Target-Setting Ending preventable newborn deaths Lily Kak, USAID Ghazaleh Samandari, KMS On behalf of the ENAP Core Team Asia Regional Meeting Kathmandu, Sept 1, 2013
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Target-Setting Ending preventable newborn deaths
Lily Kak, USAIDGhazaleh Samandari, KMS
On behalf of the ENAP Core TeamAsia Regional Meeting
Kathmandu, Sept 1, 2013
Outline
1. Recall global consensus on Millennium Development Goal and A Promise Renewed to end preventable child deaths
2. Consider options to recommend targets for the Every Newborn Action Plan to end preventable newborn deaths
Millennium Development Goal 4
Reduce under-five mortality by two-thirds
Relative Target: 66% reduction
Under-five deaths 1990-2070 (actual and projected)
Current trajectory: ARR 2.5%• MDG 4 achieved in 2035• 4 million deaths annually in
2035ARR 12.6%• Achieve MDG 4 • Reach 2 million child deaths
annually in 2020• Achieve average of U5MR
15/1000 by 2020
ARR 5.2% • 2 million deaths annually by 2035 • Every country reaches 20/1000 by 2035• Many countries below 15/1000 by then
AchieveMDG 4
Under-5 deaths millions
9.6 mm deaths in 2000
7.6 mm deaths in 2010
13
12
11
10
9
8
7
6
5
4
3
2
0
1
Accelerating progress on child survival – what can the world achieve if countries increase their annual rate of reduction?
Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035
Target-Setting“Every Newborn” Action Plan
A Promise Renewed Target for U5MAbsolute target of 20 by 2035
0
10
20
30
40
50
60
70
80
90
100U5M current trajectory: ARR 2.5%• MDG 4 achieved in 2035• 4 million deaths annually in 2035
U5M ARR 5.2% • 2 million deaths by 2035 • Every country reaches 20/1000 • Many countries below 15/1000
MDG 4
6 m deaths in 2011
Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035
NMR current trajectory of ARR 2.2%
Mortality rate (per 1,000 live births)
9.6 mm deaths in
2000
U5M20
Absolute target :U5MR 20 by 2035
Option1: Absolute Target
Source: The UN Inter-agency Group for Child Mortality Estimation
Every Newborn target by 2035
1990 1995 2000 2005 2010 2015 2020 2025 2030 20350
5
10
15
20
25
30
35
Axis Title
Current trajectoryARR: 2.2%
13
10
9
5
NMR target of 10ARR: 3.2%
NMR target of 9ARR: 3.6%
NMR target of 5ARR: 5.8%
ARR: Annual Rate of Reduction
New
born
mor
talit
y ra
te
(per
1,0
00 li
ve b
irths
)
Option 1: Absolute target NMR 5? 9? 10?
Africa & S. Asia require an ARR of over 7%
0
5
10
15
20
25
30
35
40
45
50
Sub-Saharan Africa
S. Asia
MENA
CEE/IS
E. Asia/Pacific
LAC
5
Example: Absolute target of NMR 5?N
ewbo
rn m
orta
lity
rate
(p
er 1
,000
live
birt
hs)
Region Current ARR
Required ARR
Diff in ARR
SSA 1.7% 7.80% 6.10%
S. Asia 2.1% 7.50% 5.40%
E. Asia 4.8% -- --
CEE/IS 1.9% 5.20% 3.30%
LAC 5.3% -- --
MENA 2.5% 4.80% 2.30%
some regions will have to work much harder than others
OECD Upper Limit (Turkey) : NMR 9
Source: The UN Inter-agency Group for Child Mortality Estimation
19901992
19941996
19982000
20022004
20062008
20102012
20142016
20182020
20222024
20262028
20302032
20340
5
10
15
20
25
30
35
40
45
50
OECD Upper Limit (Turkey) : NMR 9
South AsiaSub-Saharan Africa
Middle East/North Africa
East Asia/Pacifica
Latin America/Caribbean
CEE/CIS
Example: Absolute target of NMR 9?
9
New
born
mor
talit
y ra
te
(per
1,0
00 li
ve b
irths
)
Africa & S. Asia require an ARR of over 5%
some regions will have to work much harder than others
Source: The UN Inter-agency Group for Child Mortality Estimation
Option 2: Relative Target
Every Newborn target by 2035Option 2: Relative Reduction of NMR by 66% or 75%
1990 1995 2000 2005 2010 2015 2020 2025 2030 20350
5
10
15
20
25
30
35
Current trajectoryARR: 2.2%
13
7.4
5.5
NMR 66% reduction ARR: 4.4%
NMR 75% reductionARR: 5.6%
ARR: Annual Rate of Reduction
Every Newborn target by 2035
NMR
Option 2: Relative target66% reduction? 75% reduction?
