1

Roots of the SecondChild Survival Revolution

Cesar VictoraFederal University of Pelotas, BrazilBellagio Child Survival Study Group

Countdown to 2015

London, December 2005

2

The Child Survival Revolution

• New UNICEF leadership: Jim Grant

• 1982: Child Survival Revolution• Focused on 4 interventions:

– Growth monitoring– Oral rehydration– Breastfeeding– Immunisation

• 1990: World Summit for Children

3

Global coverage of DPT3 vaccine

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% c

hil

dre

n w

ith

3 d

ose

s o

f D

PT

Source: Bryce et al, Lancet 2003

4

Deaths by selected causes, 2003

0 2 4 6 8 10 12

Tropical, non-malaria

Maternal

Malaria

Tuberculosis

AIDS

Under-five

Annual deaths (millions)

Source: World Health ReportSource: WHO, 2003

5

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: GFHR 2004Source: Global Forum for Health Research, 2004

6

The Lancet Child Survival Series

7

Where do over 10 million children die every year?

c op y

righ t

Ox f

o rd

Cart o

g ra p

hers

20 0

3

Source: Black, Morris, Bryce, Lancet 2003

Leading causes•Neonatal•Diarrhoea•Pneumonia•Malaria•Undernutrition

8

13%

17%

15%

7%39%

2%

20%10-40%

CURRENT COVERAGE

Low-cost interventions can save many lives

Source: Jones et al, Lancet 2003

9

Can health systems deliver?

• 6 million lives could be saved every year by simple, cost-effective interventions

• But scaling up may be difficult– Weak health systems– Lack of trained human resources– Inadequate care seeking and low

utilization– Hard to reach those who need most

• Inappropriate delivery channels

Source: Bryce et al, Lancet 2003

10

The gap between the rich and the poor is widening

• Children born in Sub-Saharan 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 middle-income countries

Source: Victora et al, Lancet 2003

11

• 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

Paper 5 – Call to action

Source: Bellagio Group, Lancet 2003

12

What has happened since 2003?

13

Progress in child survival advocacy

January 8, 2004

UNICEF to focus on child survivalwww.BLACKBRITAIN.com

UNICEF Executive Director Ms. Carol Bellamy stated that there is “...a global imperative to do more for children in 2004.”

• UNICEF names top 5 concerns for children in 2004

14

Paper 1: 4 million deaths: When? Where? Why?

The Lancet Neonatal Survival Series

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

15

Lancet Health Systems Series

• Equity• Financing• Human Resources• Scaling up• Health systems

research priorities

16

Millennium Project Task Force

• Health systems• Financing• Human Resources• Sexual/reproductive

health and rights• Child mortality• Maternal mortality• Global mechanisms• Information systems• Targets and indicators

17

The World Health Report 2005

• The situation in 2005• Programme strategies• System and policy

implications

18

Growing concern about maternal mortality

19

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

20

21

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?

22

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

23

Paper 5, Child Survival Series

• … we commit ourselves to ensuring that there is an overall mechanism for improving accountability, re-energizing 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.