Inter agency working group on community imci geneva 3 september 2002
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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. 200. 1990. 181. 175. 180. 2000. Least.

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Inter-Agency Working Group on Community IMCI, Geneva, 3 September 2002

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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


200

1990

181

175

180

2000

Least

reduction

160

3%

140

128

120

U5MR (deaths per 1000 births)

100

100

Greatest

reduction

80

80

32%

64

58

60

53

45

44

38

37

40

20

9

6

0

Sub-Saharan

South Asia

Middle East &

East Asia and

Latin America

CEE/CIS and

Industrialized

Africa

North Africa

Pacific

& Caribbean

Baltics

countries

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

Source: UNICEF, 2001


U5MR disparity by asset quintile


Most deaths occur at home,before reaching health facilities … Implications for programming?


Bangladesh U5MR


Immunization 1980-1999, DPT3 coverage


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

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.

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


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 U5MR


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

with AIDS

per 1000 live births

250

200

150

100

50

0

without AIDS

Botswana

Kenya

Malawi

Tanzania

Zambia

Zimbabwe

Source: US Bureau of the Census

98036-E-25 – 1 December 1999


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


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