Transcript Contributing to reaching the Millennium Development Goals and the Goals of the World Fit for Children: Health and Nutrition in UNICEF's Mid-Term Strategic Plan 2002-2005 Inter-Agency.

Contributing to reaching the
Millennium Development Goals
and the Goals of the World Fit for
Children: Health and Nutrition in
UNICEF's Mid-Term Strategic
Plan 2002-2005
Inter-Agency Working Group on
Community IMCI,
Geneva, 3 September 2002
Under-five mortality rate, change over period 1990-2000
200
1990
2000
181
U5MR (deaths per 1000 births)
180
175
Least
reduction
3%
160
140
128
120
100
100
Greatest
reduction
32%
80
80
64
58
60
53
45
44
37
40
38
20
9
6
0
Sub-Saharan
Africa
Source: UNICEF, 2001
South Asia
Middle East &
North Africa
East Asia and
Pacific
Latin America
& Caribbean
CEE/CIS and
Baltics
Industrialized
countries
U5MR disparity by asset quintile
Most deaths occur at home,
before reaching health facilities
… Implications for
programming?
Under-five mortality rate (per 1000 births)
300
250
Bangladesh
U5MR
200
150
100
50
0
1960
1965
1970
1975
1980
1985
1990
1995
Year
CPSi86
DHSi93
HDSi94
DHSd96
FSd89
SRS
DHSd93
DHSd99
Est
2000
Immunization 1980-1999
DPT3 coverage
Immunization 1980-1999,
DPT3 coverage
100%
90%
80%
74%
73%
70%
60%
51%
50%
40% 37%
30%
20%
10%
0%
1980
1985
1990
Sub-Saharan Africa
Latin America & Caribbean
1995
South Asia
East Asia and Pacific
Source: Revised global coverage estimates based on joint UNICEF/WHO review
1999
150 MILLION CHILDREN IN DEVELOPING
COUNTRIES ARE STILL MALNOURISHED*
More than half of underweight children live in South Asia
Middle East/North
Africa
7
Latin Am erica /
Ca ribbean
4
CEE/CIS & Baltic
States
2
Eas t Asia and
Pacific
27
Sub-Saharan
Africa
32
Source: UNICEF, 2001.
South Asia
78
[Figu re s are in m illio ns]
* Percent of children u nd er five wh o are und erweigh t.
LOW BIRTHWEIGHT RATE
One quarter of births in South Asia weigh less than 2500 grams
South Asia
25
Sub-Saharan Africa
12
Middle East/North Africa
11
Latin Am erica/Caribbean
10
CEE/CIS & Baltic States
9
East Asia/Pacific
8
Least developed countries
15
Developing countries
15
Industrialized countries
7
World
14
0
Source: UNICEF, 2001
5
10
15
20
25
30
1 in 13 RISK OF DEATH
A woman born in Sub-Saharan Africa faces a 1 in 13 chance of dying in
childbirth. The risk for women born in industrialized countries is 1 in 4085.
Region
Sub-Saharan Africa
South Asia
Middle East/North Africa
Latin America/Caribbean
East Asia/Pacific
CEE/CIS and Baltic States
Lifetime risk of dying
in pregnancy or childbirth*
1 in 13
1 in 55
1 in 55
1 in 160
1 in 280
1 in 800
Least developed countries
Developing countries
Industrialized countries
World
1 in 16
1 in 60
1 in 4,100
1 in 75
* Affected not only by maternal mortality rates but also by the number of births per woman.
Source: Maternal mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA, Geneva, 2001.
Skilled attendants at delivery, 1995-20
South Asia
29
Sub-Saharan Africa
37
East Asia and Pacific
66
Middle East and North Africa
69
Latin America and the Caribbean
83
CEE/CIS and Baltic States
94
Developing Countries
52
World
56
0
Source: UNICEF.
20
40
60
Per cent
80
100
The ultimate challenge: HIV
HIV - the worst pandemic in human history
- risks reversing the progress of decades of
development ...
200
Under-five mortality rate (per 1000 births)
180
CENi71
160
140
Botswana
U5MR
FHSi8
4
120
CENi81
100
FHSi8
8
80
60
MCSi00
CENi91
FHSd8
8
40
FHSd96
20
0
1960
1965
1970
1975
1980
Year
1985
1990
1995
2000
Estimated impact of AIDS
on under-5 child mortality rates selected African countries, 2010
•
250 per 1000 live births
with AIDS
without AIDS
200
150
100
50
0
Botswana
Kenya
Malawi
Tanzania
Zambia
Zimbabwe
Source: US Bureau of the Census
98036-E-25 – 1 December 1999
Main Goals of A World Fit for
Children (2000-2010)
• Reduce infant and under-five mortality by at
least one third by 2010 (and by 2/3 from
1990 to 2015)
• Reduce maternal mortality ratio by at least
one third by 2010 (and by 3/4 from 1990 to
2015)
Main Goals of A World Fit for
Children (2000-2010)...
