While waiting for the slides to come on I thought I might tell you a short episode this morning listening to Juan Flavier's presentation reminded me of my visit to the Philippines. When I saw him in action, I said to a Filipino friend, I said that this is what Napoleon of France when people like Senator Flavier in mind. People asked me what Napoleon said, so I said, Napoleon said that "all great men are short". The Filipino friend said to me, you must be self serving. I said, unfortunately Napoleon did not say all short people are great.
I would like to touch on the progress made on the mid-decade goals. Now this is a story of commitment and vision of people like Mr. Grant and the world leaders. You will find a story that is extremely heartening. The glass is not half full, it is three quarters full.
I think we need to go back to the year 1990. This morning various speakers have mentioned about convention, about the achievement of the universal child immunization and summit so I will not touch on them except to mention that the year also is very unique in education because it had an international conference equivalent to the 1978 health care conference. The big charter on the basic education.
Going back to the summit for children, this was a conference attended by 159 leaders of the world and it adopted a declaration and a plan of action with 27 goals and these are now signed by 166 heads of state. These countries have drawn up the national programs of action which covered over 90% of the world's population with a monitoring mechanism attached.
Why mid-decade goals? Why goals for 1995. Experience shows us that the political will is always easier when goals are more doable and achievable. To attempt all these 27 goals is probably a little too much and therefore we need to break it down. Several goals in their logical sequence, some have to be achieved earlier and some be achieved later. If you don't succeed, then it is very difficult to breed the atmosphere of success so we need to have success stories which will then build on themselves. Then of course if you succeed it builds up confidence to deal with bigger challenges. It also builds up the momentum.
The mid-decade goals were first developed by the South Asian Association of Regional Co-operation which is the subcontinent of India and Pakistan etc. and also the African conference sponsored by the Organization of African Unity. They began to develop what countries should be achieving in five years time. These were later endorsed with some variation at different regions at the ministerial level.
The mid-decade goals are listed in the back of the room and maybe later each of us can take time to go through them. They are fundamentally ten basic goals with three supportive goals. What are the prospects? I thought the best statement of that was made in 1994 by Mr. Grant before he fell seriously ill. He and I went through all the regions in the world to discuss with the leaders as well as the various offices to see what each country, each region had. After that Mr. Grant characterized the situation as a majority of the countries will be achieving a majority of the goals.
One cynical person asked me, "Do you mean to say that 51% of the countries will achieve 51% of the goals equivalent to 26% of the goals", which is not the case of course. We found that roughly three quarters of the countries will be achieving somewhere around 5, 6, 7 goals, the top quarter will probably be achieving around 9 to 10 goals. All the basic goals.
The first goal is on the ratification of the convention on the rights of the child. This goal is likely to be the goal which is likely to be achieved through universal ratification by all countries in the world by the end of this year. This is what we hope will happen and we are working towards it. Roughly 174 countries have already ratified them and there are 17 countries which remain to be ratified and more details will be presented following my presentation.
The next is the immunization coverage. The UCI countries, those which achieved universal child immunization, meaning that they have achieved 80% of all six antigens, roughly 50% of the countries have retained their status or increased their coverage in those four years time. These are based on 1993 figures, 1994 figures are only coming up. For the non UCI countries it is roughly about three quarters. On the whole it is a good story. If we talk totally all countries, roughly three quarters have either sustained or increased their coverage. If you compare that to 1985 where the global immunization efforts started, roughly 94 - 95% have either increased or at least been sustaining their efforts. The 5-6% who have gone back compared to 1985 are mainly the countries where the conflict situations have hindered more to be done.
On neonatal tetanus, essentially there is a big data problem because the official figures all of us have, reflect only about 10% of the actual cases. Based on what the ministers are putting is to have less than 1 per one thousand live births. In the situation given 83 countries have already achieved the goal and 25 countries are more than 5 cases per thousand.
We all thought that measles goals were to reduce the incidence of mortality by 95% and incidents of morbidity by 90%. We think the trend is so good that we will probably achieve that goal. Already 84 countries have reached that 90% reduction in incidence.
As for polio, I think you have been hearing polio eradication all morning. Roughly 145 countries are now polio free. You will find not only the Americas but also East Asia and Western Pacific, the Middle East and North Africa and the smaller countries in Southern Africa are also polio free now.
