Contributing to reaching the Millennium Development Goals and the Goals of the World Fit

for Children: Health and Nutrition in UNICEF's Mid-Term

Strategic Plan 2002-2005

Inter-Agency Working Group on Community IMCI,

Geneva, 3 September 2002

Under-five mortality rate, change over period 1990-2000

Source: UNICEF, 2001

181

128

80

5853

45

175

100

64

4437 38

9 6

0

20

40

60

80

100

120

140

160

180

200

Sub-SaharanAfrica

South Asia Middle East &North Africa

East Asia andPacific

Latin America& Caribbean

CEE/CIS andBaltics

Industrializedcountries

U5M

R (

deat

hs p

er 1

000

birt

hs)

1990

2000Least reduction

3%

Greatest reduction

32%

159150

131

110

76

Low est Second Middle Fourth HighestWealth quintiles

Source: UNICEF, weighted average of 43 countries, based on DHS data, mid-1990s.

U5MR disparity by asset quintile

Most deaths occur at home, before reaching health facilities

… Implications for programming?

BANGLADESH - UNDER-FIVE MORTALITY

0

50

100

150

200

250

300

1960 1965 1970 1975 1980 1985 1990 1995 2000

Year

Und

er-f

ive

mor

talit

y ra

te (

per

1000

birt

hs)

CPSi86 DHSi93 HDSi94

DHSd96 FSd89 SRS

DHSd93 DHSd99 Est

Bangladesh U5MR

Source: Revised global coverage estimates based on joint UNICEF/WHO review

37%

51%

73% 74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1980 1985 1990 1995 1999

Sub-Saharan Africa South AsiaLatin America & Caribbean East Asia and Pacific

Immunization 1980-1999DPT3 coverageImmunization 1980-1999, DPT3 coverage

150 MILLION CHILDREN IN DEVELOPINGCOUNTRIES ARE STILL MALNOURISHED*More than half of underweight children live in South Asia

South Asia78

Sub-Saharan Africa

32

East Asia and Pacific

27

Middle East/North Africa

7

Latin America /Caribbean

4CEE/CIS & Baltic

States2

Source: UNICEF, 2001. [Figu re s are in m illio ns]

* Percent of children under five who are underweight.

LOW BIRTHWEIGHT RATEOne quarter of births in South Asia weigh less than 2500 grams

9

14

7

15

15

8

10

11

12

25

0 5 10 15 20 25 30

World

Industrialized countries

Developing countries

Least developed countries

East Asia/Pacific

CEE/CIS & Baltic States

Latin America/Caribbean

Middle East/North Africa

Sub-Saharan Africa

South Asia

Source: UNICEF, 2001

1 in 13 RISK OF DEATHA woman born in Sub-Saharan Africa faces a 1 in 13 chance of dying in childbirth. The risk for women born in industrialized countries is 1 in 4085.

RegionLifetime risk of dying

in pregnancy or childbirth*Sub-Saharan Africa 1 in 13South Asia 1 in 55Middle East/North Africa 1 in 55Latin America/Caribbean 1 in 160East Asia/Pacific 1 in 280CEE/CIS and Baltic States 1 in 800

Least developed countries 1 in 16Developing countries 1 in 60Industrialized countries 1 in 4,100World 1 in 75

* Affected not only by maternal mortality rates but also by the number of births per woman.

Source: Maternal mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA, Geneva, 2001.

56

52

94

83

69

66

37

29

0 20 40 60 80 100

World

Developing Countries

CEE/CIS and Baltic States

Latin America and the Caribbean

Middle East and North Africa

East Asia and Pacific

Sub-Saharan Africa

South Asia

Per centSource: UNICEF.

Skilled attendants at delivery, 1995-20

The ultimate challenge: HIV

HIV - the worst pandemic in human history - risks reversing the progress of decades of development ...

BOTSWANA - UNDER-FIVE MORTALITY

0

20

40

60

80

100

120

140

160

180

200

1960 1965 1970 1975 1980 1985 1990 1995 2000

Year

Und

er-f

ive

mor

talit

y ra

te (

per

1000

birt

hs) CENi71

FHSi88

CENi81

FHSi84

FHSd96

FHSd88

CENi91MCSi00

Botswana U5MR

Estimated impact of AIDS on under-5 child mortality rates - selected African countries, 2010

•

Source: US Bureau of the Census

250

200

150

100

50

0

per 1000 live births with AIDS

98036-E-25 – 1 December 1999

Botswana Kenya Malawi Tanzania Zambia Zimbabwe

without AIDS

Main Goals of A World Fit for Children (2000-2010)

• Reduce infant and under-five mortality by at least one third by 2010 (and by 2/3 from 1990 to 2015)

• Reduce maternal mortality ratio by at least one third by 2010 (and by 3/4 from 1990 to 2015)

Main Goals of A World Fit for Children (2000-2010)...

