Thank you Group G!

Dearest Group G=)

All I can say is that is has been a wonderful semester working with you guys and ladies. It was really a big change from my previous PCL group and I guess every group works differently.

I had fun listening to everyone's presentations and also had a fair share of laughter and joy.

This semester, unknowingly, disappeared from our sight and slipped out through our hands. Now we have come to the end of our 1st yr of the MBBS journey. All I can say is, I have made more friendships, forged more new bonds that I'm sure would stand the test of time.

Dependable, reliable and trustworthy, you people make me feel that I could fall back and rely on all of you at any time. Everyone in the group is just so forthcoming and helpful. A big thank you to all who actually helped Chloe and me during that car accident, we really appreciate your help. :)

Enough of sad stuff aside, I'm sure all of us had times we could look back and ponder. Times we can smile and reminiscence when we have graduated, or maybe when we ourselves become lecturers and teach the future doctors or even when we are grey and old.

I would like to take this opportunity to apologize if I have done any wrong to anyone unknowingly and caused any harm. I did not mean it and I would be man enough to say I'm sorry. =)

Anyway MBBS is one year down, and four more years to go. Do your best for the upcoming exams everyone:) I'm sure all of you would be studying hard and having books that are disintegrating. ALL the best. May all of you be blessed, healthy, happy and contented with life, after all we are quite lucky to not be born with any of the birth defects we see during lectures, so don't screw up your life.

I promise to be there for everyone in times of need and please do just drop a message, I would help you to the best I can. I promise. :)

All that is said and done is over, all the best group G and a big thank you to Dr Amudha. It has been an utmost pleasure having you as our PCL tutor. Meticulous and fun, you excellently facilitated our PCL and allowed us to mature and grow as individuals, as future doctors. Kudos.

Warmest Regards

Lincoln L.

Doha Declaration

- The November 2001 Doha Declaration on the TRIPS Agreement and Public Health was adopted by the WTO Ministerial Conference

- It reaffirmed flexibility of TRIPS member states in circumventing patent (rights granted by state) rights for better access to essential medicines.

Essential medicine is “Drugs that satisfy the health care needs of the majority of the population; therefore should be available at all times in adequate amounts & in appropriate dosage forms @ a price the community can afford”

-

"4. The TRIPS Agreement does not and should not prevent Members from taking measures to protect public health.

o Agreement can and should be interpreted and implemented in a manner supportive of WTO Members' right to protect public health and, in particular, to promote access to medicines for all.

o In this connection, we reaffirm the right of WTO Members to use, to the full, the provisions in the TRIPS Agreement, which provide flexibility for this purpose.

- Each Member has the right to determine what constitutes a national emergency or other circumstances of extreme urgency, it being understood that public health crises, including those relating to HIV/AIDS, tuberculosis, malaria and other epidemics, can represent a national emergency or other circumstances of extreme urgency.

6. We recognize that WTO Members with insufficient or no manufacturing capacities in the pharmaceutical sector could face difficulties in making effective use of compulsory licensing under the TRIPS Agreement. We instruct the Council for TRIPS to find an expeditious solution to this problem and to report to the General Council before the end of 2002."

These provisions in the Declaration ensure that governments may issue compulsory licenses on patents for medicines, or take other steps to protect public health.

PCL 13

What is Tuberculosis?

Tuberculosis (TB) is an infection caused by a bacteria called the tubercle bacillus or Mycobacterium tuberculosis. Until effective anti-tuberculosis drugs were introduced about 50 years ago, TB was one of the main causes of death. TB is still a major problem in many countries.
It can affect the lungs (pulmonary TB) or other parts of the body, such as the lymph nodes (tuberculous adenitis or scrofula), the skin and the bones. Tubercle bacilli can remain dormant for years before producing active disease. In most cases lung infection is well controlled by the immune system, and shows no symptoms. Active lung disease occurs if the immune system becomes less effective.
Also:
- Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't contagious.

