Transcript Document

Countdown to 2015
Roots of the Second
Child Survival Revolution
London, December 2005
Cesar Victora
Federal University of Pelotas, Brazil
Bellagio Child Survival Study Group
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The Child Survival Revolution
• New UNICEF leadership: Jim Grant
• 1982: Child Survival Revolution
• Focused on 4 interventions:
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Growth monitoring
Oral rehydration
Breastfeeding
Immunisation
• 1990: World Summit for Children
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% children with 3 doses of DPT
Global coverage of DPT3 vaccine
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
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Source: Bryce et al, Lancet 2003
Deaths by selected causes, 2003
Under-five
AIDS
Tuberculosis
Malaria
Maternal
Tropical, non-malaria
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4
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Annual deaths (millions)
Source: WHO, 2003
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Global R&D investments per DALY
• Global average (all diseases):
US$73
• HIV/AIDS, malaria and TB:
US$8.4
• Acute respiratory infections:
US$0.51
• Diarrhea:
US$0.32
Source: Global Forum for Health Research, 2004
Source: GFHR 2004
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The Lancet Child Survival Series
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Where do over 10 million
children die every year?
Leading causes
•Neonatal
•Diarrhoea
•Pneumonia
•Malaria
•Undernutrition
Source: Black, Morris, Bryce, Lancet 2003
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Low-cost interventions
can save many lives
CURRENT COVERAGE
15%
13%
39%
20%
7%
17%
1040%
2%
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Source: Jones et al, Lancet 2003
Can health systems deliver?
• 6 million lives could be saved every
year by simple, cost-effective
interventions
• But scaling up may be difficult
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Weak health systems
Lack of trained human resources
Inadequate care seeking and low utilization
Hard to reach those who need most
• Inappropriate delivery channels
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Source: Bryce et al, Lancet 2003
The gap between the rich
and the poor is widening
• Children born in SubSaharan Africa are
29 times more likely
to die by the age of 5
years than those
from developed
countries
– In 1990 this ratio was
equal to 20 times
• 40% of under-five
deaths would be
prevented by
eliminating
socioeconomic
differentials within
low and middleincome countries
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Source: Victora et al, Lancet 2003
Paper 5 – Call to action
• The Child Survival
Revolution of the 1980’s
saved millions of child lives
• Child deaths outnumber
HIV, malaria and
tuberculosis deaths
combined.
• Child survival has fallen off
the international agenda
• Funding for child survival
is decreasing in relative
terms; and for some
donors in absolute terms
• Cost-effective
interventions could prevent
6 million (63%) child
deaths if they reached all
mothers and children
• We now need a Second
Child Survival revolution to
complete this unfinished
agenda
• Need for global leadership
• Rolling Conference every
2 years
Source: Bellagio Group, Lancet 2003
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What has happened since 2003?
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Progress in child survival advocacy
• UNICEF names top 5 concerns for children in
2004
January 8, 2004
UNICEF to focus on child survival
www.BLACKBRITAIN.com
UNICEF Executive Director Ms. Carol Bellamy stated that
there is “...a global imperative to do more for children in
2004.”
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The Lancet
Neonatal Survival Series
Paper 1: 4 million deaths: When? Where?
Why?
Paper 2: What interventions work? How many
babies can we save?
Paper 3: How can we scale up newborn care in
countries?
Paper 4: The cost and proposed actions
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Lancet Health Systems Series
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Equity
Financing
Human Resources
Scaling up
Health systems
research priorities
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Millennium Project Task Force
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Health systems
Financing
Human Resources
Sexual/reproductive
health and rights
Child mortality
Maternal mortality
Global mechanisms
Information systems
Targets and indicators
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The World Health Report 2005
• The situation in 2005
• Programme strategies
• System and policy
implications
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Growing concern about
maternal mortality
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The Lancet series: two years later
• Renewed interest in child survival
• Launch of the Partnership for Maternal,
Newborn and Child Health
• But so far, little evidence of increased
investments at country level
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Countdown, Day 1
1. The second child survival revolution
2. Make every mother and child count
3. Making progress at country level (Senegal, Nepal,
Tanzania, Pakistan, Zambia, Bolivia)
4. Debate: Are we doing the right things?
Are we doing things right?
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Countdown, Day 2
5. Tracking progress in child survival (monitoring, finances,
human resources, equity)
6. New strategic directions in child survival (evaluation, new
interventions, research)
7. What needs to be done? (price tag, action plan, role of the
media, accountability)
8. The Partnership for Maternal, Neonatal and Child
Survival
9. Going to action for child survival
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Paper 5, Child Survival Series
• … we commit ourselves to ensuring that there is an
overall mechanism for improving accountability, reenergizing commitment, and recognizing
accomplishments in child survival.
• … this proposal for rolling conferences is not enough,
but it is a long-term commitment to change and
improve the state of child health.
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