Case studies

HIV

Financial services for the poor: India

Stunting: Peru

Global data

The stories behind the data

For years, we’ve 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. But that doesn’t mean every dollar spent on development has maximum impact. And that must be our goal.

We are launching this report this year and will publish it every year until 2030 because we want to accelerate progress in the fight against poverty by helping to diagnose urgent problems, identify promising solutions, measure and interpret key results, and spread best practices.

As it happens, this report comes out at a time when there is more doubt than usual about the world’s commitment to development. In our own country, Congress is currently considering how to deal with the big cuts to foreign aid proposed in the president’s budget. A similar mood of retrenchment has taken hold in other donor countries. Meanwhile, most developing countries need to do more to prioritize the welfare of their poorest citizens.

In 2015, the member states of the United Nations adopted the Sustainable Development Goals (SDGs), which together paint a picture of what we all want the world to look like in 2030. However, if we don’t reaffirm the commitment that has led to so much progress over the past generation, that world will remain out of reach. 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 people’s health and well-being. To complement the data, we’re also telling the stories behind the numbers—about the leaders, innovations, and policies that have made the difference in countries where progress has been most significant.

The decisions we collectively make in the next couple of years are going to have a big impact on the shape these curves take. Of course, it’s not really about the shape of the curves. It’s about what the curves signify: whether or not millions or even billions of people will conquer disease, lift themselves out of extreme poverty, and reach their full potential.

– Bill & Melinda Gates

Case studies

Child mortality

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By Melinda Gates

If I had to pick just one data point to focus on, it would be the number of children who die every year before reaching the age of 5.

There’s so much packed into that number. Child mortality is a proxy for overall well-being; it’s also a leading indicator of progress (or the lack of it). And when you talk to mothers who have experienced the death of a child, you understand what that number means in human terms. What is more fundamental than keeping children alive so they can thrive and build the future?

At a glance

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

199020162030

15m

Key Lesson

It’s a huge challenge to reach children in countries in conflict or in remote regions hours away from any infrastructure whatsoever. But it’s doable, and it’s more doable now than ever before.

Melinda Gates

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Maternal mortality: Ethiopia

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Introduction by Bill & Melinda Gates

If you were trying to invent the most efficient way to devastate communities and put children in danger, you would invent maternal mortality.

Luckily, solutions already exist. To deliver those solutions to all women, the most important priority is persuading them to give birth in health facilities, where they can get obstetric care.

At a glance

Maternal deaths per 100,000 live births in Ethiopia

19902016

From the field

Child mortality dropped by half in just eight years. Maternal mortality, though, was a different story

Kesete AdmasuCEO, Roll Back Malaria Partnership

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Family planning: Senegal

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Introduction by Bill & Melinda Gates

Perhaps the best way to describe the importance of family planning is this: achieving the family planning goal makes it more likely that we’ll achieve virtually every other Sustainable Development Goal.

Poverty. Maternal mortality. Child mortality. Education. Gender equity. They all get better when women can plan their pregnancies so they are physically and economically ready when they have a child.

At a glance

Modern contraceptive prevalence rate in Senegal

19902016

20%

From the field

Senegal revamped its supply chain to make sure that a woman seeking contraceptives never got sent home empty-handed.

Fatimata SyDirector, Ouagadougou Partnership

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HIV

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By Bill Gates

When the AIDS epidemic was totally out of control, people said attending funerals was a routine experience, like cooking breakfast or commuting to work.

Starting in the early 2000s, the world made a huge investment to address the crisis. In the history of global health, there had never been an increase of that magnitude in getting products and services to people who need them.

At a glance

Global HIV deaths per 1,000 people

199020162030

0.4

Key Lesson

A 10% cut in funding for HIV treatment could cost the lives of an additional 5.6 million people.

Bill Gates

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Financial services for the poor: India

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Introduction by Bill & Melinda Gates

Poverty is not just the lack of money. It’s also the lack of access to basic financial services that help the poor use what money they have to improve their lives.

So the development community has been trying to promote financial inclusion—that is, to connect almost 2 billion people who live completely outside the formal financial system to bank accounts and services like credit and insurance.

At a glance

Impact when Indian women receive wages directly into their own accounts - Annual earnings in Indian Rupees (INR)

Control group

13,479 INR

Treatment group

16,766 INR

A conversation with Rohini Pande

As India has gotten richer, women have actually been working less in the formal labor force. That’s a problem for women, because when they don’t work they have less power in the household. It’s also a problem for India, which fails to benefit from the talents of many women who want to work.

Rohini PandeProfessor, Harvard Kennedy School

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Stunting: Peru

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Introduction by Bill & Melinda Gates

Stunting is one of the most powerful, but most complex, measures in global health.

