Countdown to 2015: Data for action and accountability

Dr. Joy Lawn MB BS MRCP (Paeds) MPH PhD

Saving Newborn Lives/Save the Children On behalf of the Countdown Coordinating Committee

Kampala, March 26th 2012 News!

Who is Countdown?

A global movement since 2005 of 1. Individuals: Scientists & academics, policymakers, public

health workers, communications experts, teachers…

2. Governments: RMNCH policymakers, Parliamentarians…

3. Organizations: NGOs, UN agencies, HCPAs, donors, medical journals…

Linked to Global strategy for Women and Children and Commission on Information and Accountability

And from countries

What does Countdown do? Track progress For maternal, newborn & child health

In the 75 highest burden countries

Analyze and disseminate data on country progress

Advocate at national and international level

Accountability for action, highlighting gaps,

• Coverage and quality of care with detailed equity analyses

• Financial inputs by donors for MNCH

• Policies and health system strength

• Data Country Countdowns in Zambia, Senegal, Nigeria and others interested

Reports & media materials Country Profiles Publications From Technical Working Groups

And from countries

4

Subnational profiles

COUNTDOWN 2012 report

Country profiles using the latest data Commission on Information and Accountability profiles

Mortality, MDG 4 & 5

Coverage

Nutrition Equity

Country progress in reducing maternal mortality (MDG5)

6

32

20

8 0

10

20

30

40

On Track Making progress

Insufficient progress

No progress

Num

ber o

f Cou

ntdo

wn

Cou

ntrie

s (n

=73)

18 are African countries

Countdown to 2015 report March 2012, Figure 1

Bolivia China Egypt Eq Guinea Eritrea Vietnam

All African countries

Country progress in reducing under-five mortality (MDG4)

24

37

18

0

10

20

30

40

On Track Insufficient progress

No progress

Num

ber o

f Cou

ntdo

wn

Cou

ntrie

s (n

=74)

African Countries Eritrea Liberia Madagascar Malawi

Countdown to 2015 report March 2012, Figure 1

All are African countries

28 are African countries

57

29

23

0

10

20

30

40

50

60

70

80

90

100

1990 1995 2000 2005 2009 2015

Mor

talit

y pe

r 100

0 liv

e bi

rths

Year

Under-five mortality rate (UN) Under-five mortality rate (IHME)

Neonatal mortality rate (UN) Neonatal mortality rate (IHME)

MDG 4 target

Ref: Lawn J et al A decade of change for Newborn survival: multi country analysis. Health Policy and Planning Data sources: U5MR (UN): www.childinfo.org / www.childmortality.org and NMR (UN): Oestergaard et al 2011 PLoS updated for 2010

3.1 million neonatal deaths, 40% of all under-five deaths

Global Progress to MDG 4 for child survival

REGION

Neonatal mortality rate Average annual change 1990-2010

Africa < 1% Eastern Mediterranean 1.5% Southeast Asia 2.2% Western Pacific 3.3% Americas 3.4% Europe 3.5%

Global average annual rate reduction Maternal mortality ratio aARC = 2.3%

1- 59 month mortality rate aARC = 2.5% Neonatal mortality rate aARC = 1.8%

All 3 measures show increased progress since 2000

Source: Lawn J, Kinney M, Oestergaard M et al new analysis using WHO/UN time series data 1990-2010. Journal submission to HPP for 2012. Data sources: Oestergaard et al 2011 PLoS, UNICEF 2011 www.childinfo.org

Data source: Oestergaard et al 2011 PLoS

Africa 2165 Eastern

Mediterranean South-East Asia Americas

Number of years to reduce neonatal mortality to the current rate in high income countries (<5 per 1000)

Variation between regions and between countries WHY??

Not all countries are the same Malawi is on track for MDG 4

Source: Zimba E et al Malawi: a decade of change, HPP in press Data U5MR from UNICEF www.childmortality.org and Lozano et al Lancet 20101 NMR from Oestergaard et al 2011 PLoS , Malawi DHS 1999, 2000, 2004, 2010 and MICS 2006. MDG 4 target from Countdown to 2015, decade report -- 2/3 reduction from 1990 U5MR

104 73

113

30 31

0

50

100

150

200

250

1990 1995 2000 2005 2010 2015

Mor

talit

y pe

r 100

0 liv

e bi

rths

Year

Under-five mortality rate (UN) Under-five mortality rate (IHME) Under -five mortality rate (DHS/MICS) Neonatal mortality rate (UN) Neonatal mortality rate (IHME) Neonatal mortality rate (DHS/MICS)

MDG 4 target

NMR reducing at 2% per year, double the regional average Only 5 national paediatricians!