One of the major killers is diarrhea through dehydration. One of the major goals of 1995 is to raise the use of oral rehydration therapy to 80%. In 1975 the use rate was 1% and this has slowly increased and at the close of 1994 the rate is about 57%. We think in 1995 we probably won't reach 80% but more likely will be around 70%. Next year I think we are more likely to achieve that.
Of the many very innovative developments I would like to highlight two. Who carried the messages to the families you might ask? We found the most successful ones are in the countries where the scouts, girl scouts and boys scouts played a very major role because they went house to house to spread the message and until the parents have literally absorbed them they don't leave that house. We found this to be the case in Mexico, Bolivia, Morocco, Egypt, Bangladesh. Great tribute went to these little young scouts.
We are now working towards the commercialization of ORS, the oral rehydration salts. The salt iodization is to move towards the elimination of the iodine deficiency disorders. The target is to reach about 90-95% use, consumption for both humans and animals whereas the estimate for this year will probably be 80-85% and probably by next year it will reach 95%.
In the end I thought I might report to you what is the most fascinating thing, it is not the goiter not the questions that moved people to move. It was the intellectual development, studies have shown that it affects your intellectual development and that was what the leaders felt unacceptable in their countries. Another factor that moved them enormously was the finding studies made in places like Pakistan where they found that the iron deficiency was widespread not only in the mountain areas, but also in the capital cities themselves.
The Vitamin A has three approaches. The diet, supplementation, and fortification. Supplementation is going on quite well now, especially together with the measles immunization at nine months. Post partum to the mother is only beginning and the second year is a little uneven. Some countries are doing very well, some countries are not. However, we believe the best prospect is to fortify because once you fortify that is probably the most sustainable route. We have found that in Guatemala the fortification of sugar with Vitamin A has worked very well. It costs roughly 17 cents US per year per capita. Of course Guatemalans love sugar so they eat a lot. We do not ask them to eat more but all you eat should be fortified. In Southern Africa probably the mace meal will become the major food fortification and probably cooking oil in other places. We think by 1996 the problem should probably be under control.
In the baby friendly hospital, the global target was set between WHO and UNICEF as 1000, especially involving teaching hospitals, the basic principle hospitals, provincial hospitals etc. To date the various countries have targeted 6700 hospitals to become baby friendly and the last count they declared hospitals were too full. Lots of them were close to being achieved so we thought that by the end of this year it will be 3,500. The major challenge is to see that they do not relax and they let the government action on vending the free and local supply of breast milk substitute be maintained.
In the guinea worm disease the target is to reduce the incidents by 95% and as the figures show the situation has 3 million at the beginning which is about the 1988/89 figure when the extensive case search was made. By the end of 1994 there were only about 162 remaining. So a little over 5%. The three major countries that have the cases left were Nigeria,.....and Sudan. Of course Sudan was one of the difficult countries because of the armed conflict. Bill Foege mentioned this morning about the cease fire, especially through the efforts of President Carter. We now feel the figure might be closer to 70 to 75 thousand. We feel if the situation continues we might be able to get it under control by 1997.
If I may digress for half a second to tell you how guinea worm has taken peoples imagination. I visited Cameroon last November. In Cameroon the filter cloth that catches the eggs were given to one another as bridal gifts now. You can see how it has captured peoples imagination. A few years back I visited Nigeria, a place called Cancan, and they had essentially eradicated all the guinea worms in their village and they were very happily celebrating and I asked the village chief what did you gain from this. He said number one, we are able to go to the farm every day now and number two our children all go to school now, they are not laid back for two months at home. Besides we have all become so rich that we are now visited the Hoji (?). In Muslim to visit the Hoj is one of the great life's privileges. Then he added as an afterthought, all of us now have four wives.
What would be the impact if we achieved all these goals. An additional two and a half million lives would be saves. All the children who died now, two and a half would be saved. They would be a longer life expectancy naturally. Major childhood diseases which kill will be prevented, and the mental impairment will be removed. We will build a system and political will to tackle bigger challenges.
I would like to end with a statement, that when we started in 1990, no one thought or dreamed that this was possible. It is people like Mr. Grant those who believe in miracles, will make miracles, after all our reality demands that we have to believe in miracles otherwise our life would not be that meaningful. This is proof of his belief. I would like to end on a personal note, talking about Jim Grant, is that Richard Jolly has introduced I am from Burma and I am a Buddhist and we believe in afterlife and Jim Grant, the day before he died said that there was a blinding light from his behind and he asked that the blinds be drawn but of course there was no sunlight passing through. In Buddhist belief we believe that this is a very good passing of life because he is going to heaven. Thank You.