Stunted children are defined as children who are short for their age by a specified amount. But it’s not actually a child’s height we’re concerned about; rather, stunting is a proxy for something much more important.

At a glance

Prevalence of stunting among children under age 5 in Peru

19902016

50%

From the field

We are now a country that managed to redirect its resources to help millions of children break free from chronic child malnutrition. And best of all, chronic malnutrition in Peru keeps going down.

Milo StanojevichNational Director, CARE Peru

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Global Data

POVERTY

The chart shows a steady decline in poverty since 1990, much of it in fast-growing China and India.

To 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 simply guaranteeing a wage on which people can subsist.

It means, as our foundation’s mission statement says, that all people can lead a healthy, productive life.

Target: Eradicate extreme poverty for all people everywhere. Projection data from Brookings starts in 2014.

Proportion of population below the international poverty line (US $1.90/day)

Current projection2030 target

199020162030

50%

35%

STUNTING

Stunting is a proxy for overall cognitive and physical underdevelopment.

Stunted children will be less healthy and productive for the rest of their lives, and countries with high rates of stunting will be less prosperous.

Addressing stunting is not straightforward, because the condition is influenced by so many different factors, but experts have been compiling evidence about what works–and combining basic health and nutrition interventions reduces stunting significantly.

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.

Prevalence of stunting among children under age 5

Current projectionIf we progressIf we regress2030 target

199020162030

50%

36%

26%

22%

26%

18%

14%

MATERNAL MORTALITY

In recent years, there has been a massive shift in the number of women giving birth in health facilities instead of at home.

Skilled obstetric care is key to saving mothers’ lives, so countries must make sure that their facilities are fully supplied, staffed by skilled health professionals, and provide the highest quality of care.

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

Maternal deaths per 100,000 live births

Current projectionIf we progressIf we regress2030 target

199020162030

100

200

300

275

179

138

179

104

UNDER-5 MORTALITY

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 momentum will be helping countries (or regions within countries) with the weakest health systems build up the basic infrastructure they need to reach all children with lifesaving interventions.

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.

Under-5 deaths per 1,000 live births

Current projectionIf we progressIf we regress2030 target

199020162030

100

NEONATAL MORTALITY

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 different approaches. Many solutions—like breastfeeding and devices to resuscitate babies—are relatively simple. The hard part is making sure that mothers have the information to care for their babies properly and that newborns get skilled care when they need it.

Neonatal deaths per 1,000 live births

Current projectionIf we progressIf we regress2030 target

199020162030

HIV

In the early 2000s, the Global Fund, PEPFAR, and domestic spending in endemic countries helped bring new HIV infections way down.

As the sense of crisis dissipated, however, the rate of decline slowed. Eventually, new prevention methods will help speed up the decline, but for now, we have to bend this curve using currently available methods. That means continuously searching for new ways to deliver solutions and sharing best practices widely.

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.

New cases of HIV per 1,000 people

Current projectionIf we progressIf we regress2030 target

199020162030

0.25

0.5

0.75

0.37

0.25

0.21

0.5

0.1

0.02

TUBERCULOSIS

Since the early 2000s, a big investment in the fight against TB, especially through the Global Fund, has led to significant improvements in treatment.

But the annual rate of reduction is still not enough to hit our target. We are optimistic that new tools, including a vaccine, will be available in the next decade.

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.

New cases of tuberculosis per 100,000 people

Current projectionIf we progressIf we regress2030 target

199020162030

100

200

187

140

114

133

MALARIA

For decades prior to the early 2000s, malaria deaths around the world were surging.

The establishment of the Global Fund and the development 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 2000 and 2015. This projection assumes no innovation. But with continued investment and research, we expect new tools and strategies that would accelerate progress toward the 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.

New cases of malaria per 1,000 people

Current projectionIf we progressIf we regress2030 target

199020162030

NEGLECTED TROPICAL DISEASES (NTDs)

NTDs are a collection of diseases that keep 1.6 billion of the poorest, most vulnerable people in the world from fulfilling their potential.

It’s possible to prevent or treat most of the NTDs, but it’s challenging to reach the billions of people at risk. In 2012, endemic countries, donors, and drug companies agreed to the London Declaration to eliminate or control 10 NTDs. Maintaining this momentum is the key to accelerating progress.

Target: End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases.

Prevalence rate of 15 NTDs per 100,000 people

Current projectionIf we progressIf we regress

199020162030

50k

47k

27k

22k

29k

13k

FAMILY PLANNING

We’ve grouped countries and plotted the groups separately to show the gap between more and less developed countries.

