1. Maternal, neonatal, child health and nutrition
Gunta Lazdane
WHO Regional Office for Europe 1

2. A big challenge … 7,6 million children die before their 5th birthday
Globally every year…
7,6 million children die before their 5th birthday
3,2 million newborn babies in the first month of life
2,4 million infants between 1 – 12 months
women die due to complications of pregnancy and childbirth
15 million women develop long-term consequences due to pregnancy and childbirth

3. Child nutrition and MDGs
In 2010, globally, an estimated 27% of children younger than 5 years were stunted
Undernutrition continues to be high and delays progress toward reaching Millennium Development Goals
Extremely poor breastfeeding and complementary feeding practices
Micronutrient deficiencies (iodine, iron deficiency ) still a serious problem and obesity on the rise….
In 2010, globally, an estimated 27% of children younger than 5 years were stunted.
Undernutrition continues to be high and delays progress toward reaching Millennium Development Goals.
Extremely poor breastfeeding and complementary feeding practices and lack of comprehensive data on intervention coverage require urgent action to improve child nutrition.

4. The way forward…
By 2015:
Saving 16 million lives of women and children
Preventing 33 million unwanted pregnancies
Protecting 88 million children from stunting
Protecting 120 million children from pneumonia
The 2010 MDG Summit concluded with the adoption of a joint global action plan fro Women’s and Children’s Health “Investing in Our Common Future”.
A number of Heads of State and Government from developed and developing countries, along with the private sector, foundations, international organizations, civil society and research organizations, pledged over $40 billion in resources over the next five years.

5. Targets and indicators for monitoring MDG 4 and 5
Under-five mortality rate
Infant mortality rate
Proportion of 1 year-old children immunised against measles
Goal 4: Reduce child mortality
Target 4A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
Maternal mortality ratio
Proportion of births attended by skilled health personnel
Goal 5: Improve maternal health
Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Target 5B: Achieve, by 2015, universal access to reproductive health
Contraceptive prevalence rate
Adolescent birth rate
Antenatal care coverage
Unmet need for family planning
International community has agreed on the targets and developed indicators for the monitoring of the progress.

6. Mongolian Welfare Association
… and other partners 6

7. WORLD HEALTH ORGANIZATION
WHO Constitution
Executive Board, DG
Resolutions and decisions
World Health Assembly
Executive Board
Regional Committees
10-13 September 2012
Malta
The World Health Assembly is the supreme decision-making body for WHO. It generally meets in Geneva in May each year, and is attended by delegations from all 194 Member States. Its main function is to determine the policies of the Organization. The Health Assembly appoints the Director-General, supervises the financial policies of the Organization, and reviews and approves the Proposed programme budget. It similarly considers reports of the Executive Board, which it instructs in regard to matters upon which further action, study, investigation or report may be required.
The Executive Board is composed of 34 members technically qualified in the field of health. Members are elected for three-year terms. The main Board meeting, at which the agenda for the forthcoming Health Assembly is agreed upon and resolutions for forwarding to the Health Assembly are adopted, is held in January, with a second shorter meeting in May, immediately after the Health Assembly, for more administrative matters. The main functions of the Board are to give effect to the decisions and policies of the Health Assembly, to advise it and generally to facilitate its work.
The Secretariat of WHO is staffed by some 8000 health and other experts and support staff on fixed-term appointments, working at headquarters, in the six regional offices, and in countries.
The Organization is headed by the Director-General, who is appointed by the Health Assembly on the nomination of the Executive Board.
The Executive Board is composed of 34 persons who are technically qualified in the field of health, each designated by a Member State that has been elected to serve by the World Health Assembly. Member States are elected for three-year terms. EURO countries in EB: ARM, AZE, BLG, Croatia, Lithuania, NORWAY (Dr BI Larsen, DG, Norwegian Directorate of Health), Switzerland, UZB,
It is composed of delegations from the 53 Member States of the European Region.
Main functions of the RC:
to formulate regional policies;
to supervise EURO’s activities;
to comment on the regional component of the proposed programme budget;
to nominate the Regional Director and transmit to the Executive Board for endorsement.
NGOs in official relations are automatically invited to the Regional Committee and receive a letter of invitation in mid-May.
The Standing Committee of the Regional Committee (SCRC) was established by the Regional Committee (RC) in 1993 at a time when the number of Member States in the European Region increased significantly. The European Region is the only region to have such a committee.
The SCRC is composed of 12 representatives of Member States elected by the RC for a three year term, starting in September immediately following the RC. Starting in 2010, the RC elects six new members each year.
The SCRC meets approximately 6 times during the year.
Main functions of the SCRC:
to act for the RC and to represent it during sessions of the RC;
to ensure that effect is given to the RC decisions and resolutions and to submit proposals;
to advise the RC and to counsel the Regional Director;
to report to the RC on its work. Azerbaijan ( ) Belgium ( ) Bulgaria ( ) Croatia ( ) Malta ( ) Poland ( ) Russian Federation ( ) Spain ( ) Sweden ( )* Turkey ( ) Ukraine ( ) United Kingdom of Great Britain and Northern Ireland ( ) Chairperson: Dr Lars-Erik Holm - Deputy Executive President of the Sixty-first session of the WHO Regional Committee for Europe, Director-General, Chief Medical Officer National Board of Health and Welfare Sweden
*Seat declared vacant for due to the election of the representative of Sweden to the Office of Deputy Executive President of the Regional Committee
Standing Committee of RC - only in WHO/Europe

