Again we have the opportunity to change the situation. The world's community is united more than ever before to say enough is enough. We have unprecedented commitment from the UN Global Strategy for Women and Children's Health to Promises Renewed. In addition …
Transcript of "What Happened Since the Child Survival Call to Action_John Borazzo_4.26.13"
What’s happened since the ChildSurvival Call to Action? (policyreview and a little background, too)CORE Group Spring MeetingApril 26, 2013
Recall the Child Survival Call to Action in June 2012…• Joint effort byEthiopia, India, USAIDand UNICEF• Countries signed on tocommit to accleratingreductions in childmortality• Presentations from thecountries with thehighest burden ofunder-fivemortality, includingpresentation of newnational plans• A lot of momentum - APromise Renewed hasspawned major follow-up events inIndia, Ethopia(regional), others
There have been many new MCHdata, estimates, policy documents since June2012…
• Geography – numbers, severity, focus, graduation• Equity – vulnerable/lagging (sub-)populations• High-impact interventions – bottlenecks, research• Connections to broader context –“environment”, “empowerment”, etc.• Accountability – country level, global level, for/toourselves and each otherFocus issues for the Call to Action4
Under-five deaths 1990-2070(actual and projected)Current trajectory: ARR2.5%• MDG 4 achieved in 2035• 4 million deaths annually in2035ARR 12.6%• Achieve MDG 4• Reach 2 million childdeaths annually in 2020• Achieve average ofU5MR 15/1000 by 2020ARR 5.2%• 2 million deaths annually by 2035• Every country reaches 20/1000 by2035• Many countries below 15/1000 bythenAchieveMDG 4Under-5 deathsmillions9.6 mm deathsin 20007.6 mmdeaths in20101990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 2065131211109876543201Recall the key Child Survival Call to Action message – bend the curve toreach MDG targets and accelerate progress on child survivalSource: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in ChildMortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035
“Sharpening plans”• Understand structure of mortality, epidemiology, and mostvulnerable populations• Use evidence-based models (e.g. LiST) with current andprojected/aspirational coverage levels to determinepossible intervention strategies to effect desired change inmortality and epidemiology• Understand the systems bottlenecks to achieving thosechanges• Develop a costed and prioritized investment strategy toaddress the bottlenecks, change the outcomes, and reducemortality• Ensure that a system of accountability (e.g. scorecard) isestablished to track progress and make ongoingadjustments (i.e. further "sharpening)
We have an inclusive and expansive understanding ofwhat it takes to end preventable child deaths7Prevention andTreatment ofInfectious diseases• Pneumonia• Diarrhea• Malaria• AIDS/PMTCTChild survivalFamily planningNeonatal causes• Preterm birthcomplications• Intra-partum events• Neonatal infectionsNutritionEnabling Environment▪ Education▪ Empowerment ofwomen▪ Economic growth▪ Environmental factors(e.g. water supply,sanitation, hygiene)ImmunizationMaternal health
Diverse global initiatives contribute to thegoal of ending preventable child deaths• FP2020 – ongoing• Follow-up to the UN Commission on Life-SavingCommodities – ongoing• Global Action Plan for Pneumonia and Diarrhoea(GAPPD) – just launched in Geneva, London, andWashington• Global Vaccine Summit – Abu Dhabi, April 2013• Nutrition for Growth – London, June 2013
Family PlanningSummitBorn too soon A Promise RenewedCountry leadership & ImplementationDecade of VaccinesInnovation Working GroupKey advocacy events and catalytic initiatives in support ofEvery Woman Every ChildCommission on Live-saving CommoditiesCoIA independent Expert Review GroupNeed to Strengthen Global and National Leadership
