contributing to reaching the millennium development goals and the goals of the world fit for...
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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
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Under-five mortality rate, change over period 1990-2000
Source: UNICEF, 2001
181
128
80
5853
45
175
100
64
4437 38
9 6
0
20
40
60
80
100
120
140
160
180
200
Sub-SaharanAfrica
South Asia Middle East &North Africa
East Asia andPacific
Latin America& Caribbean
CEE/CIS andBaltics
Industrializedcountries
U5M
R (
deat
hs p
er 1
000
birt
hs)
1990
2000Least reduction
3%
Greatest reduction
32%
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159150
131
110
76
Low est Second Middle Fourth HighestWealth quintiles
Source: UNICEF, weighted average of 43 countries, based on DHS data, mid-1990s.
U5MR disparity by asset quintile
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Most deaths occur at home, before reaching health facilities
… Implications for programming?
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BANGLADESH - UNDER-FIVE MORTALITY
0
50
100
150
200
250
300
1960 1965 1970 1975 1980 1985 1990 1995 2000
Year
Und
er-f
ive
mor
talit
y ra
te (
per
1000
birt
hs)
CPSi86 DHSi93 HDSi94
DHSd96 FSd89 SRS
DHSd93 DHSd99 Est
Bangladesh U5MR
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Source: Revised global coverage estimates based on joint UNICEF/WHO review
37%
51%
73% 74%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1980 1985 1990 1995 1999
Sub-Saharan Africa South AsiaLatin America & Caribbean East Asia and Pacific
Immunization 1980-1999DPT3 coverageImmunization 1980-1999, DPT3 coverage
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150 MILLION CHILDREN IN DEVELOPINGCOUNTRIES ARE STILL MALNOURISHED*More than half of underweight children live in South Asia
South Asia78
Sub-Saharan Africa
32
East Asia and Pacific
27
Middle East/North Africa
7
Latin America /Caribbean
4CEE/CIS & Baltic
States2
Source: UNICEF, 2001. [Figu re s are in m illio ns]
* Percent of children under five who are underweight.
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LOW BIRTHWEIGHT RATEOne quarter of births in South Asia weigh less than 2500 grams
9
14
7
15
15
8
10
11
12
25
0 5 10 15 20 25 30
World
Industrialized countries
Developing countries
Least developed countries
East Asia/Pacific
CEE/CIS & Baltic States
Latin America/Caribbean
Middle East/North Africa
Sub-Saharan Africa
South Asia
Source: UNICEF, 2001
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1 in 13 RISK OF DEATHA 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.
RegionLifetime risk of dying
in pregnancy or childbirth*Sub-Saharan Africa 1 in 13South Asia 1 in 55Middle East/North Africa 1 in 55Latin America/Caribbean 1 in 160East Asia/Pacific 1 in 280CEE/CIS and Baltic States 1 in 800
Least developed countries 1 in 16Developing countries 1 in 60Industrialized countries 1 in 4,100World 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.
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56
52
94
83
69
66
37
29
0 20 40 60 80 100
World
Developing Countries
CEE/CIS and Baltic States
Latin America and the Caribbean
Middle East and North Africa
East Asia and Pacific
Sub-Saharan Africa
South Asia
Per centSource: UNICEF.
Skilled attendants at delivery, 1995-20
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The ultimate challenge: HIV
HIV - the worst pandemic in human history - risks reversing the progress of decades of development ...
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BOTSWANA - UNDER-FIVE MORTALITY
0
20
40
60
80
100
120
140
160
180
200
1960 1965 1970 1975 1980 1985 1990 1995 2000
Year
Und
er-f
ive
mor
talit
y ra
te (
per
1000
birt
hs) CENi71
FHSi88
CENi81
FHSi84
FHSd96
FHSd88
CENi91MCSi00
Botswana U5MR
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Estimated impact of AIDS on under-5 child mortality rates - selected African countries, 2010
•
Source: US Bureau of the Census
250
200
150
100
50
0
per 1000 live births with AIDS
98036-E-25 – 1 December 1999
Botswana Kenya Malawi Tanzania Zambia Zimbabwe
without AIDS
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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HIV/AIDS
• PMTCT
• Prevention among young people
• Care and Support
• Orphans
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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?
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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.)
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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
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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)
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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
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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 Low-Osmolarity ORS Solution
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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
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The challenge…reaching global child survival, growth
and development goals