8. Monitoring progress

9. The number of maternal deaths decreased by 47% between 1990 and 2010

10. Good progress in achieving MDG 4 in the WHO European Region
In countries achieved MDG 4 target
11 countries of the region have achieved MDG4 already in 2009 and it should ne noted that under-five mortality in 17 countries of the European Region was below 10/1000 live births in 1990 that is under the European regional target.
Ensuring a good and healthy start in life as well as healthy growth and development for children is a key priority in all countries in the WHO European Region. The majority of countries in the region will most likely be able to reach MDG 4 by 2015.
Source: WHO European Region estimates; WHO, 2011

11. Probability of dying before age 5 years per 1 000 live births10 20 30 40 50 60 70
1980
1990
2000
2010
European Region
European Union
Commonwealth of Independent States
Central Asian Republics
However big discrepancies between countries
The lack of well-functioning health systems in many of the countries in the eastern part of the region contributes to the reasons for the discrepancy.
It is worth also to note that there are also huge discrepancies of mortality rates for children under 5 years of age within countries.
Source: WHO/Europe Health for all Database

12. Major causes of deaths are known
Deaths among children under-five
Neonatal deaths
Neonatal deaths constitute half of under-five deaths in the European Region. Prematurity and low birth weight, congenital anomalies, birth asphyxia and birth trauma, and neonatal infections are among the leading causes of neonatal death.
Many neonatal and under five deaths can be prevented by improving quality in care and by introducing low cost, evidence based interventions.
Source: Major causes of under five and neonatal deaths, European Region, 2008; WHO The World Health Statistics 2011

13. Good progress in maternal health – MDG5 WHO European Region
average annual decline of 3.8%
5.5% required to achieve MDG5
Lets have a snapshot on the maternal health situation in the WHO European Region:
We have made a good progress in maternal health and observed a major decrease in number of maternal deaths per live births in the European region.
In 2008, the estimated average maternal mortality ratio was 21 per live births , which was half of the ratio in 1990.
Yet, there are striking inequities between and within countries with an estimated difference of 30 to 40 fold between countries with the highest and lowest rates.
Moreover, within countries the vulnerable groups like the poor, immigrants and the marginalized populations are at a higher risk.
Source: Trends in Maternal Mortality: 1990 to 2008; WHO, 2010

14. Maternal deaths per 100000 live births10 20 30 40 50 60 70
1980
1990
2000
2010
Central Asian Republics
Commonwealth of Independent States
European Region
This meeting and others of this kind may facilitate the exchange of experience and reduction of the differences between countries and groups of countries.
The average maternal mortality ratio for the European Union countries remains low, however, when data from different social groups is analysed – the diversities within countries are diagnosed and targeted interventions have been developed.
European Union

15. Questionnaires will be sent to countries in 2013
Every two years WHO secretariat develops a progress report based on the filled in questionnaires received from the WHO Member States and presents it to the World Health Assembly (2006,2008, 2010, 2012, 2014!)
Questionnaires will be sent to countries in 2013

16. Guidelines and tools available
European strategy for child and adolescent health and development (2005)
Tools for implementation
The WHO European strategy for child and adolescent health, endorsed by Regional Committee in 2005, is now being developed and implemented in 17 countries, in most cases with the support of WHO. Countries are also being supported to develop action plans and monitoring system for implementation.

17. Effective Interventions exist…
expected % of reduction in U5M
Intervention
Appropriate nutrition in early age is a critical factor for the reduction of infant mortality;
Breastfeeding and adequate complementary feeding practices represent together around one fifth of possible infant mortality reduction potential.
Source: Lancet Child Survival Series 2003

18. Monitor
Action
Review

19. From recommendations to actions
NHA & MNCH tracking
1 Monitoring results & CRVS
2 11 core indicators & equity
3 Digital health & innovation
4 Financial indicators tracked
5 Comprehensive reporting
6 Capacity for NHA
7 National Accountability
mechanisms
8 Transparency
9 MNCH specific reporting
10 Expert Review Mechanism
COMMISSION
RECOMMENDATIONS
Monitoring of results
Birth and death registration
Maternal
death surveillance & response
Country
assessment &
Roadmap
ehealth & innovation
Country review processes
Advocacy and action
Monitoring results
Global
actions
Tracking resources
Global review (iERG)

20. To accelerate progress …
Tackle inequities by addressing the determinants of maternal and child health through cross-sector and gender-right based approach
Strengthen health
Strengthen health information
Implement new vaccines and develop immunization service delivery strategies
Address the links between noncommunicable diseases and MDGs
To accelerate progress we are to
Tackle inequities by addressing the determinants of maternal and child health through cross-sector and gender-right based approach
Strengthen health systems- high quality reproductive, maternal, newborn, child and adolescent health services; focus on prevention, primary health care, continuum of care and integration
Strengthen health information system - use tools to analyse situation “beyond the numbers”
Implement new vaccines and develop immunization service delivery strategies
Address the links between noncommunicable diseases and MDGs

21. Sharing experiences and success stories…

22. Sharing experiences and success stories…
We have successes in the European Region – successes that have been confirmed by scientific analysis and by women themselves.
These success stories are shared with policy makers, programme managers, scientists and civil society organizations through our publications and web site.

23. Health 2020: a European policy framework supporting action across government and society for health and well-being

24. Proportion (%) of children exclusively breastfed at 3 and 6 months, 2005-2010

25. Continuum of care

26. Accelerated actions to achieve MDG 4 and 5
Developing clear policies and action plans from a life-course and multi-sectorial perspective
Improved data collection, analysis and evidence-based decision making
Supported and monitored implementation of evidence based health interventions
Improving access and quality of care; trained health professionals with right skill mix
Involvement of communities and civil society 26

27. THANK YOU!