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THE

STORIES
BEHIND
THE DATA
2017
1

INTRODUCTION
For years, weve heard people question
whether investments in the fight against
global poverty have an impact. Clearly,
we believe they do.

We are investing all our resources in that fight. health and well-being. To complement the data,
But that doesnt mean every dollar spent on were also telling the stories behind the numbers
development has maximum impact. And that about the leaders, innovations, and policies that
must be our goal. have made the difference in countries where
We are launching this report this year and will progress has been most significant.
publish it every year until 2030 because we want With the charts, we include the SDG targets
to accelerate progress in the fight against poverty for 2030. Candidly, we are unlikely to reach every
by helping to diagnose urgent problems, identify targetsome are more realistic and some are
promising solutions, measure and interpret key more aspirationalbut that doesnt absolve
results, and spread best practices. us of the responsibility to get as close as we can.
As it happens, this report comes out at a time We asked the Institute for Health Metrics and
when there is more doubt than usual about the Evaluation to project the likely range of outcomes
worlds commitment to development. In our own on many of our selected indicators between now
country, Congress is currently considering how and 2030. The spaces between the edges of the
to deal with the big cuts to foreign aid proposed red and green zones, while only an inch or two
in the presidents budget. A similar mood of on paper, represent the lives and livelihoods of
retrenchment has taken hold in other donor millions of people. If we want to be in the green
countries. Meanwhile, most developing countries zone, not the red, then we have to keep innovating
need to do more to prioritize the welfare of their and investing.
poorest citizens. The decisions we collectively make in the next
In 2015, the member states of the United couple of years are going to have a big impact on
Nations adopted the Sustainable Development the shape these curves take. Of course, its not
Goals (SDGs), which together paint a picture of really about the shape of the curves. Its about
what we all want the world to look like in 2030. what the curves signify: whether or not millions
However, if we dont reaffirm the commitment or even billions of people will conquer disease, lift
that has led to so much progress over the past themselves out of extreme poverty, and reach
generation, that world will remain out of reach. their full potential.
Leaders everywhere need to take action now to
put us on the path we set for ourselves just two
years ago.
This report tracks 18 data points included in the
SDGs that we believe are fundamental to peoples
Goalkeepers 2
The Stories Behind the Data

CHILD MORTALITY

MELINDA GATES
Co-chair, Bill & Melinda Gates Foundation

If I had to pick just one data point to In the years Ive been working in global average, as my friend and mentor
focus on, it would be the number of health, the number of child deaths the late Hans Rosling pointed out,
children who die every year before has gone down every year. By a lot. chimpanzees do better than people
reaching the age of 5. Theres so Six million fewer children died in on a multiple-choice test about how
much packed into that number. 2016 than in 1990. Thats more than many children the world has saved.
Child mortality is a proxy for overall the total number of children in France. I dont quite understand why people
well-being; its also a leading arent more aware of, and more
indicator of progress (or the lack of proud of, this accomplishment.
it). And when you talk to mothers
WHAT IS MORE Still, the global child mortality
who have experienced the death of FUNDAMENTAL THAN curve doesnt tell the whole story.
a child, you understand what that KEEPING CHILDREN It hides an important insight about
what it will take to save the next
number means in human terms.
What is more fundamental than ALIVE SO THEY CAN 5 million. If we were to break this
keeping children alive so they can BUILD THE FUTURE? single, global line into separate
thrive and build the future? lines for each country, we would
Based on global child mortality Unfortunately, not many people see massive differences among
data, the world is on the right track. know about this success. On them. Children are 75 times more
Child Mortality 3
Melinda Gates

Global number of deaths of children under age 5 (in millions)


Current projection If we progress If we regress

15m HOW FAR WEVE COME WHERE WE COULD GO

11.2m

10

5.0m
5

3.3m

2.5m

2.0m

1990 2000 2016 2030


Gavi, the Vaccine
Alliance, is formed

likely to die if they happen to be and development because we To answer the call, the world
born in Angola instead of Finland. believed it was possible to eliminate must spread best practices from
Warren Buffett calls this the ovarian gross inequities. Weve seen many exemplars like Malawi. Fortunately,
lottery. The work of this generation poor countries prove the point. we are learning more and more
is to make the ovarian lottery fairer Take Malawi. In 1990, one in four about how to save childrens lives.
(and save millions more lives) by children there died. Now, its one Close to half of the almost 5
addressing child mortality in countries in 16. This is great news, because million children who will die next year
like Angola, Nigeria, Democratic Malawi is closing the gap between will die in the first 28 days of their
Republic of Congo, and Pakistan, itself and Finland. Its also a call to lives. Most could be saved by a few
where children are most at risk. action, because now theres a big simple interventions: for example,
Bill and I began investing in health gap between Malawi and Angola. resuscitation if they cant breathe,
Goalkeepers 4
The Stories Behind the Data

antiseptics that cost pennies to explains why measles, preventable many partners in launching what
prevent infection, and breastfeeding with a vaccine that costs less than was then called the Global Alliance
to strengthen their immune 20 cents, still kills almost 150,000 for Vaccines and Immunization (now
systems. Cambodia and Ethiopia children every year. Gavi, the Vaccine Alliance). Since
have shown what happens when Its a huge challenge to reach then, Gavi has helped more than
a country prioritizes its newborns. children in countries in conflict or 70 countries vaccinate 600 million
The challenge is reaching the most in remote regions hours away from children. It has helped dozens of
vulnerable people in the world with any infrastructure whatsoever. But countries add new vaccines against
basic information and services that its doable, and its more doable leading childhood killers such as
save babies lives. now than ever before. Consider how diarrhea and pneumonia to their
About 1.5 million of the children difficult it is to deliver a vaccine that immunization programs. It has saved
who will die next year will die from needs to be kept at a specific cold more than 7 million lives.
diseases that we can prevent with temperature to a child who lives in a We know what it takes to give
vaccines. Many countries, including desert. New coolers using insulation millions of children the opportunity
Bangladesh, Honduras, and Tanzania, developed for spacecraft can keep to thrive. The question is, do we have
immunize more than 90 percent vaccines cold for a month and help the commitment?
of their children, but there are still us reach millions of children were
nearly 20 million children in the world currently missing.
who arent immunized at all. This In 2000, our foundation joined

The Arktek cooler can keep vaccines cold for a month, allowing health workers to reach children
in the most remote regions. (Addis Ababa, Ethiopia) (Photo courtesy Intellectual Ventures)
Child Mortality 5
Melinda Gates

THE GLOBAL CHILD MORTALITY CURVE


DOESNT TELL THE WHOLE STORY. IT HIDES
AN IMPORTANT INSIGHT ABOUT WHAT IT
WILL TAKE TO SAVE THE NEXT 5 MILLION.
Goalkeepers 6
The Stories Behind the Data

MATERNAL
MORTALITY

If you were trying to invent the every new solution that saves continues, the maternal health
most efficient way to devastate a mothers life, you need to deliver community must make sure that the
communities and put children in 100 times as much of that solution obstetric care provided in facilities
danger, you would invent maternal to have the same impact. is of the highest quality. With
mortality. Luckily, solutions already exist. many more mothers delivering in
So the fact that the number of To deliver those solutions to all facilities, it puts new pressures on
mothers who die has been cut in half women, the most important priority health systemsthey need more
in the past generation is one of the is persuading them to give birth in equipment, more staff, and more
more important successes in global health facilities, where they can get training. With these resources,
health. Its all the more impressive skilled obstetric care, instead of at developing countries will continue
because reducing maternal mortality home. We asked Kesete Admasu, to drive down maternal mortality
is really hard. former minister of health of Ethiopia, at the accelerated rates of the past
Statistically speaking, its rare to write about how his country 25 years.
compared to, say, child mortality. created a health infrastructure that
Thats why maternal deaths are helped women make this decision. Bill and Melinda Gates
rendered per 100,000 live births As Dr. Kesete suggests, as this
instead of per 1,000. Therefore, for shift from home to facility births
Maternal Mortality 7
Kesete Admasu

