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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.

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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

promises
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)
a great challenge
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

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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,

we know when
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

effective interventions are available
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 …
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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

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And decreasing in many countries

Source: Boschi-Pinto et al. JHPN 2009

inequities are great
Inequities are great

Source: 42 countdown countries, survey data 2000-2009

the good news
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

slide14

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 …

and working together
And working together

Maternal mortality

Under-5 mortality

Malaria in the World

HIV Global burden

from research to action community care
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

from research to action imnci
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

from research to action diarrhoea pneumonia and fever
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%

the way forward
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
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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

mncah core packages along the two continua of care
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

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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

commitments made
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

accountability
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

action can be taken now
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