More in upcoming journal supplement Decade of Change for Newborn Survival

Global causes of child death for 2010

Number 1 Pneumonia

Number 2 Preterm birth

EMBARGO – NEW UN ESTIMATES BY CHERG, BLACK RE et al

Preterm birth

Born too soon:

A global action report on preterm birth

National estimates of preterm rate (first ever), analysis, policy

and program actions, parent perspectives.

Multiple organisations involved to mobilise change. Linked to Every Women Every Child

Launch in early May 2012 at UN

Preterm birth estimates paper

Coverage Across the Continuum of Care

0

20

40

60

80

100

Demand for FP satisfied

Antenatal care

(4+ visits)

Skilled attendant

at birth

Postnatal care for mother

Postnatal care for

baby

Exclusive breast-feeding

DTP3 vaccine

AB tx for pneumonia

Countdown to 2015 report March 2012, Figure 4 Coverage levels for selected Commission indicators of intervention coverage, median and range for priority countries with data available, 2006-2010.

Med

ian

cove

rage

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Around 1995 Around 2005 2015 projection

CEE/CIS

East Asia and Pacific

Latin America and Caribbean

Middle East and North Africa

Developing countries

Sub-Saharan Africa

South Asia

Data: UNICEF 2007 (www.childinfo.org) based on a subset of 80 countries with trend data Ref: Lawn JE et al IJGO 2009

Previously highlighted slow progress in trends for births with skilled health personnel

(1995 to 2008 with projections to 2015)

By 2008 only 13 of 68 Countdown countries had increased skilled attendance by >10% in the last 20 years

Rapid change now in many countries

Changes in skilled birth attendance for Malawi, 1990-2010

Source: Malawi DHS 1992, 2000, 2004, preliminary 2010. Malawi MICS 2006

55

73

0

10

20

30

40

50

60

70

80

90

100

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Cov

erag

e (%

)

Increased by 16% over the last 5 years Multiple approaches both supply and demand > 30% increase in numbers of nurse/midwives

Save

the

Child

ren

Facility births – coverage progress but quality gap

Over half of the world’s births are in facilities Increasing rapidly in some countries

HOW TO CLOSE THE QUALITY GAP? Eg only 1 in 5 babies born in African hospitals meet an attendant with skills and

equipment for neonatal resuscitation

Evidence base Increasing with trials mainly from Asia, Cochrane review

Policy change Recent survey by WHO – 24 of 75 priority countries have a policy for mother and newborn home visits

Still gap in coverage on continuum of care, and also a data gap And many implementation research questions especially in Africa

Pregnancy and Postnatal Home Visits

Lancet paper of the year 2009

2009 Joint Statement by WHO and UNICEF, co-signatories of Save the Children and USAID

0

1000

2000

3000

4000

5000

6000

2003 2005 2007

Mill

ions

USD

(con

stan

t 200

8)

Child donor projects

mentioning newborn

Maternal donor project mentioning

newborn

MNCH donor projects exclusively benefiting newborn

Child health projects

Maternal health projects

Donor aid for MCH or MNCH? 68 Countdown priority countries 2003-2008 (constant 2008 US$)

EMBARGO - Catherine Pitt, Joy Lawn et al please do not use or cite

© Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan). Used with permission

Stillbirths Neonatal deaths

Maternal deaths

Neonatal mortality and stillbirth are closely linked to women’s health and becoming more aligned

can advance this message and dialogue

Prioritise the highest burden geographies

PEOPLE GAP… how to deliver solutions Physician density in Countries

© Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan). Used with permission

Need urgent scale up of skilled workers AND human resource innovation Most focus is on doctors and midwives Also need neonatal nurses ...and CHWS

Priority for PEOPLE

ADVOCATE Be a voice for women, newborns, and children • Use data – recent as it changes every year now! • Focus on high impact interventions, and reaching the poorest • Increase capacity for data driven, context specific decision

making • Intentional country partnerships and networks

ACCOUNTABILITY • Accountability for governments commitments • Consider having a Countdown in your country

What can we do?

We are the first generation with tools, funding and opportunities to transform global maternal, newborn

and child survival – will we deliver?

More information

PMNCH Essential interventions

Upcoming Full Countdown report 2012 – DUE JUNE Global action report preterm birth

Lancet Stillbirth series 2011 www.lancet/series/stillbirth/

Visit www.countdown2015mnch.org

Thank you !

Born too soon:

A global action report on preterm birth