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On behalf of the Study Group for the GlobalInvestment Framework for Women’s and Children’s Health

A new Global Investment Framework for Women’s and Children’s Health

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� Recommendation by independent Expert Review Group

� An opportunity to bring various RMNCH initiatives together

Why an investment framework?

Family Planning 2020

Global action plan for

prevention and control

of pneumonia (GAPP)

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� Estimating the effects of investment on RMNCH across the continuum of care, including e.g., family planning, and stillbirths;

� Extending the time-frame to 2035;

� In addition to cost and impact, analyzing the economic and social returns on investment.

What is new?

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Conceptual framework

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* South Sudan excluded due to data limitations

75 Countdown to 2015 countriesAccounting for > 95% of maternal and child deaths worldwide

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Six packages with 50 interventions for which health outcomes can be modeled

1. Modern family planning methods

2. Maternal and newborn Health

3. Malaria

4. HIV/AIDS

5. Immunization

6. Child healthPMNCH, WHO, Aga Khan University (2011)

The analysis does not include water supply, sanitation and hygiene,

girls’ education, gender empowerment, and food fortification.

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Shifting gear to accelerate progress…

Intervention Coverage (%), 74 Countdown countries, 3 scenarios

0

20

40

60

80

100

Post-abortion

case management

Skilled care

at birth

Pneumococcal vaccine Pediatric

ART

Oral Rehydration

Therapy - ORS

Current (2012) coverage maintained (LOW )Historic trends of coverage increases (since 1990) continue at current rates (MEDIUM )Accelerated scale-up (HIGH)

Some examples:

Note: pneumococcal vaccine predictions for Medium and High are based on GAVI forecasts.

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Shifting gear to accelerate progress…

Intervention Coverage (%), 74 Countdown countries, 3 scenarios

Some examples:

30

40

50

60

70

80

90

100

2013 2018 2023 2028 203330

40

50

60

70

80

90

100

2013 2018 2023 2028 2033

Skilled Birth

Assistance

during labor

Pneumonia

treatment in

children 0-4

years

Oral

Rehydration

Therapy with

ORS in children

0-4 years

Historic trends of coverage increases

continue (MEDIUM)Accelerated scale-up (HIGH)

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…would bring significant reductions in child mortality

Average under-five mortality rate (74 countries)

Deaths in children under five years of age per 1,000 live births

Current coverage

maintained (LOW)

Historic trends of

coverage increase

continue (MEDIUM)

Accelerated

scale-up (HIGH)

0

10

20

30

40

50

60

70

80

90

100

2010 2015 2020 2025 2030 2035

U5

MR

The HIGH scenario would prevent (2013-2035):

• Close to 150 million child deaths, of which 60 million newborn deaths

• More than 32 million stillbirths

By 2035:

there would be 110 million fewer children with

stunting and 36 million fewer children with wasting

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…and maternal mortality

Average maternal mortality ratio (74 countries)

Deaths per 100 000 live births

0

100

200

300

400

2010 2015 2020 2025 2030 2035

MM

R

Current coverage

maintained (LOW)

Historic trends of

coverage increase

continue (MEDIUM)

Accelerated

scale-up (HIGH)

The HIGH scenario would prevent (2013-2035):

• More than 5.3 million maternal deaths

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Investments in family planning contribute significantly to overall reduction in mortality

Reducing unintended pregnancies through

increasing access to contraceptives* would avert

54% of total preventable** maternal deaths

and 47% of preventable** child deaths

* Family planning through contraceptive use increases based on “best performer” trends, with the rate of growth restricted to a maximum

of 3% per year. The scale-up stops when TFR reaches 2.1 or CPR reaches 85%. ** in our model, high compared to low scenario

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-

1

2

3

4

5

6

12 Upper middle /high

income

27 Lower middle income 35 Low income

Interventions

RMNCH programme

management costs

Health systems

strengthening

Investment is substantial but affordable

An additional average US$ 30 billion /year, equivalent to US$ 5/ capita /year

(average 74 countries)*

Pe

r ca

pit

a e

stim

ate

s in

US

$ (

20

11

)

HIG

H c

om

pa

red

to

LO

W s

cen

ari

o

in y

ea

r 2

03

5

6 bn in

LICs

(26%)

15 bn in

LMICs

(47%)

9 bn in

HMICs

(28%)

* All costs expressed in 2011 US$

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Investment needs differ across countries

0

5

10

15

20

25

30

35

2013 2018 2023 2028 2033

Interventions

RMNCH programme management

costs including adolescents and

cash transfers

Health systems

Costs of HIGH scenario relative to LOW, US$ (2011) billion

0

1

2

3

4

5

6

Sub Saharan Africa South Asia

Maternal and

Newborn

Child Health

Family Planning

Immunization

HIV

Malaria

Est. additional cost in 2035, by region, 6 packages, US$ bn

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There are strong economic and social benefits

Benefits (by type) and cost of interventions, share of GDP (%), to 2035: high scenario

relative to low scenario; 74 countries total.

Benefits exceed

costs by a factor

approaching

9:1 by 2035:

> 30:1 by 2070

Economic benefits

Costs

Social benefits

0.00

0.25

0.50

0.75

1.00

1.25

20

13

20

15

20

20

20

25

20

30

20

35

Cost of interventions Economic benefits Social benefits

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These benefits derive from lives saved, morbidity averted and the demographic dividend from reducing

unwanted pregnancies

Benefits (by source) and cost of interventions, share of GDP (%), to 2035: high scenario relative to

low scenario; 74 countries total.

Demographic dividend

Lives saved

Morbidity avertedCosts

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

20

13

20

15

20

20

20

25

20

30

20

35

% o

f G

DP

Cost of interventions Lives saved Morbidity averted Demographic dividend

Benefits exceed costs

by a factor

approaching

9:1 by 2035:

> 30:1 by 2070

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Making a strong investment case at country level

The investment framework can serve as a guide to countries to optimize

investments in women's and children's health over the next two decades

WHO and partners provide technical support to countries for the development of

national strategies, policies and plans that identify high impact interventions to

improve women’s and children’s health, as part of sector wide health plans.

Countries are supported to use the OneHealth Tool for linking national health

plans to impact estimates, a resource envelope and a budget.

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The costs are affordable. The returns are high. The time is now.