- Active TB. This condition has clinical symptoms and signs and is contagious

Pathophysiology
Tubercle bacilli initially cause a primary infection, which only rarely causes acute illness. Most (about 95%) primary infections are asymptomatic and followed by a latent (dormant) phase. However, a variable percentage of latent infections subsequently reactivate with symptoms and signs of disease. Infection is usually not transmissible in the primary stage and is never contagious in the latent stage.

Primary infection: Infection requires inhalation of particles small enough to traverse the upper respiratory defenses and deposit deep in the lung, usually in the subpleural airspaces of the lower lung. Large droplets tend to lodge in the more proximal airways and typically do not result in infection. Infection usually begins from a single initial focus.
To initiate infection, tubercle bacilli must be ingested by alveolar macrophages. Tubercle bacilli that are not killed by the macrophages actually replicate inside them, ultimately killing the host macrophage (with the help of CD8 lymphocytes); inflammatory cells are attracted to the area, causing a focal pneumonitis that evolves into the characteristic tubercles seen histologically. In the early weeks of infection, some infected macrophages migrate to regional lymph nodes, where they access the bloodstream. Organisms may then spread hematogenously to any part of the body, particularly the apical-posterior portion of the lungs, epiphyses of the long bones, kidneys, vertebral bodies, and meninges.

In 95% of cases, after about 3 wk of uninhibited growth, the immune system suppresses bacillary replication before symptoms or signs develop. Foci of infection in the lung or other sites resolve into epithelioid cell granulomas, which may have caseous and necrotic centers. Tubercle bacilli can survive in this material for years; the balance between the host's resistance and microbial virulence determines whether the infection ultimately resolves without treatment, remains dormant, or becomes active.

Activation of the disease:
In about 10% of immunocompetent patients, latent infection develops into active disease, although the percentage varies significantly by age and other risk factors. In 50 to 80% of those who develop active disease, TB reactivates within the 1st 2 yr, but it can occur decades later. Any organ initially seeded may become a site of reactivation, but reactivation occurs most often in the lung apices, presumably because of favorable local conditions such as high O2 tension.


Signs and symptoms of active TB include:

- Unexplained weight loss
- Fatigue
- Fever
- Night sweats
- Chills
- Loss of appetite

Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:
-Coughing that lasts three or more weeks
- Coughing up blood
-Chest pain, or pain with breathing or coughing

Tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine

PCL 13- Limitations in Bringing Positive Changes to the Global Health

Limitations in Bringing Positive Changes to the Global Health

1. One important reason for this is the lack of functional health systems due to a shortage in the health workforce, management incompetence, inadequate infrastructure, and health care financing. The World Health Report 2006 estimates a global deficit of 2.3 million doctors, nurses, and midwives. Critical health workforce shortages exist in fifty-seven countries, of which thirty-seven are in sub-Saharan Africa.

2. Emphasis on vertical or disease-specific programmes such as HIV/AIDS, malaria, and tuberculosis may have further weakened the already fractured health systems, thus making delivery of general health care in low-income countries that much more difficult. Unfortunately, neither the governments of these countries nor the global donor community have invested adequately in capacity building.

3. There are more challenges facing global health. Prominent among these are the development of microbial resistance to antibiotics and disinfectants, along with the prevalence, in epidemic proportions, of non-communicable diseases and injuries in low- and middle-income countries

4. Worldwide gaps in income, opportunities and health outcomes, which motivated the quest for greater fairness in 1978, are actually greater today than at any time in recent history. Life expectancy between the richest and poorest countries differs by more than forty years. Annual government expenditure on health ranges from as little as $20 per person to more than $6,000.

5. All around the world, the costs of health care are escalating.

6. Phenomenal increases in international air travel have made emerging and epidemic-prone disease a much larger menace.

7. Universal trends, like urbanization, demographic aging, and the marketing of unhealthy lifestyles have sparked a sharp increase in chronic diseases like heart disease, stroke, cancer, and diabetes. Long considered the close companions of affluent societies, these diseases now impose around 80 per cent of their burden on low- and middle-income countries. The requirements of life-long treatment strain already weak systems of care and add to the costs.

