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

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 356 000 women die due to complications of pregnancy and childbirth 15 million women develop long-term consequences due to pregnancy and childbirth

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.

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.

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.

Mongolian Welfare Association … and other partners 6

WORLD HEALTH ORGANIZATION WHO Constitution Executive Board, DG Resolutions and decisions http://apps.who.int/gb/or/ 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 (2009-2012) Belgium (2011-2014) Bulgaria (2010-2014) Croatia (2010-2013) Malta (2011-2014) Poland (2010-2013) Russian Federation (2011-2014) Spain (2010-2012) Sweden (2009-2012)* Turkey (2010-2013) Ukraine (2009-2012) United Kingdom of Great Britain and Northern Ireland (2010-2013) 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 2011-2012 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

Monitoring progress

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

Good progress in achieving MDG 4 in the WHO European Region In 2009 11 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

Probability of dying before age 5 years per 1 000 live births 10 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

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

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 100 000 live births in the European region. In 2008, the estimated average maternal mortality ratio was 21 per 100 000 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

Maternal deaths per 100000 live births 10 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

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

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.

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

Monitor Action Review

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)

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

Sharing experiences and success stories…

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.

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

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

Continuum of care

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

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