History of Iraq

1. Add presenter name
Date
Event/location
Countdown to 2015:
Iraq

2. Notes for the presenter on
adapting this presentation
• Personalise with photos, charts
• Data presented are based on best available data up
to mid-2014. When presenting, mention more recent
studies or data. (2013 mortality on slide #18 added)
• Select which slides are appropriate for the audience.
For example: Slides are provided for each figure presented
in the country profile; select from these (choosing all or a few
depending on needs)
• Sub-national data can be substituted as appropriate
and available
• Review the Speaker Notes, adapt according to your
audience and purpose

3. Purpose of this presentation
• To stimulate discussion about Iraq country data,
especially about progress, where we lag behind, and
where there are opportunities to scale up
• To provide some background about Countdown to
2015 for MNCH, the indicators, and data sources in the
country profiles
• To showcase the country profile as a tool for
monitoring progress, sharing information and
improving accountability

4. Outline
1. Countdown to 2015: Background
2. Iraq Countdown profile

5. Part I
Countdown to 2015:
Background

6. What is Countdown?
A global movement initiated in 2003 that tracks
progress in maternal, newborn & child health in
the 75 highest burden countries to promote action
and accountability

7. • To disseminate the best and most recent
information on country-level progress
• To take stock of progress and propose new
actions
• To hold governments, partners and donors
accountable wherever progress is lacking
Countdown aims

8. What does Countdown do?
• Analyze country-level coverage and trends for
interventions proven to reduce maternal, newborn and
child mortality
• Track indicators for determinants of coverage (policies and
health system strength; financial flows; equity)
• Identify knowledge and data gaps across the RMNCH
continuum of care
• Conduct research and analysis
• Support country-level Countdowns
• Produce materials, organize global conferences and
develop web site to share findings
9

9. 75 countries that together account for > 95% of maternal
and child deaths worldwide

10. Who is Countdown?
• Individuals:
scientists/academics,
policymakers, public health
workers, communications
experts, teachers…
• Governments:
RMNCH policymakers,
members of Parliament…
• Organizations:
NGOs, UN agencies,
health care professional
associations, donors,
medical journals…
12

11. Countdown moving forward
Four streams of work to promote accountability,
2011-2015
• Responsive to global accountability frameworks
-Annual reporting on 11 indicators for the Commission on
Information and Accountability for Women’s and Children’s
Health (COIA)
-Contribute to follow-up of A Promise Renewed/Call to
Action
• Production of country profiles/report and global
event(s)
• Cross-cutting analyses
• Country-level engagement

12. Part 2
Iraq Countdown country
profile
Main findings

14. What does Countdown monitor?
• Progress in coverage for critical interventions across
reproductive, maternal, newborn & child health
continuum of care
• Health Systems and Policies – important context for
assessing coverage gains
• Financial flows to reproductive, maternal, newborn
and child health
• Equity in intervention coverage
Range of data on the profile

15. The national-level profile uses data from global databases:
• Population-based household surveys
• UNICEF-supported MICS
• USAID-supported DHS
• Other national-level household surveys (MIS, RHS and
others)
• Provide disaggregated data - by household wealth, urban-
rural residence, gender, educational attainment and
geographic location
• Interagency adjusted estimates
U5MR, MMR, immunization, water/sanitation
• Other data sources (e.g. administrative data, country reports
on policy and systems indicators, country health accounts, and
global reporting on external resource flows etc.)
Sources of data

16. National progress towards
MDGs 4 & 5
Mortality data through 2012:
2013 child mortality data was released in late 2014:
Under-five mortality rate (U5MR)= 34 deaths per 1000 live births
Infant mortality rate (IMR) = 28 deaths per 1000 live births
Neonatal mortality rate (NMR) = 19 deaths per 1000 live births

17. Leading direct causes:
Haemorrhage – 31%
Hypertension –13%
Embolism – 9%
Sepsis – 5%
Unsafe abortion – 3%
Understanding the cause of death distribution is
important for program development and monitoring
Why do West Asian mothers
die?
HICS
ND NEWBORN HEALTH
2%
Preterm 18%
Asphyxia* 14%
Other 3%
Congenital
10%
Sepsis** 10%
P
Embolism 9%
Haemorrhage
31%
Hypertension
13%
Indirect 23%
Other direct
16%
Abortion 3%
Sepsis 5%
M
(
Causes of maternal deaths, 2013
87 (2011)
M
Source: WHO/CHERG 2014
Demand for family planning satisfied (%)
Globally nearly
half of child
deaths are
attributable to
undernutrition
Source: WHO 2014
five deaths, 2012
Regional estimates
for Western Asia,
2013
L
M
I
P
a
K
b
A
m
L
t
o
** Sepsis/ Tetanus/ Meningitis/ Encephalitis
Neonatal
death: 56%

18. Leading causes:
Neonatal – 56%
Pneumonia – 13%
Injuries – 6%
Diarrhoea – 6%
Undernutrition is a major underlying cause of child
deaths
Why do Iraqi children die?
DEMOGRAPHICS
MATERNAL AND NEWBORN HEALTH
13% 2%
Preterm 18%
Asphyxia* 14%
Other 3%
Congenital
10%
Sepsis** 10%
0%
6%
Measles 0%
Injuries 6%
Malaria 0%
HIV/AIDS 0%
Other 18%
Antenatal care
Percent women aged 15-49 years attended at least once by a
Ca
Source: WHO/CHERG 2014
Dem
Ante
Globally nearly
half of child
deaths are
attributable to
undernutrition
Pneumonia
Diarrhoea
Causes of under-five deaths, 2012
* Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis
Neonatal
death: 56%
Iraq

