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Committing to ChildSurvival - A Promise
Renewed - endingpreventable child
deaths
Addis Ababa, 16January 2013
Dr. Mickey Chopra, Associate Director Health, UNICEF
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Key Messages
Globally and in Africa we are making progress
However for too many women and childrenand some conditions progress is too slow
The ambition of A Promise Renewed for Africa The immediate challenges for accelerating
progress
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The global burden of under-five deaths has fallen steadily
since 1990Global number of under-five deaths, selected years
12.0
10.8
9.6
8.2
6.9
0
2
4
6
8
10
12
14
1990 1995 2000 2005 2011
Millionsofund
er-fivedeaths
Source: The UN Inter-agency Group for Child Mortality Estimation, 2012;
provided by SMS/DPS/UNICEF
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The global under-five mortality rate has fallen by 41% from
1990 to 2011Under-five and neonatal mortality rate, 1990-2010
Source: The UN Inter-agency Group for Child Mortality Estimation, 2012;
provided by SMS/DPS/UNICEF
87
51
MDG Target: 29
32
22
0
10
20
30
40
50
60
70
80
90
100
1990 1995 2000 2005 2010 2015
Deathsper1,0
00livebirths
U5MR
NMR
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0
20
40
60
80
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035
Source: UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011;
UNICEF, Required Acceleration for Child Mortality Reduction beyond 2015, 2012; team analysis
Save the Children team analysis for NMR projection
MortalityRate
(deaths/1000
births)
20
35
Accelerated U5MR ARR = 5.1%
Current U5MR ARR = 2.2%
* ARR = annual rate of reduction
MDG 4 target = 34U5MR
Global Progress for child survivalU5MR and NMR decline 1990-2010, projected to 2035
15
Current NMR ARR = 1.8%
If 1-59 month mortality accelerates further but neonatalmortality continues on same trend then with
2 million child deaths in 2035, 1.5 million may be neonatal.
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All regions have experienced marked declines in
under-five mortality rates since 1990
Deathsp
er1,00
0l
iveb
irths
Source:IGME2012
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The global burden of under-five deaths is increasingly concentrated
in Sub-Saharan AfricaShare of under-five deaths, by region, 1990-2010 (%)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1990 1995 2000 2005 2010
Sub-Saharan Africa South Asia East Asia and Pacific
Middle East and North Africa Latin America and Caribbean CEE/CIS
Industrialized countries
Source: IGME 2011
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1) Sierra Leone(185 per 1000 live births)
2) Somalia3) Mali
4) Chad
5) Democratic Republic of the Congo
6) Central African Republic7) Guinea-Bissau
8) Angola
9) Burkina Faso
10) Burundi
11) Cameroon
12) Guinea13) Niger
14) Nigeria
15) South Sudan
16) Equatorial Guinea17) Mauritania
18) Togo
19) Benin
20) Swaziland (104 per 1000 live births)
Source for mortality rank: UN Inter-agency Group for Child Mortality Estimation 2012;Fragile Situation countriesare shown in red(source: World Bank 2011)
In 2011, for the first time, the 20 countries with the highestunder child mortality rates are all in Africa. There is a strong
correlation between conflict, fragile situations and childmortality rates.
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Top 10 countries in Africa with the
largest reductions in child mortality,2000-2011
Ran
k
Country Annual rate of reduction
(%)1. Senegal 6.4%
2. Malawi 6.2%
3. Zambia 5.6%
4. Ethiopia 5.3%
5. Namibia 5.2%
6. Niger 5.0%
7. Morocco 4.3%
8. Zimbabwe 4.1%
9. Kenya 4.0%
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170 Governments Pledged to dateIncluding 48 of the 54 countries in Africa
plus hundreds of Civil Society organisations, Faith Based
organisations, Individuals, schools and
workplaces Focus on results and accountability
But also an important technical component
www.apromiserenewed.org
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20 by 2035: selected country U5MR trajectories
0
20
40
60
80
100
120
140
160
180
200
220
240
260
280
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035
Under-fivemortalityrate(deathsper1,000livebirths)
Mali continuation of 2000-2010 trend
Mali to reach 20 by 2035
Democratic Republic of the Congo
Cte d'Ivoire
Lesotho
India
Indonesia
Peru
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0%
25%
50%
75%
100%
COMMODITIES: %
health centres with
no perinatal supply
stock-outs
HUMAN RES: %
facilities with
sufficient workers
ACCESS: % families
living near health
facility with daily
service provision
UTILISATION: %
deliveries assisted by
trained worker
CONTINUITY: %
deliveries with i) SBA
ii) weighed & iii)
receive 3 postnatal
care visits
EFFECTIVE COV: % of
SBA deliveries occur
within a ANC-
qualified health
facility
Most Deprived Least deprived
Supply Bottlenecks
> 20% difference in availability andaccessibility to facilities with SBA
Demand Bottlenecks(esp. Financial access) in
most deprived but leastdeprived tend to use even
more than what is available
Changing How We Do It: Supply and demandbottlenecks for most / least deprived areas analyzed
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Major bottlenecks to achieving results
Decentralization & Low capacity: weak supervision,management, QA and motivation
Major barriers to access: poor enforcement of pro-poor cashtransfers and fee-waivers
Incomplete uptake of life-saving interventions: e.g. zinc fordiarrhea
Ineffective resource management: especially in decentralized
settings Structural barriers: economic, political, socio-cultural
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Potential
approach
Description
Possiblestrategies
Shift intervention
within channel
Shift intervention to
different delivery channel
Improve performance of
delivery channel
Shiftexisting
within
channel
Newdelivery or
technology
approach
Improve
channel
performance
Change way of delivering
interventions within existing
channels
Task shifting among different
cadres of workersImproving outreach services
(including specialist outreach)
Shifting to different sets of
providers through public-private
partnerships, contracting out, or
franchising
Deliver the intervention through a
better performing channel
Task shifting from clinic-based to
community-basedShifting interventions from clinic-
based to child health campaigns
Shifting behaviour change
counselling from face to face to
social marketing or implementing
policy changes
Improve efficiency, capacity and
accessibility of delivery channel
Human resources availability:
Compulsory service, Hardshipallowances, retention of HR in
rural settings
Geographic access:
Increase number of service points
Financial access:
User fee abolitions, Insurance
schemes, Conditional cash
transfers, Vouchers
Continuity:
PBI, remuneration (salaries)
Defaulter tracking
Quality:
Supervision/mentoring, training,
audits, accreditation
Demand:Community/individual
empowerment, social marketing
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THANK YOU !
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