Post on 25-Dec-2014
description
What’s happened since the Child Survival Call to Action? (policy review and a little background, too)
CORE Group Spring MeetingApril 26, 2013
Recall the Child Survival Call to Action in June 2012…• Joint effort by Ethiopia,
India, USAID and UNICEF
• Countries signed on to commit to acclerating reductions in child mortality
• Presentations from the countries with the highest burden of under-five mortality, including presentation of new national plans
• A lot of momentum - A Promise Renewed has spawned major follow-up events in India, Ethopia (regional), others
There have been many new MCH data, estimates, policy documents since June 2012…
• 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/to ourselves and each other
Focus issues for the Call to Action
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Under-five deaths 1990-2070 (actual and projected)
Current trajectory: ARR 2.5%• MDG 4 achieved in 2035• 4 million deaths annually in
2035ARR 12.6%• Achieve MDG 4 • Reach 2 million child
deaths annually in 2020• Achieve average of
U5MR 15/1000 by 2020
ARR 5.2% • 2 million deaths annually by 2035 • Every country reaches 20/1000 by
2035• Many countries below 15/1000 by
then
AchieveMDG 4
Under-5 deaths millions
9.6 mm deaths in 2000
7.6 mm deaths in
2010
13
12
11
10
9
8
7
6
5
4
3
2
0
1
Recall the key Child Survival Call to Action message – bend the curve to reach MDG targets and accelerate progress on child survival
Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: 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 most vulnerable populations
• Use evidence-based models (e.g. LiST) with current and projected/aspirational coverage levels to determine possible intervention strategies to effect desired change in mortality and epidemiology
• Understand the systems bottlenecks to achieving those changes• Develop a costed and prioritized investment strategy to address
the bottlenecks, change the outcomes, and reduce mortality• Ensure that a system of accountability (e.g. scorecard) is
established to track progress and make ongoing adjustments (i.e. further "sharpening')
We have an inclusive and expansive understanding of what it takes to end preventable child deaths
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Prevention and Treatment of Infectious diseases• Pneumonia• Diarrhea• Malaria• AIDS/PMTCT
Child survival
Family planning
Neonatal causes
• Preterm birth complications
• Intra-partum events• Neonatal infections
Nutrition
Enabling Environment▪ Education▪ Empowerment of
women▪ Economic growth▪ Environmental factors
(e.g. water supply, sanitation, hygiene)
Immunization Maternal health
Diverse global initiatives contribute to the goal of ending preventable child deaths
• FP2020 – ongoing
• Follow-up to the UN Commission on Life-Saving Commodities – ongoing
• Global Action Plan for Pneumonia and Diarrhoea (GAPPD) – just launched in Geneva, London, and Washington
• Global Vaccine Summit – Abu Dhabi, April 2013
• Nutrition for Growth – London, June 2013
Family Planning Summit Born too soon A Promise Renewed
Country leadership & Implementation
Decade of Vaccines
Innovation Working Group
Key advocacy events and catalytic initiatives in support of Every Woman Every Child
Commission on Live-saving Commodities
CoIA independent Expert Review Group
Need 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 States on key actions.
• Ethiopia: Mobilized 22 countries at a regional event in January. Ethiopia itself has been central to scorecarding and accountability efforts in the region, and the Federal Ministry of Health has launched a community-based newborn care implementation plan.
• India: National Call to Action for Child Survival and Development launched in February, including a focus on eight 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 Child Health 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 major
initiatives. 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 for
August 2013. Strong focus on aligning key initiatives to support results.• LAC regional event – Panama hosting, late 2013
Global Causes of Child Deaths, 2010
Source: CHERG, 2012
USAID MCH funding increasingly focused on 24 MCH “priority” countries responsible for 75% of
maternal and child mortality
150 +100-149
40-9920-39
U5M Rate (per 1000 live births):
10-19
MDG 4 Assessment of Progress for 24 priority countries: Under-Five Mortality Rate Average
Annual Rate of Reduction(%) 1990-2011
0.0 1.0 2.0 3.0 4.0 5.0 6.0
DR Congo; 0.4Kenya; 1.4
Sudan, 1.7
Mali; 1.8
Ghana; 2.1
Yemen; 2.4
Pakistan; 2.5
Nigeria; 2.6
India; 3.0
Afghanistan; 3.1
Uganda; 3.3
Haiti; 3.4
Senegal; 3.5
Mozambique; 3.7
Tanzania, 4.0
Zambia, 4.0
Ethiopia, 4.5
Indonesia, 4.5
Madagascar; 4.6
Malawi; 4.8
Nepal; 4.9
Rwanda; 5.1
Bangladesh; 5.3
Liberia; 5.4
On Track
Insufficient Progress
4.3% (on target)
Little/No Progress
Source: Level and Trends in Child Mortality Report 2012
Regional Causes of Child Deaths, 2010: Sub-Saharan Africa and South/East Asia
Africa: 3.6 million deaths Asia: 2.1 million deaths
Source: CHERG, 2012
Reducing deaths from pneumonia and diarrhea will be critical to end preventable child deaths, especially in countries with higher under-five
mortality rates.
GAPPD: By 2025, <3 deaths /1000 live births from child pneumonia, <1/1000 diarrhea deaths
Under-5 mortality rate (per 1000) versus percentage of under-5 deaths attributed to pneumonia and diarrhoea in 2010
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.
FY 2002 FY 2008 FY 2012$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
24 USAID Priority Countries, 27%
24 USAID Priority Countries, 55%
24 USAID Priority Countries, 61%
24 Non-Priority Countries, 31%
24 Non-Priority Countries, 18%
24 Non-Priority Countries, 10%
Centrally Managed, 28%
Centrally Managed, 15%
Centrally Managed, 12%
GAVI, 14%
GAVI, 12%
GAVI, 17%
USAID Maternal and Child Health
$ in
mill
ion
Accounts: GHP/USAID, AEECA, and ESF
$391.7 Million
$773.4 Million
$577.3 Million
MCH funds have been increasingly strategically focused….
Under-Five Child Mortality in Lowest and Highest Wealth Quintiles -USAID MCH priority countries, 2004-2009
149.9
97.390.291.5
40.530.5
0
20
40
60
80
100
120
140
160
Africa Asia & Middle East Latin & AmericaCaribbean
De
ath
s P
er
10
00
Liv
e B
irth
s Lowest Quintile Highest Quintile
Source: U5MR: Demographic and Health Survey Statcompiler, latest available data. Data older than 2004 include Mozambique 2003. Data by wealth quintile are not available for Afghanistan, Angola, Sudan and Yemen.
Substantial inequity in child survival exists in all regions
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Problems in measuring change on an annual basis…
Take-aways…
• Setting priorities is critical – geography, target populations, interventions
• Using a systematic evidence-based process is critical to setting priorities
• There has been lots of country action since June 2012• There is a need for better coordination at the
international and national levels• Decreasing inequity in outcomes and impact needs
continued attention• Accountabilty/”Scorecards” very important but
mortality measurement in “near real time” is problematic