Maternal deaths per 100,000 live births in Ethiopia


Progress to date

1000

843

750

500

357

250

1990 2003 2011 2016


Health Extension Womens Development
Program begins Army launched

When I joined the Ethiopian Ministry We were committed to saving


KESETE ADMASU
CEO, Roll Back Malaria Partnership (former
of Health in 2002, we were using those lives, but it didnt make
minister of health, Ethiopia, 20122016) a health system designed for sense to put good money into a
other countries. Our tiny number bad system. So we built a new
of highly trained health providers one. Launched in 2003, the Health
was concentrated in big cities, far Extension Program gives Ethiopians
away from the 85 percent of our the services they need, where they
people who live in rural areas. need them. We trained 40,000
This mismatch led to some of the health extension workers to provide
worst child and maternal mortality basic information and care to all 100
statistics in the world. million Ethiopians. The goal was to
Goalkeepers 8
The Stories Behind the Data

The Womens Development Army encourages expecting mothers to give birth at local medical facilities.
Here, a health extension worker provides a routine check-up. (Germama Health Post, Ethiopia)

put knowledge and powerand, that happens in health facilities. But nets and use latrinesand whose
ultimately, responsibilityin the Ethiopian mothers overwhelmingly example and leadership we hoped
hands of local people. chose to give birth at home. Health would inspire others. The idea: Model
Dont let me give the impression workers advised women to give birth families create model communities,
that any of this was easy. We made in facilities, but they didnt persuade which lead to model districts and
mistakes, and we have shared lessons many families to change. eventually to a model country.
so that other countries can learn Second, our colleagues in
from our experience. But, generally Ethiopias agricultural ministry
speaking, the Health Extension
CHILD MORTALITY had been experimenting with ways
Program workedand worked fast. DROPPED BY HALF IN JUST to help smallholder farmers use
Child mortality dropped by half in EIGHT YEARS. MATERNAL better seeds and modern planting
techniques, and theyd had some
just eight years. We had proved our
theory. When it comes to the things MORTALITY, THOUGH, WAS success encouraging men to
that save childrens livesfamily A DIFFERENT STORY. advocate within their communities.
planning, vaccines, bed nets, basic We adapted that idea for health
management of common illnesses By 2010, two separate strands of and used the model families wed
you can bring care to the community. thinking had come together to suggest already trained to lead what we called
Maternal mortality, though, was a possible solution to our problem. the Womens Development Army.
a different story. It went down, but First, the Health Extension Program One health extension worker
not nearly as much as child mortality. had always included the concept covers a community of 2,500 people
We knew why. To save mothers lives, of model families, early adopters or 500 families. Thats a world of
you need skilled obstetric care, and who did things like sleep under bed improvement over the old system,
Maternal Mortality 9
Kesete Admasu

NOW THAT MORE ETHIOPIANS ARE DELIVERING


IN FACILITIES, THERE IS MORE WORK TO DO:
MAKING SURE THAT THE QUALITY OF CARE
IN FACILITIES IS UNIFORMLY EXCELLENT.

but its still too many for each worker the birth. Another concern: Women community connected to the health
to build a deep personal connection didnt want to be carried on a system, which is why the Womens
with every person under her care. stretcher, because others who left Development Army will continue to
The Womens Development Army, the village on a stretcher never play a pivotal role. We have found
on the other hand, has 3 million came back. a way for Ethiopians to voice their
members, one for every six families. Now, religious leaders go to the demands to the health ministry.
They are not health professionals health facility, so that a safer birth And when you have a demanding
talking to community members. doesnt mean a birth divorced from society, government delivers.
They are community members. peoples culture. We also designed
They meet with women in the a new stretcher just for pregnant
community every day over coffee women. We opened maternity
ceremonies and every week at church waiting homes where women in
or the mosque, and in short order their third trimester can stay close
they have helped changed the ecology to the facility while they wait to go
of childbirth in Ethiopia. Between into labor. These were problems
2011 and 2016, the proportion of and solutions wed never thought
women giving birth in facilities of, but the Womens Development
increased from 20 to 73 percent. Army opened our eyes to the
Its not just that the development communitys needs.
army tells women in a community Now that more Ethiopians are
what those of us running the health delivering in health facilities, there
system think they should be doing. is more work to do: making sure
It works the other way around, too. that the quality of care in facilities
They tell us what the community is uniformly excellent. That means a
wants us to do. For example, in the lot of things, including purchasing
Tigray region, we learned that many more equipment and medicines and
women refused to give birth at training more skilled providers, which
facilities because they wanted their we are doing.
religious leaders to be present at It also means keeping the
Goalkeepers 10
The Stories Behind the Data

FAMILY
PLANNING

Perhaps the best way to describe the funding, developing new products, West African countries committed to
importance of family planning is this: and repairing broken systems. Its reaching more women in the region
Achieving the family planning goal also deeply cultural. with family planning services. Imam
makes it more likely that well Despite these challenges, many Mouss Fall, a founder of the Islamic
achieve virtually every other developing countries have started to Network on Population, helps his
Sustainable Development Goal. prioritize family planning, because fellow imams think about how family
Poverty. Maternal mortality. Child they understand the impact it has. planning fits into their theology.
mortality. Education. Gender equity. In the past several years, more than Together, Mrs. Sy and Imam Fall
They all get better when women can 40 countries have launched rigorous demonstrate both the breadth and
plan their pregnancies so they are national family planning plans. depth of work necessary to make sure
physically and economically ready We asked two people instrumental families can unlock their full potential.
when they have a child. in one of the most successful family
But norms around sex and family planning programs, in Senegal, to Bill and Melinda Gates
life are powerful. In many countries, write about their experience. Fatimata
families havent typically planned. Sy is director of the coordination unit
The work of giving them options for the Ouagadougou Partnership,
is not just technicalraising more an alliance of the nine francophone
Family Planning 11
Fatimata Sy, Mouss Fall

Modern contraceptive prevalence rate in Senegal


Progress to date

20%

15%
15

10

3%

1990 2012 2016


National Family Planning
Action Plan launched

In 2011, increasing access to sexual But everything changed when


FATIMATA SY
Director of the Coordination Unit for
and reproductive health services in we launched the Ouagadougou
the Ouagadougou Partnership Senegal and across West Africa was Partnership, and when Senegal took
little more than a dream. Our cultures the lead to develop the first national
and norms dictated that women have action plan for family planning in
lots of children, and most people the region. Everyone in Senegal was
didnt understand the health risks involved in developing this plan.
of frequent pregnanciesor how to The government set the tone, with
avoid them. Sadly, those who did often ambitious policies to change the
found that public health facilities didnt status quo as well as the funding to
have the contraceptives they wanted. back them up. Civil society followed,
Goalkeepers 12
The Stories Behind the Data

