What’s happened since the Child Survival Call to Action? (policy review and a little background, too)

CORE Group Spring MeetingApril 26, 2013

Recall the Child Survival Call to Action in June 2012…• Joint effort by Ethiopia,

India, USAID and UNICEF

• Countries signed on to commit to acclerating reductions in child mortality

• Presentations from the countries with the highest burden of under-five mortality, including presentation of new national plans

• A lot of momentum - A Promise Renewed has spawned major follow-up events in India, Ethopia (regional), others

There have been many new MCH data, estimates, policy documents since June 2012…

• Geography – numbers, severity, focus, graduation

• Equity – vulnerable/lagging (sub-)populations

• High-impact interventions – bottlenecks, research

• Connections to broader context – “environment”, “empowerment”, etc.

• Accountability – country level, global level, for/to ourselves and each other

Focus issues for the Call to Action

4

Under-five deaths 1990-2070 (actual and projected)

Current trajectory: ARR 2.5%• MDG 4 achieved in 2035• 4 million deaths annually in

2035ARR 12.6%• Achieve MDG 4 • Reach 2 million child

deaths annually in 2020• Achieve average of

U5MR 15/1000 by 2020

ARR 5.2% • 2 million deaths annually by 2035 • Every country reaches 20/1000 by

2035• Many countries below 15/1000 by

then

AchieveMDG 4

Under-5 deaths millions

9.6 mm deaths in 2000

7.6 mm deaths in

2010

13

12

11

10

9

8

7

6

5

4

3

2

0

1

Recall the key Child Survival Call to Action message – bend the curve to reach MDG targets and accelerate progress on child survival

Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035

“Sharpening plans”

• Understand structure of mortality, epidemiology, and most vulnerable populations

• Use evidence-based models (e.g. LiST) with current and projected/aspirational coverage levels to determine possible intervention strategies to effect desired change in mortality and epidemiology

• Understand the systems bottlenecks to achieving those changes• Develop a costed and prioritized investment strategy to address

the bottlenecks, change the outcomes, and reduce mortality• Ensure that a system of accountability (e.g. scorecard) is

established to track progress and make ongoing adjustments (i.e. further "sharpening')

We have an inclusive and expansive understanding of what it takes to end preventable child deaths

7

Prevention and Treatment of Infectious diseases• Pneumonia• Diarrhea• Malaria• AIDS/PMTCT

Child survival

Family planning

Neonatal causes

• Preterm birth complications

• Intra-partum events• Neonatal infections

Nutrition

Enabling Environment▪ Education▪ Empowerment of

women▪ Economic growth▪ Environmental factors

(e.g. water supply, sanitation, hygiene)

Immunization Maternal health

Diverse global initiatives contribute to the goal of ending preventable child deaths

• FP2020 – ongoing

• Follow-up to the UN Commission on Life-Saving Commodities – ongoing

• Global Action Plan for Pneumonia and Diarrhoea (GAPPD) – just launched in Geneva, London, and Washington

• Global Vaccine Summit – Abu Dhabi, April 2013

• Nutrition for Growth – London, June 2013

Family Planning Summit Born too soon A Promise Renewed

Country leadership & Implementation

Decade of Vaccines

Innovation Working Group

Key advocacy events and catalytic initiatives in support of Every Woman Every Child

Commission on Live-saving Commodities

CoIA independent Expert Review Group

Need to Strengthen Global and National Leadership

APR Country activities:launch events, refining strategies, building scorecards (highlights)

• Nigeria: Saving One Million Lives was launched in October 2012. GON moving forward in mobilizing States on key actions.

• Ethiopia: Mobilized 22 countries at a regional event in January. Ethiopia itself has been central to scorecarding and accountability efforts in the region, and the Federal Ministry of Health has launched a community-based newborn care implementation plan.

• India: National Call to Action for Child Survival and Development launched in February, including a focus on eight high-priority States. Ministry of Health and Family Welfare (MOHFW) to launch a "1000 day campaign" from May/June 2013 - end 2015 to establish a plan to scale-up Reproductive, Maternal, Newborn and Child Health services nationally.