But this chart still doesn’t 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, including cultural norms that prevent them from raising their voice. There is more work to do to address unmet need and hidden demand in most developing countries.

Target: Ensure universal access to sexual and reproductive health care services, including those for family planning.

Socio-demographic index (SDI) is a measure based on average income per capita, education attainment, and total fertility rate.

Proportion of women of reproductive age (15–49 years) who have their need for family planning satisfied with modern methods

Current projectionIf we progressIf we regressSDI high / low

199020162030

100%

66%

76%

80%

High

Low

76%

85%

UNIVERSAL HEALTH COVERAGE

Our focus is primary health care, the most important step to universal care.

Unfortunately, low and middle-income countries spend only about one-third of their health budgets on primary care. We’ve 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 to basic health services.

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.

Performance score for coverage of essential health services

Current projectionIf we progressIf we regress2030 targetSDI high / low

199020162030

100

High

Low

SMOKING

This chart is encouraging but underestimates the prevalence of tobacco use because it measures a limited definition of current smoking and excludes smokeless tobacco 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 opportunity. Strong tobacco control 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.

Prevalence of daily smoking in populations age 10 years and older

Current projectionIf we progressIf we regress

199020162030

30%

22%

16%

13%

15%

12%

VACCINES

Vaccines are one of the most impressive 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 lifesaving vaccinations. We’ve grouped countries and plotted the groups separately to show the gap between more and less developed countries.

Target: Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing 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.

Proportion of the target population covered by eight vaccines, conditional on inclusion in national vaccine schedules

Current projectionIf we progressIf we regressSDI high / low

199020162030

100%

73%

89%

93%

High

Low

90%

97%

SANITATION

This chart is based on data that suggests that improvements will come from more sewer connections and wastewater treatment plants, which are expensive and impractical in many places.

We believe we’ll see even greater progress by safely collecting and treating more of the human waste currently gathering in pit latrines and septic tanks, and by introducing innovative toilets that kill pathogens but don’t rely on sewers.

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.

Prevalence of populations using unsafe or unimproved sanitation

Current projectionIf we progressIf we regress2030 target

199020162030

60%

57%

33%

23%

32%

20%

FINANCIAL SERVICES FOR THE POOR

Unlike the other charts, this one only goes back to 2005, when the 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 equal inclusion. People also have to use them, instead of expensive informal services. That means banks, mobile network operators, and other fintech companies must innovate to meet the poor’s most pressing needs.

Target: Strengthen the capacity of domestic financial institutions to encourage and expand 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 projection data for 2015 and beyond.

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

Current projectionIf we progress2030 target

200520162030

100%

37%

65%

82%

92%

97%

EDUCATION

It’s relatively easy to count the number of children in school. But that doesn’t tell us how much those children are actually learning.

The SDGs rightly shifted the focus from just the quantity (e.g., enrollment and completion) to both the quantity and quality of education. Quality (i.e., achievement) is harder to measure, though. Many countries don’t generate any useful learning data at all, let alone in a globally comparable way. The first step is to develop better crossnational assessments, particularly for early grades. We need to know early whether children are able to read, a pre-requisite to all further learning.

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 in reading and mathematics, by sex

199020162030

Insufficient Data

GENDER

When women smallholder farmers have secure rights to their land, it can change their lives.

They have more bargaining power in their households, which means more impact on their family’s future. The SDGs include a goal explicitly about empowering women and girls, but it’s a sign of how much we’ve neglected this issue that only three of the 14 indicators under the goal have sufficient baseline data and are trackable. When the indicator about land tenure by sex was adopted, there wasn’t yet agreement about how to measure it. Since then, the UN 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.

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

199020162030

Insufficient Data

AGRICULTURE

Agriculture is key to driving poverty reduction, so it’s important to track small-scale producers’ productivity and income. Currently, though, many countries don’t collect agriculture data in a rigorous way, because it’s cumbersome and expensive.

There’s a powerful new methodology called the Agricultural Integrated Survey (AGRIS) under development that has the potential to collect high-quality data affordably. It uses a modular approach, with countries piecing together different sources of data and using efficient sampling strategies to paint an accurate picture. The priority now is testing and validating AGRIS quickly and making sure that donors help countries implement it and scale it up.

Volume of production per labor unit by classes of farming/ pastoral/forestry enterprise size

199020162030

Insufficient Data

It is a fact that disease and poverty are solvable. We invite everyone to focus on the solvable part of the equation. We have it within our power to decide how much of it actually gets solved. Let’s be ambitious. Let’s lead.

We will publish this report every year until 2030, because we want to inspire leaders by showing what is possible and arm them with evidence and insights about how they might be more effective.