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Current NMR Level (2011)
Region Curr. ARR
Req. ARR
Diff in ARR
SSA 1.7% 4.40% 2.70%
S. Asia 2.1% 4.40% 2.30%
E. Asia 4.8% 4.40% -0.40%
CEE/CIS 1.9% 4.40% 2.50%
LAC 5.3% 4.40% -0.90%
MENA 2.5% 4.40% 1.90%
Example: Relative target of 66% reduction from 2011
South AsiaSub-Saharan Africa
Middle East/North Africa
East Asia/Pacifica
Latin America/Caribbean
CEE/CIS
All regions require an ARR of 4.4%
13.5
12.1
NMR
2.9
Africa
Asia
LAC
Inequity across
regions
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Current NMR Level (2011)
Region Curr. ARR
Req. ARR
Diff in ARR
SSA 1.7% 5.60% 3.90%
S. Asia 2.1% 5.60% 3.50%
E. Asia 4.8% 5.60% 0.80%
CEE/CIS 1.9% 5.60% 3.70%
LAC 5.3% 5.60% 0.30%
MENA 2.5% 5.60% 3.10%
Example: Relative target of 75% reduction from 2011
South Asia
Sub-Saharan Africa
Middle East/North Africa
East Asia/Pacifica
Latin America/Caribbean
CEE/CIS
All regions require an ARR of 5.6%
8.6
8.1
2.8
NMR
Africa
Asia
LAC
Inequity across
regions
1. What is the most important issue for you: • A global target that aims at achieving equity across all countries, even if some
countries have to work harder (absolute)?• A global target that aims at feasibility based on country’s capacity, but resulting in
inequity across regions (relative)?
2. Would you recommend additional targets:• Intermediate mortality targets (every five years)?• Coverage targets for high impact interventions?
Target-Setting: What do you recommend?
0
5
10
15
20
25
30
35
40
45
50
55Afghanistan Series2 Bangladesh Series4Indonesia Series6 Nepal Series8Pakistan Series10 India Series12
Indonesia
5
Example: Absolute target of NMR 5?N
ewbo
rn m
orta
lity
rate
(p
er 1
,000
live
birt
hs)
Region Current ARR
Required ARR
Diff in ARR
Afghanistan -1.5% -7.9% 6.4%
Bangladesh -3.6% -6.7% 3.1%
Indonesia -3.2% -4.6% 1.3%
Nepal -3.2% -6.8% 3.6%
Pakistan -1.5% -7.9% 6.3%
India -2.0% -7.5% 5.4%
OECD Upper Limit (Turkey) : NMR 9
Source: The UN Inter-agency Group for Child Mortality Estimation
0
5
10
15
20
25
30
35
40
45
50
55Afghanistan Series2 Bangladesh Series4Indonesia Series6 Nepal Series8Pakistan Series10 India Series12
Indonesia
9OECD Upper Limit (Turkey) : NMR 9
Example: Absolute target of NMR 9?N
ewbo
rn m
orta
lity
rate
(p
er 1
,000
live
birt
hs)
Region Current ARR
Required ARR
Diff in ARR
Afghanistan -1.5% -5.6% 4.2%
Bangladesh -3.6% -4.4% 0.8%
Indonesia -3.2% -2.2% -1.1%
Nepal -3.2% -4.5% 1.3%
Pakistan -1.5% -5.6% 4.1%
India -2.0% -5.2% 3.1%
0
5
10
15
20
25
30
35
40
45
50
55
Afghanistan Series2 Bangladesh Series4Indonesia Series6 Nepal Series8Pakistan Series10 India Series12
Indonesia
Region Curr. ARR
Req. ARR
Diff in ARR
Afghanistan -1.5% -4.4% 2.9% Bangladesh -3.6% -4.4% 0.8% Indonesia -3.2% -4.4% 1.2% Nepal -3.2% -4.4% 1.2% Pakistan -1.5% -4.4% 2.9% India -2.0% -4.4% 2.4%
