Latin Americans Efforts to Achieve the Millennium ...Latin Americans Efforts to Achieve the...

Latin Americans Efforts to Achieve the Millennium Development Goals: An Update on

Progress

Dr. Yehuda BenguiguiSenior Advisor

Child and Neonatal HealthHealthy Living Course Project

Family and Community Health Area

Family an Child Health in the Americas: Efforts to Achieve the Millennium Development Goals

April 29, 2011Denver, Colorado

Pan AmericanHealthOrganization

IMCI


I. The Millennium Development Goals

II. Latin America Profile

III. An Update on Progress

IV. Efforts to Achieve the MDG-4


IMCI


I. The Millennium Development Goals


IMCI

In 2000, 189 countries signed up to the Millennium Declaration—a global commitment to halve extreme poverty and achieve equitable and sustainable development for all. The agreement led to the creation of a historic framework revolved around eight goals: the Millennium Development goals (MDGs), which centre on targets around poverty, education, gender, health, environment, and global partnerships—to be met by 2015.

In the same year, world leaders met in New York to attend the UN MDG review summit, to reenergise commitments and determine how to accelerate progress in the coming years.

MILLENNIUM DEVELOPMENT GOALS


IMCI


End Poverty and Hunger

Universal Education

Gender Equality

Child Health

Maternal Health

Combat HIV/AIDS

Environmental Sustainability

Global Partnership


Are required only 5 years to meet MDG-4, which proposed a two-thirds reduction in mortality in children under 5 years from 1990 to 2015.

1/3

1/3

1/3 1/3

1990 20152000 2005 2010



0-28 days

From 29 days to < 1 year

From 1 year to

< 5 years

NEO

NA

TAL

POST

-NEO

NA

TAL

CH

ILH

OO

D

INFA

NT

MO

RTA

LITY

UN

DER

5 M

OR

TALI

TY

1990 2015

The countries have different degrees of progress in each of the life course stages

MILLENNIUM DEVELOPMENT GOAL - 4



Will the countries of our hemisphere achieve the MDG-4 for 2015?

Poor development Countries with high childhood mortality rates, will achieve the MDG-4 for 2015?

Developing countries with low childhood mortality rates, will achieve the MDG-4 for 2015?

Which factors affect the achievement of MDG-4 for 2015?

QUESTIONS

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II. Latin America Profile


IMCI

Malnutrition 3 %Pneumonia & ARI

12 %

Diarrhea 12 %

Respiratory & infectious diseases: 27%

Other 6 %

Accidents 6 %

Peri-neonatal

58%

Sepsis 32%

Asphyxia 29%

LWB & Prematurity

24%

Congenitalanomalies 10%

CAUSES OF DEATH IN CHILDREN < 5 IN THE AMERICAS REGION

Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009 Pan AmericanHealthOrganization

42.4

33.6

27.423.8

2118

0

5

10

15

20

25

30

35

40

45

1990 1995 2000 2005 2010 2015

EVOLUTION OF MORTALITY IN CHILDREN UNDER 5 YEARS IN THE REGION OF THE

AMERICAS. RATES PER 1000 LIVE BIRTHSPe

r 100

0 liv

e bi

rths

ODM

Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009

52%

14


66%

0

50

100

150

200

250

300

350

< 5 years < 1 year

58% 71%

42%29%

NEONATAL MORTALITY RATE IN RELATION TO TOTAL NUMBER OF DEAD IN < 5 YEARS AND <

1YEAR

Neonatal mortality

Per 1

000

live

birt

hs Post neonatal mortality

Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009Pan AmericanHealthOrganization

LAC PROFILE-1

Significant decrease in mortality in children under five years:

52% from 1990 to 2010

More than 306.000 deaths avoided

Changes in the Mortality:Decrease in post neonatal mortality (diarrhea,

respiratory and infectious diseases)

Greatest relevance of neonatal mortality in < 5

years and infants mortalityPan AmericanHealthOrganizationIMCI

LAC PROFILE-2


Lack of priority in the political agenda of the neonatal component.

Absence of action plans.

Deficiency of the data by geographic area - only national averages available.

Deficient care in health facilities. No implementation of evidence-based neonatal interventions.

High proportion of people without access to health facilities – 30%.

IMCI

LAC PROFILE-3


Low percentage of GDP for health.

Poor coordination among cooperation agencies in countries.

NGOs work in the community without adequate coordination with Ministries of Health.

Pre-Service, Training in health (medicine-nursing) misinformed the epidemiological reality and productivity in Public Health.

Poor monitoring, supervision and evaluation in the countries plan of actions.