Download report PDF

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).

Poverty

Homi Kharas, the Brookings Institution, personal correspondence, July 2017.

Financial services for the poor

Global data for the "Current projection" scenario is based on the following sources:

2005 and 2008: International Monetary Fund, Financial Access Survey. http://data.imf.org/FAS

2011 and 2014: World Bank, Global Financial Inclusion (Global Findex) Database. http://datatopics.worldbank.org/financialinclusion/

2015 and beyond: Manyika, J., Lund, S., Singer, M., White, O., and Berry, C., “Digital finance for all: Powering inclusive growth in emerging economies," McKinsey Global Institute, September, 2016. http://www.mckinsey.com/global-themes/employment-and-growth/how-digital-finance-could-boost-growth-in-emerging-economies

Field, E., Pande, R., Rigol, N., Schaner, S., and Moore, C. T., “On Her Account: Can Strengthening Women’s Financial Control Boost Female Labor Supply?” November 15, 2016. http://scholar.harvard.edu/files/rpande/files/on_her_account.can_strengthening_womens_financial_control_boost_female_labor_supply.pdf

Jack, W., and Suri, T., “The long-run poverty and gender impacts of mobile money,” Science, December 9, 2016. http://science.sciencemag.org/content/354/6317/1288

All other charts

Estimates are from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Methodologies for scenarios: “If we progress” scenarios are derived from setting the rates of change to the 85th percentile of historical median annual rates of change across countries. “If we regress” scenarios are derived from setting rates of change to the 15th percentile of historical median annual rates of change across countries. Current projections are based on past trends.

For further information on IHME data, please visit http://healthdata.org/globalgoals, and read the forthcoming article by Global Burden of Disease (GBD) 2016 SDG collaborators in the September 2017 volume of Lancet, “Measuring progress and projecting attainment based on past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. The Lancet. 2017 Sept.

Further details on IHME’s definitions for the following indicators:

NEGLECTED TROPICAL DISEASES

IHME measures the sum of the prevalence of 15 NTDs per 100,000, currently measured in the Global Burden of Disease study: Human African trypanosomiasis, Chagas disease, cystic echinococcosis, cysticercosis, dengue, food-borne trematodiases, Guinea worm, intestinal nematode infections, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis, and trachoma.

UNIVERSAL HEALTH COVERAGE

Defined by a UHC index of the coverage of nine tracer interventions and risk-standardized death rates from 32 causes amenable to personal healthcare. Tracer interventions include: vaccination coverage (coverage of three doses of DPT, measles vaccine, and three doses of the oral polio vaccine or inactivated polio vaccine); met need for modern contraception; ANC coverage; SBA coverage; in- facility delivery rates; and coverage of antiretroviral therapy among people living with HIV. The 32 causes amenable to personal healthcare include tuberculosis, diarrheal diseases, lower respiratory infections, upper respiratory infections, diphtheria, whooping cough, tetanus, measles, maternal disorders, neonatal disorders, colon and rectal cancer, non-melanoma cancer, breast cancer, cervical cancer, uterine cancer, testicular cancer, Hodgkin’s lymphoma, leukemia, rheumatic heart disease, ischaemic heart disease, cerebrovascular disease, hypertensive heart disease, peptic ulcer disease, appendicitis, hernia, gallbladder and biliary diseases, epilepsy, diabetes, chronic kidney disease, congenital heart anomalies, and adverse effects of medical treatment.

IHME then scaled 41 inputs on a scale of 0 to 100, with 0 reflecting the worst levels observed between 1990 to 2016 and 100 reflecting the best observed. They took the arithmetic mean of these 41 scaled indicators to capture a wide range of essential health services pertaining to reproductive, maternal, newborn, and child health; infectious diseases; noncommunicable diseases; and service capacity and access.

VACCINES

IHME's measurement included the following vaccines: DPT (three doses), measles (one dose), BCG, polio vaccine (three doses), hepatitis B (three doses), Haemophilus influenzae type b (Hib, three doses), pneumococcal conjugate vaccine (PCV, three doses), and rotavirus vaccine (two or three doses). IHME used the geometric mean of coverage of these eight vaccines, based on their inclusion in a country's national vaccine schedule.

SANITATION

IHME measured households with piped sanitation (with a sewer connection); households with improved sanitation without a sewer connection (pit latrine, ventilated improved latrine, pit latrine with slab, composting toilet); and households without improved sanitation (flush toilet that is not piped to sewer or septic tank, pit latrine without a slab or open pit, bucket, hanging toilet or hanging latrine, shared facilities, no facilities), as defined by the Joint Monitoring Program.

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