Maternal, neonatal, child health and nutrition

Gunta LazdaneWHO Regional Office for Europe

A big challenge …Globally every year…

•7,6 million children die before their 5th birthday– 3,2 million newborn babies in the first month of life– 2,4 million infants between 1 – 12 months

•356 000 women die due to complications of pregnancy and childbirth– 15 million women develop long-term consequences due

to pregnancy and childbirth

Child nutrition and MDGs• In 2010, globally, an estimated 27% of children

younger than 5 years were stunted• Undernutrition continues to be high and delays

progress toward reaching Millennium Development Goals

• Extremely poor breastfeeding and complementary feeding practices

• Micronutrient deficiencies (iodine, iron deficiency ) still a serious problem and obesity on the rise….

The way forward…

By 2015:

• Saving 16 million lives of women and children

• Preventing 33 million unwanted pregnancies

• Protecting 88 million children from stunting

• Protecting 120 million children from pneumonia

Goal 5: Improve maternal healthTarget 5A: Reduce by three quarters,

between 1990 and 2015, the maternal mortality ratio

Target 5B: Achieve, by 2015, universal access to reproductive health

• Maternal mortality ratio

• Proportion of births attended by skilled health personnel

Goal 4: Reduce child mortalityTarget 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

• Under-five mortality rate

• Infant mortality rate• Proportion of 1 year-old children

immunised against measles

• Contraceptive prevalence rate

• Adolescent birth rate

• Antenatal care coverage • Unmet need for family planning

Targets and indicators for monitoring MDG 4 and 5

… and other partners

Mongolian Welfare Association

World Health Assembly

WHO ConstitutionExecutive Board, DGResolutions and decisions http://apps.who.int/gb/or/

Executive Board

WORLD HEALTH ORGANIZATION

Regional Committees

10-13 September 2012 Malta

Standing Committee of RC - only in WHO/Europe

Monitoring progress

Good progress in achieving MDG 4 in the WHO European Region

In 2009 11 countries achieved MDG 4 target

Source: WHO European Region estimates; WHO, 2011

Probability of dying before age 5 years per 1 000 live births

0

10

20

30

40

50

60

70

1980 1990 2000 2010

European RegionEuropean Union

Commonwealth of Independent States

Central Asian Republics

However big discrepancies between countries

Source: WHO/Europe Health for all Database

Deaths among children under-five

Neonatal deaths

Source: Major causes of under five and neonatal deaths, European Region, 2008; WHO The World Health Statistics 2011

Neonatal deaths50%

Pneumonia(postneonatal)

11%

Diarrhoeal diseases

(postneonatal)5%

HIV/AIDS1%

Other 14%

Noncommunicable diseases

(postneonatal)14%

Injuries (postneonatal)

5%

Prematurity and low birth weight

35%

Birth asphyxia and birth trauma

15%

Neonatal infections 12%

Congenital anomalies

22%

Other 16%

Major causes of deaths are known

average annual decline of 3.8%

5.5% required to achieve MDG5

Source: Trends in Maternal Mortality: 1990 to 2008; WHO, 2010

Good progress in maternal health – MDG5 WHO European Region

44

2720

05

101520253035404550

1990 2005 2010

Estimted maternal mortality ratio

0

10

20

30

40

50

60

70

1980 1990 2000 2010

Maternal deaths per 100000 live births

European Region

European Union

Commonwealth of Independent States

Central Asian Republics

Every two years WHO secretariat develops a progress report based on the filled in questionnaires received from the WHO Member States and presents it to the World Health Assembly (2006,2008, 2010, 2012,

2014!)

Questionnaires will be sent to countries in 2013

European strategy for child and adolescent health and development (2005)

Tools for implementation

Guidelines and tools available

Effective Interventions exist…

3

3

4

4

5

6

7

13

0 2 4 6 8 10 12 14

Antenatal steroids

Water, sanitation, hygiene

Clean delivery

Hib vaccine

Zinc

Continued BF with complementary feeding

Insecticide treated materials

Exclusive breastfeeding

Source: Lancet Child Survival Series 2003

Inte

rve

nti

on

expected % of reduction in U5M

Monitor

Action

Review

From recommendations to actions

1 Monitoring results & CRVS 2 11 core indicators & equity

3 Digital health & innovation

4 Financial indicators tracked5 Comprehensive reporting6 Capacity for NHA

7 National Accountability mechanisms

8 Transparency

9 MNCH specific reporting

10 Expert Review Mechanism

COMMISSION RECOMMENDATIONS

Country assessment &Roadmap

Globalactions

Birth and death registration

Monitoring of results

Maternal death surveillance & response

NHA & MNCH tracking

ehealth & innovation

Country review processes

Advocacy and action

Monitoring results

Tracking resources

Global review (iERG)

To accelerate progress …

• Tackle inequities by addressing the determinants of maternal and child health through cross-sector and gender-right based approach

• Strengthen health

• Strengthen health information

• Implement new vaccines and develop immunization service delivery strategies

• Address the links between noncommunicable diseases and MDGs

Sharing experiences and success stories…

Sharing experiences and success stories…

Health 2020: a European policy framework supporting action across government and society for health and well-being

Proportion (%) of children exclusively breastfed at 3 and 6 months, 2005-2010

Albania

Armen

ia

Azerb

aijan

Belaru

s

Belgium

Bosnia

and

Her

zego

vina

Bulgar

ia

Croat

ia

Cypru

s

Czech

Rep

ublic

Finlan

d

Germ

any

Greec

e

Hunga

ry

Icela

nd

Irelan

dIta

ly

Kazak

hsta

n

Kyrgy

zsta

n

Luxe

mbo

urg

Mon

tege

gro

Nethe

rland

Norway

Poland

Portu

gal

Mald

ova

Russia

Slovak

ia

Slovan

iaSpa

in

Sweden

Switzer

land

Tajiks

tan

Mac

edon

ia

Ukrain

e

United

King

dom

0

10

20

30

40

50

60

70

80

90

100

3 Months6months

Sources: National Surveys

Continuum of care

Accelerated actions to achieve MDG 4 and 5

• Developing clear policies and action plans from a life-course and multi-sectorial perspective

• Improved data collection, analysis and evidence-based decision making

• Supported and monitored implementation of evidence based health interventions

• Improving access and quality of care; trained health professionals with right skill mix

• Involvement of communities and civil society

THANK YOU!