Transcript The Child Survival IMPACT Model: A quick start

Lives Saved Tool: Using LiST for Maternal,
Newborn, and Child Health Advocacy
Koki Agarwal, Director
Rebecca Levine, Program Officer
Maternal and Child Health Integrated Program
The Maternal and Child Health Integrated
Program (MCHIP)
•USAID Bureau for Global Health’s flagship maternal, newborn and
child health program
•Working in well over 30 countries worldwide
•MCHIP supports programming and opportunities for integration in:
• Maternal, Newborn and Child Health
•Immunization, Family Planning, Malaria, HIV/AIDS
•Wat/San, Urban Health, Health Systems Strengthening
Session Outline
•Advocacy Tools for Global Health
•Overview of Lives Saved Tool (LiST)
•Benefits & Limitations of LiST
•How LiST has been used for Global
Health Advocacy
•How MCHIP has used LiST for Advocacy
•Recommendations based on Experience
GLOBAL HEALTH
ADVOCACY TOOLS
What Tools Exist for
Global Health Advocacy?
• REDUCE
An advocacy model for reducing maternal mortality,
morbidity, and disability. Developed by the SARA Project.
 Safe Motherhood Model
A computer program to examine the impact of maternal
health services on the maternal mortality ratio
• ALIVE
An advocacy model for saving newborn lives
• Marginal Budgeting for Bottlenecking (MBB)
Aims at estimating the potential impact, resources needs,
costs and budgeting implications of country strategies to
remove implementation constraints of the health system.
WHAT IS THE
LIVES SAVED
TOOL?
The Lives Saved Tool - LiST
Goal of LiST
To promote evidence-based decision making
and aid in the planning for expansion of
maternal, neonatal and child health
interventions
Objectives
To estimate potential lives saved when
introducing or scaling up key MNCH
interventions
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The Lives Saved Tool - LiST
 The Lives Saved Tool
 A computer-based software that models multi-causes of
mortality
 Predicts changes in
 Under-five and neonatal mortality rates and deaths
 Maternal mortality ratios and deaths
 Causes of death
 Based on changes in health intervention coverage levels
 Using
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Country specific fertility and HIV information and trends
Country specific health status information
Effect sizes of interventions (based on RCT studies)
Baseline intervention coverage values (60+)
Which Interventions Are Included?
 Proximal factors
 Not distal (being equal)
 Work through health programs
 Not included: income, education and crowding, etc.
 Water and sanitation are the exceptions
 Feasible in a low income country
 68 priority countries with highest MNCH mortality
 Cause-specific evidence of effect
 Research studies or systematic reviews
 Delphi method if research is impossible (i.e. CEmOC)
 Updated as new evidence is published
 Several published International Journal of Epidemiology
(Apr 2010)
Intervention Types
 Maternal, neonatal, child
ex. AMTSL, Neonatal Resuscitation, Rotavirus vaccine
 Periconceptional, antenatal, birth, immediate
postnatal, child
ex. Folic acid supplementation, IPTp malaria, delivery care,
routine postnatal care, antimalarials
 Preventive, curative
ex. Vitamin A, Pneumonia case management
 Immediate, time-lagged
ex. ORS, breastfeeding
What’s NOT Calculated in LiST?
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Education
Motivation
Gender issues
Economic status
Emergencies (i.e. famine, flooding)
Delivery mechanism
Quality of care
What Information Can LiST Provide?