• DR Congo: Acceleration Plan under development. Strong MoH interest in launch, possible May timeframe.• Zambia: APR Country Launch with First Lady April 11• Senegal: MOH mobilized all donors/stakeholders to develop sharpened, costed plan that integrates major

initiatives. Will host regional meeting with UNCoLSC “pathfinder” countries in late-June• Bangladesh: working on an Action Plan and APR benchmarks for a press event with the Minister of Health• Liberia: Strong push for community mobilization supporting 9 key child health messages to district level.

Planned April APR postponed.• Malawi: UNICEF/USAID collaboration underway and launch with parliament and civil society planned for

August 2013. Strong focus on aligning key initiatives to support results.• LAC regional event – Panama hosting, late 2013

Global Causes of Child Deaths, 2010

Source: CHERG, 2012

USAID MCH funding increasingly focused on 24 MCH “priority” countries responsible for 75% of

maternal and child mortality

150 +100-149

40-9920-39

U5M Rate (per 1000 live births):

10-19

MDG 4 Assessment of Progress for 24 priority countries: Under-Five Mortality Rate Average

Annual Rate of Reduction(%) 1990-2011

0.0 1.0 2.0 3.0 4.0 5.0 6.0

DR Congo; 0.4Kenya; 1.4

Sudan, 1.7

Mali; 1.8

Ghana; 2.1

Yemen; 2.4

Pakistan; 2.5

Nigeria; 2.6

India; 3.0

Afghanistan; 3.1

Uganda; 3.3

Haiti; 3.4

Senegal; 3.5

Mozambique; 3.7

Tanzania, 4.0

Zambia, 4.0

Ethiopia, 4.5

Indonesia, 4.5

Madagascar; 4.6

Malawi; 4.8

Nepal; 4.9

Rwanda; 5.1

Bangladesh; 5.3

Liberia; 5.4

On Track

Insufficient Progress

4.3% (on target)

Little/No Progress

Source: Level and Trends in Child Mortality Report 2012

Regional Causes of Child Deaths, 2010: Sub-Saharan Africa and South/East Asia

Africa: 3.6 million deaths Asia: 2.1 million deaths

Source: CHERG, 2012

Reducing deaths from pneumonia and diarrhea will be critical to end preventable child deaths, especially in countries with higher under-five

mortality rates.

GAPPD: By 2025, <3 deaths /1000 live births from child pneumonia, <1/1000 diarrhea deaths

Under-5 mortality rate (per 1000) versus percentage of under-5 deaths attributed to pneumonia and diarrhoea in 2010

Source: WHO/UNICEF/UNFPA/World Bank. Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. Geneva, World Health Organization, 2012.

FY 2002 FY 2008 FY 2012$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

24 USAID Priority Countries, 27%

24 USAID Priority Countries, 55%

24 USAID Priority Countries, 61%

24 Non-Priority Countries, 31%

24 Non-Priority Countries, 18%

24 Non-Priority Countries, 10%

Centrally Managed, 28%

Centrally Managed, 15%

Centrally Managed, 12%

GAVI, 14%

GAVI, 12%

GAVI, 17%

USAID Maternal and Child Health

$ in

mill

ion

Accounts: GHP/USAID, AEECA, and ESF

$391.7 Million

$773.4 Million

$577.3 Million

MCH funds have been increasingly strategically focused….

Under-Five Child Mortality in Lowest and Highest Wealth Quintiles -USAID MCH priority countries, 2004-2009

149.9

97.390.291.5

40.530.5

0

20

40

60

80

100

120

140

160

Africa Asia & Middle East Latin & AmericaCaribbean

De

ath

s P

er

10

00

Liv

e B

irth

s Lowest Quintile Highest Quintile

Source: U5MR: Demographic and Health Survey Statcompiler, latest available data. Data older than 2004 include Mozambique 2003. Data by wealth quintile are not available for Afghanistan, Angola, Sudan and Yemen.

Substantial inequity in child survival exists in all regions

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Problems in measuring change on an annual basis…

Take-aways…

• Setting priorities is critical – geography, target populations, interventions

• Using a systematic evidence-based process is critical to setting priorities

• There has been lots of country action since June 2012• There is a need for better coordination at the

international and national levels• Decreasing inequity in outcomes and impact needs

continued attention• Accountabilty/”Scorecards” very important but

mortality measurement in “near real time” is problematic