elizabeth mason department of child and adolescent health and development new strategic directions...

Elizabeth MasonDepartment of Child and Adolescent Health and Development

New Strategic Directions

Tracking progress in child survival Countdown to 2015 December 13-14 2005

Countdown to 2015Child Survival

Work in child health ...

…focused in the past on delivery of specific child health interventions for single diseases... CDD and ARI programmes

…but now and in the future will address the major causes of under five mortality through integration of care ... Integrated Management of Childhood Illness


….. has moved forward

…and also addresses health policies & services…

…previously neglected or emerging areas … Neonatal health Infant and Young Child Feeding HIV and infant feeding Paediatric HIV

…recognises the continuum of care…

…and collaboration between partners through the Partnership for Maternal Newborn & Child Health


… Requiring a change of emphasis:Child survival and the big picture

Source: World Health Report 2000

Stewardship(Managing resources, power

and expectations)

Financing (Raising, pooling &

allocating revenues to purchase services)

Fairness in financial contribution

Responsiveness

Resource development(Investing in people,

infrastructure and supplies)

Coverage

Efficiency

Inputs Outputs Outcomes

Service delivery(provision of

health services)

HealthLevel and inequality

Quality


New strategic directions 1

Policy, strategies, planning and partnerships Health systems support and management Community-based interventions for child

survival Monitoring and evaluation



Policies, strategies, planning & partnerships Closing the policy-implementation gap, and

promoting the "three ones" (one action plan, one financing mechanism, one M&E framework)

Developing strategies at regional and country level Child and Adolescent Health Strategy EURO Joint WHO/UNICEF Child Survival Strategy

WPRO/EAPRO Renewing commitments

Innocenti 15+



Health system support & management Health systems are the backbone of service

provision (3x5, RBM, Immunization, Stop TB) Systematic system support for universal access to

integrated delivery of interventions during the life course, across levels of care and at the programmatic and policy level

Role of the private sector to complement the public sector


Focus on System Strengthening

Newborn and child survival also need a strong health system Care of the mother, safe delivery –

immediate newborn care Prevention of illness and care of the newborn

in the first month of life Prevention of childhood illness and

integrated management of childhood illness

Con

tinuu

m o

f C

are


Increasingly, WHO is providing supportto countries through integration at three levels

Integration at the patient level: Addressing co-morbidity (± 10% of children) Using care seeking to address missed opportunities

Integration between levels of care: Promotion of key family practices Management and care at community level Integrated Management of Childhood Illness (IMCI) at first level

facilities Management of the child with a serious infection or severe

malnutrition (Referral care management) Integration at the programmatic and policy level

Breastfeeding counselling and HIV IYCF and IMCI (synergistic implementation) Maternal, newborn and child health



Community-based interventions for child survival Promoting key family practices Improving appropriate care-seeking Ensuring universal access, utilisation and

coverage of key interventions closest to home community management of pneumonia ORT ITNs and case management of malaria Community


Focus on the Continuum of Care

Home Community Outreach First Level Health Facility Referral FacilityS

tart

with

act

ion

at h

ome


Community and facility implementationneeds careful coordination & planning

Source: MCE, Peru. MoH policy brief

0

20

40

60

80

100

120

0 10 20 30 40 50 60

Trained clinical HWs

per 10,000 children

Tra

ine

d C

HW

sp

er

10

,00

0 c

hil

dre

n


Community and facility implementationneeds careful coordination & planning

Source: MCE, Bangladesh

0

1

2

3

4

5

Jul

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

Sic

k U

5 C

hil

dre

n p

er c

hil

d p

er y

ear

IMCI Intervention IMCI Comparison

-----2001---- ------------2002-------------- --------------2003------------ -------------2004--------------

Starting IMCI

Sta

ff t

rain

ing

in

IM

CI

Pro

vis

ion

of

su

pp

lies

an

d j

ob

aid

s

-2005



Monitoring & evaluation Ensuring evidence-informed decision making Epidemiological Estimates – from global to country Focus Agreed upon simple set of core indicators (with linkage to

Health Metrics Network) Regular programme reviews Regular measurement – annual or biannual surveys Monitoring financing and adequate resource allocation for

moving towards universal access


Disaggregated country data for child health programming

Cause specific under five mortality distributionChina whole country, MCH surveillance (2004)

59%

15%

4%

0%

0%

0%

7% 15% Neonatal

Pneumonia

Diarrhoea

Malaria

Measles

HIV/AIDS

Injuries

Other

Cause specific under five mortality distributionChina inland provinces, MCH surveillance (2004)

58%

14%3%

0%

0%

0%

9%

16%

Neonatal

Pneumonia

Diarrhoea

Malaria

Measles

HIV/AIDS

Injuries

Other

WPRO, WHO estimate China, MCH surveillance system

Cause specific under five mortality distributionWPRO, WHO estimates (2000-2003)

13%

7%0%

1%

0%

17%

13%

47%

Neonatal

Pneumonia

Diarrhoea

Malaria

Measles

HIV/AIDS

Injuries

Other

Cause specific under five mortality distributionChina remote, MCH surveillance (2004)

49%

23%

7%

0%

0%

0%

6% 15% Neonatal

Pneumonia

Diarrhoea

Malaria

Measles

HIV/AIDS

Injuries

Other


Integrated management is less expensive…

Districts Measure

IMCI Comparison

Input data:

Standardized1 total annual district cost for child health care $ 393,193 $ 416,825

Quality measure (proportion of children managed correctly) 0.65 0.16

Standardized1 annual under-five consultations at government

primary care facilities

150,745 101,991

Effectiveness (Number of children managed correctly)2 97,834 16,217

Cost per child managed correctly: $ 4.02 $ 25.70

1Consultations and costs have been standardized to a district with 50,000 children under age five. 2Annual consultations multiplied by proportion managed correctly.

Source: MCE, Tanzania. Bryce et al. HPP


... and can lead to rapid mortality reduction

Sources: TEHIP and MCE


New Strategic Directions 6

Using available financing opportunities for Child survival GAVI: Delivery of multiple interventions with

immunisation – Vit A; ITNs GFATM: Malaria in children; ITNs; Prevention and

care of paediatric HIV/AIDS both now include health systems strengthening

PRSPs, SWAPs


New directions strengthen the outcome focus

Policy, Strategy, Planning & Partnerships

One plan

Monitoring & Evaluation

Regular feedback

Improved HealthHealth system support

and managementIntegrated delivery

Community-based Interventions for

child survival Continuum of care

Coverage

Efficiency

Quality

Inputs Outputs Outcomes

Reduced child

Mortality

Con

tinuu

m o

f M

NC

H c

are


Make Every Mother and Child Count

Towards attaining the MDGs

elizabeth mason department of child and adolescent health and development new strategic directions...

Documents

child survival countdown

child survival monitoring

country level child

strong health system

integration of care

levels of care

health policies services

partnerships health