By Emad Mekay

WASHINGTON, Nov 11 (IPS) - The World Bank warned Thursday that millions of children and hundreds of thousands of pregnant women are still dying every year worldwide despite a high-profile global pact that promised to sharply cut those deaths by the year 2015.

The Washington-based public lender said in a report that more than 11 million children died from preventable illness in 2002 before reaching their fifth birthday. Among the world's 613 million children under five, 140 million are underweight, it added.

The report, 'Rising to the Challenges: The Millennium Development Goals For Health', also estimated that as many as half a million women perished during pregnancy or childbirth.

But some of the World Bank's many critics say the institution itself is partly to blame for recommending policies -- delivered as conditions that developing nations must fulfil in order to receive loans -- that often deprive the poor of good health care, urge privatisation of health systems, and tacitly encourage imposing higher user fees on services.

The bank report says many developing countries lag behind in reaching goals to drastically cut the numbers of deaths of pregnant women and children under the age of five, by the year 2015.

These are part of what are known as the Millennium Development Goals (MDGs), eight targets set by the United Nations in 2000 that include halving the incidence of poverty from 1990 levels, achieving universal primary education, and developing a global partnership for development -- with targets for aid, trade and debt relief -- all by 2015.

The MDGs call for improved maternal health, with a target of decreasing maternal mortality by three-quarters between 1990 and 2015, equivalent to an annual rate of reduction of 5.4 percent.

On child mortality, the goals aim to cut the under-five mortality rate by two-thirds between 1990 and 2015, equivalent to an annual rate of reduction of 4.3 percent.

But Thursday's report by the bank, one of the main mentors of the global economy, painted a bleak picture of progress to date in meeting those objectives.

"Even with general economic growth and faster progress on the non-health MDGs, any regions will still miss many of the health MDG targets," said World Bank President James D Wolfensohn in a press release.

The report singles out sub-Saharan Africa as the region that has showed least progress on reaching the MDGs for health, especially for under-five mortality. No sub-Saharan country, where almost 42 percent of child deaths take place, is on schedule to reach the U.N. health targets.

In fact, only 16 percent of countries, representing 19 percent of the developing world's population, are on track to attain this goal, the report adds. Similarly, only 17 percent of developing countries are likely to meet the maternal mortality MDG, with Latin America and the Caribbean faring worst: only 4.2 percent of that region's countries are on track to meet the target.

The report's authors say effective treatments exist for malnutrition, child mortality, maternal mortality and communicable diseases, yet the drugs and care do not reach those who need them most. This is clear with diarrhoea, pneumonia and malaria, diseases that account for 52 percent of child deaths worldwide, it adds. All three have proven treatments.

In South Asia, notes the report, fewer than 50 percent of pregnant women receive an ante-natal check-up, and only two out of every 10 babies are delivered by medically-trained staff.

Medicines and medical care are being used too little by the people who can most benefit from them -- especially poor people, stresses the document.

For instance only 300,000 people of the estimated six million people living with HIV/AIDS in low- and middle-income countries receive antiretroviral therapy, used to fight HIV infection. In Asia, where more than seven million live with the disease, no country has exceeded five percent antiretroviral therapy coverage.

But the bank, which along with its sister Washington-based institution the International Monetary Fund (IMF) is often accused of forcing borrowing nations to cut spending on health and education in order to trim budgetary deficits, says in the report that increased official spending, often recommended by civil society groups, is insufficient to fix these problems.

"Increased government spending on health is a part of the answer to getting effective interventions used more widely. But it is not the whole story," says the document.

It blames "poor policies and institutions" for health woes and as reasons why across-the-board increases in government spending will have little, if any, impact on progress toward reaching the MDGs.

The bank recommends that health systems be "strengthened" to better distribute life-saving drugs and treatments, and that more medical staff need to be trained to offset the steady "brain-drain" of doctors, nurses and other trained workers to more affluent developed countries.

The report cites the example of Zambia, where of the more than 600 doctors trained since independence in 1964, only 50 remain.

"A key message of this report is that progress can be accelerated through a judicious mix of spending and policy and institutional reform," it concludes.

But watchdog groups that monitor international financial institutions, including the World Bank, say its policies of favouring privatisation of health care has actually made it more difficult, not less, for poor people to access that care.

While the bank now claims to be relatively neutral on the issue of governments imposing health care user fees, critics say the lingering effects of its previous longstanding support for such fees helped to erect barriers to access to health care.

And its failure to seriously tackle the debt problem of poor nations means those countries have been starved of resources that they should be devoting to health care and education, among other priority considerations, add the critics.

"There's no question that the bank, through its policy of restructuring health care, has been a huge force in increasing the role of the market and consequently diminishing access for the poor," said Robert Weissman, co-director of the Washington-based group Essential Action.

"The first priority for the bank should be to get its own house in order and stop pressuring, imposing, demanding, persuading, advocating harmful policies to go with its market fundamentalist tendencies that get in the way of good health care policy," he told IPS.