19. Countdown to 2015 Report. 2014.
Demographics

20. Variable coverage along the continuum of care

21. Maternal and newborn health

22. Maternal and newborn health

23. Maternal and newborn health
MATERNAL AND NEWBORN HEALTH
Sepsis** 10%
78 77
84
78
0
20
40
60
80
100
1996
Other NS
2000
MICS
2006
MICS
2011
MICS
Percent
Antenatal care
Percent women aged 15-49 years attended at least once by a
skilled health provider during pregnancy
Source: WHO/CHERG 2014
Women wit
(<18.5 kg/m2
Postnatal vi
(within 2 days
Postnatal vi
(within 2 days
Neonatal te
C-section ra
(Minimum ta
Malaria dur
treatment (
Demand for
Antenatal c
Diarrhoea
* Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

24. Countdown to 2015 Report. 2012.
Other maternal and newborn health indicators
EALTH
87 (2011)
- -
22, 25, 16 (2011)
- -
- -
- -
85 (2012)
Women with low body mass index
(<18.5 kg/m2, %)
Postnatal visit for mother
(within 2 days for home births, %)
Postnatal visit for baby
(within 2 days for home births, %)
Neonatal tetanus vaccine
C-section rate (total, urban, rural; %)
(Minimum target is 5% and maximum target is 15%)
Malaria during pregnancy - intermittent preventive
treatment (%)
Demand for family planning satisfied (%)
50 (2011)
Antenatal care (4 or more visits, %)
Cost
plan
child
Life
Inte
Brea
Low
man
Com
with
SY
birth
Re
Ma
Ante
man
alitis

25. Child health

26. Child health

27. Child health
CHILD HEALTH
WATER AND SANITATION
Diarrhoeal disease treatment
Percent of children <5 years with diarrhoea:
receiving oral rehydration therapy/increased fluids
with continued feeding
Percent ch
those rece
Percent
Other NS MICS MICS MICS
54
64
26
27
31
23
0
20
40
60
80
100
2000
MICS
2006
MICS
2011
MICS
Percent
treated with ORS
Malar
(<18.5 kg/m

28. Child health
Density o
midwive
Percent children receiving first line treatment among
those receiving any antimalarial
-
Percent children < 5 years sleeping under ITNs
Per capi
health (I
ICS
23
1
S
Malaria prevention and treatment
(<18.5 kg/m2, %)
General
on healt
expendi
FINA
Reprod
Matern
Newbo
Child h
National
Obstetri
(% of recom
Out of p
expendi

29. Child health

30. Child health

31. Water and sanitation
WATER AND SANITATION
72
9
13
6
1995
Improved faci
2000
MICS
2006
MICS
2011
MICS
Improved drinking water coverage Improved s
Source: WHO/UNICEF JMP 2014
Unimproved
Other improved
Piped on premises
Percent of population by type of drinking water source, 1990-2012
Tot
Source: WHO/UNIC
Percent of popula
Unimproved f
Total Urban Rural
Surface water
100
80
60
40
20
0
100
80
60
40
20
0
Percent
Percent
75 74
3 11
7
11
15
4
1990 2012
95
84
0
10
3 5
2 1
1990 2012
29
56
10
13
15
22
46
9
1990 2012

32. Water and sanitation
72
85
9
10
13
5
6 0
1995 2012
82
86
11 11
7 3
0 0
1995 2012
47
82
5
8
29
10
19
0
1995 2012
Externa
Genera
Out-of-
Other
Shared facilities
Improved facilities
Open defecation
MICS
Improved sanitation coverage
990-2012
Total Urban Rural
Source: WHO/UNICEF JMP 2014
Percent of population by type of sanitation facility, 1995-2012
Unimproved facilities
Rural
ODA to child
ODA to mate
per live birth
Reproductiv
and child he
100
80
60
40
20
0
Percent
Note: See annex
Out of pocke
expenditure
56
13
22
9
2012

33. MNCH policies
• NO - Maternity protection in accordance with Convention 183
• YES - Specific notifications of maternal deaths
• NO - Midwifery personnel authorized to administer core set of
life saving interventions
• PARTIAL - International Code of Marketing of Breastmilk
Substitutes
• YES - Postnatal home visits in first week of life
• NO - Community treatment of pneumonia with antibiotics
• YES - Low osmolarity ORS and zinc for diarrhoea management
• - Rotavirus vaccine
• - Pneumococcal vaccine
* Policy information not available

34. • Costed national implementation plans for MNCH: Partial
(2013)
• Density of doctors, nurses and midwives (per 10,000
population): 6.1 (2010)
• National availability of EmOC services: - -
(% of recommended minimum)
• Per capita total expenditure on health (Int$): $149 (2012)
• Government spending on health: 4% (2012)
(as % of total govt spending)
• Out-of-pocket spending on health: 46% (2012)
(as % of total health spending)
• Official development assistance to child health per child
(US$): $6 (2011)
• Official development assistance to maternal and newborn
health per live birth (US$): $7 (2011)
Systems and financing for MNCH

35. Who is left behind?
Iraq
The wide bars for many
indicators show important
inequalities in coverage.
Inequality is greatest for
antenatal care and DTP3.
Breastfeeding, family
planning, ORT and
careseeking for
pneumonia show much
smaller gaps in coverage.

36. Thank you!

37. Optional additional slides
Equity profiles
Iraq

38. Coverage levels in poorest and richest
quintiles

39. Coverage levels in the 5 wealth
quintiles

40. Co-coverage of health interventions

41. Composite coverage and coverage gap