Committing to Child Survival - A Promise Renewed - ending - PowerPoint PPT Presentation

Committing to Child Survival - A Promise Renewed - ending preventable child deaths Addis Ababa, 16 January 2013 Dr. Mickey Chopra, Associate Director Health, UNICEF

Key Messages • Globally and in Africa we are making progress • However for too many women and children and some conditions progress is too slow • The ambition of A Promise Renewed for Africa • The immediate challenges for accelerating progress

The global burden of under-five deaths has fallen steadily since 1990 Global number of under-five deaths, selected years 14 12.0 12 10.8 Millions of under-five deaths 9.6 10 8.2 8 6.9 6 4 2 0 1990 1995 2000 2005 2011 Source: The UN Inter-agency Group for Child Mortality Estimation, 2012; provided by SMS/DPS/UNICEF

The global under-five mortality rate has fallen by 41% from 1990 to 2011 Under-five and neonatal mortality rate, 1990-2010 100 U5MR 87 90 NMR 80 Deaths per 1,000 live births 70 60 51 50 40 30 MDG Target: 29 32 20 22 10 0 1990 1995 2000 2005 2010 2015 Source: The UN Inter-agency Group for Child Mortality Estimation, 2012; provided by SMS/DPS/UNICEF

Global Progress for child survival U5MR and NMR decline 1990-2010, projected to 2035 Current U5MR ARR = 2.2% Accelerated U5MR ARR = 5.1% 80 Mortality Rate (deaths / 1000 births) Current NMR ARR = 1.8% 60 40 35 MDG 4 target = 34 U5MR 20 20 15 0 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 If 1-59 month mortality accelerates further but neonatal Source: UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011; * ARR = annual rate of reduction UNICEF, Required Acceleration for Child Mortality Reduction beyond 2015, 2012; team analysis mortality continues on same trend then with Save the Children team analysis for NMR projection 2 million child deaths in 2035, 1.5 million may be neonatal.

All regions have experienced marked declines in under-five mortality rates since 1990 Deaths per 1,000 live births Source: IGME 2012

The global burden of under-five deaths is increasingly concentrated in Sub-Saharan Africa Share of under-five deaths, by region, 1990-2010 (%) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1990 1995 2000 2005 2010 Sub-Saharan Africa South Asia East Asia and Pacific Middle East and North Africa Latin America and Caribbean CEE/CIS Industrialized countries Source: IGME 2011

In 2011, for the first time, the 20 countries with the highest under child mortality rates are all in Africa. There is a strong correlation between conflict, ‘fragile situations’ and child mortality rates. 1) Sierra Leone (185 per 1000 live births) 11) Cameroon 2) Somalia 12) Guinea 3) Mali 13) Niger 4) Chad 14) Nigeria 5) Democratic Republic of the Congo 15) South Sudan 6) Central African Republic 16) Equatorial Guinea 7) Guinea-Bissau 17) Mauritania 8) Angola 18) Togo 9) Burkina Faso 19) Benin 10) Burundi 20) Swaziland (104 per 1000 live births) Source for mortality rank: UN Inter-agency Group for Child Mortality Estimation 2012; Fragile Situation countries are shown in red (source: World Bank 2011) 8

Top 10 countries in Africa with the largest reductions in child mortality, 2000-2011 Ran Country Annual rate of reduction k (%) 1. Senegal 6.4% 2. Malawi 6.2% 3. Zambia 5.6% 4. Ethiopia 5.3% 5. Namibia 5.2% 6. Niger 5.0% 7. Morocco 4.3% 8. Zimbabwe 4.1% 9. Kenya 4.0% 10. Nigeria 3.8%

170 Governments Pledged to date Including 48 of the 54 countries in Africa plus hundreds of • Civil Society organisations, Faith Based organisations, Individuals, schools and workplaces • Focus on results and accountability • But also an important technical component www.apromiserenewed.org

20 by 2035: selected country U5MR trajectories 280 Mali continuation of 2000-2010 trend 260 Mali to reach 20 by 2035 Democratic Republic of the Congo 240 Côte d'Ivoire Under-five mortality rate (deaths per 1,000 live births) Lesotho 220 India Indonesia 200 Peru 180 160 140 120 100 80 60 40 20 0 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

Changing How We Do It: Supply and demand bottlenecks for most / least deprived areas analyzed Demand Bottlenecks Supply Bottlenecks (esp. Financial access) in > 20% difference in availability and most deprived but least 100% accessibility to facilities with SBA deprived tend to use even more than what is available 75% 50% 25% 0% COMMODITIES: % HUMAN RES: % ACCESS: % families UTILISATION: % CONTINUITY: % EFFECTIVE COV: % of health centres with facilities with living near health deliveries assisted by deliveries with i) SBA SBA deliveries occur no perinatal supply sufficient workers facility with daily trained worker ii) weighed & iii) within a ANC- stock-outs service provision receive 3 postnatal qualified health care visits facility Most Deprived Least deprived

Major bottlenecks to achieving results • Decentralization & Low capacity: weak supervision, management, QA and motivation • Major barriers to access : poor enforcement of pro-poor cash transfers and fee-waivers • Incomplete uptake of life-saving interventions: e.g. zinc for diarrhea • Ineffective resource management: especially in decentralized settings • Structural barriers : economic, political, socio-cultural

Shift New Improve existing delivery or channel within technology performance channel approach Potential Shift intervention Shift intervention to Improve performance of approach within channel different delivery channel delivery channel Change way of delivering Improve efficiency, capacity and Deliver the intervention through a Description interventions within existing accessibility of delivery channel better performing channel channels Human resources availability: Task shifting among different Task shifting from clinic-based to Possible Compulsory service, Hardship cadres of workers community-based strategies allowances, retention of HR in Improving outreach services Shifting interventions from clinic- rural settings… (including specialist outreach) based to child health campaigns Geographic access: Shifting to different sets of Shifting behaviour change Increase number of service points providers through public-private counselling from face to face to Financial access: partnerships, contracting out, or social marketing or implementing User fee abolitions, Insurance franchising policy changes schemes, Conditional cash transfers, Vouchers Continuity: PBI, remuneration (salaries) Defaulter tracking Quality: Supervision/mentoring, training, audits, accreditation… Demand: Community/individual empowerment, social marketing…

THANK YOU ! 16