1. 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

2. UNICEFAccelerating Child Survival RESULTS FOR CHILDREN UNICEF RMT CEECIS 9 MAY 2006 Global Agenda: Strategic Directions Regional and country level Knowledge Base National Priority in A Country: National Development Strategy Poverty Reduction Strategy Alliance Building Alliance Building National Policy Development Reform Process Implementation External Environment Analysis

3. UNICEFAccelerating 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)

4. UNICEFAccelerating 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

5. UNICEFAccelerating 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)

6. UNICEFAccelerating 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.

7. UNICEFAccelerating 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)

8. UNICEFAccelerating 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.

9. UNICEFAccelerating Child Survival Summary of Findings Quality of Care Areas assessedNo significant problemsNeed for some improvementNeed 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 KAZMDARUS

10. UNICEFAccelerating Child Survival Summary Findings - Structure & Supplies Existing hospital networkGood Staffing Generally adequate and dedicated Physical structure and equipment Need renovation and updating Essential drugs and supplies Sometimes lacking Accessibility Partially limited due to need for financial contribution

11. UNICEFAccelerating Child Survival Unnecessary Admissions & Treatment (WHO Study Rus, KZ, MDA)*

12. UNICEFAccelerating 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

13. UNICEFAccelerating Child Survival Use available health staff effectively

14. UNICEFAccelerating 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.

15. UNICEFAccelerating Child Survival

16. UNICEFAccelerating Child Survival Focus on neonatal care

17. UNICEFAccelerating Child Survival What kills neonates?

18. UNICEFAccelerating Child Survival Simple steps in preparing and implementing child survival plan Step 1. Set a goal Step 2. Divide the goal into sub-goals Step 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 process Step 7. Monitor the progress and take corrective action where required

19. UNICEFAccelerating 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

20. UNICEFAccelerating 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

21. UNICEFAccelerating Child Survival Together we can do it!