooperation with the private sector, make available · Telephone lines and cellular subscribers per 100 people the benefits of new technologies, especially information · Personal computers in use per 100 people and communications technologies · Internet users per 100 people a. For monitoring at the country level, national poverty lines should be used. b. Among contraceptive methods, only condoms are effective in reducing the spread of HIV. c. The proportion of orphan to nonorphan 10­ to 14-year-olds who are attending school. d. Percentage of children under five sleeping under insecticide-treated bed nets (prevention) and appropriately treated (treatment). e. The Organisation for Economic Co-operation and Development and the World Trade Organization are collecting data, which will be available from 2001 on. f. An improved measure of the target is under development by the International Labour Organization.