The Post 2015 Development AgendaPerspectives from Asia and the Pacific

Susann Roth, Senior Social Development Specialist, ADB February, 2013, Manila
Disclaimer: The views expressed are a collection of regional perspectives and not an official position of ADB.

Outline
Progress of MDGs (Health related) in Asia and the Pacific

Key messages from consultations

A proposed Post 2015 framework with goal areas, themes and illustrative indicators Post 2015 Development Framework: ZEN approach Summary

MDG Progress in Asia

MDG 1 on Poverty and Hunger
Remarkable success on poverty, but hunger remains a big challenge.

MDG 2 on Primary Education

Enrollment rate rose from around 86% in 1999 to 94% in 2010, with 30 of 42 economies achieving net enrollment rates of 95% or higher.

MDG 3 on Gender Equality in primary education

The gap has been filled with a gender parity ratio of 0.99 in 2010, up from 0.86 in 1991.

MDG 4 on Child Mortality

Steady progress but not on track to achieve targets. In 2011, Asian child mortality rate stood at 44 deaths per 1,000 live births, down from 87 in 1990. But this is still more than twice the rate of 19 in Latin America and the Caribbean.

MDG Progress in Asia

MDG 5 on Maternal Health
Early signs of progress, although far too little. Many of the deaths still occur due to lack of access to skilled birth attendants and inadequate antenatal care.

MDG 6 on Infectious Diseases

The absolute number of persons living with HIV has increased although the rate of HIV infection has declined.

MDG 7 on Environmental Sustainability

Economic progress is pushing planetary boundaries. Limited progress in WSS

MDG 8 on Development of a Global Partnership for Development

Flows of ODA to the region has been declining.

Progress towards Health MDGs has been mixed since 1990

Income poverty Underweight children

Primary enrollment rate

Primary completion rate Gender parity, primary Gender parity, secondary Gender parity, tertiary Women in non-agricultural wage employment Maternal mortality rate Child mortality rate Access to clean water, urban Access to clean water, rural Access to improved sanitation, urban Access to improved sanitation, rural 20 40 60 80 100 120 140 160 180 200 220

Latest 2015 Forecast 2015 Target

Distance to goal achieved by ADB developing member countries since 1990, %

Asia/Pacific is different
Most economically dynamic region in the world Massive private sector led investments and large natural resource reserves Most diverse region in the world Home to more than 50% population of the world as well as most poor people in the world Inequality has grown in most countries Most disaster prone and most vulnerable to climate change Potential to make the biggest impact on climate change Fastest reduction in bio-diversity

There are new health issues for the region

Weak health systems

Demogra phic changes

Widening inequilties

Regional health security

Migration

Lifestyle related diseases

The consultations are participatory

The 2012/2013 MDG Report Post 2015 Development Agenda in Asia and the Pacific: Regional Perspectives
Launch of MDG report at the UN General Assembly Sept 2013

Sub-regional consultations Country/regional consultations Expert panel seminars

The Asia/Pacific views of the Post 2015 development agenda

Inception Meeting at UN HQ to present findings May 2012

Soft launch of MDG report

Jan 2012

March 2013

Sub-regional consultations were held

Central and East Asia and Caucasus Least Developed Countries

South Asia Southeast Asia

Pacific Region

The consultations were held with representatives from government agencies, civil society, think tanks, and other stakeholders

Lessons learnt Health MDGs are not always integrated in national development plans
Around 30 % of ADB developing member countries do not have national MDG reports or adapted the MDGs to their own needs.
Most do not integrate MDGs in planning and budgeting. ODA replaced funds from the national budget for health.

Focus of investments went into single diseases instead of health system strengthening. Service delivery to improve health outcomes remains weak.

