Missing Millions and Measuring Progress towards the Millennium Development Goals with a focus on Central Asia States

BACKGROUND: In developing countries, population estimates and assessments of progress towards the Millennium Development Goals are based increasingly on household surveys. It is not recognised that they are inappropriate for obtaining information about the poorest of the poor. This is because they, typically, omit by design: those not in households because they are homeless; those who are in institutions; and mobile, nomadic or pastoralist populations. In addition, in practice, because they are difficult to reach, household surveys will typically under-represent: those in fragile, disjointed or multiple occupancy households; those in urban slums; and may omit certain areas of a country deemed to pose a security risk. Those six sub-groups constitute a pretty comprehensive ostensive definition of the ‘poorest of the poor’. METHODS: This paper documents these omissions in general, drawing on worldwide literature about the theory and practice of implementing censuses and household surveys; and shows how substantial proportions are missing from both censuses and the sample frames of surveys. RESULTS: This paper suggests that between 300 and 350 million will effectively be missed worldwide from the sampling frames of such surveys and from most censuses. The impact on the health MDGs is illustrated for the five republics of the former Soviet Union making up Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. CONCLUSIONS: It is impossible to assess progress towards or away from the MDGS in both the Central Asian Republics and worldwide. It is urgent to find solutions to the problem of the ‘missing’ poor population sub-groups.