8. Growing numbers of the frail elderly further increase the demands on health systems, the health workforce, and for social welfare.

Causes & Risk Factor for TB and Epidemiology

Causes

Tuberculosis is caused by an organism called Mycobacterium tuberculosis. The bacteria spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings. Rarely, a pregnant woman with active TB may pass the bacteria to her unborn child.

Although tuberculosis is contagious, it's not especially easy to catch. You're much more likely to get tuberculosis from a family member or close co-worker than from a stranger. Most people with active TB who've had appropriate drug treatment for at least two weeks are no longer contagious.

Risk Factors:

• Lowered immunity. A healthy immune system can often successfully fight TB bacteria, but your body can't mount an effective defense if your resistance is low. A number of factors can weaken your immune system. Having a disease that suppresses immunity, such as HIV/AIDS, diabetes, end-stage kidney disease, certain cancers or the lung disease silicosis, can reduce your body's ability to protect itself. Your risk is also higher if you take corticosteroids, certain arthritis medications, chemotherapy drugs or other drugs that suppress the immune system.
• Close contact with someone with infectious TB. In general, you must spend an extended period of time with someone with untreated, active TB to become infected yourself. You're more likely to catch the disease from a family member, roommate, friend or close co-worker.
• Country of origin. People from regions with high rates of TB — especially sub-Saharan Africa, India, China, the islands of Southeast Asia and Micronesia, and parts of the former Soviet Union — are more likely to develop TB. In the United States, more than half the people with TB were born in a different country. Among these, the most common countries of origin were Mexico, the Philippines, India and Vietnam.
• Age. Older adults are at greater risk of TB because normal aging or illness may weaken their immune systems. They're also more likely to live in nursing homes, where outbreaks of TB can occur.
• Substance abuse. Long-term drug or alcohol use weakens your immune system and makes you more vulnerable to TB.
• Malnutrition. A poor diet or one too low in calories puts you at greater risk of TB.
• Lack of medical care. If you are on a low or fixed income, live in a remote area, have recently immigrated to the United States or are homeless, you may lack access to the medical care needed to diagnose and treat TB.
• Living or working in a residential care facility. People who live or work in prisons, immigration centers or nursing homes are all at risk of TB. That's because the risk of the disease is higher anywhere there is overcrowding and poor ventilation.
• Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in crowded, unsanitary conditions, refugees are at especially high risk of TB infection.
• Health care work. Regular contact with people who are ill increases your chances of exposure to TB bacteria. Wearing a mask and frequent hand washing greatly reduce your risk.
• International travel. As people migrate and travel widely, they may expose others or be exposed to TB bacteria.

Epidemiology

More than 2 billion people (about one-third of the world population) are estimated to be infected with tuberculosis [1].

The global incidence of TB peaked around 2003 and now appears to be declining slowly [2].

In 2006 the World Health Organization (WHO) issued the following estimates [2]:

-The prevalence of active infection was 14.4 million, corresponding to a prevalence rate of 219/100,000 persons.
-The incidence of new cases was estimated to be 9.2 million, corresponding to an incidence rate of 139/100,000.
-Twelve of the 15 countries with the highest estimated TB incidence are in Africa, where the TB incidence rate was 363/100,000 (figure 1).
-In 2006 there were 1.7 million deaths from TB worldwide, a death rate of 25/100,000.
-The epidemiology of tuberculosis varies substantially around the world (figure 2). The highest rates (100/100,000 or higher) are observed in sub-Saharan Africa, India, China, and the islands of Southeast Asia and Micronesia.

-Intermediate rates of tuberculosis (26 to 100 cases/100,000) occur in Central and South America, Eastern Europe, and northern Africa. Low rates (less than 25 cases per 100,000 inhabitants) occur in the United States, Western Europe, Canada, Japan, and Australia.

