Tracking Intervention Coverage for Child Survival

Tracking Intervention Coverage for Child Survival

Jennifer BryceCountdown to 2015

London, December 2005

Tracking child survival

Contributors

Tracking child survival

Countdown Monitoring Why?

What? Where?

Who & how & when?

Some preliminary findings

Countdown monitoring in 2005: Where are we?

Tracking child survival

Why monitor?

Track progress toward targets Improve effectiveness

Be transparent Increase accountability

Generate commitment and resources

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What “set” of interventions?

Effectiveness (current set of Lancet neonatal and child interventions together can prevent over 60% of deaths) Feasibility (each can theoretically be scaled up in poor countries)

Affordability (running costs for current Lancet set are about US $25 per year per child for all children in developing countries)

Available (now!)

All interventions must have evidence of:

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What interventions?

Nutrition Vaccination

Other prevention Newborn

Case management

Programme areas:

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What is coverage?

The proportion of individuals who need a service or intervention who actually receive it

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Coverage is unacceptably lowfor child survival interventions in all developing countries

0 20 40 60 80 100

Exclusive Breastfeeding

Complementary foods

Continued Breastfeeding

Measles

DPT3

Hib

Vitamin A

Water

Sanitation

ITNs

Skilled attendant

Tetanus toxoid

Breastfeeding initiation

PMTCT

Careseeking for pneumonia

AB for pneumonia

ORT for diarrhoea

Antimalarials (LDC)

Vaccination

Other prevention

Newborn

Case manage-

ment

Breast-feeding

Source: The State of the World’s Children, 2006.

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What makes coverage a good choice for global monitoring?

Complements country efforts

Good proxy for impact Signals whether

programme is operating adequately

Serves as “red flag” for further action, not comprehensive info for programme management

National programme monitoring

Policies/plans/resources Implementation Outcomes Impact

Global monitoring

National and global monitoring should reinforce one another

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What will the Countdown track in addition to coverage?

Mortality, nutritional status and causes of death

Key coverage determinants: Policies & political

commitment Human resources Financial flows

Equity

Key determinants of coverage

Policies &political

commitmentHuman

resourcesFinancial

flowsCommunitymobilization

Implementation

Coverage

Impact on child survival

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Where? In what countries?

These countries represent 500 million children < 5 years old: 75% of all children alive; and 94% of all child deaths.

50,000 child deaths per year, or under-5 mortality rate of 90

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Who? How? When?

Mortality, nutrition, causes of death:

UN consensus, countries

Coverage & equity: for most, household surveys; programme reports for EPI, vitamin A, PMTCT

Policies: in-country reports

Political commitment, human resources & financial flows:

under development

MICS (46 surveys, 18 in priority countries)DHS (31 surveys, 22 in priority countries)Other (6 surveys, 3 in priority countries)

Household surveys planned for2005-2006

No survey in 17 priority countries. For 9, “other” survey in 2004; For 8, no data for Countdown 2007

Countdown Country ReportsOne for each priority

country

Basic demographicsCause of death

profile, as basis for knowing which

interventions are most important. Nutritional status and

child feeding (including

breasfeeding)

COVERAGE RESULTS

Key Policies

Equity

Determinants of coverage: political

commitment, human resources, financial

flows

What types of information will Countdown monitoring

produce?

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Summary information about

where the needs are,

and where there is success.

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Who’s on track? Who’s not?

“On Track” : If current trends continue, MDG-4 is likely to be met

“Watch” : signs of progress – but intensified efforts still required.

“High alert” : children in danger; intensified efforts needed urgently

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Only 7 countries on track for MDG mortality target

MDG-4 Target: Two-thirds reduction by 2015, from

1990 levels

For all 60 countries, needed reduction in U5M is 8% each year to reach MDG-4; current average is 1.2%.

7 countries are “on track”: Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and the Philippines.

Averages hide big differences among countries.

7

34

19

"On target" "Watch" "High alert"

60 Priority Countries: Annual rate of reduction in U5M

is equal to that neededto reach MDG-4 by 2015

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(90%) (50%) (90%) (50%)

Measles DPT3

Source: The State of the World’s Children, 2006.

60 priority countries by levels of coverage

for measles and DPT3 vaccines. N

umbe

r of p

riorit

y co

untr

ies

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Sources: The State of the World’s Children, 2006; plus for Malawi, Centre for Social Research, University of Malawi. The coverage and utilisation of insecticide treated nets and malaria prevention and treatment practices at the community level in Malawi, December 1004; and for Togo, Centers for Disease Control and Prevention. Distribution of insecticide-treated bednets during an integrated nationwide immunization campaign – Togo, West Africa, December 2004. MMWR 2005; 54: 994-996.

30% 60%

45 priority countries with endemic malaria by levels of coverage for

ITN use by children under age fiveN

umbe

r of p

riorit

y co

untr

ies

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Information about country adoption of policies

supportive of neonatal and child survival

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Country adoption of child survival policies lagging

PolicyNumber of priority countries (n=60)where adopted as national policy

Fully Partially Not at allInt’l Code of Marketing of Breastmilk Substitutes (2=ND)

15 40 3

New ORS formula 18 4 38

Zinc for treatment of diarrhoea 7 3 50

Hib vaccine (national implementation) 11 - 49

Community treatment of pneumonia with antibiotics 17 2 41

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Country-specific information on equity -- which children are

receiving essential interventions.

Tracking child survivalGap: 48.5

Huge equity gaps in intervention coverage are the norm

Based on a total of 9 possible interventions

Based on a total of 8 possible interventions

0 10 20 30 40 50 60 70 80 90 100

Bangladesh

Benin

Brazil

Cambodia

Chad

Eritrea

Egypt

Haiti

India

Indonesia

Madagascar

Malawi

Nepal

Nicaragua

Phillipines

% of children receiving 6+ interventions in poorest and least poor quintiles

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Monitoring data: Use it or lose it

Tracking Intervention Coverage for Child Survival

Preliminary conclusions ofthe 2005 (baseline) Report

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Is the monitoring plan feasible?

Yes, especially if UNICEF, WHO and PMNCH continue to provide leadership and support.

Draws on existing data but brings them together in ways that accountability.

May require learning from EPI, i.e., – more frequent monitoring of coverage as measure of progress toward impact.

Highlights data gaps so they can be filled.

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What is new, and how will it contribute to child survival?

We have a clear starting line for the race to 2015.

Much remains to be done, but variations among countries can show how to move forward

Country-by-country reports highlight where intensified efforts are needed

Monitoring equity brings it into focus

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Where are we in 2005?

Only 7 of 60 priority countries are “on track” with mortality reduction.

Coverage levels are too low across the board. Rapid progress is possible, and has been

demonstrated by some countries for some interventions.

The Countdown will track progress, and pose hard questions.

Accountability will lead to success.

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Comments?Questions?

Corrections to report?

nterreri@unicef.org