1. Tracking Intervention Coverage for Child Survival Jennifer Bryce Countdown to 2015 London, December 2005

2. Tracking child survival Contributors

3. Tracking child survival Countdown Monitoring Why? What? Where? Who & how & when? Some preliminary findings Countdown monitoring in 2005: Where are we?

4. Tracking child survival Why monitor? Track progress toward targets Improve effectiveness Be transparent Increase accountability Generate commitment and resources

5. Tracking child survival 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:

6. Tracking child survival What interventions? Nutrition Vaccination Other prevention Newborn Case management Programme areas:

7. Tracking child survival What is coverage? The proportion of individuals who need a service or intervention who actually receive it

8. Tracking child survival Coverage is unacceptably low for child survival interventions in all developing countries Vaccination Other prevention Newborn Case manage- ment Breast- feeding Source: The State of the World’s Children, 2006.

9. 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

10. Tracking child survival 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

11. Tracking child survival 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

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

13. Countdown Country Reports One for each priority country Basic demographics Cause 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

14. What types of information will Countdown monitoring produce?

15. Tracking child survival Summary information about where the needs are, and where there is success.

16. Tracking child survival 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

17. Tracking child survival 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. 60 Priority Countries: Annual rate of reduction in U5M is equal to that needed to reach MDG-4 by 2015

18. Tracking child survival (  90%) (  50%) (  90%) (  50%) MeaslesDPT3 Source: The State of the World’s Children, 2006. 60 priority countries by levels of coverage for measles and DPT3 vaccines. Number of priority countries

19. Tracking child survival 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 five Number of priority countries

20. Tracking child survival Information about country adoption of policies supportive of neonatal and child survival

21. Tracking child survival Country adoption of child survival policies lagging Policy Number of priority countries (n=60) where adopted as national policy FullyPartiallyNot at all Int’l Code of Marketing of Breastmilk Substitutes (2=ND) 15403 New ORS formula18438 Zinc for treatment of diarrhoea 7350 Hib vaccine (national implementation) 11-49 Community treatment of pneumonia with antibiotics 17241

22. Tracking child survival Country-specific information on equity -- which children are receiving essential interventions.

23. Tracking child survival Gap: 48.5

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

25. Tracking child survival Monitoring data: Use it or lose it

26. Tracking Intervention Coverage for Child Survival Preliminary conclusions of the 2005 (baseline) Report

27. Tracking child survival 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.

28. Tracking child survival 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

29. Tracking child survival 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.

30. Tracking child survival Comments? Questions? Corrections to report? nterreri@unicef.org nterreri@unicef.org