Poverty, HIV and drug resistance are major contributors to the resurging global TB epidemic [3,4].

Approximately 95 percent of TB cases occur in developing countries.

Approximately 1 in 14 new TB cases occur in individuals who are infected with HIV; 85 percent of these cases occur in Africa [2]. An estimated half million cases of multidrug resistant (MDR)-TB also occur annual in Africans; even higher rates of drug resistant infections occur in Eastern Europe.

It is estimated

that, in 2007, there were 1.37 million incident cases of HIV-positive TB (14.8%

of total incident cases) and 456 000 deaths from TB among HIV-positive people

(equivalent to 26% of deaths from TB in HIV-positive and HIV-negative people,

and 23% of an estimated 2 million HIV-related deaths) (from WHO)

Doha Declaration

Doha Declaration, was issued in November 2001, which indicated that TRIPs should not prevent states from dealing with public health crises.

- Reaffrimed flexibility of TRIPS member states in circumventing patent rights for better access to essential medicines

- Essential medicine is “Drugs that satisfy the health care needs of the majority of the population; therefore should be available at all times in adequate amounts & in appropriate dosage forms @ a price the community can afford”

- It is agreed that Each WTO member has right to deremine what constitutes a national emergency or extreme urgency, including public health crisis such as HIV/AIDS, tb, malaria and other epidemics.

- We recognize that WTO Members with insufficient or no manufacturing capacities in the pharmaceutical sector could face difficulties in making effective use of compulsory licensing under the TRIPS Agreement. We instruct the Council for TRIPS to find an expeditious solution to this problem and to report to the General Council before the end of 2002

-

PCL 13 TRIPS (Trade Related Aspects of Intelectual Property Rights)

ESSENTIAL INFORMATION

- International agreement, adminstired by World Trade Organisation

- Set standard for intelectual property regulation
~ nations law must meet for copyrights rights
~ protect confidential information
~ trademarks

- was negotiated at the end of Uruguay Round of General Agreement Tariffs and Trade (GATT)
in 1994

- most comprehensive international agreement on intelectual property



COMPULSORY LICENSING IN PUBLIC HEALTH

-enables a competent government authority to license compulsory licensing of patented
invention to a third party or government agency witouth the consent of patent holder

- Article 31 of the Agreement sets forth a number of conditions for the granting of compulsory \
licences.
~ include a case-by-case determination of compulsory licence applications,
~ the need to demonstrate prior (unsuccessful) negotiations with the patent owner for a
voluntary licence and the payment of adequate remuneration to the patent holder.
~ address a national emergency or other circumstances of extreme urgency, certain
requirements are waived in order to hasten the process, such as that for the need to have had
prior negotiations obtain a voluntary licence from the patent holder

- leaves Members full freedom to stipulate other grounds, such as those related to non-working
of patents, public health or public interest.


PARALLEL IMPORTATION

- parallel importation is importation without the consent of the patent-holder of a patented
product marketed in another country either by the patent holder or with the patent-holder’s
consent.

-the principle of exhaustion states that once patent holders, or any party authorized by him,
have sold a patented product, they cannot prohibit the subsequent resale of that product since
their rights in respect of that market have been exhausted by the act of selling the product.

- since many patented products are sold at different prices in different markets, the rationale
for parallel importation is to enable the import of lower priced patented products


EXTENSION OF TRANSITION PERIOD FOR LEAST DEVELOPED COUNTRIES

-the Doha Declaration also extended the transition period for LDCs for implementation of the TRIPS obligations from 2006 to 2016.

-however, the extension is limited to the obligations under provisions in the TRIPS Agreement relating to patents and marketing rights, and data protection for pharmaceutical products. Thus, LDCs are still obliged to implement the rest of their obligations under the TRIPS Agreement as of 2006

WHO- INTRO

WHO

Introduction

1. The World Health Organization (WHO) is the directing and coordinating authority on international health within the United Nations’ system. WHO experts produce health guidelines and standards, and help countries to address public health issues. WHO also supports and promotes health research. Through WHO, governments can jointly tackle global health problems and improve people’s well-being. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.