After addressing issues in the supply chain, Senegal can now provide contraceptive options
for women seeking services during their first visit to the clinic. (Dakar, Senegal)

with virtually every interest group On the supply side, Senegal they used: When there are no
in Senegal represented: religious decentralized its contraceptive products, there is no program.
leaders, community advocates, youth, supply chains, with the guidance Senegals progress took the world by
and others. For the first time, there of private-sector partners, to make surprise, and now the other countries
was momentum for change. sure that a woman seeking services in the Ouagadougou Partnership are
The action plan addressed many never got sent home empty-handed. making extraordinary gains, too.
interconnected challenges in creative What excites me even more is that
ways, including strategies to increase now its not just ministers of health
the demand for and the supply of SENEGAL REVAMPED ITS who want to hear about family
reproductive health services. For SUPPLY CHAIN TO MAKE planning. Its ministers of finance,
instance, to increase demand, population, and education as well.
Senegal launched a public awareness
SURE THAT A WOMAN They get that family planning isnt just
campaign about how frequent SEEKING CONTRACEPTIVES about health, which is somebody
pregnancies affect the health of NEVER GOT SENT HOME elses problem. Its about the future,
women and their children. For a year, which were all responsible for.
the press spoke constantly of family
EMPTY-HANDED. For so long, life in Senegal has
planning on TV, on the radio, and in been about the lack of things. Lack
newspapers and magazines. There When we started, some types of of water. Lack of electricity. Lack
were debates. There were posters contraceptives were in stock as little of schools. Lack of jobs. Lack, lack,
everywhere. This was a monumental as 20 percent of the time, but now lack. But for the next generation, life
shift in a country where such subjects that number is over 98 percent, can be better. Its possible. Its my
had long been taboo. nationwide. I still think of the slogan dream, and its becoming a reality.
Family Planning 13
Fatimata Sy, Mouss Fall

WHAT WEVE ACHIEVED CAN HAPPEN


THROUGHOUT WEST AFRICA. SENEGALS
SUCCESSES CAN BE A SOURCE OF INSPIRATION.

for Skype in the Quran. However, understand how contraceptives work


MOUSS FALL
all the Qurans themes related to and what the side effects can be.
Imam and founder of the
Islamic Network on Population communication can apply to Skype. This is hard and continuous work.
That is the intellectual effort that Weve trained over 3,000 imams who
religious authorities must take on. are now on our side. At the start, they
We try to help them do that. were really against family planning.
For example, the Prophet of Im sure that what weve achieved
Islam encourages women to space in Senegal can happen throughout
births because they have a duty West Africa. Our realities are
to breastfeed for two full years. not different, considering it was
Hadiths corroborate that. In the most the colonists who drew borders
commonly used one, the Prophet between the countries. We have the
My mother had eight kids. I was speaks about losing his son, named same values and nearly the same
second-to-last. She passed away Ibrahim, when he was a year and languages. We received Islam at the
when she was 43. From that moment 10 months old. The Prophet says, same time. Senegals successes can
on, I had to face the dangers of My son has left this world although be a source of inspiration.
the world alone. We realized that his nursing time was not yet done. What I wish for is people who
the main cause of her death was The imams we work with know all can use their strengths in building a
pregnancies that were too close the verses. After we study them better future. I believe the work were
together. I didnt want that to together, they usually agree with our doing together is progress toward
happen to anyone else. arguments. The next steps are to try this goal. Inshallah.
When I got older and started to normalize the subject and reserve
studying Islamic thought, I noticed it for couples duly bound by the
how many religious authorities sacred ties of marriage.
opposed family planning. The In every district in Senegal, we
Quran is authentic, but religious offer training sessions with local
authorities have to interpret it based doctors and influential imams.
on the reality of their time. We have We cover both theological and
Skype today, but no ones looking medical issues, so that imams also
Goalkeepers 14
The Stories Behind the Data

HIV

BILL GATES
Co-chair, Bill & Melinda Gates Foundation

When you talk to people who worked what would have happened if the of cuts. In a world of competing
in Africa around the turn of the curve had stayed on its original priorities and limited resources,
millennium, when the AIDS epidemic trajectory, the fight against HIV these conversations are mandatory,
was totally out of control, they say also has to be counted among our but I want to be sure that the
attending funerals was a routine greatest successes. people having them are clear about
experience, like cooking breakfast But its a success at risk. the consequences.
or commuting to work. Starting in We asked the Institute for Health
the early 2000s, the world made
a huge investment to address the
A 10 PERCENT CUT Metrics and Evaluation to develop
a simple model to help us think
crisis, especially through the Global IN FUNDING FOR HIV about the potential impact of a 10
Fund to Fight AIDS, Tuberculosis and TREATMENTCOULD percent annual cut in donor funding
Malaria and PEPFAR, the Presidents for HIV treatment. The top red line
Emergency Plan for AIDS Relief. In
COST THE LIVES OF in the chart illustrates that such a
the history of global health, there AN ADDITIONAL 5.6 budget cut could cost the lives of an
had never been an increase of that MILLION PEOPLE. additional 5.6 million people, over
magnitude in getting products and and above the current projection.
services to people who need them. Governments in both donor and Given the tenor of the global
Thats why the curve of AIDS deaths developing countries that responded discussion, an even bigger cut to
bends so sharply around 2005. so aggressively to the crisis 15 years global HIV funding is a very
With 35 million dead, AIDS is the ago are now focusing on other real possibility.
worst humanitarian disaster of my things. Funding for HIV control Im not advocating for a blank
lifetime. But when you consider has been flat, and now theres talk check for HIV treatment, because
HIV 15
Bill Gates

Global HIV deaths per 1,000 people


Current projection If we progress If we regress 10% budget cut

0.4 HOW FAR WEVE COME WHERE WE COULD GO

0.3

0.2 0.19

0.17
0.14

0.1
0.09

0.05 0.06

1990 2002 2003 2016 2030


Launch of Global Fund Launch of PEPFAR
to Fight AIDS, TB and Malaria

This model reflects the impact of a cut in donor funding to HIV treatment, just one aspect of global HIV programs, which also include diagnosis and prevention.

I dont think we need one. First, we only once every three months. infected in the first place, the fewer
can treat people more efficiently. However, patients who are less likely who will need treatment. We dont
Some countries, such as Zimbabwe, to stick to the regimen get extra want to just control a disease when
have implemented whats known as support. In this model, no one is we can end it.
differentiated care. Most patients wasting money by getting more Unfortunately, the outlook for
adhere to the treatment regimen services than they need, and no one prevention is also concerning. In
closely, so they receive longer- is risking getting sicker by getting the past decade, the rate of decline
lasting supplies of drugs and go to less than they need. of new infections has slowed. The
health facilities less regularly. More Second, the key to solving the current rate of decrease is not nearly
than two-thirds of Zimbabweans on AIDS crisis over the long term enough to offset the population
treatment visit a health professional is prevention. The fewer people increases well be seeing in Africa
Goalkeepers 16
The Stories Behind the Data

over the next generation. Africas is more funding, not less. And, as Its been flat, and now its targeted
youth are a reason for optimism with treatment, we need to identify for cuts.
more and more talented young and promote the best prevention Thats a scary prospect. Without
people who want to solve big practices so that we can get maximum R&D investments, we wont have the
problems are coming of age every impact from every dollar we spend. new discoveries that will make it
yearbut making sure theyre cared Kenya has been a leader in this easier to prevent transmission of HIV.
for is also a challenge. area, emphasizing both voluntary In the meantime, if we dont spend
In 1990, there were 94 million medical male circumcision and pre- more to deliver the tools we have
people on the continent between exposure prophylaxis, or PrEP, two now, well have more cases. If we
the ages of 15 and 24, the age range of the most effective prevention have more cases, well need to spend
when people are most at risk of methods currently available. Other more on treatment, or people will die.
contracting HIV. By 2030, there will countries can learn a lot from But this chain of causation works in
be more than 280 million. Kenyas experience. the other direction, too. If we invest
What that means is pretty clear. Over time, we will need better more, if we are more efficient, if we
If we only do as well as weve been tools, such as long-acting drugs that share what we learn, if we show more
doing on prevention, the absolute prevent HIV infection and, eventually, leadership, then we will write the
number of people getting HIV will go a vaccine. But the pattern with story of the end of HIV as a public
up even beyond its previous peak. research and development funding health threat.
We have to do better. Part of that is the same as with delivery funding:

