Keeping promises, Measuring results: Global overview of progress in achieving MDG 4

1. Keeping promises, Measuring results: Global overview of progress in achieving MDG 4 Dr Bernadette Daelmans Coordinator, Policy, Planning and Programmes Department of Maternal, Newborn, Child and Adolescent Health Family, Women and Children's Health Cluster World Health Organization

2. Promises • Adoption of the Millennium Declaration - 189 countries endorsing 8 Millennium Development Goals (2000) • 2005: Start of Countdown to 2015: Tracking progress in maternal, newborn and child survival & Launch of the Partnership for Maternal, Newborn & Child Health (PMNCH) • G8 Muskoka initiative - commitment of US$ 7.3 billion in new and additional funding for MDGs 4 and 5 (2008) • UN Secretary General's Global Strategy for Women's and Children's Health (2010) • Commitments to implement the strategy of over US$ 40 billion • Commission on Information and Accountability for Women's and Children's Health - 10 recommendations and global oversight (2011)

3. A great challenge …. EVERY YEAR: • 7.6 million children die before their 5th birthday • 3.2 million newborn babies in the first month of life • 2.4 million infants between 1 – 12 months • 356,000 women die due to complications of pregnancy and childbirth • 3 million stillbirths These are silent tragedies that have to be prevented

4. MDG 4: progress too slow

5. 7.6 million children die from preventable causes every year Ontrack Insufficientprogress Noprogress/reversal No data Source: Levels & Trends in Child Mortality, Report 2010 and 2011. WHO / UNICEF / UNPD / World Bank,

6. We know the why …

7. Malnutrition: a major contributing cause

8. We know when.. 75% of neonatal deaths occur in the first week Up to 50% of neonatal deaths occur in the first 24 hours Source: Levels and Trends in Child Mortality, UN-IGME Report 2011

9. Treatment interventions Neonatal resuscitation Extra care of LBW babies Treatment of neonatal sepsis ORT and zinc for diarrhoea Antibiotics for dysentery Antibiotics for pneumonia Anti-malarials Antiretroviral treatment Preventive interventions Skilled care at birth Postnatal care for all newborns Early initiation and exclusive breastfeeding for 6 months Complementary feeding Immunization Insecticide treated bed-nets Prevention of mother to child transmission of HIV Effective interventions are available …

10. But coverage is low… Pre-pregnancy  Pregnancy  Birth  Postnatal  Neonatal  Infancy  Childhood Median national coverage levels for 19 Countdown interventions and approaches, most recent estimate since 2000

11. And decreasing in many countries Source: Boschi-Pinto et al. JHPN 2009

12. Inequities are great Source: 42 countdown countries, survey data 2000-2009

13. The good news … Good news! 19 of 68 Countdown countries on track to achieve MDG4 17 countries have reduced child mortality by at least 50% 47 countries have accelerated progress since 2000

14. Good news! 5 Countdown countries are on track to achieve MDG 5 and 32 countries are making progress However, progress is insufficient especially in sub-Saharan Africa For every woman who dies there are 20 who suffer injuries, infection and disability The good news …

15. Driving progress:The continuum of care

16. And working together Maternal mortality Under-5 mortality Malaria in the World HIV Global burden

17. From research to action: community care 1. Cluster-RCT in 6 districts of central Ghana: Effect of home visits during pregnancy and postnatal period by CHW Preliminary results: moderate improvement in early and exclusive breastfeeding; mortality impact 8-14% but not statistically significant 2. Cluster-RCT in Hala, Pakistan: Effect of community-based interventions Results: 15% reduction in neonatal mortality, 21% reduction in stillbirths

18. From research to action: IMNCI 3. Cluster-RCT in one district in India to evaluate mortality impact of IMNCI Preliminary results: 18% reduction in IMR, 13% in NMR 4. Country-wide evaluation on mortality impact of IMCI implementation in Egypt Preliminary results: Annual rate of mortality decline 6.3% after IMCI implementation compared with 3.3% before IMCI

19. From research to action; Diarrhoea, Pneumonia and Fever 5. Cluster-RCT in Pakistan to evaluate community management of severe pneumonia Preliminary results: CHW can effectively treat severe pneumonia (chest indrawing) with oral amoxycillin 6. Multi-country RCT to evaluate short-course treatment for meningitis in children Preliminary results: 5-day treatment of meningitis is as effective as 10-day treatment 7. Cluster-RCT in India to evaluate effectiveness of zinc plus ORS for diarrhoea in infants aged less than 6 months Results: Zinc and ORS use for treatment of acute diarrhoea reduced prevalence of diarrhoea and pneumonia by about 40%

20. By 2015: Saving 16 million lives of women and children Preventing 33 million unwanted pregnancies Protecting 88 million children from stunting Protecting 120 million children from pneumonia The way forward

21. Key areas where action is urgently needed Support to country-led health plans Integrated delivery of quality health services and life-saving interventions Stronger health systems, with sufficient skilled health workers at their core Innovative approaches to financing, product development and the efficient delivery of health services Promoting human rights, equity and gender empowerment Improved monitoring and evaluation to ensure the accountability of all actors for resources and results

22. MNCAH CORE PACKAGES ALONG THE TWO CONTINUA OF CARE IT* = Implementation tool to be used as the primary delivery mechanism in countries Green font: Does not require an immediate update Blue font: Requires moderate work for update/merging Red font: Requires major work for update/development

23. All have a role to play Govt / Policy makers Parlia-mentarians UN agencies Women and children Health care workers Business community Academic /research institutions Donors Civil society

24. Commitments made 93 commitments made in 2010 amounting to over US$ 40 billion 39 Low-income countries; 21 NGOs; 15 high income countries; 14 foundations; 14 business community Many new commitments were announced at the Every Woman Every Child first –year anniversary. 29 Low-income countries; 4 high income countries; 12 UN and partnerships; 2 philanthropic institutions; 40 NGOs & civil society; 15 business community; 11 HCW and academic institutions Graphs of commitments: http://www.who.int/pmnch/topics/part_publications/2011_pmnch_report/en/index4.html

25. Accountability Commission established by UN Secretary General in Jan 2011 Co-chaired by President of Tanzania and Prime Minister of Canada Supported by 2 working groups: results and resources Commission's report released in May 2011 Ten recommendations to monitor results and track resources Unprecedented opportunity to strengthen national health information systems and to hold each other to account

26. Action can be taken now • Strengthen health systems and improve quality of health services • Bring health services closer to homes • Improve measurement and use of data

27. Together, we must do better