History

1. When diplomats met in San Francisco to form the United Nations in 1945, one
of the things they discussed was setting up a global health organization. WHO’s Constitution came into force on 7 April 1948 – a date we now celebrate every year as World Health Day.

2. Delegates from 53 of WHO’s 55 original member states came to the first World Health Assembly in June 1948. They decided that WHO’s top prioritieswould be malaria, women’s and children’s health, tuberculosis, venereal disease, nutrition andenvironmental sanitation – many of which we are still working on today. WHO’s work has since grown to also cover health problems that were not even known in 1948, including relatively new diseases such as HIV/AIDS.


Participation

1. 193 countries and two associate members are WHO’s membership. They meet every year at the World Health Assembly in Geneva to set policy for the Organization, approve the Organization’s budget, and every five years, to appoint the Director-General. Their work is supported by the 34-member Executive Board, which is elected by the Health Assembly. Six regional committees focus on health matters of a regional nature.

2. More than 8000 people from more than 150 countries work for the Organization in 147 country offices, six regional offices and at the headquarters in Geneva, Switzerland.
In addition to medical doctors, public health specialists, scientists and epidemiologists, WHO staff include people trained to manage administrative, financial, and information systems, as well as experts in the fields of health statistics, economics and emergency relief.

The role of WHO in public health
WHO fulfils its objectives through its core functions:

• providing leadership on matters critical to health and engaging in partnerships where joint action is needed;
• shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;
• setting norms and standards and promoting and monitoring their implementation;
• articulating ethical and evidence-based policy options;
• providing technical support, catalysing change, and building sustainable institutional capacity; and
• monitoring the health situation and assessing health trends.

The WHO agenda
1. Promoting development
2. Fostering health security
3. Strengthening health systems
4. Harnessing research, information and evidence
5. Enhancing partnerships
6. Improving performance

Partners of WHO
1. WHO and its Member States work with many partners, including UN agencies, donors, nongovernmental organizations, WHO collaborating centres and the private sector.


Achievement

1948
WHO took over the responsibility for the International Classification of Disease (ICD), which
dates back to the 1850s and was first known as the International List of Causes of Death. The ICD is used to classify diseases and other health problems and has become the international standard used for clinical and epidemiological purposes.

1952
- Dr Jonas Salk (US) develops the first successful polio vaccine

1952–1964
Global yaws control programme One of the first diseases to claim WHO’s attention was yaws, a crippling and disfiguring disease that afflicted some 50 million people in 1950. The global yaws control programme, fully operational between 1952-1964, used long-acting penicillin to treat yaws with one single injection. By 1965, the control programme had examined 300 million people in 46 countries and reduced global disease prevalence by more than 95%.

1967
South African surgeon Christiaan Barnard conducts the first heart transplant.

1974
The World Health Assembly adopts a resolution to create the Expanded Programme on
Immunization to bring basic vaccines to all the world’s children.


1979
The eradication of smallpox – a disease which had maimed and killed millions – in
the late 1970s is one of WHO’s proudest achievements. The campaign to eradicate
the deadly disease throughout the world was coordinated by WHO between 1967
and 1979. It was the first and so far the only time that a major infectious disease has
been eradicated

1983
Institut Pasteur (France) identifies HIV.

1988
Global Polio Eradication Initiative established Since its launch in 1988, the Global Polio Eradication Initiative has reduced the number of cases of polio by more than 99% – from more than 350 000 per year to 1956 in 2006. Spearheaded by national governments, WHO, Rotary
International, the US Centers for Disease Control and Prevention and UNICEF, it has immunized more than two billion children thanks to the mobilization of more than 20 million volunteers and health workers. As a result, five million children are today walking, who would otherwise have been paralysed, and more than 1.5 million childhood deaths have been averted. The goal is to eradicate polio worldwide so that no child will ever again be







2003
21 May 2003 was a historic day for global public health. After nearly four years of
intense negotiations, the World Health Assembly unanimously adopted WHO’s first
global public health treaty. The treaty is designed to reduce tobacco-related deaths
and disease around the world.

