The challenges
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While the region is broadly on track to reach the health-related Millennium Development Goals (MDG 1 on hunger, MDG 4 on child mortality and MDG 5 on maternal mortality) there are alarming health disparities between countries in the region and, within countries, between geographic areas and population groups. Countries in Central Asia and the Caucasus have mortality rates that are two to three times higher than the regional average. In many countries, the under-five mortality rate is between 50 and 100 per cent higher in the poorest families than in the richest and there are similar disparities by gender, level of maternal education, location (whether urban or rural), ethnicity and mother tongue. For Roma children, child mortality is often two times higher than average. Only one in four children are immunised. Their families` access to health services is extremely poor. Low public expenditures in health persist in the region being below 4 per cent of Growth Domestic Production in many countries, according to the 2010 TransMonee database. In most of the countries in the region out-of-pocket expenditures represent about 40-50 per cent of Total Health Expenditures, reaching 60-70 per cent in some countries in Caucasus and Central Asia, WHO Europe reported in the 2010 Health for All Database. Out-of pocket expenditures expose families to poverty and catastrophic health expenditures. For Roma children, child mortality is often two times higher than average. Only one in four are immunised. Chronic malnutrition problems, exacerbated by poverty and rising food prices, are reflected in high rates of stunting. The prevalence of stunting in Tajikistan is as high as 39 per cent of under-five-year-olds while the regional average is 16 per cent. The proportion of households consuming adequately iodized salt in the region at 51 per cent. It is is the lowest in the world as Russia and Ukraine, two countries with the largest populations in the region, have not enacted national universal salt iodization legislations. Progress on MDG6 – combating HIV and AIDS, malaria and other diseases – is simply inadequate. Many countries are witnessing the resurgence of vaccine-preventable diseases including, most recently and alarmingly, the spectre of polio in a region once declared polio-free. New health concerns include mortality rates among children aged 5 to 18. Overall, poor access to health services – and the weaknesses of health services themselves – is having a negative impact on child wellbeing. It is fuelling child poverty. Analysis of the impact of reforms in the region suggests that countries have often focused on improving the overall financial sustainability of health systems, introducing new service delivery and financing models. Mothers and children have not always received better care. Evidence demonstrates that ensuring families with access to a minimum of package of cash benefits and welfare services, including comprehensive health and early childhood development services helps reduce inequity and child income poverty. All data from State of the World`s Children 2011 unless stated otherwise. UPDATED 28 May, 2011.
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