Tracking Intervention Coverage for Child Survival Jennifer Bryce Countdown to 2015 London, December 2005
Feb 11, 2016
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
Tracking child survival
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.
Tracking child survival
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
Tracking child survival
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?
Tracking child survival
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.
Tracking child survival
Comments?Questions?
Corrections to report?