2003
Severe Acute Respiratory Syndrome (SARS) first recognized and then controlled.

2004
Adoption of the Global Strategy on Diet, Physical Activity and Health.

2005
World Health Assembly revises the International Health Regulations.

PCL 12 - Millenium Goals

United Nations Millennium Development Goals (MDGs)

- 8 goals

- all 191 UN member states agreed to try to achieve by 2015

- derived from the United Nations Millennium Declaration (signed in September 2000 in New York)

- provide concrete, numerical benchmarks for tackling extreme poverty in its many dimensions

- MDGs breakdown into 21 quantifiable targets that are measured by 60 indicators

Goal 1: Eradicate extreme poverty and hunger

Targets

• Target 1a: Reduce by half the proportion of people living on less than a dollar a day

1.1 Proportion of population below $1 (PPP) per day 1.2 Poverty gap ratio 1.3 Share of poorest quintile in national consumption

• Target 1b: Achieve full and productive employment and decent work for all, including women and young people

1.4 Growth rate of GDP per person employed 1.5 Employment-to-population ratio 1.6 Proportion of employed people living below $1 (PPP) per day 1.7 Proportion of own-account and contributing family workers in total employment

• Target 1c: Reduce by half the proportion of people who suffer from hunger

1.8 Prevalence of underweight children under-five years of age 1.9 Proportion of population below minimum level of dietary energy consumption WHO activities WHO is working with countries: to build capacity in using standard growth assessment tools; to assist in planning and conducting nutritional surveys; to support the analysis and interpretation of nutritional survey results; to support the development of nutritional surveillance systems; to ensure that nutrition is an integral part of care and support for people with HIV and TB; to develop national nutrition plans and policies; and to strengthen the delivery of essential nutrition actions.

Goal 2: Achieve universal primary education

Targets

• Target 2a: Ensure that all boys and girls complete a full course of primary schooling

  2.1 Net enrolment ratio in primary education 2.2 Proportion of pupils starting grade 1 who reach last grade of primary 2.3 Literacy rate of 15-24 year-olds, women and men

While UNDP is not a specialised expert agency in education, we use our role as coordinator of the UN development system to support the mandates of other agencies.

Goal 3: Promote gender equality and empower women

Targets

• Target 3a: Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015

3.1 Ratios of girls to boys in primary, secondary and tertiary education 3.2 Share of women in wage employment in the non-agricultural sector 3.3 Proportion of seats held by women in national parliament WHO key working areas In partnership with Member States and others, WHO: furthers the empowerment of women, especially as it contributes to health; supports the prevention of and response to gender-based violence; promotes women's participation and leadership, especially in the health sector; defines ways in which men can be engaged to promote gender equality and to contribute more to their own health and that of their families and communities; builds the capacity of WHO and its Member States to identify gender equality-related gaps; and provides support for gender-responsive policies and programmes.

Goal 4: Reduce child mortality

Targets

• Target 4a: Reduce by two thirds the mortality rate among children under five

4.1 Under-five mortality rate 4.2 Infant mortality rate 4.3 Proportion of 1 year-old children immunised against measles

While UNDP is not a specialised expert agency in health, we use our role as coordinator of the UN development system to support the mandates of other agencies.

WHO strategies To deliver these interventions, WHO promotes four main strategies: appropriate home care and timely treatment of complications for newborns; integrated management of childhood illness for all children under five years old; expanded programme on immunization; infant and young child feeding. These child health strategies are complemented by interventions for maternal health, in particular, skilled care during pregnancy and childbirth.