11 million people living with HIV receive their antiretroviral medications through programs supported by the
Global Fund to Fight AIDS, Tuberculosis and Malaria. The majority are in sub-Saharan Africa. (Kigali, Rwanda)
HIV 17
Bill Gates

WE NEED TO IDENTIFY AND PROMOTE


THE BEST PREVENTION PRACTICES SO THAT
WE CAN GET MAXIMUM IMPACT FROM
EVERY DOLLAR WE SPEND.
Goalkeepers 18
The Stories Behind the Data

FINANCIAL SERVICES
FOR THE POOR
Poverty is not just the lack of themselves out of poverty. been that inclusion could be
money. Its also the lack of access India has been especially especially revolutionary for women,
to basic financial services that help innovative about investing in the who traditionally have been excluded
the poor use what money they building blocks of digital financial from making economic decisions.
have to improve their lives. So inclusion. Aadhaar, a nationwide Now, researchers are starting to
the development community has biometric identification system, test it. Last year, a study in Kenya
been trying to promote financial makes it simpler and more secure by Tavneet Suri and William Jack
inclusionthat is, to connect almost for poor people to do business established a clear link between
2 billion people who live completely with banks. Indias regulators have financial inclusion and womens
outside the formal financial system implemented new rules that give empowerment. This year, Rohini
to bank accounts and services like financial institutions greater flexibility Pande and her colleagues added to
credit and insurance. The problem to provide a wider variety of services. the evidence base with fascinating
is, its been too expensive to do at For example, a new class of banks results. Melinda talked to Dr. Pande
any kind of scale. called payment banks has brought about her research, what financial
Until now. With mobile phones, in new private-sector players to the inclusion can do for Indians and
its orders of magnitude easier and market and opened millions of new India, and how to speed up progress.
cheaper to reach the poor with accounts. In 2014, the government
financial services. The number of launched a program called PMJDY Bill and Melinda Gates
people with accounts is going up to help the poor open accounts
quickly, and were starting to see in huge numbers, and it recently
the impact. In particular, theres started providing benefits to
exciting new evidence that digital them through these accounts.
financial services like payments and One of the development
savings do indeed help people lift communitys hypotheses has
Financial Services for the Poor 19
A Conversation with Rohini Pande

Impact when Indian women receive wages


directly into their own accounts
Control group Treatment group

Annual earnings Purchases from own income


20,000 rupees 100%

16,766 rupees

13,479 rupees

13%
2%

Melinda: What problem is your research on


A CONVERSATION
financial inclusion for Indian women trying to
solve?

MELINDA GATES Rohini: As India has gotten richer, women have


Co-chair, Bill & Melinda
Gates Foundation
actually been working less in the formal labor force.
Thats a problem for women, because when they
dont work they have less power in the household
and, usually, less of a chance to live lives as fulfilling
ROHINI PANDE as they want. Its also a problem for India, which
Mohammed Kamal Professor of Public fails to benefit from the talents of many women
Policy, Harvard Kennedy School who want to work.
Goalkeepers 20
The Stories Behind the Data

M: Why are Indias women working in the private sector. After the world, youre not in a world of
less? intervention, when we asked the internet banking where you have a
women to tell us their occupation, smartphone app. If you own a phone
R: One important reasonand one they were more likely to say worker and your bank is diligent, then you
that our research focuses onis instead of housewife. That hopefully receive an SMS that tells
social norms that block womens suggests a story of empowerment. you when money turns up in your
mobility. Many Indian women need Having and using a bank account account, or, at best, an SMS on a
to ask permission just to leave changed her sense of self, or her regular basis that tells you whats
the house. Working outside the ability to express her sense of self. there. In reality, what we find is that
home can be seen as shameful. an SMS typically gets sent only if
These norms arent just imposed M: You were able to do this study you have a large enough account,
on women. In some places, men because India has invested in and that is exactly what we dont
are considered bad providers if digital financial services. How want. We want the people with the
their wives work. We wanted to does digital technology facilitate smallest accounts who are likely to
know whether connecting women financial inclusion? be the furthest away to get the most
to the financial system would help information. Transparency is easier
them transgress these norms. And R: Digital has changed the nature once you have a digital system, but
perhaps, over time, even start to of banking and made it cheaper you have to invest in it.
change them. to reach the rural poor. The poor
make very small and very frequent M: What do you see that makes
M: How did you test your theory? transactionsthe two things that you most optimistic about the
traditionally make it hard for banks future?
R: The Government of India to earn money. Now, though, you
guarantees every rural household have a single person with a point- R: Generational change. When you
100 days of work. This is an income of-service machine who can sit in go to a bank in a village right now,
security program, sometimes called a room in the village and be the the people you see outside are
workfare. Households can split up equivalent of the bank. Digital lowers school kids. Adolescent girls are
who does the work however they the cost significantly. Moreover, well-versed in the financial system.
want, but historically the wages have bringing banking closer to villages You hear the bank tellers complaining
been paid to the head of household, is hugely important for women that theyre always putting in one
not the actual worker. So, usually, its because of the mobility constraints rupee at a time, and the tellers really
men keeping most of the money and we talked about. dont want to do it, but they cant
deciding how to spend it. We wanted say no.
to see what happened if wages for M: As India ramps up its efforts
womens work went directly into at financial inclusion, what does
accounts they controlled. the country need to focus on to
maximize its impact on women in
M: What was the most interesting particular?
thing you learned?
R: This world of digital banks is
R: Women who received wages in a very new world for women. An
their own accounts earned more important finding from our study was
and saved more. The interesting that women need a lot of additional
thing was that they not only worked training to feel comfortable using
more in the governments workfare digital financial services. Remember,
program; they also worked more in India, even if youre in a digital
Financial Services for the Poor 21
A Conversation with Rohini Pande

WOMEN WHO RECEIVED WAGES IN THEIR OWN


ACCOUNTS EARNED MORE, SAVED MORE, AND
WORKED MORE. HAVING AND USING A BANK
ACCOUNT CHANGED THEIR SENSE OF SELF.

