At the beginning of the transition decade, social indicators for many Europe and Central Asia countries appeared better than countries in other regions with similar income levels. But after a severe economic downturn, many of the transition countries could no longer afford the huge social infrastructure they inherited, resulting in the reversal of many social indicators. And poverty levels rose significantly in many countries in the region during the early phase of the transition.

However, there has been a robust turn around in ECA with all countries having begun to experience positive economic growth. This is likely to continue but be at a more moderate pace than in recent years. While growth is starting to lead to poverty reduction in countries such as the Kyrgyz Republic, Moldova and Russia either growth will need to accelerate or the poverty elasticity of growth will need to rise to boost prospects for meeting the MDG target across the region. It remains to be seen if this will translate into comparable progress toward meeting the education, health, and environmental goals, which will require significant resource reallocations and major public sector and institutional reforms.

Universal primary education appears achievable across most of the region, although in several countries improvements in enrollment and completion rates would need to accelerate a litttle over the trend observed for the MDG target to be met. Similarly, gender equity in education does not appear to be a significant issue with the MDG targets being close to or already having been met.

The health MDGs present the greatest challenge in ECA. There are many countries (predominantly those from the CIS) where the child and maternal mortality MDGs are unlikely to be met. Progress with U5MR may be limited because utilization rates at secondary hospitals are often lower than international averages and there are concerns about quality and out-of-pocket payments acting as barriers to care. With MMR, poverty, distance and poorly performing hospital networks inhibit progress towards this goal and in some cases such as Georgia maternal deaths are increasing rather than decreasing.

HIV/AIDS represents a very significant issue for the region. While absolute numbers may be lower than in other regions, ECA is experiencing the world’s fastest growing HIV epidemic. There is a pressing need to improve the effectiveness of disease control through epidemiological and behavioral surveillance systems that can identify the status and trends of HIV and its determinants. Denial, stigma, and the institutional challenges of providing services to marginalized and vulnerable sub-populations, such as injecting drug users, jeopardize progress to combating HIV/AIDS in this region.

While on the basis of access to improved water sources, the ECA region appears to be doing well, there has been little investment in water infrastructure so that water quality is becoming a serious issue with drinking water frequently not meeting basic biological and chemical standards.