Goal 5: Improve maternal health

Targets

• Target 5a: Reduce by three quarters the maternal mortality ratio

5.1 Maternal mortality ratio 5.2 Proportion of births attended by skilled health personnel

• Target 5b: Achieve, by 2015, universal access to reproductive health

5.3 Contraceptive prevalence rate 5.4 Adolescent birth rate 5.5 Antenatal care coverage (at least one visit and at least four visits) 5.6 Unmet need for family planning

• While UNDP is not a specialised expert agency in health, we use our role as coordinator of the UN development system to support the mandates of other agencies.

WHO key working areas Strengthening health systems and promoting interventions focusing on policies and strategies that work, are pro-poor and cost-effective. Monitoring and evaluating the burden of maternal and newborn ill-health and its impact on societies and their socio-economic development. Building effective partnerships in order to make best use of scarce resources and minimize duplication in efforts to improve maternal and newborn health. Advocating for investment in maternal and newborn health by highlighting the social and economic benefits and by emphasizing maternal mortality as human rights and equity issue. Coordinating research, with wide-scale application, that focuses on improving maternal health in pregnancy and during and after childbirth.

• 

• 
  
Goal 6: Combat HIV/AIDS, malaria and other diseases
• Targets
• Target 6a: Halt and begin to reverse the spread of HIV/AIDS

6.1 HIV prevalence among population aged 15-24 years 6.2 Condom use at last high-risk sex 6.3 Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS 6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years

• Target 6b: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it

6.5 Proportion of population with advanced HIV infection with access to antiretroviral drugs WHO is working with countries: to prevent people becoming infected with HIV – helping to change behaviours to reduce HIV risks; increasing access to prevention commodities; supporting programmes for prevention of mother to child transmission of HIV; promoting safe blood supplies and prevention of HIV transmission in health care settings; assessing new prevention technologies; to expand the availability of treatment; to provide the best care for people living with HIV/ AIDS and their families; to expand access and uptake of HIV testing and counselling so that people can learn their HIV status; to strengthen health care systems so that they can deliver quality and sustainable HIV/AIDS programmes and services; and to improve HIV/AIDS information systems, including HIV surveillance, monitoring and evaluation and operational research.

• Target 6c: Halt and begin to reverse the incidence of malaria and other major diseases

6.6 Incidence and death rates associated with malaria 6.7 Proportion of children under 5 sleeping under insecticide-treated bednets 6.8 Proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs 6.9 Incidence, prevalence and death rates associated with tuberculosis 6.10 Proportion of tuberculosis cases detected and cured under directly observed treatment short course WHO strategies Malaria WHO urges three main strategies to tackle malaria: prevention with long-lasting insecticidal nets; prevention with indoor residual spraying; and rapid treatment with effective anti-malarial medicines. WHO also recommends a special focus on preventing pregnant women and young children. WHO’s target, and that of the Roll Back Malaria Partnership, is to cut malaria by half by 2010, with the goal of reaching the MDG target by 2015. Tuberculosis WHO – in collaboration with the Stop TB Partnership – is working to combat the epidemic through Stop TB Strategy. This six-point strategy seeks to: pursue high-quality DOTS expansion and enhancement; address TB/HIV, multidrug-resistant TB and the needs of poor and vulnerable populations; contribute to health system strengthening based on primary health care; engage all care providers; empower people with TB, and communities through partnership; and enable and promote research.







Goal 7: Ensure environmental sustainability

Targets




• Target 7a: Integrate the principles of sustainable development into country policies and programmes; reverse loss of environmental resources




• Target 7b: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss




• Target 7a and 7b Indicators:




7.1 Proportion of land area covered by forest 7.2 CO2 emissions, total, per capita and per $1 GDP (PPP) 7.3 Consumption of ozone-depleting substances 7.4 Proportion of fish stocks within safe biological limits 7.5 Proportion of total water resources used 7.6 Proportion of terrestrial and marine areas protected 7.7 Proportion of species threatened with extinction