Financial inclusion programs can unlock opportunities for women, such as


starting a small business. (Delhi, India) (Photo courtesy of Microsave)
Goalkeepers 22
The Stories Behind the Data

STUNTING

Stunting is one of the most powerful, to a childs diet, disease history, they cut through a lot of that
but most complex, measures in and environment. We dont yet complexity and focused on what
global health. Stunted children are have a complete picture of the we know works. Peru proved that
defined as children who are short for root causesand there is no single stunting is a solvable problem when
their age by a specified amount. But intervention to prevent it. We leaders are committed to following
its not actually a childs height were have to mix and match a variety of the evidence.
concerned about. Rather, stunting interventions. We have spent a lot We asked Milo Stanojevich, the
is a proxy for something much of our time recently speaking national director for CARE Peru,
more important: how children are to global experts to learn more and Ariela Luna, former deputy
developing cognitively, emotionally, about stunting and its solutions. minister of development and social
and physically. Stunting is the As development experts and assessment, to write short essays
opposite of well-being, which is why practitioners continue to build the explaining how the country made so
we say its such a powerful measure. evidence base, however, countries much progress in such a short time.
But its complex because its need to scale up the set of health and
caused by multiple factors that nutrition interventions already proven Bill and Melinda Gates
accumulate over a period of time to reduce stunting significantly.
everything from a mothers health Perus story is impressive because
Stunting 23
Milo Stanojevich, Ariela Luna

Prevalence of stunting among children under age 5 in Peru


Progress to date

50%

40
39%

30

20
18%

10

1990 2006 2016


Child Malnutrition
Initiative formed

I grew up in Peru, left for a while, were never going to work.


MILO STANOJEVICH
National Director, CARE Peru and Chair, SUN
and came back home after 13 years, CARE Peru had just ended a large
Civil Society Network in 2005, to find it was a different program, funded by USAID, that took
country, a middle-income country. a different approach. Wed combined
But we still had the malnutrition a range of nutrition, food security,
rates of a low-income country. water and sanitation, and health
The government had been trying investments in 1,200 communities,
to address the problem with and the results were just amazing.
traditional feeding programs, but We reduced chronic malnutrition in
interventions that didnt address those communities by 10 percentage
health and nutrition more broadly points. We wanted the government
Goalkeepers 24
The Stories Behind the Data

to take up the lessons wed learned, president, the prime minister ratified do to continue reducing chronic
so, working with other NGOs and his commitment in a speech to malnutrition in the country?
UN agencies, we formed the Child Congress. We were euphoric. We are proud of our advocacy,
Malnutrition Initiative just in time for The government was promising to but advocacy alone does not take
the 2006 presidential election. fight chronic malnutrition in front programs to scale. You have to
We explained to the candidates of the entire Peruvian public on TV. design programs that fit in with
that stunting was the core of poverty In fact, President Garcia eventually the way government works. We
in Peruthat having 30 percent of pledged to do even moreto didnt have all the answers about
children chronically malnourished reduce stunting by 9 percentage how to do that. But we knew
put a huge dent in the whole points, a goal he achieved. Nutrition that it was essential to have the
country. We also showed them was indeed a national priority. highest-level political commitment,
our evidence about a package of In 2011, the government changed, more investment for nutrition,
interventions that worked. Clear and we did the whole thing all over and a strategy that coordinated
problem, clear solution. We got all again. And again last year. We interventions across ministries and
the major candidates to sign what wanted to get a question on nutrition different levels of government. We
we called the 5x5x5 commitment: into the presidential debates, so just kept the pressure on and kept
a pledge to reduce stunting among we tapped our networks and got the support through three different
children under 5, by 5 percentage 2,000 people to send in the same administrations, and the government
points, in 5 years. question to the election board. The made it happen.
When Alan Garcia was elected moderator asked it: What will you

We started by designing a causal


ARIELA LUNA
model for reducing chronic child
Former Deputy Minister of Development
and Social Assessment, Peru malnutrition based on the available NOBODY WILL STAND
scientific evidence, and we got all AGAINST INITIATIVES FOR
the stakeholders to agree to it. Next,
we prioritized two cost-effective, CHILDREN WHEN THE
high-impact interventions: child SOLUTIONS ARE PROVEN
vaccination and counseling for
mothers, to help them understand
AND AFFORDABLE.
how to keep themselves and
their babies healthy and well
nourished during the 1,000 days budget strategy and created the
from conception to the childs Articulated Nutritional Program,
second birthday. You can design a which allowed us to rearrange the
wonderful program with two dozen existing budget and refocus it toward
interventions, but youll never get it chronic malnutrition. That was what
off the ground. It was important to convinced the Ministry of Economics
prioritize and reprioritize. and Finance. They tend to say, If this
The health sector worked very is going to cost a lot, well stay out
effectively with the Ministry of of it, but nobody will stand against
Economics and Finance. We initiatives for children when the
implemented a results-based solutions are proven and affordable.
Stunting 25
Milo Stanojevich, Ariela Luna

Parents learn good feeding practices such as exclusive breastfeeding during


the first months and supplementary feeding with locally available food in the
months that follow. (Lima, Peru) (Photo courtesy of CARE)

When we started to implement been neglected before. work. And the day-to-day work
the program, we targeted the areas We also gave extra money changed life for Perus children.
in the country where stunting rates to regions that invested in the We are now a country that
were the highest. In those regions, infrastructure they needed to managed to redirect its resources
we started budgeting based on the meet the goals wed agreed upon. to help millions of children break free
needs of each health care center In order to make a shoe, you need from chronic child malnutrition. And
and tracking the results. When I leather, scissors, and workers. best of all, chronic malnutrition in
traveled to any region to supervise And to implement a vaccination Peru keeps going down.
the coverage, they couldnt lie to me, program, you need nurses and
because we kept evaluating them, supplies. Regions got more budget
not just once every year, but every when they put those pieces in place.
day if possible.
Our ability to measure results
also helped us to provide incentives
WE MANAGED TO HELP
to regional governments that MILLIONS OF CHILDREN
performed well, which accelerated
progress. First, we withheld a small
BREAK FREE FROM
part of the Ministry of Healths CHRONIC MALNUTRITION.
budget until the regions met key
targets. In six months, almost 100 With these two incentives, we
percent of the countrys regions were could be certain that health care
carrying out best practices that had centers were fit for the day-to-day
Goalkeepers 26
The Stories Behind the Data
Conclusion 27
Bill and Melinda Gates

CONCLUSION
People always ask us why we invest in
global development. Thats easy: Poverty
and disease in poor countries are the
clearest examples we know of solvable
human misery.

Take it from the point of view of justice, or take We will publish this report every year until 2030,
it from the point of view of creating a secure and because we want to inspire leaders by showing
stable world: Development deserves our attention. what is possible and arm them with evidence and
We wish more people asked us how development insights about how they might be more effective.
happens. Thats the hard part. Working on this Above, we used the phrase solvable human
reportcommissioning case studies and stacking misery. We invite everyone to focus on the
charts next to each otherhelped us reflect on the solvable part of the equation. It is a fact that this
how question. To oversimplify the answer, the key misery is solvable. We have it within our power to
is effective leadership. decide how much of it actually gets solved. Lets
In one way or another, every story in this report be ambitious. Lets lead.
is about a leader or leaders who decided to solve
a problem, thought critically about innovative Bill and Melinda Gates
strategies and tactics, and kept at it. Some of the
leaders we highlight work in government, some in
local communities, others at research institutions,
but theyre all focused on what it takes to make
progress. Every time one of the curves takes
a turn for the better, its because a person or a
group of people pushed to do more.
We are strong supporters of the Sustainable
Development Goals because they help leaders be
effective. First, they help identify the problems that
need solving. Every country now knows precisely
how on or off track it is across a range of key
priorities. Second, they help people work together
on solutions. When one country is especially
successful on a given indicator, its a good sign
that theres something worth learning from that
country. Sharing best practices is so much easier
when everybody agrees on the goals and how to
measure progress toward them.
Goalkeepers 28
The Stories Behind the Data

GLOBAL DATA
Global Data 29

Current projection If we progress If we regress

POVERTY 50% HOW FAR WEVE COME WHERE WE COULD GO

Proportion of population below


the international poverty line
(US $1.90/day)
35%
The chart shows a steady decline
in poverty since 1990, driven by
fast-growing China and India. To
25
hit the target, many countries must
accelerate their rate of growth and
share growth more equally. Ultimately,
the goal is to end poverty in all its
forms, which is more ambitious than 9%
simply guaranteeing a wage on which
people can subsist. It means, as our 6%

foundations mission statement says,


that all people can lead a healthy, 0 2030 TARGET
productive life. 1990 2016 2030
Target: Eradicate extreme poverty for all people everywhere. Projection data from
Brookings starts in 2014.