Example: Relative target of 66% reduction from 2011
All countries require an ARR of 4.4%
New
born
mor
talit
y ra
te
(per
1,0
00 li
ve b
irths
)
0
5
10
15
20
25
30
35
40
45
50
55
Afghanistan Series2 Bangladesh Series4Indonesia Series6 Nepal Series8Pakistan Series10 India Series12
Indonesia
Region Curr. ARR
Req. ARR
Diff in ARR
Afghanistan -1.5% -5.6% 4.1% Bangladesh -3.6% -5.6% 2.0% Indonesia -3.2% -5.6% 2.4% Nepal -3.2% -5.6% 2.4% Pakistan -1.5% -5.6% 4.1% India -2.0% -5.6% 3.6%
Example: Relative target of 75% reduction from 2011
All regions require an ARR of 5.6%
New
born
mor
talit
y ra
te
(per
1,0
00 li
ve b
irths
)
Current Trajectory 75 percent reductionCountry 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035Afghanistan 50.5 46 42.6 39.7 36.8 28.7 21.5 16.1 12.1 9.1Bangladesh 51.9 46 39.3 33.1 27.5 21 15.7 11.8 8.8 6.6Bhutan 43.6 38.8 34.1 29.6 25.4 19.6 14.7 11 8.2 6.2India 47.1 44 40.5 36.7 33.1 25.6 19.2 14.4 10.8 8.1Nepal 50.7 44.5 38.6 33 27.9 21.4 16.1 12 9 6.8Pakistan 48.5 45.7 42.1 39.1 36.1 28.3 21.2 15.9 11.9 8.9Indonesia 29.2 25.4 22 18.8 15.9 12.1 9.1 6.8 5.1 3.8China 22.8 21.7 17.9 13.3 9.4 6.9 5.2 3.9 2.9 2.2
Current Trajectory 66 percent ReductionCountry 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035Afghanistan 50.5 46 42.6 39.7 36.8 30.2 24.2 19.3 15.4 12.3Bangladesh 51.9 46 39.3 33.1 27.5 22.1 17.6 14.1 11.2 9Bhutan 43.6 38.8 34.1 29.6 25.4 20.6 16.5 13.2 10.5 8.4India 47.1 44 40.5 36.7 33.1 27.0 21.6 17.2 13.7 11Nepal 50.7 44.5 38.6 33 27.9 22.6 18 14.4 11.5 9.2Pakistan 48.5 45.7 42.1 39.1 36.1 29.7 23.8 19 15.2 12.1Indonesia 29.2 25.4 22 18.8 15.9 12.8 10.2 8.2 6.5 5.2China 22.8 21.7 17.9 13.3 9.4 7.3 5.8 4.6 3.7 3
Relative Target
Absolute TargetCurrent Trajectory NMR Target of 9
Country 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035Afghanistan 50.5 46 42.6 39.7 36.8 28.7 21.5 16.1 12.0 9Bangladesh 51.9 46 39.3 33.1 27.5 22.1 17.6 14.1 11.3 9Bhutan 43.6 38.8 34.1 29.6 25.4 20.9 16.9 13.7 11.1 9India 47.1 44 40.5 36.7 33.1 26.1 20.0 15.3 11.7 9Nepal 50.7 44.5 38.6 33 27.9 22.5 17.9 14.2 11.3 9Pakistan 48.5 45.7 42.1 39.1 36.1 28.3 21.3 16.0 12.0 9Indonesia 29.2 25.4 22 18.8 15.9 14.0 12.5 11.2 10.1 9China 22.8 21.7 17.9 13.3 9.4 8.7 8.8 8.9 8.9 9
Current Trajectory NMR Target of 5Country 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035Afghanistan 50.5 46 42.6 39.7 36.8 26.0 17.2 11.4 7.6 5Bangladesh 51.9 46 39.3 33.1 27.5 20.0 14.1 10.0 7.1 5Bhutan 43.6 38.8 34.1 29.6 25.4 18.9 13.6 9.7 7.0 5India 47.1 44 40.5 36.7 33.1 23.7 16.0 10.9 7.4 5Nepal 50.7 44.5 38.6 33 27.9 20.4 14.3 10.1 7.1 5Pakistan 48.5 45.7 42.1 39.1 36.1 25.7 17.1 11.3 7.5 5Indonesia 29.2 25.4 22 18.8 15.9 12.7 10.1 8.0 6.3 5China 22.8 21.7 17.9 13.3 9.4 7.9 7.1 6.3 5.6 5
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