• Target 7c: Reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation







7.8 Proportion of population using an improved drinking water source 7.9 Proportion of population using an improved sanitation facility WHO activities WHO is working with countries and other UN agencies to: monitor progress towards the drinking water and sanitation target, through updated and refined estimates in collaboration with UNICEF in the Joint Monitoring Programme for Water Supply and Sanitation (JMP); report on trends in policy, institutional and finance issues related to sanitation and drinking-water through the UN-Water Global Annual Assessment of Sanitation and Drinking-Water (GLAAS); develop guidelines on quality of drinking-water, safe use of wastewater in agriculture and aquaculture, and management of safe recreational waters; provide guidance, capacity strengthening and good practice models to countries. This includes capacity building in over 20 countries to develop water resource management systems to insure the long term sustainability of water resources; manage networks of specialized issues including: small community water supply management; for the promotion and dissemination of information on household water treatment and safe storage; and for drinking-water regulators; assess needs and ensuring safe drinking water and sanitation to health facilities and vulnerable groups during emergencies and natural disasters.




• Target 7d: Achieve significant improvement in lives of at least 100 million slum dwellers, by 2020




7.10 Proportion of urban population living in slums










Goal 8: A global partnership for development

Targets




• Target 8a: Develop further an open, rule-based, predictable, non-discriminatory trading and financial system
• Includes a commitment to good governance, development and poverty reduction; both nationally and internationally




• Target 8b: Address the special needs of the least developed countries
• Includes tariff and quota free access for the least developed countries' exports; enhanced programme of debt relief for heavily indebted poor countries (HIPC) and cancellation of official bilateral debt; and more generous ODA for countries committed to poverty reduction







• Target 8c: Address the special needs of landlocked developing countries and small island developing States through the Programme of Action for the Sustainable Development of Small Island Developing States and the outcome of the twenty-second special session of the General Assembly




• Target 8d: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term.







• Indicators for Targets 8a, 8b, 8c and 8d:




• Some of the indicators listed below are monitored separately for the least developed countries (LDCs), Africa, landlocked developing countries and small island developing States.
• Official development assistance (ODA)




8.1 Net ODA, total and to the least developed countries, as percentage of OECD/DAC donors; gross national income 8.2 Proportion of total bilateral, sector-allocable ODA of OECD/DAC donors to basic social services (basic education, primary health care, nutrition, safe water and sanitation 8.3 Proportion of bilateral official development assistance of OECD/DAC donors that is untied 8.4 ODA received in landlocked developing countries as a proportion of their gross national income 8.5 ODA received in small island developing States as a proportion of their gross national incomes




• Market access




8.6 Proportion of total developed country imports (by value and excluding arms) from developing countries and least developed countries, admitted free of duty 8.7 Average tariffs imposed by developed countries on agricultural products and textiles and clothing from developing countries 8.8 Agricultural support estimate for OECD countries as a percentage of their gross domestic product 8.9 Proportion of ODA provided to help build trade capacity




• Debt sustainability




8.10 Total number of countries that have reached their HIPC decision points and number that have reached their HIPC completion points (cumulative) 8.11 Debt relief committed under HIPC and MDRI Initiatives 8.12 Debt service as a percentage of exports of goods and services




• Target 8e: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries




8.13 Proportion of population with access to affordable essential drugs on a sustainable basis




WHO's activities WHO has developed global indicators for availability, price and affordability of essential medicines. WHO/Health Action International pricing survey methodology used in over 50 countries has increased awareness of the pricing, affordability and availability of branded and generic medicines in the public and private sectors. WHO provides pharmaceutical manufacturers with the information they need to produce quality, safe, effective essential medicines to address leading public health concerns. WHO offers essential capacity building and quality assurance monitoring for over 250 medicines to treat millions of patients with HIV/AIDS, tuberculosis and malaria, and with reproductive health needs in developing countries.




• Target 8f: In cooperation with the private sector, make available the benefits of new technologies, especially information and communications




8.14 Telephone lines per 100 population 8.15 Cellular subscribers per 100 population 8.16 Internet users per 100 population