Key findings from the sub-regional consultations (1)

Central and East Asia Pacific Southeast Asia Least Dev. Countries South Asia

Priorities

Wellbeing for all, Leaving Poverty and Hunger behind, Employment/Decent Jobs, Gender Equality, Governance, Decreased Inequality, Climate Change Mitigation and Adaptation, Food Security
Natural Resource Management Climate Change Mitigation and Adaptation Education Health Economic Growth Living standards Education Health Economic Growth Improved Living standards Education Health Economic Growth Improved Living standards

Convergence

Keep the MDGs as unfinished business at its core (minimum standards) but expand to cover the triple bottom line of the economic, social, and environmental pillars considering countries development stage (supporting evidence for ZEN approach)

Key findings from the sub-regional consultations (2)

Central and East Asia Architecture Pacific Southeast Asia Least Dev. Countries South Asia Agenda applicable to all countries with a global agenda setting and vision, with indicators specific to the Asia-Pacific region and target setting at the country level, Focus on how results can be achieved and sustained at a country level. Needs to go beyond ODA Mobilize resources from national budgets Avoid aid fragmentatio n Strengthen Regional and SouthSouth cooperation Private sector Strengthen Regional and South South cooperation Leverage FDI National budget ODA stays very relevant More efficient use of ODA is necessary Increased allocation to Asian/Pacif ic LDCs ODA stays relevant Needs private sector Strengthen Regional and SouthSouth cooperation Leverage FDI National budget

Resources

Sub-regional consultations confirm the need to address old and new health issues
Keep Health MDGs but expand MCH

Strengthen Health Systems

Strengthen governance in health systems Improve quality of service delivery

Strengthen Health Financing

CDs

NCDs

Strengthen intersectoral collaboration

Access to health Insurance Coverage (private and public)

Think piece - How to address health in the Post 2015 Development Agenda
Improve quality of life for all

Global shared goal

e.g. Healthy life expectancy

Strengthen health systems and sector governance

Region and country specific goal themes e.g. MCH, CDs, non-CDs, Health Systems, Health and environment

Respond to country needs

Regional, Sub-regional and national targets

Sub-regional consultations agree that country context needs to be considered

Country Context Approach

High-income group Natural resource rehabilitation towards sustainability and adjustments of life-style to live a healthy life in peaceful societies within a sustained environment.
Middle-income group Strengthen quality of education, availability of decent jobs, provide social protection and health insurance coverage, decouple growth from resource-intensive production. Provide access (in sustainable manner) to basic services, health, education decent jobs, shelter, WSS (social protection floor), and infrastructure.

Low-income group

Changing development priorities in Asia-Pacific

Poverty: focus broadens to include near poor ($2) Hunger: emphasis on food and nutrition security Education: focus on skills development and education quality Health: focus on healthy life expectancy and wellbeing, regional health security, communicable and non-communicable diseases, aging, health impact from disasters, strengthening health systems and health financing and retain MMR and U-5M Gender: focus on productive participation in employment; representation in decision making; and sexual and reproductive rights Environment: In addition to mitigation, focus on climate adaptation, disaster risk management, sustainable urbanization, conservation of water and other natural resources New issues:
Governance: Responsiveness, accountability, and performance of the public sector Inequality and disparities between and within countries Improving Living Standards (urban and rural)

Protection against risks and vulnerabilities

Growing vulnerabilities in Asia and Pacific region
Social protection missing in MDGs

Non-formal sector in region without any social protection

Household-related shocks Problem of ageing Vulnerability to economic shocks internal and external Increasing frequency of natural disasters and impact of climate change

Idea of social protection floor and basic minimum guarantees

Essential health care for all Basic income security in cases of unemployment, maternity, sickness, disability for those in active age groups without sufficient income Income security for the elderly and disabled Assistance to those affected by natural disasters

Key messages from consultations

What do we need to do? Sustain top priority on multiple dimensions of extreme poverty Address emerging challenges related to aging, disasters, non-communicable diseases related to unhealthy lifestyle Address governance at a global, regional and sectoral level Add goals for fast-growing environmental challenges Also monitor the means and process for achieving the goals Establish coordinated and inclusive political approach for local targets around global priorities Institutionalize a robust and inclusive monitoring mechanism

Summary
Post 2015 development agenda needs to be applicable to all countries with global agenda setting and vision, and targets and indicators specific to regions and countries. Asia/Pacific has specific challenges to address: e.g. increasing impact from disasters, demographic changes, increasing inequality Focus needs to stay on a core set of human development priorities and equality and sustainability as underpinning principles. Need for ODA ++ (leveraging & SS cooperation).

Thank you

The Economist, September 2012 http://www.economist.com/node/21562210