• Reduce under-five child malnutrition by at
least one third by 2010, with special
attention to children under two and reduce
the rate of low-birth weight by at least one
third by 2010
• Reduce proportion of households without
access to hygienic sanitation facilities and
affordable and safe water by at least one
third by 2010
Main Goals of A World Fit for
Children (2000-2010) ...
• Develop and implement national early
childhood development policies and
programmes (children’s physical, social,
emotional, spiritual and cognitive
development)
• Develop and implement national health
policies and programmes for adolescents,
including goals and indicators, to promote
their physical and mental health
Main Goals of A World Fit for
Children (2000-2010) ...
• Access through the primary health-care
system to reproductive health for all
individuals of appropriate ages as soon as
possible and no later than 2015
Main Goals of A World Fit for
Children (2000-2010)...
• Reduce by 2005 HIV prevalence among
young men and women age 15 to 24 in the
most affected countries by 25 per cent and
by 25 percent globally by 2010
• By 2005, reduce the proportion of infants
infected by HIV by 20%, and by 50% by
2010
Organizational Priorities 2002-2005:
UNICEF’s Mid-Term Strategic Plan
• Immunisation+
• Integrated Early Childhood Development
(Health, Nutrition, Water & Sanitation,
Psychosocial Care and Early Learning,
Child Protection)
• HIV/AIDS
• Girl’s Education
• Child Protection
Immunization +
• By 2010, ensure full immunization at least
90% of children nationally with at least
80% coverage in every district
• Certify by 2005 the global eradication of
polio
• Reduce deaths due to measles by half by
2005
• Eliminate maternal and neonatal tetanus by
2005
Immunization + ...
• Extension of the benefits of new and
improved vaccines and other preventive
health interventions to children in all
countries, especially vitamin A where
appropriate
Integrated Early Childhood
Development (IECD)
• Health:
– Major childhood killers (diarrhea, pneumonia, malaria)
– Maternal and newborn health
• Nutrition
– Exclusive breastfeeding, complementary feeding,
infant-feeding informed choices
– Micronutrients (supplementation and fortification:
iodine, vitamin A, anemia and iron, folic acid, others?)
• Water and environmental sanitation
• Psychosocial care and early learning
HIV/AIDS
•
•
•
•
PMTCT
Prevention among young people
Care and Support
Orphans
With business as usual, we will not reach
the MDGs or those of the World Fit for
Children
• Need to redouble our efforts to support
countries to reach these goals
• How can we support countries to provide
high coverage of a limited number of the
most cost-effective interventions (the
essential package) and support the
development of sustainable national health
systems?
Principles of good development
• Seek maximal impact on human
development (eg. health and education) and
on poverty reduction
• Evidence-based decision-making
• High impact, low-cost interventions
• Universal coverage, reaching the unreached,
especially the poor
• Home- and community-based strategies
• Essential knowledge and commodities
(vaccines, treated bednets against malaria,
etc.)
Consensus from the Global Consultation
on Child and Adolescent Health in
Stockholm, March 2002: the Challenge
• 11 million children die each year
• Most of these deaths are preventable: they
are from a limited number of conditions for
which we have high impact, low cost
interventions
• The challenge is to go to scale, to reach
every child
Consensus from the Global Consultation on
Child and Adolescent Health in Stockholm,
March 2002: the Way Forward
• Political commitment and national ownership by
government, civil society and families
• Clear time-bound goals: Reduce Under-five and
Maternal Mortality by one-third during this decade
(focus on outcomes and not just process)
• High impact, low cost, focused programs with specific
targets, standardised and taken to scale to reach every
child (examples: immunisation, oral rehydration for
diarrhea, treated bednets for malaria)
Consensus from the Global Consultation on
Child and Adolescent Health in Stockholm,
March 2002: the Way Forward ...
• Strong and well-coordinated partnerships
supporting these programs: developing countries,
civil society and NGOs, multilateral agencies
(WHO, UNICEF, World Bank)
• Both developing country and donor resources
• Strong monitoring and evaluation systems
tracking progress towards targets
• Reaching the Child and Maternal Survival Goals
is possible if we commit our energy and our
resources to it
Progress - Summary
• The UN Special Session on Children: A
World Fit for Children goals
• UNICEF’s Mid-term Strategic Plan
• Global Consultation on Child and
Adolescent Health, Stockholm, March 2002
• Launch at Special Session on New LowOsmolarity ORS Solution
Progress - Summary...
• Consultation on the Community
Management of Pneumonia, Stockholm,
June 2002
• Major effort on Roll Back Malaria
• Major Measles results in Africa
• A Secretariat for the C-IMCI IAWG
• Increase child survival funding and staffing
at UNICEF
The challenge…reaching
global child survival, growth
and development goals