Poverty, hunger and disease: so much done yet so much left to do

from The Guardian Katine Project

The millennium development goals set by the UN at the turn of the century made up the most aspirational development programme ever devised. But a progress report published today by Unicef says that even though more babies are surviving, more children are in school and fewer families live in poverty, urgent action is needed if the goals are to be met by the target date of 2015. Here Sarah Boseley and Larry Elliott look at seven of the goals and assess how much progress has been made

Goal 1: To eradicate extreme poverty and hunger

Targets by 2015 To halve the proportion of people in 1990 who were suffering from hunger. To halve the proportion of people whose income is less than $1 a day

To monitor the fight against hunger, the UN took as its yardstick the proportion of children under five who are underweight. In 1990, 32% of under-fives in the developing world were underweight, undernourished and therefore at high risk of stunted growth, disease and death. Today that figure has come down, but not by much, to 27%. East Asia, the Pacific and eastern Europe have made the biggest advances and 58 countries are on target to reach the millennium development goal.

But 143 million children under five in the developing world continue to suffer from inadequate nutrition. The highest numbers are in south Asia, where over half the under-fives (54%) were underweight in 1990, but there is progress in this region, with the proportion falling to 46% by 2006. Asia, the second poorest part of the globe, has seen a drop from 41.1% living below the poverty line to 29.5% by 2004. However there have been no such gains in sub-Saharan Africa. If progress continues to be this slow and patchy, the 2015 target will be missed by a margin of 30 million children.

Poverty is more widespread in sub-Saharan Africa than anywhere else: in 1990, 46.8% of people were on less than $1 a day. That had reduced to 41.1% by 2004. Because of Asia's rapid economic growth, the overall level of poverty has been cut from 31.6% in the developing world to 19.2% and if this continues, the global target will be met, although Asia's success is masking the lack of progress in sub-Saharan Africa.

Progress report Target on poverty likely to be reached, but goal on hunger is unlikely.

Goal 2: To achieve universal primary education

Target To ensure that, by 2015, children everywhere, both boys and girls, will be able to complete a full course of primary schooling

The two indicators used to monitor progress in meeting this goal are the percentage of children enrolled in primary school and those who complete this stage of education by reaching grade five or "primary completion rate". Both developed and developing countries have put considerable effort into achieving the education goal and the Unicef report says there has been "substantial progress". Partly as a result of debt cancellation, countries such as Tanzania are on course to achieve 100% primary participation by 2015, although sub-Saharan Africa as a whole will not meet the target without more rapid progress over the next seven years. The UK has a 10-year £10bn programme for education in developing countries.

According to the Unicef report, more than 85% of primary school-age children are now receiving a basic education, although the figure drops to 70% in eastern and southern Africa and just 62% in west and central Africa. Between 2002 and 2005, the number of children out of school dropped from 115 million to 93 million, and of those still without a school place 41 million live in sub-Saharan Africa and a further 31.5 million live in south Asia.

Actual attendance rates tend to be lower than enrolment rates. In eastern Africa, for example, fewer than three out of five children attend primary school, and Unicef says that some of those are pupils of secondary school age who have started their education late or are retaking grades. For countries nearing universal primary education, Unicef says that reaching the last 10% of children out of school is a "particular challenge".

Progress report There are 86 countries in the world that have yet to achieve universal primary education. On current trends 58 will still not have done so by 2015. Even so, there are hopes that progress will be speeded up, with attention in the better performing countries now switching to quality of education and expansion of secondary schooling.

Goal 3: To promote gender equality and empower women

Target To eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015

The gap between boys and girls receiving a primary education narrowed between 1990 and 2005 - from 8 percentage points to 4 percentage points - but Unicef says big gender disparities remain, particularly in west and central Africa, the Middle East and north Africa, and south Asia. Only two thirds of countries met the target of gender parity in primary education by 2005, with one third achieving gender parity in secondary education. Gender disparities are greatest in rural areas and among poor households.

Progress report The gender equality target is unlikely to be met on current trends, even though Unicef says it is just a starting point towards the eventual goal of education being a "fulfilling experience for all girls and boys".

Goal 4: To reduce child mortality

Target To reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Unicef recently celebrated the passing of a milestone in the battle to reduce the death toll among babies in the developing world. In 2006, for the first time since records were kept, the number of children dying before their fifth birthday dropped below 10 million a year, to 9.7 million.

But baby deaths are still distressingly commonplace. The death rate is substantially higher in sub-Saharan Africa than elsewhere. In 1990, 187 babies and children under five died there for every 1,000 births. By last year, that had been reduced, but only to 160 per 1,000 births. South Asia has the next highest death rate, but has been making significant progress, dropping from 123 per 1,000 births in 1990 to 83.