STUNTING 50% HOW FAR WEVE COME WHERE WE COULD GO

Prevalence of stunting among


children under age 5

Stunting is a proxy for overall cognitive 36%


and physical underdevelopment.
Stunted children will be less healthy and 26%
productive for the rest of their lives, and 26%
25
countries with high rates of stunting
22%
will be less prosperous. Addressing
stunting is not straightforward, because 18%
the condition is influenced by so many 2030 TARGET
different factors, but experts have
been compiling evidence about what
worksand combining basic health and
nutrition interventions reduces stunting
significantly. 0
1990 2016 2030
Target: End all forms of malnutrition, including achieving, by 2025, the internationally
agreed-upon targets on stunting and wasting in children under 5. Target shown on chart is
provisional and has been extrapolated based on existing 2025 target.
Goalkeepers 30
The Stories Behind the Data

Current projection If we progress If we regress

MATERNAL MORTALITY 300 HOW FAR WEVE COME WHERE WE COULD GO


275
Maternal deaths per
100,000 live births

In recent years, there has been a


200
massive shift in the number of women 179
giving birth in health facilities instead 179
of at home. Skilled obstetric care is key
to saving mothers lives, so countries 138
must make sure that their facilities are
fully supplied, staffed by skilled health 100 104
professionals, and provide the highest
quality of care. 2030 TARGET

0
1990 2016 2030
Target: Reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

UNDER-5 MORTALITY 100 HOW FAR WEVE COME WHERE WE COULD GO

Under-5 deaths per 85


1,000 live births

More than 100 million children have


been saved since 1990, due in large
part to better newborn care practices
and vaccines. The key to keeping the
50
momentum will be helping countries
(or regions within countries) with the
weakest health systems build up the
38 31
basic infrastructure they need to reach
all children with lifesaving interventions. 23

19

2030 TARGET
0
1990 2016 2030
Target: End preventable deaths of newborns and children under age 5, with all countries
aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per 1,000 live births. Target shown on chart has
been extrapolated from country level to global level.
Global Data 31

NEONATAL MORTALITY 40 HOW FAR WEVE COME WHERE WE COULD GO

Neonatal deaths per


1,000 live births 32

Almost half of all child deaths happen


within the first 28 days of life. Newborns
tend to die from different causes than
older children, so saving them requires
20
different approaches. Many solutions 17
like breastfeeding and devices to 14
resuscitate babiesare relatively
simple. The hard part is making sure 11
that mothers have the information
to care for their babies properly and
9
that newborns get skilled care when
they need it.
2030 TARGET
0
1990 2016 2030
Target: End preventable deaths of newborns and children under 5 years of age, with all
countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births
and under-5 mortality to at least as low as 25 per 1,000 live births. Target shown on chart
has been extrapolated from country level to global level.

HIV 0.75 HOW FAR WEVE COME WHERE WE COULD GO

New cases of HIV per


1,000 people

In the early 2000s, the Global Fund,


0.50 0.50
PEPFAR, and domestic spending in
endemic countries helped bring new
HIV infections way down. As the sense
0.37
of crisis dissipated, however, the rate
of decline slowed. Eventually, new
prevention methods will help speed
0.25
up the decline, but for now, we have 0.21
0.25
to bend this curve using currently
available methods. That means
continuously searching for new ways 0.10
to deliver solutions and sharing best
2030 TARGET
practices widely. 0
1990 2016 2030
Target: End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases.
Target shown on chart has been extrapolated from UNAIDS target of 200,000 new
infections among adults in 2030.
Goalkeepers 32
The Stories Behind the Data

Current projection If we progress If we regress

TUBERCULOSIS 187
200 HOW FAR WEVE COME WHERE WE COULD GO

New cases of tuberculosis


per 100,000 people
140
Since the early 2000s, a big investment
in the fight against TB, especially 133
through the Global Fund, has led to
114
significant improvements in treatment.
100
But the annual rate of reduction is
89
still not enough to hit our target. We
are optimistic that new tools, including
a vaccine, will be available in the
next decade.

2030 TARGET

0
1990 2016 2030
Target: End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases.
Target shown on chart has been extrapolated from Stop TB Partnership target of <20 cases
per 100,000 in 2030.

MALARIA 40 HOW FAR WEVE COME WHERE WE COULD GO


39

New cases of malaria


per 1,000 people
31
For decades prior to the early 2000s, 28
29
malaria deaths around the world were
surging. The establishment of the
Global Fund and the development
20
of new tools, including insecticide-
treated bed nets and improved anti-
malaria drugs, started to turn the tide
against the disease. Malaria deaths
decreased by 60 percent between 2030 TARGET
2000 and 2015. The projection on the
chart assumes no innovation. But with 5
continued investment and research, we
expect new tools and strategies that 0
would accelerate progress toward the 1990 2016 2030
elimination of the disease.
Target: End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases.
Target shown on chart has been extrapolated from the WHO Global Technical Strategy
target of reducing incidence by 90 percent.
Global Data 33

NEGLECTED TROPICAL 47k


50k HOW FAR WEVE COME WHERE WE COULD GO

DISEASES (NTD s)
Prevalence rate of 15 NTDs
per 100,000 people

NTDs are a collection of diseases that 27k


29k
keep 1.6 billion of the poorest, most
vulnerable people in the world from 25
fulfilling their potential. Its possible to 22k
prevent or treat most of the NTDs, but
its challenging to reach the billions
of people at risk. In 2012, endemic 13k
countries, donors, and drug companies
agreed to the London Declaration
to eliminate or control 10 NTDs.
Maintaining this momentum is the key
0
to accelerating progress.
1990 2016 2030
Target: End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases.

FAMILY PLANNING 100% HOW FAR WEVE COME WHERE WE COULD GO

85%
Proportion of women of
reproductive age (1549) who HIGH SDI

have their need for family 80%

planning satisfied with modern 66%


76%
76%
methods LOW SDI

Weve grouped countries and plotted 50


the groups separately to show the gap
between more and less developed
countries. But this chart still doesnt
tell the whole story, because the
indicator being measured, met need,
depends on women saying they want
to delay or stop childbearing. There
are many reasons women might not
express a need for contraceptives, 0

including cultural norms that prevent 1990 2016 2030


them from raising their voice. There
Target: Ensure universal access to sexual and reproductive health care services, including
is more work to do to address unmet
those for family planning. Socio-demographic index (SDI) is a measure based on average
need and hidden demand in most income per capita, education attainment, and total fertility rate.
developing countries.
Goalkeepers 34
The Stories Behind the Data

Current projection If we progress If we regress

UNIVERSAL HEALTH 100 HOW FAR WEVE COME WHERE WE COULD GO


2030 TARGET

COVERAGE HIGH SDI

Performance score for coverage 69


of essential health services
67
Our focus is primary health care, the 63
most important step to universal care. 60
Unfortunately, low and middle-income 50 LOW SDI

countries spend only about one-third 45

of their health budgets on primary care.