IMCI


80 60 40 20 0 20 40 60 80

70.0 10.0

10.0 75.0

15.0 10.0

5.0

5.0

Hospital (Internment)

Ambulatory (primary care))

Ambulatory specialized

Hospital (Emergency care)

Other

Proportion of student time for the various training activities

Proportion of graduates working in each type of facility

PROPORTION OF TIME SPENT AT VARIOUS ACTIVITIES DURING THE PEDIATRIC TRAINING COMPARED TO THE BACK OF GRADUATE WORK

Source: OPS/ALAPE, 2000


LAC 500,000 CHWs

> 400 NGOs

30,000 students of medicine in rural areas

400 Schools of Medicine

> 1000 training centers for nurses and auxiliary


III. An Update on Progress


IMCI


-25 -20 -15 -10 -5 0

ARG ATG BHS BLZ BOL BRA BRB CAN CHL COL CRI CUB DMA DOM ECU GTM GUY HND HTI JAM LCA MEX NIC PAN PER PRY SLV SUR TTO URY USA VCT VEN

DECREASE (%) OF INFANT MORTALITY RATE (IMR) DURING PERIOD 2004-2009 AND ANNUAL PORCENTUAL VARIATION REQUIERED TO ACHIVE MDG-4 BY 2015 IN THE REGION OF

THE AMERICAS

% 2004 – 2009 annual (IMR)

% 2010 -2015 annual (IMR)

Source: Estimates of PAHO/HSD/HA data, 2010


FACTORS AFFECTING THE ACHIEVEMENT OF MDG-4 IN THE COUNTRIES OF THE REGION

2.6

2.4

2.2

2

2.1

2.2

2.3

2.4

2.5

2.6

2.7

TM<5a TM<1a TM<28d

Rate of reduction in mortality from 1990 to 2010

%

Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009 and www.thelancet.com Vol 375 June 5, 2010

http://www.thelancet.com/

0

50

100

150

200

250

300

350

< 5 years < 1 year

58% 71%

42%29%

NEONATAL MORTALITY RATE IN RELATION TO TOTAL NUMBER OF DEAD IN < 5 YEARS AND <

1YEAR

Neonatal mortality

Per 1

000

live

birt

hs Post neonatal mortality

Source: Estimates of FCH /HL-based PAHO/HSD/HA data, 2009Pan AmericanHealthOrganization

2.6

2.2

2.4

2.2

Infant Mortality Rate in Various Indigenous & Non-IndigenousCommunities in Latin America

0102030405060708090

100

Bolivia Guatemala Ecuador Honduras Peru Venezuela Mexico

Source: Estimations FCH, PAHO/WHO

Rat

e pe

r 100

0 Li

ve B

irths

IndigenousNI


76

5957

3935

3129 28

2624 24 23 22 22 21 20 19

16 1614

119 8 7 6

HAI GUY BOL GUT NIC JAM DOR MEX Total ELS HON PAN PAR ECU COL BRA VEN ARG BLZ URU COR CHI USA CUB CAN

8% of births18% of deaths

32% of births13% of deaths

Source: Estimations from FCH/CA with a data base from HIA-PAHO, 2008

80

70

60

50

40

30

20

10

0

> 30 < 15

RR = 5

Under 5 Mortality Rate in the Latin American Region x 1000 lb



IV. Efforts to Achieve the MDG-4


IMCI


ADVOCACY: NEONATAL HEALTH PRIORITY IN PUBLIC HEALTH AGENDA

An Interagency Strategic Consensus


REGIONAL STRATEGY AND PLAN OF ACTION FOR NEONATAL HEALTH WITHIN THE CONTINUUM OF

MATERNAL, NEWBORN, AND CHILD CARE

Strategic Areas

1. Create an enabling environment for the promotion of peri-neonatal health.

2. Strengthen health systems to improve access to maternal, newborn, and child health services.

3. Promote community-based interventions.

4. Develop and strengthen monitoring and evaluation systems.

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Neonatal and child profiles with disaggregated countries data

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EVIDENCE-BASED INTERVENTIONS

The interventions that are presented in this document, they were selected on the basis of the current scientific evidence and in the analysis of its feasibility and its potential to reduce neonatal morbidity.

These interventions can be included in a package in accordance with the level of care that health systems offer.

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Establishment of New WHO Collaborations Centers to support LAC priority Country.

• Texas Children’s Hospital, Houston, TX• University of Colorado, Center for Global Health• Maimonides University,

Buenos Aires, Argentina

Pan AmericanHealthOrganizationIMCI


IMCI AS A KEY STRATEGY FOR IMPROVING CHILD HEALTH

Nutrition Immunization Other diseaseprevention

Promotion ofgrowth and

development

Managementof sick

children

Integrated Managementof Childhood Illness


IMCI


50

55

60

65

70

75

80

85

90

95

100

Brazil Cono Sur CentralAmerican

Andean Area Latin Caribbean Mexico

IMMUNIZATION COVERAGES IN CHILDREN UNDER TWO YEARS IN

LATIN AMERICA REGIONS


%

DPT3 Polio3 MMR


ACCELERATE THE WORK WITH SCHOOLS OF MEDICINE AND

NURSING

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COMMUNITY INTERVENTIONS

NGOs

CHWs


Follow-up

Monitoring

and

Evaluation

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1990 2000 2015

Necessary decline for fulfilling MDG: annual 4.4%

Necessary increase in

decline speed

671.300

522.600

40

30

20

10


Gap to achieve MDG # 4 for mortality in children less than 5 years old by 2015


THE CHALLENGEEffective

Evidence BasedInterventions

ImpactChildhoodMortality

Reduction MDG#4

Public Health

Vulnerable Population

Priority Areas

Strategies

BIG

https://intranet.paho.org/dpi/photogallery/img0047.jpg

IMCIPan AmericanHealthOrganization


April 29, 2011Denver, Colorado

Latin Americans Efforts to Achieve the Millennium ...Latin Americans Efforts to Achieve the...

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