The stakes are high. If the millennium development goal target is reached by 2015, 5.4 million children's lives will be saved in that year alone. Most deaths occur during and shortly after birth (37%), but preventable diseases also take a big toll. Pneumonia kills 19%, diarrhoea 17% and malaria 8%.

One bright spot has been the success of routine measles vaccination, which cut measles deaths by 75% in sub-Saharan Africa between 1999 and 2005. And when mothers bring their babies to be vaccinated, they are being offered other life-saving interventions at the clinic, such as bed nets to protect against malaria, deworming medicines and vitamin A.

Progress report A long way off target.

Goal 5: To improve maternal health

Target To reduce by three-quarters the 1990 maternal mortality ratio

Every year, half a million women die in pregnancy or childbirth, almost all of them in sub-Saharan Africa and Asia. Having a baby is a very high risk in southern Africa. According to the latest figures published today by Unicef, a woman has a one in 22 lifetime chance of dying in pregnancy or childbirth, compared with one in 8,000 in countries like the UK.

It has proved very difficult to get accurate figures for maternal deaths in the developing world. Many countries have no system of death registration, and death from diseases such as Aids or malaria will not be added to the maternal mortality count, even though they are made more likely by pregnancy.

Experts believe that the global rate of maternal mortality did come down between 1990 and 2005, but only by about 5.4%. To reach the target, the death rate would have to come down by about that much every year.

But not even this small rate of progress is being achieved in sub-Saharan Africa, according to a report from the World Bank, the World Health Organisation, Unicef and the UN Population Fund, which claims that the numbers of maternal deaths actually rose in sub-Saharan Africa from 212,000 a year to 270,000 over that period (although there was negligible change in the maternal mortality rate because live births also increased).

More than a third of the deaths are cause by haemorrhage and 16% by blood poisoning and infections including Aids. Skilled birth attendants are key to reducing deaths, but sub-Saharan Africa has only managed to increase their presence at births from 43% to 47% and South Asia from 31% to 40%.

However, antenatal care has improved in all regions. Preventing unplanned pregnancies could cut deaths by a quarter, but only 23% of sub-Saharan African women use any form of contraception.

Progress report A long way off target.

Goal 6: To combat HIV and Aids, malaria and other diseases

Target To halt and begin to reverse the spread of HIV and Aids. To halt and begin to reverse the incidence of malaria and other major diseases

The percentage of people living with HIV/Aids levelled off for the first time this year, UNAids said last month, at 33.2 million (less than last year's estimate because of a big revision in the figures). The number of new infections fell to 2.5 million and is now thought to have peaked in the late 1990s, when it was more than 3 million a year. But the total number of people living with HIV continues to rise, as people survive longer thanks to treatment. Efforts to educate young people about protecting themselves from HIV and encourage condom use have not been very successful. Only 24% of 15- 24-year-olds in low and middle income countries have a comprehensive understanding of HIV.

Malaria kills more than a million people a year, 80% of them children under five in sub-Saharan Africa. Africa has widely adopted, in principle, new antimalarial drugs recommended by the WHO, but they are not always given to the children who need them. While 16 out of 20 countries have tripled their use of bed nets to protect against bites from carrier mosquitoes, only a handful came close to the target of 60% bed net coverage set in 2000, and in sub-Saharan Africa only 5% of small children sleep under them.

Progress report Could reach target, but too soon to say.

Goal 7: To ensure environmental sustainability

Target To halve, between 1990 and 2015, the proportion without sustainable access to basic sanitation

With health and education given priority, sanitation has been the forgotten millennium development goal. Although sanitation coverage increased from 49% in 1990 to 59% in 2004, progress has been far too slow to meet the UN's goal and the Unicef report says that on current trends the target will be missed by more than half a billion people. This is despite the fact that the UN itself says that there is a direct link between sanitation and achieving the other goals.

Lack of sanitation, poor hygiene and unsafe drinking water cause the deaths of more than 1.5 million children every year from diarrhoeal diseases and lead to millions of children, particularly girls, being kept off school.

The latest figures, for 2004, show that 2.6 billion people - almost half the world's population - lack access to proper sanitation and Unicef admits that simply keeping pace with population growth remains a huge challenge. This is especially true in sub-Saharan Africa, where the number of people without access to sanitation has increased by 100 million since 1990.

Progress report With Unicef admitting that a lack of political support is a "major barrier to progress", the sanitation goal is one of the least likely to be hit, and will not be achieved for another 70 years on current trends.