Weve grouped countries and plotted
the groups separately to show the gap
between more and less developed
countries. Primary care in key countries
would go a long way toward covering
the 400 million people without access
0
to basic health services.
1990 2016 2030
Target: Achieve universal health coverage for all. Socio-demographic index (SDI) is a
measure based on average income per capita, education attainment, and total fertility rate.

SMOKING 30% HOW FAR WEVE COME WHERE WE COULD GO

Prevalence of daily smoking


in populations age 10 years
and older 22%

This chart is encouraging but


underestimates the prevalence of 16%
tobacco use because it measures a 15%
15
limited definition of current smoking
13%
and excludes smokeless tobacco
12%
products. Still, the number of people
covered by at least one tobacco control
measure has quadrupled since the
landmark WHO Framework Convention
on Tobacco Control in 2003. The
great unknown is what will happen in
Africa, where tobacco companies see 0
opportunity. Strong tobacco control 1990 2016 2030
laws there are critical to maintaining the
downward trend. Target: Strengthen the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries.
Global Data 35

VACCINES 100% HOW FAR WEVE COME WHERE WE COULD GO HIGH SDI
97%
Proportion of the target
89% 93%
population covered by
90%
eight vaccines, conditional 73%
on inclusion in national LOW SDI

vaccine schedules
Vaccines are one of the most impressive 50
success stories in global health. More
people are being immunized and
protected against more diseases
than ever before. The next steps for
immunization programs are to battle
stagnation by finding the pockets
of inequity that exist within countries
even those with high average rates
and reach all children with a full set of 0
lifesaving vaccinations. Weve grouped 1990 2016 2030
countries and plotted the groups
Target: Support the research and development of vaccines and medicines for the
separately to show the gap between communicable and noncommunicable diseases that primarily affect developing countries
more and less developed countries. and provide access to affordable essential medicines and vaccines. Socio-demographic
index (SDI) is a measure based on average income per capita, education attainment, and
total fertility rate.

SANITATION 57%
60% HOW FAR WEVE COME WHERE WE COULD GO

Prevalence of populations using


unsafe or unimproved sanitation

This chart is based on data that


suggests that improvements will come
33%
from more sewer connections and
wastewater treatment plants, which 32%
30
are expensive and impractical in many
places. We believe well see even
23%
greater progress by safely collecting
and treating more of the human waste 20%
currently gathering in pit latrines
and septic tanks, and by introducing
innovative toilets that kill pathogens
but dont rely on sewers.
2030 TARGET
0
1990 2016 2030

Target: Achieve access to adequate and equitable sanitation and hygiene for all, and end
open defecation, paying special attention to the needs of women and girls and those in
vulnerable situations.
Goalkeepers 36
The Stories Behind the Data

Current projection If we progress If we regress

FINANCIAL SERVICES 100% HOW FAR WEVE COME WHERE WE COULD GO


2030 TARGET

FOR THE POOR 92%

82%
Proportion of adults (age 15
and older) with an account
at a bank or other financial
institution or with a mobile- 65%
money service provider 50

Unlike the other charts, this one


only goes back to 2005, when the 37%
International Monetary Fund started
collecting the data. The 75 percent
increase in accounts in a single decade
demonstrates the stunning potential
of digital financial services. However,
merely having an account does not 0
equal inclusion. People also have to use 2005 2016 2030
them, instead of expensive informal
services. That means banks, mobile Target: Strengthen the capacity of domestic financial institutions to encourage and expand
network operators, and other fintech access to banking, insurance, and financial services for all. International Monetary Fund
data for 2005 and 2008. World Bank data for 2011 and 2014. McKinsey Global Institute
companies must innovate to meet the projection data for 2015 and beyond.
poors most pressing needs.
Global Data 37

INSUFFICIENT
DATA

1990 2016 2030

EDUCATION GENDER AGRICULTURE


Proportion of children and Proportion of total agricultural Volume of production per labor
young people: in grades 2 and 3; population with ownership or unit by classes of farming/
at the end of primary; at the end secure rights over agricultural pastoral/forestry enterprise size
of lower secondary achieving at land, by sex; and share of
Agriculture is key to driving poverty
least a minimum level in reading women among owners or
reduction, so its important to track
and mathematics, by sex rights-bearers of agricultural
small-scale producers productivity
land, by type of tenure and income. Currently, though, many
Its relatively easy to count the number
of children in school. But that doesnt When women smallholder farmers countries dont collect agriculture
tell us how much those children are have secure rights to their land, it can data in a rigorous way, because its
actually learning. The SDGs rightly change their lives. They have more cumbersome and expensive. Theres a
shifted the focus from just the quantity bargaining power in their households, powerful new methodology called the
(e.g., enrollment and completion) which means more impact on their Agricultural Integrated Survey (AGRIS)
to both the quantity and quality of familys future. The SDGs include a under development that has the
education. Quality (i.e., achievement) goal explicitly about empowering potential to collect high-quality data
is harder to measure, though. Many women and girls, but its a sign of how affordably. It uses a modular approach,
countries dont generate any useful much weve neglected this issue that with countries piecing together
learning data at all, let alone in a only three of the 14 indicators under different sources of data and using
globally comparable way. The first the goal have sufficient baseline data efficient sampling strategies to paint
step is to develop better cross- and are trackable. When the indicator an accurate picture. The priority now
national assessments, particularly for about land tenure by sex was adopted, is testing and validating AGRIS quickly
early grades. We need to know early there wasnt yet agreement about and making sure that donors help
whether children are able to read, a how to measure it. Since then, the UN countries implement it and scale it up.
prerequisite to all further learning. has agreed on a definition, standards,
and a methodology. We still have to
test this approach and ensure that
countries are equipped to track the
indicator regularly. When we actually
have the data on hand, it will be much
easier to devise policies and programs
that empower women and girls.
Goalkeepers 38
The Stories Behind the Data
Sources and Notes 39

SOURCES AND NOTES


In this report, we have selected 18 out of the 232 SDG indicators. Below are
the sources for the chart data. Where the Institute for Health Metrics and
Evaluation has a measurement definition that needs further explanation, we
have included additional details below. The 2030 global targets included on
the charts illustrate the progress the world is aiming to achieve. Some SDG
indicators have a quantifiable global target (e.g., maternal mortality), some
have a quantifiable country target (e.g., child and neonatal mortality), which
we have extrapolated to a global level, and for others we have used the WHO
proposed 2030 targets (e.g., for HIV, malaria, and TB).

coverage; in-facility delivery rates; and coverage

POVERTY ALL OTHER CHARTS of antiretroviral therapy among people living with
HIV. The 32 causes amenable to personal health
Homi Kharas, the Brookings Institution, personal Estimates are from the Institute for Health care include tuberculosis, diarrheal diseases, lower
correspondence, July 2017. Metrics and Evaluation (IHME) at the University of respiratory infections, upper respiratory infections,
Washington. Methodologies for scenarios: diphtheria, whooping cough, tetanus, measles,
maternal disorders, neonatal disorders, colon and
If we progress scenarios are derived from rectal cancer, non-melanoma cancer, breast cancer,

FINANCIAL SERVICES FOR setting the rates of change to the 85th percentile
of historical median annual rates of change across
cervical cancer, uterine cancer, testicular cancer,
Hodgkins lymphoma, leukemia, rheumatic heart

