Accelerating Child Survival Dr. Sanjiv Kumar, Regional Adviser Health and Nutrition, CEE/CIS Second Subregional Workshop for Acceleration of Child Survival, Tashkent, 10 – 14 September, 2007
Mar 27, 2015
Accelerating Child Survival
Dr. Sanjiv Kumar, Regional Adviser Health and Nutrition, CEE/CIS
Second Subregional Workshop for Acceleration of Child Survival, Tashkent, 10 – 14 September, 2007
UNICEF
Accelerating Child Survival
RESULTS FOR CHILDRENUNICEF RMT CEECIS9 MAY 2006
Global Agenda: Strategic Directions
Regional and country level Knowledge Base
National Priority in A Country:National Development Strategy
Poverty Reduction Strategy
AllianceBuilding
AllianceBuilding
National Policy DevelopmentReform Process
Implementation
External Environment Analysis
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Accelerating Child Survival
Health in CEE/CIS: General Trends:
Only region in the world where Crude Death Rate has increased from 9 (1970) to 11 (1990) to 12 (2004)
Lowest Population Growth Rate 0.2% (1990 – 2004) down from 1% (1970 -1990).One third of industrialized countries and one seventh of global rate.
Life expectancy is stagnating: 67 (1970), 68 (1990) and 67 (2004)
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Accelerating Child Survival
Health in CEE/CIS: Child Health
7% babies do not have skilled attendant at birth
14% do not receive antenatal care
75% do not receive ORT in diarrhea
3.8% or 1 in 25 (212,000) U-5 die every year. 77% of the deaths in nine countries
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Accelerating Child Survival
Health in CEE/CIS: Nutrition
78% are not exclusively breastfed
14% are stunted and 5% underweight
45% (2.4 million) newborns are not protected against iodine deficiency.Russia (1.5 m), Turkey (1.5 m) Ukraine, Belarus and which have 4 million newborn)
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Accelerating Child Survival
Continuum of Health Care-1
• Family/Home/Self management in conjunction with primary care team– Empower families/individuals– Redefine the boundaries– Timely Referral to appropriate level
• Home care indicators EBF rates, CF rates, ORT use rate, Home management of Pneumonia…. are low. Preventive and promotive care provided mainly at home and home care plays an important role in curative care as well.
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Accelerating Child Survival
Continuum of Health Care-2
• Primary care- has always been and continues to be a poor relation of hospital care
• Hospital care: overspecialized, overstaffed, overmedicalized..(WHO study in Russia, Kazakhstan & Moldova)
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Accelerating Child Survival
Quality of care
• Adoption on international norms and standards– Time gap in adoption and real implementation– Skills of health care providers, upgrade basic
training• Delegation of decision making and move from the old
command-and-control model • Supportive environment to implement guidelines
through supportive supervision and on the job training.
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Accelerating Child Survival
Summary of Findings Quality of Care
Areas assessed No significant problems Need for some improvement Need for substantial improvement
Hospital network
Availability beds
Physical structure
Financial accessibility
Health personnel
Equipment
Drugs, supplies
Triage
Diagnosis
Treatment
Intensive care
Monitoring
Guidelines
Child friendly attitude
KAZKAZ MDAMDA RUSRUS
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Summary Findings - Structure & Supplies
Existing hospital network GoodGood
Staffing Generally adequate and dedicatedGenerally adequate and dedicated
Physical structure and equipment
Need renovation and updatingNeed renovation and updating
Essential drugs and supplies Sometimes lackingSometimes lacking
Accessibility Partially limited due to need for Partially limited due to need for financial contributionfinancial contribution
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Accelerating Child Survival
Unnecessary Admissions & Treatment (WHO Study Rus, KZ, MDA)*
0
20
40
60
80
100
%
No need for hospitalization Unnecessary therapies
MDA N=45KAZ N=53
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Accelerating Child Survival
WHO study concluded
More effective and more child-friendly case management could be provided within existing structure, staff and facilities
Available resources now used for unnecessary treatments could be used to improve availability and access to essential drugs and effective care
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Accelerating Child Survival
Use available health staff effectively
0102030405060708090
100
Africa Asia LatinAmerica
Developedcountries
Tajikistan05101520253035404550
% of trained personnel Perinatal mortality Assumed
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Accelerating Child Survival
Health Reforms
• In all countries • Rapid pace in many countries• Insurance:
– Minimum Package for women and children– Does it benefit those for whom free
• Staff Skills• Staff Morale: Salaries, Move from punitive culture to openness
to learn from mistakes. • Need to step back and reflect, how best the health can be
promoted rather than caring only for the sick through hospitals.
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Accelerating Child Survival
UNICEF
Accelerating Child Survival
Focus on neonatal care
0
20
40
60
80
100
120
Arm Aze Geo Kaz Kgz Tjk Tur Tkm Uzb
x 10
00
mortality 1-4 y
PNMR
late NMR
early NMR
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Accelerating Child Survival
What kills neonates?
0%
20%
40%
60%
80%
100%
Other
Congenital
Infection
Asphyxia
Preterm
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Accelerating Child Survival
Simple steps in preparing and implementing child survival plan
Step 1. Set a goal Step 2. Divide the goal into sub-goalsStep 3. Convert the (sub) goals into tasks. Step 4. Task are manageable, assign them to resources
- who will do what and allocate resources. Step 5. Plan the tasks regarding interdependencies. Step 6. Manage the processStep 7. Monitor the progress and take corrective action
where required
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Accelerating Child Survival
Monitor Progress
Reliable and accurate indicator: Neonatal, Infant and child mortality,
Home care: EBF, CF, ORT use rate, home management of pneumonia
Quality of institutional care
Timely information
Prompt action at every level
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Accelerating Child Survival
Strengths in CEE & CIS
• Vast infrastructure and health care functionaries
• Almost all children come to health centres (SVP) regularly and are weighed
• BFHI doing relatively well
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Accelerating Child Survival
Together we can do it!