 Number of deaths
 Total, by cause, by age group
 Mortality rates/ratios (NMR, U5MR, MMR)
 Deaths averted (Lives Saved)
 Total, by cause, by intervention, by age group
 Intermediate outcomes
 Stunting, breastfeeding
 Displays (over a chosen period of time)
 Tables, graphs, pie charts
 Single country, multiple scenarios within one
country
 Multiple countries, single or multiple scenarios
Some Limitations of LiST
 Data availability
• If no baseline, can’t evaluate impact accurately
 Data quality
 User Friendliness
 Sensible scale up targets
• Feasible, acceptable, funds available
 Interventions included in software
 Costing/budgeting considerations*
* Links to existing costing tools including MBB and the WHO supported
costing tool for child survival are being developed
Using LiST for
Advocacy
The Lancet South Africa series –
August 2009
The Lancet, Volume 374, Issue 9692, Pages 835 - 846, 5 September 2009
NEONATAL
-Obstetric care packages
-Resuscitation
-Kangaroo mother care
-Facility case mx of neonatal
illness
12,200 lives
saved in
2015
PMTCT
37,000 lives
-Dual therapy
"We cannot allow a single…neonate
to die because of our saved in
feeding
negligence...it will be criminal for -Appropriate
us to allow any
of these things to happen. “
Minister of Health Dr Aaron Motsoaledi, South Africa
Source: Chopra M, Lawn et al Lancet 2009
2015
National situation analyses for
newborn health in Africa
National as well as sub-national analysis
e.g. 36 states in Nigeria, 3 regions in Mali, South Sudan
“Science in Action”
African Science Academies Development Initiative
http://www.nationalacademies.org/asadi/2009_Conference/PDFs/ScienceInActionFullReport.pdf
Coverage of skilled
attendance at birth
9 example countries
Total maternal, neonatal,
and child lives saved
Percentage reduction in
deaths with 90% coverage
<30%
Ethiopia
Northern
Nigeria
31-60%
>61%
Ghana, Kenya
Senegal,
Uganda,
Tanzania
Cameroon
South Africa
Southern
Nigeria
TOTAL
903,400
606,000
310,200
1,819,700
79%
90%
59%
78%
Country specific lives saved and cost for:
-
Births in facilities – achievable missed opportunities to save lives
Outreach or community interventions – achievable increases (20%)
For Ethiopia, Kenya, Nigeria, Uganda, Tanzania, Senegal, Cameroon, South Africa
MCHIP & LiST
How LiST is being used at MCHIP
 Strategic Planning for country workplans
 Which interventions are necessary to reduce
mortality? (maternal, neonatal, under-5)
 Based on feasible targets, what potential reduction
in mortality will our program have?
Can counteract current emphasis on one-sizefits-all intervention packages, by suggesting
which specific interventions are more likely to
have an impact in different contexts
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Helping to Reach MDG 4 in Zimbabwe:
Under 5 Mortality Rate
Zimbabwe Current Trend
Zimbabwe MCHIP Package
Zimbabwe 90% Maternal Health Coverage
Implementation
begins in 2010
Zimbabwe MDG 4 Target
Helping to Reach MDG 5 in Zimbabwe:
Maternal Mortality Ratio
Zimbabwe Current Trend
Zimbabwe MCHIP Package
Zimbabwe 90% Maternal Health Coverage
Zimbabwe MDG 5 Target
MDG Goal for Maternal Mortality
Decreased Child Deaths in Zimbabwe
How LiST is being used at MCHIP con’t
 Advocacy and Planning
Intervention
Most Recent
Survey
Target Coverage by
2015
Maternal Lives
Saved Cumulatively
2010-2015
Newborn Lives Saved
Cumulatively 20102015
0
100
70
2,000
4,000
24,000
4,000
24,000
MATERNAL & NEWBORN
Antenatal Care
47%
67%
Skilled Birth Attendance
44%
64%
Clean Practices & ENC (Home)*
3.9%
24%
Facility-Based Births
40.1%
60%
Essential Care for All Women &
Newborns**
20.1%
15%
BeMONC** (Essential Care +)
12.0%
9%
CeMONC** (Essential, BeMONC +)
8.0%
36%
Combined Maternal/Newborn
Interventions
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MCHIP Lessons
Learned
& Recommendations
What LiST Is, What LiST Isn’t
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Is
Multi-cause mortality model
Mathematic model
Models coverage impacts
Potential impact
assessment
National or sub-national
planning tool
Discussion points
Evidence-based
Effective advocacy tool
Isn’t
Truth
Probabilistic model
Natural history model
Detailed costing or
planning tool
 Bottlenecks, budgeting
 Exhaustive
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Food for Thought
Maternal Health Intervention Assumptions:
 Because of the much smaller numbers of
maternal deaths & the continuing work to
determine the impact that some interventions
have on maternal survival, LiST may not be the
best tool to weigh the relative value of different
investments in maternal survival
 MH interventions included in LiST are packages
that are only effective in reducing mortality if all
services are provided at quality
Food for Thought
 It is often just as important to show the impact
of scaling back interventions that already have
high coverage levels (ie. Lives LOST due to rollback in coverage)
 Particularly important for mature interventions
(i.e. Immunization, Vit A coverage)
 We do not want projections to inadvertently
make the case for decreasing funding/coverage
for these interventions
Thank you!
wwww.mchip.net
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