THE POOR
countries. disease, ischaemic heart disease, cerebrovascular
If we regress scenarios are derived from setting disease, hypertensive heart disease, peptic ulcer
rates of change to the 15th percentile of historical disease, appendicitis, hernia, gallbladder and biliary
Global data for the Current projection scenario is
median annual rates of change across countries. diseases, epilepsy, diabetes, chronic kidney disease,
based on the following sources:
congenital heart anomalies, and adverse effects of
2005 and 2008: International Monetary Fund, Current projections are based on past trends. medical treatment.
Financial Access Survey. http://data.imf.org/FAS For further information on IHME data, see IHME then scaled 41 inputs on a scale of 0 to 100,
2011 and 2014: World Bank, Global Financial http://healthdata.org/globalgoals, and read the with 0 reflecting the worst levels observed between
Inclusion (Global Findex) Database. http:// forthcoming article by Global Burden of Disease 1990 to 2016 and 100 reflecting the best observed.
datatopics.worldbank.org/financialinclusion/ (GBD) 2016 SDG collaborators in the September They took the arithmetic mean of these 41 scaled
2017 volume of Lancet, Measuring progress and indicators to capture a wide range of essential
2015 and beyond: Manyika, J., Lund, S., Singer, projecting attainment based on past trends of the health services pertaining to reproductive, maternal,
M., White, O., and Berry, C., Digital finance health-related Sustainable Development Goals in newborn, and child health; infectious diseases;
for all: Powering inclusive growth in emerging 188 countries: an analysis from the Global Burden of noncommunicable diseases; and service capacity
economies, McKinsey Global Institute, Disease Study 2016. and access.
September, 2016. http://www.mckinsey.com/
global-themes/employment-and-growth/how- Further details on IHMEs definitions for the
digital-finance-could-boost-growth-in-emerging- following indicators: VACCINES
economies
NEGLECTED TROPICAL DISEASES IHMEs measurement included the following
Field, E., Pande, R., Rigol, N., Schaner, S., and vaccines: DPT (three doses), measles (one dose),
IHME measured the sum of the prevalence of 15
Moore, C. T., On Her Account: Can Strengthening BCG, polio vaccine (three doses), hepatitis B (three
NTDs currently measured in the Global Burden of
Womens Financial Control Boost Female Labor doses), Haemophilus influenzae type b (Hib, three
Disease study:
Supply? November 15, 2016. http://scholar. doses), pneumococcal conjugate vaccine (PCV, three
harvard.edu/files/rpande/files/on_her_account. Human African trypanosomiasis, Chagas disease, doses), and rotavirus vaccine (two or three doses).
can_strengthening_womens_financial_control_ cystic echinococcosis, cysticercosis, dengue, IHME used the geometric mean of coverage
boost_female_labor_supply.pdf food-borne trematodiases, Guinea worm, of these eight vaccines, based on their inclusion in a
intestinal nematode infections, leishmaniasis, countrys national vaccine schedule.
Jack, W., and Suri, T., The long-run poverty
leprosy, lymphatic filariasis, onchocerciasis, rabies,
and gender impacts of mobile money, Science,
schistosomiasis, and trachoma.
December 9, 2016. http://science.sciencemag.org/ SANITATION
content/354/6317/1288
IHME measured households with piped sanitation
UNIVERSAL HEALTH COVERAGE
(with a sewer connection); households with
Defined by a UHC index of the coverage of nine improved sanitation without a sewer connection (pit
tracer interventions and risk-standardized death latrine, ventilated improved latrine, pit latrine with
rates from 32 causes amenable to personal slab, composting toilet); and households without
healthcare. Tracer interventions include: vaccination improved sanitation (flush toilet that is not piped
coverage (coverage of three doses of DPT, to sewer or septic tank, pit latrine without a slab or
measles vaccine, and three doses of the oral polio open pit, bucket, hanging toilet or hanging latrine,
vaccine or inactivated polio vaccine); met need shared facilities, no facilities), as defined by the Joint
for modern contraception; ANC coverage; SBA Monitoring Program.
Goalkeepers 40
The Stories Behind the Data

GLOBAL DATA Current projection


AN AT-A-GLANCE VIEW OF THE 18 If we progress
INDICATORS TRACKED IN THE REPORT If we regress

POVERTY STUNTING
Proportion of population below the international poverty line Prevalence of stunting among children under age 5
(US $1.90/day)
50% 50%

35% 36%

26%
26%
25 25
22%
18%
2030
9% TARGET

6%

0 2030 0
1990 2016 2030 TARGET 1990 2016 2030

MATERNAL MORTALITY UNDER-5 MORTALITY


Maternal deaths per 100,000 live births Under-5 deaths per 1,000 live births

300 100
275
85

200 179
179
50
138 38

100 104
31
2030 23
TARGET
19

2030
0 0 TARGET
1990 2016 2030 1990 2016 2030
Global Data 41
Overview

NEO-NATAL MORTALITY HIV


Neonatal deaths per 1,000 live births New cases of HIV per 1,000 people

40 0.75

32

0.50 0.50

20 17 0.37

14 0.25
11 0.25 0.21
9
0.10

2030 2030
0 TARGET 0 TARGET
1990 2016 2030 1990 2016 2030

NEGLECTED TROPICAL DISEASES (NTD s) FAMILY PLANNING


Prevalence rate of 15 NTDs per 100,000 people Proportion of women of reproductive age (1549) who have their
need for family planning satisfied with modern methods

50k 100%
47k
85%
HIGH SDI
80%
76% 76%
66%
27k LOW SDI
29k
25 50
22k

13k

0 0
1990 2016 2030 1990 2016 2030

VACCINES SANITATION
Proportion of the target population covered by eight vaccines, conditional Prevalence of populations using unsafe or unimproved sanitation
on inclusion in national vaccine schedules

100% HIGH SDI 60%


97% 57%
93%
89% 90%
73% LOW SDI

33%
32%
50 30

23%
20%

2030
0 0 TARGET
1990 2016 2030 1990 2016 2030
Global Data 42
Overview

TUBERCULOSIS MALARIA
New cases of tuberculosis per 100,000 people New cases of malaria per 1,000 people

200 40
39
187

140 31
28
133 29
114
100 20
89

2030
TARGET
5
2030
TARGET
0 0
1990 2016 2030 1990 2016 2030

UNIVERSAL HEALTH COVERAGE SMOKING


Performance score for coverage of essential health services Prevalence of daily smoking in populations age 10 years and older

100 30%
2030
TARGET
HIGH SDI

69 22%
60 67
63 16%
50 LOW SDI 15 15%
45 13%
12%

0 0
1990 2016 2030 1990 2016 2030

FINANCIAL SERVICES FOR THE POOR INSUFFICIENT DATA


Proportion of adults (age 15 and older) with an account at a bank or other
financial institution or with a mobile-money-service provider

100%
2030
TARGET
EDUCATION
92% Proportion of children and young people: in grades 2 and 3; at the end of
primary; at the end of lower secondary achieving at least a minimum level
82%
in reading and mathematics; and by sex

65%
50
GENDER
Proportion of total agricultural population with ownership or secure rights
over agricultural land, by sex; and share of women among owners or rights-
37% bearers of agricultural land, by type of tenure

AGRICULTURE
Volume of production per labor unit by classes of farming/pastoral/forestry
0 enterprise size
2005 2016 2030
Bill & Melinda Gates Foundation