committing to child survival - a promise renewed - ending preventable child deaths

7/29/2019 Committing to Child Survival - A Promise Renewed - ending preventable child deaths

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Committing to ChildSurvival - A Promise

Renewed - endingpreventable child

deaths

Addis Ababa, 16January 2013

Dr. Mickey Chopra, Associate Director Health, UNICEF


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Key Messages

Globally and in Africa we are making progress

However for too many women and childrenand some conditions progress is too slow

The ambition of A Promise Renewed for Africa The immediate challenges for accelerating

progress


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The global burden of under-five deaths has fallen steadily

since 1990Global number of under-five deaths, selected years

12.0

10.8

9.6

8.2

6.9

0

2

4

6

8

10

12

14

1990 1995 2000 2005 2011

Millionsofund

er-fivedeaths

Source: The UN Inter-agency Group for Child Mortality Estimation, 2012;

provided by SMS/DPS/UNICEF


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The global under-five mortality rate has fallen by 41% from

1990 to 2011Under-five and neonatal mortality rate, 1990-2010

Source: The UN Inter-agency Group for Child Mortality Estimation, 2012;

provided by SMS/DPS/UNICEF

87

51

MDG Target: 29

32

22

0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2010 2015

Deathsper1,0

00livebirths

U5MR

NMR


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0

20

40

60

80

1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

Source: UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011;

UNICEF, Required Acceleration for Child Mortality Reduction beyond 2015, 2012; team analysis

Save the Children team analysis for NMR projection

MortalityRate

(deaths/1000

births)

20

35

Accelerated U5MR ARR = 5.1%

Current U5MR ARR = 2.2%

* ARR = annual rate of reduction

MDG 4 target = 34U5MR

Global Progress for child survivalU5MR and NMR decline 1990-2010, projected to 2035

15

Current NMR ARR = 1.8%

If 1-59 month mortality accelerates further but neonatalmortality continues on same trend then with

2 million child deaths in 2035, 1.5 million may be neonatal.


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All regions have experienced marked declines in

under-five mortality rates since 1990

Deathsp

er1,00

0l

iveb

irths

Source:IGME2012


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The global burden of under-five deaths is increasingly concentrated

in Sub-Saharan AfricaShare of under-five deaths, by region, 1990-2010 (%)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1990 1995 2000 2005 2010

Sub-Saharan Africa South Asia East Asia and Pacific

Middle East and North Africa Latin America and Caribbean CEE/CIS

Industrialized countries

Source: IGME 2011


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1) Sierra Leone(185 per 1000 live births)

2) Somalia3) Mali

4) Chad

5) Democratic Republic of the Congo

6) Central African Republic7) Guinea-Bissau

8) Angola

9) Burkina Faso

10) Burundi

11) Cameroon

12) Guinea13) Niger

14) Nigeria

15) South Sudan

16) Equatorial Guinea17) Mauritania

18) Togo

19) Benin

20) Swaziland (104 per 1000 live births)

Source for mortality rank: UN Inter-agency Group for Child Mortality Estimation 2012;Fragile Situation countriesare shown in red(source: World Bank 2011)

In 2011, for the first time, the 20 countries with the highestunder child mortality rates are all in Africa. There is a strong

correlation between conflict, fragile situations and childmortality rates.

8


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Top 10 countries in Africa with the

largest reductions in child mortality,2000-2011

Ran

k

Country Annual rate of reduction

(%)1. Senegal 6.4%

2. Malawi 6.2%

3. Zambia 5.6%

4. Ethiopia 5.3%

5. Namibia 5.2%

6. Niger 5.0%

7. Morocco 4.3%

8. Zimbabwe 4.1%

9. Kenya 4.0%


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170 Governments Pledged to dateIncluding 48 of the 54 countries in Africa

plus hundreds of Civil Society organisations, Faith Based

organisations, Individuals, schools and

workplaces Focus on results and accountability

But also an important technical component

www.apromiserenewed.org


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20 by 2035: selected country U5MR trajectories

0

20

40

60

80

100

120

140

160

180

200

220

240

260

280

1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

Under-fivemortalityrate(deathsper1,000livebirths)

Mali continuation of 2000-2010 trend

Mali to reach 20 by 2035

Democratic Republic of the Congo

Cte d'Ivoire

Lesotho

India

Indonesia

Peru


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0%

25%

50%

75%

100%

COMMODITIES: %

health centres with

no perinatal supply

stock-outs

HUMAN RES: %

facilities with

sufficient workers

ACCESS: % families

living near health

facility with daily

service provision

UTILISATION: %

deliveries assisted by

trained worker

CONTINUITY: %

deliveries with i) SBA

ii) weighed & iii)

receive 3 postnatal

care visits

EFFECTIVE COV: % of

SBA deliveries occur

within a ANC-

qualified health

facility

Most Deprived Least deprived

Supply Bottlenecks

> 20% difference in availability andaccessibility to facilities with SBA

Demand Bottlenecks(esp. Financial access) in

most deprived but leastdeprived tend to use even

more than what is available

Changing How We Do It: Supply and demandbottlenecks for most / least deprived areas analyzed


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Major bottlenecks to achieving results

Decentralization & Low capacity: weak supervision,management, QA and motivation

Major barriers to access: poor enforcement of pro-poor cashtransfers and fee-waivers

Incomplete uptake of life-saving interventions: e.g. zinc fordiarrhea

Ineffective resource management: especially in decentralized

settings Structural barriers: economic, political, socio-cultural


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Potential

approach

Description

Possiblestrategies

Shift intervention

within channel

Shift intervention to

different delivery channel

Improve performance of

delivery channel

Shiftexisting

within

channel

Newdelivery or

technology

approach

Improve

channel

performance

Change way of delivering

interventions within existing

channels

Task shifting among different

cadres of workersImproving outreach services

(including specialist outreach)

Shifting to different sets of

providers through public-private

partnerships, contracting out, or

franchising

Deliver the intervention through a

better performing channel

Task shifting from clinic-based to

community-basedShifting interventions from clinic-

based to child health campaigns

Shifting behaviour change

counselling from face to face to

social marketing or implementing

policy changes

Improve efficiency, capacity and

accessibility of delivery channel

Human resources availability:

Compulsory service, Hardshipallowances, retention of HR in

rural settings

Geographic access:

Increase number of service points

Financial access:

User fee abolitions, Insurance

schemes, Conditional cash

transfers, Vouchers

Continuity:

PBI, remuneration (salaries)

Defaulter tracking

Quality:

Supervision/mentoring, training,

audits, accreditation

Demand:Community/individual

empowerment, social marketing


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THANK YOU !

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committing to child survival - a promise renewed - ending preventable child deaths

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