• Reduce under-five child malnutrition by at least one third by 2010, with special attention to children under two and reduce the rate of low-birth weight by at least one third by 2010

• Reduce proportion of households without access to hygienic sanitation facilities and affordable and safe water by at least one third by 2010

Main Goals of A World Fit for Children (2000-2010) ...

• Develop and implement national early childhood development policies and programmes (children’s physical, social, emotional, spiritual and cognitive development)

• Develop and implement national health policies and programmes for adolescents, including goals and indicators, to promote their physical and mental health

Main Goals of A World Fit for Children (2000-2010) ...

• Access through the primary health-care system to reproductive health for all individuals of appropriate ages as soon as possible and no later than 2015

Main Goals of A World Fit for Children (2000-2010)...

• Reduce by 2005 HIV prevalence among young men and women age 15 to 24 in the most affected countries by 25 per cent and by 25 percent globally by 2010

• By 2005, reduce the proportion of infants infected by HIV by 20%, and by 50% by 2010

Organizational Priorities 2002-2005: UNICEF’s Mid-Term Strategic Plan

• Immunisation+• Integrated Early Childhood Development

(Health, Nutrition, Water & Sanitation, Psychosocial Care and Early Learning, Child Protection)

• HIV/AIDS• Girl’s Education• Child Protection

Immunization +• By 2010, ensure full immunization at least 90%

of children nationally with at least 80% coverage in every district

• Certify by 2005 the global eradication of polio

• Reduce deaths due to measles by half by 2005

• Eliminate maternal and neonatal tetanus by 2005

Immunization + ...

• Extension of the benefits of new and improved vaccines and other preventive health interventions to children in all countries, especially vitamin A where appropriate

Integrated Early Childhood Development (IECD)

• Health:– Major childhood killers (diarrhea, pneumonia, malaria)– Maternal and newborn health

• Nutrition– Exclusive breastfeeding, complementary feeding, infant-

feeding informed choices

– Micronutrients (supplementation and fortification: iodine, vitamin A, anemia and iron, folic acid, others?)

• Water and environmental sanitation• Psychosocial care and early learning

HIV/AIDS

• PMTCT

• Prevention among young people

• Care and Support

• Orphans

With business as usual, we will not reach the MDGs or those of the World Fit for

Children• Need to redouble our efforts to support

countries to reach these goals

• How can we support countries to provide high coverage of a limited number of the most cost-effective interventions (the essential package) and support the development of sustainable national health systems?

Principles of good development• Seek maximal impact on human development (eg.

health and education) and on poverty reduction• Evidence-based decision-making• High impact, low-cost interventions• Universal coverage, reaching the unreached,

especially the poor• Home- and community-based strategies• Essential knowledge and commodities (vaccines,

treated bednets against malaria, etc.)

Consensus from the Global Consultation on Child and Adolescent Health in

Stockholm, March 2002: the Challenge• 11 million children die each year• Most of these deaths are preventable: they

are from a limited number of conditions for which we have high impact, low cost interventions

• The challenge is to go to scale, to reach every child

Consensus from the Global Consultation on Child and Adolescent Health in Stockholm,

March 2002: the Way Forward • Political commitment and national ownership by

government, civil society and families

• Clear time-bound goals: Reduce Under-five and Maternal Mortality by one-third during this decade (focus on outcomes and not just process)

• High impact, low cost, focused programs with specific targets, standardised and taken to scale to reach every child (examples: immunisation, oral rehydration for diarrhea, treated bednets for malaria)

Consensus from the Global Consultation on Child and Adolescent Health in Stockholm,

March 2002: the Way Forward ...

• Strong and well-coordinated partnerships supporting these programs: developing countries, civil society and NGOs, multilateral agencies (WHO, UNICEF, World Bank)

• Both developing country and donor resources • Strong monitoring and evaluation systems

tracking progress towards targets• Reaching the Child and Maternal Survival Goals

is possible if we commit our energy and our resources to it

Progress - Summary• The UN Special Session on Children: A

World Fit for Children goals

• UNICEF’s Mid-term Strategic Plan

• Global Consultation on Child and Adolescent Health, Stockholm, March 2002

• Launch at Special Session on New Low-Osmolarity ORS Solution

Progress - Summary...• Consultation on the Community

Management of Pneumonia, Stockholm, June 2002

• Major effort on Roll Back Malaria

• Major Measles results in Africa

• A Secretariat for the C-IMCI IAWG

• Increase child survival funding and staffing at UNICEF

The challenge…reaching global child survival, growth

and development goals