APR Country activities:launch events, refining strategies, building scorecards (highlights)• Nigeria: Saving One Million Lives was launched in October 2012. GON moving forward in mobilizing Stateson key actions.• Ethiopia: Mobilized 22 countries at a regional event in January. Ethiopia itself has been central toscorecarding and accountability efforts in the region, and the Federal Ministry of Health has launched acommunity-based newborn care implementation plan.• India: National Call to Action for Child Survival and Development launched in February, including a focus oneight high-priority States. Ministry of Health and Family Welfare (MOHFW) to launch a "1000 day campaign"from May/June 2013 - end 2015 to establish a plan to scale-up Reproductive, Maternal, Newborn and ChildHealth services nationally.• DR Congo: Acceleration Plan under development. Strong MoH interest in launch, possible May timeframe.• Zambia: APR Country Launch with First Lady April 11• Senegal: MOH mobilized all donors/stakeholders to develop sharpened, costed plan that integrates majorinitiatives. Will host regional meeting with UNCoLSC “pathfinder” countries in late-June• Bangladesh: working on an Action Plan and APR benchmarks for a press event with the Minister of Health• Liberia: Strong push for community mobilization supporting 9 key child health messages to district level.Planned April APR postponed.• Malawi: UNICEF/USAID collaboration underway and launch with parliament and civil society planned forAugust 2013. Strong focus on aligning key initiatives to support results.• LAC regional event – Panama hosting, late 2013
Global Causes of Child Deaths, 2010Source: CHERG, 2012
USAID MCH funding increasingly focused on 24MCH “priority” countries responsible for 75% ofmaternal and child mortality150 +100-14940-9920-39U5M Rate (per 1000 live births):10-19
MDG 4 Assessment of Progress for 24 prioritycountries: Under-Five Mortality Rate AverageAnnual Rate of Reduction(%) 1990-2011DR Congo, 0.4Kenya, 1.4Sudan, 1.7Mali, 1.8Ghana, 2.1Yemen, 2.4Pakistan, 2.5Nigeria, 2.6India, 3.0Afghanistan, 3.1Uganda, 3.3Haiti, 3.4Senegal, 3.5Mozambique, 3.7Tanzania, 4.0Zambia, 4.0Ethiopia, 4.5Indonesia, 4.5Madagascar, 4.6Malawi, 4.8Nepal, 4.9Rwanda, 5.1Bangladesh, 5.3Liberia, 5.40.0 1.0 2.0 3.0 4.0 5.0 6.0On TrackInsufficientProgress4.3% (on target)Little/NoProgressSource: Level and Trends in Child Mortality Report 2012
Regional Causes of Child Deaths, 2010:Sub-Saharan Africa and South/East AsiaAfrica: 3.6 million deaths Asia: 2.1 million deathsSource: CHERG, 2012
Reducing deathsfrom pneumoniaand diarrhea willbe critical to endpreventable childdeaths, especiallyin countries withhigher under-fivemortality rates.GAPPD: By 2025, <3 deaths /1000 live births from childpneumonia, <1/1000 diarrhea deathsUnder-5 mortality rate (per 1000) versus percentage ofunder-5 deaths attributed to pneumonia and diarrhoea in2010
Source: WHO/UNICEF/UNFPA/World Bank. Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. Geneva, World Health Organization, 2012.24 USAID PriorityCountries, 27%24 USAID PriorityCountries, 55%24 USAID PriorityCountries, 61%24 Non-PriorityCountries, 31%24 Non-PriorityCountries, 18%24 Non-PriorityCountries, 10%Centrally Managed, 28%Centrally Managed, 15%Centrally Managed, 12%GAVI, 14%GAVI, 12%GAVI, 17%$0$100$200$300$400$500$600$700$800$900FY 2002 FY 2008 FY 2012$inmillionUSAID Maternal and Child HealthAccounts: GHP/USAID, AEECA, and ESF$391.7 Million$773.4 Million$577.3 MillionMCH funds have been increasinglystrategically focused….
Under-Five Child Mortality in Lowest and Highest Wealth Quintiles -USAID MCH priority countries, 2004-2009149.997.390.291.540.530.5020406080100120140160Africa Asia & Middle East Latin & AmericaCaribbeanDeathsPer1000LiveBirthsLowest Quintile Highest QuintileSource: U5MR: Demographic and Health Survey Statcompiler, latest available data. Data older than 2004 includeMozambique 2003. Data by wealth quintile are not available for Afghanistan, Angola, Sudan and Yemen.Substantial inequity in child survival existsin all regions17
Problems in measuring changeon an annual basis…
Take-aways…• Setting priorities is critical – geography, targetpopulations, interventions• Using a systematic evidence-based process is critical tosetting priorities• There has been lots of country action since June 2012• There is a need for better coordination at theinternational and national levels• Decreasing inequity in outcomes and impact needscontinued attention• Accountabilty/”Scorecards” very important butmortality measurement in “near real time” isproblematic
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